A Master of Science in Nursing (MSN) provides RNs with an educational foundation in advanced health assessment, pharmacology, and pathophysiology, allowing them to enjoy the respect, autonomy and higher pay that comes with becoming an advanced practice registered nurse (APRN). RNs interested in moving into advanced nonclinical roles in academia, administration, research, patient advocacy and more, also pursue a graduate level education.
Of the 33,780 RNs practicing in Connecticut, only an elite few were licensed in APRN roles, including 2,710 nurse practitioners and 340 nurse anesthetists (US Bureau of Labor Statistics, 2014). While Connecticut’s ADN and BSN-educated registered nurses earned an average annual salary of $76,370 in 2014, BLS statistics show the rather dramatic increase that comes with earning an MSN and entering advanced practice:
- Nurse Anesthetists: $153,780 (4th highest average salary for CRNAs in the nation)
- Nurse Practitioners: $95,350
In a move to further align with the APRN Consensus Model, in 2014 Connecticut Governor Dannell Malloy signed a bill into law that allows APRNs to become independent practitioners after a three-year provisionary period. Though APRNs are required to maintain a formal collaborative agreement with a physician during this provisionary period, after three years the state’s APRNs would be able to practice to the full extent of their education and training without physician oversight.
Licensing Requirements for the Three APRN Roles Recognized in Connecticut
In order to become a licensed APRN in Connecticut, candidates must:
- Hold an unrestricted RN license in Connecticut
- Graduate from a nationally accredited MSN program
- Become nationally certified in their chosen advanced practice role
The Connecticut State Board of Examiners for Nursing (CSBEN) licenses APRNs in one of three distinct roles:
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
Nurse practitioners and clinical nurse specialists further focus their studies and become certified in a particular patient population focus (adult-gerontology; family/individual across the lifespan; neonatology; pediatrics; psychiatric/mental health; or women’s health). Certified registered nurse anesthetists are able to work with all patient population groups without the need for population-specific education and certification.
For the purpose of APRN state licensure, the CSBEN recognizes the following seven national certification agencies as being authorized to confer certification in the respective advanced practice role and patient population focus (additional specialty certifications are available, but are not listed because they are not required for becoming licensed as an APRN through the CSBEN):
Registered Nurse Practitioner (RNP)
- American Nurses Credentialing Center
- Acute Care NP
- Adult Nurse NP
- Adult-Gerontology Acute Care NP
- Adult-Gerontology Primary Care NP
- Adult Psychiatric-Mental Health NP
- Family NP
- Gerontological NP
- Pediatric Primary Care NP
- Psychiatric-Mental Health NP
- School NP
- Diabetes Management—Advanced
- Emergency NP
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology
- Acute Care Nurse Practitioner Adult
- American Academy of Nurse Practitioners
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- Pediatric Nursing Certification Board
- Pediatric Nurse Practitioner Primary Care
- Pediatric Nurse Practitioner Acute Care
- Pediatric Primary Care Mental Health Specialist
- National Certification Corporation
- Women’s Health Care Nurse Practitioner
- Neonatal Nurse Practitioner
- Oncology Nursing Certification Corporation
- Advanced Oncology Certified Nurse Practitioner
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Clinical Nurse Specialist; Wellness through Acute Care
- Clinical Nurse Specialist; Wellness through Acute Care (Pediatric)
- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal)
- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal)
- Oncology Nursing Certification Corporation
- Advanced Oncology Certified Clinical Nurse Specialist
Certified Registered Nurse Anesthetist (CRNA)
Temporary licensing allows recent graduates to practice to a limited extent while waiting to sit for a scheduled national certification exam specific to one of the APRN roles. The CSBEN offers APRN candidates temporary licensing for 120 days after graduating from a qualifying MSN program, provided that the APRN candidate:
- Is employed under a supervising physician
- Has applied to sit for a national certification exam
- Is prohibited from prescribing medication during the temporary licensing period
Pursuing a Master of Science in Nursing (MSN) in Connecticut
Online MSN programs are the preferred format for most working RNs interested in pursuing graduate studies. Online programs allow working nurses to complete online coursework without having to adhere to a rigid schedule. Accredited online graduate programs partner with healthcare facilities across the country, allowing working RNs to complete their clinical hours at a facility close to home.
Nurse practitioner and clinical nurse specialist graduate programs must be accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), while CRNA programs must be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
Select accredited programs are available within Connecticut, while accredited online programs from esteemed nursing schools throughout the nation are also available to nurses in the state.
