n

DEPARTMENTS

Debra Hardy Havens, BS, RN, FNP Washington Representative for NAPNAP Capitol Associates, Inc. Washington, D.C.

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n

Licensure of Advanced

ISSUE

The National Council of State Boards of Nursing (NCSBN) proposed the adoption of a position paper and model legislation that would require licensure of all advanced practice nurses, nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. This is a substantial and significant change from the NCSBWs 1986 position that concluded that the preferable method of regulating advanced practice nursing was through designation/recognition. n

BACKGROUND

ON NCSBN

The NCSBN is comprised of representatives from each of the nation’s and the US territories’ State Boards of Nursing. All State Boards of Nursing belong to the Council. Annually, the NCSBN meets with its House of Delegates whereby each State Board of Nursing sends two delegates to attend and vote on policies and positions. The 14th annual meeting of the Council occurred in August of 1992. One of the issues the delegates voted on was the adoption of the Council’s position paper and model legislation on the “Licensure of Advanced Practice.” Adoption means that each of the State Boards of Nursing must decide what to do with this information and how to implement it either through state legislation, rules, or regulations. Much of the proposal, in most states, must be passed by the legislature and signed by the Governor before becoming law. n

NCSBN POSITION ON LICENSURE

The NCSBN stated that “further regulation and regulatory authority is needed due to the economic, legislative and policy changes affecting health care in the U.S., including concerns about accessto health care and increased activity regarding prescriptive authority of the advanced practice nurses. Such license will be entitled, the Advanced Practice Registered Nurse (APRN) and will encompass all nurses who are nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists.” NCSBN believes that this one title will alleviate public confusion and better protect the public.

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Practice Nurses . To obtain the APRN license, the individual must fulfill the following requirements: . Be currently licensed as a registered nurse; . Submit a completed written application and appropriate fees as established by the Boards of Nursing; . Provide evidence of graduate education and comply with other requirements set forth in the rules; and . Have committed no acts of omissions that are grounds for disciplinary action. In other words, the NCSBN feels that it will increase the protection of the public by requiring advanced practice nurses to have a Masters degree and to pay a fee for this second license. The plan does not address issues of clinical competency or the mastery of skill. To date, the NCSBN has not provided any compelling evidence that the current system of advanced nursing practice is deficient or harmful to the public. In fact, the only data that the NCSBN has provided were the results of a NCSBN telephone survey providing information on the various state laws and regulations regarding advanced nursing practice, which was noted to be full of inaccuracies (presentation by NCSBN to advanced practice specialty nursing associations, June 16, 1992). One of the draft NCSBN position papers stated that variability “of systems used by states to regulate the advanced practice of nursing has resulted in problems of credentialing, practice and geographic mobility for licensees, and for Boards in implementing an endorsement process. The variability of titles, education and scopes of advanced practice among jurisdictions creates confusion for consumers of care, legislators, regulators, nurses, and other health care providers.” However, the NCSBN failed to provide any justification as to how or why licensure would reduce variability in states any more than designation/recognition. Further, licensure does not equate to geographic mobility. If anything, state mandatory APRN licensure would make moving quickly from one state to another more ditlicult for an APRN. Another alarming fact is that the NCSBN proposed

JOURNAL

OF PEDIATRIC

HEALTH

CARE

Journal of Pediatric Health Care

immediate licensure with no “grandfathering in” for any advanced practice nurse who does not hold a Masters degree. This alone could force thousands of health care providers-including pediatric nurse practitioners-to lose their jobs and thousands of patients to lose their accessto health care. Such a proposal could exacerbate, not alleviate, the health care crisis. Interestingly the nursing community has yet to resolve the baccalaureate degree requirement as the “entry into practice” for registered nurses. This proposal appears to be a backhanded way of getting to an issue that has been debated over the last two decades and has yet to be resolved! This proposal, as it is currently written, makes one wonder where more than one half of the currently practicing advanced practice nurses would obtain their Masters degrees. This is at a time when federal and state financial support for advanced practice nurses is dwindling, with only a limited number of programs around in which such nurses would have immediate access. For example, only about 40 pediatric nurse practitioner education programs exist in the country, with an average enrollment per classof about five to six students. Most of these programs have reported that they have more applicants than they can handle. Where will the pediatric nurse practitioners without Masters degrees go? At a time when nurse practitioners-especially pediatric nurse practitioners-have made major strides in the public policy arena on national, state, and local levels and with the public in terms of educating policy makers and consumers about who they are, that the NCSBN even contemplated taking such action was disappointing. This is a major step backwards and falls into the hands of those who have opposed the concept of advanced nursing practice and the great strides that have been made in the last decade. Further this is another example of nursing doing itself in, taking 10 steps backward while setting up a scenario where nurses will be fighting nurses while nursing’s credibility will be diminished in the eyes of the public, regardless of the consequences to the patients now. This is also a classic case of a profession over-regulating itself out of the market, which could open the door for other allied health professionals, who are less skilled, to fill the void. Each and every nurse practitioner and advanced practice nurse must become knowledgeable about the NCSBN’s proposal and must know the position of your own State Board of Nursing and professional nursing organization’s position. At the August 1992 NCSBN meeting, a decision was made to send this proposal back to committee for review and further input from interested parties. Once the review is completed, the

