Stakeholder perceptions of APRN consensus model implementation in mid-Atlantic states

Castaldo, Ronald R.
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University of Delaware
The purpose of this exploratory multiple-case study research was to identify and compare similarities and differences in stakeholder perceptions of Advanced Practice Registered Nurse (APRN) Consensus Model implementation processes in the Mid-Atlantic States of Delaware, Maryland, New Jersey, and Pennsylvania. The Consensus Model is a regulatory model that establishes licensure, accreditation, certification, and education (LACE) standards for uniform APRN regulation. Every state separately determines the legal scope of practice for APRNs. As long as inconsistencies exist from state to state regarding APRN regulatory requirements, each state border signifies a potential barrier for APRNs' ability to provide high-quality, cost-effective patient healthcare services. Complexity science theory provided a framework for this study. The purposive sample included 16 stakeholders, including one APRN clinician, one APRN educational program director or professor who teaches in an APRN program, one representative from nursing regulation, and one policymaker or lobbyist who possesses knowledge and expertise with APRN legislation and regulation in each of the four study states. Each 4-member stakeholder group was the primary unit of analysis, and data from all of the stakeholders and cases were included to complete this multiple-case study. Data were collected via an investigator-developed, semi-structured interview guide and a 21-item, Likert scale survey. The interview guide was pilot tested by the investigator in 2012 and 2013. The survey, pilot tested twice in 2014, was first reviewed by an expert in survey development. The data were also corroborated by an analysis of relevant documents. Data bits, including investigator-formed concepts and codes, were analyzed and reprocessed to form final study results, including two major themes. These two overriding themes, "Roadblocks to Model Implementation" and "Model Implementation Attractors and Adaptable Elements," were present in each state case study. Under the first "roadblocks" theme, three common subthemes were uncovered in each state, including Model opposition, deficient Consensus Model understanding, and inadequate relationships with change agents. A fourth subtheme of APRN apathy or unconcern emerged in the Maryland, New Jersey, and Pennsylvania case studies. A fifth subtheme of pre-existing lack of all-inclusive APRN legislation was uncovered in Pennsylvania. Under the second theme, two subthemes, Model facilitators and preferred strategies, emerged in each state. The findings not only provide important insight for APRN clinicians, educators, and scientists, but recommendations for promoting advanced practice nursing healthcare policy were also provided.