As of 2015, six states—including Arizona—reported that more than 30 percent of their population resides in areas known as Primary Care Health Professional Shortage Areas (HPSAs). The Henry J. Kaiser Family Foundation reports that advanced practice nurses with master’s level training in pathophysiology, health assessment and pharmacology will be the best, most viable solution to physician shortages in Arizona, and throughout the nation.
Thanks to Arizona’s state legislators, which have allowed nurse practitioners and certified nurse-midwives to enjoy a broad scope of independent practice, few restrictions, and prescriptive authority, these advanced practice registered nurses (APRNs) are able to fill the void in areas that lack an adequate number of physicians.
Licensing Requirements for the APRN Roles Recognized in Arizona
The standard degree for RNs seeking APRN licensure is the Master of Science in Nursing (MSN). RNs interested in becoming licensed as an APRN must complete a graduate program specific to the role for which they are applying and provide the Arizona Board of Nursing with evidence of national certification in that role.
The Arizona State Board of Nursing recognizes the following advanced practice nursing roles:
- Registered Nurse Practitioner (RNP)
- Certified Nurse-Midwife (CNM) (only as a population focus for RNPs)
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
According to the Arizona Action Coalition, the vast majority of APRNs licensed in the state were nurse practitioners, at 4,205; followed by nurse anesthetists, at 640; nurse-midwives, at 211; and clinical nurse specialists, at 201 (2013).
RNPs and CNSs must also select one or more population group in which to focus their education and become certified. Population focus options for RNPs and CNSs in Arizona include:
- Family-individual across the lifespan
- Adult-gerontology primary or acute care
- Pediatric primary or acute care
- Women’s health- gender related
- Psychiatric-mental health
Certified registered nurse anesthetists work with all population groups rather than being certified to work with a particular population.
MSN degrees are also a common pursuit among RNs in Arizona considering careers in non-clinical roles in areas such as academia, research, administration, and informatics
Earning a Master of Science in Nursing (MSN) in Arizona
Many nursing schools now offer accredited graduate programs partially or fully online, including part-time and accelerated options designed to accommodate RNs with different educational and scheduling needs. Online MSN programs allow students in Arizona to complete all or most of their didactic requirements through online study and then complete their clinical requirements at sites close to home.
MSN programs specific to the four APRN roles (nurse practitioner, clinical nurse specialist, nurse anesthetist and nurse-midwife) that have received programmatic accreditation through specialized accrediting bodies offer the assurance that all components necessary for graduates to meet national certification standards in the respective roles are included:
- Nurse Practitioner and Clinical Nurse Specialist – The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the accrediting agencies for nurse practitioner and clinical nurse specialist programs at the graduate and residency levels.
- Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs.
- Nurse-Midwife – The American College of Nurse-Midwives (ACNM) is the accrediting agency for nurse-midwife programs.
Arizona Board Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
Board-approved MSN programs for each APRN role must include, at a minimum:
- Three separate graduate-level courses in:
- Advanced physiology and pathophysiology, including general principles across the lifespan
- Advanced health assessment, including assessment of all human systems, advanced assessment techniques, concepts, and approaches
- Advanced pharmacology, including pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad category agents
- Diagnosis and management of diseases across practice settings, including diseases representative of all systems
- Preparation that provides a basic understanding of the principles for decision-making in the identified role
- Preparation in the core competencies for the identified APRN role, including legal, ethical, and professional responsibilities
- Role preparation in an identified population focus
Additionally, board-approved programs for registered nurse practitioners and clinical nurse specialists must:
- Be a formal educational program that is part of a master’s or doctoral program or post-master’s program in nursing with a concentration in an advanced practice registered nursing role and population focus
- Offer a curriculum that covers the scope of practice for both the role of advanced practice and the population focus
An approved APRN graduate degree or post-master’s program must include at least 500 hours of faculty supervised clinical practice specific to the role and population focus.
Accredited MSN programs for the respective APRN roles and population foci are specifically designed to meet the requirements for national certification by including the appropriate number of clinical hours and coursework specific to the role and population focus.
