NR 510 Week 7 Assignment: Recorded LACE PowerPoint – Slide Notes
Slide 2:
LACE Model:
The model identifies the essential elements of APRN
... [Show More] regulation as licensure, accreditation, certification, & education (LACE). Licensure refers to the authority to practice as an independent practitioner. The APRN education program must be accredited. The APRN must be certified in the APRN role by a national board.
The LACE Model defines advanced practice nursing (APRN) & delineates four roles: clinical nurse specialist (CNS), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), & certified nurse midwife (CNM).
Advanced education builds on the pre-licensure preparation for RNs & occurs at the role & population level, which then prepares the individual for initial certification. The LACE Model specifies educational program requirements & the program is accredited accordingly.
Slide 3:
The APRN Consensus Model:
The APRN Consensus Model was authored by a number of national professional advanced practice nursing organizations & was created to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. This model makes a clear distinction between acute care & primary care practice preparation, noting that acute care focused, & primary care focused Nurse Practitioner programs have distinct competencies based on the consensus model as well as specific certification processes.
All c&idates must first earn a Master of Science in nursing or doctoral degree from an accredited nursing education program in the United States. While the length of the program varies across APRN roles & specialties, a minimum 2-year full-time course of study should be expected. The typical APRN curriculum includes health promotion &/or health maintenance; advanced health assessment, physiology/pathophysiology, & pharmacology; & research, ethics, policy, finance, & organization of health care delivery. APRN students also must successfully complete extensive clinical practicum learning experiences.
Following degree conferral, the graduate obtains national certification by passing an examination administered by a recognized certifying body, such as the American Nurses Credentialing Center. After becoming certified, the APRN follows the procedure in his or her state to become authorized for APRN practice. No uniformity in the nurse practice act exists across the United States.
Slide 4:
California Licensure Considerations:
California's advanced practice nurses are under the jurisdiction of the California Board of Registered Nursing (BRN). In order to be certified as an advanced practice nurse, a practitioner must also be licensed as a registered nurse.
The Board recognizes the following graduate-level advanced specialty areas:
Nurse Anesthetist (NA)
Nurse Practitioner (NP)
Nurse-Midwife (NMW)
Clinical Nurse Specialist (CNS)
Psychiatric/ Mental Health Nurse (PMH)
A nurse can become an NP by
1) completing an in-state program recognized by the Board as meeting st&ards
2) earning certification through an accepted organization or
3) completing an equivalent program.
In order to be certified by equivalency, a nurse will need to verify clinical experience & clinical competency in provision of primary care services. Clinical competency will be verified by both a licensed physician & a licensed nurse practitioner.
Slide 5:
Washington Licensure Considerations:
Washington State’s Advanced Registered Nurse Practitioners (ARNPs) are regulated by the Nursing Care Quality Assurance Commission, a part of the Washington Department of Health (DOH). ARNP is a broad license category that includes three advanced nursing roles: Nurse Practitioner (NP), Certified Nurse Midwife (CNM), & Certified Registered Nurse Anesthetist (CRNA). Of these, NP is the most common specialty.
Applicants that are educated in a commission approved Washington state nursing education program & applying for initial licensure must first:
(1) Successfully complete a commission approved nursing education program. For applicants from a commission approved registered nurse program who are applying for a practical nurse license:
(a) Complete all course work required of commission approved practical programs
(2) Required courses not included in the registered nurse program may be accepted if the courses were obtained through a commission approved program.
(b) Be deemed as capable to safely practice within the scope of practice of a practical nurse by the nurse administrator of the c&idate's program.
(2) Complete seven clock hours of AIDS education as required
(3) Successfully pass the commission approved licensure examination
Slide 6:
Illinois Licensure Considerations:
Illinois advanced practice nurses are licensed by the Illinois Department of Financial & Professional Regulation (IDPR). Illinois recognizes the following advance practice roles:
Certified Nurse Practitioner
Certified Clinical Nurse Specialist
Certified Nurse Midwife
Certified Registered Nurse Anesthetist
An Illinois advanced practice nurse must hold RN & APN licensing. The National Council for State Boards of Nursing lists Illinois as a state with pending nurse compact legislature. Currently, however, a nurse must hold his or her primary RN licensure in Illinois.
