Nursing's Leading Edges: Advancing the Profession through Specialization, Credentialing, and Certification
By Lisa Summers and Carol J. Bickford
()
About this ebook
This book leverages American Nurses Association’s long history of leading the profession in the areas of specialization and credentialing, as well as in the creation and ongoing implementation of the Consensus Model for APRN Regulation.
Updating and building on ANA’s Specialization and Credentialing in Nursing Revisited: Understanding the Issues, Advancing the Profession published in 2008—which presented a unity model for the specialization and credentialing of nurses, with a focus on APRNs—this new ANA publication will examine the constant changes in educational expectations and certification requirements.
Nursing’s Leading Edges: Advancing the Profession through Specialization, Credentialing, and Certification will guide you through the APRN Consensus Model and help you effectively implement it.
The nation’s 3.6 million RNs who work in every sector of our health care system have been called “the glue” that holds that system together for the patients who must navigate its services. Take this key and unlock the doors of the nursing profession today!
Related to Nursing's Leading Edges
Related ebooks
Nurse Staffing 101: A Decision-making Guide for the RN Rating: 2 out of 5 stars2/5Nightingale's Vision: Advancing the Nursing Profession Beyond 2022 Rating: 5 out of 5 stars5/5A Guide for the Nurse Entrepreneur: Make a Difference Rating: 0 out of 5 stars0 ratingsFaith Community Nursing: Scope and Standards of Practice Rating: 5 out of 5 stars5/5What Would Florence Do?: A Guide for New Nurse Managers Rating: 0 out of 5 stars0 ratingsThe Art and Science of Nurse Coaching, 2nd Edition: The Provider’s Guide to Coaching Scope and Competencies, 2nd edition Rating: 0 out of 5 stars0 ratingsMeasuring Capacity to Care Using Nursing Data Rating: 0 out of 5 stars0 ratingsCare Coordination: A Blueprint for Action for RNs: A Blueprint for Action for RNs Rating: 0 out of 5 stars0 ratingsCommunication Skills for Nurses: A Practical Guide on How to Achieve Successful Consultations Rating: 4 out of 5 stars4/5Guide to the Code of Ethics for Nurses: Interpretation and Application Rating: 0 out of 5 stars0 ratingsThe Art and Science of Nurse Coaching: The Provider's Guide to Coaching Scope and Competencies Rating: 5 out of 5 stars5/5Advanced Practice Nursing: Setting a New Paradigm for Care in the 21St Century Rating: 0 out of 5 stars0 ratingsPublic Health Nursing: Scope and Standards of Practice, 3rd Edition Rating: 0 out of 5 stars0 ratingsNursing: Scope and Standards of Practice Rating: 5 out of 5 stars5/5Advanced Practice Nursing Leadership: A Global Perspective Rating: 0 out of 5 stars0 ratingsA Handbook for Student Nurses, second edition: Introducing Key Issues Relevant for Practice Rating: 0 out of 5 stars0 ratingsNursing Programs 2015 Rating: 0 out of 5 stars0 ratingsA Caring Approach in Nursing Administration Rating: 0 out of 5 stars0 ratingsCommunication, Collaboration, and You: Tools, Tips, and Techniques for Nursing Practice Rating: 4 out of 5 stars4/5Venepuncture and Cannulation Rating: 0 out of 5 stars0 ratingsInformation Overload: Framework, Tips, and Tools to Manage in Complex Healthcare Environments Rating: 0 out of 5 stars0 ratingsImproving Patient Outcomes: a guide for Ward Managers Rating: 0 out of 5 stars0 ratingsThe Care Process: Assessment, planning, implementation and evaluation in healthcare Rating: 0 out of 5 stars0 ratingsCare Coordination: The Game Changer: The Game Changer How Nursing is Revolutionizing Quality Care Rating: 0 out of 5 stars0 ratingsHow to be a Great Nurse – the Heart of Nursing Rating: 0 out of 5 stars0 ratingsCardiovascular Nursing: Scope and Standards of Practice Rating: 5 out of 5 stars5/5School Nursing: Scope and Standards of Practice, 3rd Edition Rating: 5 out of 5 stars5/5Correctional Nursing: Scope and Standards of Practice, Third Edition Rating: 5 out of 5 stars5/5Vascular Nursing: Scope and Standards of Practice Rating: 0 out of 5 stars0 ratingsNursing Administration: Scope and Standards of Practice Rating: 5 out of 5 stars5/5
Medical For You
