APNA Position: LACE Recommendations

Summary

The American Psychiatric Nurses Association (APNA) and the International Society of Psychiatric Nurses (ISPN) convened a Joint Task Force to review the “Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education” and make recommendations on changes needed to position psychiatric-mental health nursing (PMHN) to follow the new model. This resulted in a 2010 presentation at the APNA 24th Annual Conference and subsequent distribution of the recommendations to APNA membership for comment. In 2011, the APNA Board of Directors adopted the report as the official position of the APNA. The following provides information regarding the Consensus Model and the APNA/ISPN recommendations.

Introduction

There is general agreement among nurses and nursing organizations that the system of licensure, accreditation, certification and education for advanced practice registered nurses is confusing. There is an absence of uniformity that impedes nursing’s advancement as a profession and its ability to meet the emerging changes of the healthcare system. The need to reduce the issues associated with the inconsistency of rules, policies, and standards resulted in the development of the “Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education” (2008). The model has been adopted by  48 national nursing organizations and national accrediting and certification bodies such as the Commission on Collegiate Nursing Education (CCNE), National League for Nursing Accrediting Commission, Inc. (NLNAC), and the American Nurse Credentialing Center (ANCC). The National Council of State Boards of Nursing (NCSBN), which is comprised of directors from state boards of nursing, is fully committed to its implementation.

APNA participated in the development of the Consensus Model, embraces the model’s goals, and stands with our colleagues in nursing in support of the model. However, the APNA Board of Directors also understands that existing PMH-APRNs are comprised of four separate certifications. APNA has and will continue to advocate that the plan’s implementation move forward in a manner that does not compromise existing licensed and certified PMH-APRNs, now or in the future.

To that end, APNA convened a special task force in partnership with ISPN to study the Consensus Model and make recommendations for its implementation. Those recommendations were presented by the Task Force at the APNA 24th Annual Conference and were made available on the APNA website along with an FAQ (APNA, 2011). These recommendations are directed at the future development of PMH-APRNs.

An essential aspect of the recommendations is the recognition that currently licensed and certified PMH-APRNs are qualified now and that their ability to practice in the future is protected by a grandfathering provision. The Consensus Model calls for each State Board of Nursing to “institute a grandfathering clause that will exempt those APRNs already practicing in the state from new eligibility requirements” (2008, p.15).

The Consensus Model document defines ‘Grandfathering’ as a: “Provision in a new law or regulation exempting those already in or a part of the existing system that is being regulated. When states adopt new eligibility requirements for APRNs, currently practicing APRNs will be permitted to continue practicing within the state(s) of their current licensure” (2008, p.15).

Grandfathering is based on the ability of the APRN to show current certification. ANCC’s current policy is to continue to offer nurses, including APRNs, with a current ANCC certification the ability to renew their certification through professional development and practice hours even when a certification examination is retired (ANCC, 2026).

The area that saw an immediate impact of the recommendations is in the graduate schools of nursing. In the year 2000, after the introduction of the PMH-NP exam and then the PMH-Family NP exam, programs began migrating toward an NP platform. By 2009, 84% of all new PMH-APRN certifications were PMH-NP (APNA, 2014).  As of 2014, all new psychiatric-mental health APRNs are certified as PMH-NPs across the lifespan (ANCC, 2025; Phoenix & Chapman, 2020). All accredited graduate programs in psychiatric-mental health nursing are now offered as an NP. APNA believes that PMH-APRNs share a common scope of practice and that existing faculty, whether licensed as PMHCNS or PMHNP, have the required competencies to continue in their role (APNA, 2025b).

The recommendations promote a uniform approach for entry to practice so that PMH-APRNs will have the full scope of practice to address psychiatric-mental health needs across the lifespan. Post-master’s certificates in specialized areas, such as child and adolescent, can lead to additional certification but under the Consensus Model, there is no need for additional licensure in the specialty area.

APNA/ISPN Recommendations for Implementing APRN Consensus Model

• That there is one entry educational focus for the future: PMHNP with preparation across the lifespan, addressing mental health promotion and mental illness diagnosis and treatment.
• That currently licensed and certified PMH APRNs who complete requirements to re-certify will be permitted to continue practicing under their current license and certification.
• That didactic curriculum content address the assessment and diagnosis, age-specific interventions, and mental health needs and issues across the lifespan. This includes the three P’s (advanced pharmacology, physical assessment, physiology/pathophysiology) and the PMH-specific content, including psychotherapeutic modalities (the fourth P).
• That during supervised practica, students will provide psychiatric-mental health services across the lifespan. For more on this, see existing APNA Guidance Regarding Precepting and Mentorship (APNA, 2025a). An essential outcome of educational preparation is demonstration of entry level competence in psychotherapeutic modalities. In addition to prescriptive practice, PMH-APRNs must be prepared in multiple psychotherapy modalities to meet the needs of individuals and families, including group therapy.
• That in addition to traditional mental health settings, clinical experience in various settings is encouraged for the purpose of promoting integrated and collaborative healthcare.
• The minimum number of clinical hours will need to be sufficient for entry level competence across the lifespan.
• That graduates be eligible for the certification examination through role of Certified Nurse Practitioner in the population of Psychiatric-Mental Health (PMHNP). After certification and appropriate state credentialing, graduates will be able to provide psychiatric-mental health services across the lifespan.
• That in recognition of the substantial changes that the implementation of the Consensus Model will have on psychiatric-mental health nursing, a reasonable amount of time to successfully initiate and complete the transition is required.

Approved by the APNA Board of Directors February 18, 2011. Reviewed February 2020, February 2022. Updated February 2023, April 2026.

References

American Nurses Credentialing Center (2026). ANCC Certification Handbook. https://www.nursingworld.org/globalassets/certification/ancc-certification-handbook.pdf

American Nurses Credentialing Center (2025). Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC^TM). https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

American Psychiatric Nurses Association (2011). APRN Consensus Model and FAQs. https://www.apna.org/about-psychiatric-nursing/about-pmh-aprns/aprn-consensus-model/

American Psychiatric Nurses Association (2025a). APNA Guidance Regarding Precepting and Mentorship. https://www.apna.org/resources/apna-guidance-regarding-precepting-and-mentorship/

American Psychiatric Nurses Association (2025b). APNA Position: Psychiatric-Mental Health Advanced Practice Nurses. https://www.apna.org/pmh-aprns-position-statement/

American Psychiatric Nurses Association (2014). PMH NP and CNS Shared Role [Presentation].

APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee (2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. https://www.ncsbn.org/public-files/Consensus_Model_for_APRN_Regulation_July_2008.pdf

Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of psychiatric nursing, 34(5), 370-376.