NR510 week 6 discussion1

NR510 week 6 discussion1 NR510 week 6 discussion1 Discussion Part One (graded) You have completed your nurse practitioner education, likely one of the most challenging tasks you have ever undertaken. Several of you ...

NR510 week 6 discussion1 NR510 week 6 discussion1 Discussion Part One (graded) You have completed your nurse practitioner education, likely one of the most challenging tasks you have ever undertaken. Several of your graduated colleagues live in different states, including California, Washington, and Illinois. After a year of primary care practice in your respective states, you get together for a reunion and share your practice perspectives. It is apparent that your experiences are not equal. Discussion Question: How do licensure, accreditation, certification, and education (LACE) considerations differ for APN clinical roles for these three states: California, Washington and Illinois? Provide evidence for your response. Topic responses  Discussion  Expand All More Sort By: Jose DelAcruz Discussion Part One Hello Dr Duncan and Classmates, APN Clinical Roles DeNisco & Barker (2012) asserts that advanced practice nurses (APN) mostly include nurse midwives, nurse practitioners or clinical nurses among many other types of nurses. APN’s are usually very crucial when it comes to healthcare and they mostly deal with ensuring that the general public receives care from the illnesses they may suffer from. Licensure involves giving license majorly through state agencies to people who have successfully taken the nursing program so that they are able to practice as nurses. Accreditation is the process through which allthe schools that offer nursing programs must be approved by government officials and sometimes even the legislature (Sumner, 2013). Certification mostly involves evaluating the level of understanding and knowledge that the individuals who have undergone the nursing program have achieved and also evaluating their abilities and all the skills they have acquired, while education is that process where individuals are imparted the knowledge and skills at their different educational levels. How LACE differs for APN Clinical Roles in California, Washington and Illinois For someone to be registered as an advanced practice nurse in California, the minimum requirement is a master’s degree at the area of their specialization with only one exemption to public health nurses whose minimum requirement is just a bachelors’ degree. Anyone willing to be an APN must also attend one of the schools that have been accredited by the National League of Nursing (NLN) for their nursing degrees to be recognized by the California state. In California, only six APN classifications are recognized which include; nurse practitioner, a public health nurse, psychiatric health nurse, clinical nurse specialist, a nurse midwife and a nurse anesthetist. Certification of individuals usually happens after individuals undertake a nursing exam and they pass it (Alleman & Houle (2013). Then all the nursing students who have passed their exams are supposed to apply for their certificates where it is a must for them to give their social security numbers during the process. In Washington, for an individual to become an APN, one must first of all complete the advanced nursing program one year before they apply for their APN license. The nursing programs that one wishes to take should be accredited by an agency that is well recognized by the United States Department of Education (USDE). In a case where, a nursing student got their degree from outside the U.S, the nursing program that they underwent must be similar to that offered in Washington for them to be allowed to work in the State. For nursing students to be certified in Washington, all individuals undertaking the program must undergo an examination that will test their competences (Alleman & Houle, 2013). The APN categories that are recognized by the Washington State Department of Health are: Nurse practitioner, certified nurse-midwife, certified registered nurse anesthetist. Individuals who have been successful in undertaking the program should then apply for their licenses and it is a must for them to provide their Taxpayer identification numbers together with their social security numbers. In Illinois, for one to be able to get an APN license, one must have to finish a graduate level in any of the APN categories. The nursing school and the program that one undertakes in Illinois must be accredited by any recognized body in the USDE (Carter et al, 2013). It is a requirement in Illinois State for one to earn a national certificate way before they are given anAPN license. For one to apply for a license in Illinois, it is a must for one to have the following: An Illinois registered nurse license number, one should also indicate the APN category that one is applying for, a copy of the national certification, a transcript that shows that one received a graduate degree and finally one must also pay some application fees. Jose References Alleman, K., & Houle, K. (2013). Advanced practice registered nurse certification. Nephrology Nursing Journal, 40(3), 219. Retrieved from http://search.proquest.com/openview/18874768c2d715e7fadac9a12214b89e/1?pqorigsite=gscholar> Carter, N., Dobbins, M., Ireland, S., Hoxby, H., Peachey, G., & DiCenso, A. (2013). Knowledge gaps regarding APN roles: What hospital decision-makers tell us. Nursing Leadership, 26(4), 60- 75. Retrieved from http://s3.amazonaws.com/academia.edu.documents/44996110/Knowledge_Gaps_Regarding_AP N_Roles_What_20160422-11514-1u1j7it.pdf? AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1467299421&Signature=t9itFXD V2UzjxS17SuurOg iogVg%3D&response-contentdisposition=inline%3B%20filename%3DKnowledge_Gaps_Regarding_APN_Roles_What.pdf> DeNisco, S. M., & Barker, A. M. (2012). Advanced Practice Nursing. Jones & Bartlett Publishers. Retrieved from https://books.google.com/books?hl=en&lr=&id=YGSSHUlMTaEC&oi=fnd&pg=PR1&dq=DeN isco+%26+Barker, +2012) &ots=R1- RTg3jPp&sig=miLIyDVrZ4Gpi8WyPZH_uQePkkw&redir_esc=y#v=onepage&q=DeNisco%20 %26%20Barker%2C%202012) &f=false> Sumner, J. (2013). Advanced Nursing Practice in the United States. Advanced Practice in Healthcare: Skills for Nurses and Allied Health Professionals, 113. Retrieved fromhttps://scholar.google.com/scholar?as_ylo=2012&q=LACE+in+illinois&hl=en&as_sdt=0,5 >Show Less Instructor Duncanreply to Jose DelAcruz RE: Discussion Part One Jose, As you so eloquently described, there are vast differences between these three states as is relates to LACE considerations. Excellent work! Dr. Duncan Show Less Mijanou Marretta-Lewis 8/8/2016 7:28:28 AM Discussion Part One Dr. Duncan and Classmates, The Consensus Model for the Advance Practice Registered Nurse (APRN) regulation uses the Licensure Accreditation, Certification & Education (LACE Model), as a platform to define the National Council of State Boards of Nursing role of the APRN. The LACE model defines four roles of the APRN as clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), certified nurse practitioner (CNP) and certified nurse midwife (CNM). This mode requires each of these four roles to be educated in at least one patient population focus: family/individuals across a lifespan, adult-gerontology,neonatal, pediatrics, women’s health, and psychiatric-mental health across lifespans (Foster & Flanders, 2014). Each state has its own state legislation with policies that govern the practice of the APRN. Each state requires different courses that are required before sitting for the exams of certification. All states have different requirements as licensures, educations, accreditation and certification to practice in that state (Buppert, 2014). In the United States the clinical role model allow for:  Diagnose, treat, prescribe medications and test for disease processes.  The scope of practice with the necessary education for competency in a given area of practice.  With each state the APRN is mandated to practice under the state’s legislation in regards to practicing with an independent licensure or under the supervision of a physician and the prescribing of Schedule II narcotics depending on the state.  The education of the APRN requires theory and evidence-based scientific knowledge. The APRN has the ability to be a healthcare provider, educator, coach, consultant, administrator and researcher (Foster & Flanders, 2014).  The APRN can diagnosis medical and chronic disease processes using diagnostic tools. However, the APRN cannot perform complex surgeries, but may do some invasive procedures, which change depending on the state’s requirements.  APRNs may work in a primary care facility, hospital setting with a specialty area, of a small clinic. APRN have the ability to care for patients in a variety of setting such as hospice, long-term facilities, family planning clinics, health care agencies, and HMOs. The roles and requirement of the APRN in Illinois. In accordance with the Illinois Nurse Practice Act’s APRN scope of practice, the APRN must have education that includes: Advanced nursing patient assessment and diagnosis  Ordering by using nursing therapeutic, medical and corrective actions in treatments  End of life and palliative care  Health education  Patient advocacy  Advanced counseling  Advanced pharmacology  To prescribe controlled narcotics, by law the APRN must have completed 45 graduate contact hours of pharmacology from an accredited graduate course.  Illinois allows the APRN afte4r graduation and before national certification exams can request a temporary permit to practice.  