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Career advancement, a broader scope of practice, the freedom to practice independently and better pay are all important factors that weigh in an RN’s decision to earn a Master of Science in Nursing.
Alaska’s master’s-prepared advanced nurse practitioners (ANPs) and nurse anesthetists (NAs) practice independently and enjoy full prescriptive authority without the restrictions of a written collaborative physician agreement. If Alaska’s more than 1,000 ANPs and NAs are successful in petitioning for the full implementation of the APRN Consensus Model, they will soon align their titles with the standardized titles more commonly used throughout the county, which denote role and patient population focus.
As of 2016, the Alaska Board of Nursing, organized under the Department of Commerce, Community, and Economic Development Division of Corporations, Business, and Professional Licensing, recognizes these advanced practice roles:
- Nurse Anesthetist (NA)
- Advanced Nurse Practitioner (ANP) – ANPs are further classified into one of three categories: Nurse Practitioner, Certified Nurse-Midwife or Clinical Nurse Specialist
Licensing Requirements for NAs and the Recognized ANP Roles in Alaska
ANPs and NAs in Alaska possess advanced credentials that afford them a broad scope of practice. These advanced credentials include:
- A graduate-level education in nurse anesthesia or in an ANP focus approved by the Alaska Board of Nursing
- Certification in a specific advanced practice role and patient population focus granted by a national certification body recognized by the Alaska Board of Nursing
The standard among graduate nursing degrees is the Master of Science in Nursing (MSN), largely recognized as the educational core that allows advanced practice nurses to work in any number of specialized roles.
By completing an MSN and becoming nationally certified in one of these three areas, ANPs may earn Board-authorization to practice as:
- Clinical Nurse Specialists (CNS)
- Nurse Practitioners (NP)
- Certified Nurse-Midwives (CNM)
Alaska’s nurse practitioners and clinical nurse specialists further specialize through education and certification in one of a number of specific patient population groups:
- Acute care/emergency
- Pediatric
- Family
- Geriatric
- Adult
- Neonatal
- Women’s health
- Adult/gerontology
- Family/individual across the lifespan
- Women’s health/gender related
- Adult psychiatric/mental health
- Family psychiatric/mental health
Certified registered nurse anesthetists are authorized to work with all patient population groups and would NOT select a particular patient population focus. ANPs authorized as certified nurse-midwives would NOT select a patient population group, as their patient population focus is implicit in their area of specialty.
The Board recognizes the following national certification agencies as being qualified to grant the credentials necessary to practice as a CRNA, or as an ANP in one of the Board-approved patient population foci:
Certified Registered Nurse Anesthetist (CRNA)
Advanced Nurse Practitioner
- National Certification Corporation
- Neonatal nurse practitioner – Board certified (NNP-BC)
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care (CPNP-PC)
- Pediatric nurse practitioner acute care (CPNPAC)
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
- 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)
- Psychiatric-mental health nurse practitioner – Board certified (PMHNP-BC)
- Adult psychiatric- mental health nurse practitioner – Board certified (PMHNP-BC)
- American Academy of Nurse Practitioners
- Adult nurse practitioner (ANP)
- Family nurse practitioner (FNP)
- Gerontologic nurse practitioner (GNP)
- AACN Certification Corporation
- Clinical nurse specialist; wellness through acute care (adult-gerontology) (ACCNS-AG)
- American Nurses Credentialing Center
- 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)
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
Earning a Master of Science in Nursing (MSN) in Alaska
To be eligible for initial ANP/NA licensure through the Alaska Board of Nursing, candidates must complete an MSN program that has been accredited by an accrediting agency recognized by the U.S. Department of Education.
Major nationally recognized accrediting agencies for programs in the respective advanced practice roles include:
APN – Nurse Practitioner and Clinical Nurse Specialist
- Commission on Collegiate Nursing Education (CCNE) accredits nursing programs in the U.S. at all levels.
- There are currently no CCNE-accredited programs in Alaska.
- Accreditation Commission for Education in Nursing (ACEN) accredits post-secondary and the higher degree including, among others, master’s/post-master’s certificates.
- There is currently one ACEN-accredited program in Alaska, located in Anchorage.
Certified Registered Nurse Anesthetist
- Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accredits nurse anesthetist programs in the U.S.
- There are currently no COA-accredited programs in Alaska.
APN – Certified Nurse Midwife
- Accreditation Commission for Midwifery Education (ACME) accredits nurse-midwifery programs in the U.S.
- There are currently no ACME-accredited programs in Alaska.
RNs in Alaska seeking a specialized MSN degree in preparation for advanced practice licensure have the option of pursuing online programs that work in partnership with local hospitals to facilitate clinical sequences. These programs allow students to satisfy all of their didactic requirements through web-based study and complete their clinical requirements at sites close to home.
