The Colorado APN: Sorting Out The Confusion
Author: Annette Cannon, PhD, MA, RN, MSN
Advanced nursing practice in the state of Colorado is described as a registered professional nurse who is currently licensed to practice in the State of Colorado and who meets the qualifications established by the Nurse Practice Act (CDHCPF, 2008). The Colorado State Board of Nursing (CSBON) identifies those who fall under the title of Advanced Practice Nurse (APN), as being a nurse who is listed in the advanced practice registry. Within the advanced practice registry, a nurse can use the title of APN or can use other titles of CNM (Certified Nurse Midwife), NP (Nurse Practitioner), CNS (Certified Nurse Specialist) or a CRNA (Certified Registered Nurse Anesthetist) if the board has given them authorization to do so.
To be included into the advanced practice registry, the nurse must meet the requirements. The Nurse Practice Act states requirements for those who were recognized as APNs on and after July 1, 1995 until July 1, 2008, were to either pass a nationally accredited education program for APN or pass a national certification exam. The new requirements, which start on July 1, 2008, state that the nurse must successfully complete a graduate degree in the appropriate specialty to be in the registry. It also notes that those who were in the registry previously, prior to June 30 that have not completed the degree. On all APN applications found on the CSBON website, they now state that a Master’s degree is required on or after July 1, 2008.
The basic requirements for APNs are the same. It states that all applicants must hold a current and valid Colorado Registered Nurse license, in good standing and without discipline OR a valid multi-state Compact Registered Nurse license in good standing, without discipline (Colorado Division of Regulations, 2008). However, it also states that each application requires its own documentation. Further down on each application, the requirements change to fit the discipline.
The requirements for the CNS and NP are different from that of the CRNA and CNM, noting a further difference in requirements for the CNS and NP. For example, all applications require the documents submitted, be original and come from the applicant. Both the CNS and NP applications require verification (official transcripts) from a CNS Program or NP Program that was passed successfully or verification of a national certification as a CNS or NP. However, in looking at the scope of practice for these two roles, there is a noted difference.
The application for the CNS identifies the area of practice as the focus of the CNS program or the area in which you are certified. For the NP, it states that the area of practice for the Nurse Practitioner (NP) is the focus of the NP program (for example: FNP, PNP, GNP, WHNP) or the area in which you are certified (CDR, 2008). The CRNS and the CNM applications are different in that they only require official verification of the certification and require that it comes directly to the BON through the mail or email from the certifying body.
The Nurse Practice Act also states what the practice of professional nursing means
…the performance of both independent nursing functions and delegated medical functions in accordance with accepted practice standards. Such functions include the initiation and performance of nursing care through health promotion, supportive or restorative care, disease prevention, diagnosis and treatment of human disease, ailment, pain, injury, deformity, and physical or mental condition using specialized knowledge, judgment, and skill involving the application of biological, physical, social, and behavioral science principles required for licensure as a professional nurse pursuant to section 12-38-111 (Nurse Practice Act, 2008).
The practice act also describes what services are included in this practice, such as evaluating health status, health teaching, counseling, therapy, evaluation and treatment. It addresses those nurses whose license has been suspended, revoked or expired and that practice would be unauthorized in these cases.
The Colorado Department of Health Care Policy and Financing (CDHCPF) gives a definition of a nurse/nurse practitioner as a registered professional nurse who is currently licensed to practice in the State of Colorado and who meets the qualifications established by the Nurse Practice Act and defines a nurse midwife as a registered professional nurse currently licensed to practice in the State of Colorado who meets the following requirements: is certified as a nurse-midwife by the American College of Nurse-Midwives; is authorized under state statute to practice as a nurse-midwife; and whose services are rendered pursuant to the Colorado Medical Practice Act (CDHCPF, 2008). The Nurse Practice Act states that a certified nurse midwife shall practice in accordance with the standards of the American college of nurse-midwives including, but not limited to, having a safe mechanism for consultation or collaboration with a physician or, when appropriate, referral to a physician (Nurse Practice Act, 2008).
In addition, the Nurse Practice Act covers the scope of prescribing privileges in the state. These rules are more extensive in nature than the others previously mentioned. To obtain prescribing privileges, it is required that an advanced practice nurse who is listed on the advanced practice registry, have a license in good standing without disciplinary sanctions issued pursuant to section 12-38-111, and fulfill requirements established by the board pursuant to this section may be authorized by the board to prescribe controlled substances or prescription drugs as defined in article 22 of this title (Nurse Practice Act, 2008). The Act lists the rules added to this section, which include description of types of persons who can be prescribed prescription drugs and controlled substances and gives some legal coverage of actions under that authority. It also lists what requirements will be provided to the board as evidence, such as the graduate degree in a nursing specialty, additional education requirements for use of substances and drugs, post graduate experience of not less than 1800 hours in a relevant clinical setting within a preceding 5 year period. The nurse must have completed a satisfactory structured plan that is regulated by the Colorado Nurse Practice Act. The plan must prove adequate interaction with the physician, have a written collaborative agreement, experience with specific drugs according to the nurse’s scope of practice, and provide the name and identifier of the physician.
In conclusion, every state’s Nurse Practice Act has different rules and recognizes certain roles of the nurse. This has historically created confusion for the patient, insurers, and health care professionals. The American Nurses Credentialing Center (ANCC) put new credentials into effect this year and sent notice out to the Boards of Nursing. They previously had credentialed nurses as APRN, BC which meant Advanced Practice Registered Nurse, Board Certified. Now, they have created new credentials which separate and identify the CNS and NP roles. For example, one of the new titles for CNSs would be GCNS-BC, meaning Geontological CNS – Board Certified. An example of a new title for NPs would be FNP-BC, signifying a Family Nurse Practitioner – Board Certified. This was all done to help eliminate the confusion of the roles and to differentiate them.
This seems to be a more simple solution to the problem than trying to ‘blend the roles’. The journey to the blended CNS/NP role can be long and painful (Hamric, Spross, Hanson, 2005). The CNS role has gone through many changes over the years and almost eliminated, however, now seems in a position to stand on its own. The State Board of Nursing in Colorado has not yet adopted or changed this new credentialing on their website.
Colorado Nurse Practice Act. Colorado Revised Statutes. Title 12. Professions and Occupations Article 38 Nurses Effective July 1, 2007.
Colorado Division of Registrations (CDR) State Board of Nursing http://www.dora.state.co.us
Colorado Department of Health Care Policy and Financing (CDHCPF). Clinic Services – Certified Health Agencies
Hamric, A., Spross, J., & Hanson, C. (2005). Advanced nursing practice: An integrative approach (3nd ed.). Philadelphia: W.B. Saunders.