Why Do I Need a New Certification to Maintain my Current NP Role?

Marilyn W. Edmunds, PhD, CRNP


August 28, 2006


I am a family nurse practitioner, currently working as a trauma nurse practitioner with responsibilities in both the ED and the ICU. I have been told that in the near future I will be required to attain certification as an acute care NP in order to continue working in the ED and ICU. Is this true, and what is the reason for the change?

Response from Marilyn W. Edmunds, PhD, CRNP

Your situation is not unique. Many NPs employed for years are facing new regulations that affect their current NP roles. You are practicing at a time of transition when new rules and regulations are increasingly governing the scope of practice of advanced practice nurses. The barriers you now face developed as the NP role matured and the scope of practice and educational requirements changed over time at both the state and national levels.

Perhaps when you first began your position as a trauma NP there were no NP acute care programs or national examinations or these were not yet required in your state. Acute care settings hired NPs who graduated from primary care programs because they had no alternative. Employers were quick to recognize that NPs had many of the diagnostic and assessment skills that were required in acute care settings particularly if the NP had an acute care nursing background.

Now that there are both designated curriculum and national examinations for acute care practitioners, most states require acute care clinicians to have the corresponding credentials. Core competencies that reflect the knowledge base and scope of practice of the acute care nurse practitioner were recently developed.[1] Increasing litigation is another factor driving the regulations requiring NPs to be prepared and have credentials in the role in which they are practicing.

Our physician colleagues have a saying: "It doesn't matter how competent you are; if you want to practice medicine, you have to go to medical school." This situation is really an extension of that same logic. You may have learned how to practice competently in the acute care role, but if you wish to continue to do so in today's settings, you are going to have to have the credentials that legally allow you to do so.

Whether or not you will be required to seek certification as an acute care NP depends upon your state's nurse practice act. NPs should regularly review their state's nurse practice act, the final authority on what is required to practice in their state. The general rule for many years has been that if an NP has board of nursing approval to practice in a given setting, that approval is often not rescinded, even if regulations change. But if the NP moves to a new job or a new setting, even if they are doing exactly the same thing they were doing in a previous job, the new regulations may apply and prevent them from continuing to practice the same way. However, what the NP will be permitted to do as the state board begins to implement new regulations is up to the specific board of nursing.

To access the rules and regulations of the state board of nursing in the state in which you practice or to contact a member of the board, see the National Council of State Boards of Nursing (http://www.ncsbn.org/). After reviewing your state's nurse practice act you may still have questions regarding how these policies apply to your situation. A telephone call to your state board may be required to understand how the regulations affect you. For an excellent discussion of the ethical and practical issues related to scope of practice of the nurse practitioner, see "Scope of Practice and the Nurse Practitioner: Regulation, Competency, Expansion, and Evolution" by Tracy A. Klein.[2]


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