Legislative

News

379

NCSBN plans to present the proposal to its delegates at its next annual meeting. Therefore this is still an issue that requires a vigilant watch and perhaps lobbying efforts. n

RECOMMENDATIONS

FOR ACTION

1. Write the NCSBN and ask for a copy of its position paper and model legislation. The proposal and model legislation have numerous implications. Each of you as pediatric nurse practitioners should review it and evaluate how it could affect you. Share the information with your colleagues, so they also can become knowledgeable about this issue. The NCSBN can be reached at the following address : National Council of State Boards of Nursing, Inc. 676 North St. Clair Street, Suite 550 Chicago, IL 60611-2921 (312) 787-6555 FAX: (312) 787-6898 2. Contact your own State Board of Nursing to inquire about the following information: n Find out its position on this paper and model legislation. n Obtain a list of the members of the State Board of Nursing and who or what area of nursing the individuals represent. More often than not State Boards of Nursing do not have any “advanced practice nurse” or pediatric nurse practitioner on the Board. n Find out how someone can get appointed to serve on the State Board of Nursing. Generally, most representatives to State Boards of Nursing are appointed by the governor of the state. n Find out when openings of the Board occur and the process for nominating individuals to serve. In some states, the years of service are staggered. Often, an individual will need letters of support (by other nursing organizations) to be considered. n Obtain a schedule of when the your State Board of Nursing meets and the agenda. If appropriate, send a representative to attend the meetings to hear what is being discussed, and when appropriate offer your opinion or knowledge about the issue. More often than not, the members of the State Boards of Nursing do not have any knowledge about advanced nursing practice and the individual specialties. Being present offers not only you and your colleagues an opportunity to see and hear what is being considered and debated, but an opportunity to keep the State Boards of Nursing “honest.” n Request that you be apprised of upcoming

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Legislative

Volume 6, Number 6 November-December 1992

News

meetings and any proposed rule and regulation changes by the State Board of Nursing. Once a proposed rule or regulation is published, review it and provide written comments. . If you oppose the NCSBN proposal, write your State Board of Nursing outlining your concerns. In addition, write to your state representatives and Governor about your views. n Monitor, track, and be alert for state legislative proposals regarding State Board of Nursing activities and advanced practice nursing. When appropriate provide input.

REFERENCES National Council of State Boards of Nursing. (1992, March 5). Positimpaper on the lizemure of advance numiygpractiu. Chicago, IL. National Council of State Boards of Nursing. (1992, March 6). Model nurriqq practice act draft. Chicago, IL. National Council of State Boards of Nursing. (1992, May 15). Summary-position papm on the ltiure of advanced nun& practice. Chicago, IL. National Council of State Boards ofNursing. (1992, May 18). PaAm paper on the kensure of advanced nursingprake and m&d nursing prh act. Chicago, IL. *Substantial portions of this article were reprinted from vanced Practice: Be Informed, Be Alert” by Debra Hardy diatric Nursing, IS, p. 540. Copyright 1992 by Anthony printed by permission.

ROUNDTABLE

DISCUSSION LEADERS NEEDED NAPNAP CONFERENCE ANAHEIM, CALIFORNIA March 31 -April 4, 1993 The 1993 NAPNAP conference, “Capture the Magic: NAPNAP Celebrates Twenty Years,” will again offer breakfast roundtables to provide an opportunity for conference participants to network with colleagues on issues of interest to them. Each roundtable will have 10 participants, who will receive 1.5 hours of CE credit, and will last 1 hour 15 minutes. Roundtable topics include: Approaches to Obesity l Clinical Research l Communicating with the Adolescent Patient l Holistic Therapies l Hospital Privileges l International Nursing l Lead Poisoning Prevention Programs l Politics and the PNP l Primary Care of the Chronically III Child l School-based Clinics l

Discussion leaders do not have to be “experts” on the topic. The main job of the leader is to coordinate the group process: start, guide, and end the discussion according to developed objectives. If you are interested in being a discussion leader for a roundtable, please send your name, address, work and phone numbers, the topic you would like to lead, and a copy of your resume to: Ann Linguiti Pron, 7930 Montgomery Ave., Elkins Park, PA 19117. If you have questions, call (215) 635-3642. DEADLINE for receipt of the above items is January 15,1993.

“Licensure for AdHavens, 1992, Pe1. Janetti, Inc. Re-

Licensure of advanced practice nurses.

n DEPARTMENTS Debra Hardy Havens, BS, RN, FNP Washington Representative for NAPNAP Capitol Associates, Inc. Washington, D.C. n n Licensure of Adv...
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