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The State of APRN Practice 2011 Sue LaMotte, RN, CNM, MS MN NP Group April 30, 2011. Agenda. History Current State Statute Language APRN Data Future State Consensus Model for APRN Regulation IOM Report APRN Coalition. Mission Statement.

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the state of aprn practice 2011 sue lamotte rn cnm ms mn np group april 30 2011
The State of APRN Practice 2011

Sue LaMotte, RN, CNM, MS

MN NP Group

April 30, 2011



Current State

Statute Language


Future State

Consensus Model for APRN Regulation

IOM Report

APRN Coalition


Mission Statement

…to protect the public’s health and safety by providing reasonable assurance that the people who practice nursing are competent, ethical practitioners with the necessary skills appropriate to their title and role

about the board
About the Board
  • 1907
  • 16 Board members
    • 4 Public members
    • 8 RNs (Bacc, AD, LTC, APRN,


    • 4 LPNs
  • 33 Staff
  • Meet 6 times / year
functions of the board
Functions of the Board
  • authorize individuals to practice nursing
  • approve licensure-preparing nursing education programs
  • identify standards of nursing practice
  • discipline individuals who do not meet the standards
the nurse practice act
The Nurse Practice Act
  • Authorizes APRN practice
    • Licensed as RN
    • Current certification on APRN Registry
  • APRN is independently accountable for practice
  • Language is very broadly written
    • Does not detail specifics of scope of practice
    • Look to professional bodies, certification organizations, ANA Standards, etc

“Advanced practice registered nurse, abbreviated APRN, means an individual licensed as a registered nurse by the board and certified by a national nurse certification organization acceptable to the board to practice as a:

  • clinical nurse specialist,
  • nurse anesthetist,
  • nurse-midwife, or
  • nurse practitioner

Minnesota statutes, section 148.171, subd 3

definition continued

The practice includes functioning as a:

direct care provider,

case manager,


educator, and


Minnesota statutes, section 148.171, subd. 13

Definition Continued
definition continued1

The APRN must practice within a health care system that provides for:


collaborative management, and


Minnesota statutes, section 148.171, subd. 13

Definition Continued
cnp practice
CNP Practice

…means, within the context of collaborative management:

(1) diagnosing, directly managing, and preventing acute and chronic illness and disease; and

(2) promoting wellness, including providing nonpharmacologic treatment.

The NP is certified in a specific field of clinical practice.

Minnesota statutes, section 148.171, subd. 11

collaborative management
Collaborative Management

…is a mutually agreed upon plan between an APRN and one or more physicians… that designates the scope of collaboration necessary to manage the care of patients.

Minnesota statutes, sections 148.171, subd. 6

national nurse certification organizations
National Nurse Certification Organizations
  • American Academy of Nurse Practitioners
  • American Association of Critical-Care Nurses Certification Corporation
  • American Nurses Credentialing Center
  • American Midwifery Certification Board
  • Pediatric Nursing Certification Board
  • National Certification Corporation for Obstetric, Gynecological, and Neonatal Nursing Specialties
  • Council on Certification of Nurse Anesthetists
aprn registry
APRN Registry

Practicing without current certification or failure to notify Board of current certification is subject to payment of a penalty fee:

$200 first month

$100 each subsequent month

  • Delegated medical function (exception:CNMs)
  • Memorandum of Understanding
    • Created by MNA and MMA
    • Identifies elements required for written agreement

Minnesota statutes, section 148.235



An advanced practice registered nurse …….. shall use the appropriate designation:

  • RN,CNS
  • RN,CNM
  • RN,CNP

for personal identification and in documentation of services provided. Identification of educational degrees and specialty fields may be added.

Minnesota statutes, section 148.233 subd 2

reasons for a future aprn model
Reasons for a Future APRN Model

Lack of common definitions related to APRN roles

Lack of standardization in programs leading to APRN preparation

Proliferation of specialties and subspecialties

Lack of common legal recognition across jurisdictions

benefits of aprn consensus model
Benefits of APRN Consensus Model
  • Facilitates mobility

of APRNs

  • Ensures public safety
  • Increases access to health care
  • Advocates appropriate scope of practice
consensus model for aprn regulation
Consensus Model for APRN Regulation

APRN regulation includes:


The granting of authority to practice


Formal review and approval by a recognized agency of certification agencies and APRN education programs


The formal recognition of knowledge, skills and experience demonstrated by the achievement of standards identified by the profession


The formal preparation of APRNs in graduate or post-graduate programs

Implementation target date: 2015


APRN Regulatory Model

APRN Specialties

Focus of Practice beyond role and population focus

Linked to health care needs

Examples include but are not limited to: Oncology, Older Adults,

Orthopedics, Nephrology, Palliative care, Critical Care



Across lifespan



Women’s Health/

Gender Related





Licensure at levels of role and population foci






Clinical Nurse




iom rwjf landmark report
IOM / RWJF Landmark Report

Nurses should practice to the full extent of their education and training.

Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

Effective workforce planning and policy making require better data collection and an improved information infrastructure.

the stars align
The Stars Align
  • Synergy
  • Affordable Healthcare Act
  • Growing participation
  • Birth of the Minnesota APRN Coalition
  • IOM/RWJF Report: The Future of Nursing: Leading Change, Advancing Health
minnesota aprn coalition
Minnesota APRN Coalition

Vision Statement

The Minnesota APRN Coalition’s vision is that the people of Minnesota have unrestricted access to APRNs who have statutory authority to practice to the fullest extent of their education and training.

Mission Statement

The Minnesota APRN Coalition is dedicated to improving patient access to and choice of safe, cost-effective healthcare providers by removing statutory, regulatory and institutional barriers that prevent APRNs from practicing at the highest level of their education and training.

minnesota aprn coalition1
Minnesota APRN Coalition
  • ALL APRN “roles” are participating
  • Several active working groups
  • Participated in NCSBN APRN Summit
  • Bill authors recruited; Statute language drafted
  • Strategy developing
suggested statute changes
Suggested Statute Changes
  • Eliminate written prescribing agreement
  • Second license
  • Delete “collaborative management” language
  • Practice to fullest extent of education & training
  • New credential designation

National Council of State Boards of Nursing

  • Excellent resource
  • APRN Summit in January
  • Toolkit for implementation of IOM / Consensus Model recommendations
  • APRN Video: