Whether in advanced clinical practice or in advanced nonclinical roles in areas like administration and informatics, the value of a Master of Science in Nursing (MSN) is only expected to increase in the coming years. According to the Indiana Department for Workforce and Labor Development, a number of key practice areas of nursing associated with a graduate level education are expected to grow significantly in the state during the period spanning 2012-2022:
- Nurse anesthetists 28.7% projected growth
- Nurse midwives 10.9% projected growth
- Nurse practitioners 28.5% projected growth
- Post-secondary nursing educators and instructors 9.9% projected growth
On October 2nd, 2015, Indiana’s nurses and health care leaders convened at the 2015 Indiana Nursing Summit, entitled “One Voice”, to discuss the future of nursing within the state. One of the summit’s objectives, according to the Indiana Center for Nursing, was to develop strategies to implement the Institute of Medicine’s (IOM’s) Recommendations for the Future of Nursing — a model that would remove significant scope of practice barriers for advanced practice nurses (APNs) in the U.S.
The effort to implement the IOM’s recommendations is just one way the field of advanced practice nursing is growing in the state. In fact, during the Indiana General Assembly in 2015, Governor Mike Pence signed into law a bill that allows APNs with prescriptive authority to dispense the overdose intervention drug naloxone to patients without an initial examination, provided certain conditions are met. The bill represents Indiana’s increased reliance on APNs to meet the state’s health care needs.
Meeting the Requirements for the four APN Roles Recognized by the Indiana State Board of Nursing
Registered nurses with unencumbered licenses in good standing can become recognized as APNs through the Indiana State Board of Nursing (ISBN) in one of four distinct roles:
- Certified Nurse Midwife (CNM)
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
- Certified Registered Nurse Anesthetist (CRNA)
The ISBN issues a limited license to certified nurse midwives, granting them the authority to perform the acts associated with advanced clinical practice (limited license does not grant immediate prescriptive authority). Although the Board states that NPs and CNSs may perform these same acts, the Board does not issue licenses for NPs, CNSs, and CRNAs in the state, instead allowing RNs to work under such titles if they complete the following educational guidelines:
- NPs must graduate from a relevant program accredited by an agency recognized by the Council for Higher Education Accreditation (CHEA) as well as earn and maintain certification from a national body
- CNSs must graduate from a relevant program accredited by the Council for Higher Education Accreditation (CHEA)
- CRNAs must graduate from a program accredited by the National Board of Certification and Recertification for Nurse Anesthetists and pass the National Certification Examination, offered by the National Board for Certified Counselors
To prepare for a career as an APN in Indiana, RNs enroll in Master of Science in Nursing or higher degree programs that teach theory and provide coursework and clinical experience specific to their chosen APN role. After completing a graduate degree program in advanced clinical practice, APN candidates would then become nationally certified in the role that aligns with their education and clinical training.
Master’s degree programs and national certification for nurse practitioners and clinical nurse specialists are further specialized by focusing on one of a number of patient population groups (adult-gerontology; family/individual across the lifespan; neonatology; pediatrics; psychiatric/mental health; or women’s health). While the ISBN does not recognize APN specializations and patient population foci as most other jurisdictions do, NPs and CNSs will find that accredited graduate programs and national certification align with national standards by including a focus in one of the above named patient population groups.
For the purpose of APN recognition in all four roles, the ISBN recognizes these certification agencies and associated advanced practice credentials:
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- 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)
- School Nurse Practitioner-Board Certified (SNP-BC)
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- Acute Care Nurse Practitioner Adult (ACNPC) – not aligned with APRN Consensus Model
- Pediatric Nurse Practitioner Primary Care (CPNP-PC)
- Pediatric Nurse Practitioner Acute Care (CPNPAC)
- Pediatric Primary Care Mental Health Specialist (PMHS)
- Women’s Health Care Nurse Practitioner-Board Certified (WHNP-BC)
- Neonatal Nurse Practitioner-Board Certified (NNP-BC)
- Certified in Nurse-Midwifery (CNM)
Clinical Nurse Specialists
- 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
- 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)
- Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
- Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
- Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC)
Certified Registered Nurse Anesthetist (CRNA)
- Certified Registered Nurse Anesthetist (CRNA)
Earning a Master of Science in Nursing (MSN) in Indiana
Indiana is home to campus locations for 26 MSN programs as well as one BSN-to-PhD program. While many RNs in Indiana pursue their graduate education through campus-based programs, others elect to pursue online MSN programs, preferring the flexibility these programs offer. These programs allow students to take online courses while completing clinical hours at one of several partner facilities located throughout Indiana.
In accordance with national standards established by the National Council of State Boards of Nursing’s (NCSBN), all graduate APN programs:
- Advanced pathophysiology/physiology
- Advanced health assessment
- Advanced pharmacology, including pharmacokinetics, pharmacodynamics, and pharmacotherapeutics of broad categories of agents
The Indiana State Board of Nursing (ISBN) establishes the requirements for the state’s educational programs that prepare APNs. According to the Board, programs must meet requirements including, but not limited to:
- Programs must offer both a program of study and supervised clinical experience opportunities
- Programs must include instruction in the following areas related to practice as an advanced practice nurse in a specific role:
- Biological sciences
- Behavioral sciences
- Medical sciences
- Nursing sciences
- Legal, ethical, and professional responsibilities of advanced practice nursing
Qualifying graduate programs must be accredited by an accrediting body recognized by the US Department of Education and/or the Council for Higher Education Accrediation (CHEA):
- Nurse Practitioner and Clinical Nurse Specialist Programs must be accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN).
