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Certification, Barriers, Titles, and the
DNP: An Update on the
Implementation of the Consensus
Model and the Transition to the DNP
2012 NPAM MeetingNovember 3, 2012
Joan Stanley, PhD, CRNP, FAAN, FAANP
Senior Director of Education Policy
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Objectives:
• Discuss current activities related to
implementation of the APRN Consensus Model,
including an update on the LACE Network.
• Provide an overview on the transition to the DNP
and key areas of discussion.
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Projected Timeline for Sequential
Implementation of Model
• Implementation started immediately by all LACE entities
• Original target for full implementation is 2015
– APRN education programs should be transitioned by 2012-2013
– Accreditation processes should be in place by 2012-2013
– Certification examinations should be in place by 2012-2014
ALL ARE ON TARGET!
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Implementation of LACE Network
• In August 2010, MOU signed by 28 organizations who
agreed to support the implementation of LACE
electronic network
• Currently, 27 organizations have re-committed to
supporting and participating in LACE electronic network
+ one new participant GAPNA
– Ensure transparent and ongoing communication
among LACE entities
– Provide a platform for the ongoing work
– LACE not a formal, separate organization
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Implications of CM for:
APRN Education Programs
• Timeline for education programs to transition
continues to be 2012-2013!
• Ensure that grads eligible for national
certification/licensure
• All new APRN programs/tracks must be pre-
accredited/pre-approved prior to admitting students
• All post-graduate certificate APRN programs will need
to be accredited by 2015
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Changes in Accreditation of NP and
CNS Programs: Update from CCNE
• In September, Board endorsed the new A-G NP and CNS Competencies
• Revised accreditation standards were released last week comment period (21 days)
• New standards address all levels of education including post-graduate certificate programs
• Clarifying expectations for 3P’s to be consistent with CM
• Pre-approval process for all new CNS and NP programs will be in place by 2015 at latest
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Adult/Gerontology APRN
Competencies
• Adult-Gerontology Primary Care NP Competencies
(2010)
• Adult-Gerontology Acute Care NP Competencies (2012)
• Adult-Gerontology CNS Competencies (2010)
*Process to develop competencies funded by JAHF
http://www.aacn.nche.edu/Education/
adultgerocomp.htm
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Implementation Issues for APRN
Education• Clarification of APRN Core (3 P’s)
• Official Transcript
• Age parameters
• Clinical experiences in curriculum
• Differentiation of Acute and Primary Care NP roles for the
pediatric and adult-gerontology populations
• Inclusion of wellness in all APRN curricula
• Enhancing content related to care of older adults in all
APRN curricula
• Preparation of CNSs from wellness to acute care
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APRN Core
• 3 P’s (separate graduate-level courses)
– Advanced physiology/pathophysiology, including general principles that apply across the lifespan; (lifespan is defined as prenatal through old age including death).
– Advanced health assessment, which includes all systems and advanced techniques.
– Advanced pharmacology, which includes …. all broad categories of agents- not solely for population
Specific competencies delineated in 1996 Master’s Essentials &
2006 DNP Essentials www.aacn.nche.edu/Education/essentials.htm
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Transcript
• CM states that the transcript or official
document must state the role and population of
program from which student graduated.
(same wording now in 2012 NTFC, p7)
Example: Adult- Gerontology Primary Care NP
Acute Care NP: Adult- Gerontology
Adult-Gerontology CNS
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Age Parameter for Populations
• Intent of CM is not to be prescriptive or restrictive
• Age Parameter statement posted on the LACE site
• …”rigid establishment of population age parameters is not in the
best interest of patients. The definition of a population identified by
specific age ranges may create barriers and limit access to care for
patients with specific needs or health conditions. Circumstances
exist in which a patient, by virtue of age, could fall outside the
traditionally defined population focus of an APRN but, by virtue of
special need, is best served by that APRN. Such patients may be
identified as non-traditional patients for that APRN. In these
circumstances, the APRN may manage the patient or provide expert
consultation to assure the provision of evidence-based care to these
patients.”
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Clinical Experiences in the NP and
CNS Curricula
• Adult-Gerontology Primary Care Nurse Practitioner Competencies
(2010), p. 12
• Adult-Gerontology Acute Care Nurse Practitioner Competencies
(2012), p. 11
• Adult-Gerontology Clinical Nurse Specialist Competencies (2010) p.
