The prospects for job growth and salary increases are just two of the factors that make earning a Master of Science in Nursing (MSN) inevitable for many RNs with their sights set on career progression. In addition to opening doors to careers in teaching and healthcare administration, an MSN is the educational standard for RNs who want to gain advanced practice nurse (APN) certification through the Tennessee Board of Nursing.
Data from the US Department of Labor as well as the Tennessee Department of Labor and Workforce Development, combined with the Tennessee Board of Nursing’s 2016 annual report merge to create compelling APN statistics for the state (2014):
- Nurse practitioners – 8,989 professionals earning an average salary of $91,950, with the number of jobs growing by a projected 36 percent over the ten-year period leading up to 2022
- Nurse anesthetists – 2,561 professionals earning an average salary of $151,630, with the number of jobs growing by a projected 32 percent over the ten-year period leading up to 2022
- Nurse midwives – 178 professionals earning an average salary of $71,000, with the number of jobs growing by a projected 43 percent over the ten-year period leading up to 2022
- Clinical nurse specialists – 137 professionals working throughout Tennessee as of 2016
The 2016 report published by the Tennessee Board of Nursing is particularly revealing, showing the number of APNs renewing their certification went from 2,644 in 2008 to 4,766 in 2016 – a nearly 100 percent increase.
To keep up with the growing demand for APNs, universities and dedicated nursing schools have been expanding and developing new programs in an effort to increase capacity and make earning a master’s degree more accessible to RNs in Tennessee. In 2015 alone, the Tennessee Board of Nursing recognized four new in-state MSN programs.
Aside from the tangible benefits RNs can enjoy by gaining APN certification, there are also intangible benefits that come from providing badly needed healthcare services. A 2015 report released by the University of Memphis cited APNs, and nurse practitioners in particular, as being in a unique position to fill the primary healthcare provider gap that exists in 51 counties, which currently prevents nearly 40% of the state’s residents from having adequate access to primary-care physicians.
Licensing Requirements for the APN Roles Recognized in Tennessee
The Tennessee Board of Nursing issues advanced practice nurse (APN) certificates for four distinct roles:
- Nurse practitioners
- Nurse anesthetists
- Nurse midwives
- Clinical nurse specialists
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; pediatrics).
To be eligible for an APN certificate, candidates must have these qualifications:
- Current RN license in Tennessee or another compact state
- Master’s degree in the APN role/specialty area
- Three quarter hours of pharmacology education – for APNs who want to apply for prescriptive authority
- National certification from a recognized organization
National certification must be issued by a Board-recognized national organization that offers primary certification in an APN role and patient population focus. The Tennessee Board of Nursing-recognized national certification organizations are as follows:
- Nurse-Midwives – the American Midwifery Certification Board (AMCB) is the recognized national certification organization for these APNs
- Nurse Anesthetists – the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the national certification for these APNs
- Nurse Practitioners and Clinical Nurse Specialists – the following national certification organizations certify these APNs, including in specific population foci:
Earning a Master of Science in Nursing (MSN) in Tennessee
Tennessee law requires all RNs earning APN certification after 2005 to have a master’s degree in their area of specialization (role and patient population focus).
Accredited online MSN programs offer the traditional academic and clinical rigors of a campus-based curriculum, with the added advantages of flexible class schedules and part time options. For clinical sequences, graduate schools with online programs develop clinical partnerships with local hospitals and universities in Tennessee to keep commuting to a minimum. In many cases, students are able to complete clinical requirements through their existing employer.
For those that would prefer to attend a program on campus, the Tennessee Board of Nursing lists approved MSN programs that are located throughout the state in the cities of:
- Nashville (three programs)
- Memphis (two programs)
- Jefferson City
- Johnson City
When choosing an MSN program, students must ensure it is accredited by an agency recognized by the national certification organization that will be issuing their credentials. Recognized accrediting agencies are shown here with their corresponding APN role:
- Nurse Practitioner and Clinical Nurse Specialist – The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the two most prominent and widely recognized accrediting agencies for nurse practitioner and clinical nurse specialist programs
- Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs recognized by the NBCRNA
- Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwife programs recognized by the AMCB
Tennessee Requirements for MSN Programs that Prepare Advanced Practice Nurses
Tennessee holds its APNs to high standards. The following curricula requirements are provided by professional nursing organizations for each APN role:
Nurse Practitioners – The National Task Force of Quality Nurse Practitioner Education describes the nurse practitioner graduate curriculum as follows:
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused competencies
- It must be continuously updated by current nurse practitioner faculty members
- It must prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the NP’s role and population focus
- It must meet the standards for national certification in a population-focused area of practice
- Nurse practitioner core competency objectives must be included in the curriculum
- Didactic coursework must be reinforced by clinical coursework
- Supervised direct patient care clinical hours must total at least 500 hours
Clinical Nurse Specialist – The National Association of Clinical Nurse Specialists (NACNS) describes 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 CNS graduate program’s curriculum must be clearly aligned to address the care of a specific population, and be aligned with state requirements and nationally-recognized competencies
- The academic 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
- There must be an adequate number of faculty instructors and preceptors to ensure there is ample supervision during clinical courses
- Clinical courses must give students many opportunities to develop skills in key areas and meet the CNS certification requirements
- Master’s-level clinical course preparations must include at least 500 supervised clinical hours
Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) specifies that the nurse-midwifery graduate program curriculum must cover:
- Professional responsibilities of nurse midwives and the components of midwifery care
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
- Hallmarks of midwifery, including the promotion of family-centered care
- Management of common health problems
- Fundamentals of midwifery care
- Midwifery management process
- Primary health care of women
- Childbearing family
- Newborn care
Nurse-midwife APNs must cover all of these core competencies during clinical training, which is usually completed in not less than 500 hours of supervised clinical experience.
