In early 2006, The National Council of State Boards of Nursing (NCSBN) published Vision Paper: the Future Regulation of Advanced Practice Nursing. The purpose of the paper was to provide "direction to Boards of Nursing and APRN stakeholders in the regulation of advanced practice nursing." It also projected a regulatory model for 10 years into the future.
The need for a vision and direction became evident due to the lack of uniformity in advanced practice nursing (APN) across the country. In some states, Boards of Nursing recognize four categories of APNs (nurse anesthetists [CRNAs], nurse midwives [CNMs], clinical nurse specialists [CNSs], and nurse practitioners [NPs]), while others only recognized two or three categories.
Prescribing authority and degree of independence varied. There was also a lack of uniformity in standards leading to authority to practice and in education. Specifically, some professional nursing groups do not agree on the role of the CNS or even if the CNS role should be included in the definition of APRN. NCSBN, along with many APN professional associations, agree that this lack of consistency has "led to confusion among APRN stakeholders, the public, and even APRNs themselves."
The Recommendations
The NCSBN paper envisions a model with three categories of APRNs: CRNA, CNM, and NP. CNSs practicing within the RN scope of practice will not be considered APRNs. CNSs practicing in an advanced role beyond the RN scope of practice will be grandfathered in.
The NCSBN envisioned one basic examination to certify NPs for generalist practice. In addition to the basic exam, an NP could choose to take a specialized certification examination in family practice, adult, pediatrics, women's health, and so forth. This concept would prepare NPs to practice at a basic level or would allow them to advance into a specialty.
The NCSBN makes eight basic recommendations in the vision paper. The full text of the paper is available online at http://www.nursingworld.org/practice/aprn/ncsbn/021706APRNVision%20PaperNCSBN.pd.
The Backlash
The publication of the NCSBN vision paper caused quite a stir in the APN community. Many nursing organizations, including the American Nurses Association, American Academy of Nurse Practitioners, American Association of Nurse Anesthetists, American Association of Colleges of Nursing, Tri-Council for Nursing, the National Organization of Nurse Practitioner Faculties, and the American Nurses Credentialing Center, responded to the vision paper with concern. While most organizations acknowledged that the lack of uniformity in practice and education was a problem, there was no consensus on how to achieve unity.
As a result of the many objections to the vision paper, NCSBN convened a number of meetings with the national professional, educational, and credentialing organizations. These meetings have resulted in a closer meeting of the minds, although issues still remain. The NCSBN APRN Joint Dialogue Group met in May and has scheduled another meeting for mid-July. No date has been published for presentation of the revised vision paper.
The APN profession has evolved rapidly, causing many variations on practice; and in some cases, confusion about APRN roles. The NCSBN's APN vision paper has raised the collective nursing consciousness on this issue, and has initiated a national dialogue. Through the dedicated work of many, this vision paper may bring greater cohesion to the profession and allow APRNs to move forward to a better professional future.