Are You Familiar with LACE?

One of the main reasons I chose nursing as a profession was for the potential limitless possibilities of practice. Hospitals are only one setting where nurses work and within that system, there are various types of nursing one can do. I worked as a staff nurse in a community hospital and also dabbled in home care prior to becoming a nurse practitioner. I can say the same thing in my role as a nurse practitioner – there are many settings and specialties to choose from.

I decided to become a family nurse practitioner because I thought it would give me the greatest opportunity for various practice settings since I would be educated and trained from pediatrics and women’s health on up to geriatrics. However, there are options that include adult, pediatric, women’s health, geriatrics, and critical care.

Part of the current problem with advanced practice nursing’s Licensure, Accreditation, Certification, and Education (LACE) is that it is very diverse and not standardized across the board. For example, in New York State, there are 16 specialties for NPs which includes college health, holistic nursing and perinatology. Interestingly, there are no college or university NP programs that even offer programs in these specialties. It is for this very reason that the National Organization of Nurse Practitioner Faculties (NONPF) came up with the LACE and APRN Consensus documents.  These documents basically define the advanced practice registered nurse role as:

  1. Certified Registered Nurse Anesthetist
  2. Certified Nurse Midwife
  3. Clinical Nurse Specialist
  4. Certified Nurse Practitioner

This doesn’t mean NPs can’t specialize in practice. But what it does is helps to standardize the specialties across state lines for consistency. The image below (from NONPF) helps to visualize the specialties.

The foci of practice essentially becomes based on the population served (i.e. women’s health or pediatrics). For Nurse Practitioners that means the specialties are:

  1. Family
  2. Adult-Gerontology
  3. Neonatal
  4. Pediatrics
  5. Women’s Health/Gender-Related
  6. Psychiatric-Mental Health

NONPF has set a goal for 2015 for all of this to be implemented and one of the major reasons for this is to avoid the silos that are often created in health care. If you have the time, it is definitely a good idea to read these documents as it may influence a NP student’s choice for program focus.

That is LACE in a nutshell. We are on the verge of a major transformation of licensure, accreditation, certification, and licensure as NPs are becoming increasingly visible and a viable solution to the ills of our current health care system.


I’m Dr. Stephen Ferrara, a practicing Nurse Practitioner with over 10 years of clinical experience. I’m a senior clinical associate at a large urban hospital system in the Bronx, NY and I’ve owned and operated the largest Nurse Practitioner retail based clinic operation in New York State. I have experience in college, correctional and men’s health.

I have my Bachelor’s degree in Biology and Nursing as well as my Master’s degree, and recently I attained the Doctor of Nursing Practice degree! I’m active within my state’s nurse practitioner association and have lectured at numerous conferences.

In addition to blogging here at, for the past 3 years I’ve authored A Nurse Practitioner’s View. I have a passion for health care technology and integrating evidence-based practice into daily practice.Thanks for stopping by! I hope you find the information on this blog useful for your educational and career endeavors into the field of nursing.