Avoiding Liability Bulletin – April 15, 2016
As you probably know, states retain the power and authority through their respective constitutions to regulate many things, including the practice of nursing and advanced practice nursing. This authority is especially important in the regulation of health professions in order to ensure that the citizens of the state receive competent and safe health care.
However, one of the drawbacks of the “state sovereignty” doctrine is states are free to utilize different titles for advanced practice nurses. As an example, Iowa requires the nurse practitioner to use the title “ARNP” (Advanced Registered Nurse Practitioner) for its nurse practitioners.1 Other examples abound, including “CNP” (Certified Nurse Practitioner).
This is not a new phenomenon. The history of your specialty’s title and practice development since its title inception in the 1960s was constantly changing.1 As the specialty developed and spread throughout the United States and beyond, additional titles were utilized: ”physician extenders”, “physician associate”, and “mid-level provider”.1
None of these titles sat well with nursing since the designations did not accurately describe your advanced practice.
In 2015, The National Council of State Boards of Nursing (NCSBN) has, through its member boards of nursing, adopted as a model law an APRN Compact and Rules for states to enact through their state legislatures. The Compact would provide uniform legislation regulating advanced nursing practice and allow an advanced practice nurse with a multistate license the privilege to practice seamlessly in other compact states.2
The Compact also provides for a uniform titling of all categories of advanced practice registered nurses (APRN): CNS (clinical nurse specialist), CNP (certified nurse practitioner), CRNA (certified registered nurse anesthetist), and CNM (certified nurse midwife). Specific elements of the four roles are also specified in the Compact and Rules.1
The adoption of the APRN Compact by respective states is still in progress, albeit in different phases. For a complete overview of its progress, you can read a comprehensive article that appears in the Journal of Nursing Regulation.3
The Compact is an essential development for your practice as an APRN. It is hoped that with its passage by the states, your practice will be uniformly regulated regardless of the state in which you provide care to your clients. Moreover, the privilege to practice in other Compact states, whether telephonically or personally, will be a great benefit, both to you and to your patients.
If your state is not yet a member of the Compact, research information about it through on-line articles, discuss the Compact with your colleagues, dialogue with your professional nursing association’s members, attend your board of nursing meetings to identify its stand on the Compact, and personally evaluate the benefits of the Compact on your nursing practice.
Contact your state legislators and ask for their support of the legislation and model rules. Participate in grass roots programs for its passage. Educate the public about your role as an APRN and what this legislation can do to ensure safe and competent care.
1. Rebecca Fotsch (2016), “What’s In A Name Change: Legislative Challenges With APRN Title Change”, 6(4) Journal of Nursing Regulation, 73-74 (available athttp://journalofnursingregulation.com/article/S2155-8256(16)31006-7/fulltext ).
2. National Council of Boards of Nursing website at: https://www.ncsbn.org/aprn-compact.htm.
3. Maureen Cahill, Maryann Alexander, and Lindsey Goss, “The 2014 NCSBN Consensus Report On APRN Regulation”, 4(4) Journal of Nursing Regulation, 5-12. (available at: journalofnursingregulation.com, click on “Articles and Issues”).
THIS BULLETIN IS FOR EDUCATIONAL PURPOSES ONLY AND IS NOT TO BE TAKEN AS SPECIFIC LEGAL OR ANY OTHER ADVICE BY THE READER. IF LEGAL OR OTHER ADVICE IS NEEDED, THE READER IS ENCOURAGED TO SEEK SUCH ADVICE FROM A COMPETENT PROFESSIONAL.