UPDATE ON ARIZONA APRN CONSENSUS MODEL LEGISLATION Paula Christianson-Silva DNP, RN, FNP-BC, ANP-BC Tucson, AZ November 20, 2015

Objectives Participants will be able to: 1. Identify key components of the APRN Consensus Model 2. Discuss the purpose and implications of APRN Consensus Model legislation 3. Identify strategies to assure successful adoption of the APRN Consensus Model in Arizona 4. Support Arizona APRN Consensus Model Legislation and formulate a personal action plan for advocacy

Key Components APRN Consensus Model 1

APRN Consensus Work Group, APRN Consensus Work Group, N Regulation (published widely 7/8/2008)  National Council of State Boards of Nursing  American Association of Colleges of Nursing  Stakeholders in Education, Certification, Accreditation, APRN roles Endorsed by 45 APRN organizations (now 48) The Consensus Model for APRN Regulation (published widely 7/8/2008)

Definition of Advanced Practice Registered Nurse (APRN) An individual who has:  Completed an accredited graduate-level educational program  Passed a national certification examination that matches the educational preparation  Acquired advanced clinical skills and knowledge  Practice built upon the competencies of an RN  Clinical experience of sufficient depth and breadth to reflect the intended license  Obtained a license to practice as an APRN in one of the four roles (NCSBN, 2008)

APRN Consensus Model Fundamentals  Nurse Practitioner  Certified Nurse Midwife  Nurse Anesthetist  Clinical Nurse Specialist  Family/Individual Lifespan  Adult/Gerontology  Pediatrics  Neonatal  Women/Gender Based  Psychiatric/Mental Health APRN RolesPopulation Foci

APRN Regulatory Model: LACE APRN regulation includes:  Licensure – the granting of authority to practice  Accreditation – formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing related programs  Certification – the formal recognition of knowledge, skills and experience demonstrated by the achievement of standards identified by the profession  Education – the formal preparation of APRNs in graduate or post-graduate programs (NCSBN, 2008)

Source: National Council State Boards of Nursing (2008).

APRN Consensus Model Met in Licensure change requires legislation in every state and still has a long way to go! ????

What about the DNP? ? ? ?  Target date of 2015 should not be confused with APRN Consensus Model legislation

Purpose and Implications APRN Consensus Model Legislation 2

Purpose and Implications  All APRNs would be regulated by State Boards of Nursing  All states would use the same terminology for APRN roles  All states would have one piece of legislation covering the four APRN roles  All states would require graduate education

Purpose and Implications  All states would have full practice authority for all APRNs  Would allow for APRN compact legislation which lets an APRN hold one multistate license with a privilege to practice in other compact states (and eventually all states)

NCSBN Campaign for Consensus Project National initiative to assist states in aligning their APRN regulation with the major elements of the Consensus Model for APRN Regulation See:

Strategies for Adoption in Arizona APRN Consensus Model Legislation 3

Arizona APRN Coalition

AZ APRN Coalition - Timeline  Meeting since 2013 – now 60+ active members from each of the four APRN groups  APRN Lobby Day – March 2015  Each APRN group wrote their sections; these were combined into one Sunrise report and submitted to the Joint Legislative Audit Committee (JLAC) - September 2015  Developed APRN Fact Sheet, legislation summary, template for support letters, and document library available at

AZ APRN Coalition - Timeline  Meetings with key stakeholders – in progress  Public Relations Campaign (Veridius) - in progress  AzANA Lobbyist Rory Hays, JD  Administrative support from AzNA  Committee of Reference assigned by JLAC; Hearing – now December 7, 2015  Goal is to submit to Legislature - January 2016  Lobby Day - January 19, 2016

What is the Sunrise Review Process? Established by Laws 1985, Title 32, Chapter 31 Arizona’s sunrise review process provides a mechanism for both health professions and nonhealth professions to request regulation and, for health professions, expansion in scope of practice. Link to AZ Sunrise/Sunset Process (Left navigation bar) Title 32 = Arizona Nurse Practice Act

What changes are included?  Consensus among APRN roles – full and uniform practice authority for all  NPs – remove word “collaboration” in one section; no change in Scope of Practice (SOP)  CNMs – no longer under NPs; no change in SOP

What changes are included?  CRNAs – full practice authority, prescriptive authority (will no longer require MD supervision on site)  CNSs – full practice authority, prescriptive authority (will require 3-4 credit academic courses the “3 P’s” in Pharmacology, Pathophysiology and Physical Assessment)

Personal Action Plan APRN Consensus Model Legislation 4

Personal Action Plan

Gather letters of support from:  Physicians  Leaders of healthcare facilities  Disease focused organizations  Patients Draft letter available at:

Personal Action Plan  Watch for updates from your professional organization and respond - at this time, the majority of the Committee of Reference Members are undecided New PR Logo:

What else can we do? Attend Committee of Reference Hearing Monday, December 7, 2015 at 9 AM at the AZ State Capital in Phoenix - news conference on the Capital Steps just prior (bring family, friends, patients, etc.) (or sign in online) Attend Lobby Day Tuesday, January 19, 2016 at the AZ State Capital in Phoenix Goal is to have every legislator visited by an APRN constituent!

Questions ?

References  American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, DC: Author.  APRN Consensus Work Group & the National Council of State Boards of Registered Nursing APRN Advisory Council. (2008, July 7). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from  Boland, B. A., Treston, J., Weill, V. a., & O’Sullivan, A. L. (2009, November/December). Are you ready for the consensus model? Implications of the model on NP practice. The American Journal for Nurse Practitioners, 13(11/12),  Center on Budget and Policy Priorities. (2006). The number of uninsured Americans is at an all time high. Retrieved from  Emanuele, D. (2010). APRN Consensus Model: Implications for nursing education and practice (Presentation to California Association for Nurse Practitioners Greater Pasadena Chapter). Pasadena, CA: Author.  IOM. (2001). Crossing the quality chasm: A new health system for the 21 st century. Washington DC: The National Academies Press.  Keenan, C. (2010). APRN regulatory consensus: Issues for nurse practitioners (Presentation to California State Board of Nursing). Sacramento, CA: Author.  Link, D. (2015). APRN Consensus Model Legislation (Presentation to Arizona Nurse Practitioner Council). Flagstaff, AZ: Author.  NCSBN. (2008 and 2015). Retrieved from  Stanley, J. (2010). The APRN consensus model: Implications for educators and practitioners (AACN Faculty Link, Powerpoint). Washington DC: AACN.

THANK YOU! Paula Christianson-Silva