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Stfstihjnsil
It's Time to RecognizeAPRN Practice Nationally
Cynthia W. Ward, DNP, RN-BC, CMSRN, ACNS-BC
Editorial Board Member
A
Consensus Model for Advanced PracticeRegistered Nurse (APRN)
regulation was devel-
oped in 2008 through the work of the AdvancedPractice Nursing
Consensus Work Group and theNational Council of State Boards of
Nursing (NCSBN)APRN Committee. The model recognized the four
APRNroles: certified registered nurse anesthetist (CRNA),
cer-tified nursemidwife (CNM), clinical nurse specialist(CNS), and
nurse practitioner (NP). The model endorsedlicensure of APRNs as
independent practitioners in oneof the APRN roles in one of six
population focus areas:family/individual across lifespan,
adultgerontology,neonatal, pediatrics, women's
health/genderrelated, or
psychiatricmental health (APRN Consensus WorkGroup &
National Council of State Boards of Nursing
APRN Advisory Committee, 2008 [APRN ConsensusWork Group]).
The model identifies the essential elements of APRNregulation as
licensure, accreditation, certification, andeducation (LACE).
Licensure refers to the authority topractice as an independent
practitioner. The APRN edu-cation program must be accredited. The
APRN must becertified in the APRN role by a national board.
APRNeducation is at the graduate level and must includegraduate
courses in advanced physiology/pathophysiology, advanced health
assessment, and advanced phar-macology (APRN Consensus Work Group,
2008).
R e c o m m e n d a t io n s a n d P ro v is io n s
The Committee on the Robert Wood JohnsonFoundation Initiative on
the Future of Nursing at theInstitute of Medicine (Committee, 2011)
identified fourkey recommendations in the report The Future of
Nursing: Leading Change, Advancing Health. One recom-mendation
is that "nurses should practice to the fullextent of their
education and training" (p. 29).Limitations to scope of practice
are seen as a barrier to
nurses' ability to lead changes to transform health care.The
Committee recommended scope of practice barriers
be removed so APRNs can practice to the full extent oftheir
education and training.The Committee also pointed to opportunities
for
APRNs as a result of the Patient Protection andAffordable Care
Act (ACA), such as increasing access tocare, care coordination, and
health promotion.Accountable care organizations, medical homes,
com-munity health centers, and nursemanaged health cen-ters are
places where APRNs could team with otherhealth professionals to
provide care in medically under-
served areas.The ACA, enacted into law in 2010, included
many
provisions addressing APRN practice. Section 3022
defined accountable care organizations (ACOs) andincluded all
APRN roles in the definition of ACO profes-sionals. An ACO is
defined as a shared saving program
promoting accountability for a patient population tocoordinate
care and services under Medicare and pro-vide high quality and
efficiency. Section 5208 discussedclinics managed by APRNs to
provide primary care andwellness services. Section 5509 defined the
four APRNroles and made them eligible to provide primary
care,preventive care, transitional care, chronic care manage-ment,
and other nursing services for Medicare patients.
B e n e f it s f o r P a t ie n t s an d C o m m u n i t ie
s
Full recognition of APRN practice offers many poten-tial
advantages for patients and communities. The mainadvantage is
increased access to health care. Theexpanded payment coverage of
CNS services by theCenters for Medicare & Medicaid Services
created by theACA increases access to health care by offering
anotherprovider option. APRNs could partner to operate nurserun
primary care clinics to increase access to care.APRNs also could
partner with physicians and other
J o u r n a l Mis s io n S t a t em e n tMEDSURC Nursing, the
official journal of the Academy of Medical-Surgical Nurses, is a
scholarly journal dedicated to advancing
ad ult health nursing practice, clinical research, and
professional developm ent. The journal's goal is to enhance the
know ledge and
skills of adult health and advanced practice nurses to prevent
and manage disease, and to wo rk w ith patients and the ir
families
to improve the health status of the nation's adults.
July-August 2015 Vol. 24/No. 4 MEDSURG 210
7/24/2019 Recognize APRNs
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health professionals to implement the medical homemodel to
manage chronic illness through care coordina-tion and provision of
holistic care. Monitoring andmanaging chronic illness can prevent
unnecessary hos-pital admissions and readmissions. Other
communitybased settings for APRN practice could include
privatepractice, clinics, or longterm care facilities.
As a practicing CNS in a hospital setting, I see manybenefits
for inpatients from expanded CNS practice. Forexample, care
coordination by clinical nurse specialistswould facilitate
discharge planning, assist patients tonavigate through the health
care system, and decreaselength of stay. CNSs practicing to the
full extent of theireducation, including prescriptive authority,
would alloworders for necessary treatments, medications, or
consul-tations to be delivered timely and prevent delays
intreatment or discharge.