As per the LACE Model, in Illinois the APRN can be a CNM, CNP, CNS, and CRNA. Illinois requires the APRN to hold a valid unencumbered license to practice with the state, a current national certification, in one of the four APRN areas listed above and a completion of a advanced practice formal education program (Kleinpell, Hudspeth, Scordo, Magdic, 2012). California Nurse Practitioner Roles and Requirements A Master’s degree is required to practice as an APRN in the state of California. One exception is the public health nurse which requires a bachelor’s degree.  Must have attended a college that has been accredited by the National League of Nursing (NLN) or an agency recognized by the United States Department of Education.  Graduate from a college/school that meets the California Board of Nursing Code of Regulations, Section 1484. Become nationally certified by an organization that is equivalent the APRN program standards for CNP, CNM, CRNA, and CNS.  Prescriptive authority requires a course of advance pharmacology and 520 hours of physician-supervised experience furnishing patients with medical devices and drugs.  Application for exam and request for prescription authority once a verification of physician supervision experience form is submitted and copy of advanced pharmacy course verification course is submitted. California Board of Registered Nurses recognizes and certifies six different advanced practice specialties:  CNS  CRNA  CNM  CNP  Psychiatric/mental health nurse (PMH)  Public Health Nurse (PHN) California allows clinical practice for the APRN to have the ability to:  Dispense contraceptives.  Prescriptive ability of up to Schedule II narcotics if able to meet all the above requirements.  May practice in the emergency room.  The APRN may order durable medical equipment; sign workman’s comp claims, approve disabilities, allow and sign for home health care.  Can sign and request samples of drugs deemed dangerous by pharmaceutical sales representatives. The CNP may supervise medical assistance (Graduate Nursing EDU, 2016). California requires an unencumbered license as a registered nurse to becomes certified as a APN. Washington APRN Roles and Requirements  Must have an unencumbered registered nurse license.  Graduate from a qualified program/college accredited by the United States Department of Education or Council of Higher Education Accreditation.  Clinical and didactic course work in specific area of preferred license.  Advanced courses in pharmacology, pathophysiology, health assessment, with 500 hours of direct patient care that is specific to area of practice with clinical preceptor and faculty oversight.  Must have diagnostic theory and health care management problems courses.  Must have HIV/AIDS training and course that must be submitted for certification.  Washington recognizes: CNP, CNM, CRNA certification for practice. The Clinical role of the Washington APN  May preform physicals with comprehensive histories with the required screenings.  May diagnosis, treat, and manage the care of acute or chronic patients.  May interpreted lab values, order labs, order durable medical equipment, prescribes medications and advanced therapy modalities. May promote health care initiatives, disease prevention, education and counseling.  Collaborate with multi-disciplinary teams to bring about effective treatment plans  May implement transitional levels of care (Graduate Nursing EDU, 2016). It is apparent the role of the APN across the country in a clinical role shows the varied challenges posed by our health care system as skill sets lack uniformity across the continuum. (Chamberlain College of Nursing, 2016). There remains great disparages in the health care of diverse populations as well as the chronically ill and elderly patients seen in the United States. The need for consistency of delivery for high quality primary care has fallen to the CNP (Fontenot, 2014). The need to have uniform practice of care throughout the states by allowing the CNP and APNs to practice with autonomy within their scope of practice which represents their education is essential to the care of our patient population and allows for best practice quality care throughout the United States. Mijanou References Buppert, C. (2014). Nurse practitioner's business practice and legal guide. New York, NY: Jones & Bartlett Publishers. Chamberlain College of Nursing. (2016). NR-510 Week 3: Leadership and the Role of the APN [Online lesson}. Downers Grove, Il: DeVry Education Group. Fontenot, S.F. (2014). The affordable care act, the FTC and the independent practice of nurses. Physician Executives, 40(3), 98. Retrieved from eds.a.ebscohost.comFoster, J., Flanders, S., (May 31, 2014) "Challenges in CNS Practice and Education" OJIN: The Online Journal of Issues in Nursing Vol. 19. doi: 10.3912/OJIN.Vol19No02Man01 Graduate Nursing EDU.org (2016).Retrieved from http://www.graduatenursingedu.org/california/ Graduate Nursing EDU.org (2016).Retrieved from http://www.graduatenursingedu.org/illinois/ Graduate Nursing EDU.org (2016).Retrieved from http://www.graduatenursingedu.org/washington/ Kleinpell, R.M., Hudspeth. R., Scordo, K.A., Magdic, K.(2012).Defining NP scope of practice and associated regulations: Focus on acute care. J Am Acad Nurse Practice, 24(1):11-8. doi:10.111/j.1745-7599.2011.00683x Show Less Hannah Miller LACE Dr. Duncan and class, The states of California, Washington, and Illinois hold very different licensure requirements for advanced practicing nurses. According to the American Association of of Nurse Practitioners, nurse practice laws and regulations are specific to each state. The state of Washington practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing (AANP, 2016). The state of Illinois differs from Washington in that it holds a reduced practice law that limits nurse practitioners to engage in one of the elementsof nurse practitioner practice. The State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice (AANP, 2016). In terms of accreditation and education, the states of Washington and Illinois both require nurse practitioners to hold an RN licence, be national certified by a nursing licensing bored, and have a graduate degree in NP. The state of California requires the NP's to only hold an RN and NP degree, but does not hold the practitioners to a national licensing board (AANP, 2016). The State of California State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care (AANP, 2016). American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved from https://www.aanp.org/legislationregulation/state-legislation/state-practice-environment Hannah Miller Show Less Instructor Duncanreply to Hannah Miller RE: LACE Hi Hannah, You have effectively described the various landscapes for APN practice. What about the education and certification requirements? Do they differ? Dr. DuncanShow Less Hannah Millerreply to Instructor Duncan RE: LACE Dr. Duncan and class, With regards to education requirements, all three states, California, Washington, and Illinois make it mandatory for an NP to hold a graduate degree in an NP role (AANP, 2016). The three states do however differ when it comes to certification requirements. The states of Illinois and Washington require all NP's to hold a national certification by a licensing board. California has a very restricted practice on the NPs as they are not required to hold a national certification (AANP, 2016). When it comes to becoming a practitioner, I would feel most comfortable not only in my educational background and knowledge, but also with the care I give to patients, being required to hold a national certification. American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Hannah Miller Show Less Meghan Mills Part One How do licensure, accreditation, certification, and education (LACE) considerations differ for APN clinical roles for these three states:California, Washington and Illinois? Provide evidence for your response. CALIFORNIA WASHINGTON I LICENSURE Advanced practice nurses include nurse practitioners (NP), nursemidwives (NMW), clinical nurse specialists (CNS), and nurse anesthetists (NA) – and these APRNs do not require a license for practice, instead one must possess a Certificate to Practice as approved by the board. In order to apply for this certification, one must hold a valid and active RN License (California Board of Registered Nursing [BRN], 2016). APRN is referred to as an ARNP and consists of three designations: CRNA, CNM, and NP – all ARNPs require an advanced license to practice, which is granted by the state board (Washington State Department of Health, 2009). APRN is referr includes: CRN CNS. All requ nurse licensur Department o Professional R ACCREDITATION APRNs – do not need to graduate from an accredited academic/educational program however, the director or codirector of the educational program must be a graduate of an accredited institution (California Board of Registered Nursing [BRN] NP Committee, 2013). ARNPs – one must graduate from an accredited educational program (Washington State Legislature, 2016). APNs – in ord advanced pra Illinois, the ed one has gradu accredited (GraduateNur CERTIFICATION APRNs – national certification NOT required to practice; however one must apply for a certificate to practice in the state of California, and must hold an active RN license in order to do so (BRN NP Committee, 2013). ARNPs – national certification is required to practice i.e., the American Academy of Nurse Practitioners, American Nurses Credentialing Center, National Certification Corporation for Obstetric, Gynecological and Neonatal Nursing, Pediatric Nursing Certification