The Evolving Role of the NP

The Evolving Role of the NP
The role of the NP has evolved dramatically over the course of the last 50 years. The
evolution of the role is impacted by changes in legislation affecting licensure, credentialing,
scope of practice, and educational requirements. Choose a legislative issue related to the
role of the NP and describe this for your colleagues. How does this issue impact the scope of
practice for NPs? What changes might this issue catalyze? Describe the implications of the
DNP credential in regard your selected issue.
Include a minimum of 4 reference at the end of this section.
SECTION B (2 pages minimum)
The Consensus Model/LACE
The Consensus Model was developed with the idea of uniform regulation of NPs across the
United States. Review the document Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification and Education (NCSBN, 2008). The document will be uploaded
in the file section for the writer.
Evaluate the proposed model. What are the strengths and weaknesses of the Consensus
Model? Consider the implications, as well. How might this model impact competition
and/or collaboration between NPs and physicians in the U.S. health care system?
Include a minimum of 4 reference at the end of this section.


The Evolution of the Role of the NP

SECTION A: The evolving role of the NP
The chosen legislative issue is the expansion of the scope of practice of the Nurse
Practitioners (NP). The scope of NPs should be expanded and NPs actually qualify for
independent practice – they should be allowed to practice independently without being
supervised or directed by a physician. NPs are registered nurses with a postgraduate degree in
nursing – commonly a master’s degree. In many states, scope-of-practice laws give Nurse
Practitioners the ability to carry out various primary care services which might be delivered
whenever people make an initial approach to a nurse or physician for treatment and continuing
care for chronic illnesses (Cassidy et al., 2014).
With an envisaged shortage of primary care as the population continues to increase and as
millions of Americans become newly insured beginning the year 2014, it is imperative to expand
the role of NPs in a lot more areas and to permit them to deliver a broader range of acute as well
as preventive healthcare services (Vestal, 2013). Some groups of physicians are against the
expansion of NPs’ scope of practice because of concerns over safety of patients. This
controversy mostly plays out in state capitals, in which legislators and medical boards determine
scope of practice for professionals who are not physicians, such as NPs. In addition, there are
concerns and worries at the national level that bear on the ability of NPs to be reimbursed for the
care they deliver (Cassidy et al., 2014).
NPs are essentially prepared in master’s degree programs and they are typically team-
trained together with medical students and they share similar course work, patient rounds, in
addition to other on-site clinical experiences. Studies have indicated over and over again that

NPs, within their level of training, provide cost-efficient, quality treatment of common diseases
as well as management of minor chronic disorders. Studies have also shown that NPs are as
competent as doctors in carrying out a common endoscopic screening test for cancer of the colon
(Yee et al., 2013).
The chosen issue impacts the scope of practice for Nurse Practitioners in that it advocates
for the expansion of the scope of practice for NPs. The change that this issue may catalyze is
allowing nurse practitioners to practice independently to the full scope of their capabilities
without being under supervision of physicians. In essence, the critical shortage of primary care
providers might actually make the appointment of a physician hard to come by (American
Association of Colleges of Nursing, 2014). Some states are attempting to fill the shortage of
doctors in primary care with nursing staffs that have advanced degrees in family medicine. This
calls for relaxing of old medical licensing limits, understood as scope of practice laws, which are
preventing these NPs from playing the lead role in the delivery of basic health services. They
should be allowed to work without a supervising doctor (Vestal, 2013).
A Doctor of Nursing Practice (DNP) is basically designed for nursing staffs who are
seeking a terminal degree in nursing practice. DNP-prepared nurses are properly equipped to
execute fully the science developed by nurse researchers. For the selected issue, the implication
of the DNP credential is that DNPs will help in designing and providing care for diverse
populations. This is necessitated by the quick expansion of knowledge underpinning practice,
countrywide concerns regarding patient safety and the quality of care; the complexity of patient
care; as well as shortages of faculty and personnel (Yee et al., 2013).


