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APRN Consensus Model1

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Reprinted with permission from Kathy Apple, NCSBN, from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf (accessed December 9, 2010).



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D APRN Consensus Model1 1 Reprinted with permission from Kathy Apple, NCSBN, from https://www.ncsbn.org/Consensus_ Model_for_APRN_Regulation_July_2008.pdf (accessed December 9, 2010). 323

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324 THE FUTURE OF NURSING Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education July 7, 2008 Completed through the work of the APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee The APRN Consensus Work Group and the APRN Joint Dialogue Group members would like to recognize the significant contribution to the development of this report made by Jean Johnson, PhD, RN-C, FAAN, Senior Associate Dean, Health Sciences, George Washington School of Medicine and Health Sciences. Consensus could not have been reached without her experienced and dedicated facilitation of these two national, multi-organizational groups.

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32 APPENDIX D LIST OF ENDORSING ORGANIZATIONS This Final Report of the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee has been disseminated to participating organizations. The names of endorsing organizations will be added periodically. The following organizations have endorsed the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (July 2008). (Posted December 2010) N = 48 Academy of Medical-Surgical Nurses (AMSN) Accreditation Commission for Midwifery Education (ACME) American Academy of Nurse Practitioners (AANP) American Academy of Nurse Practitioners Certification Program American Association of Colleges of Nursing (AACN) American Association of Critical-Care Nurses (AACN) American Association of Critical-Care Nurses Certification Corporation American Association of Legal Nurse Consultants (AALNC) American Association of Nurse Anesthetists (AANA) American Board of Nursing Specialties (ABNS) American College of Nurse-Midwives (ACNM) American College of Nurse Practitioners (ACNP) American Holistic Nurses Association (AHNA) American Midwifery Certification Board (AMCB) American Nurses Association (ANA) American Nurses Credentialing Center (ANCC) American Psychiatric Nurses Association (APNA) Arkansas State Board of Nursing Association of Faculties of Pediatric Nurse Practitioners (AFPNP) Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) Commission on Collegiate Nursing Education (CCNE) Council on Accreditation of Nurse Anesthesia Educational Programs (COA) Dermatology Nurses Association (DNA) Dermatology Nursing Certification Board (DNCB) Emergency Nurses Association (ENA) Gerontological Advanced Practice Nurses Association (GAPNA) Hospice and Palliative Nurses Association (HPNA) The International Society of Psychiatric Nurses (ISPN) National Association of Clinical Nurse Specialists (NACNS) National Association of Neonatal Nurses (NANN)

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32 THE FUTURE OF NURSING National Association of Orthopedic Nurses (NAON) National Association of Pediatric Nurse Practitioners (NAPNAP) National Board for Certification of Hospice and Palliative Nurses (NBCHPN) National Board on Certification & Recertification of Nurse Anesthetists (NBCRNA) National Certification Corporation (NCC) National Council of State Boards of Nursing (NCSBN) National Gerontological Nursing Association (NGNA) National League for Nursing (NLN) National League for Nursing Accrediting Commission, Inc. (NLNAC) National Organization of Nurse Practitioner Faculties (NONPF) Nurse Practitioners in Women’s Health (NPWH) Nurses Organization of Veterans Affairs (NOVA) Oncology Nursing Certification Corporation (ONCC) Oncology Nursing Society (ONS) Orthopedic Nurses Certification Board (ONCB) Pediatric Nursing Certification Board (PNCB) Wound, Ostomy and Continence Nurses Society (WOCN) Wound, Ostomy and Continence Nursing Certification Board (WOCNCB)