Board, American Midwifery Certification Board, and Council on Certification of Nurse Anesthetists (Washington State Department of Health, 2009). APNs – nation required to pr Council of Sta [NCSBN], 201 EDUCATION APRNs – need at least a Masters degree in nursing or a clinical field relating to nursing (BRN, 2016). ARNPs – need at least a Masters degree, ―formal graduate education‖ (Washington State Legislature, 2016). APNs – need degree (NCSB References California Board of Registered Nursing (BRN). (2016). Advanced practice certification. Retrieved from http://www.rn.ca.gov/applicants/adpract.shtml#cnsCalifornia Board of Registered Nursing (BRN) NP Committee. (2013). Nurse practitioners: Laws and regulations. Retrieved from http://www.rn.ca.gov/pdfs/regulations/bp2834-r.pdf GraduateNursingEDU.org. (2016). Steps to becoming an APN in Illinois. Retrieved from http://www.graduatenursingedu.org/illinois/#license Illinois Department of Financial & Professional Regulation (IDFPR). (2016). Advanced practice nurse (professions code – 209). Retrieved from https://www.idfpr.com/renewals/apply/forms/rn-apn.pdf National Council of State Boards of Nursing (NCSBN). (2016). Certification map. Retrieved from https://www.ncsbn.org/5403.htm National Council of State Boards of Nursing (NCSBN). (2016). Education map. Retrieved from https://www.ncsbn.org/5402.htm Washington State Department of Health. (2009). Advanced registered nurse practitioners (ARNPs) in Washington state: Frequently asked questions. Retrieved from http://www.doh.wa.gov/portals/1/Documents/6000/ARNPFAQs.p df Washington State Legislature. (2016). WAC: Title 246, chapter 246-840, section 246-840-010. Retrieved from http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840-010 Washington State Legislature. (2016). WAC: Title 246, chapter 246-840, section 246-840-455. Retrieved from http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840-455 Show Less Amber Kelly Discussion Part One Professor and classThe consensus model for the advanced practice registered nurse regulation states that the APRN is one who has completed an accredited graduate level nursing program, they will be certified nationally, and have an active RN license (American Association of Colleges of Nursing [AACN], 2008). The consensus model was developed in the hopes to improve healthcare across the United States by creating a uniform model of regulations for the APRN across the country. According to the American Association of Nurse practitioners (n.d.) there are only 25 states in the US that are full practice. California is a restricted practice state, the California state practice and licensure laws restrict the APRN the ability to engage in at least one element of practice (AANP, n.d.). According to the AANP (n.d.) the state of California requires all APRN’s to have an active registered nursing license and a graduate degree. Washington state is one of the 25 states that are considered full practice states in which state practice laws allows the APRN to evaluate, diagnose, initiate and manage treatment, order diagnostic test, and prescribe medications (AANP, n.d.). The licensing requirements for Washington are an active RN license, graduate degree, and national certification (AANP, n.d.). Illinois is a reduced practice state in which the practice and licensure laws reduce the ability of the APRN to practice in at least one element (AANP, n.d.). The licensure requirements for Illinois are an active RN license, graduate degree, and a national certification (AANP, n.d.). American Association of Colleges of Nursing. (2008). Consensus Model for APRN Regulation: Licensure... Retrieved from http://www.aacn.nche.edu/education-resources/APRNReport.pdf American Association of Nurse Practitioners. (n.d.). State Practice Environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Show Less Instructor Duncanreply to Amber Kelly RE: Discussion Part One Hi Amber, Great description of the practice landscape in these states. How do the credentialing and licensure requirements change? Dr. DuncanShow More Kirsten EnglishWK6DT1 Hello Dr. Duncan and classmates, The Consensus Model is a tool used to standardize and regulate the role of the advanced practice nurse (APN) from state to state. Currently, the role of the APN is not uniform across the United States (U.S.) and this poses a problem if/when an APN would like to take their talents elsewhere. The National Council of State Board of Nursing (NCSBN) for APNs is in the process of implementing the Consensus Model across the U.S. however, many states have only implemented portions of the Consensus Model and inconsistencies remain from state to state. The NCSBN (2014), indicates which states have implemented the Consensus Model and to what degree. The states are scored and placed into four different categories,  Less than 14 points  14-20 points (50-71%)  21-27 points (75-96%)  28 points (100%) (NCSBN, 2014) California and Illinois are both in the same range of 50-71%. Washington however, is in a higher range of 75-96%. Graduate degrees are recognized in all states however the licensure, independent practice and independent prescribing are not the same throughout the three states. Illinois and Washington both recognize the APN as a licensed practitioner while California recognizes the role with a certificate to practice. Independent practice and prescribing practice are the same in Illinois and California, the APN cannot prescribe or practice independently while in Washington the APN can be independent. By implementing the Consensus Model, standardized requirements for education and model of care can ensure public safety from state to state. Thank you for your time, Kirsten References National Council of State Board of Nursing. (2014). The consensus model for APRN regulation, licensure, accreditation, certification, and education: About the APRN consensus model. Retrieved from https://www.ncsbn.org/736.htmShow Less Instructor Duncanreply to Kirsten English RE: WK6DT1 Kirsten, When you say "independent," what do you mean? Also, there is a difference between IL and CA scope of practice? What is that specific difference as it relates to practice authority? Dr. Duncan Show Less Kirsten Englishreply to Instructor Duncan RE: WK6DT1 Hello Dr. Duncan, The National Council of State Board of Nursing (NCSBN) (2015) recognizes independent practice and independent prescribing I to mean that there no requirement for a written collaborative agreement as there are with restrictions and that there is no supervision and no conditions required for practice for APRN (NCSBN, 2015). When an APN is not independent a written contract and direct supervision is necessary to allow practice with specific scope overseen by a MD, DO, DDS, or podiatrist (NCSBN, 2015). Illinois and California and Illinois are similar in many ways but they do divide in some situations not conforming to the APRN consensus model. In Illinois CRNA practice and prescribing is not independent and in California they are able to practice independently but have no prescriptive authority. In Illinois a CNS is not even recognized as an APRN and they do not have prescriptive authority, while California recognizes them as an APRN but they are notindependent in practice or prescribing authority. The different restrictions in each state truly show the importance of streamlining the roles. Thank you for your input and thought provoking questions Dr. Duncan, Kirsten References National Council of State Board of Nursing. (2014). The consensus model for APRN regulation, licensure, accreditation, certification, and education: About the APRN consensus model. Retrieved from https://www.ncsbn.org/736.htm Show Less Molly McIntyre Part 1 When prepping to write this weeks discussion post I delved into the Illinois, Washington, and California Board of Nursing (BON) websites and quickly became aware that some BON websites are much easier to navigate than others! According to the American Association of Nurse Practitioners (2016) licensure is the authority to practice in a selected state, certification is the recognition of knowledge and skills through approved testing, accreditation recognizes the educational program as being one that meets set standards, and education as the accepted level to practice in each state. To practice as an advanced practice nurse (APN) in these three states has different requirements to obtaining a licensure. One thing that they all have in common is that all of them required a current nursing license in their respective states. Both Illinois and Washington required the individual to pass a certification exam by an approved certification body such as National Commission of Certification Agencies. Illinois website made it very clear that they require a minimum of a masters graduate degree from an accredited program. Washington required education from an 'approved program' but did not specific accreditation while California accepted acertificate degree, masters or post-masters degree. Another difference in California was that you could get your APN licensure through a method of 'equivalency' which didn't require the education or certification but letters/proof from one practicing nurse practitioner and one physician to attest to their competency and experience. This assignment was eye opening in realizing the differences in minimum requirements from state to state to APNs. All information from Washington, Illinois,and California was found on their BON websites below. American Association of Nurse Practitioners (2016). National certification expectations for entry level NPs. Retrieved from