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Introduction
Advanced practice registered nurses (APRNs) are educated at the graduate level and licensed to provide care beyond the scope of the registered nurse. Their regulation has varied widely by state, which can limit where an APRN may practice and what they may do. The Consensus Model for APRN Regulation, published in 2008, set out a shared framework intended to make APRN regulation consistent across states (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008).
Four roles and six population foci
The Consensus Model recognizes four APRN roles:
- Certified registered nurse anesthetist (CRNA)
- Certified nurse-midwife (CNM)
- Clinical nurse specialist (CNS)
- Certified nurse practitioner (CNP)
Each APRN is educated, certified and licensed in one of these roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women's health/gender-related, and psychiatric/mental health. Nurse practitioners in adult-gerontology and pediatrics are further prepared for either acute or primary care. Specialties, such as oncology or palliative care, can be added on top of a role and population focus but are not licensed separately.
LACE
The model's regulatory structure is often summarized as LACE:
| Element | What it covers |
|---|---|
| Licensure | The state grants the authority to practice in a role and population focus |
| Accreditation | Graduate programs are accredited by a nursing accrediting body |
| Certification | National certification exams test competence in the role and population focus |
| Education | A graduate or postgraduate program, including separate graduate courses in advanced physiology/pathophysiology, advanced health assessment and advanced pharmacology |
Aligning all four means that an APRN's education, exam and license match, so the license reflects what the APRN was prepared to do.
Why it matters for my role
I plan to practice as a family nurse practitioner. Under the Consensus Model, my program, certification exam and license should all align with the family/individual across the lifespan population focus, which prepares me to care for patients of all ages in primary care. If I later want to care for acutely ill hospitalized adults, the model makes clear that this would require additional education and certification as an adult-gerontology acute care nurse practitioner, not just on-the-job experience.
The evidence on nurse practitioner care
Debates about APRN scope of practice often turn on quality. A systematic review of US studies published between 1990 and 2008 compared outcomes of care provided by nurse practitioners and physicians and found that nurse practitioner care was comparable and, on some measures, better (Stanik-Hutt et al., 2013). This evidence supports regulation that allows APRNs to practice to the full extent of their education.
Ongoing challenges
Although the Consensus Model was published in 2008, states have adopted its elements at different speeds, and some still require nurse practitioners to have physician supervision or collaborative agreements. As a future APRN, I will need to know my state's rules, keep my certification current, and support professional organizations working toward full adoption.
References
APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. https://www.ncsbn.org/public-files/Consensus_Model_for_APRN_Regulation_July_2008.pdf
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492–500. https://doi.org/10.1016/j.nurpra.2013.07.004
