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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
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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_7/24/2019 Recognize APRNs
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