The Advanced Practice Nursing Consensus WorkGroup and the National Council of State Boards of Nursing APRN Committee collaborated to develop the Consensus Model for APRN Regulation. The model recognizes four essential elements of nursing practice that are licensure, accreditation, certification, and education (APRN Joint Dialogue Group, 2008, p. 6). Additionally, the model recognizes four roles in the nursing practice; certified registered nurse-anesthetist, certified nurse-midwife, clinical nurse specialist, and certified nurse-practitioner. The practitioners in each of the four roles are trained in at least one of six population foci which are: adult-gerontology, women’s health/gender-related practice, psychiatric/mental-health, family/individual across the lifespan, paediatrics, and neonatal care. Each of the population foci requires that practitioners possess various competencies, and independent practice is one such competency. The implementation of the independent practice competency is discussed in this essay.

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The independent practice competence requires that APRNs function as licensed independent practitioners. They are required to obtain their authority to practice from the various licensing bodies in their regions. For example, each of the four nursing practitioners’ roles is regulated by a different body in the state of North-Carolina. As such, political and policy issues regarding licensure, national certification, and scope of practice emerge and hinder the independent competency of APRNs. The professionals are not granted the independence to perform to their full potential. For example, the State of Michigan does not allow APRNs to do business as independent healthcare providers (Michigan Department of Community Health, 2012, p. 94-95). It has laws and regulations that prevent competition in the healthcare industry. Its Learned Professions Doctrine, for example, restricts the practice of APRNs by protecting doctors from competition. It, therefore, promotes monopoly in the healthcare field. There is, therefore, the need to allow competition in the healthcare field to implement the independence competency among APRNs.

The scope of practice among APRNs should be expanded to enhance their competence of independence. Their education, training, and experience put them in a position to provide more healthcare services then they are legally allowed to. For example, they can provide disease prevention, screening, diagnosis, prescription of drugs, and disease management practices. However, the laws in the various states regulate the limit to which APRNs can provide their services. For example, some states do not allow APRNs to serve primary care patients without the supervision of or collaboration with physicians (Committee on the Robert Wood Johnson Foundation, 2011, p. 127). Others prohibit APRNs from prescribing drugs, from accessing the conditions of their patients, from ordering or evaluating diagnostic tests, and from prescribing medications. Such prohibitions leave the APRNs reliant and dependent on other healthcare professionals to perform their duties. They should, therefore, be abolished to enhance the independence of APRNs.

Independent APRNs should have the capacity to manage their previous and new patients independently. They should have the capacity to provide services such as health promotion, disease prevention, counseling, disease management, and anticipatory guidance. They should also have the capacity to screen and apply diagnostic strategies during the development of diagnoses for their patients (Thomas, Crabtree, Delaney & Dumas, 2014, p. 12). As such, there is the need to provide APRNs with the necessary equipment and facilities to perform their duties, especially in the rural areas where people are poor and lack adequate healthcare.

APRNs need adequate education, training and experience to carryout their duties independently. They need an in-depth understanding of the various practical sciences in their profession such as pharmacology, physiology, and pathophysiology (Thomas, Crabtree, Delaney & Dumas, 2014, p. 12). They are required to make their decisions based on clinical evidence and the relationships with their patients. Additionally, the healthcare field is dynamic and requires professionals to acquire additional education to remain relevant. As such, APRNs

The independence competency of APRNs can be implemented and enhanced in a number of ways. Expanding the scope of practice would have the biggest influence on the independence of APRNs. They should be allowed to provide all the services within their ability without any prohibits. Additionally, laws that prevent competition in the healthcare field should be abolished to allow APRNs to establish business practices. APRNs should be encouraged to acquire additional education continuously to cope with the dynamism of the healthcare field and to make decisions made on clinical evidence. Lastly, they should be provided with all the necessary equipment and facilities to perform their duties properly and independently.

  • APRN Joint Dialogue Group,. (2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (pp. 6-8).
  • Committee on the Robert Wood Johnson Foundation,. (2011). The Future of Nursing: Leading Change, Advancing Health (1st ed.). National Academy of Sciences.
  • Michigan Department of Community Health,. (2012). Michigan Department of Community Health Task Force on Nursing Practice Final Report and Recommendations. Retrieved from
  • Thomas, A., Crabtree, M., Delaney, K., & Dumas, M. (2014). Nurse Practitioner Core Competencies Content (1st ed.). Retrieved from