APRN LACE dialogue for CNSs

Blog is about the changes and updates related to the implementation of the Advanced Practice Registered Nurse Consensus Model for Regulation and the Licensure, Accreditation, Certification and Education changes that will need to take place over the next few years.

Friday, February 4, 2011

What is the APRN Consensus Model anyway?
It seems there are a few of you out there who are lurking but not posting. Let's see if we can generate some discussion with this post!
The APRN Consensus Model was created through a four year process of discussion, frustration (at times), and non-consensus consensus....yes there is such a thing! A large number of national nursing organizations (approximately 25)had feedback to the process of creation and it is truly a monumental feat that the organizations were able to come to some level of consensus on what should be in the document. It was finally released to the public in July of 2008. Since then the focus has been on implementing the suggested actions within the document and attempting to get it fully activated on all levels. The difficulty is that there are some unintended consequences that are having a tremendous impact on all four of the roles but particularly CNSs. Let's talk about each of the elements in the model and what is happening for CNSs.
The basic principles of the model are fairly straightforward. They include massive changes to the FUTURE education of CNSs, accreditation of the educational programs, certification for all APRNs and (a sticking point for CNSs), and licensure practices in the states. I highlighted FUTURE for a reason that will become clear as I define the elements.
Think of a pyramid...with a broad foundation and ever-narrowing elements stacked on that foundation. The base of the pyramid or the foundation of all APRN roles is what are are commonly called "the three P's:" pathophysiology, pharmacology, and physical/health assessment. These elements were actually defined way back in 1995 as essential for the APRN role but were implemented to varying degrees in CNS programs. Some never implemented them. Others put them into a variety of courses but did not have separate courses identifiable on a transcript.
The next layer on the pyramid is the role itself. Each of the four APRN roles (nurse anesthetists, nurse midwives, nurse practitioners and CNSs) have nationally vetted core competencies. These core and essential elements of the role are expected to be educated to the future practitioners in that role. CNSs have not necessarily had that either in the past. Core competencies were created by NACNS back in 1995 but they were not recognized by all educational programs and have not been expected to be used...they were recently updated and now will be expected to be used by all educational programs preparing CNSs.
The next layer is the population focus. There are six of them: adult/gero, neonatal, pediatrics, psychiatric, women/gender related, and family/across the lifespan. This area is also a little tricky for CNSs since we have always thought of ourselves as specialty focused rather than age grouping related. We focus on diabetes, community health, orthopedics, pain, etc....which can all reach across the lifespan. We also tend to settle into a specific popluation that we address though too...we deal with child diabetics, or we address adult/gero orthopedic issues. This one is a little harder than the core elements of the role but I think we can "get there" for most of the specialty groups that currently exist and will exist into the future.
These three layers are the ones that regulation will address. You will be licensed as an adult/gero CNS for example...or a psychiatric CNS....or a pediatric CNS.
The final capstone on the pyramid is your specialty. This is outside of the boundaries of licensure (a very good thing from my perspective) and you can choose to be an expert clinician in whatever areas you need to be throughout your career).
So why did I highlight FUTURE in the previous paragraph? This model is expected to be implemented by 2015...massive changes in each of the elements of licensure, accreditation, certification and education will have to occur. Unfortunately or fortunately, depending on how you want to look at it, there are some states that are implementing the expectations NOW for accreditation, certification and education before they will license you as a CNS. They are not allowing time for the changes to occur and are expecting instant gratification and instant results. This is causing major strife for some of the specialties...have YOU been affected?
That is the foundation of the APRN Consensus Model and I have rambled on enough for an early morning...now it is your turn. What do you see as positives or negatives in the model as described so far? What do you see already in terms of issues you are facing? Let's hear from you....