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32 APPENDIX D INTRODUCTION 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 of the importance of APRNs in caring for the current and future health needs of patients, the educa- tion, 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. APRNs include certified registered nurse anesthetists, certified nurse-mid- wives, clinical nurse specialists and certified nurse practitioners. Each has a unique history and context, but shares the commonality of being APRNs. While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state. Currently, there is no uniform model of regulation of APRNs across the states. Each state independently determines the APRN legal scope of practice, the roles that are recognized, the criteria for entry-into advanced practice and the certification examinations accepted for entry-level competence assess- ment. This has created a significant barrier for APRNs to easily move from state to state and has decreased access to care for patients. Many nurses with advanced graduate nursing preparation practice in roles and specialties (e.g., informatics, public health, education, or administration) that are essential to advance the health of the public but do not focus on direct care to individuals and, therefore, their practice does not require regulatory recognition beyond the Registered Nurse license granted by state boards of nursing. Like the four current APRN roles, practice in these other advanced specialty nursing roles requires specialized knowledge and skills acquired through graduate-level educa- tion. Although extremely important to the nursing profession and to the delivery of safe, high quality patient care, these other advanced, graduate nursing roles, which do not focus on direct patient care, are not roles for Advanced Practice Registered Nurses (APRN) and are not the subject or focus of the Regulatory Model presented in this paper. The model for APRN regulation is the product of substantial work conducted by the Advanced Practice Nursing Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Committee. While these groups began work independent of each other, they came together through rep- resentatives of each group participating in what was labeled the APRN Joint Dialogue Group. The outcome of this work has been unanimous agreement on most of the recommendations included in this document. In a few instances, when agreement was not unanimous a 66 percent majority was used to determine the final recommendation. However, extensive dialogue and transparency in the decision-making process is reflected in each recommendation. The background

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32 THE FUTURE OF NURSING of each group can be found on pages 13-16 and individual and organizational participants in each group in Appendices C-H. This document defines APRN practice, describes the APRN regulatory model, identifies the titles to be used, defines specialty, describes the emergence of new roles and population foci, and presents strategies for implementation. Overview of APRN Model of Regulation The APRN Model of Regulation described will be the model of the future. It is recognized that current regulation of APRNs does not reflect all of the compo- nents described in this paper and will evolve incrementally over time. A proposed timeline for implementation is presented at the end of the paper. In this APRN model of regulation there are four roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse special- ist (CNS), and certified nurse practitioner (CNP). These four roles are given the title of advanced practice registered nurse (APRN). APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related or psych/mental health. APRN education programs, including degree-granting and post-graduate education programs2, are accredited. APRN education consists of a broad-based education, including three separate graduate-level courses in ad- vanced physiology/pathophysiology, health assessment and pharmacology as well as appropriate clinical experiences. All developing APRN education programs or tracks go through a pre-approval, pre-accreditation, or accreditation process prior to admitting students. APRN education programs must be housed within graduate programs that are nationally accredited3 and their graduates must be eligible for national certification used for state licensure. Individuals who have the appropriate education will sit for a certification examination to assess national competencies of the APRN core, role and at least one population focus area of practice for regulatory purposes. APRN certification programs will be accredited by a national certification accrediting body 4. APRN certification programs will require a continued competency mechanism. Individuals will be licensed as independent practitioners for practice at 2 Degree granting programs include master’s and doctoral programs. Post-graduate programs in- clude both post-master’s and post-doctoral certificate education programs. 3 APRN education programs must be accredited by a nursing accrediting organization that is rec- ognized by the U.S. Department of Education (USDE) and/or the Council for Higher Education Ac- creditation (CHEA), including the Commission on Collegiate Nursing Education (CCNE), National League for Nursing Accrediting Commission (NLNAC), Council on Accreditation of Nurse Anesthe- sia Educational Programs (COA), Accreditation Commission for Midwifery Education (ACME), and the National Association of Nurse Practitioners in Women’s Health Council on Accreditation. 4 The certification program should be nationally accredited by the American Board of Nursing Specialties (ABNS) or the National Commission for Certifying Agencies (NCCA).

