Consensus Model for APRN Regulation: Licensure, Accreditation,
Certification and Education

Background: The Consensus Model was developed over four years by a group of Advanced Practice Nursing (APRN) organizations including representation by several nurse practitioner organizations, clinical nurse specialists, nurse anesthetists and ACNM.  The group, known as the Joint Dialogue Group, included accreditation and certification organizations, as well as membership organizations and the National Council of State Boards of Nursing (NCSBN).  The document has been endorsed by 44 national nursing organizations including ACNM, the American Midwifery Certification Board (AMCB), and the Accreditation Commission for Midwifery Education (ACME).  The purposes of the document are to:

• Promote common definitions related to APRN roles

• Establish a set of standards that protect the public and improve access to safe, quality APRN care
• Improve mobility for APRNs state to state
• Strive for harmony and common understanding in the APRN regulatory community

Implementation: Nursing organizations are beginning to make changes in their educational standards, criteria for certification, and criteria for accreditation in order to better align with the recommendations in the Consensus Model. In addition, many state boards of nursing (BONs) are changing the regulations that govern the licensing of APRNs in order to comply with the recommendations in the model. In 44 jurisdictions, CNMs are regulated by BONs, including 5 in which they are jointly regulated by Boards of Nursing and Boards of Medicine; whereas in the remaining states they are regulated by Boards of Midwifery, Boards of Health, or Boards of Medicine.

The midwifery certification process (governed by the American Midwifery Certification Board)already aligns with the recommendations in the Model, as does our accreditation process (governed by the Accreditation Commission for Midwifery Education). Most nurse-midwifery education programs are already in alignment with the Model; however, a few programs are in the process of assuring that their graduates will have three separate graduate level courses in advanced health assessment, physiology/pathophysiology and advanced pharmacology as recommended in the Model.

Opportunities: The Model consistently insists that APRNs be licensed as "independent practitioners", and further affirms that they have "no regulatory requirements for collaboration, direction or supervision" (p. 13). This language will be very helpful in making changes in regulations in states where CNMs are still required to have collaborative arrangements with physicians.

The Model recommends that all BONs have APRN advisory committees which include one member of each of the four APRN roles, CNM, CRNA, NP, and CNS. It further recommends that there be at least one APRN on every BON. This opens the door for CNMs to have more representation and input to the majority of the boards that regulate them.

In order to separate APRNs from Boards of Medicine, the Model states that Boards of Nursing will be "solely responsible for licensing APRNs"…"except in states where state boards of nurse-midwifery or midwifery regulate nurse-midwives or nurse-midwives and midwives jointly." This provides an opportunity for midwives to establish boards of midwifery without opposition from nursing.

Concerns: Because the majority* of APRNs are Nurse Practitioners, many state BONs may loosely interpret the recommendations in the Model and insert new language in their regulations that are valid for NPs but are incorrect for CNMs. For example, NPs must have documented 500 hours of clinical experience during their educational program in order to sit for their national certification exams, and this language is now appearing in some states' licensing regulations as a requirement for all APRN licenses, including CNMs—even though the Consensus Model does not support or recommend this change. This confusion may have been further exacerbated by imprecise statements included in an article on the Consensus Model that was recently published in the American Journal of Nurse Practitioners, which ACNM and the American Association of Nurse Anesthetists have called to the attention of AJNP editors.

Another incorrect interpretation that has arisen is that some BONs have asserted that all APRNs must hold a Masters in Science in Nursing. The Consensus Model does not require an MSN for CNMs. Click here to access a sample letter to regulatory boards that provides clarity as to what the Consensus document recommends on this issue.

Recommendations: In short, while the LACE Consensus Model included a number of very positive recommendations and ACNM believes that the Model will generally provide benefits to CNMs and all APRNs, it has created a highly dynamic environment in which there are opportunities for improvements as well as setbacks if misinterpreted.

ACNM recommends that ACNM state leaders and midwifery advocates:
1. Become familiar with the Consensus Model by reading the complete document and by monitoring this webpage and ACNM’s LACE Consensus Model FAQs
2. Monitor what steps are being taken by your regulatory boards. Be vigilant for opportunities for improved regulations for midwifery as well as for interpretations that are incorrect or could be adverse for CNMs.
3. Volunteer for your state regulatory board when a position becomes open. CNMs should be represented on BONs in the 44 jurisdictions in which CNMs are regulated and/or jointly regulated by BONs.

*approximate numbers: 140,000 NPs
55,000 CNSs
40,000 CRNAs
11,000 CNMs

Resources

• Report: Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education - July 7, 2008
  
  
• ACNM/LACE Stakeholders PowerPoint presentation - August 2009
  description of Consensus Model recommendations presented to ACNM Chapter Chairs, Legislative Contacts, Division, Section and Committee chairs, and the Directors of Midwifery Education (DOME)
  
  
• ACNM/LACE teleconference (podcast) - August 2009 (members only)
  Recording of presentation and discussion
  
  
• ACNM Endorsement Letter
  from ACNM President to Joint Dialogue Group, stating our concerns about the Model
  
  
• Letter to ACNM Members
  from ACNM President regarding Consensus Model
  
  
• FAQs
  For members; updated regularly in response to questions that have arisen.
  

For more information, please contact us at: laceqa@acnm.org.

back to State Policy page