The past several years have seen significant evolution in the education of advanced practice registered nurses. And with an important target date of 2015 behind us, it is a good time to focus on the educational requirements to become an APRN.
Many of the changes in APRN education were driven by the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, completed in 2008 and referred to as LACE. As the subtitle implies, education is an essential element of the consensus model, which sought to standardize education across the four APRN roles. The consensus model describes the requirements for broad-based APRN education that are necessary for entry into APRN practice and for regulatory purposes. Education programs and tracks leading to APRN licensure must, among other requirements, be preapproved, pre-accredited or accredited before accepting students; be at the graduate or postgraduate level; and ensure that graduates are eligible for national certification and state licensure. Education programs worked diligently to comply with the consensus model requirements before the target date of 2015, including instituting curriculum changes that were sometimes required to meet the “three P’s”: three separate, comprehensive graduate-level courses in advanced physiology/pathophysiology, advanced health assessment and advanced pharmacology.
A common misconception about the consensus model is that it mandated the DNP for entry into APRN practice rather than a “graduate degree or postgraduate certificate (either post-master’s or postdoctoral).” That misconception is understandable given that in 2004 the American Association of Colleges of Nursing endorsed a position statement identifying the DNP as the most appropriate degree for APRNs to enter practice, and set the same target date as the consensus model requirements: 2015. A RAND report, sponsored by AACN, summarized progress made toward that goal by April 2014: The master’s degree remains the dominant route into APRN practice, but the landscape is changing. There has been a tenfold increase in the number of schools with a DNP program, and many that were offering only MSN-level APRN education at the time of the report were planning to offer a DNP in the future. The report projects that “in the next several years, the percentage of schools (with any APRN education) that have a BSN-to-DNP program for at least one APRN group could approach 50 percent.”
While all four APRN roles are implementing the requirements of the consensus model, there is some variation. For example, the American Association of Nurse Anesthetists announced its support of doctoral education for entry into nurse anesthesia practice by 2025, while the American College of Nurse-Midwives has stated that the DNP may be one option but will not be a requirement for entry into practice for CNMs or CMs. The American Association of Nurse Practitioners has summarized issues to be addressed to promote a smooth transition to clinical doctoral preparation for NPs without disenfranchising master’s prepared NPs. The National Association of Clinical Nurse Specialists has endorsed the DNP as a requirement for CNSs for entry into practice by 2030.
Throughout this evolution, funding for APRN education remains critically important. ANA advocates with AACN and other members of the Nursing Community, a coalition of 62 organizations, for adequate federal investment, chiefly for programs supported by Title VIII of the Public Health Service Act. Suzanne Miyamoto, PhD, RN, FAAN, senior director of Government Affairs and Health Policy at AACN, noted, “While [this is] still a work in progress, many lawmakers see and value the role APRNs play in providing high quality, cost-effective care. National nursing organizations have come together to educate and garner federal support that will bolster and modernize APRN funding streams, as well as remove practice barriers.”
— Lisa Summers is the senior policy advisor, APRN issues, in Health Policy at ANA.
As a part of ANA’s work to closely monitor implementation of the Affordable Care Act and advocate for nursing, staff in the Department of Health Policy have reviewed an important new proposed regulation to implement MACRA – the Medicare Access and CHIP Reauthorization Act. MACRA is bipartisan legislation passed in 2015 that replaced the flawed sustainable growth rate formula with a new approach to paying clinicians for the value and quality of care they provide; it is better known as “the doc fix.” This proposed rule has important implications for how nurses – particularly APRNs – will be paid. The timeline for implementing this rule is tight – the Centers for Medicare and Medicaid Services would begin measuring performance for physicians and other clinicians (including APRNs) in January 2017, with payments based on those measures beginning in 2019.
Read more about MACRA, including ANA’s comments on the proposed rule and ongoing developments, at www.nursingworld.org/What-is-MACRA.
Consensus Model for APRN Regulation
The DNP by 2015: A Study of the Institutional, Political, and Professional Issues that Facilitate or Impede Establishing
a Post-Baccalaureate Doctor of Nursing Practice Program.
RNAction.org – Nursing Workforce Development
Nursing Community: Title VIII Nursing Workforce Reauthorization Act