APRN Regulation
Kathy Thomas Executive Director Texas Board of Nurse Examiners
NURSING REGULATION
Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements
NCSBN (2000/2001)
Uniform Core Licensure Requirements
APRN regulation lacked uniformity Awareness of the value of uniformity to facilitate mutual recognition Uniformity diminishes concerns over disparate qualifications for licensure in Compact states Adoption of uniform requirements drives consistency across states
Uniform Core Licensure Requirements
Recognition that an APRN Compact would need to be predicated on uniformity Development included stakeholder groups:
Five meetings were held between December 1997 and December 1998, in Chicago, San Diego and Washington, DC.
Uniform Core Licensure Requirements
Adopted by the NCSBN Delegate Assembly in 2000 Compact Administrators Commit to Adoption in 2001 Requirements for Education and Examination are already met
Uniform Core Licensure Requirements --Principles
Avoid simply choosing the least common denominator. Legal recognition can be any of the various ones used by states to authorize advanced practice, e.g., certificate of authority, licensure, or recognition. The underlying goal is to promote public safety in the least restrictive manner.
Uniform Core Licensure Requirements--Issues
Alternative mechanism to certification
originally included in the requirements (2000) Currently certified by national certifying body in the APRN specialty appropriate to educational preparation
Delegate Assembly voted to expire this provision (2001)
For applicants for whom there is no appropriate certifying exam available, states may develop alternate mechanisms to assure initial competence until January 1, 2005. Evidence of an equivalent mechanism to certification examinations will not be accepted after January 1, 2005 and individuals will no longer be licensed without an approved APRN examination.
NCSBN Position Paper on Regulation of Advanced Practice
Changes in the United States health care system
nursing evolved into multiple levels of practice with an increasingly differentiated body of knowledge.
APRNs are practicing independently and performing procedures previously reserved for physician practice. Nurses with advanced skills are seeking professional and economic recognition through certification and the authority to practice through nursing regulation.
Lack of consistency in education, titling, credentialing, program accreditation, scope of practice and reimbursement is confusing.
Regulation Perspective
Legal recognition to practice carries with it certain standards
Formal Education Examination
Legally defensible Psychometrically sound
Regulation Perspective
Limited resources In the position of denying graduates who do not qualify Dealing with complaints against APRNs who are working outside their scope because they could not be employed in their narrow scope of preparation
NCSBN Position Paper: Issues
EDUCATION
Most BONs do not approve APRN programs
Accrediting bodies should assure standards are met.
Although Essentials of Masters Education (AACN) have been published since 1995
There are still programs which do not comply with these standards
Issues -- Scope of Preparation
Minimum preparation for entry into advanced practice nursing for legal recognition Examples of broad preparation include areas such as adult health, pediatrics, psychiatric mental health, etc.
APRNs who are certified in a subspecialty, such as a specific disease entity, have a narrow scope of practice Difficult to evaluate the validity and reliability of certification examinations administered to only a small number of candidates Graduates of these programs expect to be licensed as APRNs Educational programs may wish to provide special emphasis areas that are subspecialty focused
Issues -- Informed Students
Students must be given accurate information about their eligibility for certification and subsequent licensure, and that certifying bodies are given accurate information about the program. For regulatory purposes, it is important that accreditation processes provide for conclusive verification of these elements.
Issues -- Certification
It is necessary for these examinations:
to measure only job-related knowledge, skills, and abilities; to be at entry-level; require minimal level competence; and be psychometrically sound.
NCSBN Position Paper: Conclusions
The current approach to licensure involves reliance on educational credentials, certification examinations and the information provided by the applicant. Thus, cooperation of educational institutions, accrediting bodies, credentialing organizations, regulators and licensees is essential to produce the best result for the health care of the public.
Definitions
APRN
Master’s preparation Program of study in a specialty area in an accredited nursing program Taken a licensing exam in same area Granted licensure in advanced practice Hallmark is direct patient care Subcategories: CRNA, CNM, NP, CNS
Definitions
APRN Nursing
Expanded scope which includes RN scope Scope includes advanced assessment, diagnosing, prescribing, selecting, administering, and dispensing therapeutic measures, including OTC, legend and controlled substances within the role and specialty appropriate education and certification.
Definitions
Specialty
A broad, population based focus of study encompassing common problems of that group of patients and likely co-morbidities, inteventions and repsonses to those problems e.g., neonatal, child, women, adult, family, mental health, anesthesia, midwifery NOT a specific disease/health problem or specific intervention
Definitions
Sub-Specialty
A focus of practice within a specialty assuring expert knowledge of a particular area of patient problem, e.g., cardiovascular disease, palliative care, oncology, substance abuse, orthopedics, critical care, etc.
APRN Regulatory Principles
Scope of Education, Certification and Practice are congruent Role and title should reflect educational preparation and examination APRN licensure is necessary because scope of practice exceeds RN scope Boards must approve educational programs leading to licensure
APRN Regulatory Principles
Individuals must graduate from approved programs in the specialty Licensing exams must be acceptable to Boards of Nursing Exams leading to licensure must be legally defensible and psychometrically sound. Content validity must be based on a job analysis.
APRN Regulatory Principles
All educational programs leading to licensure must be accredited. For dual track programs, each track must have a minimum of 500 clinical hours. The APRN specialty must consist of broad population-based focus of study. Curricula should be standardized and based on nationally recognized core competencies.