Agencies offering national certification in each APRN role and patient population focus that the Arizona Board of Nursing recognizes are shown here:
Registered Nurse Practitioner (RNP)
- American Academy of Nurse Practitioners
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- American Nurses Credentialing Center
- Acute Care Nurse Practitioner-Board Certified (ACNP-BC)
- Adult Nurse Practitioner-Board Certified (ANP-BC)
- Family Nurse Practitioner-Board Certified (FNP-BC)
- Gerontological Nurse Practitioner-Board Certified (GNP-BC)
- Pediatric Primary Care Nurse Practitioner-Board Certified (PPCNP-BC)
- Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC)
- Adult-Gerontology Primary Care Nurse Practitioner-Board Certified (AGPCNP-BC)
- Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC)
- Adult Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- Acute Care Nurse Practitioner Adult (ACNPC) – not aligned with APRN Consensus Model
- Pediatric Nursing Certification Board
- Pediatric Nurse Practitioner Primary Care (CPNP-PC)
- Pediatric Nurse Practitioner Acute Care (CPNPAC)
- National Certification Corporation
- Women’s Health Care Nurse Practitioner-Board Certified (WHNP-BC)
- Neonatal Nurse Practitioner-Board Certified (NNP-BC)
- American Midwifery Certification Board (for NPs with the CNM patient population focus)
- Certified in Nurse-Midwifery (CNM)
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Clinical Nurse Specialist; Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
- Clinical Nurse Specialist; Wellness through Acute Care (Pediatric) (ACCNS-P)
- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal) (ACCNS-N)
- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal) (CCNS) – not aligned with APRN Consensus Model
- American Nurses Credentialing Center
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
- Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
Selecting the Right Program Based on Current Education
RNs in Arizona pursuing an MSN degree must select a program that corresponds to their current level of education:
- Bachelor of Science in Nursing (BSN): RNs that possess a BSN are eligible to pursue a Master of Science in Nursing (MSN), also called BSN-to-MSN programs. These conventional MSN programs take about two years to complete.
- Associate’s degree in nursing: RNs in Arizona that possess an associate’s degree must complete both a BSN and MSN. RN-to-MSN programs accommodate these students and allow them to complete the requirements of both their BSN and MSN in one accelerated program over the course of about three years.
- Bachelor’s degree in an area other than nursing: A number of MSN programs now exist that allow students that possess a bachelor’s degree in an area other than nursing to pursue their MSN in an accelerated format. Called entry-level or direct-entry programs, these programs allow students to earn their RN license and complete their MSN in one, comprehensive program.
Scope of Practice and Arizona State Laws Governing Advanced Practice Registered Nursing
Registered Nurse Practitioner (RNP) and Certified Nurse-Midwife (CNM) Scope of Practice
According to the Arizona Board of Nursing, RNPs (and CNMs, as the Board of Nursing regulates them as a category of RNP) may perform the following acts, within the limits of their population focus of certification:
- Examine a patient and establish a medical diagnosis by client history, physical examination, or other criteria
- Within a healthcare facility:
- Admit patients to the facility
- Manage the care of the patients
- Discharge patients from the facility
- Order and interpret laboratory, radiographic, and other diagnostic tests and perform those tests RNPs are qualified to perform
- Prescribe, order, administer, and dispense therapeutic measures, including pharmacologic agents and devices, and non-pharmacological interventions such as durable medical equipment, nutrition, home healthcare, hospice, physical therapy, and occupational therapy
- Identify, develop, implement, and evaluate a plan of care for a patient to promote, maintain, and restore health
- Delegate therapeutic measures to qualified assistive personnel, including medical assistants
- Perform additional acts that an RNP is qualified to perform and are recognized as being within the role and population focus of certification
Clinical Nurse Specialist (CNS) Scope of Practice
According to the Arizona Board of Nursing, CNSs may perform the following acts for an individual, family, or group within the population of certification:
- Conduct an advanced assessment, analysis, and evaluation of a patient’s complex health needs
- Establish primary and differential health status diagnoses
- Direct health care as an advanced clinician
- Develop, implement, and evaluate a treatment plan according to a patient’s need for specialized nursing care
- Establish nursing standing orders, algorithms, and practice guidelines related to interventions and specific plans of care
- Manage healthcare according to written protocols
- Facilitate system changes on a multidisciplinary level to assist a healthcare facility and improve patient outcomes cost effectively
- Consult with the public and professionals in healthcare, business, and industry in research, case management, education, and administration
- Perform psychotherapy if certified as a CNS in psychiatric and mental health nursing
- Prescribe and dispense durable medical equipment
- Perform additional acts that a CNS is qualified to perform
Certified Registered Nurse Anesthetist (CRNA) Scope of Practice
According to the Arizona Board of Nursing, certified registered nurse anesthetists (CRNAs) may perform the following acts:
- Administer anesthetics under the direction of and in the presence of a physician or surgeon connected with the preoperative, intraoperative, or postoperative care of the patient or as part of a procedure performed by a physician or surgeon in the following settings:
- Healthcare institution
- Office of a healthcare professional
- As part of the care or procedure may:
- Issue a medication order for drugs or medications to be administered by a licensed, certified, or registered healthcare provider
- Assess the health status of an individual as it relates to the relative risks associated anesthetic management
- Obtain informed consent
- Order and evaluate laboratory and diagnostic test results and perform point of care testing
- Order and evaluate radiographic imaging studies
- Identify, develop, implement, and evaluate an anesthetic plan or care for a patient to promote, maintain, and restore health
- Take action necessary in response to an emergency situation
- Perform therapeutic procedures
Prescriptive Authority for APRNs in Arizona
The Arizona Board of Nursing grants prescriptive authority to RNPs and CNMs only, allowing them to:
- Prescribe drugs and devices
- Provide for refill of prescription-only drugs and devices for one year from the date of the prescription
- Prescribe controlled substances provided they obtain a DEA registration number before prescribing a controlled substance and file the DEA registration number with the Board
RNPs and CNMs seeking dispensing and prescribing privileges must submit written evidence of at least 45 contact hours of education in pharmacology or clinical management of drug therapy within the past three years. RNPs and CNMs cannot begin prescribing or dispensing medications until the Board of Nursing grants dispensing authority.