What Happened to You?: Conversations on Trauma, Resilience, and Healing Rating: 4 out of 5 stars4/5Brain on Fire: My Month of Madness Rating: 4 out of 5 stars4/5Mediterranean Diet Meal Prep Cookbook: Easy And Healthy Recipes You Can Meal Prep For The Week Rating: 5 out of 5 stars5/5Adult ADHD: How to Succeed as a Hunter in a Farmer's World Rating: 4 out of 5 stars4/5The Song of the Cell: An Exploration of Medicine and the New Human Rating: 4 out of 5 stars4/5Gut: The Inside Story of Our Body's Most Underrated Organ (Revised Edition) Rating: 4 out of 5 stars4/5The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine Rating: 5 out of 5 stars5/5Mating in Captivity: Unlocking Erotic Intelligence Rating: 4 out of 5 stars4/5Living Daily With Adult ADD or ADHD: 365 Tips o the Day Rating: 5 out of 5 stars5/5The Emperor of All Maladies: A Biography of Cancer Rating: 5 out of 5 stars5/5Women With Attention Deficit Disorder: Embrace Your Differences and Transform Your Life Rating: 5 out of 5 stars5/5The People's Hospital: Hope and Peril in American Medicine Rating: 4 out of 5 stars4/5The Amazing Liver and Gallbladder Flush Rating: 5 out of 5 stars5/5A Letter to Liberals: Censorship and COVID: An Attack on Science and American Ideals Rating: 3 out of 5 stars3/5Holistic Herbal: A Safe and Practical Guide to Making and Using Herbal Remedies Rating: 4 out of 5 stars4/5The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally Rating: 4 out of 5 stars4/5Herbal Healing for Women Rating: 4 out of 5 stars4/5Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner Rating: 4 out of 5 stars4/5The Art of Dying Well: A Practical Guide to a Good End of Life Rating: 4 out of 5 stars4/5"Cause Unknown": The Epidemic of Sudden Deaths in 2021 & 2022 Rating: 5 out of 5 stars5/5Peptide Protocols: Volume One Rating: 4 out of 5 stars4/5The 40 Day Dopamine Fast Rating: 4 out of 5 stars4/5The Hormone Reset Diet: Heal Your Metabolism to Lose Up to 15 Pounds in 21 Days Rating: 4 out of 5 stars4/5David D. Burns’ Feeling Good: The New Mood Therapy | Summary Rating: 4 out of 5 stars4/5
Reviews for Nursing's Leading Edges
0 ratings0 reviews
Book preview
Nursing's Leading Edges - Lisa Summers
Nursing’s Leading Edges
American Nurses Association
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
1-800-274-4ANA
http://www.Nursingworld.org
The America Nurses Association (ANA) is the premier organization representing the interests of the nation’s 3.6 million registered nurses. ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all.
Copyright ©2017 American Nurses Association. All rights reserved. Reproduction or transmission in any form is not permitted without written permission of the American Nurses Association (ANA). This publication may not be translated without written permission of ANA. For inquiries, or to report unauthorized use, email copyright@ana.org.
Library of Congress Cataloging-in-Publication Data available on request.
978-1-55810-671-0 print SAN: 851-3481 12/2016
978-1-55810-672-7 ePDF
978-1-55810-673-4 ePub
978-1-55810-674-1 mobi
First published: December 2016.
Contents
Introduction i
Acknowledgments i
1 An Overview of Nursing Practice in Today’s World 1
Today’s Nursing Practice Environment 1
The Nursing Workforce 2
Recent Evolution of Nursing Education 3
Doctoral Education in Nursing 5
Development of the DNP 5
Other AACN and NLN Contributions to Nursing Education 7
Regulation and Licensure 9
National Council of State Boards of Nursing 9
Key Stakeholders in the Practice Environment 11
Professional Associations 11
Certifying Bodies 11
Accrediting Organizations 12
Recommended Competencies Associated with Nursing Education and Practice 13
The Growth of Specialization in Nursing 13
Specialty Nursing Organizations 14
Certification and Credentialing for Specialty Practice 15
Documents Essential for All Nursing Practice 15
Code of Ethics for Nurses with Interpretive Statements 15
Nursing: Scope and Standards of Practice 17
Nursing’s Social Policy Statement 18
Nursing-External Forces and Initiatives 18
Health System Reform 18
The Institute of Medicine: Five Key Reports 19
Information Technology 24
Quality Agenda 26
A Model for Defining Practice and Acceptable Competence 29
References 32
2 Specialization and Credentialing: Concepts and Definitions 37
Definition of Key Terms 38
Elements of Credentialing 41
Respective Roles and Mutual Recognition: Diagrams of Credentialing 42
Types of Credentialing 44
Credentialing of Individuals 45
Accreditation and Recognition of Organizational Programs 45
Practice Transition Accreditation Program™ (PTAP) 46
References 52
3 Specialization and Certification for RNs: Growth and Recognition 57
Formal Recognition of Nursing Specialties 58
Recognition of Specialty Nursing Competence and Expertise 59
Growth of Certification in Nursing 60
State of the Science: Research on Certification in Nursing 61
References 64
4 APRN Specialization and Certification: The Consensus Model for APRN Regulation 67
The Four APRN Roles 68
Certified Registered Nurse Anesthetist (CRNA) 70
Certified Nurse-Midwife (CNM) 71
Clinical Nurse Specialist (CNS) 74
Certified Nurse Practitioner (CNP) 78
The Consensus Model for APRN Regulation 80
What Drove the Development of the Model? 80