Other unique options found throughout many of today’s master’s degrees in nursing include part-time and accelerated programs.
Alaska Board Requirements for MSN Programs that Prepare Advanced Nurse Practitioners and Nurse Anesthetists
RNs in Alaska seeking initial ANP or NA licensure must, at a minimum, complete an MSN program that:
- Is one academic year in length
- Prepares registered nurses to perform an expanded role in the delivery of healthcare
- Includes a combination of classroom instruction
- Includes at least 500 supervised clinical practice
- Includes three graduate courses in:
- Advanced pathophysiology
- Advanced pharmacotherapeutics
- Advanced physical assessment
The Board requires that the curriculum is congruent with national standards for graduate-level and APRN education and consistent with nationally recognized core role and population-focused competencies. The Board also requires clnical settings to be “diverse and sufficent in number” to ensure that students will meet all program/track goals and core curriculum guidelines.
Selecting the Right Program Based on Current Education
MSN programs are structured in a variety of ways to accommodate graduate students with different degrees and backgrounds:
- RNs with a Bachelor of Science in Nursing (BSN) may pursue a conventional terminal MSN, which takes about two years to complete.
- RNs with an Associate’s Degree in Nursing would complete an RN-to-MSN degree program to earn both a BSN and MSN in one accelerated program that takes about three years to complete.
- RNs with a Master of Science in Nursing (MSN) in another area may pursue a post-graduate certificate that allows them to receive advanced, graduate-level education in their APRN role and patient population focus of choice.
- Professionals with a Bachelor’s Degree in a Subject Other Than Nursing would enroll in what is often referred to as a direct-entry pre-licensure MSN program, which would allow them to earn a BSN, RN licensure, and an MSN in one, combined program in preparation for APN or NA licensure.
In addition to offering specialty tracks in advanced clinical practice, earning a master’s degree in nursing would also prepare RNs for nonclinical roles in administration, academia and informatics.
Scope of Practice and Alaska State Laws Governing Advanced Nursing Practice
Scope of practice and state laws concerning prescriptive privileges are detailed in the Alaska Nursing Statutes and Regulations.
Nurse Anesthetist Scope of Practice
According to the Alaska Board of Nursing, NAs may perform, within the scope of their educational preparation, the following procedures:
- Administer anesthesia in consultation with:
- A primary physician or designee of the primary physician responsible for the patient’s care
- A medical director of the anesthesia services or a qualified designee of the director
- A primary dentist or a qualified designee of the primary dentist responsible for the patient’s care
Nurse anesthetists are licensed, independent practitioners that practice both autonomously and in collaboration with a variety of health providers. Nurse anesthetists care for patients at all acuity levels across the lifespan and in a number of settings for procedures such as:
- Surgical
- Diagnostic
- Therapeutic
- Pain management
- Obstetrical
Their scope of practice includes (but is not limited to):
- Consultation requests
- The evaluation of diagnostic tests
- Acute, chronic, and interventional pain mangement services
- Planning and inititation of anesthetic techniques
- Facilitating emergency and recovery from anesthesia
- Providing post-anesthesia care
NAs in Alaska must submit notarized, written practice guidelines with their application for licensure that detail their scope of practice and practice plans. The written practice guidelines must include:
- The primary location of the applicant’s anesthesia practice
- The name of the anesthesiologist, physician or dentist with whom they will primarily consult
- A description of the communication plan for consulting on cases related to the preoperative, perioperative, and postoperative periods
- A description of the procedure for transferring care of a patient to the responsible personnel for post-anesthesia care
- A description of the quality assurance plan to be used to evaluate the applicant’s practice ( standards that apply to the area of practice, review of the practice, and a written evaluation of the quality assurance review with a plan for corrective action)
- A completed reference form signed by an anesthesiologist, physician, or dentist that the applicant is competent to practice
Advanced Nurse Practitioners Scope of Practice
The Alaska Board of Nursing defines advanced nurse practitioners (ANPs) as registered nurses with advanced education and experience. ANPs are authorized to medically diagnose and prescribe/dispense medical, therapeutic, or corrective measures.
ANPs in Alaska must submit a notarized, written consultation and referral plan with their application for licensure that details their scope of practice and practice plans. The written plan must include:
- A description of routine consultations and how they will be documented in the patient’s record
- A description of the applicant’s clinical practice, including the geographical location, the clients expected on a routine basis, and the focus of care
- The process for quality assurance – to include national standards, type of review process, and any correction action plans/follow-ups, if needed
- A completed ANP reference form
Prescriptive Authority for ANPs in Alaska
The Board authorizes ANPs to prescribe and dispense legend drugs. At the Board’s discretion, ANPs may receive authorization to prescribe and dispense Schedule II through V controlled substances.