CSBEN Requirements for APRN Graduate Programs
The Connecticut State Board of Examiners for Nursing (CSBEN) requires graduate programs for advanced practitioners in all three APRN roles to complete at least thirty hours of education in pharmacology for advanced nursing practice as a requirement for gaining prescriptive authority. The CSBEN requires nurse practitioner, clinical nurse specialist and certified registered nurse anesthetist programs to align with requirements specified by accrediting agencies, and national certification bodies:
Nurse Practitioner Programs
The National Task Force on Quality Nurse Practitioner Education requires accredited nurse practitioner programs to include at least 500 hours of supervised clinical experiences and prepare students in the following competencies:
- Health Delivery System Competencies
- Scientific Foundation Competencies
- Quality Competencies
- Leadership Competencies
- Ethics Competencies
- Technology and Information Literacy Competencies
- Independent Practice Competencies
- Practice Inquiry Competencies
- Policy Competencies
Certified Registered Nurse Anesthetist Programs
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the academic curriculum and prerequisite courses of nurse anesthesia programs to include:
- Anatomy, physiology, and pathophysiology
- Clinical conferences
- Basic and advanced anesthesia practices
- Professional aspects of nurse anesthesia practice
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry
- Radiology and ultrasound
Clinical experiences should allow students the opportunity to:
- Apply knowledge to clinical problems
- Test theory
- Learn anesthesia techniques
Clinical Nurse Specialist Programs
The National Association of Clinical Nurse Specialists (NACNS) requires the clinical nurse specialist academic experience to include:
- The curriculum must be accredited by a nursing education organization that is recognized by the US Department of Education
- The CNS graduate program’s curriculum must be clearly aligned to address the care of a specific population, and be congruent with state requirements and nationally-recognized competencies
- The CNS program must be led by a CNS who has at least a master’s degree in the particular area of focus of the CNS program
- Students should have RN licenses throughout their studies
- There must be an adequate number of faculty instructors and preceptors to ensure there is direct and indirect supervision during clinical courses, recommended at a 1:1 or 1:2 faculty-student ratio
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the CSN/APRN licensure or certification requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Selecting an Appropriate MSN Program Based on Current Education
RNs seeking a master’s degree in nursing will find specialized programs are available to accommodate their current level of education:
- RNs with an Associate Degree in Nursing (ADN): RNs with an associate degree must obtain both a bachelor’s and a master’s degree to become an APRN in Connecticut. RN-to-MSN bridge programs offer both a BSN and an MSN in one accelerated program that typically takes about three years to complete.
- RNs with a Bachelor of Science in Nursing (BSN): RNs who have already earned a BSN will complete a traditional two-year MSN program.
- Professionals with a Bachelor’s Degree in a Major Other than Nursing: Select MSN programs are structured as direct-entry programs designed for bachelor’s-educated professionals from a non-nursing background. These direct entry programs result in a BSN, RN license and an MSN.
Laws Concerning Prescriptive Authority and Independent Practice for APRNs in Connecticut
The Connecticut Nurse Practice Act states that the scope of practice for APRNs in all roles includes:
- Performing activities commensurate with education
- Performing acts of diagnosis
- Authorization to make determination and pronouncement of death
As of 2014, the CSBEN allows APRNs the opportunity to become independent practitioners, granting them the authority to prescribe medicine and treat patients without physician oversight provided the APRN:
- Provides documented proof of three years of practice within a signed collaborative agreement with a physician
- Has obtained 2,000 hours of practice under the three-year collaborative agreement
After the three-year period, APRNs would be recognized as independent practitioners.
The CSBEN requires that all APRNS complete 30 hours of pharmaceutical training within their educational program in preparation for being granted prescriptive privileges. All APRNS in Connecticut, including nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialist, may apply for prescriptive authority after the three-year collaborative period.
During the three-year probationary period, only the physician can determine the scope of the APRN’s prescriptive authority. After the three-year period, the scope of prescriptive authority is determined by the APRN.
In order to apply for prescriptive authority, APRNs must seek registration through the Drug Enforcement Administration as well as obtain a Connecticut controlled substance permit from the Department of Consumer Protection. The controlled substance permit will need to be renewed every two years, on February 28th of each odd numbered year.
Implementation of the APRN Consensus Model in Connecticut
The APRN Consensus Model, created by the National Council of State Boards of Nursing’s (NCSBN) with input from more than 40 other nursing associations, certifying bodies and program accreditation agencies, seeks uniformity in the scope of practice and licensing laws for APRNs in all states and jurisdictions, with a particular focus on allowing APRNs to practice independently. While 11 states have completely implemented the model, other states have worked to implement some components of the model.
Connecticut has made significant advances in working towards compliance with the consensus model. In 1999, the state passed legislation allowing APRNs to work in collaboration with physicians rather than under their supervision. In 2014, Connecticut implemented a law that only requires APRNs to enter into a collaborative agreement with a supervising physician for the first three years of practice, and includes modifications that would then eliminate the need to maintain the agreement after three years and at least 2,000 hours of practice. Thus, APRNs in the state of Connecticut are moving closer to fully adopting the consensus model.
According to the CSBEN, ’Collaboration’ means a mutually agreed upon relationship between an APRN and a physician who is educated, trained or has relevant experience related to the role of the advanced practice registered nurse.
APRN Continuing Education Requirements in Connecticut
The CSBEN requires APRNs in all roles to renew their license every 24 months. Upon renewal, candidates must provide proof of obtaining 50 contact hours of continuing education during the preceding 24-month period. Continuing education hours are required to be specific to the APRN’s area of practice. The CSBEN requires at least 5 of these contact hours to be in pharmacotherapeutics, as well as at least one contact hour in each of the following areas:
- Risk management
- Sexual assault
- Domestic violence
- Cultural competency
- Substance abuse
The CSBEN recognizes continuing education credits in the form of seminars, conferences, training workshops, and other educational forums sponsored by:
- The American Nurses Association
- Connecticut Nurses Association
- Connecticut League for Nursing
- A specialty nursing society or equivalent organization
- Educational offering through a hospital, health care institution, local health department, or regionally accredited academic institution
The CSBEN offers a waiver of up to 10 contact hours of continuing education for APRNs that serve as members of the CSBEN or that otherwise assist the department. Waivers may also be made available in case of illness or disability.
In addition to the CSBEN’s requirements for continuing education, APRNs will be required to complete all renewal and continuing education necessary to maintain their national certification.