The most recent Michigan Center for Nursing survey asking about the education level among Michigan’s RNs with specialty certification was performed in 2013. It found that over 75 percent of all specialty-certified nurses held an MSN (with an additional seven percent holding a doctoral degree). According to the survey, 90 percent of nurse practitioners had an MSN, and 81 percent of nurse midwives held an MSN.
An article published in the Midland Daily News in July 2015 titled, “Time is Right for Michigan Nurse Practitioners,” points out that advanced practice nurses with specialist certification are in the right state at the right time. It cites the American Medical Association as saying a serious physician shortage is coming Michigan’s way, and argues the best way to avoid this is to encourage more RNs to gain specialty certification.
The Michigan Center for Nursing’s 2015 Nursing Tableau and Survey of Nurses revealed the following information about nurse specialties statewide:
- Of Michigan’s 104,351 active RNs, about 5.3 percent (5,530 RNs) hold a nurse specialty certification, which is divided among three roles:
- Nurse practitioners – almost four percent, or about 4,070 RNs
- Nurse anesthetists – around one percent, or about 1,044 RNs
- Nurse midwives – less than 0.5 percent, or less than 521 RNs
- 10 percent of all RNs in Michigan, approximately 10,435, hold an MSN
While an MSN is an essential part of preparing for a career as a nurse practitioner, nurse anesthetist or nurse-midwife, the Michigan Center for Nursing’s 2015 data shows that about half of RNs with an MSN do not hold specialty certification. This indicates they have used their MSN credential to attain positions in academia, management, upper-level administrative roles, or remained in clinical practice as generalists.
State Specialty Certification Requirements for Michigan RNs Entering Advanced Practice
The Michigan Board of Nursing is responsible for establishing and maintaining the regulations that apply to certifying nurse specialties, while the state’s Department of Licensing and Regulatory Affairs (LARA) is responsible for licensing RNs who want to become certified for practice in one of the three recognized nurse specialties:
- Nurse Practitioner
- Nurse Anesthetist
- Nurse Midwife
Out-of-state applicants will recognize these as being traditionally referred to as advanced practice registered nursing (APRN) roles, while Michigan RNs will recognize these as what the Michigan Board of Nursing and LARA refer to as “nurse specialties.” RNs in Michigan complete this process by adding certification in one or more nurse specialty roles onto their RN license.
Nurse practitioners can further specialize by becoming educated and certified in a specific patient population focus (family-individual across the lifespan; adult-gerontology primary or acute care; neonatal; women’s health; psychiatric-mental health).
To be eligible to add a nurse specialty certification to an RN license in Michigan, candidates must:
- Be of good moral character
- Have a traditional RN license in good standing (Michigan allows for RN licensure via endorsement by meeting similar conditions for licensure in another state)
- Gain national certification from a board-recognized national organization that certifies the specific nurse specialty (and population focus for nurse practitioners) – herein this is always referred to as “national certification,” and should not be confused with the “nurse specialty certification” regulated by the Michigan Board of Nursing and granted by LARA
For the purpose of specialty certification, LARA recognizing these national certifying bodies as providing the specialty credentials necessary for each of the recognized specialty areas:
- Nurse Midwives gain national certification from the American Midwifery Certification Board (AMCB)
- Nurse Anesthetists gain national certification from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
- Nurse Practitioners gain national certification from one of several organizations
Earning an Master of Science in Nursing (MSN) in Michigan
Holding an MSN or a graduate certificate in a specific nurse specialty area of focus is mandatory for becoming nationally certified as a nurse practitioner, nurse midwife or nurse anesthetist. While there are many different national certifying organizations, they all require a graduate-level education specific to the nurse specialty, and in the case of nurse practitioners, a patient population focus as well.
The Michigan Center for Nursing provides a searchable list of MSN programs statewide, which reveals local programs in the cities of:
- Berrien Springs
- Flint (two schools)
- Ann Arbor (two schools)
- Grand Rapids
- Big Rapids
- East Lansing
- University Center
- Spring Arbor
- Detroit (two schools)
Aside from the campus-based options, an increasing number of Michigan students are choosing to earn their MSN from an online school. Online MSN programs offer the flexibility many students need to complete their education while maintaining their current career. These schools establish clinical partnerships with local hospitals, universities, and other healthcare facilities to ensure their students can complete their clinical segment at a convenient location.
When choosing an MSN program it is important to make sure that it meets the standards for national certification. The following nurse specialties are listed along with the accrediting agencies that sign off on the academic rigor of MSN programs in each specialty with their national certification organizations, along with accrediting agencies these national certification organizations recognize:
Nurse Midwife candidates must enroll in MSN programs accredited by the Accreditation Commission for Midwifery Education (ACME)
Nurse Anesthetist candidates must enroll in MSN programs accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
Nurse Practitioners must enroll in MSN programs accredited by one of these organizations:
- Commission on Collegiate Nursing Education (CCNE)
- Accreditation Commission for Education in Nursing (ACEN)
- Any accrediting organization recognized by the US Department of Education
Michigan Requirements for MSN Programs that Prepare RNs for Specialty Certification
To understand the curriculum expectations for each nursing specialty role, one can look at national authorities in each area of nursing specialization:
Nurse Practitioners – The National Task Force of Quality Nurse Practitioner Education describes the nurse practitioner graduate curriculum as follows:
- It must be updated by nurse practitioner faculty members and meet the standards for national certification in a population-focused area of practice
- It must prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the nurse practitioner’s role and population focus
- Nurse practitioner role/population core competency objectives must be included in the curriculum
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused competencies
- Didactic coursework must be reinforced by clinical coursework
- At least 500 hours of supervised direct patient care clinical hours must be included
Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) specifies that nurse-midwifery graduate program curriculum must include the study of:
- Promotion of family-centered care
- Fundamentals of nurse midwifery care
- The components of midwifery care and the professional responsibilities of nurse midwives
- Midwifery management process
- Primary health care of women
- Gynecologic, perimenopausal, postmenopausal, and care for other aging periods
- Management of common health problems
- Care for the childbearing family
- Newborn care
The clinical segment must cover all of these core competencies, which typically demands at least 500 hours of supervised direct patient care.
Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the CRNA graduate program curriculum to include the following didactic elements:
- At least 135 hours covering pathophysiology, anatomy, and physiology
- At least 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- At least 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- At least 45 hours covering clinical correlation conferences
- At least 45 hours covering the professional aspects of the practice of nurse anesthesia
- At least 30 hours covering nurse anesthesia research
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
- Ultrasound and radiology
A program with COA accreditation must also meet these conditions:
- It must be at least 24 months in length, or its part-time equivalent
- Student applicants must be registered nurses with at least one year of experience in a critical-care setting
- Students must complete 2,000 hours of supervised clinical training and study at least 600 clinical cases
Selecting the Right Program Based on Current Education
There is an MSN program designed for all Michigan RNs, regardless of their educational background:
- Those with a Bachelor’s of Science in Nursing (BSN) – these RNs can apply directly to conventional MSN programs and potentially graduate in two years
- Those with an Associate’s Degree in Nursing (ADN) – these RNs can apply to RN-to-MSN bridge programs that offer fast-track completion options, and potentially graduate in as little as three years
- Those with a Bachelor’s Degree in an Area Other than Nursing – these RNs can apply to direct-entry or entry-level MSN programs that allow for enrollment upon completion of prerequisites; these programs can be completed in less than three years
Scope of Practice and Michigan State Laws Governing Advanced Practice Registered Nursing
Michigan currently does not have a specific nurse practice act. Rather, RNs who are certified in different specializations practice within several sets of regulations:
- Article 15, Part 172 of the Public Health Code
- Article 7 for Advanced Practice Nurses
- Administrative Rules for the Board of Nursing
Scopes of Practice and Working Under Physician Supervision
The scopes of practice for RNs with certifications as nurse practitioners, nurse midwives, and/or nurse anesthetists revolve around the scope of practice for traditional RNs. Any time a specialized nurse goes beyond the bounds of the traditional RN’s scope of practice, they must be working under the direct supervision of a physician who specializes in a similar area of practice.
All anesthetic services provided by a nurse anesthetist must be done under the direct supervision of a physician who is licensed in a similar area of practice.
Scope of Practice for a Nurse Practitioner:
- Treatment for common illnesses and chronic conditions
- Health promotion and health maintenance
- Disease prevention
- Patient education and health counseling
- Provision of primary care services
Scope of Practice for a Nurse Midwife:
- Provide gynecological care of women
- Provide primary women’s healthcare services
- Manage pregnancies and childbirth
- Provide newborn care
- Family planning and treatment
Scope of Practice for a Nurse Anesthetist:
- Provide and assist with basic anesthetic care
- Health assessments
- Patient needs before, during, and after surgery
- Patient needs before, during, and after labor/delivery
Prescriptive Authority Collaboration for Nurse Specialties
Nurse midwives and nurse practitioners can only prescribe medication in Michigan if they write the prescription using a supervising physician’s controlled substance license number.
Nurse midwives and nurse practitioners must register with the Drug Enforcement Administration (DEA) to obtain a DEA number if they will write delegated prescriptions for controlled substances outside of a hospital setting. Those who work in a hospital setting, surgical suite, oncology, or palliative care unit have the option to obtain a registration number from the DEA that allows for the delegated prescription of Schedule II-V substances. Nurse practitioners and nurse midwives working elsewhere may apply for a DEA number that allows for the delegated prescription of Schedule III-V substances.
Nurse midwives and nurse practitioners may not write delegated prescriptions for Schedule II controlled substances for a quantity that exceeds a seven-day supply. Schedule III-V substances may be prescribed for longer periods in line with existing protocol.
APRN Consensus Model in Michigan
Michigan has not made major modifications to its legislation and rules regarding specialty-certified (advanced practice) nursing since 1978.
Established with support from the National Council of State Boards of Nursing’s (NCSBN), the APRN consensus model aims to:
- Standardize specialty nursing throughout the nation, making it easier for specialized nurse to fulfill the healthcare demands throughout the nation
- Improve the access to, and quality of, healthcare for consumers throughout Michigan and the nation
The NCSBN recommends that Michigan take steps towards the APRN consensus model that many other states have taken. These include:
- Changing the definition of specialty nursing to advanced practice registered nursing (APRN)
- Adding the role of clinical nurse specialist to the possible role options for APRN nurses
- Clearly define the APRN scopes of practice
- Allowing all nurse specialists/APRNs to work independently of physicians, including in the realm of prescriptive authority
In fact, steps are currently being taken to this end. As of January 2016, House Bill 4207 is making its way through the Michigan Legislature. If passed as is, it would incorporate the first three recommendations.
Continuing Education Requirements for Nurse Specialties in Michigan
The Michigan Board of Nursing stipulates the following continuing education and renewal requirements for RNs who want to maintain their nurse specialty certification, in addition to the traditional RN license renewal/continuing education requirements:
- Nurse practitioner – must maintain national certification and renew their Michigan specialty license every two years
- Nurse midwife – must earn 20 hours of continuing education that specifically relates to nurse-midwifery, or maintain national certification, and renew their Michigan specialty license every two years
- Nurse anesthetist – must maintain national certification and renew their Michigan specialty license every two years
The traditional RN license and its nurse specialty certification(s) must be renewed biannually by March 31st.