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Master of Science in Nursing (MSN) in Nebraska for Nurse Practitioners and Other APRNs

Nebraska’s registered nurses pursue a Master of Science in Nursing (MSN) to develop advanced clinical skills in health assessment, pharmacology, and pathophysiology, which positions them to become nationally certified as nurse practitioners, clinical nurse specialists, nurse anesthetists or nurse midwives. RNs interested in moving into advanced nonclinical roles in education, administration, research, informatics, patient advocacy and more, will also find MSN programs with specialized tracks in each of these areas.

In March of 2015, Nebraska adopted a series of laws that significantly increased the level of autonomy granted to many of the state’s advanced practice registered nurses (APRNs). Under these new regulations, nurse practitioners, clinical nurse specialists, and nurse anesthetists with a minimum of 2,000 hours of experience in their respective roles may practice independently without any kind of physician oversight.

This increased level of autonomy will create new opportunities for the state’s MSN-prepared APRNs, who will now be better positioned to establish independent practices of their own. Many of these new opportunities for independent practice will be in the state’s high needs areas, which have been struggling with a shortage of physicians and a lack of access to primary and specialty care services. According to the U.S. Health Resources and Services Administration (HRSA), Nebraska was identified as having 105 primary care shortage areas as of January 2016.

Licensing Requirements for the APRN Roles Recognized in Nebraska

The Nebraska Department of Health and Human Services (DHHS), Board of Nursing requires APRN candidates to hold a an unrestricted Nebraska RN license, as well as a graduate degree and national certification in one of the four Board-recognized roles:

  • Certified Registered Nurse Anesthetist (APRN-CRNA)
  • Certified Nurse-Midwife (APRN-CNM)
  • Clinical Nurse Specialist (APRN-CNS)
  • Nurse Practitioner (APRN-NP)

NPs and CNSs also focus their graduate education and national certification in a specific patient population focus such as women’s health, family-individual across the lifespan, psychiatric-mental health, adult-gerontology primary or acute care, or neonatology.

The Nebraska Board of Nursing recognizes the following national certifying bodies as conferring the credentials necessary for APRN licensure in the respective role and patient population focus:

Clinical Nurse Specialist (CNS)

  • American Nurses Credentialing Center
    • Medical-Surgical Clinical Specialist
    • Gerontological Clinical Specialist
    • Adult Psychiatric & Mental Health Clinical Specialist, and
    • Child and Adolescent Psychiatric & Mental Health Clinical Specialist

Certified Registered Nurse Anesthetist (CRNA)

Certified Nurse-Midwife (CNM)

Nurse Practitioner (NP)

  • American Nurses Credentialing Center
    • Adult Nurse Practitioner
    • Family Nurse Practitioner
    • School Nurse Practitioner
    • Pediatric Nurse Practitioner
    • Gerontological Nurse Practitioner
    • Acute Care Nurse Practitioner

Earning a Master of Science in Nursing (MSN) in Nebraska

With few campus-based MSN programs in Nebraska, many of aspiring APRNs in the state pursue their graduate education through accredited online programs. Working RNs often choose this option to complete didactic coursework on a flexible schedule that allows them to maintain their current practice hours. For the clinical portion of these programs, nurses would work with program advisors to find placement in an approved medical facility nearby. In most cases, graduate students are able to complete clinical hours in their current place of employment.

All Nebraska APRN licensure candidates must graduate from a master’s or higher degree program that meets the following minimum requirements:

  • Program must be a minimum of one full-time academic year or nine months in length
  • Program must include both a didactic component and a preceptorship of 500 contact hours
  • Program must include instruction in biological, behavioral, and health sciences relevant to practice as an APRN in a specific clinical area
  • Program must include coursework in pharmacotherapeutics, advanced health assessment, and pathophysiology or psychopathology

Programs that have been accredited by the following organizations all meet these minimum requirements:

Clinical Nurse Specialist/Nurse Practitioner Programs – The Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are the two recognized national certifying bodies for CNS and NP graduate-level nursing programs. There are four ACEN-accredited graduate programs in Nebraska, located in Lincoln and Omaha.

The CCNE accredits three MSN programs in Nebraska, all of which are located in Omaha.

Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized certifying body for CRNAs. The COA accredits two schools in Nebraska, located in Lincoln and Omaha.

Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body nurse-midwives programs. There are no ACME-accredited programs in Nebraska.

Selecting the Right Type of Program Based on Current Education

Aspiring APRNs in Nebraska would apply to MSN programs specifically structured to accommodate their current level of education:

  • RNs with an Associate’s Degree in Nursing: Associate’s prepared RNs must earn both a BSN and MSN. To do so, they would enroll in RN-MSN programs, which typically take three years to complete.
  • RNs with a Bachelor of Science in Nursing (BSN): BSN-prepared nurses would apply to traditional two-year terminal MSN programs.
  • Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Several schools offer direct entry (also referred to as entry-level) programs that allow students with a bachelor’s in an area other than nursing to earn both licensure as an RN and an MSN degree.

