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The LACE Model and Consistency in APRN Practice Nationwide

Four Pillars of Advanced Nursing Practice under the LACE Model


Total minimal posts over a discussion board for each student is four posts. All discussion board responses should be substantial, and further the scholarly conversation. For example, responding to a classmate with, “Great post. I totally agree,” would not qualify and substantial, and would not receive credit. Discussion board activity is intended to spark active conversation, synthesis, and reflection. It is a scholarly forum, and thus requires a scholarly tone and appropriate citations in APA format. Grading Rubric for Discussion Board Criteria Exemplary (4) Proficient (3) Developing (2) Emerging (1) Content of Initial Post 10 points (40/100) Fully responds to all questions in DB prompt and answers each completely Answers all questions without fully developing answers for each Answers some of the questions and/or does not fully develop answers Off topic or not responsive to DB prompt Comments on Others’ Posts 8 points (32/100) Provides relevant, timely and helpful feedback to at least 2 classmates for a minimum of 5 total responses Provides feedback to 2 or more classmates that is less relevant, timely, and/or helpful. A minimum of 4 substantive responses Provides feedback to one classmate that is less relevant, timely, and/or helpful. Only 2 to 3 substantive responses Provides irrelevant feedback or comments on fewer than 2 classmates’ work. Only 1 substantive response Timeliness of Posts 3 points (12/100) Initial post and responses completed on time Late on initial post or responses Late on initial post AND responses Significantly late on initial post and/or responses Format 4 points (16/100) Correct English; perfect APA format Minimal grammatical, typographical or APA errors.

Nursing profession has come a long way especially in the United States with a tremendous growth in the nursing profession. The growth in nursing is mostly in the area of advanced practice.  LACE, the acronym that stands for licensing, accreditation, certification, and education is a united body with an intent to provide structure and place advanced nursing practice role into 4 pillars (Goudreau, 2011).  The 4 pillars (APRN roles) are  certified nurse practitioner (CNP),  certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM) and clinical nurse specialist  (CNS) (Goudreau, 2011). An agreement model was developed in 2008 called the advanced practice registered nurse (APRN) Consensus model that involved stakeholders such as the American Nurses Association and received affirmation  from over 40 nursing organizations (Goudreau, 2011). LACE has a several positive aspect such as being a collaborative body that aims to bring all advanced nursing practice pillars together to have a structure and eliminate inconsistencies in their education and accreditation requirements (Goudreau, 2011). The lack of inconsistencies that exist in the roles of APRN has made it difficult at the state level to move to and practice in other states (American Psychiatric Nurses Association, 2019). Therefore, it is long overdue for APRN to have a collaborative and regulatory body such as LACE to place sound structure in the licensing, accreditation, certification, and education of APRN. There needs to be unity in nursing groups regarding APRN practice nationwide. Consistency in APRN nationwide is paramount for further growth of the profession. Yoder-Wise (2010) stated in her editorial that creating consensus in APRN is critical and timely.

As with any good change there will exist some controversies. One of the main controversial discussions surrounding this collaborative process is the elimination of the role of clinical nurse specialist (CNS) and child/adolescent (C/A) psychiatric mental health (PMH) nurses from performing the role of mental health nurse practitioner. The LACE had to clarify role confusion and role conflict by elimination of the role of psychiatric CNS and C/APMH (Regan-Kubinski & Horton-Deutsh, 2012). The psychiatric mental health nurse practitioners (PMHNP) curriculum changed to practice across populations, which includes children (Delaney, 2014). The full scope of PMHNP now is to practice across lifespan with their practice focusing on mental health and well-being of children in relation to their full-range of mental health needs (Delaney, 2014).

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