Transcript File - Diane Morris

CONSENSUS MODEL
FOR APRN REGULATION:
Amy Higgins
Diane Morris
LICENSURE
ACCREDITATION
CERTIFICATION &
EDUCATION
Stephanie
Kimbrel
PROBLEM IDENTIFICATION
 LACK OF UNIFORMIT Y ACROSS STATE LINES
DEFINING APRNS
 SCOPE OF PRACTICE
 ADVANCED PRACTICE EDUCATION
 LICENSING
 CREDENTIALING
 TITLE
LIMITING THE ACCESSIBILITY OF HIGH QUALITY, COSTEFFECTIVE HEALTHCARE
BACKGROUND: TIMELINE
**1940’S APRN ROLE CAME INTO EXSTENCE
**EARLY 1990’S OFFICIAL CERTIFICATION EXAMS
**1993 POSITION STATEMENT: NEED FOR CERTIFICATIONS
**2002 2ND POSITION STATEMENT: REGULATORY
CONCERNS REGARDING CERTIFICATION EXAM
**2004 THE ALLIANCE FOR APRN CREDENTIALING
**2008 CONSENSUS MODEL FOR APRN
REGULATION: LICENSURE, ACCREDITATION,
CERTIFICATION& EDUCATION
BACKGROUND: APRN REGULATORY MODEL
BACKGROUND: LACE MODEL
LICENSURE
ACCREDITATION
• GRANTING THE INDIVIDUAL AUTHORITY
TO PRACTICE
• STATE LICENSURE
• INDEPENDENT PRACTITIONER
•VOLUNTARY, SELF-REGULATING, NONGOVERNMENTAL PROCESS
•ASSURES BASIC LEVEL OF EDUCATION
•COMMISSION OF COLLEGIATE NURSING
EDUCATION AND NATIONAL LEAGUE OF NURSING
ACCREDITATION
CERTIFCATION
EDUCATION
•NATIONAL CERTIFICATION EXAM
•CORE COMPREHENSIVE COURSES
•PATHO
•HEALTH ASSESSMENT
•PHARMACOLOGY
•APPROPRIATE CLINICAL AND DIDACTIC
EXPERIENCES
ETHICAL FACTORS
 IMPROTANT FOR THE
PUBLIC TO TRUST THAT
ANY APRN PROVIDING
CARE IS EDUCATED,
CERTIFIED, AND
LICENSED WITHIN
HIS/HER SCOPE OF
PRACTICE.
 ENSURING PATIENT
THAT THEY RECEIVE
SAFE AND EQUITABLE
CARE.
POLITICAL FACTORS
Politically NEED EFFECTIVE
CONSENSUS MODEL
 DEFINED ROLE
 REGULATIONS ACROSS ALL
50 STATES
 UNITED FRONT WITH A
UNIFIED VOICE
LEGAL FACTORS
 OUTLINE THE SCOPE OF PRACTICE FOR EACH OF THE FOUR ROLES
OF APRNS.
 PRESCRIPTIVE AUTHORIT Y




AUTHORITY TO PRESCRIBE W/OUT MD INVOLVEMENT
AUTHORITY TO PRESCRIVE WITH MD COLLABORATION
WRITTEN PROTOCOL REQUIRED TO PRESCRIBE
AURTHORITY TO PRESCRIBE CONTROLLED SUBSTANCES
 ADDITIONAL LIABILIT Y ISSUES






UNLICENSED PRACTICE OF MEDICINE
FAILURE TO ADEQUATELY DIAGNOSE
NEGLIGENCE IN THE DELIVERY OF HEALTHCARE
CONDUCT EXCEEDING MD-DELGATED AUTHORITY: RESULTING IN HARM
CONDUCT EXCEEDING SCOPE OF PRACTICE: RESULTING IN HARM
FAILURE TO REFER APPROPRIATELY
ISSUE STATEMENT
How can the LACE model be
expeditiously implemented in all states
to ensure that the APRN profession
continues to grow and meet the
demands of changing healthcare, while
increasing the APRN scope of practice
and assuring that licensure,
accreditation, certification, and
education are uniform across all 50
states?
