Education and Communication). The APRN Consensus Model document was released in 2008 after approximately 15 years of meetings and discussions with 48 nursing
organization stakeholders. The document, addressing APRN licensure, accreditation, certification, and education requirements also describes the four APRN roles, population foci, and titling. Each participant discussed the numerous components to the Model, and some participants expressed uncertainty with certain Model facts, stating that it would have been helpful to have a summary sheet or guide to which to refer during the interviews.
One participant discussed “town hall” meetings that occurred throughout Delaware. The purpose of these meetings was to educate APNs about the Consensus Model, including the basic components of the Model and the actions of the Delaware Advanced Practice Committee (APC). This participant stated:
I think that there is a gap there, certainly here in Delaware, in terms of the understanding amongst nurses, about what the Model is and what it means for APRNs. We need to move forward with introducing the legislation to adopt the Consensus Model. It really comes down to educating everyone. And I know we've
had the Town Hall educational meetings, and have gone specifically to different healthcare systems across the state, provided education for nurses around the Consensus Model as well as the three Town Halls in each of the counties…and I think part of the challenge is really to simplify the message. Or, it's too much information sometimes, which perpetuates, or even increases the level of confusion out there. So, I think that's really critical, how you simplify it, the
“elevator speech,” so that it makes sense for everyone regardless of whether you're a practicing nurse, or you're a legislator, or a committee member. I think that there needs to be a focus on education and increasing awareness.
In the same vein, another participant commented:
I think that we have made great strides in the last 3 years in getting APRNs more educated and on target. I still feel there are some out there who have
misconceptions about the Model and what it’s going to do as far as their license and current practice is concerned. They're worried about their licenses being renewed and all of that, and being grandfathered.
Another participant commented on the confusion or lack of education regarding population foci component of the Consensus Model:
I know of adult-gerontology nurse practitioners who see kids and family in a walk-in care center, and I also know of a pediatric nurse practitioner who did the opposite. It’s like they’re putting their licenses on the line if they’re doing that because they’re seeing patients outside the population foci that they’re supposed to see. They don’t get it, they don’t understand that…and somebody else who’s
not knowledgeable about the population foci, such as a physician who they might work under saying, “Oh, don’t worry about it. You’re okay. You’re under my malpractice.” Well, yeah, do you really want to put yourself at risk? Especially, yeah you might be under that malpractice for that entity, but you still must abide by your scope of practice.
It stands to reason that if groups of APRNs do not fully comprehend the Model or they find the Model complex or confusing, then non-APRNs are likely to feel equally, if not more, confused or deficient in their understanding of the content. Each Delaware participant discussed the need to educate non-APRN stakeholders, especially physicians and policymakers, regarding the Model. A participant commented that
physician-opponents are chiefly interested and concerned about the collaborative agreement piece.
From this legislator’s experience, physician-opponents were not knowledgeable about the majority of the Model’s content, including licensure, accreditation, certification, and education (LACE) and title components. However, any Model content pertaining to independent practice, including no longer requiring a state-regulated collaborative agreement, elicited a negative reaction. The following comment captured this sentiment:
With educating physician groups, in order to get the buy-in, or to address their concerns, it might be something where it’s a two-step process. You’ll do half, and then the other half. Kind of like a few years ago, when APRNs weren’t allowed to prescribe. But through the collaborative agreement piece, certain increases in autonomy occurred. It’s like a step-by-step process sometimes, instead of the adopting the whole change at once.
Several participants discussed concerns regarding physicians misinterpreting components of the Model. Specifically, one participant raised concerns that some physicians may be confused or fearful regarding a perceived expansion of current APN roles and perhaps the elimination of certain physician roles. The participant commented:
It’s a lack of understanding of the interprofessional roles. Between the professions. In our roles, there’s a big overlap in skills with APRNs and
physicians. There’s overlapping knowledge bases, but in terms of complex cases, the physician may have a better knowledge base than I do.
Patients are also Model stakeholders and a CAS. Although most of the Model education discussion revolved around APRNs, physicians, and legislators, some
participants discussed educating the public and what implementing the Model means for patients, as expressed by this participant:
I think other stakeholders don’t understand the Model. Again, it goes back to the education piece. Why should we do this? The biggest communication I think needs to say, “We’re standardizing terminology. We’re making it understandable.
That in this state, an APRN is the same thing as an APRN there, and in that state too.
Subtheme 3: Inadequate relationships with change agents (Legislators)