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Our nation’s healthcare system is experiencing an unprecedented period of change, which includes, among other things, the introduction of the Affordable Care Act, an aging baby boomer population requiring more healthcare services, and swiftly advancing healthcare technology. Healthcare leaders argue that the number of nurses with advanced education must increase to meet the challenges of today’s healthcare delivery system, and specialized Master of Science in Nursing (MSN) programs for advanced clinicians, educators, and nurse leaders are largely seen as the solution.
Alabama’s educators and administrators agree, which is why they developed the Alabama 80×20 Taskforce (part of The Alabama Health Action Coalition) to encourage nurses to continue their education by earning BSN and higher degrees.
The standard educational requirement for RNs in Alabama who want to serve as educators, clinical leaders, informaticists, administrators, researchers, and advanced practice nurses (APNs) is the Master of Science in Nursing.
According to the American Association of Colleges of Nursing (AACN), there are 4,411 advanced practice nurses in Alabama in 2014, broken down into the following APN categories:
- 2,755 Nurse practitioners
- 20 Certified Nurse-Midwives
- 1,554 Certified Registered Nurse Anesthetists
- 82 Clinical Nurse Specialists
During the same period, there were 4,324 nursing students studying to become APNs, which included:
- 4,112 Nurse Practitioners
- 154 Certified Registered Nurse Anesthetists
- 57 Clinical Nurse Specialists
- 1 Nurse-Midwife
Licensing Requirements for the Advanced Practice Nurse Roles Recognized in Alabama
To receive approval to practice as an advanced practice nurse (APN) in Alabama, candidates must possess:
- An active and unencumbered Alabama registered nurse license
- A master’s degree or higher in their chosen advanced practice nursing role from an accredited program recognized by the Board
- Certification through a national certifying agency recognized by the Board in the clinical specialty consistent with educational preparation and appropriate to the area of practice
Currently, the Alabama Board of Nursing (ABN) grants RNs approval for advanced practice nursing in the following categories:
- Certified Nurse-Midwife (CNM)
- Certified Registered Nurse-Practitioner (CRNP)
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
CNSs and CRNPs further specialize by selecting a population group in which to focus graduate studies in alignment with national certification. CNMs and CRNAs do not choose a population focus.
The Alabama Board of Nursing recognizes the following certification agencies and related certification for the purpose of APN licensure in the state:
Registered Nurse Practitioner (RNP)
- 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)
- Adult Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC)
- Adult-Gerontology Acute Care Nurse Practitioner-Board Certified (AGACNP-BC)
- Adult-Gerontology Primary Care Nurse Practitioner-Board Certified (AGPCNP-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)
- School Nurse Practitioner-Board Certified (SNP-BC)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- 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 (CNS)
- 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)
- American Nurses Credentialing Center
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
- Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
- Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
Earning a Master of Science in Nursing (MSN) in Alabama
The Alabama Board of Nursing requires all APNs to possess a master’s degree or higher in advanced practice nursing from an accredited program recognized by the Board.
Graduate nursing students have many educational options thanks to the many accredited institutions that offer MSN programs in an online format. These programs allow students to complete all of their didactic requirements through online study and then complete their clinical requirements at sites close to home.
The following accrediting agencies accredit advanced practice MSN nursing programs in Alabama:
Nurse Practitioner and Clinical Nurse Specialist Programs – The Commission on Collegiate Nursing Education (CCNE) accredits nursing programs in the U.S. at all levels. There are 12 master’s degree programs in Alabama, located in the following cities:
- Mobile
- Florence
- Tuscaloosa
- Huntsville
- Birmingham
- Jacksonville
- Auburn
One Alabama institution, located in Birmingham, offers a CCNE-accredited post-graduate APRN certificate.
The 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, located in Troy.
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accredits nurse anesthetist programs in the U.S. There are currently two COA-accredited programs in Alabama, both of which are located in Birmingham.
Certified Nurse Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) accredits nurse-midwifery programs in the U.S. There are currently no ACME-accredited programs in Alabama.
