Tuesday October 22nd 2019

Celebrating a milestone

Lisa Summers

As 2015 drew to a close, advanced practice registered nurse stakeholders gathered to celebrate and take stock of a significant accomplishment:  the Consensus Model for APRN Regulation.  The American Nurses Association co-hosted the daylong meeting with the American Association of Colleges of Nursing to celebrate the success and impact of the APRN Consensus Model and to assess continued progress toward its full implementation.

The consensus model is an important document completed at an opportune time. In 2004, when work began, APRNs had expanded in numbers and capabilities and were increasingly being recognized as highly valued professionals. However, effective alignment of the education, accreditation, certification and licensure of APRNs was lacking. Without a uniform model of regulation, each state independently determined the APRN roles, legal scope of practice and criteria for entry into advanced practice. There was a proliferation of specialties within APRN practice, and there were variations in education programs and requirements for certification as well.

The December stakeholder meeting provided an opportunity to acknowledge the individuals who invested effort over a period of years to address these problems and provide a road map for alignment.  “We can be proud of the nursing community for having the patience and discipline to work collaboratively in the best interest of patients and families to move to the APRN Consensus Model,” said Carol Hartigan, MA, RN, certification and policy strategist, AACN Certification Corporation, American Association of Critical-Care Nurses.

The model, completed in 2008, clearly defines APRN practice, describes the regulatory model, identifies titles to be used and addresses specialty practice. It describes the responsibilities or foundational requirements of the four essential elements of APRN regulation: licensure, accreditation, certification and education, also known as LACE.

The year 2015 was set as the target date for implementation of the model and all embedded recommendations, with an understanding that implementation would occur incrementally.  The organizations that represent each of the LACE elements and the four APRN roles have been actively engaged in that work since the model was completed.

So, where are we in implementing the consensus model?  With four LACE elements and four roles, it is a complicated answer, but there is agreement that a great deal of important and difficult work has been completed. The APRN LACE Network has prepared a number of statements (available on its public website) to address implementation challenges, such as clarifying the APRN core courses (“the 3 Ps”) and age parameters for APRN patient populations, and differentiating primary and acute care nurse practitioners.

As was noted in the January/February 2014 APRN Focus column, “Calling all nurses: State legislation needed to implement the APRN Consensus Model,” much of the work must be done at the state level. The National Council of State Boards of Nursing maintains a series of maps that display state progress toward uniformity. Several organizations have prepared white papers and other documents describing progress and challenges in implementation, and ANA has linked to those on its consensus model web page at www.nursingworld.org/consensusmodel.

Meeting participants agreed that there is still a need to educate key stakeholders about the components of the model, and the LACE Network is committed to responding to inquiries, developing resources and disseminating information. ANA continues to work with its members, state and constituent nurses associations, and LACE colleagues toward full implementation of the APRN consensus model.

— Lisa Summers is the senior policy fellow in Health Policy at ANA.


ANA Consensus Model web page:

APRN LACE Network:

NCSBN APRN Implementation:

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