Advanced degree of nursing shortages (Joel, 2013). Even though

Practice Registered Nurse (APRN) is an integral part of the health care
system.  Four major roles that is given
the title of APRN is Clinical Nurse Specialist, Nurse Practitioner, Certified
Nurse Midwife and Certified Registered Nurse Anesthetist.  Six population foci of APRN includes:
Neonatal, Pediatrics, Women’s Health, Adult/Gerontology, Family and Mental
Health.  Many nurses with advanced
graduate nursing preparation practice in roles and specialties that are
essential to advance the health of the public but do not provide direct patient
care and therefore their practice does not require regulatory recognition
beyond the RN license granted by State Board of Nursing.  Some examples include Nursing Informatics,
Nurse educators, Public Health (Consensus Model, 2008).  Several factors have influenced the emergence
and acceptance of a APRN.  These factors
include the growing numbers of elderly patients as baby boomers reach
retirement age, increased complexity and severity of illness in hospitalized
patients, a call for greater access to care for all citizens, and a varying
degree of nursing shortages (Joel, 2013). 
Even though the role of a APRN has evolved significantly over the years,
there are still some barriers.  There is
variation among the 50 states in regards to scope of practice, prescriptive
authority and collaborative practice requirements (Hain & Fleck, 2014).   Due to
the variation in scope of practice, APRNs are not able to easily move from one
state to another and remain eligible to practice.   State
licensure regulates APRN practice and only one third of the nation has adopted
full practice authority.  Due to this
restriction, APRN is not able to practice to their full extent of education and
training (Hain & Fleck, 2014).  “Variation
of scope-of-practice across states has an indirect impact on patient care
because the degree of physician supervision may affect practice opportunities
and payer polices for NPs” (Hain & Fleck, 2013).  As a part of the solution to this problem, APRN
consensus model was proposed in an effort to standardize the APRN role.  Four major elements of consensus model are Licensure,
Accreditation, Certification and Education. 
The purpose of this model is to create uniformity in all of these four
elements across the United States (Consensus Model, 2008).  Creating uniformity and removing barriers are
necessary elements of providing superior primary care (Hain & Fleck, 2014).  This will also increase access to care for
patients.  There is increase in demand
for primary care providers due to the expansion of health care coverage.  APRNs have the training and education to
serve in these roles.  Removing these
barriers demands collaboration between APRNs, nursing professional
organizations, educators, policymakers and payers (Hain & Fleck,