Consensus Building Around Advanced Practice Nursing
Consensus Building Around Advanced Practice Nursing
A priority for the profession is a collaboratively developed conceptualization of advanced practice nursing and what is common across the various APRN roles. Achieving this is a prerequisite for building consensus among APRNs, stakeholder organizations, and policymakers and ensuring that all patients will benefit from advanced practice nursing. The APRN Consensus Model represents substantial progress in this area with regard to regulation. Studies are underway worldwide (see Chapter 6) that could inform efforts to refine conceptualizations of advanced nursing practice. Ongoing development of consensus on advanced practice nursing should involve:
· • Periodic updates on the progress of nationwide implementation of the regulatory model—successes and challenges (note that the NCSBN periodically updates state-by-state maps on its website).
· • Communication between national and global APRN accrediting and certification bodies. Because US nurse anesthetists and nurse-midwives operate under different accrediting and certification bodies and mechanisms than CNSs and NPs, their experience may be helpful in countries in which nurses and midwives are regulated separately, or where nurse anesthesia is not a practice role.
· • Consensus of common terms used in documents describing APRN practice.
It is evident from this review that there is still a need for common language to describe advanced practice nursing. Clear articulation and consensus of the conceptual differences among terms such as essentials, competencies, hallmarks, and standard of care is needed among the various users within the profession and among other stakeholders. The responses of the AANA, ACNM, NACNS, and NONPF to the DNP initiative and concerns about selective implementation of the APRN Consensus Model are likely to influence the evolution of advanced practice nursing in the next decade. The extent to which we reach agreement within the profession will affect policy related to advanced practice and whether the public recognizes and requests the services of APRNs. Disagreement on the nature and credentialing of advanced practice nursing should be resolved by continued efforts to foster true consensus by:
· • Addressing the legitimate concerns of these organizations (e.g., impact on access to care, concerns about certification or grandfathering existing APRNs)
· • Establishing priorities for negotiation and resolution by stakeholder groups and initiating a process to find common ground and address disagreements
· • In the face of disagreements, working toward agreement on a common identity to facilitate public understanding of APRN roles
These consensus-building efforts are needed if our profession is to remain attractive to new nurses and new APRNs and to make room for evolving APRN roles.
Consensus on Key Elements of Practice Doctorate Curricula
Several authors have expressed concern that, because the DNP is a practice degree and not a research degree, it may not be demanding enough with regard to theory and research methods, which may be just as important for evaluating practice and testing practice models as they are in nursing Ph.D. programs. Although the ACNM does not currently support the practice doctorate for entry into practice and the AANA has delayed endorsing doctoral preparation for entry into practice until 2025 and the NACNS until 2030, APRN organizations have prepared doctoral-level competencies that are consistent with those proposed in the DNP. One question that will need to be addressed is whether regulations will specify which type of nursing practice doctorate will be needed when, and if, a doctorate becomes the entry-level credential for all APRNs because, as Dreher (2011) has noted, there are other practice doctorates in nursing.
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