Amy Higgins

Diane Morris

Stephanie Kimbrel

CONSENSUS MODELFOR APRN REGULATION:

LICENSUREACCREDITATIONCERTIFICATION &EDUCATION

LACK OF UNIFORMITY ACROSS STATE LINES DEFINING APRNS

SCOPE OF PRACTICEADVANCED PRACTICE EDUCATIONLICENSINGCREDENTIALING TITLE

PROBLEM IDENTIFICATION

LIMITING THE ACCESSIBILITY OF HIGH QUALITY, COST-EFFECTIVE HEALTHCARE

BACKGROUND: TIMELINE

**1940’S APRN ROLE CAME INTO EXSTENCE

**EARLY 1990’S OFFICIAL CERTIFICATION EXAMS

**1993 POSITION STATEMENT: NEED FOR CERTIFICATIONS

**2002 2ND POSITION STATEMENT: REGULATORY CONCERNS REGARDING CERTIFICATION EXAM

**2004 THE ALLIANCE FOR APRN CREDENTIALING

**2008 CONSENSUS MODEL FOR APRN REGULATION: LICENSURE, ACCREDITATION, CERTIFICATION& EDUCATION 2015

BACKGROUND: APRN REGULATORY MODEL

LICENSURE• GRANTING THE INDIVIDUAL

AUTHORITY TO PRACTICE• STATE LICENSURE• INDEPENDENT PRACTITIONER

ACCREDITATION• VOLUNTARY, SELF-REGULATING, NON-GOVERNMENTAL PROCESS

• ASSURES BASIC LEVEL OF EDUCATION• COMMISSION OF COLLEGIATE NURSING EDUCATION AND NATIONAL LEAGUE OF NURSING ACCREDITATION

CERTIFCATION• NATIONAL CERTIFICATION EXAM

EDUCATION• CORE COMPREHENSIVE COURSES• PATHO• HEALTH ASSESSMENT• PHARMACOLOGY

• APPROPRIATE CLINICAL AND DIDACTIC EXPERIENCES

BACKGROUND: LACE MODEL

IMPROTANT FOR THE PUBLIC TO TURST THAT ANY APRN PROVIDING CARE IS EDUCATED, CERTIFIED, AND LICENSED WITHIN HIS/HER SCOPE OF PRACTICE.

ENSURING PATIENT THAT THEY RECEIVE SAFE AND EQUITABLE CARE.

ETHICAL FACTORS

Politically-NEED EFFECTIVE CONSENSUS MODEL

DEFINED ROLEREGULATIONS ACROSS ALL 50 STATES

UNITED FRONT WITH A UNIFIED VOICE

POLITICAL FACTORS

OUTLINE THE SCOPE OF PRACTICE FOR EACH OF THE FOUR ROLES OF APRNS.

PRESCRIPTIVE AUTHORITY AUTHORITY TO PRESCRIBE W/OUT MD INVOLVEMENT AUTHORITY TO PRESCRIVE WITH MD COLLABORATION WRITTEN PROTOCOL REQUIRED TO PRESCRIBE AURTHORITY TO PRESCRIBE CONTROLLED SUBSTANCES

ADDITIONAL LIABILITY ISSUES UNLICENSED PRACTICE OF MEDICINE FAILURE TO ADEQUATELY DIAGNOSE NEGLIGENCE IN THE DELIVERY OF HEALTHCARE CONDUCT EXCEEDING MD-DELGATED AUTHORITY: RESULTING IN

HARM CONDUCT EXCEEDING SCOPE OF PRACTICE: RESULTING IN HARM FAILURE TO REFER APPROPRIATELY

LEGAL FACTORS

How can the LACE model be expeditiously implemented in all states to ensure that the APRN profession continues to grow and meet the demands of changing healthcare, while increasing the APRN scope of practice and assuring that licensure, accreditation, certification, and education are uniform across all 50 states?

ISSUE STATEMENT

STAKEHOLDERS

FUTURE APRN STATE

LEGISLATURE

NURSING EDUCACTIO

N PROGRAMS

APRN NURSING

EDUCATION PROGRAMS

“CONSUMER” OR

PATIENT

EXISTING APRN

INDIVIDUAL STATES

NURSES SHOULD PRACTICE TO THE FULL EXTENT OF EDUCATION AND TRAINING

NURSES SHOULD ACHIEVE HIGHER LEVELS OF EDUCATION AND TRAINING THROUGH AN IMPROVED EDUCATION SYSTEM THAT PROMOTES SEAMLESS ACADEMIC PROGRESSION

NURSES SHOULD BE FULL PARTNERS, WITH PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS

EFFECTIVE NURSING WORKFORCE PLANNING AND POLICY MAKING REQUIRE BETTER DATA COLLECTION AND IMPROVED INFORMATION STRUCTURE

POLICY OBJECTIVES

• CONTINUE APRN PROGRAMS AS THEY AREDO NOTHING

• RECOMMENDATION OF THE AACN• MASTERS TO DNP BY 2015DNP

• PROVIDE SUFFICIENT KNOWLEDGE AND SKILLS TO OFFER HIGHER QUALITY CARE WITHIN SPECIALTY FIELDS

• PREPARE APRNs IN SPECIALTIES SUCH AS MENTAL HEALTH

SPECIALISTS’

POLICY ALTERNATIVES

ONGOING FUNDING

PRO: FEDERAL FUNDING INCLUDING

TITLE VII, VIII, MEDICARE EDUCATION

FUNDING, AND AFFORDABLE CARE

ACTCON: CURRENT

STATE OF HEALTHCARE IS

FAILING AND IN NEED OF PRIMARY CARE

PROVIDERS.