STAKEHOLDERS
INDIVIDUAL
STATES
FUTURE
APRN
STATE
LEGISLATURE
NURSING
EDUCACTION
PROGRAMS
EXISTING
APRN
“CONSUMER”
OR PATIENT
APRN
NURSING
EDUCATION
PROGRAMS
POLICY OBJECTIVES
NURSES SHOULD PRACTICE TO THE FULL EXTENT OF EDUCATION
AND TRAINING
NURSES SHOULD ACHIEVE HIGHER LEVELS OF EDUCATION AND
TRAINING THROUGH AN IMPROVED EDUCATION SYSTEM THAT
PROMOTES SEAMLESS ACADEMIC PROGRESSION
NURSES SHOULD BE FULL PARTNERS, WITH PHYSICIANS AND
OTHER HEALTH CARE PROFESSIONALS
EFFECTIVE NURSING WORKFORCE PLANNING AND POLICY
MAKING REQUIRE BETTER DATA COLLECTION AND IMPROVED
INFORMATION STRUCTURE
POLICY ALTERNATIVES
DO NOTHING
DNP
SPECIALISTS’
• CONTINUE APRN PROGRAMS AS THEY ARE
• RECOMMENDATION OF THE AACN
• MASTERS TO DNP BY 2015
• PROVIDE SUFFICIENT KNOWLEDGE AND SKILLS TO
OFFER HIGHER QUALITY CARE WITHIN SPECIALTY FIELDS
• PREPARE APRNs IN SPECIALTIES SUCH AS MENTAL
HEALTH
ANALYSIS FOR OPTION 1: DO NOTHING
ONGOING
FUNDING
PRO: FEDERAL FUNDING
INCLUDING TITLE VII, VIII,
MEDICARE EDUCATION
FUNDING, AND
AFFORDABLE CARE ACT
CON: CURRENT STATE OF
HEALTHCARE IS FAILING
AND IN NEED OF
PRIMARY CARE
PROVIDERS.
SIZE &
AVAILABILITY OF
FUNDING STREAM
PRO: TITLE VIII NURSING
WORKFORCE
DEVELOPMENT PROGRAMS
PRIMARY SOURCE OF
FUNDING
CON: TITLE VIII AND
OTHER MONIES
ALLOTTED TO NURSING
EDUCATION ARE
PRIMARILY
DISCRETIONARY FUNDS.
ANALYSIS FOR OPTION 1: DO NOTHING
ABILITY TO MEET
CURRENT &
FUTURE DEMAND
PRO: PRIMARY CARE
PROVIDERS ARE IN
NEED, APRN’S CAN
FULFILL THIS NEED
CON: APRNs ARE NOT BEING
FULLY UTILIZED AT THIS TIME
DUE TO DECREASE
ACCESSIBILITY
POLITICAL
FEASIBILITY
PRO: CURRENT
ADMINISTRATION SUPPORTS
AND RECOGNIZES THE NEED
FOR APRNs AND ROLE THEY
CAN FILL
CON: WITHOUT A UNIFIED
MESSAGE FROM THE APRN
COMMUNITY APRNs COULD
GET LOST
ANALYSIS FOR OPTION 2-DNP
ONGOING
FUNDING
PRO:FEDERAL FUNDING
INCLUDING TITLE VII, VIII,
MEDICARE EDUCATION
FUNDING, AND
AFFORDABLE CARE ACT
CON: INCREAED
COST OF
EDUCATION
SIZE & AVAILABILITY OF
FUNDING STREAM
PRO: CURRENT ADMINISTRATION
SUPPORT
REAUTHORIZATION OF TITLE VIII
NEW LOAW REMOVING 10% CAP
PREVIOUSLY IMPOSED ON SUPPORT
FOR DOCTORAL STUDENTS
CON: SIZE OF FUNDING
WOULD BE DECREASED
DUE TO INCREASED COST
OF EDUCATION
ANALYSIS FOR OPTION 2-DNP
ABILITY TO MEET
CURRENT &
FUTURE DEMAND
PRO:CURRENTLY THE DEMAND
IS GREATER THEN THE SUPPLY,
ADMINSITRATION MAKING IT A
PRIORITY TO INCREASE