https://www.aanp.org/education/student-resource-center/starting-your-career/9- education/1060-certification-for-entry-level-nps California Board of Registered Nursing (n.d.). General instructions and application requirements for nurse practitioner certification. Retrieved from http://www.rn.ca.gov/pdfs/applicants/np-app.pdf Illinois Department of Financial and Professional Regulation (2008). Licensure requirements for APNs. Retrieved from http://www.idfpr.com/DPR/LR/lrapneng.asp Washington State Department of Health (n.d.). Nurse licensing. Retrieved from http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/Nu rseLicensing/AdvancedRegisteredNursePractitioner Show Less Jill Coles Discussion part one Dr. Duncan and Class, The Consensus Model for APRN Regulation: licensure, accreditation, certification, and education (LACE) and is foundational to the future of APN practice (Goudreau, 2011). Regulation of all APRNs will be achieved through the Consensus Model and will provide a formal mechanism for facilitating communication among all stakeholders in the healthcarecommunity (Stanley, 2012). LACE will allow APRNs to practice to the full scope of their education and more easily move from one state to another. Under the Consensus Model, APRN practice is not restricted by setting, but rather is patient-centered and based on patient needs (Stanley, 2012). In all three states, California, Washington and Illinois, APNs are required to have a valid registered nurse license and completion of a master’s degree or post master’s certificate; however only Washington and Illinois require national certification to practice, California will accept state or national certification (American Association of Nurse Practitioners, n.d.). Washington State APRNs in Washington State are permitted to practice without any physician involvement because state law recognizes APNs as qualified to assume primary responsibility and accountability for the care of patients (Washington State Legislature, n.d.). APNs in Washington State practice with complete independence and do not have to have instruction, supervision or consultation from a physician (Washington State Legislature, n.d.). This means that they can prescribe Schedule II-V substances without any physician involvement and also prescribe medical marijuana. APNs must complete 15 hours of continuing education in pharmacology for each license renewal period to maintain their prescriptive authority (Washington State Legislature, n.d.). APNs are recognized as official primary care providers and can do everything from giving out handicap parking permits, ordering, performing and interpreting diagnostic tests, referring patients to other healthcare providers to signing death certificates (Washington State Legislature, n.d.). Illinois APNs in Illinois practice under a collaborative practice agreement with a physician. This agreement outlines the working relationship between the APN and physician by describing the categories of care, treatment and procedures the APN is expected to perform (Illinois Center for Nursing, n.d.). The physician does not have to be physically present for the APN to practice, they just have to be available for consultation via in person or by telephone, and a monthly meeting between the APN and physician must take place (Illinois Center for Nursing, n.d.). In order to prescribe medication a physician must delegate you as having prescriptive authority (Illinois State Medical Society, n.d.). This means the physician must specifically outline which schedule of controlled substances, II, III, IV and/or V, you will be prescribingand a copy of the agreement must be available at all times at all practice locations (Illinois State Medical Society, n.d.). In order to prescribe medication, the APN must submit an application to the Illinois Division of Professional Regulation. Further, the APN must obtain 45 hours of continuing education in pharmacology before receiving schedule II prescriptive authority, and APNs can only prescribe up to a 30 day supply of controlled substances unless a physician has given prior approval to do so (Illinois State Medical Society, n.d.). Just like Washington State, APNs can sign handicap parking permits, but you cannot sign death certificates. California APNs in California must practice under a collaborative practice agreement with a physician, however, the physician cannot supervise more than four drug-prescribing APNs at one time (State of California Board of Registered Nurses, n.d.). The collaborative agreement outlines the working relationship between the APN and physician by describing the categories of care, treatment and procedures the APN is expected to perform. The physician does not have to be physically present for the APN to practice, they just have to be available for consultation via in person or by telephone (State of California Board of Registered Nurses, n.d.). The supervising physician does not have to sign the APNs charts, however, some insurance carriers require this (State of California Board of Registered Nurses, n.d.). Under physician supervision, APNs can order, administer, dispense and prescribe medications including schedule II-V controlled substances. The APN who wants to prescribe hydrocodone combination products have to take a controlled substance course approved by the state (State of California Board of Registered Nurses, n.d.). APNs in California can write for handicap stickers, but cannot sign death certificates. References American Association of Nurse Practitioners (n.d.). State practice environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Goudreau, K. (2011). LACE, APRN consensus…and WIIFM (what’s in it for me)? Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 25(1), 5-7. Illinois State Medical Society (n.d.) Advanced practice nurse’s authority to diagnose and prescribe. https://www.ilpmp.org/news/APN.pdf Illinois Center for Nursing (n.d.). Nurse practice act and nurse ruleshttp://nursing.illinois.gov/nursepracticeact.asp. Retrieved fromStanley, J. M. (2012). Impact of new regulatory standards on advanced practice registered nursing: the APRN Consensus Model and LACE. Nursing Clinics of North America, 47(2), 241-250. State of California Board of Registered Nurses (n.d.). Frequently asked questions regarding nurse practitioner practice. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-i-25.pdf State of California Board of Registered Nurses (n.d.). General information nurse practitioner practice. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf Washington State Legislature (n.d.). APRN scope of practice. Retrieved from http://app.leg.wa.gov/wac/default.aspx?cite=246-840-300 Washington State Department of Health (n.d.). Medical marijuana authorization guidelines. Retrieved from http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission Show Less Instructor Duncanreply to Jill Coles RE: Discussion part one Hi Jill, You almost have this right! There is a strong difference between having a collaborative agreement and a supervisory agreement. This is clear in the case of California. Will you please explain the correct level of oversight required in California? How do those two types of oversight differ? Dr. Duncan Show Less Jill Colesreply to Instructor DuncanRE: Discussion part one Dr. Duncan, As far as I can tell, APNs in California must have a collaborative agreement with a physician that outlines standardized procedures that they can implement as well as having a collaborative agreement to prescribe schedule II-V controlled substances. The American Academy of Family Physicians (n.d.) states that physician supervision means that the physician is ultimately responsible for the patient and the care they receive, and APNs can only perform medical acts and procedures that have been specifically authorized by the supervising physici an. The difference between collaboration and supervision is very confusing to me since California is a state that requires APNs to collaborate with physicians and develop joint, written protocols that cover all major elements of their practice. I would say that there is some form of supervising going on, regardless of what you want to call it. Further, depending on what article I read, it seems that "collaboration" and "supervision" are interchangeable when discussing APNs in California, so this confuses me even more. The American Association of Nurse Practitioners (n.d.) states that reduced practice is characterized by a state practice and licensure law that reduces the ability of the APN to engage in at least one element of practice. So, to answer you question, the correct level of oversight is a reduced one because the APN has to have a collaborative agreement with a physician in order to practice and prescribe medications.Jill References American Academy of Family Physisicans (n.d.). Guidelines on the supervision of certified nurse midwives, nurse practitioners and physician assistants. Retrieved from http://www.aafp.org/dam/AAFP/documents/news/NP_Info_GlinesNP- 060710.pdf American Association of Nurse Practitioners (n.d.). State practice environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/statepractice-environment Show Less Kasey Shipp Week 6, Part 1 Dr. Duncan and Class, The purpose of the Consensus Model is for states to adopt a uniformity in the regulation of APN roles. The APRN regulation includes four essential elements, which are licensure, accreditation, certification, and education. Licensure is granting the authority to practice; accreditation is the review and approval from a recognized agency of educational degree or certification program; certification is the formal