The Regulation of Advanced Practice Registered Nurses

The regulation of APRNs differs significantly from state to state among BONs. In addition, it is important to note that in some states advanced practice nurses, such as certified registered nurse anesthetists (CNRAs), may be managed by the state’s medical board. Currently, the NCSBN recommends the use of APRN certification examinations as a basis for determining APRN credentialing.

However, the scope of practice and prescriptive privileges that APRNs have depend on each state’s NPA. Until states adopt the APRN Compact, APRNs must seek and receive recognition from each state in which they practice. Currently, Texas, Utah, and Iowa are the only three APRN Compact states with partial implementation. The NLC applies only to nursing licensure and currently does not apply to APRN certifications.

Generally, an APRN would need to contact the state in which he or she anticipates practicing as an APRN and meet the requirements for licensure and certification as an APRN with prescribing privileges (as permitted) in that state. The APRN who resides in a state that is part of the mutual recognition model and declares that state as their primary residence may go to another compact state and practice as an RN because he or she has a compact RN license but may not practice as an APRN until he or she receives advanced practice licensure and meets the certification requirements for that state.

It is important to know that regulatory state requirements can affect certification within a particular state. APRNs can track state legislative changes through the NCSCN website at https://www.ncsbn.org/aprn.htm and the ANA Advance Practice Nurses Consensus Model Toolkit at http://www.nursingworld.org/consensusmodel.

In 2008, the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (LACE Model) was developed as a collaborative effort by more than 40 nursing organizations to make APRN practice and regulation more uniform and consistent. The APRN Regulatory Model (LACE) defines four advance nurse practice roles: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and certified nurse practitioner (CNP).

Under the APRN Regulatory Model, certification and licensure must be congruent in terms of role and population focus. With the progression of implementation of the APRN Consensus Model, certifying organizations such as ANCC are changing certification programs to more accurately reflect the roles and populations required by the Model.

For example, the Adult Nurse Practitioner Primary Care Nurse Practitioner certification is being retired in December 2016 and is being replaced by the Adult Gerontology Primary Care Nurse Practitioner certification (ANCC, 2016d). As the APRN Regulatory Model and Enhanced Compact and new state legislative changes are implemented, it will be critically important for APRNs to understand the issues affecting their licensure, certification, and practice.

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