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32 APPENDIX D the level of one of the four APRN roles within at least one of the six identified population foci. Education, certification, and licensure of an individual must be congruent in terms of role and population foci. APRNs may specialize but they cannot be licensed solely within a specialty area. In addition, specialties can provide depth in one’s practice within the established population foci. Education and assessment strategies for specialty areas will be developed by the nursing profession, i.e., nursing organizations and special interest groups. Education for a specialty can occur concurrently with APRN education required for licensure or through post-graduate education. Competence at the specialty level will not be assessed or regulated by boards of nursing but rather by the professional organizations. In addition, a mechanism that enhances the communication and transparency among APRN licensure, accreditation, certification and education bodies (LACE) will be developed and supported. APRN REGULATORY MODEL APRN Regulation includes the essential elements: licensure, accreditation, certification and education (LACE). • Licensure is the granting of authority to practice. • Accreditation is the formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing- related programs. • Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession. • Education is the formal preparation of APRNs in graduate degree- granting or post-graduate certificate programs. The APRN Regulatory Model applies to all elements of LACE. Each of these elements plays an essential part in the implementation of the model. Definition of Advanced Practice Registered Nurse Characteristics of the advanced practice registered nurse (APRN) were iden- tified and several definitions of an APRN were considered, including the NCSBN and the American Nurses Association (ANA) definitions, as well as others. The characteristics identified aligned closely with these existing definitions. The defi- nition of an APRN, delineated in this document, includes language that addresses responsibility and accountability for health promotion and the assessment, diag- nosis, and management of patient problems, which includes the use and prescrip- tion of pharmacologic and non-pharmacologic interventions.

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330 THE FUTURE OF NURSING The definition of an Advanced Practice Registered Nurse (APRN) is a nurse: 1. who has completed an accredited graduate-level education program preparing him/her for one of the four recognized APRN roles; 2. who has passed a national certification examination that measures APRN, role and population-focused competencies and who maintains continued competence as evidenced by recertification in the role and population through the national certification program; 3. who has acquired advanced clinical knowledge and skills preparing him/her to provide direct care to patients, as well as a component of indirect care; however, the defining factor for all APRNs is that a sig- nificant component of the education and practice focuses on direct care of individuals; 4. whose practice builds on the competencies of registered nurses (RNs) by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and greater role autonomy; 5. who is educationally prepared to assume responsibility and account- ability for health promotion and/or maintenance as well as the assess- ment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic interventions; 6. who has clinical experience of sufficient depth and breadth to reflect the intended license; and 7. who has obtained a license to practice as an APRN in one of the four APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). Advanced practice registered nurses are licensed independent practitioners who are expected to practice within standards established or recognized by a li- censing body. Each APRN is accountable to patients, the nursing profession, and the licensing board to comply with the requirements of the state nurse practice act and the quality of advanced nursing care rendered; for recognizing limits of knowledge and experience, planning for the management of situations beyond the APRN’s expertise; and for consulting with or referring patients to other health care providers as appropriate. All APRNs are educationally prepared to provide a scope of services across the health wellness-illness continuum to at least one population focus as defined by nationally recognized role and population-focused competencies; however, the emphasis and implementation within each APRN role varies. The services or care provided by APRNs is not defined or limited by setting but rather by patient care

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331 APPENDIX D needs. The continuum encompasses the range of health states from homeostasis (or wellness) to a disruption in the state of health in which basic needs are not met or maintained (illness), with health problems of varying acuity occurring along the continuum that must be prevented or resolved to maintain wellness or an op- timal level of functioning (WHO, 2006). Although all APRNs are educationally prepared to provide care to patients across the health wellness-illness continuum, the emphasis and how implemented within each APRN role varies. The Certified Registered Nurse Anesthetist The Certified Registered Nurse Anesthetist is prepared to provide the full spectrum of patients’ anesthesia care and anesthesia-related care for individu- als across the lifespan, whose health status may range from healthy through all recognized levels of acuity, including persons with immediate, severe, or life- threatening illnesses or injury. This care is provided in diverse settings, including hospital surgical suites and obstetrical delivery rooms; critical access hospitals; acute care; pain management centers; ambulatory surgical centers; and the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons. The Certified Nurse-Midwife The certified nurse-midwife provides a full range of primary health care services to women throughout the lifespan, including gynecologic care, family planning services, preconception care, prenatal and postpartum care, childbirth, and care of the newborn. The practice includes treating the male partner of their female clients for sexually transmitted disease and reproductive health. This care is provided in diverse settings, which may include home, hospital, birth center, and a variety of ambulatory care settings including private offices and community and public health clinics. The Clinical Nurse Specialist The CNS has a unique APRN role to integrate care across the continuum and through three spheres of influence: patient, nurse, system. The three spheres are overlapping and interrelated but each sphere possesses a distinctive focus. In each of the spheres of influence, the primary goal of the CNS is continuous improve- ment of patient outcomes and nursing care. Key elements of CNS practice are to create environments through mentoring and system changes that empower nurses to develop caring, evidence-based practices to alleviate patient distress, facilitate ethical decision-making, and respond to diversity. The CNS is responsible and accountable for diagnosis and treatment of health/illness states, disease manage- ment, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities.