recognition of skills, knowledge, and experience demonstrated; and education is the formal preparation for APNs in graduate degree or post graduate programs, ANA (2009). For the most part, the states have developed a model elements to go by; however, there are some variations from state to state. According to the NCSBN (2014), both Washington and Illinois have the equivalent of a license in order to maintain conformity with the consensus model, but California does not. California has a "Certificate to Practice." National certification is required inboth Washington and Illinois, but not in California. For all three states, a graduate or post graduate degree is required to practice in the advanced role. ANA, (2009). Consensus Model for APN Regulation: Licensure, Accreditation, Certification, and Education. http://www.nursingworld.org/cmissuebrief NCSBN, (2014). APRN Consensus Model. https://www.ncsbn.org/736.htm Show Less Dana Harbuck Discussion part one Hello Dr. Duncan and class, Due to inconsistencies amongst regulatory agencies, licensure, accreditation, certification, and education (LACE) was created as a formal mechanism for communication amongst organizations that represent and regulate APRN licensure. LACE is a consensus model that defines the APRN practice, identifies their titles, and describes their roles in their population focus. Although LACE attempts to standardize that APRN practice, regulation is determined by each state (Stanley, 2012). Licensure California: Active California registered nurse (RN) license is required for initial licensure and renewals. Thirty hours of continuing education for license renewal and a minimum of 250 hours of independent clinical practice in the advanced practice registered nurse (APRN) role within the last two years (Board of Registered Nursing, n.d.).² APRN’s are required under the California Board of Registered Nursing to work under standardized procedures written by the agencies they are employed. These standardized procedure outline the APRN’s scope of practice and prescriptive authority. They must have a collaborative agreement with a physician who provides supervision for the APRN. APRN’s are regulated by the California BRN, a part of the California Department of Consumer Affairs (Board of Registered Nursing, n.d.).²Washington: Active RN Washington license for initial license and to renew. Thirty hours of continuing education for license renewal. Minimum of 250 hours of independent clinical practice in the advanced registered nurse practitioner (ARNP) role within the last two years. An additional 15 hours in pharmacology is required if you have prescriptive authority, and must relate the ARNP’s scope of practice. ARNP’s work without a collaborative agreement with another physician. They have prescriptive and practice authority within their scope of practice. ARNP’s are regulated by the Nursing Care Quality Assurance Commission, a part of the Washington Department of Health (DOH) (Washington State Department of Health, n.d.). Illinois: An active Illinois RN license is required for licensure. APRN’s are required to complete 50 hours of continuing education, and show proof of continued, current national certification in their specialty area (Illinois Center for Nursing. (n.d.). If the APRN works within a hospital or ambulatory surgical treatment center they are not required to have prescriptive authority or a written collaborative agreement with a physician. An APRN who is practicing outside of a hospital or ambulatory surgical treatment must enter into a collaborative agreement. The collaborative agreement does not need to describe steps taken to treat each specific condition, disease or symptom. It must be specific as to which authorized procedures require the physician's presence during the procedure. The Physician does not have to be present at all times but must have methods of communication at written in the collaboration. The APRN may have prescriptive authority under the collaborative agreement and may only prescribe and dispense controlled substances that the collaborating physician prescribes. The APRN must place the collaborating physicians name on the prescription, but the physician does not have to co-sign the prescription. The Illinois Department of Financial and Professional Regulation and the Illinois Center for Nursing govern the issuance of licenses to qualified APRN’s practicing in the state (Illinois Center for Nursing (n.d.). Accreditation California: Colleges that are accredited and accepted by the BRN follow the “Standards of Education for Nurse Practitioner Programs” California code of regulation (Board of Registered Nursing).¹Washington: ARNP programs accepted by Washington must hold accreditation by the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing (Washington State Department of Health, n.d.). Illinois: The graduate programs must be accredited by an accrediting body recognized by the United States Department of Education (USDE), and that offers preparation for advanced practice certification(NursingLicensure.Org, n.d.). Certification California: Applicant will be required for initial qualification or certification as a nurse practitioner. Certification is required through the California Board of Registered Nursing (BRN). If applicant graduated from a college within California, they do not also need a certification from a National Organization. If they attended college outside the state, they must be tested and receive a certification from a national certification organization to apply for a license from the BRN (Board of Registered Nursing, n.d.).² Washington: The student will need pass a national certification examination at some point after educational requirements have been met. Washington has approved four nurse practitioner certification organizations. American Nurses Credentialing Center, American Academy of Nurse Practitioners, Pediatric Nursing Certification Board, National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing (Washington State Department of Health, n.d.). Illinois: Certification is gained through a national certification through the American Academy of Nurse Practitioners, American Nurses Credentialing Center, Pediatric Nurse Certification Board, the National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (as nurse practitioners); or the Certification Board for Urologic Nurses and Associates as a Urologic Nurse Practitioner (Illinois Center for Nursing. (n.d.). Education California:Possess a master’s degree in nursing, a master’s degree in a clinical field related to nursing, or a graduate degree in nursing, and to have satisfactorily completed a nurse practitioner program approved by the board(Board of Registered Nursing, n.d.)². Washington: Within the educational programs, the student must complete, 500 hours of clinical work, advanced physiology, health assessment, and pharmacology. Seven hours of HIV/ AIDS training is required and usually covered within most nurse practitioner programs (Washington State Department of Health, n.d.). Illinois: Graduate degree or a post-master's certificate as required for national certification in the clinical advanced practice nursing specialty (Illinois Center for Nursing. (n.d.). References: Board of Registered Nursing. (n.d.). Barclays official California code of regulations: § 1484. Standards of Education. Retrieved from https://govt.westlaw.com/calregs/Document/I78166E70FAEE11DEAB9F840E8C11CEE5 Board of Registered Nursing. (n.d.). Frequently asked questions regarding nurse practitioner practice. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf Illinois Center for Nursing. (n.d.). Joint committee on administrative rules: administrative code. Retrieved from http://www.ilga.gov/commission/jcar/admincode/068/068013000D04000R.html NursingLicensure.Org. (n.d.). Advanced practice nursing Illinois. Retrieved from http://www.nursinglicensure.org/np-state/illinois-nurse-practitioner.html#education Stanley, J. M. (2012). Impact of new regulatory standards on advanced practice registered nursing: the APRN consensus model and LACE. Nursing Clinics of North America, 47(2), 241- 250. Washington State Department of Health. (n.d.). Advanced registered nurse practitioners in Washington State: frequently asked questions. Retrieved from http://www.doh.wa.gov/portals/1/Documents/6000/ARNPFAQs.pdfShow Less Jenica Hughes Discussion Part one Dr. Duncan and class, When reviewing the requirements for the states of California, Illinois, and Washington, it seems that there are differences in the licensure, accreditation, certification, and education, depending on what state a nurse practitioner (NP) practices in. According to Buppert (as cited by the California Code of Regulations 1482, 2011, p. 127), the following are required to practice as an NP in California:  * an RN license  * completion of a program of study that is approved by the board, certification by a national or state organization, or documentation of deficient areas in course content and/or clinical experience  * verification by a NP and a physician who meet classification for faculty members specified in Section 1484 (c) of clinical competence in primary care delivery Certification agencies for this state include the Academy of Nurse Practitioners, American Association of Critical-Care Nurses, American Nurses Credentialing Center, Pediatric Nursing Certification Board, and the National Certification Corporation for the Obstetric, Gynecological, and Neonatal Nursing Specialties (Nursing Licensure, 2016). Buppert (as cited by the Illinois Administrative Code, title 68, 1305.20, 2011, p. 131) also states the requirements