The licensing agency will require official graduate transcripts & a copy of the qualifying certification.
I. A person shall be qualified for licensure as an advanced practice nurse if that person:
(a) has applied in writing to the Department & has not violated any provisions
(b) Also, they must hold a current license to practice as a registered nurse in Illinois;
(c) has successfully completed requirements to practice as, & holds a current national certification as, a nurse midwife, clinical nurse specialist, nurse practitioner, or certified registered nurse anesthetist from the appropriate national certifying body
(e) & finally, has successfully completed a post-basic advanced practice formal education program in the area of his or her nursing specialty.
Slide 7:
California Accreditation Considerations:
Restricted Practice: State practice & licensure law restricts the ability of an NP to engage in at least one element of NP practice. The outside state requires supervision, delegation, or team management by an outside health discipline for an NP to provide patient care.
ACEN - Accreditation Commission for Education in Nursing
CCNE - Commission on Collegiate Nursing Education
CNEA - Commission for Nursing Education Accreditation
Slide 8:
Washington Accreditation Considerations:
A Washington program will seek accreditation through an agency recognized by the Council on Higher Education Accreditation or the United States Department of Education.
The American Nurses Credentialing Center, which offers a variety of certifications for nurse practitioners, lists among the requirements, 500 hours of clinical work under faculty supervision.
The ANCC m&ates discrete courses in advanced physiology, health assessment, & pharmacology.
Full Practice: State practice & licensure law provides for nurse practitioners (NPs) to evaluate patients, diagnose, order & interpret diagnostic tests, initiate & manage treatments-including prescribing prescriptions-under the exclusive licensure authority of the state board of nursing.
Slide 9:
Illinois Accreditation Considerations:
Advanced practice nurses (APNs) may fulfill new roles in the redesigned health system, provided that the law allows them to practice to the full extent of their education & training. Eliminating the requirement for a collaborative agreement between APNs & physicians is a viable mechanism for increasing primary care capacity & reducing health care costs. Under a reformed scope of practice, public & private insurers could choose to reimburse APNs directly for their services, as opposed to reimbursing them as a part of clinics or physician practices. It would also allow consumers to choose a non-physician health professional as their primary care provider. It is in the interest of the state of Illinois & the greater healthcare community to allow advanced practice nurses to provide unrestricted, safe, quality health care services to the residents of Illinois.
Reduced Practice: State practice & licensure law reduces the ability of NPs to engage in at least one element of NP practice. State requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care.
American Nurses Credentialing Center (ANCC)
Illinois Society for Advanced Practice Nursing (ISAPN)
American College of Nurse Practitioners
American Academy of Nurse Practitioners
Slide 10:
Certification Considerations:
California: The Board of Registered Nursing (BRN) certifies public health nurses & advanced practice nurses. Advanced practice nurses include nurse practitioners, nurse-midwives, clinical nurse specialists, & nurse anesthetists. The BRN also maintains a listing of psychiatric/mental health nurses. In each of these categories, the individual must first have a California registered nurse license before obtaining the certificate.
The BRN then issues a furnishing number to a nurse practitioner that allows him or her to "order" or furnish drugs & devices to patients using approved st&ardized procedures. A nurse practitioner with a furnishing number may obtain a Drug Enforcement Administration (DEA) registration number if they want to order controlled substances as needed for patient care.
Washington: The student will need pass a national certification examination at some point after educational requirements have been met. Washington has approved four nurse practitioner certification organizations:
-American Nurses Credentialing Center
-American Academy of Nurse Practitioners
-Pediatric Nursing Certification Board
-National Certification Corporation for Obstetric, Gynecological, & Neonatal Nursing
Illinois: A prospective advanced practice nurse will need to pursue an examination-based certification. An Illinois RN who has graduated from an advanced practice program & has applied to take a qualifying national certification examination may be authorized to practice pending certification. The graduate will need to apply for a temporary permit. The licensing agency will need documentation from the certifying agency, identifying the date that the nurse will sit for examination.
