2008 HEALTHCARE AND NP NEWS
First National Consensus Model for APRN Regulation described in Report Now Available On Nursing World and ANA NurseSpace
Advanced Practice Registered Nurses (APRNs) have expanded in numbers and capabilities over the past several decades with APRNs being highly valued and an integral part of the health care system. Because 240,000 APRNs are presently prepared to care for the current and future health needs of patients, the education, accreditation, certification and licensure of APRNs need to be effectively aligned in order to continue to ensure patient safety while expanding patient access to APRNs. Collectively, APRN stakeholder nursing organizations, including ANA, persisted for nearly 4 years to complete this first ever model in order to achieve greater alignment of the elements needed to prepare APRNs to be competent practitioners and ensure public safety.
In summary, the Consensus Model for APRN Regulation includes: description of a futuristic model for regulation of APRNS that includes requirements for education, accreditation, certification and licensing; a definition of the Advanced Practice Registered Nurse; a definition of broad-based APRN education; a model for regulation that ensures APRN education and certification as a valid and reliable process, that is based on nationally recognized and accepted standards; uniform recommendations for licensing bodies across states; a process and characteristics for recognizing a new APRN role; and a definition of an APRN specialty that allows for the profession to meet future patient and nursing needs. The APRN Regulatory Model will be implemented in every state and program by 2015.
ANA believes strongly in the value of Advanced Practice Registered Nurses. APRNs are one of the keys to solving America’s health care crisis, which was outlined in ANA’s Nursing Agenda for Health Care Reform. We have been working for the APRN community for decades, and we continue to work for you today.
Wall Street Journal article and Julie Stanik-Hutt's response as ACNP president:
April 9, 2008
Julie A. Stanik-Hutt, PhD, CRNP – AC
The American College of Nurse Practitioners was pleased to see your report noting that nurse
practitioners (NPs) are an enormous asset to this country, providing accessible, affordable, high
quality health care to millions of Americans. We are however concerned regarding a number of
inaccuracies in your article “Making Room for Dr. Nurse” (April 2, 2008).
For more than 40 years master’s prepared nurse practitioners (registered nurses who have
completed graduate training in the diagnosis and management of a full spectrum of health problems)
have been legally authorized to provide health care in all 50 states and the District of Columbia. 1
Today, more than 141,000 NPs are licensed to provide primary and specialty health care, prescribe
medications and therapies, and are reimbursed by all types of insurance plans. NPs fill critical gaps in
all areas of health care. They are the provider of choice for health promotion and disease prevention
services, and are often the only health care provider for rural and underserved populations. In
addition, NPs are 3 times more likely to enter family practice than are physicians. 2,3 Many NPs also
have admitting privileges, and are credentialed to provide care to all types of hospitalized individuals
from the smallest neonate to the most critically ill elder.
NPs practice completely independently in 23 states and in collaboration with other providers in 20
additional states. Only 8 states require that NPs be supervised by a physician. 4 Research, including
work done by Ms. Mundinger and others, demonstrates that even without a Doctor of Nursing
Practice (DNP) degree, these master’s prepared NPs are already highly qualified and provide
excellent health care. 5 – 9
Rather than being confused regarding NP’s titles or roles, patients’ confidence in our services is
evidenced by the fact that they seek out NPs for the added value we provide, such as focus on the
patient with a health problem rather than the pathology in a patient, ease of communication,
expertise at patient education for self-care management, willingness to collaborate with other
providers, and seamless coordination of comprehensive care services.
NPs are not physician practitioners, and since the medical board examination described in the
article is based in the practice of medicine, it is not an appropriate measure of any nurses’
professional expertise. NPs knowledge, skills and abilities are better evaluated by one of the existing
national board certification examinations.
In 2003 the Institute of Medicine called for improvements in the educational preparation of all health
care providers. 10 They specifically called for educators to improve their graduate’s competencies in
five new areas: patient centered care, interdisciplinary teamwork, evidence-based practice, quality
improvement, and the application of information technology to enhance care. Nurse educators have
incorporated these areas into DNP educational options for nurses. An accurate description of DNP
education is available at http://www.aacn.nche.edu/. These practice doctorates are not designed to
prepare only future NPs, but all types of advanced practice nurses. Graduates of DNP programs,
whether NPs or not, will transform health care through excellence in practice and will collaborate
with the thousands of already PhD prepared “Dr. Nurses” who improve practice through research
every day.
1. Christian, S., Dower, C. & O’Neill, E. (2007). Overview of Nurse Practitioner Scopes of Practice in
the United States – Discussion. Center for the Health Professions, University of California, San
Francisco.
2. American Association of Colleges of Nursing (2007). Nurse Practitioner Enrollment and
Graduations by National Certification.
3. National Resident Matching Program (2008). Advance Data Tables: 2008 Main Residency Match.
4. Pearson, L.J. (2007). The Pearson Report: A National overview of nurse practitioner legislation and
healthcare issues. American Journal for Nurse Practitioners, 11(2), 10-101.
5. Lenz, E., Mundinger, M., Kane, R, Hopkins, S. & Lin, S. (2004). Primary ., are outcomes in patients
treated by nurse practitioners or physicians: two-year follow-up. Medical Care Research Review,
61(3), 332-5
6. Horrocks, S., Anderson, E. & Salisbury, C. (2002). Systematic review of whether nurse
practitioners working in primary care can provide equivalent care to doctors. British Medical Journal,
324, 819-823.
7. Lambing, A., Adams, D., Fox, D. & Divine, G.(2004). Nurse practitioners' and physicians' care
activities and clinical outcomes with an inpatient geriatric population. Journal of the American
Academy of Nurse Practitioners, 16(8), 343-52.
8. Ohlman-Strickland, P., Orzano, A., Hudson, L., Solberg, L., DiCiddio-Bloom, B., O'Malley, D., Tallia,
A., Balasubramanian, B. & Crabtree, B.(2008). Quality of diabetes care in family medicine practices:
influence of nurse-practitioners and physician's assistants. Annals of Family Medicine, 6(1),14-22.
9. Woodburn, J., Smith, K.& Nelson, G. (2007). Quality of care in the retail health care setting using
national clinical guidelines for acute pharyngitis. American Journal of Medical Quality, 22(6), 457 –
462.
10. Greiner, A., Knebel, E. (Eds). Health Professions Education: A Bridge to Quality. National
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