Adoption of the Consensus Model nationwide willprovide
consistency in APRN practice and uniformity inregulations across
the nation, and be beneficial tohealth care consumers, employers,
and APRNs. In the 7years since the Consensus Model for APRN
Regulationwas endorsed by the NCSBN, only 11 states have adopt-ed
all components of the model (National Council ofState Boards of
Nursing, 2014). I urge all registered nurs-es to learn the status
of APRN practice in their state andsupport the enactment of
legislation to align with theConsensus Model. 'Krari
REFERENCES
APRN Consensus Work Group & the National Council of State
Boards
of Nursing APRN Advisory Committee. (2008). Consensus model
for APRN regulation: Licensure, accreditation, certification
& edu-
cation. Retrieved from
https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
Committee on the Robert Wood Johnson Foundation Initiative on
theFuture of Nursing, at the Institute of Medicine. (2011). The
future of
nursing: Leading change, advancing health. Washington,
DC:National Academies Press.
National Council of State Boards of Nursing. (2014).
Implementation sta-
tus map. Retrieved from https://www.ncsbn.org/5397.htm
iyihiuMni*H
L]The Newly Insured
Between early 2013 and early 2014, about 30%of uninsured
nonelderly adults gained health
1Hinsurance coverage. That rate is higher than the
IS25% of those initially uninsured who acquiredcoverage during a
similar time period in 2012 and2013. Uninsured nonelderly adults in
fair/poor or
r J good health (rather than those in very good orj i excellent
health) in early 2013 were substantiallyVc* more likely to have
gained coverage in 2014 than
their counterparts during the 20122013 period.For more info, see
Vistnes and Cohen. (2015).
Transitions in health insurance coverage over time,2012-2014
(selected intervals): Estimates for the U.S.civilian
noninstitutionalized adult population underage 65 (Statistical
Brief #467). Rockville, MD:Agency for Healthcare Research and
Quality. FT171
MEDSURGnursing.JulyAugust 2015 Vol. 24/No. 4
President's Messagecontinued from page 209
Nursing, which contains the body of knowledge for thespecialty
of medicalsurgical nursing, is evidence based.Chapter 29
specifically addresses EBP and research. Thelatest edition will be
released in fall 2015.
The Clinical Leadership Development Program is
nearly complete and a task force now is strategizingabout an
outcome evaluation research study to deter-mine program
effectiveness. The Clinical PracticeCommittee based answers to
clinical questions posed bymembers on the evidence. The responses
are posted onthe AMSN website. Research grants are also
availablefrom AMSN. Funding ranges from $5,000 to $20,000.Explore
the website to learn more. The AMSN Board ofDirectors uses
responses from member surveys to movethe organization forward.
Although this is not formalresearch, evidence from members is an
important tool.
As a seasoned nurse, I have developed some guide-lines for EBP
and research. First, ask questions. Is this
practice based on tradition or evidence? Is there anotherway to
provide an aspect of care that would result in bet-ter quality
outcomes or decreased cost? Does this fityour organization's goals?
Find a mentor. It may be anurse on your unit, an advanced practice
nurse, or a fac-ulty member with whom you work well. Never
workalone. There is strength in numbers for brainstorming aswell as
getting the work accomplished. Ensure yoursupervisor supports the
project or it will not take flight.Share your results with your
unit, the organization, andthe world. AMSN has many opportunities
for sharingresults of EBP and research projects: a poster or
podium
presentation at convention, or a publication inMedSurg
Matters!orMEDSURG Nursing. Once you have complet-ed an EBP
project, you have the expertise to assist oth-ers: see one, do one,
teach one. Share the spirit ofinquiry and ignite it in others.
Never stop questioning.As professional medicalsurgical nurses, you
can meetthe goal to improve practice now as well as for thefuture.
EIJ
REFERENCES
Berwick, D., Nolan, T & Whittington, J. (2008). The triple
aim: Care,
health and cost. Health Affairs, 27(3), 759-769.
Institute of Medicine. (2009). Roundtable on evidencebased
medicine.
Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK52847/Melnyk, B
Fineout-Overholt, E Gallagher-Ford, L., & Kaplan, L.
(2012). The state of evidence-based practice in U.S. nurses:
Critical implications for nurse leaders and educators. Journal
of
Nursing Administration, 42(9), 410-417.
doi:10.1097/NNA0b013e3182664e0a
ADDITIONA L READING
Melnyk, B.M., Grossman, D.C, Chou, R., Mabry-Hernandez, I.,
Nicholson, W., DeWitt, T.G...... Flores, G., and for the
U.S.
Preventive Services Task Force. (2012). USPSTF perspective
on
evidence-based practice preventive recommendations for
children.Pediatrics, 130(2),399-407.
https://www.ncsbn.org/Consensus_Model_https://www.ncsbn.org/5397.htmhttp://www.ncbi.nlm.nih.gov/books/NBK52847/http://www.ncbi.nlm.nih.gov/books/NBK52847/https://www.ncsbn.org/5397.htmhttps://www.ncsbn.org/Consensus_Model_
