In its 2014 state profile of New Jersey, the American Association of Colleges of Nursing (AACN) reported that 2,611 students were enrolled in Master of Science in Nursing (MSN) programs throughout the state. The profile also discussed the high demand for advanced practice nurses (APNs), and how the shortage of advanced clinicians is becoming more acute due to an inadequate number of nurse educators in the state’s nursing schools.
Fortunately, however, his situation has improved in more recent years thanks to the proliferation of fully accredited online MSN programs with specialty tracks in advanced clinical practice that welcome students from anywhere in the country. In 2016, the New Jersey Board of Nursing reported that there were nearly 4,000 active APN licenses in the state.
In many ways, RNs in New Jersey looking to enter advanced practice are experiencing an ideal environment as demand for their services continues to increase amid a growing physician shortage, while at the same time online programs make an MSN more accessible than ever. The New Jersey Department of Labor and Workforce Development expects strong job growth for a number of advanced clinical roles during the ten-year period leading up to 2022:
- Nurse anesthetists – 20 percent growth
- Nurse midwives – 21 percent growth
- Nurse practitioners – 22 percent growth
State Certification Requirements for the Advanced Practice Nursing (APN) Roles Recognized in New Jersey
To be eligible for APN certification, candidates must meet these requirements:
- Have a current New Jersey RN license in good standing
- Earn an MSN at minimum with at least 30 hours in pharmacology training, including at least six hours devoted to addiction prevention and management
- Become certified in a Board-recognized APN role and patient population focus through a Board-approved national certifying organization
The New Jersey Board of Nursing, a branch of the state’s Division of Consumer Affairs, certifies qualified candidates in one of three distinct APN roles:
- Nurse practitioners
- Clinical nurse specialists
- Nurse anesthetists
Nurse practitioners and clinical nurse specialists 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).
Qualified advanced practice nurses from other states can become state certified APNs in New Jersey by way of endorsement if they had to meet equivalent requirements to become an APN in their home state.
Nurse Midwives – While not recognized as an APN role in New Jersey, nurse midwives also need an MSN to be eligible for licensure. The graduate degree in midwifery must be from a school that is accredited by the Accreditation Commission for Midwifery Education (ACME). Upon earning this, prospective nurse midwives can take the national certification exam sponsored by the American Midwifery Certification Board (AMCB). Passing this exam results in national certification as a certified nurse midwife (CNM).
The New Jersey Board of Nursing recognizes national certification organizations that are accredited by these agencies:
The accredited certification agencies recognized by the New Jersey Board of Nursing as granting the credentials necessary to become an APN in the state are as follows:
Nurse Practitioner Certification
- 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)
- School Nurse Practitioner-Board Certified (SNP-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)
- Pediatric Primary Care Mental Health Specialist (PMHS)
- National Certification Corporation
- Women’s Health Care Nurse Practitioner-Board Certified (WHNP-BC)
- Neonatal Nurse Practitioner-Board Certified (NNP-BC)
Clinical Nurse Specialist Certification
- 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)
- 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)
Nurse Anesthetist Certification
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
Earning a Master of Science in Nursing (MSN) in New Jersey
Becoming an APN (nurse practitioner, clinical nurse specialist or nurse anesthetist) or nurse midwife starts by earning an MSN with an emphasis in the respective role. Online MSN programs are becoming increasingly popular since they offer a greater level of flexibility that better accommodates the schedules of working RNs, while providing greater access to diverse specialty tracks in advanced clinical practice. Schools that sponsor online programs develop partnerships with local universities and hospitals in New Jersey to minimize commuting for the clinical segment of the program. In most cases, students can complete their clinical requirements at their current place of employment.
MSN programs are also available in New Jersey at campus locations in West Long Branch, Mahwah, Newark, Jersey City, Galloway, Ewing, Glassboro, South Orange, Trenton and Union.
In order to qualify for national certification, and subsequently, APN state certification through the New Jersey Board of Nursing, candidates must graduate from MSN programs that have received accreditation through nationally recognized accrediting agencies:
- Nurse anesthetists programs must be accredited through the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
- Nurse practitioners and clinical nurse specialists programs are accredited through one of two organizations:
- Nurse midwife programs are accredited through the Accreditation Commission for Midwifery Education (ACME).
MSN Curriculum Requirements for Advanced Practice Nurses and Nurse Midwives in New Jersey
The curriculum found in accredited MSN programs that prepare nurse-midwives and APNs in each of the three Board-recognized roles align with national standards put in place by professional nursing organizations:
Nurse Practitioners – The National Task Force of Quality Nurse Practitioner Education describes the nurse practitioner graduate curriculum as follows:
- It must prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the NP’s role and population focus
- The curriculum must be continuously updated by current nurse practitioner faculty members
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused competencies
- It must meet the standards for national certification in a population-focused area of practice
- Population focus core-competency objectives must be included in the curriculum
- Didactic coursework must be reinforced by clinical coursework
- The curriculum must include at least 500 hours of supervised direct patient care clinical education
Clinical Nurse Specialist – The National Association of Clinical Nurse Specialists (NACNS) describes the clinical nurse specialist academic requirements as follows:
- The curriculum must be accredited by a nursing education organization that is recognized by the US Department of Education
- The curriculum must be clearly aligned to address the care of a specific population, and be consistent with state requirements as well as 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
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the CNS/APN licensure or certification requirements
- There must be an adequate number of faculty instructors and preceptors to ensure there is direct and indirect supervision during clinical courses
- Clinical course preparation must include at least 500 supervised clinical hours
Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires nurse anesthetist curriculum to include the following didactic elements:
- 135 hours covering pathophysiology, anatomy, and physiology
- 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- 45 hours covering professional aspects of the practice of nurse anesthesia
- 45 hours covering clinical correlation conferences
- 30 hours covering nurse anesthesia research
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
- Ultrasound and radiology
Students must also complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) specifies that nurse-midwifery curriculum must cover:
- Management of common health problems
- Newborn care
- Promotion of family-centered care
- Childbearing family
- Central tenants of midwifery
- Professional responsibilities of nurse midwives and the components of midwifery care
- Midwifery management process
- Fundamentals of midwifery care
- Primary health care of women
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
Master’s programs in nurse midwifery cover all of these core competencies during clinical training, which is usually accomplished in no less than 500 hours of supervised clinical experience.