- Nurse midwife programs must be accredited by the American College of Nurse-Midwives (ACNM).
- Certified registered nurse midwife programs must be accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
Selecting the Right MSN Program Based on Current Level of Education
RNs with a Bachelor of Science in Nursing – RNs who have earned their bachelor’s degree may apply to Indiana’s 20 BSN-MSN programs or an accredited online BSN-MSN program. Typically consisting of 40-60 credits, these programs take roughly 18-30 months to complete.
Additionally, bachelor’s-prepared nurses may apply to BSN-Doctorate of Nursing Practice (DNP) programs, which allow them to take both a master’s and doctorate curriculum at the same educational institution. These programs typically take four-to-five years to complete, although some programs offer an opt-out option at the master’s level.
RNs with an Associate’s Degree in Nursing – RN-MSN programs allow RNs who have earned their associate’s degree to complete a bachelor’s and master’s curriculum in one accelerated program. These programs typically take two-to-three years of full-time study or three-to-four years of part-time study to complete. As of January, 2016, there were six RN-MSN programs based in Indiana, although many nurses pursue this degree online to maintain their current work schedules.
Professionals with a Bachelor’s in an Area Other than Nursing – Direct-entry MSN programs prepare professionals who have received a bachelor’s degree in an area other than nursing through an accelerated learning process. Bachelor’s educated professionals are usually able to complete these programs within 15-24 months.
Scope of Practice and Indiana State Laws Governing Advanced Practice Nursing
The scope of practice for APNs in Indiana is defined by the ISBN and Board-approved national certification bodies. According to the Board, nationally certified nurse practitioners, nurse midwives, and clinical nurse specialists in the state may perform acts including, but not limited to:
- Making independent decisions regarding client’s’ nursing needs
- Assessing clients and diagnosing medical conditions
- Evaluating patient outcomes
- Teaching clients and health care team members about health-related issues
- Collaborating with other members of the health care team
- Conducting client assessments such as physical examinations and analysis of family health history
- Analyzing results of physical examinations and laboratory work
- Planning and implementing care
- Taking part in periodic or join evaluations of services rendered such as outcome statistics and client evaluations
- Researching findings related to APN role and implementing those findings when appropriate
- Providing care in settings including, but not limited to:
- Community agencies
- Private practice
- Hospital outpatient clinics
- Health maintenance organizations
CRNAs have the same scope of practice as RNs, with the additional ability to administer anesthesia under the immediate direction of a present physician.
Implementation of the APRN Consensus Model and Prescriptive Authority in Indiana
CRNAs may not earn prescriptive authority in Indiana. NPs, CNSs, and CNMs may be granted the authority to prescribe legend drugs by the Indiana Board of Nursing. To earn this authority, APNs must:
- Obtain an Indiana controlled substances registration
- Obtain a federal Drug Enforcement Administration (DEA) substances registration
Continuing Education Requirements for APNs in Indiana
Continuing Education (CE) requirements vary for APNs in Indiana based on their role, and whether or not they have prescriptive authority.
Certified Nurse Midwives
CNMs in Indiana have no CE requirements for renewal of a limited license to practice nurse midwifery. However, to maintain national certification from the American College of Nurse Midwives, they must complete the ACNM Certificate Maintenance Program by the end of every five-year licensure cycle.
Advanced Practice Nurses with Initial Prescriptive Authority
APNs in Indiana who have been granted initial prescriptive authority, including CNMs, must meet the following CE requirements during their first renewal cycle, which ends October 31st of the first odd-numbered year following initial licensure:
- APNs granted prescriptive authority more than a year before October 31st of the next odd-numbered year must complete a minimum of 15 contact hours of CE, with a minimum of four contact hours in pharmacology (APNs granted initial prescriptive authority less than a year before October 31st of the next odd-numbered year are exempt from CE requirements during their first renewal cycle)
- The CE must be approved by the ISBN and a nationally approved sponsor of continuing education for nurses (because approved programs are not listed by the Board, nurses should contact the Board for details regarding approved CE)
- The CE must be listed by the Indiana Professional Licensing Agency as approved hours.
Prescriptive Authority Renewal in Subsequent Years
Following the first renewal cycle, APNs must complete the following CE requirements by October 31st of each odd-numbered year to maintain their prescriptive authority:
- APNs must complete minimum of 30 hours of CE, with a minimum of eight hours in pharmacology
- CE programs must be approved by a nationally approved sponsor of CE for nurses
- CE programs must be approved by the ISBN
Certified Registered Nurse Anesthetists
To maintain national licensure, CRNAs must complete 40 CE credits approved by the American Association of Nurse Anesthetists every two years. Because CRNAs are ineligible for prescriptive authority, they are not required to complete the CE requirements listed in the next section of this article.