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Regulatory changes propel advanced practice nurses in Nevada toward nationally standardized practice.

Exciting and significant changes for Nevada Advanced Practice Nurses (APNs) are being proposed by the Nevada State Board of Nursing (NSBON). A workshop, that should be attended by all APNs in Nevada, to review proposed changes to the regulations and laws related to nursing practice is on December 21, 2011, followed by a public hearing on January 10, 2011. These meetings are to discuss adoption and amendment of the changes that pertain to chapter 632 of the Nevada Administrative Code. The Board proposes adoption, amendment or repeal for 49 of the 197 regulations contained in chapter 632, which contains most of the relevant regulations governing the scope and practice of nursing in the state. Familiarity with the regulations is a requirement of licensure.

The Board of Registered Nursing is clearly adopting a proactive stance, moving the profession toward proposals identified in two landmark documents, "The Future of Nursing" report prepared by the Institute of Medicine (2011) and the Robert Wood Johnson Foundation, and the "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education" (APRN Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, 2008). Changing state regulations to reflect proposals by professional practice associations at the national level may ease the barriers and restrictions allowing advanced practice nurses to employ a full scope of practice within the rapidly changing healthcare environment.

As stated in the IOM report and supported by the recommendations within the consensus model, 'Nurses have the opportunity to play a central role in transforming the health care system to create a more accessible, high-quality, and value-driven environment for patients. If the system is to capitalize on this opportunity, however, the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted, most notably for advanced practice registered nurses.'(IOM, 2011). The advance practice scope of services should be defined by patient care needs. (WHO, 2006).

APRN regulations noted within the consensus model include the essential elements of licensure, accreditation of nursing-related educational degrees and certification programs, formal recognition of certification that recognize the achievement of standards recognized by the profession and that the formal preparation of APRNs is at a graduate degree or post-graduate certification level.

The NSBON regulatory proposals reflect changes related to those elements. To bring Nevada closer to the consensus model, eleven of the regulatory changes are related to the name change from the current term of "advanced practitioner of nursing" (APN) to the nationally recognized title "advanced practice registered nurse" (APRN). The definition proposed within the Nevada regulations is: "Advanced practice registered nurse means a registered professional nurse who has specialized skill, knowledge and experience obtained from an organized formal program of training, and who is authorized in special conditions (NAC 632.255 to 632.295) inclusive, to provide designated services in addition to those which a registered nurse is authorized to perform." (NAC 632.020). The proposal includes language that recognizes the four recognized advanced practice registered nurse roles of certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists and certified nurse practitioners included in the definition of APRN within the consensus model (2006).

Scope of practice for Advanced Practice Registered Nurses (APRNs) is variable and changing nationally across states and territories. Within the consensus model, the scope of practice for Certified Registered Nurse Anesthetists is identified as: being prepared to provide a full-spectrum of anesthesia care and anesthesia related care to clients across the lifespan, in diverse inpatient and outpatient medical settings. Certified Nurse-Midwives (CNMs) provide a full range of primary health care services including gynecologic and obstetrical care, preconception care, family planning, childbirth, prenatal and postpartum care and care of the newborn across diverse inpatient and outpatient medical settings. Clinical Nurse Specialists (CNS) integrate care across the continuum through three spheres of influence: patient, nurse and system, and are responsible and accountable for diagnosis and treatment of health across a continuum from health to illness, disease management, health promotion, and prevention of illness and risk behaviors for individuals, families, groups and communities. Certified Nurse Practitioners (CNP) provides care along the wellness-illness continuum across settings. CNPs practice autonomously in diverse areas such as family practice, pediatrics, internal medicine and medical subspecialties such as geriatrics, behavioral health and women's health care. Clinical CNP care includes health promotion, disease prevention, health education and counseling as well as the diagnosis and management of acute and chronic diseases. CNPs are prepared to be primary care CNPs as well as acute care CNPs, having separate national consensus-based competencies and separate certification processes.

Advanced Practice Nurses in Nevada must be informed and involved in standardizing practice that will promote 21st century healthcare delivery in the state. Proposed changes can be viewed on the Nevada State Board of Nursing website at: act-upon-a-regulation/.


APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. Retrieved 12/4/11 from: APRNConsensusModelFinal09.pdf

Nevada State Board of Registered Nursing(2011) Notice of intent to act upon a regulation. Retrieved 12/4/2011 from: act-upon-a-regulation/.

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine [IOM]. (2011). The Future of Nursing: Leading Change, Advancing Health. The National Academies Press. Retrieved 12/4/2011 from: Advancing-Health.

World Health Organization, (2006). WHO Health Promotion Glossary: new terms. HealthPRomotion International Advance Access. Oxford University Press: Author. Retrieved 12/4/2011 from:

Susan Watson, PhD, FNP-BC

Dr. Watson graduated with a PhD in 2010 from the University of Miami. She has been a registered nurse for 34 years and is now working as an assistant professor of nursing at Roseman University of Health Sciences and as a Family Nurse Practitioner at Cornerstone Family Practice in Henderson, NV.
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Title Annotation:APRN Practice
Author:Watson, Susan
Publication:Nevada RNformation
Geographic Code:1U8NV
Date:Feb 1, 2012
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