ANPs that apply for authorization to prescribe and dispense drugs must:
- Provide proof of having completed at least 15 contact hours of education in advanced pharmacology and clinical management of drug therapy within the two years prior to the date of application
- Complete and submit an application and application fee
Authorized prescriptions provided by ANPs must:
- Comply with all applicable state and federal laws
- Use the initials “ANP” following their signature and prescriber ID number assigned by the Board
ANPs must renew their prescriptive authority biennially at the same time as their ANP authorization renewal. The renewal application must include proof of having completed at least 12 contact hours of continuing education in advanced pharmacotherapeutics and at least 12 contact hours of continuing education hours in the clinical management of patients.
Prescriptive Authority for CRNAs in Alaska
The Board authorizes CRNAs in Alaska to prescribe legend drugs and schedule II through V controlled substances. CRNAs applying for authorization to prescribe drugs must:
- Be currently authorized as a CRNA in Alaska
- Provide evidence that they have completed at least 15 contact hours of advanced pharmacology related to the administration of anesthesia is the past two years
- Complete and submit an application and application fee
CRNAs in Alaska with prescriptive authority must:
- Comply with all state and federal laws
- Use the initials “CRNA” following their signature and prescriber ID number assigned by the Board
CRNAs must renew their prescriptive authority biennially at the same time as their CRNA authorization renewal. The renewal application must include proof of having completed at least 12 contact hours of continuing education in advanced pharmacotherapeutics and at least 12 contact hours of continuing education hours in the clinical management of patients.
Continuing Education Requirements for ANPs and NAs in Alaska
ANPs and NAs in Alaska must complete the following to fulfill their continuing education requirements:
- Nursing employment totaling at least 320 hours of nursing practice during the two, preceding years; OR
- At least 30 contact hours (one contact hour=at least 60 minutes of actual organized instruction; 10 contact hours=one quarter academic credit, or 15 contact hours=one semester academic credit)
- At least 20 of the 30 required contact hours must be through a program aligned with the standards of one of the following organizations:
- A certifying body for nurse practitioners
- A certifying body for nurse anesthetists
- American Nurses Credentialing Center (ANCC)
- Accreditation Council for Continuing Medication Education (ACCME)
- Accreditation Council for Pharmacy Education (ACPE) (courses must have a “P” designation or ID number)
- At least 20 of the 30 required contact hours must be through a program aligned with the standards of one of the following organizations:
ANPs and NAs in Alaska may also seek Board approval for continuing education through sponsors not listed above.
The contact hours must be earned in at least one of the following subject areas:
- Nursing practice areas and special healthcare problems
- Legal or ethical aspects of healthcare
- Biological, physical, or behavioral sciences
- Management or administration of healthcare personnel and patient care
- Subjects approved by the Board that are required as part of a formal nursing program more advanced than what was required for original licensure
The Board also accepts professional activities toward the fulfillment of continuing education requirements, provided applicants document the following:
- The completion of at least 30 hours of participation in professional activities for the renewal of a license
- The hours spent in the participation of professional activities were earned in at least one of the following ways:
- Author or contributor to a book, article, or publication related to healthcare
- Work with a professional nursing or health-related organization
- Design and conduct a research study related to nursing and healthcare
- Development and oral presentation of a paper before a professional or lay group in a subject related to new or current areas of nursing techniques, philosophy, or theory
- The hours spent in the participation of professional activities were earned in at least one of the following ways:
Note: ANPs and NAs in Alaska with prescriptive authority may apply the 24 hours of continuing education required for prescriptive authority renewal as part of their continuing hours.
Additional continuing education requirements would also be required for maintaining national certification.
The APRN Consensus Model and Independent Practice in Alaska
The Alaska Center of Nursing Excellence introduced Senate Bill 53 on February 18, 2015, which would update the State’s 34-year-old statutory title from Advanced Nurse Practitioner and Nurse Anesthetist to one, umbrella title: Advanced Practice Registered Nurse (APRN).
The change to the APRN title will bring Alaska into compliance with the APRN Consensus Model, a national effort to standardize the practice of advanced practice nurses. If Senate Bill 53 passes, Alaska will move to the APRN title and the four APRN specialties:
- Certified Registered Nurse Anesthetists
- Certified Nurse-Midwives
- Certified Nurse Practitioners
- Certified Clinical Nurse Specialists
As more states adopt the APRN Consensus Model, the ANP and NA titles are becoming increasingly outdated. Further, the ANP title does not reflect the title or education of CNSs and CNMs, which can be confusing when using the title outside of Alaska. Finally, Medicare, the VA, and many insurance companies now use the APRN title; therefore, the use of the APRN title in Alaska would eliminate the denial of reimbursement based on confusion about the service provider.