The American Nurses Association (ANA) co-hosted with the American Association of Colleges of Nursing (AACN), the National Nursing Stakeholders’ Meeting about Advanced Practice Nurses on December 16, 2004, at the ANA headquarters in Silver Spring, Maryland. Over 70 participants representing more than 60 organizations attended. Stakeholders included state nurses associations, state boards of nursing, specialty nursing organizations, credentialing organizations, certification boards, government agencies, Commission on Graduates of Foreign Nursing Schools (CGFNS), Commission on Collegiate Nursing Education (CCNE), National League for Nursing Accrediting Commission (NLNAC), American Nurses Credentialing Center (ANCC), National Council of State Boards of Nursing (NCSBN), National League for Nursing (NLN), AACN, and ANA.

Barbara Blakeney, MS, RN, ANA President, welcomed attendees and provided a very brief synopsis of recent events that precipitated the call for this meeting. Jean Bartels, PhD, RN, AACN President, then offered additional welcome comments.

Dr. Margretta Madden Styles provided the keynote address, “Advanced Practice Nursing: Definitions, Positions, Examples, Issues,” that set the stage for the follow-up four-member reaction panel and the afternoon’s facilitated discussion. Dr. Styles explained that confirmation of definitions of terms should begin any discussion of regulatory and licensure issues. She offered several models to consider during her explanation and assessment of the current environments of state licensure, national certification, and national accreditation.

Dr. Styles closed her presentation with the identification of these questions to be answered by the stakeholders during their afternoon discussion, planning, and decision-making efforts:

• What are the basic goals/principles that should characterize a credentialing system for Advanced Practice Nursing?
• What are the models that could be used for the system?
• What defining concept would be used for:
  • Specialty?
  • Sub-Specialty?
• What process might be used to move to a future model?
• The presentation slides can be reviewed at www.NursingWorld.org.

Stakeholder participants then had an opportunity to ask specific questions to Dr. Styles that clarified her points and enhanced understanding.

The reaction panel followed with comments from:

• Kathy Apple, MS, RN, CAE, Executive Director, National Council of State Boards of Nursing
• Kathy Thomas, MN, RN, Executive Director, Texas Board of Nurse Examiners
• Joan Stanley, PhD, RN, CRNP, FAAN, Director of Education Policy, American Association of Colleges of Nursing
• Kathleen White, PhD, RN, CNAA, CMAC, Chairperson, ANA Committee on Nursing Practice Standards and Guidelines

Facilitated afternoon discussion led by Linda J. Shinn, MBA, RN, CAE, identified these concerns:

• Discussion about recognition of APRN (Advanced Practice Registered Nurse) to practice in state is different issue than the definition of specialty practice
• Identification of nursing specialties are the profession’s responsibility
• How should the nursing profession proceed to define specialties and validate those related competencies?

• Inconsistencies in academic preparation, regulation, and accreditation of academic educational programs for APRN
• Core curriculum content applicable for all APRNs
• APRN certification exam for mastery of core curriculum content plus certification exam for mastery of specialty practice content
• Correct and uniform core content means we can reduce regulation
• Educational programs recognized in one state don’t equate to recognition in another
• Need careful consideration about mobility and evolving practice for APRNs
• Consider the significant impact genetics research will have on practice

• No evidence that we have problems in APRN malpractice
• RN licensure with APRN recognition vs. 2 levels of licensure
• Regulation can’t resolve the issues and needs to recognize certification and educational preparation

• Need to strengthen partnerships and trust to move work forward
• Address definitions issues for clarity
• Need impartial body to examine common issues in current environment and identify the envisioned future

• Stakeholders can’t attend and support the work of all the consensus meetings going in multiple and diverse directions
• The Alliance For Nursing Accreditation, established to facilitate collaboration to create definition, specialty, and certification and hosted by AACN, has 2 meetings scheduled in 2005 and can bring that work to the stakeholders for consideration
• Any decisions must not adversely affect CNM and CRNA communities

The group agreed to the goals and principles outlined by Dr. Styles for a System of Advanced Practice Nursing that:

• Demonstrates consistency and standardization
• Serves the purposes for which it is established
• Reflects collaboration among credentialing sectors (roles, procedures, compacts, etc.)
• Permits flexibility, evolution of practice, and career development
• Is understandable to nurses, consumers, and the public
• Does no harm to any nurse in times of transition
• Builds upon what we have in place

The group also recommended that the models and proposals for specialties/subspecialties should focus on the following options:

• Core preparation for each role-CNS, NP, CRNA, CNM
• Core preparation for all, plus additional specialties/subspecialties content

Closing comments about the next steps from: Dr. Bartels:

• Continue the work of the AACN Advanced Practice Nurse Consensus Process Workgroup to answer the questions posed during the discussion at the stakeholders’ meeting and extend the invitation to join in this work to those who may not yet have been included
• Reiterated the willingness of AACN to bring the work of the APN Consensus Process to a Spring 2005 National Nursing Stakeholders Meeting on Advanced Practice Nurses

Barbara Blakeney:

• Identify how to make APRN practice better
• Recognize the problem is not solved but has moved “a little bit”
• Try to reach consensus on “What does APRN practice, education, and regulation look like?”
• Invite Dr. Styles back for the spring 2005 stakeholders’ meeting
• Committed ANA resources to hold a Spring 2005 National Nursing Stakeholders Meeting on Advanced Practice Nurses

View slides presented by Dr. Margretta Madden Styles [PDF format]