In the second edition of their text, Nursing: Scope and Standards of Practice (ANA, 2010b), six standards of practice and 16 standards of professional performance are described. Of the 22 standards, one standard outlines additional expectations for APNs compared with RNs; Standard 5, “Implementation,” addresses the consultation and prescribing responsibilities of APRNs . Each standard is associated with competencies. It is in the description of the competencies that RN practice is differentiated from APNs and nurses prepared in a specialty at the graduate level. This document is must reading for APN students, practitioners, and others wishing to understand how basic, advanced, and specialized practice differ. In addition to these documents, ANA, together with the American Board of Nursing Specialties (ABNS), convened a task force on CNS competencies. For many reasons, including the recognition that developing psychometrically sound certifications for numerous specialties, especially for clinical nurse specialists (CNSs), would be difficult as the profession moved toward implementing the APRN Consensus Model, the ANA and ABNS convened a group of stakeholders in 2006 to develop and validate a set of core competencies that would be expected of CNSs entering practice (National Association of Clinical Nurse Specialists [NACNS]/National CNS Core Competency Task Force, 2010). This group was charged with identifying core, entry-level competencies that are common in CNS practice, regardless of specialty. This work is discussed later in this chapter in the section on NACNS. ANA continues to make numerous contributions to promoting clarity about all nursing roles, including advanced practice nursing. Its definitions of expansion, specialization, and advanced practice have remained consistent over time. ANA's Nursing: Scope and Standards of Practice (2010), should inform theoretical and empirical work that aims to differentiate nursing roles • _American Association of Colleges of Nursing Over the last decade, the AACN has undertaken two nursing education initiatives aimed at transforming nursing education . In 2006, AACN called for all APN preparation to take place at the doctoral level in practice-based programs (DNP), with master's level education being refocused on generalist preparation for roles such as clinical nurse leaders (CNLs) and staff and clinical educators. CNLs are not APNs (AACN, 2005, 2012a; Spross, Hamric, Hall, et al., 2004) and, therefore, are not included in this discussion of conceptualizations. Through these initiatives, and to the extent that the AACN and Commission on Collegiate Nursing Education (CCNE) influence accreditation, the DNP may become the preferred degree for most APNs, although this goal is controversial. Since the last edition, despite lingering disagreements, DNP education has advanced considerably. In 2006, there were 20 DNP programs; in 2011, there were 182. Similarly, enrollments in and graduation from DNP programs have also risen substantially (AACN, 2012). The DNP Essentials (AACN, 2006) are comprised of eight competencies for DNP graduates (Box 2-2).
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