APN Clinical Roles, Evidence-Based Strategies for Achieving Continuity

Background: APN, Licensing, and the Associated Challenges

  • The changing landscape of nursing requires improved services;
  • An assessment of nurses’ skills and competencies is required;
  • A wide range of terms used in APN licensing complicates the understanding;
  • Lack of consistency between regulations in different states reduces nurses’ mobility;
  • Changes to the current APN licensing policies are required.

Licensure, Accreditation, Certification, and Education (LACE) Considerations

  • Licensure: the provision of practice-associated guarantees to an APN;
  • Accreditation: the process of determining the quality of education in different nursing schools;
  • Certification: the assessment of nursing students’ knowledge and skills;
  • Education: the provision of programs aimed at increasing nurses’ proficiency;
  • LACE standards and considerations are different in each state.

LACE for APN Clinical Roles in California

  • Requirements for licensure: completing an in-state program;
  • Requirements for accreditation: attending an accredited program;
  • Requirements for certification: 500 hours of clinical experience;
  • Presence of clinical leadership and clinical research skills;
  • Ability to provide patient education and consultations (“Advanced Practice Nurse requirements in California,” 2017).

LACE for APN Clinical Roles in Illinois and Comparison to California

  • Requirements for licensure: graduate or post-master degree in nursing;
  • Requirements for accreditation: attending an accredited program;
  • Requirements for certification: substantial clinical experience;
  • Application fee of $125 as a necessary component;
  • Applicants from other states must have an official verification (“Advanced Practice Nursing Illinois,” 2017).

LACE for APN Clinical Roles in Washington and Comparison to California and Illinois

  • Requirements for licensure: finishing an approved academic program;
  • Requirements for accreditation: Council on Higher Education Accreditation recognition;
  • Requirements for certification: clinical experience of at least 500 hours;
  • Provision of the application fee for nurses;
  • Certification provided by the National Certification Corporation.

Evidence-Based Strategies (EBS): Continuity between State Regulatory Boards

  • Importance of maintaining continuity between state boards;
  • Use of the existing legal system;
  • Creation of regulations for maintaining the continuity intact;
  • The active promotion of interdisciplinary communication among nurses (Rudner & Kung, 2017);
  • Focus on compromise as the basis for conflict management.

EBS: Enhancing Communication and Reciprocity between Boards

  • Using social media as the means of retaining communication and reciprocity between boards;
  • Promoting interdisciplinary cooperation among boards;
  • Altering the legal standards for cooperation between the boards;
  • Shaping communication values to encourage boards to cooperate;
  • Addressing cross-cultural and economic factors preventing boards from reciprocity.

EBS: Introducing a System of Rigid Standards for Decision-Making

  • A clear and well-developed value system and nursing philosophy across boards;
  • The active promotion of patient-centered values and the focus on improving patient outcomes;
  • Using observations within the community to determine the necessary improvements;
  • Focusing on the needs of all stakeholders, including nurses, to improve the quality of services;
  • Introducing opportunities for nurses to improve their skills and acquire new knowledge;
  • Cooperating to design new educational programs for patients and nurses alike.

Independent NP Practice in Florida: Obligatory Supervision of Physicians as the Current Status Quo

  • The current status: no independent practice for nurses in Florida;
  • The necessity for nurses to be supervised by physicians or other healthcare practitioners;
  • Nurses can monitor patients and introduce changes to drug therapies;
  • Nurses are allowed to run diagnostic tests and define possible therapies for managing patients’ needs;
  • However, nurses must be supervised by physicians (“Advanced Registered Nurse Practitioner requirements in Washington,” 2017).

Conclusion: Addressing Current Issues Related to APN Licensing

  • The lack of clear and uniform standards across boards;
  • The absence of cooperation among members of different boards;
  • Need to introduce more opportunities for nurses to develop crucial competencies;
  • The necessity to offer a more patient-centered approach;
  • The urgency of enhancing communication and collaboration.


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Rudner, N., & Kung, Y. M. (2017). An assessment of physician supervision of nurse practitioners. Journal of Nursing Regulation, 7(4), 22-29.

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