American Association of Colleges of Nursing. (2014). Expanded Roles for Advanced Practice
Nurses. Available at
(Accessed November 22, 2014).
Cassidy, A., Aiken, L. H., Bodenheimer, T. S., Agres, T., Schwartz, A., & Dentzer, S. (2013).
Health Policy Brief: Nurse Practitioners and Primary Care. Health Affairs.
Vestal, C. (2013). Nurse Practitioners Slowly Gain Autonomy. Kaiser Health News.
Yee, T., Boukus, E. R., Cross, D., Samuel, D. R. (2013). Primary Care Workforce Shortages:
Nurse Practitioner Scope-of-Practice Laws and Payment Policies. National Institute for
Health Care Reform, 13.


SECTION B: The Consensus Model – LACE

The Consensus Model for ARPN Regulation is essentially the product of considerable
work carried out by the ARPN Consensus Work Group and the NCSBN APRN Advisory
Committee. It is a consistent model of regulation for the future of advanced practice nursing and
was actually designed for the purpose of aligning the interrelationships amongst licensure,
accreditation, certification, as well as education (LACE). The 4 main roles of advanced practice
registered nurse as specified in the Consensus Model document include the following: certified
nurse-midwife; certified nurse practitioner; clinical nurse specialist; and certified registered nurse
anesthetist (American Association of Colleges of Nursing, 2013).
Strengths and weaknesses of the Model: it is expected that the clarity and consistency
resulting from this regulatory model would benefit individual nursing staff members and enhance
patient care. The uniformity that is anticipated to be produced from this model may enable
advanced practice registered nurses to practice to the full extent of their licensure and education
(Summers, 2011). Additionally, the more consistent system would offer opportunities for nursing
staffs through the likelihood of ease of mobility across state lines. As implementation of the
Consensus Model is carried out in every state across the country, it would ensure that the
advanced practice registered nurse profession keeps on growing and meeting the demands of
changing healthcare (American Nurses Credentialing Center, 2014).
Moreover, the model also ensures the scope of practice of APRN is used to its fullest
extent. Equally important, the Consensus Model will also ensure that accreditation, licensure,
education, as well as certification are uniform throughout all states in America for advanced
practice registered nurses (American Nurses Credentialing Center, 2014). The other benefits of

the Conceptual Model are as follows: it ensures public safety; it increases access to healthcare; it
advocates appropriate scope of practice; and it facilitates mobility of advanced practice nurses.
The Model is basically designed to raise the responsibility of advanced practice registered nurses
and increase satisfaction with work through opportunities to practice more autonomously
(American College of Nurse-Midwives, 2014). Even though this Model consists of several
highly positive recommendations and is believed that it would provide benefits to nurse
practitioners and advanced practice registered nurses, it has actually created a very dynamic
environment wherein there are opportunities for improvements and setbacks if misinterpreted.
The Consensus Model might impact competition and/or collaboration between physicians
and NPs in America’s healthcare system considering that it provides APRNs with opportunities
to practice independently with doctors. It impacts competition between physicians and APRNs
since APRNs will also launch their own practice in an effort to address the problem of doctor
shortage thereby competing with physicians for clients and patients. The Model establishes
various standards which are aimed at protecting the public; improving access to quality, safe
advanced practice registered nurse care; and improving mobility. American Nurses Credentialing
Center (2014) pointed out that the Consensus Model emphasizes that advanced practice
registered nurses should be licensed as autonomous practitioners. It also claims that APRNs do
not have any regulatory requirement for direction, collaboration, or supervision. The Model
impacts collaboration in that it does not foster the collaboration of a qualified physician with
nurse practitioners. In essence, it stipulates that advanced practice registered nurses are not
required by law to collaborate with physicians, and not to be supervised or directed by physicians
(Summers, 2011).


American Association of Colleges of Nursing. (2013). APRN Consensus Process. AACN
American College of Nurse-Midwives. (2014). Consensus Model for ARPN Regulation:
Licensure, certification, accreditation, and education.
Accreditation-Certification-Education . (Accessed November 22, 2014).
American Nurses Credentialing Center. (2014). Consensus model for APRN regulation. ANCC
Summers, L. (2011). Taking stock of the consensus model. The American Nurse. American
Nurse Association.

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