To the Editor:
Bridget Mejza's excellent View From Here in the May/June 2009 issue of the Journal of Wound, Ostomy and Continence Nursing (JWOCN) "Will the WOC Nurse of the Future Also Be a DNP?" reminded readers of the 2004 position statement from the American Association of Colleges of Nursing (AACN) that recommended the educational level of preparation for advanced practice registered nursing (APRN) be a doctoral degree by the year 2015. I would like to respond by making JWOCN readers aware of the current developments in advanced practice nursing nationwide. In July 2008, the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee released the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (LACE). The AACN, as well as the American Nurses Association (ANA), the American Nurses Credentialing Center (ANCC), the National League for Nursing, the Wound Ostomy Continence Nurses Society (WOCN), the Wound Ostomy Continence Nursing Certification Board (WOCNCB), and 40 other professional nursing organizations, endorsed this model. The purpose of this model is to standardize advanced practice nursing across the 50 states.
The LACE model for APRN regulation addresses 4 areas: licensure, accreditation, certification, and education. It is proposed that starting in 2015, the APRN student must attend an APRN graduate nursing program that has received a formal review and been "accredited" by a recognized accreditation agency of educational degree programs. The program of APRN "education" will prepare the student within a role-a nurse practitioner, a clinical nurse specialist, a nurse midwife, or a nurse anesthetist-and focus on a specific population-family/individual across the life span, adult/gerontology, neonatal, pediatrics, women's health/gender-related, or psychiatric-mental health. The APRN core must include 3 separate comprehensive graduate-level courses: advanced physiology/ pathophysiology, advanced physical assessment, and advanced pharmacology. After graduation, the nurse must pass a "certification" examination designed to assess APRN core competencies (eg, pathophysiology, physical assessment, and pharmacology), competency within the role (eg, clinical nurse specialist), and competency within at least 1 population (eg, adult/gerontology). The provider of this certification examination (eg, ANCC) must be "accredited" by an independent, nationally recognized accreditation body. APRNs cannot be certified solely within a specialty area (eg, WOC nursing). Once the role and population certification examination has been passed, the nurse will apply to their State Board of Nursing for "licensure" as an APRN. It is proposed that each State Board of Nursing will license the APRN as an independent practitioner with no regulatory requirements for collaboration, direction, or supervision. In addition, there will be a grandfathering clause to exempt those nurses already practicing in the state as APRNs from the new criteria.
Education within a specialty (eg, WOC nursing) will be optional for the APRN. Competency at the specialty level will not be assessed or regulated by State Boards of Nursing but rather by professional organizations (eg, WOCN or WOCNCB). Currently, WOC nursing is not recognized as a specialty by the ANCC, but the WOCN is applying for specialty recognition under the ANA Criteria for Recognition as a Nursing Specialty.
I hope that this simplified explanation of the LACE model is helpful to your readers. The document is available at http://www.aacn.nche.edu/education/pdf/APRNReport.pdf.
Sincerely, Leanne Richbourg, MSN, APRN-BC, CWOCN, GCNS-BC, CWON-AP
Chair, WOCNCB Advanced Practice Committee