Please give a rebuttal to each statement listed below 1) I, too agree that Emily has done a great job of summarizing the LACE model of Consensus. I am pleasantly surprised that the APN groups are trying to get organized so there is consistency. That will be an incredible strength. It sure is not that was for the RN! Unfortunately, my specialty, Informatics, is not included in this process, but I have more to do with the non-living (i.e. a computer!). One that has struck me, and I will follow with a post after I can explore this, is the Implementation Status Map (www.ncsbn.org). I am having difficulty figuring it out, but I would like to see how it aligns with compact states, even though the LACE program calls for the licensing to be universal. I would also like to see if there is a discernible pattern for which states are most supportive (political, number of Level 1 trauma centers, physician saturation, average age of citizen, etc.). The article states that by 2030 “20% of the population will be over 65 years or older” (Stanley, 2012). Does this map reflect the states that are going to need more providers? Is it rural areas that are looking for providers with more autonomy? I had never heard of the LACE program until I read this article, although I do admit to being somewhat confused by many of the credentialing acronyms. This is one the weaknesses that I see: I work on an orthopedic floor and we have advanced practice nurses with different credentials and certifications. There is an orthopedic NP program at Duke and there is an orthopedic certification at the advanced practice level (https://oncb.org/), however, I don’t see that in our NPs. There are “BC” certifications which again, depends on specialty. Are we going to end up with NPs having as many specialty board certifications as physicians? I might get a little muddied. There is the CRNA-that is pretty specific and easy to identify. I think we all know what that is. When we get into CNS, APRN, NP, then, we have adult, Gerontologic, pediatric- the list goes on and I wonder if that is why some of the states are not on board yet. 2) Emily, I agree that clearly defining APRN roles is a major strength of LACE. Also, offering the ability to obtain certification and licensure related to one’s specialty practice is important. As a nursing education major, I was disappointed to see that nurse educators do not fall under APRN nomenclature. However, at DUSON, nursing education majors do take courses in the three P’s – pharmacology, pathophysiology, and physical assessment. (Stanley, 2012) This provides us with a similar foundation of core competencies that LACE recommends, despite not being considered APRNs. Emily did a great job discussing strengths/weakness. One strength that she did not address is LACE ensures that someone who has received APRN licensure is one state would be eligible for licensure in another state. (Stanley, 2012) In addition, Emily mentioned the notion of minimum education for practice. I also believe that this extremely important. This is in contrast to eligibility for RN licensure, in which there are three types of educational preparations: diploma, Associates, and Bachelors. Varied RN preparation leads to gaps in education, whereas APRN is more likely to be standardized across accredited programs. Furthermore, LACE was created within the framework of patient safety. The recommendations from a workgroup comprised of leading experts likely ensure a minimum competency for professional practice across states. I agree that the fact LACE has not been implemented across all states is its major weakness. In addition, it offers no recommendations for graduate prepared nurses in other roles such as informatics, nursing education, health leadership, etc. I acknowledge that the APRN role requires direct patient care but the other non-APRN roles could also benefit from standardization. In my opinion, threats to APRN practice are reduced after the Consensus Model/LACE. Standards of licensure, accreditation, certification, and education undoubtedly strengthen advanced practice nursing.
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