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332 THE FUTURE OF NURSING The Certified Nurse Practitioner For the certified nurse practitioner (CNP), care along the wellness-illness continuum is a dynamic process in which direct primary and acute care is pro- vided across settings. CNPs are members of the health delivery system, practicing autonomously in areas as diverse as family practice, pediatrics, internal medicine, geriatrics, and women’s health care. CNPs are prepared to diagnose and treat pa- tients with undifferentiated symptoms as well as those with established diagnoses. Both primary and acute care CNPs provide initial, ongoing, and comprehensive care, includes taking comprehensive histories, providing physical examinations and other health assessment and screening activities, and diagnosing, treating, and managing patients with acute and chronic illnesses and diseases. This includes or- dering, performing, supervising, and interpreting laboratory and imaging studies; prescribing medication and durable medical equipment; and making appropriate referrals for patients and families. Clinical CNP care includes health promotion, disease prevention, health education, and counseling as well as the diagnosis and management of acute and chronic diseases. Certified nurse practitioners are pre- pared to practice as primary care CNPs and acute care CNPs, which have separate national consensus-based competencies and separate certification processes. Titling The title Advanced Practice Registered Nurse (APRN) is the licensing title to be used for the subset of nurses prepared with advanced, graduate-level nurs- ing knowledge to provide direct patient care in four roles: certified registered nurse anesthetist, certified nurse-midwife, clinical nurse specialist, and certified nurse practitioner.5 This title, APRN, is a legally protected title. Licensure and scope of practice are based on graduate education in one of the four roles and in a defined population. Verification of licensure, whether hard copy or electronic, will indicate the role and population for which the APRN has been licensed. At a minimum, an individual must legally represent themselves, including in a legal signature, as an APRN and by the role. He/she may indicate the population as well. No one, except those who are licensed to practice as an APRN, may use the APRN title or any of the APRN role titles. An individual also may add the specialty title in which they are professionally recognized in addition to the legal title of APRN and role. 5 Nurses with advanced graduate nursing preparation practicing in roles and specialties that do not provide direct care to individuals and, therefore, whose practice does not require regulatory recogni- tion beyond the Registered Nurse license granted by state boards of nursing may not use any term or title which may confuse the public, including advanced practice nurse or advanced practice registered nurse. The term “advanced public health nursing” however, may be used to identify nurses practicing in this advanced specialty area of nursing.

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333 APPENDIX D APRN REGULATORY MODEL APRN SPECIALTIES Focus of practice beyond role and population focus linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative Care POPULATION FOCI Licensure occurs at levels of role and population foci Family/ Women’s Psychiatric- Adult- Neonatal Pediatrics individual across health/gender- gerontology* mental health** lifespan related APRN ROLES Nurse Nurse- Clinical nurse Nurse anesthetist midwife specialist ++ practitioner + FIGURE D-1 APRN Regulatory Model Under this APRN Regulatory Model, there are four roles: certified registered nurse anes- Fig D-1.eps thetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). These four roles are given the title of advanced practice registered nurse (APRN). APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender-related or psych/mental health. Individuals will be licensed as independent practitioners for practice at the level of one of the four APRN roles within at least one of the six identified population foci. Education, certification, and licensure of an individual must be congruent in terms of role and population foci. APRNs may specialize but they can not be licensed solely within a specialty area. Specialties can provide depth in one’s practice within the established population foci. NOTES: * The population focus, adult-gerontology, encompasses the young adult to the older adult, including the frail elderly. APRNs educated and certified in the adult-gerontol- ogy population are educated and certified across both areas of practice and will be titled Adult-Gerontology CNP or CNS. In addition, all APRNs in any of the four roles providing care to the adult population, e.g., family or gender specific, must be prepared to meet the growing needs of the older adult population. Therefore, the education program should include didactic and clinical education experiences necessary to prepare APRNs with these enhanced skills and knowledge. ** The population focus, psychiatric/mental health, encompasses education and practice across the lifespan. +The certified nurse practitioner (CNP) is prepared with the acute care CNP competen- cies and/or the primary care CNP competencies. At this point in time the acute care and

