In 2008, the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf) was released for the purpose of standardizing the regulation of advanced practice registered nurses (APRNs) in the United States. The 4 APRN roles recognized in the United States are the clinical nurse specialist, certified registered nurse anesthetist, nurse practitioner, and certified nurse midwife. The ultimate purpose of the collaborative effort of the model was to improve patient access to quality care by setting general standards for APRN entry to practice, ensuring education was consistent for APRN preparation, and facilitating easier transition for APRNs seeking licensure when relocating from one state to another. In addition, the model supports national certification in a specific APRN role with a population focus (defined by the model) and based on national competencies. To ensure quality, the model specifies that “the certification program should be nationally accredited by the American Board of Nursing Specialties or the National Commission for Certifying Agencies” (page 6).
In the United States, new APRN graduates seeking regulatory recognition for advanced practice are being required to obtain professional certification in role and population. Certification eligibility criteria specify that the graduate’s educational program be accredited by a nursing education accreditation body. In addition, the director of the accredited program is required to verify that the applicant has met the educational requirements (both didactic and clinical) specified by the model and has achieved minimal professional role competencies. For clinical nurse specialists, professional role competencies are defined by the National Association of Clinical Nurse Specialists—the Clinical Nurse Specialist Core Competencies (http://www.nacns.org/docs/CNSCoreCompetenciesBroch.pdf). This process has recently become burdensome and frustrating for the applicant as well as the academic representative.
Over time, the certification eligibility criteria have increasingly encroached into the academic role and responsibility of faculty. The goal of certification is to affirm that successful certificants demonstrate knowledge required for entry into advanced practice (Evolving Education and Certification of Advanced Practice Registered Nurses, http://www.aacn.org/wd/practice/content/aprnregulatorymodel.pcms?menu=practice). The certification examination is validated through a role delineation, which is routinely updated to reflect current practice. The development and validation of the certification examination through role delineation are the responsibility of the certification board.
Conversely, academic curricula, the responsibility of faculty, are expected to prepare graduates to perform in entry-level positions by integrating knowledge and skills for safe performance. In addition, curricula should be preparing students to lead the profession into the future. Thus curricula, unlike certification, are performance based and are both present and future oriented. Academic programs use professional practice standards to guide curricula, but curriculum development rests solely with the faculty. In addition, the delivery of curricula belongs to faculty, who are expected to shape the courses to meet the mission of the university or school, reflect regional health priorities, and address the needs of the community of interest (ie, students, employers, consumers) in addition to meeting professional standards.
Recently, there has been increased scrutiny of applicants’ academic preparation beyond the program director’s verification. Graduate program directors are being asked to provide the certification body with a priori “evidence” that the applicant has been prepared to successfully pass the certification examination. Requests for evidence may include documentation of the program of study, course syllabi, topical outlines, course schedules, and lecture notes addressing specific content. An applicant’s eligibility for certification is then determined by the certification body based on review of the academic materials.
This practice suggests the certification body is judging the adequacy and quality of an academic program, although this is not the role of a professional certification body. Nursing education accreditation is evidence that the program meets standards for an academic graduate nursing program. Certification bodies that request specific and often narrow evidence of program quality are encroaching into the role of academic accreditation bodies. Graduate nursing programs should not be required to provide additional evidence of a valid curriculum to professional certification bodies. The ultimate evidence is the success rate of graduates taking the certification examinations.
Collegiality between academia and certification boards is certainly valued; both exist to protect the public and ensure practitioners are prepared to deliver safe and high-quality care. Their roles in this goal, however, are different and distinct. Requiring certification applicants and academic programs to justify programs of study is a redundant and inefficient barrier. A curriculum is larger in scope than the knowledge measured on a certification examination, and maintaining a quality graduate program is the responsibility of academia, not a certifying body.
As the model is further implemented nationally, it is critical for certification bodies, academia, and practice to continue the dialogue regarding what promotes success in meeting the outcomes of the model and what requires further clarification or modification. Feedback from graduates seeking certification and program directors challenged with supporting these graduates will provide useful feedback to certification bodies. The process should, however, be streamlined to further facilitate the education of APRNs desperately needed for the public good.
So whose job is it to promote certification success? All clinical nurse specialists, individually and collectively, must invest time and effort in continuing to advance the initiatives of the Consensus Model. However, it is important that the responsibilities of each partner in the model be respected and clarified: professional organizations determine performance standards, educational program accreditation bodies validate quality of education, education programs prepare graduates for safe practice, and certification bodies assess minimal knowledge requirements for entry to practice. Certification examinations have become a cornerstone of the model, but certification bodies must recognize and respect the boundaries of their role in seeking predictive evidence of successful applicant performance. Collectively, we promote the value of clinical nurse specialists and all APRNs in improving the public’s access to quality care.