Development of the Consensus Model 83
Multiyear Process 84
Key Stakeholders Committed to Consensus 84
Basic Assumptions About the Consensus Model 85
ANA’s Role in the Consensus Model 86
Key Aspects of the Consensus Model 86
Definition of an APRN 87
Four APRN Roles 87
LACE: The Four Essential Elements 89
Relevance of Specialties 89
APRNs as Independent Practitioners
89
APRN Education 90
Emergence of New APRN Roles and Population Foci 91
Implementation: Strategies, Challenges, and Progress to Date 91
Implementation Strategies 91
2015 Target Date 92
Development of the LACE Network 95
Changes in APRN Certification Examinations 95
Is Additional Postgraduate Education and Certification Needed? 97
Evaluation and Implementation 98
References 100
5 Specialization and Certification: Issues, Trends, Moving Forward 103
The Impact of Occupational Licensing Reform 104
Building the Business Case for Certification 105
Building a Stronger Research Base 105
The Potential Role of Electronic Health Records 106
Expanded Use of the National Provider Identifier (NPI) 107
Proliferation of Specialties and New Models of Certification 108
Proliferation of Specialties and New Specialties 108
Interprofessional Certification 109
Certification of Teams 111
Impact of Globalization 112
Public Understanding 113
Continuing Competence 116
Lifting Barriers to APRN Practice
Conclusion
References
Glossary of Acronyms 125
Index 129
Introduction
Wherever you work in the health care industry—whether hospital administrator, credentialing professional, regulator, educator, or nurse—you need to understand the profession of nursing. The nation’s 3.6 million registered nurses, who comprise the largest sector of the health care workforce, have been called the glue
that holds our health care system together for the patients who must navigate its services. Nurses work in every sector of health care, from small rural health centers to massive urban tertiary hospitals and multihospital systems. They provide primary and preventive care as well as highly specialized nursing care and disease management. Quite literally from cradle to grave
—from the newborn nursery to hospice—we encounter nurses, and therefore the nursing profession.
Because nurses are integrated throughout our health care system, as health care has become increasingly complex, so has the profession of nursing. Nurses have developed the skills and knowledge necessary to keep a tiny preemie alive in the neonatal intensive care unit, or manage the operating room throughout a multiorgan transplant surgery. The nursing profession, through its professional and specialty organizations, has defined standards of practice to ensure safe, quality nursing care and, ultimately, to protect the public.
Specialization and credentialing—significant concerns for many professions—are especially important in light of the responsibilities assumed by the registered nurse. The American Nurses Association (ANA) has done groundbreaking work in this area for decades, creating and revising essential documents such as Code of Ethics for Nurses with Interpretive Statements and Nursing: Scope and Standards of Practice. Since the late 1990s, ANA has been the steward of a process to formally recognize new nursing specialties. Additionally, the American Nurses Credentialing Center (ANCC), an ANA subsidiary, is one of the oldest credentialing organizations promoting excellence in nursing and health care in the United States and globally.
While many nurses have contributed to the development of specialization and credentialing in nursing, Magretta Gretta
Styles, EdD, RN, FAAN, was recognized as a thought leader in this field for many years. (For a snapshot of her career, see http://nursecredentialing.org/CertifiedNursesDay-MeetGrettaStyles.) At the time of her death in 2005, Dr. Styles was creating a subsequent edition to her work, On Specialization in Nursing: Toward a New Empowerment (1989).
ANA committed to continuing the work of Dr. Styles, and in 2008 published Specialization and Credentialing in Nursing Revisited: Understanding the Issues, Advancing the Profession, her final written work. The book’s emphasis on advanced practice nursing and related topics helped frame the discussions of the Advanced Practice Registered Nurses (APRN) Stakeholder’s Group, at whose meeting the book was unveiled. Later that same year, the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (the Consensus Model
), was completed and endorsed.
As stakeholders began activities to implement the Consensus Model, the importance of Dr. Styles’s foundational work became increasingly clear. Yet the 2008 book had become outdated as it was published, given the completion of the Consensus Model in the same year.
