3: THE EVOLUTION OF ADVANCED PRACTICE NURSING ROLES ■ 89stakeholder organizations, promulgated targeted educational guidelines for NP prepara-
tion. NONPF established a set of specialty- specific educational guidelines outlining com-
petencies for NP education in both general and specialty areas of practice (NONPF, 2002,
2003, 2004). In 2008, the National Task Force produced the consensus document— Criteria
for Evaluation of Nurse Practitioner Programs. Nurse anesthetist, nurse- midwife, and CNS
education are, in addition, more specifically guided by the respective specialty accredit-
ing organizations. Educational “landmarks” are critical, because they demonstrate the
evolution of a cohesive view of advanced nursing practice on the part of those involved
in preparing advanced clinicians for practice.
■ CONSENSUS MODEL AND LACE
Advanced practice nursing has continued to grow toward a unified licensure and prac-
tice model through the collaboration of a variety of advanced practice nursing stake-
holder organizations, including the NCSBN, the APRN Consensus Workgroup, and
representatives from multiple professional nursing organizations, building on a frame-
work established in the 1990s. The Consensus Model for Advanced Practice Registered
Nurses (APRN Consensus Workgroup and NCBSN APRN Advisory Committee, 2008),
developed through this collaboration, prescribed the regulatory strategy for APRNs,
identified the same four direct care providers as APRNs, and specified that other nurses
prepared at the graduate level, whose scope is not direct care, do not fall under the
rubric of the APRN as defined by the model. A proposed timeline for implementation of
the model has been developed; as it is implemented and state regulations are amended,
the title “ advanced practice registered nurse” will be restricted. The model specifies that
APRNs are licensed and practice in one of the following clinical roles: certified nurse
practitioner (CNP), certified nurse- midwife (CNM), certified nurse anesthetist, or certi-
fied CNS. Education for practice will occur within six population foci (adult– geriatric,
pediatric, neonatal, women’s/ gender- related health, psychiatric– mental health, or
family/ individual life span), with certification and licensing within the respective pop-
ulation focus as well. Specialization will involve an additional layer of certification, via
professional organizations, beyond the population focus (e.g., adult- gerontology pop-
ulation focus, specialty of oncology; APRN Consensus Workgroup and NCBSN APRN
Advisory Committee, 2008; Partin, 2009; Stanley, Werner, & Apple, 2009). It is important
to note the definition of the CNS as an APRN with relevant licensing and regulatory
expectations, because the title CNS is not currently universally restricted, nor are there
license/ certification requirements across all states for the CNS role.
The model offers a discrete definition of advanced practice nursing and outlines
recommendations for uniform regulation of APRN practice via LACE : “licensure, accred-
itation [of APRN educational programs], certification, education” (APRN Consensus
Workgroup and NCSBN APRN Advisory Committee, 2008, p. 7). Characteristics of an
APRN as outlined in the consensus statement are that he or she is a clinician:
- Who has completed an accredited graduate- level education program prepar-
ing him or her for one of the four recognized APRN roles - Who has passed a national certification examination that measures APRN role
and population- focused competencies and who maintains continued compe-
tence as evidenced by recertification in the role and population through the
national certification program - Who has acquired advanced clinical knowledge and skills preparing him or
her to provide direct care to patients, as well as a component of indirect care;