10 *
• Statement in each regarding the breadth and length of experiences,
patient population and settings to prepare graduate with all of the
delineated competencies.
• Also, statement on faculty representation with expertise to prepare
graduate across the entire adult-older adult spectrum and wellness-
illness continuum
• http://www.aacn.nche.edu/education-resources/competencies-older-
adults
* Process to develop competencies funded by JAHF
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All APRNs and Preparation to Care
for Older Adult
• CM states that all APRNs in any of the 4 roles
providing care to the adult population, e.g. family
or women’s health, must be prepared to meet
the growing needs of the older adult population
• Recommended Competencies for Older Adult
care for Non- Adult-Gerontology APRNs
– WHNPs & FNPs
– WH and Across the Lifespan CNSs
http://www.aacn.nche.edu/education-
resources/competencies-older-adults
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APRN REGULATORY
MODELAPRN 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
Lic
en
su
re o
ccu
rs a
t L
evels
of
Ro
le &
Po
pu
lati
on
Fo
ci Family/Individual
Across Lifespan
Adult-
Gerontology*Neonatal Pediatrics
POPULATION FOCI
APRN ROLES
Nurse
Anesthetist
Nurse-
MidwifeClinical Nurse
Specialist
Nurse
Practitioner *
Women’s
Health/Gender
- Related
Psychiatric-
Mental Health
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Acute & Primary Care NPConsensus Model states: The CNP is prepared with the acute care CNP competencies and/or the primary care CNP competencies. This applies only to the pediatric and adult-gerontology CNP.
Programs may prepare individuals across both the primary care or acute care; however, then individuals must be prepared with consensus based competencies for both roles and obtain certification in both.
A workgroup facilitated by NONPF is developing a statement for employers of NPs clarifying the intent of the CM.
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Incorporation of Wellness in All
APRN Curricula“All APRNs are educationally prepared to provide scope of services across health wellness-illness continuum… however emphasis and implementation within each role varies.”
– Requires review and enhancement of national core competencies for roles and population foci
– Evaluation of curricula
– Enhancement of certification examinations
– CNS educated and assessed across the continuum from wellness through acute care
– New A-G NP and CNS competencies reflect this
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Changes in Certification
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Implications for APRN Certification
• All APRNs must be nationally certified by a
recognized, accredited certifying body
• Assess APRN core, role/population
competencies
• For licensure, individuals must be certified in the
role/population which matches education
program
• Specialty must be tested separately
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Certification Timeline New NP certification examinations will be
available in 2013 Addition of wellness Enhanced care of older adult New A-G NP and CNS and new psych/MH NP
exams
• New Timelines for retiring current exams posted: – ANCC will retire gero and adult exams mid 2014
– ANCC will retire current psych/MH CNS and NP exams mid-late 2014
– AANPCP will retire GNP exam by end of 2012
– AANPCP will retire ANP exam probably at end of 2015
– AACNCC will retire Adult ACNP exam end of 2014
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Timeline for New NP Exams• ANCC
– AGACNP – available 1/2013
– AGPCNP – available 1/2013
– AGCNS – expected 4/2014
• AANP CP
– Primary Care A-G NP available 2013
• AACN CC
– A-G ACNP exam available 2/2013
– A-G Acute Care CNS 6/2013
– Pediatric Acute Care CNS 6/2013
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Maintaining Your Certification
• Currently certified NPs and CNSs will be
grandfathered if maintain certification
– Credential will not be retired.