Selecting the Right Type of Program Based on Current Education
MSN programs are structured in a variety of ways to accommodate different educational backgrounds:
- RNs with a Bachelor of Science in Nursing (BSN) – RNs with a BSN can apply directly to conventional terminal MSN programs and expect to graduate about two years later
- RNs with an Associate Degree in Nursing (ADN) – RN-to-MSN bridge programs are designed especially for nurses with an ADN who want to earn an MSN; bridge programs result in earning both a BSN and MSN in one accelerated program that takes about three years to complete
- Non-nursing professionals with a bachelor’s degree in an area other than nursing – Professionals from a non-nursing background can apply to direct-entry (also referred to as entry-level) MSN programs designed for those with a bachelor’s degree in a field other than nursing; these programs can take around three years to complete
Scope of Practice and New Jersey State Laws Governing Advanced Practice Registered Nursing
Specific rules and regulations governing the practice of New Jersey’s APNs can be found here:
- Chapter 37 of the New Jersey Board of Nursing Regulations, especially subchapter 7
- Chapter 45 of the New Jersey Annotated Statutes
When applying for state certification as an APN, candidates must attest to having read these selections in full.
APNs can perform all functions named within the scope of practice for registered nurses. Additionally, the New Jersey Board of Nursing specifies that APNs may:
- Initiate laboratory and other diagnostic tests
- Prescribe and order medications and medical devices
- Prescribe and order treatments, including referrals
- Prescribe medications in an inpatient setting provided specific protocol is followed
- Prescribe medications in all other settings within the protocol established with a physician
Prescriptive Authority for APNs in New Jersey
APNs in New Jersey must establish a joint protocol with a collaborating physician before they can prescribe any medication. This written protocol must be kept at the location where the APN works, and must be reviewed at least once yearly. The content of the protocol must detail:
- The nature of the APN’s practice, population focus, and practice setting
- Under what circumstances a patient examination is required before a prescription is possible
- The type of record keeping to be used
- A list of categories of medications that are appropriate to the practice
- Any specific restrictions on APN prescribing as specified by the physician
- Any medical conditions or findings that require direct physician consultation prior to prescribing
- Identification of the means by which the physician and APN can be in direct communication
- Procedures for prescribing in emergency situations
Upon establishing this written protocol, APNs may prescribe and order medications as well as medical devices.
To prescribe controlled substances, APNs must take these additional steps:
- Register with the New Jersey Drug Control Unit
- Register with the Drug Enforcement Administration (DEA)
Effective January 2016, prescribers of controlled substances must give patients a notice issued by the Division of Consumer Affairs that provides details on how to dispose of unused medication.
Prescriptive authority can be renewed biannually along with the APN certification. To be eligible for renewal of prescriptive authority, APNs must complete six hours of continuing education relating to the prescription of controlled substances during each two-year licensing cycle.
Nurse Midwives – Nurse midwives are also eligible for prescriptive authority after completing a 30-hour course in pharmacology with at least six hours devoted to addiction prevention and management. They must follow the same procedure if they want to prescribe controlled substances. Unlike APNs, nurse midwives can prescribe without a written protocol in place with a physician. Prescriptive authority must be renewed every two years.
Independent Practice for APNs and Implementation of the APN Consensus Model in New Jersey
With the exception of the requirement to maintain a written protocol for prescriptive privileges, New Jersey allows its APNs and nurse midwives to practice independent of physician oversight. This is one of the key tenets of the National Council of State Boards of Nursing’s (NCSBN) APRN Consensus Model, which aims to improve access to quality healthcare throughout the nation by giving APNs greater autonomy.
While APNs in New Jersey can practice independently, currently they cannot prescribe independently. Having independent prescriptive authority is key to allowing APNs the ability to practice to the full extent of their knowledge and training so that they can serve the public as independent primary healthcare providers.
To complete align New Jersey laws and regulations governing APNs with the national goals outlined in the APRN Consensus Model, New Jersey would still need to adopt the following changes:
- Create a separate licensing process for APNs independent of RN licensure
- Grant full prescriptive independence to APNs
- Define a specific scope of practice for each APN role
- Adopt the title APRN (Advanced Practice Registered Nurse)
- Recognize all four APRN roles: nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist
Continuing Education Requirements for APNs in New Jersey
APN certificates through the New Jersey Board of Nursing must be renewed every two years, coinciding with the renewal of the standard RN license. APN state certificate renewal is contingent upon maintaining national certification in one of the three Board-recognized APN roles. To keep their license valid, nurse midwives must also maintain their national certification.
Additionally, the New Jersey Board of Nursing requires APNs to complete two credits of education that relate to end-of-life care during each two-year renewal cycle. This requirement may be waived at the discretion of the Board.