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3 THE FUTURE OF NURSING APPENDIX D 2006 NCSBN APRN Roundtable Organization Attendance List Alabama Board of Nursing American Academy of Nurse Practitioners American Academy of Nurse Practitioners National Certification Program, Inc American Association of Colleges of Nursing American Association of Critical-Care Nurses American Association of Nurse Anesthetists American Association of Psychiatric Nurses American Board of Nursing Specialties American College of Nurse-Midwives American College of Nurse Practitioners American Holistic Nurses’ Certification Corporation American Midwifery Certification Board American Nurses Association American Nurses Credentialing Center American Organization of Nurses Executives Association of Women’s Health, Obstetric and Neonatal Nurses Board of Certification for Emergency Nursing Council on Accreditation of Nurse Anesthesia Educational Programs Emergency Nurses Association George Washington School of Medicine Idaho Board of Nursing Kansas Board of Nursing Kentucky Board of Nursing Massachusetts Board of Nursing Mississippi Board of Nursing National Association of Clinical Nurse Specialists National Association of Nurse Practitioners in Women’s Health National Association of Pediatric Nurse Practitioners National Board for Certification of Hospice & Palliative Nurses National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties National League for Nursing Accrediting Commission North Carolina Board of Nursing Oncology Nursing Certification Corporation Pediatric Nursing Certification Board Rhode Island Board of Nursing Texas Board of Nurse Examiners Utah Board of Nursing

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3 APPENDIX D Vermont Board of Nursing Wound, Ostomy and Continence Nursing Certification Board 2007 APRN Roundtable Attendance List ABNS Accreditation Council Alabama Board of Nursing American Academy of Nurse Practitioners American Academy of Nurse Practitioners National Certification Program, Inc American Association of Colleges of Nursing American Association of Critical-Care Nurses American Association of Nurse Anesthetists American College of Nurse-Midwives American College of Nurse Practitioners American Midwifery Certification Board American Nurses Credentialing Center - Certification Services American Organization of Nurse Executives Arkansas State Board of Nursing Association of Women’s Health, Obstetric and Neonatal Nurses Board of Certification for Emergency Nursing Colorado Board of Nursing Commission on Collegiate Nursing Education Council on Accreditation of Nurse Anesthesia Educational Programs Council on Certification of Nurse Anesthetists and Council on Recertification of Nurse Anesthetists Emergency Nurses Association Idaho Board of Nursing Illinois State Board of Nursing Kansas Board of Nursing Kentucky Board of Nursing Loyola University Chicago Niehoff School of Nursing Minnesota Board of Nursing Mississippi Board of Nursing National Association of Clinical Nurse Specialists National Association of Pediatric Nurse Practitioners National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties National League for Nursing Accrediting Commission National Organization of Nurse Practitioner Faculties Oncology Nursing Certification Corporation Pediatric Nursing Certification Board Pennsylvania Board of Nursing

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30 THE FUTURE OF NURSING Rhode Island Board of Nursing Rush University College of Nursing South Dakota Board of Nursing Tennessee Board of Nursing Texas Board of Nurse Examiners Vermont Board of Nursing

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31 APPENDIX D APPENDIX E APRN Joint Dialogue Group Organizations represented at the Joint Dialogue Group Meetings American Academy of Nurse Practitioners Certification Program American Association of Colleges of Nursing American Association of Nurse Anesthetists American College of Nurse-Midwives American Nurses Association American Organization of Nurse Executives Compact Administrators National Association of Clinical Nurse Specialists National Council of State Boards of Nursing National League for Nursing Accrediting Commission National Organization of Nurse Practitioner Faculties NCSBN APRN Advisory Committee Representatives (5)

