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National Council of State Boards of Nursing presents draft document "Vision Paper: the future of regulation of advanced practice nursing"--ANA responds.

The APRN Advisory Panel Of the National Council of State Boards of Nursing (NCSBN) has completed a document they have dubbed "APRN Vision Paper" which is the product of approximately three years of work. The stated purpose is to "bring uniformity, simplicity and clarity to the regulation of APRNs." At their February meeting, the Board of Directors approved a dissemination plan to obtain feedback on the draft paper. The feedback period will have closed by the time of the printing of this article (March 30, 2005) It is important for the APRN community to know that the direction taken by the NCSBN as outlined in the APRN document has implications not only for regulation but also for practice, education, certification and accreditation bodies.

The purpose of this document as outlined by Nancy Chornick, PhD, RN, CAE, Director of Practice and Credentialing for NCSB, is to address what NCSBN sees as issues of "regulatory sufficiency" of advanced practice nursing. The Executive Summary states the NCSBN view that there is a lack of uniformity nationally in the regulation, standards, certification and legal authorization for APRNs practice; a lack of agreement on the role of the clinical nurse specialist. The "Vision Paper" represents the NCSBN's perspective on the direction that boards of nursing and "APRN stakeholders" should take over the next decade in the regulation of advanced practice nursing. The "APRN Vision Paper" can be read in it's entirety on the NCSBN website http://www. ncsbn.org/.

The following recommendations are made in the draft paper:

1. Boards of Nursing will be the sole regulators of APRNs.

2. APRN licensure will be in the categories and titles of nurse anesthetist, nurse midwife, and nurse practitioner.

3. Boards of Nursing will approve APRN Programs for purposes of licensure.

4. All programs leading to APRN licensure as a nurse practitioner including clinical practice doctorate and post master's degree requirement will meet established educational requirements.

5. Requirements for licensure as a nurse practitioner will include successful completion of a core nurse practitioner licensure examination and a residency program.

6. Evidence of continued competency will be required for purposes of licensure renewal.

7. Fully licensed APRNs will be independent practitioners. After licensure there will be no regulatory requirements for supervision.

8. The Advanced Practice Compact will be the regulatory model used to effect mutual recognition of advanced practice nurses.

There is certainly not unanimity in the nursing community on this perspective. While there are some points of agreement, the American Nurses' Association as well as other professional and credentialing bodies have offered responses that take issue with both some assumptions and directions made explicit in the "Vision Paper."

In the document entitled American Nurses' Association (ANA) Comments Regarding the 2006 NCSBN Draft Vision Paper (read in it's entirety on www.nursingworld.org) several overarching comments are made. ANA states that "while it respects the right of NCSBN to identify it's concept of future regulation of the nursing profession" they believe there are a number of "incorrect assumptions" that underly the approach.

* Boards of nursing define scope of nursing practice (NCSBN)--ANA believes actual practice should be defined by the profession and the professional practitioners not the regulatory entities.

* The profession supports the need for second licensure (NCSBN)--ANA disagrees with the assumption that the profession supports the need for second licensure for an APRN.

* The Clinical Nurse Specialist(CNS) no longer has a relevant role in advanced practice nursing--ANA believes the skill set of the CNS provides critical advanced practice interventions in order to provide quality health care.

* All states will adopt the RN multi state compact and the compact concept will be applicable to APRN's (NCSB)--ANA states only 21 states thus far have legislated (though not necessarily fully implemented) multi state compacts. ANA House of Delegates is on record opposing multi state licensure and would extend the same concerns, i.e. reconciling differences between state practice with an APRN multi state compact.

* The broadest level of education for an advanced practice role is what is required for public safety, consumer knowledge and uniformity of regulation (NCSBN)--ANA does not support a generalist model for the APRN. The knowledge base for lifecycle continuum of care is established at the RN level. ANA further maintains that consumer populations are well served by APRN specialty care--for example it can be demonstrated that pediatric nurse practitioners are in a position to share more expert specialized knowledge in pediatric needs than the average general practice physician concluding that it makes it possible for consumers have increased access to expert services.

I urge you all to read these draft papers in their full form. They are both compelling and provocative to those of us engaged in issues surrounding advanced practice. ANA has very specific responses to each of the 8 points made in the NCSBN paper. The effects on the future of nursing practice and more importantly the health care model in which we practice and receive care are critical.

Eve Franklin, MSN, RN
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Title Annotation:Advanced Practice Nursing
Author:Franklin, Eve
Publication:The Pulse
Geographic Code:1USA
Date:Apr 1, 2006
Words:833
Previous Article:Montana State University College of Nursing celebrates 10 years of family nurse practitioner graduates.
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