'Occupy ANCC' in the Words of Its Creator
ADVANCE for NPs & PAs caught up with Rodney Fox, PhD, NP, of Pride Medical in Atlanta, to ask him about the "Occupy ANCC" page he created on Facebook. Here are his responses to a few of our questions.
Jennifer Ford (JF): Tell me about why you chose to take up the torch for this cause.
Rodney Fox (RF): Yes, I have started a campaign that provides a forum for currently credentialed nurse practitioners to object to ANCC’s policy of retiring respected credentials. The site is Occupy ANCC, say no to retiring your NP credential. The National Organization of Nurse Practitioner Faculty found that broadly trained family and adult NPs are the most marketable APRN credentials. It seems ridiculous to retire these highly esteemed credentials. I am attempting to bring a unified voice to others who may feel the same. First, allow me to state that I believe that ANCC has made this move in good faith, and that those involved have the best intentions. This move is in response to the LACE Consensus Model for APRN Regulation, a model with the intent to align the relationship among licensure, accreditation, certification, and education that creates uniform practice among APRNs. A major goal of the model is to advance advanced practice nursing to the next level, while benefiting individual APRNs and enhancing patient care. The radical step of retiring the current credential of practicing NPs, and developing a new credential without providing a bridge, misses the mark on multiple levels.
First, it is nearly impossible to move the profession to the next level when the process serves to segregate those now practicing from those who will continue to practice. The new certification introduces a new and, by definition, different class of NP. I recently completed a study where stigma was a measure, and stigma by definition arises from the notion that others are different from us. Who knew that nurses were capable of producing stigma, but on a professional scale? Nursing is already the laughing stock of health with multiple certifications and letters following our names: alphabet soup. This shiny new certification will only serve to muddy the water and confuse our colleagues, our patients, the community and us.
This process assumes that the current adult and acute curriculum is, and has been, inadequate in providing elderly content. By any measure of logic, geriatric patients are adults and make up a majority of the patients admitted to hospitals. This is the very population that adult NPs (ANPs) are trained to treat as outpatients, and acute care nurse practitioners (ACNPs) are trained to treat within healthcare facilities. The response I received from ANCC was that there are rogue NP programs that are not providing geriatric content, and ANCC’s response is to scrap the whole system. One cannot open any nursing or health-related journal without coming across the term evidence-based practice. I must ask, if our current training and nomenclature is so inadequate, where is the evidence?
I do not disagree that geriatrics is an important issue. Geriatric concepts should be taught and tested in future credentialing exams. However, I have not read any research that suggests ANPs or ACNPs are providing geriatric patients with incompetent care. In fact, the research suggests otherwise, NPs provide high-quality care, offer high patient satisfaction and achieve excellent health outcomes. Any perceived gap in competency exists in the minds of a few individuals. Any ANP or ACNP graduating from a reputable program had geriatrics as part of their curriculum. This change is not supported by evidence and is really a change in semantics.
Finally, this change does not benefit individual APRNs currently in practice. In fact, this could produce a nightmare situation for individual NPs going forward. The fine print to this deal is that NPs need only renew their credentials through professional development and continuing education. Well, I agree this is something we should do and are doing. However, if a person for any reason allows his or her certification to expire, that individual will not be able to sit for boards. Their board exam will not be available, and if they were educated prior to around 2013, their education will not be adequate to sit for the new exam. In fact, it is not clear if current NP programs will meet the new credentialing requirements, or if the new test will be psychometrically sound.
The fact is that many unforeseen events can arise that may prevent a person from recertifying, such as raising a family, doing research, caring for an aging parent or personal and family illness. If this situation arises, then the person must find an academic program, apply for admission, hope they are accepted, and then complete formal academic coursework that may take one to two semesters, or longer. This also assumes you are near a program that will accept you, you have adequate faculty and mentors to teach you, and you can afford both the real cost and opportunity cost to meet this new requirement. This whole process may take 1 to 2 years, and all this to receive content that was arguably previously provided, or could have been provided through alternative and more efficient methods. Many states require certification to practice as an NP, so we are discussing a person’s livelihood.
JF: What made you decide to create the Facebook page?
RF: I decided to go with Facebook because it is free, and searchable through Google. Anyone can join, and the only limitation is for those without a Facebook page. I felt it would have the greatest impact.
JF: What kind of response have you had to the page and the campaign?
RF: There are just over 50 members. This is not an adequate number because ANCC told me that only 150 certified NPs called to object to this move. Obviously we need more involved. That said, I did receive a call from ANCC’s executive director of credentialing, who was very kind and receptive to my thoughts. We simply disagree on this issue.
JF: What would be the ideal outcome of your efforts? What has happened so far?
RF: I am in favor of maintaining the adult and acute care NP certification, or at least provide a mechanism for currently credentialed ANPs and ACNPs (and others) to move into this new certification. I am not suggesting that credentialing and certification content should remain stagnant; far from it! Nursing should continue to evolve along with the scientific body of knowledge. If any rogue NP programs are deficient in proving adolescent through geriatric content within its adult and acute care curriculum, those programs should be dealt with individually. That is the purpose of our educational credentialing bodies whose objective is to maintain educational standards.
Any deficiencies, perceived or real, of currently practicing adult and acute care NPs can be addressed through educational modules, seminars and/or case studies. A 2- to 3-day seminar structure could provide this content, or for those unable to travel, through completion of online modules, just as continuing education is now provided. Mandating completion of a geriatric-specific educational module prior to the next recertification cycle would ensure everyone is up to date with geriatric content. NPs need continuing education to recertify anyhow. The development of such a module would be a perfect project for researchers at organizations such as the American Academy of Nursing's “Building Academic Geriatric Nursing Capacity,” or the Robert Wood Johnson Foundation. This module would meet the need of almost every APRN, except geriatric NPs who would need an adolescent to geriatric module. An adequate template likely already exists on some nurse faculty’s laptop.
A process that provides a mechanism to move all APRNs together is best for APRNs and the community in need of their services. APRNs are on the cusp of something great, and nursing, in general, has a real opportunity to provide leadership in the future of healthcare. We do not do this by chopping off our base – all currently certified NPs. The educational modality that I propose would be beneficial for several reasons. First, those who need the content receive it, and can immediately apply the knowledge. Secondly, everyone’s competency is up to date and standardized. Thirdly, each APRN receives continuing education credits, a necessary requirement. Fourthly, through fees, the program will pay for itself, and knowledge will be broadly disseminated. Finally, the nursing profession moves forward together, united as one. The current plan to change our profession, by drawing a line in the sand on certification, does more than its initial intent and I believe is not the intent of the consensus model. The current plan cuts a gorge between currently practicing NPs and the newly certified NPs. The proposed changes are not grounded in evidence-based knowledge. There is a real risk of ostracizing all currently certified NPs. The risk to our professional image and opening ourselves to unintended consequences is too great. I support the consensus model and believe the demand for gerontology services will grow, but this is not a favorable way forward.
I believe a petition should be started at Change.org. Verizon dropped a proposed $2 monthly convenience charge, and we might have the same effect on ANCC. If someone does start a petition, that person can borrow any of my objections to formulate their argument. And, naturally, I would sign it.