APRN Toolkit – Overview

Clearing the Fog:  Roles for the Advanced Practice Registered Nurse

As roles for the Advanced Practice Registered Nurse (APRN) expand, it is important for nurse leaders to understand what APRN’s can do within their scope, what is governed by licensure and certification, and what is dictated by their own organization’s bylaws or rules and regulations. The APC Toolkit provides nurse leaders with valuable resources to support the utilization and expansion of APRNs in a variety of practice settings.

APRN’s are categorized as certified nurse practitioners, certified nurse midwives, certified nurse anesthetists, and certified nurse specialists.

APRN’s are governed by their state licensure, their education and certification, and the bylaws or rules and regulations within their place of employment. In the state of Wisconsin, APRN’s must still function under a collaborative agreement. It is often within the collaborative agreement and system bylaws or rules and regulations, where variations occur on what the APRN will be allowed to perform within their role. The employer organization has the ability to place higher restrictions on the APRN’s scope than what their licensure allows.  Working collaboratively with your medical staff is essential to moving the APRN to practice to the fullest extent of their licensure.

Once you have determined what the APRN can legally do within their scope of practice and within your organization, you must then understand what is actually reimbursed by the various payers.  It is important to understand the variation that may occur within Medicare, Medicaid, Managed Care groups and commercial payers.

The last area to clearly understand within your organization is the oversight structure for the APRN. Although they will function under a collaborative agreement, having an oversight structure for quality of care and competency development is important.  There is variation across the State on whether APRN’s report up through nursing or through the medical staff structure.

The APC Toolkit is categorized by Licensure, Accreditation, Certification, and Education; Legislative Issues; Rules, Regulations, and Billing; and Impact on Practice.  Each category contains links to additional information. Our goal is to help fellow nurse leaders across Wisconsin to develop platforms for optimizing the use of APRN’s within their own organizations.

Laura Hieb, MBA, BSN, RN, NE‐BC, Board of Directors
1 Dubree, M., Jones, P., Kapu, A., & Parmley, C. L. (April 2015).  APRN Practice: Challenges, Empowerment, and Outcomes.  Nurse Leader, 13 (2), 43‐49.

2  Department of Health and Human Services Center for Medicare and Medicaid Services (February 2015).  Medicare Information for Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants.  Medicare Learning Network, ICN 901623.

For more information or if interested in contributing to this toolkit, contact Tom Veeser or Peggy Lutz.