to practice as a NP in Illinois are as follows: * up to date nursing licensure number * national certification from an accrediting body * a graduate degree or post master's certificate from a graduate program in a clinical advanced practice nursing specialty or proof of completion of a graduatedegree for national certification in a clinical advanced practice nursing specialty * verification of NP licensure where the applicant was licensed originally, licensure of current state, and also any state where the applicant has practiced as an APN over the past five years NP's can hold certification through the American Academy of Nurse Practitioners Certification Program, the American Nurses Credentialing Center, the Certification Board for Urologic Nurses and Associates, the National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties, and the Pediatric Nurse Certification Board (Nursing Licensure, 2016). ■ In order to practice as a NP in the state of Washington, Buppert relates (as cited by the Washington Administrative Code 246-839-300, 2011, p. 145) that the following requirements must be met: * a current RN license * completion of an advanced nursing education that meets criteria of the Washington Administrative Code 246-839-305 * documentation of original certification by a national certifying body acknowledged by the commission, a certification program approved by the commission for an ARNP specialty and also maintaining current competency requirements * accountability for practice based on and limited to the scope of education, demonstrated competence, as well as advanced nursing experience * documentation of skills training, additional formal education, and clinical practice beyond ARNP preparation Certifying bodies for Washington include the American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing, and the Pediatric Nursing Certification Board (Nursing Licensure, 2016). The Advanced Practice Nursing Consensus Work Group and the National Council of State Boards of Nursing partnered to create a Consensus Model that includes the components of licensure, accreditation, certification, and education (LACE). This purpose of this Model is to give APRN's the capability to practice to their full scopeof their education and relocate to another state if need be, without additional requirements that are not necessary in their current state of practice (Stanley, 2012). With the demands of healthcare, there is an increased need for NP's since many new physicians are specializing rather than entering the field as a family practice physician. The implementation of the Consensus Model will make it easier for NP's to practice to the full extent of their education and clinical training in order to meet the needs of healthcare in the United States (Stanley, 2012). Jenica References Buppert, C. (2011). Nurse practitioner's business practice & legal guide (4th ed.). Sudbury, MA: Jones and Bartlett. Nursing Licensure. (2016). Advanced registered nurse practitioner requirements in California. Retrieved from http://www.nursinglicensure.org/np-state/california-nursepractitioner.html Nursing Licensure. (2016). Advanced registered nurse practitioner requirements in Illinois. Retrieved from http://www.nursinglicensure.org/np-state/illinois-nursepractitioner.html Nursing Licensure. (2016). Advanced registered nurse practitioner requirements in Washington. Retrieved from http://www.nursinglicensure.org/np-state/washingtonnurse-practitioner.html Stanley, J. (2012). Impact of new regulatory standards on advanced practice registered nursing: The APRN consensus model and LACE. Nursing Clinics of North America, 47, p. 241-250. doi:10.1016/j.cnur.2012.02.001  ■ Show Less Instructor Duncanreply to Jenica Hughes RE: Discussion Part one Hi Jenica, How do the supervisory requirements differ between the various states? Dr. Duncan Show Less Jenica Hughesreply to Instructor Duncan RE: Discussion Part one Hi Dr. Duncan, In comparing the supervisory requirements of each State, they each have different levels of supervision required by that State. In the state of California the NP has restricted practice. The State mandates supervision, delegation, or team-management by a physician order to provide patient care (American Association of Nurse Practitioners [AANP], 2016). The state of Illinois has reduced practice which means that the State mandates a regulated collaborative agreement with a physician in order to provide patient care and limits the setting or scope of one or more elements of NP practice (AANP, 2016). Lastly, Washington State allows full practice by a NP. This means that all NP's have the authority to "evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments, (including prescribing medications), under the exclusive licensure authority of the state board of nursing"(AANP, 2016). Jenica Reference American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved from https://www.aanp.org/legislation-regulation/statelegislation/state-practice-environment Show Less Marsha Wiersteiner Discussion part 1 Dr. Duncan and Class Licensure, accreditation, certification and education (LACE) are criteria that form an APRN Consensus Model. This Consensus Model is an attempt to standardize the scope of practice for APN roles nationally. However, there is still much variance from state to state related to the practice of APN and their SOP. According to Kendig (2014) more that 65% of US have changed legislation to utilize Consensus Model elements, and while this shows great promise, there is still a long way to go to achieve uniformity. When describing differences among states it is somewhat difficult to reflect minute variances. For licensure in Washington, Illinois, and California, the only major difference is that California refers to this as certification, but the basic premise is there is an exam to earn the privilege for advanced practice. A national certification exam is required by Washington and Illinois for practice and California does not require this certification for practice ("https://www.ncsbn.org/," 2016). All three states require the APN to be at minimum a Master’s prepared RN from an accredited institution to sit for the accreditation exam. These three states vary by their independent practice and prescriptive authority laws. Washington is the only one of thethree that allows independent practice as well as prescriptive authority ("https://www.ncsbn.org/," 2016). As a side note another difference in these three states national Consensus Model attributes, is that in Washington they do not recognize CNS as an APN ("Licensing," 2016). References Implementation Status Map. (2016). Retrieved 08/09/2016, from https://www.ncsbn.org/ Kendig, S. (2014). The Consensus Model for APRN regulation: Review and update. Women’s Healthcare, 2(1), 29-31. Retrieved from http://npwomenshealthcare.com/ Nurse Licensing. (2016). Retrieved from http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/ NurseLicensing/AdvancedRegisteredNursePractitioner Show Less Dana Harbuckreply to Marsha Wiersteiner RE: Discussion part 1 Hello Marsha, I also noted in my research that Washington State does not recognize Clinical nurse specialists (CNS) as advanced practice nurses. CNS’s, as do nurse practitioners (NP) help fill the much needed gap of healthcare providers. Unfortunately the contributions of CNS’s are often overlooked. Clinical nurse specialists focus on a specific area of practice or a defined population. They often perform their specialized functions in the community or acute care setting. CNS’s also have difficulty defining their profession and roles in many states. Evidence demonstrates that patients value their interactions with CNS’s. They report more meaningful, longer consultation sessions, than those experienced with medical colleagues. They claim that CNS’s demonstrate greater communication and provide more information than the doctors (McCorkell, Brown, Michaelides, & Coates, 2015).Although, a large portion of our studies focus on our NP’s, we has healthcare professionals, must remember there are other advanced practice nurses fighting for autonomy as we are. Recognition for our profession and contributions to the healthcare community, need to be nursing wide. References: McCorkell, G., Brown, G., Michaelides, B., & Coates, V. (2015). Protecting an endangered species: the contribution and constraints of nurses working in a specialist role. Journal of Nursing Management, 23(2), 221-230. doi:10.1111/jonm.12117 Show Less Katherine De Los Trinos-Ocampo Week 6 Discussion Part 1 The purpose of the Consensus Model for APRN Regulation is to standardize APN education and the scope of practice for APNs (Sabol, 2013). This model was established in 2008 with a goal of being impleShow More Joshua Richardson LACE Professor and classmates, According to the American Association of Nurse Practitioners, California has restricted practice, Illinois has reduced practice, and Washington has full practice. This means that Washington allows the NP to perform all functions solely under the exclusive licensure authority of the state board of nursing. Illinois, being a reduced practice state, requires a regulated collaborative agreement with an outside health discipline. In California theyrequire supervision by an outside health discipline to provide patient care. So the NP that works in Washington is able to practice fully and freely without the constraints of needing a physician. This would give them a lot more autonomy. California, however, requires supervision by a physician to provide care. This would mean almost no autonomy in practice. In Illinois I can practice