What is the Model Act and What Does It Mean for Me?

I have practiced as a nurse practitioner in several different states. When I moved from Missouri to Maine several years ago, I discovered that I was now competent to practice independently and to write prescriptions for controlled substances (CS). In Missouri, the regulatory board had ruled that NPs couldn’t practice without a physician supervisor or write prescriptions for CS. As I’ve participated in the politics of NP practice, I’ve wondered why states vary in their assessment of NP competence. In Missouri, for example, the physicians who sat on the regulatory board for NPs were certain that we couldn’t safely practice independently or write prescriptions for CS. Yet, when I moved to Maine, I learned that the regulatory board had no problem with NPs doing those same things. What accounted for the difference between the two states? Were the NPs in Missouri and Maine somehow different in their knowledge and skills? Or was it simply that the regulations were different? Was I qualified and adequately trained to practice independently and prescribe CS safely and effectively or was I not?

Right now, NPs must meet the licensing requirements and follow the practice regulations of the state(s) in which they practice. The problem is that these requirements and regulations vary from state to state. So NPs who practice in more than one state or who want to move from one state to another state may need to meet two different sets of criteria and have different roles and responsibilities in the two states. In addition, educational requirements vary from state to state, and some states don’t require national certification in order to be licensed. Some states license NPs and others have an endorsement for the RN license. There is no required consistency of education, certification, or licensure.

This hodgepodge of requirements and regulations should concern us as NPs. We want to establish a reputation of providing safe, effective, competent care. Yet NPs across the country are practicing with varying levels of education and tests of competency. How can we tell the public what NPs are and how well we do what we do when we don’t have a standard that all NPs across the country need to meet? To complicate the picture, each state requires that practicing NPs use a specific title: NPC, RNC, APN, ARNP, and APRN are a few examples. If we find these titles confusing, imagine how baffling this alphabet soup must be to the populations we serve.

In 2004, nurse leaders began what became a 4-year project to help resolve some of these inconsistencies. This effort, known as the Consensus Model for APRN Regulation, was released in 2008 as the APRN Model Act/Rules and Regulations (Model Act).1 The purpose of this undertaking was to establish consistency for advanced practice nurse Licensure, Accreditation, Certification, and Education (LACE). This document was the result of collaborative work of the more than 48 nursing organizations nationwide.

Are you familiar with the Model Act? If not, is it because you assume that this act is of interest only to politically active NPs and those in academia? Or maybe you’re somewhere in the middle: You’ve heard of the document and you’re worried about how it may affect your practice, but you’re not really sure of all the details. The truth is, the Model Act is of importance to all practicing NPs. This act will solidify and clarify who we are as NPs so that we can demonstrate our safety, effectiveness, and competency as healthcare practitioners. If adopted by all states, this act will allow NPs to move from state to state without constraint (if Model Act requirements are met) and it will mean that NPs practicing in a state that has adopted the Model Act will be able to practice independently—without a collaborative practice act or supervision and with full prescriptive privileges. No longer will NPs be competent in one state but not in another if that state has adopted the Model Act. The goal is for all 50 states to adopt the Model Act by 2015.

What does the Model Act entail for practicing NPs? In short, the act requires all advanced practice registered nurses or APRNs to have consistent education in what are referred to as the 3 P’s: advanced physical assessment, advanced pharmacology, and advanced pathophysiology. To meet this requirement, all APRNs will take the same foundational courses. The act also requires that the APRN educational program include ≥500 supervised clinical hours in one’s role and a population focus. Beyond the RN license, one of four APRN role licenses will be issued: certified nurse anesthetist, certified nurse midwife, clinical nurse specialist, or certified nurse practitioner. Licenses are population focused into one of six areas based on one’s education and training: family/lifespan, adult/gerontology, neonatal, pediatrics, women’s health, or psychiatric/mental health. The official designation of NPs nationwide will be standardized as APRN, CNP.

National certification and a graduate degree (but not necessarily a DNP) are the minimum standards. Currently licensed NPs will be grandfathered in the state(s) in which they are currently licensed, regardless of whether or not they meet these requirements. No one's license will be taken away. If NPs (or other APRNs) want to move to another state that has adopted the Model Act, they may need to meet the requirements of the act or take action through education and certification.