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32 THE FUTURE OF NURSING APPENDIX F Organizations invited to APN Consensus Conference June 2004 Accreditation Commission for Midwifery Education American Academy of Nurse Practitioners American Academy of Nurse Practitioners Certification Program American Academy of Nursing American Association of Critical Care Nurses American Association of Critical Care Nurses Certification Program American Association of Nurse Anesthetists American Association of Occupational Health Nurses American Board of Nursing Specialties American College of Nurse-Midwives American College of Nurse Practitioners American Nurses Association American Nurses Credentialing Center American Organization of Nurse Executives American Psychiatric Nurses Association Association of Faculties of Pediatric Nurse Practitioners Association of Rehabilitation Nurses Association of Women’s Health, Obstetric and Neonatal Nurses Certification Board Perioperative Nursing Commission on Collegiate Nursing Education Council on Accreditation of Nurse Anesthesia Educational Programs Division of Nursing, DHHS, HRSA Emergency Nurses Association Hospice and Palliative Nurses Association International Nurses Society on Addictions International Society of Psychiatric-Mental Health Nurses NANDA International National Association of Clinical Nurse Specialists National Association of Neonatal Nurses National Association of Nurse Practitioners in Women’s Health National Association of Nurse Practitioners in Women’s Health, Council on Accreditation National Association of Pediatric Nurse Practitioners National Association of School Nurses National Board for Certification of Hospice and Palliative Nurses National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties National Conference of Gerontological Nurse Practitioners

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33 APPENDIX D National Council of State Boards of Nursing National Gerontological Nursing Association National League for Nursing National League for Nursing Accrediting Commission National Organization of Nurse Practitioner Faculties Nurse Licensure Compact Administrators/State of Utah Department of Commerce/Division of Occupational & Professional Licensing Nurses Organization of Veterans Affairs Oncology Nursing Certification Corporation Oncology Nursing Society Pediatric Nursing Certification Board Sigma Theta Tau, International Society of Pediatric Nurses Wound Ostomy & Continence Nurses Society Wound Ostomy Continence Nursing Certification Board

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34 THE FUTURE OF NURSING APPENDIX G Organizations participating in APRN consensus process Academy of Medical-Surgical Nurses Accreditation Commission for Midwifery Education American Academy of Nurse Practitioners American Academy of Nurse Practitioners Certification Program American Association of Colleges of Nursing American Association of Critical Care Nurses Certification American Association of Neuroscience Nurses American Association of Nurse Anesthetists American Association of Occupational Health Nurses American Board for Occupational Health Nurses American Board of Nursing Specialties American College of Nurse-Midwives American College of Nurse-Midwives Division of Accreditation American College of Nurse Practitioners American Holistic Nurses Association American Nephrology Nurses Association American Nurses Association American Nurses Credentialing Center American Organization of Nurse Executives American Psychiatric Nurses Association American Society for Pain Management Nursing American Society of PeriAnesthesia Nurses Association of Community Health Nursing Educators Association of Faculties of Pediatric Nurse Practitioners Association of Nurses in AIDS Care Association of PeriOperative Registered Nurses Association of Rehabilitation Nurses Association of State and Territorial Directors of nursing Association of Women’s Health, Obstetric and Neonatal Nurses Board of Certification for Emergency Nursing Commission on Collegiate Nursing Education Commission on Graduates of Foreign Nursing Schools Council on Accreditation of Nurse Anesthesia Educational Programs Department of Health Dermatology Nurses Association District of Columbia Board of Nursing Division of Nursing, DHHS, HRSA Emergency Nurses Association George Washington University

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3 APPENDIX D Health Resources and Services Administration Infusion Nurses Society International Nurses Society on Addictions International Society of Psychiatric-Mental Health Nurses Kentucky Board of Nursing National Association of Clinical Nurse Specialists National Association of Neonatal Nurses National Association of Nurse Practitioners in Women’s Health, Council on Accreditation National Association of Orthopedic Nurses National Association of Pediatric Nurse Practitioners National Association of School of Nurses National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties National Conference of Gerontological Nurse Practitioners National Council of State Boards of Nursing National League for Nursing National League for Nursing Accrediting Commission National Organization of Nurse Practitioner Faculties Nephrology Nursing Certification Commission North American Nursing Diagnosis Association International Nurses Organization of Veterans Affairs Oncology Nursing Certification Corporation Oncology Nursing Society Pediatric Nursing Certification Board Pennsylvania State Board of Nursing Public Health Nursing Section of the American Public Health Association. Rehabilitation Nursing Certification Board Society for Vascular Nursing Texas Nurses Association Texas State Board of Nursing Utah State Board of Nursing Women’s Health, Obstetric & Neonatal Nurses Wound, Ostomy, & Continence Nurses Society Wound, Ostomy, & Continence Nursing Certification