NUMBERS OF PRIMARY CARE
PROVIDERS
CON: DECREASES THE NUMBER
OF GRADUATING APRNs AFTER
2015
AVAILABILITY OF DNP
PROGRAMS
FACULITY
POLITICAL
FEASIBILITY
PRO: DEVELOPMENT OF NONRESEARCH CLINICAL DOCTORATE
PROGRAM WILL:
PREPARE EXPERT PRACTITIONERS
ALIGN APRNs WITH DOCTORATES OF
OTHER HEALTH PROFESSIONS
CON: SIGNIFICANT FUNDING ALONG WITH
SUPPORT IS REQUIRED FOR THIS
CHANGE: CURRENT US ECONOMIC STATUS
POSSIBLE TURF WAR WITH AMA
OPTION 3: SPECIALISTS’
ONGOING
FUNDING
PRO:FEDERAL FUNDING
INCLUDING TITLE VII, VIII,
MEDICARE EDUCATION
FUNDING, AND AFFORDABLE
CARE ACT
CON:MODEL DOES NOT ALLOW
FOR WORKFORCE MOBILITY
DECREASED COST
EFFECTIVENESS OF MODEL
SIZE &
AVAILABILITY
OF FUNDING
PRO: INCREASED MONIES
ALLOTTED TO ADVANCED
EDCUATION NURSING
GRANTS FROM TITLE VIII
CON: DISCRETIONARY FUNDS WILL
BE DISTRIBUTED TO AREAS OF
NURSING FULFILLING GREATEST
NEEDS. CURRENT FOCUS IS ON
PREVENTATIVE, PRIMARY, AND
CHRONIC CARE MANAGEMENT
OPTION 3: SPECIALISTS’
ABILITY TO MEET
CURRENT &
FUTURE DEMANDS
PRO: FULFILL HEALTH
DISPARITIES SUCH AS
MENTAL HEALTH, WOMAN’S
HEALTH, OR PEDIATRICS
CON: SHORTAGE OF
AVAILABLE HEALTHCARE
WILL BE BENEFITED MORE
BY A PRACTITIONER WHO
IS ABLE TO OFFER
BROADER CARE
POLITICAL
FEASIBILTY
PRO: CREATE A HEALTHIER
AMERICA AND REDUCE HEATLH
DISPARITIES
HEALTH PEOPLE 2020
CON: CURRENT ADMINISTRATIVE
SUPPROT IS ON PRIMARY,
PREVENTATIVE AND CHRONIC
CARE MANAGEMENT.
SCORECARD COMPARISON
Alternatives
Do Nothing Option
DNP’s
Specialists’’
LACE
++
+++
+
+++
+
++
+
++
-
-
-
++
+
++
-
+
4+/1-
7+/1-
2+/2-
8+/0-
Criteria
Substantive Funding Stream
Likelihood of Ongoing Funding
Ability to Meet Current/Future
Demands
Political Feasibility
SUMMARY
 As the LACE model is
implemented across all states, it
will ensure that the APRN
profession continues to grow and
meet the demands of changing
healthcare. The LACE model also
ensures the APRN’s scope of
practice is utilized to its fullest
extent. It also will assure that
licensure, accreditation,
certification, and education are
uniform across all 50 states for
APRNs, creating more accessible
healthcare to meet the
increasing demands of the
nation .
LACE
REFERENCES
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AlterNet. (2011). Number of Uninsured Americans Soars to 50 Million. Retrieved May 2011, from
AlterNet:
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