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APRN Regulation

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Uniform Core Licensure Requirements. Adopted by the NCSBN Delegate Assembly in 2000 ... e.g., neonatal, child, women, adult, family, mental health, anesthesia, ... – PowerPoint PPT presentation

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Title: APRN Regulation


1
APRN Regulation
  • Kathy Thomas
  • Executive Director
  • Texas Board of Nurse Examiners

2
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3
State Budget Crises
IOM reports
Technological advances
Consumers Expectations
Board quality improvement
Changes in nursing roles/practice
Radical transformation of health care delivery
system
4
Uniform Advanced Practice Registered Nurse
Licensure/Authority to Practice
RequirementsNCSBN (2000/2001)
5
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

6
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.

7
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

8
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.

9
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.

10
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.

11
Regulation Perspective
  • Legal recognition to practice carries with it
    certain standards
  • Formal Education
  • Examination
  • Legally defensible
  • Psychometrically sound

12
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

13
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

14
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

15
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16
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.

17
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.

18
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.

19
Definitions
  • APRN
  • Masters 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

20
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.

21
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

22
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.

23
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

24
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.

25
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.

26
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