in an independent setting, but I need a collaborative agreement with a physician for prescribing authority. It was surprising to see how different the states are in the role of the APN. Everyone in this program receives the same education but will not be able to practice the same. Josh https://www.aanp.org/legislation-regulation/state-legislation/state-practiceenvironment Show Less Instructor Duncanreply to Joshua Richardson RE: LACE Joshua, What do you mean by "no autonomy in practice" as you described in California? Do you mean that nurse practitioners do not make independent patient care decisions in CA? Dr. Duncan Show Less Leslie GarnerLACE In 2008, the AACN Board of Directors endorsed the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. This landmark document defines the APRN practice, describes the APRN regulatory model, identifies the titles to be used, defines specialty, describes the emergences of new roles and population foci, and presents strategies for implementation. This model was a four year effort of work conducted by the Advanced Practice Nursing Consensus Work Group and the NCSBN APRN Committee (APRN Consensus Process, 2016). Each state has different regulations for APRNs. According to the California Board of Registered Nursing (2014), the APRN degree is offered to graduates of a nationallyaccredited graduate, post-graduate, and doctoral level adult, adult-gerontology, and family nurse practitioner programs in the U.S.A. and Canada. For certification, the APRN must have an active RN license. Certification renewal is every five years. There are two options for license renewal. Option one is 1000 clinical hours as an NP and 75 continuing education hours applicable to population focus within five years. The second option would be to retake the national certification examination. Accreditation is granted by the National Commission for Certifying Agencies and the Accreditation Board for Specialty Nursing Certification. The state of Illinois has similar requirements for their licensure. The nurse must have a current RN license in the state. They must provide proof of current national certification which includes completion of an examination. In addition to the certifications listed on their website, Board may review and make a recommendation to the Division to accept a certification if the certifying body meets specific requirements. Also, proof of successful completion of a graduate degree appropriate for national certification in the clinical advances practice or a graduate degree or postmaster’s certificate from a graduate level program in a clinical advanced specialty. Every APN license expires every two years. Every APN must show proof of fifty hours of continuing education hours and current national certification in their specialty. In the state of Washington, credentialing requirements include graduation from an approved nurse practitioner program and has an active RN license in the state. To renew your license in the state of Washington, you must have an active registered nursing license and have an active certification in your area of practice. The APN must have a minimum of 250 hours of independent clinical practice within the last two yearsand complete thirty contact hours of continuing education during the renewal period. An additional fifteen hours of pharmacology education is required if you have prescriptive authority. Washington state board of nursing Also requires a statement about physical and mental health status, lack of impairment due to chemical dependency/substance abuse, history of loss of license, certification or registration, felony convictions, loss or limitations of privileges, any disciplinary actions, and a professional liability claims history. Applicants are also required to answer a personal data question test. Additional requirements include seven hours of training in HIV/AIDS, successful completion of the national certification exam, and documentation of current certification sent directly from the certifying body (Nursing Licensing, n.d.). References APRN Consensus Process. (2016). Retrieved August 09, 2016, from http://www.aacn.nche.edu/education- resources/aprn-consensus-process Certification Requirements. (2014, November). Retrieved from http://www.rn.ca.gov/pdfs/regulations/certrequirements.pdf Nurse Licensing. (n.d.). Retrieved August 09, 2016, from http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/NurseLi censing/AdvancedRegisteredN ursePractitioner/LicenseRequirements PART 1300 NURSE PRACTICE ACT : Sections Listing. (2015, November). Retrieved August 09, 2016, from http://www.ilga.gov/commission/jcar/admincode/068/06801300sections.html Show Less Urvashi Shah Post one Advanced education builds on the pre-licensure preparation for RNs and occurs at the role and population level, which then prepares the individual for initial certification. The LACE Model specifies educational program requirements and the program isaccredited accordingly. APRNs may achieve specialization; however, licensure cannot be exclusively within a specialty focus. The CNS is educated and certified to practice across the range of wellness to acute care. Specialty education, recognition, and regulation will be the responsibility of the professional specialty organizations. Despite the difficulties the LACE Model may generate, one of the primary benefits is that it provides for standardization in educational and certification requirements with APRN recognition in all states. Of all the APRN roles, this is especially valuable to CNSs because in many states, graduate education is not a requirement and CNSs do not enjoy advanced practice recognition. The LACE Model will help move along process changes in these states, which will be good for CNS education and practice. In California, A nurse can become a clinical nurse specialist on the strength of a master's degree in a clinical nursing specialty or a master's degree in a related clinical field. If the master’s program meets Board standards, the graduate can qualify by verifying education and clinical experience. The professional who verifies clinical experience must be a familiar with the clinical nurse specialist role and must have observed the applicant carry out the five advanced nursing component areas: expert clinical nursing practice, clinical leadership, research, education, and consultation. A clinical nurse specialist who qualifies by equivalency will need to document having had coursework in the five component areas; this is in addition to clinical experience. In Wisconsin, for several years, nursing organizations, including ours, have been meeting to clarify the murky territory of advanced-practice nursing. The product of these meetings, The Consensus Model for APRN: Licensure, Accreditation, Certification & Education. In nursing professional organization, you must know how APNA is involved in changes and recognize how you can be involved in improving LACE.Licensure is how a member of a profession is granted the ability to practice. State agencies and the legislature define advancedpractice nursing, decide who can prescribe and determine the requirements for licensure. Accreditation is the process of evaluating schools of nursing and their programs nationwide. Accrediting bodies have published essentials for advanced-practice education. Certification concerns the evaluation of an individual’s knowledge, skills and abilities in a specialty. For most states, one component of advanced-practice licensure is certification. Licensure and certification, however, are separate processes. Education refers to advanced-practice educational programs at the master’s post-master’s and doctoral levels and is intertwined with certification and accreditation. At this point, psychiatric mental health nurses are educated as either clinical nurse specialists or nurse practitioners. A small number of PMH programs are ―blended,‖ educating nurses as both clinical nurse specialists and nurse practitioners. Alleman, K., & Houle, K. (2013). Advanced practice registered nurse certification. Nephrology Nursing Journal, 40(3), 219. Oleck, L. G., Retano, A., Tebaldi, C., McGuinness, T. M., Weiss, S., Carbray, J., & McCoy, P. (2012). Advanced practice psychiatric nurses legislative update: State of the states, 2010. Journal of the American Psychiatric Nurses Association, 17(2), 171-188. Show Less Nicole Cassedy Part OneThe licensure, accreditation, certification and education (LACE) requirements for advanced practice nurses (APNs) in California, Washington and Illinois differ in several ways. All three states do require that you have or obtain a registered nurse (RN) license in that state before you can be licensed as an APN, but there are differences in the required education and accepted accreditation by each board. The California Board of Registered Nursing (CABRN) only accepts accreditation for nurse practitioner certification from the following agencies: American Academy of Nurse Practitioners (AANP), American Nurses Association-American Nurses Credentialing Center (ANCC), Pediatric Nursing Certification Board (PNCB), National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC) and the American Association of Critical Care Nurses (AACN) (CABRN, 2014, p.5). The Illinois Department of Financial and Professional Regulation (IDFPR) also accepts accreditation for nurse practitioner certification from AANP, ANCC and the PNCB, but does not accept certification from the the AACN; the IDFPR also accepts certification from the Certification Board for Urologic Nurses and Associates (2016, p. 2). Both California and Illinois have licensure routes that