An Introduction to LACE
Most of the questions that come to the APNA Board and staff center on one or more aspects of licensing, accreditation, certification or education, or LACE. Curiosity is good; action would be even better. To say that LACE is confusing and inconsistent is an understatement. In a changing landscape, advanced-practice nurses, those who educate them and those who strive for advanced practice must understand the differences among these terms. As members of this professional organization, you must know how APNA is involved in changes and recognize how you can be involved in improving LACE.
Just to ensure that we are on the same page:
Licensure is how a member of a profession is granted the ability to practice. State agencies and the legislature define advanced-practice nursing, decide who can prescribe and determine the requirements for licensure.
Accreditation is the process of evaluating schools of nursing and their programs nationwide. Accrediting bodies have published essentials for advanced-practice education.
Certification concerns the evaluation of an individual’s knowledge, skills and abilities in a specialty. For most states, one component of advanced-practice licensure is certification. Licensure and certification, however, are separate processes.
Education refers to advanced-practice educational programs at the master’s post-master’s and doctoral levels and is intertwined with certification and accreditation. At this point, psychiatric mental health nurses are educated as either clinical nurse specialists or nurse practitioners. A small number of PMH programs are “blended,” educating nurses as both clinical nurse specialists and nurse practitioners.
How does all this relate to you?
For several years, nursing organizations, including ours, have been meeting to clarify the murky territory of advanced-practice nursing. The product of these meetings, The Consensus Model for APRN: Licensure, Accreditation, Certification & Education, defines advanced nursing practice, describes a proposed regulatory model, identifies advanced-practice titles, defines “specialty,” and describes how new roles and population foci might develop. In October, the APNA Board endorsed this document. To find out more, visit the APRN Consensus Model page.
The lack of consistency and clarity in the titles used to regulate advanced practice nurses at the state level hurts nurses’ ability to move to and practice in different states. Although all of the work cited above represents efforts to clarify and standardize LACE, the regulation of nursing practice is still determined by states’ nurse practice acts and associated rules and regulations.
Imagine how much influence we as a profession could have if each state chapter would set as a goal the gubernatorial appointment of one APNA member to each state board of nursing.