The subsequent years have been called a perfect storm
for nursing, with the passage of the Affordable Care Act in 2010 and the publication that same year of The Future of Nursing: Leading Change, Advancing Health Practice, a report from the what was then the Institute of Medicine (see pg. 20 for the name change). Policy makers are increasingly aware of the need to ensure an adequate nursing workforce to meet demands, and to ensure that all nurses practice to the full extent of their education.
And so the decision was made to once again revisit specialization and credentialing in nursing with a redux of the 2008 book.
In my role as Senior Policy Advisor for APRN Issues in ANA’s Department of Health Policy, the primary incentive for taking a fresh look at Dr. Styles foundational work and updating it in this book was ANA’s involvement in implementation of the Consensus Model for APRN Regulation. I did not have the privilege of knowing or working with Dr. Styles, (and I confess that I read her work only as I became involved in implementation of the Consensus Model in 2009), but have felt her strong influence nonetheless. Each time this book hit a slowdown, there would be a conversation or an inquiry that would remind me of the importance of this relatively narrow but critically important topic of specialization and credentialing of the largest cadre of healthcare professionals.
Most recently, I fielded an inquiry that led to a connection to Dr. Styles’ children and the work they are doing through The Gretta Foundation. The Foundation funds nursing and midwifery scholarships to impoverished persons living in disease burdened countries, and consistent with her legacy, the Gretta scholars
attend accredited programs in their country’s system of education.
ANA is in the unique and important role of advocating for all nurses—registered nurses and advanced practice registered nurses—across all roles and specialties. As the profession of nursing has evolved and the industry in which we work has undergone seismic changes, ANA has fielded inquiries from a wide variety of stakeholders. Nurses long credentialed in a role or specialty wonder how the changes affect them, while nurses seeking to advance their career wonder how to choose between a growing number of new programs. Employers wonder how to retain experienced nurses with old
credentials and how to attract the most qualified new nurses. Policy makers seek to make sense of competing requests for changes in the legislative and regulatory framework. And payers (both private sector and in the government) are wielding influence as they move toward limiting reimbursement to providers with particular credentials.
This book sets out to meet the difficult challenge of providing concise background and information for this broad audience. In some instances, decisions and the path forward are clear. In others, there are important questions that remain to be answered. ANA has and will continue to work closely with colleagues in the nursing community toward a unified message.
Chapter 1 provides a foundation for understanding nursing in today’s rapidly changing health care environment. Discussion of the nursing workforce, evolution of nursing education, regulation and licensure, and components of the practice environment provide insights about the context and complexities of contemporary nursing practice.
Chapter 2 borrows heavily from the foundational work of Dr. Styles. When discussing specialization and credentialing in nursing, it is important to have a clear understanding of definitions and basic concepts. In Chapter 2 of Specialization and Credentialing in Nursing Revisited, Dr. Styles provided a series of definitions and figures that helped to clarify the relationships between various forms of credentialing. Although Dr. Styles presented this as a foundation for thinking about the practice of advanced practice registered nurses, the basic concepts are applicable to credentialing of RNs and APRNs alike.
Chapter 3 and Chapter 4 expand on these basic concepts. While Chapter 3 addresses RN specialization and credentialing, the process of formal recognition of nursing specialties described in that chapter formed the foundation for understanding specialty practice for APRNs as well. There is also a brief review of the state of the science on certification in nursing.
Chapter 4 brings us up to date on how this basic work evolved into the Consensus Model for APRN Regulation. The four APRN roles are described as well as the factors that drove the development of the Consensus Model. Key aspects of the model are explained; there is a brief summary of implementation of the Consensus Model to date.
The final chapter looks to the future, addressing some of the emerging issues and questions being tackled as the profession of nursing evolves, along with health care delivery sites, systems, and technologies.
The audience for this book is a broad one, and we hope it meets the needs of practitioners, administrators, employers, and regulators.
—Lisa Summers, MSN, DrPH, FACNM
Acknowledgments
Mary Jean Schumann, DNP, RN, MBA, CPNP, an author of Specialization and Credentialing in Nursing Revisited, introduced me to that book early on in my tenure at ANA. It provided a foundation I was lacking and made me want to see that critical information updated and widely disseminated. Colleague Carol J. Bickford, PhD, RN-BC, CPHIMS, FHIMSS, FAAN, another author of Specialization and Credentialing in Nursing Revisited, proved to be an invaluable ally and supporter moving through the creation and publication of this professional resource.
Many colleagues answered queries, contributed sections, and reviewed drafts. At the risk of overlooking some (and accepting full responsibility for the final product), we want to acknowledge in particular the following ANA colleagues: Janet Haebler MSN RN, Senior Associate Director, State Government Affairs; and Peter McMenamin, PhD, Kelly Cochran, MS, RN; and Maureen Dailey, PhD, RN, CWOCN in the Department of Health Policy. Martha Turner, PhD, RN-BC, Assistant