Scope of Practice and Nebraska State Laws Governing Advanced Practice Registered Nursing

In March of 2015, Nebraska adopted significant changes to its laws regarding collaborative practice requirements for nurse practitioners through Legislative Bill 107. In place of an integrative practice agreement with a physician, NPs are required to enter into a written transition-to-practice agreement with an approved “supervising provider” for their first 2,000 hours of practice. A supervising provider may include one of the following professionals:

  • A physician
  • An osteopathic physician
  • A nurse practitioner who has completed a minimum of 10,000 hours of practice within an advanced practice nursing role and who practices in the same practice specialty, related specialty, or field of practice as the nurse practitioner being supervised

Through the transition-to-practice agreement, NPs work collaboratively with their supervising provider, who must be readily available for consultation at all times. Once the APRN-NP has completed 2,000 hours of practice, they may begin practicing independently.

CNMs, CNSs and CRNAs in Nebraska are not eligible to earn independent practice authority. CNMs, CNSs and CRNAs in Nebraska must practice within an integrative practice agreement with a physician, who must be readily available for consultation and direction of activities.

Scope of Practice for APRNs in All Roles

Nebraska’s Advanced Practice Registered Nurse Practice Act outlines the general scope of practice for the state’s APRNs. The scope of practice for APRNs varies based on role and specialization:

Nurse Practitioner Scope of Practice – The scope of practice for NPs in Nebraska is defined through the state’s Nurse Practitioner Practice Act. The act has yet to be updated to reflect the changes made through Legislative Bill 107.

All NPs in Nebraska may perform acts including, but not limited to:

  • Assessing patients
  • Ordering diagnostic tests and therapeutic treatments
  • Synthesizing and analyzing data

NPs with approved certification in a psychiatric or mental health specialty may additionally manage the care of patients committed under the Nebraska Mental Health Commitment Act. Within this care, NPs may refer patients who require care beyond the NP’s scope of practice to an appropriate health care provider.

NPs may additionally pronounce death and complete and sign death certificates and any other forms if such acts are defined by the Nebraska DHHS to be within the NP’s scope of practice.

Clinical Nurse Specialist Scope of Practice – The scope of practice for CNSs in Nebraska is defined through the state’s Clinical Nurse Specialist Practice Act. The act has yet to be updated to reflect the changes made through Legislative Bill 107.

CNSs in Nebraska may perform acts including, but not limited to:

  • Assessing patients
  • Synthesizing and analyzing data
  • Conducting and applying research
  • Engaging in system management
  • Assessing complex health care problems with the CNSs’ specialty and intervening with appropriate care

Certified Registered Nurse Anesthetist Scope of Practice – The scope of practice for CRNAs in Nebraska is defined through the state’s Certified Registered Nurse Anesthetist Practice Act. The act has yet to be updated to reflect the changes made through Legislative Bill 107.

CRNAs in Nebraska may perform acts including, but not limited to:

  • Conducting preanesthesia evaluation including physiological studies to determine proper anesthetic management
  • Obtaining informed patient consent
  • Selecting and administering anesthetic techniques
  • Managing a patient’s postanesthesia period

CRNAs may additionally use fluoroscopy under the following conditions:

  • Fluoroscopy use must be in conjunction with a licensed medical radiographer in connection with the performance of authorized duties and functions
  • CRNA must complete education and training approved jointly by the DHHS and the Nebraska Advanced Practice Registered Nursing Board

Certified Nurse Midwife Scope of Practice – The scope of practice for CNMs in Nebraska is defined through the state’s Certified Nurse Midwifery Practice Act.

CNMs in Nebraska may perform acts within an integrated practice agreement with a physician including, but not limited to:

  • Attending cases of normal childbirth
  • Providing prenatal, intrapartum, and postpartum care
  • Providing normal obstetrical and gynecological services for women
  • Providing care for the newborn immediately following birth

All acts must take place in one of the following locations:

  • A licensed or certified health care facility
  • The primary office of a licensed practitioner or in any setting authorized by the collaborating licensed practitioner (except those where a CNM would attend home delivery)
  • An organized public health agency

Prescriptive Authority for APRNs in Nebraska

According to Legislative Bill 107, the most recent update regarding scope of practice for APRNs in Nebraska, APRN-NPs may “prescribe medications relating to health conditions within the scope of practice.” The bill removed language that required limitations on these nurses’ authority to prescribe Schedule II controlled substances to be listed in an integrated practice agreement.

According to Title 172 Chapter 104 of Nebraska Legislature, CNMs may prescribe the following substances within an integrated practice agreement:

  • Legend drugs
  • Schedule II controlled substances for up to 72 hours and for pain control
  • Schedule III, IV and V controlled substances

Nebraska and the APRN Consensus Model

In 2008, over 40 nursing organizations collaborated to establish the national APRN consensus model, a uniform set of rules designed to allow nurses to practice to the full extent of their education without significant restrictions. As of February 2016, Nebraska had adopted the following major components of the model:

  • Titles
  • Roles
  • License
  • Education
  • Certification
  • Independent practice for NPs, CNSs, and CRNAs
  • Independent prescriptive authority for NPs and CRNAs

Continuing Education Requirements for APRNs in Nebraska

To maintain licensure as an APRN, nurses must complete a minimum of 40 contact hours of Continuing Education (CE) related to their clinical specialty every two-year renewal cycle. The CE must include 10 contact hours in pharmacotherapeutics.

The Nebraska Department of Health and Human Services requires CE to consist of continuing medical education or contact hours that are specifically designated for advanced practice nurses.

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