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3 THE FUTURE OF NURSING APPENDIX H APRN Consensus Process Work Group Organizations Represented at the Work Group Meetings Jan Towers, American Academy of Nurse Practitioners Certification Program Joan Stanley, American Association of Colleges of Nursing Carol Hartigan, American Association of Critical Care Nurses Certification Corporation Leo LeBel, American Association of Nurse Anesthetists Bonnie Niebuhr, American Board of Nursing Specialties Peter Johnson & Elaine Germano, American College of Nurse-Midwives Mary Jean Schumann, American Nurses Association Mary Smolenski, American Nurses Credentialing Center M.T. Meadows, American Organization of Nurse Executives Edna Hamera & Sandra Talley, American Psychiatric Nurses Association Elizabeth Hawkins-Walsh, Association of Faculties of Pediatric Nurse Practitioners Jennifer Butlin, Commission on Collegiate Nursing Education Laura Poe, APRN Compact Administrators Betty Horton, Council on Accreditation of Nurse Anesthesia Educational Programs Kelly Goudreau, National Association of Clinical Nurse Specialists Fran Way, National Association of Nurse Practitioners in Women’s Health, Council on Accreditation Mimi Bennett, National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties Kathy Apple, National Council of State Boards of Nursing Grace Newsome & Sharon Tanner, National League for Nursing Accrediting Commission Kitty Werner & Ann O’Sullivan, National Organization of Nurse Practitioner Faculties Cyndi Miller-Murphy, Oncology Nursing Certification Corporation Janet Wyatt, Pediatric Nursing Certification Board Carol Calianno, Wound, Ostomy and Continence Nursing Certification Board Irene Sandvold, DHHS, HRSA, Division of Nursing (observer)

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3 APPENDIX D ADDENDUM Example of a National Consensus-Building Process to Develop Nationally Recognized Education Standards and Role/Specialty Competencies The national consensus-based process described here was originally de- signed, with funding by the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing, to develop and validate national consensus-based primary care nurse practitioner competencies in five specialty areas. The process was developed with consultation from a nationally recognized expert in higher education assessment. The process subsequently has been used and validated for the development of similar sets of competencies for other areas of nursing practice, including com- petencies for mass casualty education for all nurses and competencies for acute care nurse practitioners and psych/mental health nurse practitioners. This process for developing nationally recognized educational standards, nationally recognized role competencies and nationally recognized specialty competencies is an iterative, step-wise process. The steps are: Step 1: At the request of the organization(s) representing the role or specialty, a neutral group or groups convenes and facilitates a national panel of all stake- holder organizations as defined in step 2. Step 2: To ensure broad representation, invitations to participate should be extended to one representative of each of the recognized nursing accrediting organizations, certifiers within the role and specialty, groups whose primary mission is graduate education and who have established educational criteria for the identified role and specialty, and groups with competencies and standards for education programs that prepare individuals in the role and specialty. Step 3: Organizational representatives serving on the national consensus panel bring and share role delineation studies, competencies for practice and edu- cation, scopes and standards of practice, and standards for education programs. Step 4: Agreement is reached among the panel members Step 5: Panel members take the draft to their individual boards for feedback. Step 6: That feedback is returned to the panel. This is an iterative process until agreement is reached. Step 7: Validation is sought from a larger group of stakeholders including organizations and individuals. This is known as the Validation Panel. Step 8: Feedback from the Validation Panel is returned to National Panel to prepare the final document. Step 9: Final document is sent to boards represented on the National Panel and the Validation Panel for endorsement. The final document demonstrates national consensus through consideration of broad input from key stakeholders. The document is then widely disseminated.

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