differentiate between the roles of nurse practitioner, clinical nurse specialist, nurse midwife and nurse anesthetist. The Washington State Department of Health does not differentiate between nurse practitioner, clinical nurse specialist, nurse midwife and nurse anesthetist roles and instead offers one advanced practice licensure, the Advanced Registered Nurse Practitioner (ARNP) (n.d.). The Washington State Department of Health (2016) approves accreditation as a ARNP from: AANP, ANCC, PNCB, AACN, NCC, American Midwifery Certification Board (AMCB), American Association of Nurse Anesthetists (AANA), and the Oncology Nursing Certification Corporation (ONCC) (p.7). References: California Board of Registered Nursing. (2014). General instructions and application requirements for nurse practitioner (np) certification. Retrieved from http://www.rn.ca.gov/pdfs/applicants/np-app.pdf Illinois Department of Financial and Professional Reguation. (2016). Instruction/information sheet: Advanced practice nurse. Retrieved from http://www.idfpr.com/Renewals/apply/forms/rn-apn.pdf Washington State Department of Health. (2016). Advanced registered nursepractitioner application packet. Retrieved from http://www.doh.wa.gov/portals/1/Documents/Pubs/669220.pdf Washington State Department of Health. (n.d.). Nurse licensing: Advanced registered nurse practitioner (arnp). Retrieved from http://www.doh.wa.gov/LicensesPermitsandCertificates/NursingCommission/Nu rseLicensing/AdvancedRegisteredNursePractitioner Show Less Hannah Millerreply to Nicole Cassedy RE: Part One Hi Nicole, I enjoyed reading your post as I was not aware of how different the states requirements were when it came to identifying the roles and scope of practice of Advanced Practicing Nurses. You mentioned that the state of Washington does not identify an NP from an CNS, CRNA, or Midwife role, but instead offers one APN certification. Do you think this produces clinicians that are just as effective in their various roles of specialty versus other states that do recognize Midwifes, CRNA, and CNS? My viewpoint is that if an educational content is focused upon a particular area of study that is relevant, the practitioner's outcome will be more appropriate. All three states do, however, require the same educational background. Washington, California, and Illinois require an NP to hold a degree in an NP role (AANP, 2016). American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Hannah MillerShow Less Tammy Kill Part One In the state of California to become an APN the nurse must first hold a current registered nursing (RN) license of California (Graduate Nursing, 2015). If you hold an RN license from another state you must first apply for your RN from California. The RN must complete a Masters degree level APN program in the field of their choice and the school must be accredited by the National League of Nursing (NLN) (2015). The RN seeking a masters as an APN must graduate from a California graduate program that meets the Board standards of California (2015). The Certification for the APN will then be in a designated field of choice. An application can then be submitted for prescriptive authority which is completed by the academic program. As an APN in California there are no continuing education requirements, however if you are certified in a specialized area of advanced practice nursing you will be required to finish the particular agencies requirements for education (2015). In the state of Illinois, the nurse must hold a current RN and APN license with the National Council of the State Board of nursing of Illinois (Nursing License, 2016). The APN will pursue a certification through an examination process depending on the area of specialty. In many cases the APN may be granted the ability to practice pending the results of the certification examination. The APN in Illinois will have to renew the license every two years (2016). Prescriptive authority is granted in collaboration with the physician. To practice in the state of Washington the APN must hold a current RN and APN license from the State Board of Nursing (Graduatenursing.edu, 2016). The APNs course work will vary from that of other states such as, the APN will take courses in dictation and diagnostic theory (2016). To complete the requirements for prescriptive authority the APN will complete30 of practical experience with contact hours (2016). These hours must be completed two years before application for prescriptive authority. To receive a degree as a Certified Nurse Practitioner (CNP), a Certified Nurse Midwife (CNM), or a Certified Nurse Anesthetist (CRNA) the APN must complete a certification within the specialty (2016). The APN for the state of Washington must renew their license every two years and must complete no fewer than 30 continuing education hours in their specialty (2016). References Nursing License.org (2015). Advanced practice nurse requirements in California. Retrieved from http://www.nursinglicensure.org/np-state/california-nursepractitioner.html#np Illinois Center of Nursing. Retrieved from http://nursing.illinois.gov/nursinginillinois.asp Nursing Licensure.org (2016). Advanced practice nursing Illinois. Retrieved from http://www.nursinglicensure.org/np-state/illinois-nurse-practitioner.html Graduate Nursing.edu (2016). Steps to becoming an APRN in Washington. Retrieved from http://www.nursinglicensure.org/np-state/washington-nursepractitioner.html Show Less Michelle Ince Discussion Part OneThe following information is how licensure, accreditation, certification, and education requirements differ for the Advanced Practice Nurse (APN) between the states of California, Washington, and Illinois. Licensure: California: Licensing in the state of California is done by the Board of Registered Nurses (BRN). Any person applying for APN licensure in the state of California must first possess an RN license. Then the applicant is able to apply for APN licensure by one of three methods. The first method for California graduates only. It requires that the applicant submit all coursework and transcripts to the Board with the application. The second method is for those who are nationally certified whose standards are equivalent to those set forth by the state of California. And method three is equivalency. This means that the applicant has not completed a nurse practitioner program that meets the Boards standards. In addition to the application and transcripts, this applicant must submit paperwork called “Verification of Clinical Competency” that is signed and submitted by another nurse practitioner or physician (BRN, 2013). Washington: Licensing in the state of Washington is done by the state’s department of health (DOH). To apply for an APN license in Washington, one must first posses an RN license in the state. Then official transcripts along with an application are submitted. Also, national certification is a requirement for licensure in this state (DOH, 2016). Illinois: In Illinois, the department of financial and professional regulation are who provides licensing of APNs. In this state, an applicant must submit the application, transcripts, as well as proof of national certification (IDFPR, 2014). Accreditation: California: The California Board of Nursing recognizes APN programs that are accredited by the American Academy of Nurse Practitioners (AANP), the American Nurses Association - American Nurses Credentialing Center (ANCC), the Pediatric Nursing Certification Board, the National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC), and the American Association of Critical-Care Nurses (AACN) (BRN, 2013). Washington: The state of Washington does not require that schools be accredited by an specific bodies (DOH, 2016). Illinois: The state of Illinois does not require that schools be accredited by an specific bodies (IDFPR, 2014). Certification:California: If an applicant is certified by the any of national organizations or associations, that organization/association must have standards that are equivalent as the state of California’s standards. These include the AANP, the ANCC, the Pediatric Nursing Certification Board, the NCC, and the AACN (BRN, 2013). Washington: This state requires applicants be certified nationally. It does not specify which certifying bodies can provide the certification (DOH, 2016). Illinois: National certification is required by one of the following organizations: American Academy of Nurse Practitioners, American Nurses Credentialing Center, The Pediatric Nurse Certification Board, The National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties, and The Certification Board for Urologic Nurses and Associates (IDFPR, 2014). Education: California: If the student completed an APN program in California, the school must meet standards as described by the California Code of Regulations Section 1484 (BRN, 2013). Washington: This state only requires that an APN program be completed. It does not specify which programs are allowed (DOH, 2016). Illinois: This state only requires that an APN program be completed. It does not specify which programs are allowed (IDFPR, 2014). References Board of Registered Nursing. (2013). General instructions and application requirements for the nurse practitioner (NP) certification. Retrieved from http://www.rn.ca.gov/pdfs/applicants/npapp.pdf Illinois Department of Financial & Professional Regulation. (2014). Instruction/Information sheet: Advanced practice nurse. Retrieved from https://www.idfpr.com/renewals/apply/forms/rnapn.pdf Washington State Department of Health (2016). Nurse licensing: Advanced practice nurse practitioner. Retrieved from