Slide 11:
Education Considerations:
The education domain is central to APRN professional practice. The APRN assesses learning needs & uses educational strategies to promote knowledge development of students, peers, nursing staff, & interdisciplinary colleagues. The APRN uses professional expertise to develop educational programs & resources that address specific patient- & family-learning needs. APRNs also educate the public on pertinent healthcare issues related to specialty care practice & the APRN role.
California: The nurse practitioner is a registered nurse who possesses additional preparation & skills in physical diagnosis, psychosocial assessment, & management of health & illness needs in primary health care.
Washington Education: Programs include diagnostic theory & health management, advanced coursework in physiology, health assessment, & pharmacology, & clinical & didactic preparation for the advanced practice role. Students will receive no fewer than 500 hours of patient care under faculty oversight.
Illinois: A prospective advanced practice nurse must earn a graduate degree or post-master certificate. The individual must complete a program that offers preparation for advanced practice certification.
An APN who seeks licensing in a second advanced practice specialty will not need to complete a second graduate degree but will need to complete whatever additional education is necessary to qualify for the desired certification.
Slide 12:
Evidence-based Strategies should be implemented to achieve continuity between state regulatory boards…some examples are:
Removing Scope-of-Practice Barriers
Advanced practice registered nurses (APRNs) should be able to practice to the full extent of their education & training. To achieve this goal, the committee recommends the following actions.
Enable Nurse Practitioners (NPs) To Practice to the Full Extent of Their License
By amending current statutes or directing the Centers for Medicare & Medicaid Services to revise outdated rules & manuals, Congress should take action to remove obsolete limitations in federal laws & regulations that do not recognize nurse practitioners’ advanced education & clinical preparation to furnish the full range of services they are licensed to provide.
Another strategy would be to Enable Nurse Practitioners (NPs) to Participate Fully as Members of Hospital Medical Staffs. This can be done by amending Medicare Conditions of Participation to Require Hospitals to Consider NPs for Appointment to Medical Staffs. Current proposed Medicare regulations allow hospitals to consider nurse practitioners for appointment to medical staffs & granting of clinical privileges, but the rules fail to ensure that NPs will be evaluated, & that the evaluation will be done objectively in a timely manner with clear explanations & a right to appeal a hospital’s decision.
Last strategy would be to Improve Patient Access to Medicare Skilled Nursing. This can be done by Authorizing Nurse Practitioners (NPs) to Perform Admitting Examinations & Monthly Patient Assessments. Current recommendations are that Congress should pass legislation to amend Medicare conditions of participation for skilled nursing facilities to authorize nurse practitioners to provide admitting examinations & required monthly visits for Medicare beneficiaries in skilled nursing facilities.
Slide 13:
Arizona is a Full Practice State & allows NPs to practice independently:
Full Practice: State practice & licensure law provides for nurse practitioners (NPs) to evaluate patients, diagnose, order & interpret diagnostic tests, initiate & manage treatments-including prescribing prescriptions-under the exclusive licensure authority of the state board of nursing.
For 97 years: The Arizona Nurses Association (AzNA) has been leading the way to advance the nursing profession for a healthy Arizona. As the only nurses’ organization representing the interests of all 85,000 Arizona RN’s we have most recently used our voice, volunteers & resources to try to modernize State regulations governing APRNs.
In March 2015 there was a historic merger of forces, specialty associations representing Nurse Practitioners, Nurse Anesthetists, Nurse Midwives & Clinical Nurse Specialists created a collaborative group; the Arizona Coalition of Advanced Practice Nurses, to share resources & communication strategies.
In April of 2017, Governor Doug Ducey signed bill SB1336 which allowed Advanced Practice Nurses to practice to the full extent of their education & training while increasing patient accessibility of safe, cost-effective care.
My opinion regarding independent NP practice is all positive. I believe that APNs should be able to practice to their full availability because their scope of practice allows for them to be trained in this manner. It is a huge resolution to the future conflict of a provider shortage & it also helps to cut health care costs for everyone. I think it’s only a matter of time before every state in the US passes this law & allows for all NPs to practice independently. We all have a voice, therefore we ALL need to use it.
Footprints in History are Not Made Sitting Down; 1 in 79 Arizonans is a Registered Nurse!
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