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
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
Students must also complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Selecting the Right Program Based on Current Education
RNs can find an MSN program that is designed specifically to build upon their educational background:
- RNs with a Bachelor’s of Science in Nursing (BSN) – Nurses from this background can apply to conventional MSN programs, which take around two years to complete
- RNs with an Associate’s degree in nursing (ADN) – Nurses from this background can apply to RN-to-MSN bridge programs, which often result in a BSN along the way and take about three years to complete
- RNs with a Bachelor’s degree in an area other than nursing – Nurses from this background can apply to direct-entry MSN programs, completing any outstanding prerequisites and then moving on to core-MSN nursing subjects; these programs can take around three years to complete
Tennessee State Laws Governing Advanced Practice Nursing
The laws governing advanced practice nursing in Tennessee are detailed in the following e-documents:
- Tennessee Board of Nursing Rules Chapter 1000, especially subchapter 1000-04
- Tennessee Code Unannotated Title 63, Chapter 7
Tennessee expects its APNs to abide by the nationally recognized scopes of practice developed by professional nursing organizations. Tennessee APNs must work within a supervising agreement.
APN Collaborative Agreement in Tennessee
Before being granted an APN certification by the Tennessee Board of Nursing, candidates must complete a practitioner profile, which would include:
- Address of primary practice location
- Type of graduate education program complete
- Type of national APN certification
- Any previous disciplinary actions
- Any past criminal offenses
- Any instances of malpractice or malpractice claims
- Name of a supervising physician
Tennessee law requires APNs to practice under the supervision of a physician who works in a similar area of practice. The APN and supervising physician must establish a set of protocols that govern the activities and procedures an APN can and cannot perform. The supervising physician must be licensed to practice in Tennessee.
APNs must also keep and update a notice and formulary at their site of practice any time they change their supervising physician, practice site, or prescription formulary.
Prescriptive Authority for APNs in Tennessee
APNs can obtain prescriptive authority by obtaining a certificate of fitness. To be eligible, the candidate must have completed at least three quarter hours of education in pharmacology.
After completing the application for prescriptive authority contained in the initial APRN application, candidates must establish prescription protocols with their supervising physician. These should include information about:
- The medications the APN is allowed and not allowed to prescribe
- Methods for conducting a patient assessment
- Means of evaluating patient outcomes
Within 15-30 days of prescribing medications, APNs must register with Tennessee’s Controlled Substance Monitoring Data program.
APNs can additionally gain prescriptive authority for controlled substances (Schedule II-V drugs) by obtaining a certificate from the Drug Enforcement Administration (DEA). However, APNs may not prescribe more than a 30-day supply of Schedule II or III opioid drugs per patient.
When prescribing medications to treat pain, sound judgment must always be exercised and prescriptions must be made within established protocols.
Renewing the certificate of fitness requires maintaining the qualifications for certification as an APN through the board. In addition to this, APNs must obtain two hours of continuing education that relate to controlled substance prescribing practices, including those for opioids, benzodiazepines, barbiturates, and carisoprodol.
Implementation of the APRN Consensus Model in Tennessee
Designed to increase the mobility of APNs nationwide and thereby improve Americans’ access to quality healthcare providers, the National Council of State Boards of Nursing (NCSBN) has developed its APRN (advanced practice registered nurse) consensus model.
Tennessee has taken two steps that align its advanced practice nurses with the NCSBN’s national model:
- Provide a certification process for APNs that is separate from the licensure process for RNs
- Define the four roles of APN to be: nurse midwife, nurse practitioner, nurse anesthetist, and clinical nurse specialist
However Tennessee has yet to implement two of the main pillars of the national APRN consensus model: full independent APN practice and APN independent prescriptive authority. The Knoxville News Sentinel’s 2016 article, “Tennessee Nurse Practitioners Pushing for More Autonomy,” features a nurse practitioner who explains that the requirement for APNs to have a supervising physician is, “…inefficient, expensive – and unnecessary.” The article goes on to explain that Tennessee is just one of 13 states to have such restrictive laws regarding the independence of APNs.
The Tennessee Nurses Association, especially its APRN Committee, is one of the organizations that keeps track of, and lobbies for, legislative changes towards the full implementation of the NCSBN’s APRN consensus model. Its 2016 agenda includes these issues:
- Advocate for a clearly defined scope of practice for each APN role
- Remove barriers to APN independent practice
- Involve APNs in practice and policy decisions
Continuing Education Requirements for APNs in Tennessee
APN certification from the Tennessee Board of Nursing is renewed every two years. Candidates must meet these requirements to be eligible for renewal:
- Maintenance of Tennessee or compact state RN license
- Continual national certification
- Proof of competency, as evidenced by examples such as:
- Satisfactory employee evaluation
- Adequate performance review from a peer, patient, patient’s family member, or self
- Employment contract renewal
- Five hours of continuing education