In 2004, the American Nurses Association and the American Association of Colleges of Nursing hosted a series of Advanced Practice Registered Nursing (APRN, i.e., nurse anesthetists, nurse midwives, clinical nurse specialists, and nurse practitioners) practice and regulation meetings. Several specialty organizations were also present at those initial meetings. Then, in 2006, the National Council for State Boards of Nursing (NCSBN) and other nursing groups also held an APRN stakeholder meeting, and a joint effort was established between the groups.
During the summer of 2008, the APRN Consensus model document was finalized. The primary aim of the APRN Consensus model document (APRN Consensus Work Group and APRN Joint Dialogue Group, 2008) is centered around patient safety and practice oversight. This document represents a future model and visions for uniform APRN regulation. Regulation is defined more broadly in this document to include licensure, accreditation, credentialing, and education (LACE). That same year, the APRN Consensus Work Group and the NCSBN APRN advisory committee met to offer other nursing groups the opportunity to learn about the new model and to ask questions regarding implementation. Representatives from 32 nursing groups attended the initial APRN meeting, and by 2008, nearly 50 nursing organizations had approved the consensus model document. Today, more than 100 nursing and regulatory authorities have approved the document's legislative language.
In January 2011, the NCSBN held an APRN Summit, “The Campaign for Consensus: Uniting APRNs, Promoting Uniformity, and Fostering Collaboration.” The purpose of this summit was to update nursing organizations on the status of the APRN Consensus model. The NCSBN invited nursing organizations and health care policy experts who had lobbied for the adoption of this national model of APRN regulation. Summit attendees shared stories, compared notes, and offered future suggestions as to how to continue to implement standardized regulatory requirements in each state of the states and in the District of Columbia. The APRN groups at the summit requested adoption of uniform APRN standards.
WHAT WILL THE CONSENSUS MODEL DO FOR ADVANCED PRACTICE REGISTERED NURSES?
Each state ultimately controls how APRNs are licensed, accredited, certified, and educated. The adoption of the APRN Consensus model in each state and the District of Columbia will provide the following:
- Appropriate regulatory oversight;
- Implementation of the language in the APRN Consensus model document bringing state licensure policies in alignment for APRNs;
- Remove APRN scope of practice barriers (e.g., prescriptive authority limitations, physician collaboration issues);
- The APRN with mobility to practice in various states; and
- The APRNs with the ability to practice to the full extent of their education and training; Institute of Medicine (IOM; 2010).
Regulatory barriers that currently prevent APRNs from practicing to the fullest extent of their training are being eliminated, as each state embraces LACE standards for the APRN groups.
WHAT WILL THE CONSENSUS MODEL DO FOR PATIENTS?
There is a tome of research over the past several decades, demonstrating that APRNs provide high-quality, cost-effective care, with clinical outcomes comparable with those of physicians. In addition, most individual physicians are in favor of APRNs practicing to their full capabilities. When the model is implemented, the goals are to
- ensure patient safety,
- improve patients' access to health care (e.g., underserved and vulnerable populations),
- promote excellent patient outcomes,
- achieve cost savings for patients, and
- demonstrate patient satisfaction with their overall care
The APRNs have been supported by groups such as the Robert Woods Johnson Foundation, the IOM, and the American Association of Retired Persons (AARP). The AARP, for example, supports increased patient access to APRNs. Recently, AARP thanked the NCSBN for its efforts to offer greater patient access by utilizing APRNs in various health care delivery models.
In sum, APRNs must be able to articulate the tenets of the APRN Consensus model to other nursing colleagues, other health care providers, legislators, and the public—the consumers of our care. As APRNs, we need to become involved at our local and state levels to support grass-root campaigns that propel state boards to adopt the legislative language contained in the APRN Consensus model document.
Ultimately, the goal is to have each state and the District of Columbia adopt the APRN Consensus model document by 2015. For more information about the APRN Consensus model, see the “Campaign for APRN Consensus” at www.ncsbn.org or the American Nurses Association at http://www.nursingworld.org/consensusmodeltoolkit.
— K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner St. Mary Medical Center Long Beach, CA
— Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
Emergency Clinical Nurse Specialist Proehl PRN, LLC Cornish, NH