Pursuing a Master of Science in Nursing (MSN) with an emphasis in a specialized area of advanced clinical practice is a natural progression for RNs with their sites set on careers that involve a greater level of professional autonomy and higher salaries. RNs interested in moving into advanced nonclinical roles in academia, administration, research, informatics, patient advocacy and more, will also find MSN programs that offer focus areas specifically designed to prepare nurses for these roles.
An August 2015 article in the Seattle Times shined a spotlight on the growing need for advanced registered nurse practitioners (ARNPs) to serve as primary care providers in Washington. As more state residents gain access to health insurance and the state’s growing elderly population continues to require a greater level of care, advanced clinicians serving as nurse practitioners, nurse-anesthetists and nurse-midwives are seen as the solution to an impending health provider shortage in the state.
Even as job growth projections for Washington’s ARNPs in all roles show the number of advanced clinicians in the state increasing by 20% or more during the current ten-year projection period, the demand is growing even faster and employers are offering top salaries to complete for talent. In a state where RNs earn a very respectable average salary of $78,540, the value of the state’s ARNPs is apparent in the average salaries they earn (US Department of Labor; Washington State Employment Security Department, 2014):
- Nurse practitioners – $100,530
- Nurse midwives – $95,860
- Nurse anesthetists – $163,280
The Washington State Nurses Association and Washington Center for Nursing released the results of a 2015 ARNP survey showing that 94 percent of ARNPs in the state hold at least a master’s degree.
Licensing Requirements for the ARNP Roles Recognized in Washington
The Washington State Department of Health’s Nursing Commission licenses ARNPs in three distinct roles:
- Nurse Practitioner (NP)
- Certified Nurse Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
Nurse practitioners further specialize by earning a graduate degree and national certification 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 apply for an ARNP license, candidates must meet these requirements:
- Have a current and active Washington State RN license
- Hold an MSN or higher graduate degree in a specific ARNP role and patient population focus, as applicable
- Have completed at least seven hours of approved education regarding the prevention, transmission, and treatment of AIDS
- Be nationally certified in an ARNP role and patient population focus through an organization recognized by Washington’s Nursing Commission
The national certification organizations that are recognized by the Washington Nursing Commission as granting the role and patient population focus-specific credentials necessary for ARNP licensure are:
Nurse Practitioner (NP)
- 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)
Certified Nurse-Midwife (CNM)
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
Earning an Master of Science in Nursing (MSN) in Washington
Graduate nursing students often prefer the flexibility of accredited online programs designed to accommodate the schedules of working RNs. Many online MSN programs also offer part time options for an even greater level of convenience. Out-of-state schools offering online MSN programs strive to create partnerships with local universities and hospitals in Washington so students won’t have to travel for clinical preceptorships. In many cases, students of online programs are able to complete clinical sequences at their current place of employment.
In fact, online MSN programs are so prevalent that the Washington State Department of Health maintains a list of approved clinical sites in Washington and throughout the country for out-of-state MSN programs.
For those that would prefer a fulltime campus-based experience, approved MSN and MN programs in Washington can be found in Spokane, Tacoma, Seattle, Bothell, Richland, Vancouver, Walla Walla and Yakima.
Whether online or campus-based, all graduate programs that prepare ARNPs in the three roles must be accredited in order for candidates to meet the qualifications for national certification and state licensure:
- Nurse Practitioner MSN Programs – The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the two largest accrediting agencies for nurse practitioner MSN programs
- Nurse Anesthetist MSN Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the only approved accrediting agency for nurse anesthetist MSN programs
- Nurse-Midwife MSN Programs – The Accreditation Commission for Midwifery Education (ACME) is the only approved accrediting agency for nurse-midwife MSN programs
Washington State Requirements for MSN Curriculum Designed to Prepare ARNPs
To ensure its future ARNPs earn a quality education, Washington maintains general MSN and graduate program requirements:
- The programs must culminate in a graduate degree with a concentration in a specific ARNP role
- Programs must include a clinical segment of at least 500 hours with faculty/preceptor oversight
- The program’s primary purpose must be to prepare ARNPs
- The program must meet the standards of the appropriate ARNP’s national certification organization
- Clinical and didactic coursework must cover:
- Advanced physiology and pathophysiology
- Advanced health assessment
- Diagnostic theory and management of health care problems
- Advanced pharmacology, including pharmacodynamics, pharmacokinetics, pharmacotherapeutics, and pharmacological management of individual patients
Specific MSN curriculum requirements are described by the following national professional nursing organizations:
Nurse Practitioners – The National Task Force of Quality Nurse Practitioner Education specifies nurse practitioner curriculum must:
- Be continuously updated by current nurse practitioner faculty members
- Consistent with nationally-recognized population-focused competencies
- Meet the standards for national certification in a population focused area of practice
- Include core competency objectives
- Prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the NP’s role and population focus
- Didactic coursework must be reinforced by clinical coursework
Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) specifies that the nurse-midwife graduate curriculum must cover:
- Hallmarks of midwifery, including the promotion of family-centered care
- 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
- Management of common health problems
- Childbearing family
- Newborn care
- The clinical sequence must include coverage of all these core competencies
Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) describes the CRNA graduate curriculum as including these didactic elements:
- 30 hours covering nurse anesthesia research
- 45 hours covering professional aspects of the practice of nurse anesthesia
- 45 hours covering clinical correlation conferences
- 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- 135 hours covering pathophysiology, anatomy, and physiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
- Ultrasound and radiology
Students also must complete 2,000 hours of supervised clinical training and study at least 600 separate clinical cases.
