In the Consensus Model for APRN Regulation, Should the Adult-Gerontology Population Foci be Combined?

Article Outline

• Support for Combining the Adult/Gerontological Foci
• Rationale Against Combining the Adult/Gerontological Foci
• Copyright

B. Darlene Byrd, MNSc, APN, CPC, is a certified family nurse practitioner, a certified professional coder, and the owner of APN HealthCare. She has 20 years' experience in nursing, with the last 12 years as an APN in family practice and occupational health care. She holds a BA from Ouachita Baptist University in Arkadelphia, AR, and a BSN and MNSc from the University of Arkansas for Medical Sciences. She has worked in health policy and regulations through her involvement in professional organizations on the national, state, and local level since 1997. In 2002, she received a governor's appointment to the Arkansas State Board of Nursing and is currently in her second term. She is also a member of the National Council of State Boards of Nursing APRN Committee and serves on the National Advisory Committee for Rural Health and Human Services.

M.J. Henderson, MS, RN, GNP-BC, is an assistant professor and gerontology coordinator at the Massachusetts General Hospital Institute of Health Professions. She graduated from Boston University in 1986 with an MS in the GNP track. She has lived and worked in both Canada and the United States, has enjoyed a varied career in nursing education and clinical practice, and currently works in a rheumatology practice in Providence, RI. She is a past president of the Gerontological Advanced Practice Nursing Association (formerly the National Conference of Gerontological Nurse Practitioners) and is the current co-chair of the ACNP PAC. She is active on the conference planning committees for NONPF and ACNP and is a member of Sigma Theta Tau (Theta Chapter), the American Geriatrics Society, and the International Council of Nurses APN group.

The lack of a uniform regulatory model for advanced practice nurses has been a source of confusion and burden. After 4 years, the National Council of State Boards of Nursing APRN Advisory Committee and the APRN Consensus Work Group completed the Consensus Model for APRN Regulation (www.ncsbn.org) in July 2008. This historical document defines APRN practice, describes the APRN regulatory model, identifies the titles to be used, defines specialty, describes the emergence of new roles and population foci, and presents strategies for implementation.

This model of the future states that APRN licensure may not occur at the specialty level but must occur at the role/population focus level. The model defines four APRN roles and 6 population foci (family, neonatal, pediatrics, women's health, psychiatric/mental health, and adult-gerontology). Combining adult-gerontology into one population focus rather than 2 separate foci remains an area of debate.

What do you think? Contact Editor Janet Selway at janet.selway@gmail.com if you would like to comment on this matter.

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Support for Combining the Adult/Gerontological Foci 

B. Darlene Byrd

There are a couple of things to remember when answering this question. First, the Consensus Model is a look at the future regulation of advanced practice nursing. Second, an unprecedented group of licensure, accreditation, certification, and education representatives came together to develop this consensus.

As a very important sector of health care consumers, the geriatric population is growing with the aging of the baby boomers. Currently, gerontology is covered in the curriculum of 2 population foci, family and adult. Although the depth of study may not match that of the current gerontology curriculum, it is the consensus that the future adult/gerontology curriculum adds depth and emphasis for the care of the geriatric patient. This would eliminate duplication of curriculum in the population foci and provide a larger workforce of health care providers to care for this growing sector of our population. It does not eliminate the possibility of an APRN to subspecialize in gerontology; however, this would be beyond the basic education and certification for APRN licensure.

Currently, the scope of practice of a geriatric APRN is limited to a defined age group that varies with the certifying bodies. The variation of definitions poses problems for the board of nursing (BON) and the individual APRN. For the BON, the concerns are in regard to scope of practice discipline and public safety. For the individual APRN, the concern is the lack of mobility in cases of burnout, relocation, or loss of employment. The combined adult-gerontology APRN population foci and certification will address both concerns. The BON will have one definition for scope of practice and administrative hearings, and the APRN will have greater job mobility and opportunity for employment. In time, this will be a win-win-win for regulation, for the profession, and for the geriatric patient.

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Rationale Against Combining the Adult/Gerontological Foci 

M.J. Henderson

The frail older adults in our society are a very special group of people. They are a growing population with health care needs that demand special attention on all levels, much like the neonatal population. Older adults need their providers to have a specialized education and clinical experiences in order to provide appropriate and safe care. When one lumps adult and gerontological NP content into one curriculum, the focus is disparate and much is missed as a result. If universities do not educate pure GNP specialists, who will teach the next generation of GNPs? Nursing students will not receive the best education available without advanced practice nursing educators who have expertise in gerontological advanced practice nursing.

Some will argue that, with a combined adult/gerontology model, more NPs will be exposed to the world of gerontology and hence the care of older adults will be better. That is debatable. Students need good GNP role models to learn safe, effective practice. If faculties are forced to teach content in which they have no expertise, the resulting education will not be of the caliber of a specialized program, and the students lose. More importantly, our geriatric patients lose. Whom do you want taking care of your 96-year-old mother?