RNPs and CNMs cannot apply for a DEA number until they have attained prescribing and dispensing privileges from the Board.
RNPs and CNMs with a DEA registration number may prescribe:
- A Schedule II controlled substance
- A Schedule III or IV controlled substance
- A Schedule V controlled substance
CRNAs may order medication administered by a healthcare provider preoperatively, post-operatively, and/or as part of the procedure, but they may not prescribe or dispense medications.
The APRN Consensus Model and Independent Practice in Arizona
The APRN Consensus Model is a uniform regulatory model for the future of advanced practice nursing, with the goal of achieving consistency across state lines regarding licensure, accreditation, certification, and education. One of the primary goals of implementing the APRN Consensus Model is to allow APRNs in all states to practice to the full scope of their education and training without the need to enter into restrictive collaborative agreements with a physician.
Arizona is a plenary state for RNPs and CNMs, meaning that they do not work under the supervision of physicians. RNPs and CNMs have full practice authority within the population focus they are certified, enjoying full prescriptive authority, which includes the authority to prescribe controlled substances.
The Arizona Coalition of Advanced Practice Nurses (a collaboration between the Arizona Nurse Practitioner Council, the Arizona Chapter of the American College of Nurse Midwives, the Arizona Association of Nurse Anesthetists, and the Arizona Clinical Nurse Specialists) introduced what is known as a Sunrise Application to the House and Senate committee in December 2015. The application, which was approved, allows the Coalition the ability to introduce legislation on behalf of Arizona’s entire community of advanced practice nurses.
The Coalition hopes to propose legislation that will enable Arizona to recognize the APRN Consensus Model and therefore allow APRNs to practice to the full extent of their abilities, which, in specific instances, grants them the same privileges as physicians.
The Coalition proposes that CRNAs be allowed to administer anesthesia without a licensed physician or surgeon being present.
Continuing Education Requirements for APRNs in Arizona
APRN licenses in Arizona expire at the same time as RN licenses—every four years on or before April 1. The Board grants APRN renewals if the holder provides evidence of current national certification or has practiced for a minimum of 960 hours as an APRN within the past five years. The 960-hour requirement equates to 24 weeks of full-time practice every 5 years.
APRNs who have not satisfied the practice requirements must complete coursework or continuing education activities at the graduate or advanced practice level that include, at a minimum, 45 contact hours of advanced pharmacology and 45 contact hours in a subject or subjects related to the role and population focus in which they are certified.
Upon completion of the required coursework, they must complete a period of precepted clinical practice directly supervised by an APRN in the same role and population focus. Precepted clinical practice may range from 300 to 1,000 hours, depending on the number of practice hours attained in the last 5 to 10 years:
- 300 hours if the applicant has practiced less than 960 hours in the last 5 years
- 600 hours if the applicant has not practiced at least 960 hours in the last 6 years
- 1,000 hours if the applicant has not practiced at least 960 hours in the last 6 years but has practiced 960 hours in the last 7 to 10 years
If the applicant has not practiced 960 hours of advanced practice nursing in the role and population focus being renewed in more than 10 years, they must complete a program of study as recommended by an approved advanced practice nursing program that includes, at a minimum, 500 hours of faculty-supervised clinical practice in the role and population focus of certification.