Selecting the Right Program Based on Current Education
RNs can choose from a variety of MSN programs specifically designed to build on a nurse’s current level of education:
- RNs with a Bachelor of Science in Nursing (BSN) would apply directly to traditional MSN programs, which take about two years to complete
- RNs with an Associate Degree in Nursing (ADN) would apply to accelerated RN-to-MSN bridge programs that result in earning both a BSN and MSN in as little as three years
- Non-nursing professionals with a bachelor’s degree in an area other than nursing would apply to entry-level (sometimes called direct-entry) MSN programs that result in RN licensure and an MSN degree in about three years time
Scope of Practice and Washington State Laws Governing ARNPs
Washington state laws that govern advanced registered nurses practitioners are found in the state’s Revised and Administrative Code:
- Chapter 18.79 of the Revised Code of Washington (RCW)
- Chapter 246-840 of the Washington Administrative Code (WAC)
The general scope of practice for ARNPs in all roles is legally defined as including these activities:
- Assume primary responsibility for the continuous and comprehensive management of a broad range of patient care, concerns, and problems
- Assume primary responsibility and accountability for the care of patients
- Use independent judgment as well as collaborative interaction with other health care professionals
- Function within the ARNP’s scope of practice according to standards developed by national certification organizations
- Obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices
- Perform within the scope of the ARNP’s knowledge, experience, and practice
- Examine patients and establish diagnoses by patient history, physical examination, and other assessment methods
- Admit, manage, and discharge patients to and from health care facilities
- Order, collect, perform, and interpret diagnostic tests
- Manage health care by identifying, developing, implementing and evaluating a plan of care and treatment for patients
- Prescribe therapies, medical equipment, and medications when granted the authority to do such
- Refer patients to other health care practitioners or facilities as needed
Prescriptive Authority for ARNPs in Washington
Washington’s ARNPs can earn full prescriptive authority by taking these steps:
- Verify completion of at least 30 hours of graduate education in pharmacology in the past two years
- Verify having read the Interagency Guideline on Prescribing Opiods for Pain
- Indicate on the ARNP application that prescriptive authority is desired
Washington’s ARNPs can gain authorization to prescribe Schedule II-V controlled substances if they register with the Drug Enforcement Administration (DEA). ARNPs are not eligible to gain authorization to prescribe Schedule I controlled substances under any circumstances.
While ARNPs can be granted full prescriptive authority, an employing public or private health care institution can limit the drugs an ARNP can prescribe as desired.
ARNPs who want to renew their prescriptive authority biannually with their ARNP license must earn an additional 15 hours of continuing education per ARNP role, related to pharmacotherapeutics and the ARNP’s specific role and/or scope of practice.
Independent Practice for ARNPs in Washington and the Implementation of the Consensus Model
Washington is among the most progressive states when it comes to granting its ARNPs full autonomy and prescriptive authority. This has allowed the state’s ARNPs to practice to the full extent of their education and training, serving as primary healthcare providers who can diagnose illnesses, establish treatment plans and prescribe medicine.
This level of independence aligns with the National Council of State Boards of Nursing’s (NCSBN) APRN (advanced practice registered nurse) Consensus Model, which advocates for allowing master’s-prepared advanced clinicians throughout the nation to be granted full practice and prescriptive independence.
To align fully with Consensus Model guidelines, Washington’s Nursing Commission would still need to:
- Define the scopes of practice for each ARNP role
- Re-introduce the fourth ARNP role of clinical nurse specialist
- Adopt the acronym APRN instead of ARNP (this latter move is supported by over 60 percent of current ARNPs in Washington)
The independence that ARNPs in Washington enjoy today has been achieved gradually over time. In 2007 Washington’s Nursing Commission reexamined the rules governing ARNP practice, opening them up for discussion and modification. This allowed changes to be made to ARNP scopes of practice and definitions, replacing those that were over a decade old. Two years later in 2009 the process was completed and new ARNP rules were adopted.
These new rules recognized the three ARNP roles that are familiar today – nurse practitioner, nurse midwife, and nurse anesthetist – and broadened the ARNP scope of practice. It also did away with the ARNP role of clinical nurse specialist.
ARNP independence continues to evolve to this day. Washington’s governor signed House Bill 1259 into law in 2015, granting ARNPs the authority to sign certificates, forms, and other official documents, a level of authority that was previously reserved only for physicians. Ongoing developments in 2016 include new developments in the prescribing of medical cannabis.
Continuing Education Requirements for ARNPs in Washington
ARNP licensure in Washington must be renewed every two years by the licensee’s birthday while renewing the standard RN license and national certification.
ARNPs must complete 30 hours of continuing education per renewal period. ARNPs with more than one role must complete 30 hours of continuing education per role. For example, a nurse practitioner who is also licensed as a nurse midwife would need to complete 60 hours of continuing education (plus an additional 30 for those with prescriptive authority). Nurse practitioners certified in two different population foci need only complete 30 hours of continuing education per renewal period (plus an additional 15 for those with prescriptive authority).
To be valid, the continuing education must be approved by the ARNP’s national certifying organization.
ARNPs can apply the continuing education they earn for renewal of their ARNP license towards the CE required to renew their RN license.