SIZE & AVAILABILITY OF FUNDING

STREAM

PRO: TITLE VIII NURSING WORKFORCE

DEVELOPMENT PROGRAMS PRIMARY SOURCE OF FUNDING

CON: TITLE VIII AND OTHER MONIES ALLOTTED TO

NURSING EDUCATION ARE

PRIMARILY DISCRETIONARY

FUNDS.

ANALYSIS FOR OPTION 1: DO NOTHING

ABILITY TO MEET

CURRENT & FUTURE DEMAND

PRO: PRIMARY CARE PROVIDERS ARE IN NEED, APRN’S CAN FULFILL THIS NEED

CON: APRNs ARE NOT BEING FULLY UTILIZED AT

THIS TIME DUE TO DECREASE

ACCESSIBILITY

POLITICAL FEASIBILITY

PRO: CURRENT ADMINISTRATION SUPPORTS AND

RECOGNIZES THE NEED FOR APRNs AND ROLE

THEY CAN FILL

CON: WITHOUT A UNIFIED MESSAGE FROM THE APRN COMMUNITY

APRNs COULD GET LOST

ANALYSIS FOR OPTION 1: DO NOTHING

ONGOIN

G FUNDINGPRO:FEDERAL FUNDING

INCLUDING TITLE VII, VIII, MEDICARE

EDUCATION FUNDING, AND AFFORDABLE

CARE ACT

CON: INCREAED COST OF

EDUCATION

SIZE & AVAILABILITY OF FUNDING STREAM

PRO: CURRENT ADMINISTRATION SUPPORT

REAUTHORIZATION OF TITLE VIII

NEW LOAW REMOVING 10% CAP PREVIOUSLY IMPOSED ON

SUPPORT FOR DOCTORAL STUDENTS

CON: SIZE OF FUNDING WOULD BE DECREASED

DUE TO INCREASED COST OF EDUCATION

ANALYSIS FOR OPTION 2-DNP

ABILITY TO MEET

CURRENT & FUTURE DEMAND

PRO:CURRENTLY THE DEMAND IS GREATER THEN

THE SUPPLY, ADMINSITRATION MAKING

IT A PRIORITY TO INCREASE NUMBERS OF PRIMARY

CARE PROVIDERS

CON: DECREASES THE NUMBER OF GRADUATING

APRNs AFTER 2015AVAILABILITY OF DNP

PROGRAMS FACULITY

POLITICAL FEASIBILITY

PRO: DEVELOPMENT OF NON-RESEARCH CLINICAL DOCTORATE

PROGRAM WILL: PREPARE EXPERT PRACTITIONERS

ALIGN APRNs WITH DOCTORATES OF OTHER HEALTH PROFESSIONS

CON: SIGNIFICANT FUNDING ALONG WITH SUPPORT IS REQUIRED FOR

THIS CHANGE: CURRENT US ECONOMIC STATUS

POSSIBLE TURF WAR WITH AMA

ANALYSIS FOR OPTION 2-DNP

ONGOING FUNDING

PRO:FEDERAL FUNDING INCLUDING TITLE VII, VIII, MEDICARE EDUCATION

FUNDING, AND AFFORDABLE CARE ACT

CON:MODEL DOES NOT ALLOW FOR WORKFORCE

MOBILITYDECREASED COST

EFFECTIVENESS OF MODEL

SIZE & AVAILABILIT

Y OF FUNDING

PRO: INCREASED MONIES ALLOTTED TO

ADVANCED EDCUATION NURSING GRANTS FROM TITLE

VIIICON: DISCRETIONARY FUNDS

WILL BE DISTRIBUTED TO AREAS OF NURSING

FULFILLING GREATEST NEEDS. CURRENT FOCUS IS ON

PREVENTATIVE, PRIMARY, AND CHRONIC CARE MANAGEMENT

OPTION 3: SPECIALISTS’

ABILITY TO MEET CURRENT

& FUTURE DEMANDS

PRO: FULFILL HEALTH DISPARITIES SUCH AS

MENTAL HEALTH, WOMAN’S HEALTH, OR

PEDIATRICS

CON: SHORTAGE OF AVAILABLE

HEALTHCARE WILL BE BENEFITED MORE BY A PRACTITIONER WHO IS

ABLE TO OFFER BROADER CARE

POLITICAL FEASIBILTY

PRO: CREATE A HEALTHIER AMERICA AND REDUCE HEATLH DISPARITIESHEALTH PEOPLE 2020

CON: CURRENT ADMINISTRATIVE SUPPROT

IS ON PRIMARY, PREVENTATIVE AND

CHRONIC CARE MANAGEMENT.

OPTION 3: SPECIALISTS’

    Alternativ

es

   

  Do Nothing

Option

DNP’s Specialists

’’

LACE

Criteria        

Substantive Funding

Stream

++ +++ + +++

Likelihood of Ongoing

Funding

+ ++ + ++

Ability to Meet

Current/Future

Demands

- - - ++

Political Feasibility + ++ - +

  4+/1- 7+/1- 2+/2- 8+/0-

Score for Each Alternative 3 6 0 8

SCORECARD COMPARISON

As the LACE model is implemented across all states, it will ensure that the APRN profession continues to grow and meet the demands of changing healthcare. The LACE model also ensures the APRN’s scope of practice is utilized to its fullest extent. It also will assure that licensure, accreditation, certification, and education are uniform across all 50 states for APRNs, creating more accessible healthcare to meet the increasing demands of the nation.

SUMMARY

LACE