– Recertification through ceu’s and practice option
only
• If dually certified as ANP and GNP will be
given new credential by AANP CP and
ANCC
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Certification Contacts• ANCC Resources
– APRN Consensus Model FAQs
http://www.nursecredentialing.org/Certification/APRNCorner.aspx
– 800.924.4194
• AANP CP– Capitol Station
P.O. Box 12926
Austin, TX 78711
– (512) 442-5202
Fax: (512) 442-5221
Email: [email protected]
• AACN CC
– www.certcorp.org
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Implications for Practicing APRNs
• Stay tuned to professional organizations
and state board of nursing for updated
information
• Get or stay certified
• Adult or Gero NPs and CNSs recertified
through practice and ceu requirements
• If stay in same state are grandfathered in
and can not have license withdrawn if
implement new requirements
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Update on Licensure
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https://www.ncsbn.org/aprn.htm
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https://www.ncsbn.org/aprn.htm
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Update on Transition to the DNP
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APRN Consensus Model & DNP
• Consensus Model complementary to transition to DNP
• DNP part of continuous dialogue
• All certification entities have stated in writing they allow DNP graduates to sit for certification
• Certification bodies have not said when may require DNP except AANA will require DNP for all new applicants in 2025
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Enrollments Increasing in Both
DNP & PhD Programs: 1997-2011
Source: © American Association of Colleges of Nursing. All Rights Reserved
2906 2928 2879 3024 3070 3098 3229 34393718 3927 3982 3976 4161
46114907
70 170 329862
1874
3415
5165
7034
9094
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Research Focused DNP
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70 70 170392
862
1,874
3,415
5,165
7,034
9,094
15 17 7 44 74122 361 660
1,282
1,595
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Enrollments
Graduations
Programs: 2 2 3 11 20 53 92 153 183
Response: 100% 100% 100% 100% 100% 100% 100% 99.2% 99.5%
Enrollments and Graduations in Doctor of Nursing Practice (DNP)
Programs,2002-2011
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Doctorate of Nursing Practice (DNP)
2006 2007 2008 2009 2010 2011
Total # schools with
DNP programs20 53 92 120 153 184
# of post-master’s
DNP programs20 50 87 114 _ _
# of post-bachelor’s
DNP programs8 12 26 33 _ _
DNP NP programs - - - 76 86 95
DNP CNS programs - - - 35 37 38(AACN, Enrollments and Graduations in Baccalaureate and Graduate Programs in Nursing.)
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Enrollments and Graduations in DNP Programs
2007 2008 2009 2010 2011
Enrollment 186 575 1,060 1,887 3,036
Graduations 11 23 48 40 103
Post-Baccalaureate DNP
2007 2008 2009 2010 2011
Enrollment 1,688 2,840 4,105 5,147 6,058
Graduations 111 338 612 1,242 1,492
Post-Master’s DNP
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Doctorate of Nursing Practice (DNP) Programs(2011)
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Facilitating the Transition
• Both CCNE and NLNAC accredit DNP programs
• In 2009, CCNE amended standards to require
DNP Essentials
• CCNE has accredited 100 DNP programs; and
48 additional DNP programs are in pipeline
(2012-2013)
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Other Organizational Responses
• American Association of Nurse Anesthetists– Council on Accreditation will not accredit new master’s programs
for nurse anesthesia after 2015.
– Mandate that all CRNA programs transition to the practice doctorate by 2022.
– All new CRNA grads must hold a practice doctorate by 2025 to be eligible for certification.
• The Nurse Practitioner Coalition Statement– 7 NP organizations (AANP, ACNP, AFPNP, NCGNP, NONPF,
NPWH, NPNP): “the DNP degree more accurately reflects current clinical competencies and includes preparation for the changing healthcare system.”
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Other Organizational Responses
• National Organization of Nurse Practitioner Faculties
Endorsed the DNP and developed competencies for NP practice at the doctoral level. Approved Integrated Core NP Competencies 4/2011.
• National Association of Clinical Nurse Specialists Neutral position on the DNP; has developed DNP-level competencies for CNS graduates.
• American College of Nurse-MidwivesRecognizes the DNP as an option for midwifery programs.
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Issues Being Watched &
Discussed
• Complementary but different: the PhD & DNP curricula and expected outcomes– Research-Focused: generate new knowledge and
research in the discipline
– Practice-Focused: experts in an advanced area of nursing practice, focuses on improving practice, implementation of evidence and innovation.
• Clarifying the characteristics of the DNP scholarly product
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Resources• AACN Position Statement on the Practice Doctorate in
Nursing
www.aacn.nche.edu/DNP/DNPPositionStatement.htm
• AACN DNP Essentials for Advanced Nursing Practice (2006)
www.aacn.nche.edu/DNP/pdf/Essentials.pdf
• AACN Essentials for Master’s Nursing Education (2011)
www.aacn.nche.edu/Education/pdf/Master’sEssentials11.pdf
• White Paper on the CNL (2004)
www.aacn.nche.edu/Publications/WhitePapers/ClinicalNurse
Leader.htm
• AACN The Research-Focused Program in Nursing:
Pathways to Excellence
www.aacn.nche.edu/Education/pdf/PhDPosition.pdf
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http://www.aacn.nche.edu