Alabama Board Requirements for MSN Programs that Prepare Advanced Practice Nurses
The Alabama Board of Nursing approves only those programs that follow the AACN’s APRN Consensus Model, which states that an advanced practice nursing education must include the following core courses:
- Advanced pathophysiology/physiology
- Advanced health assessment
- Advanced pharmacology, including pharmacokinetics, pharmacodynamics, and pharmacotherapeutics of broad categories of agents
Accredited MSN programs in Alabama must meet the requirements for national certification by including the appropriate clinical and didactic content specific to the role and population focus:
Certified Nurse-Midwife: The American College of Nurse Midwives (ACNM) requires all CNM programs to meet the ACNM Core Competencies for Basic Midwifery Practice, which includes the following areas of study:
- Hallmarks of Midwifery
- Components of Midwifery Care: Professional Responsibilities of CNMs
- Components of Midwifery Care of Women
- Components of Midwifery Care of the Newborn
- Components of Midwifery Care: Midwifery Management Process
- Components of Midwifery Care: Fundamentals
Areas of study within accredited CNM programs include (among others):
- Anatomy and physiology
- Epidemiology
- Nutrition
- Normal growth and development
- Clinical genetics and genomics
- Pharmacokinetics and pharmacotherapeutics
Clinical Nurse Specialist: The National Association of Clinical Nurse Specialists oversees the National CNS Competency Task Force, which outlines the requirements for CNS-accredited programs. All CNS programs must prepare students in the following core competencies:
- Direct Care Competency
- Consultation Competency
- Systems Leadership Competency
- Collaboration Competency
- Coaching Competency
- Research Competency
- Ethical Decision-Making, Moral Agency and Advocacy Competency
Certified Registered Nurse Anesthetist: The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), as the accrediting agency for CRNA programs in the U.S., outlines the basic nurse anesthesia academic curriculum and prerequisite courses focus on coursework in anesthesia practice:
- Anatomy, physiology, and pathophysiology (135 hours)
- Basic and advanced anesthesia practices (105 hours)
- Professional aspects of nurse anesthesia practice (45 hours)
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry (105 hours)
- Research (30 hours)
- Clinical conferences (45 hours)
- Radiology and ultrasound
Nurse Practitioner: The National Task Force on Quality Nurse Practitioner Education sets the standards for accredited nurse practitioner programs in the U.S.
- Ethics Competencies
- Health Delivery System Competencies
- Independent Practice Competencies
- Leadership Competencies
- Policy Competencies
- Practice Inquiry Competencies
- Quality Competencies
- Scientific Foundation Competencies
- Technology and Information Literacy Competencies
Specific coursework requirements for the following population foci are detailed in the Population-Focused Nurse Practitioner Competencies:
- Women’s Health/Gender-Related
- Psychiatric-Mental Health
- Pediatric Primary Care
- Pediatric Acute Care
- Neonatal
- Family/Across the Lifespan
Selecting the Right Type of MSN Program Based on Current Education
RNs in Alabama pursuing an MSN degree must select a program that corresponds with their current level of education:
- BSN-to-MSN Programs: The traditional MSN accommodates RNs that possess a BSN. These programs take about two years to complete.
- RN-to-MSN Programs: RN-to-MSN programs accommodate RNs who possess an associate’s degree in nursing and must therefore earn both their BSN and MSN. TN-to-MSN programs (often called bridge programs) take about three years to complete.
- Entry-level MSN Programs: Entry-level (also often called direct-entry) MSN programs are designed for students that possess a bachelor’s degree in an area other than nursing and still need to earn both an RN license and MSN.
Scope of Practice and Alabama State Laws Governing Advanced Practice Registered Nursing
The Alabama Board of Nursing recognizes APNs as registered nurses that have gained additional knowledge and skills through the successful completion of an organized program of nursing education designed to prepare nurses for advanced practice roles.
APNs in Alabama must practice in accordance with national standards and functions as identified by the appropriate specialty certifying agency and according to Alabama law:
Nurse Practitioners: CRNPs possess advanced knowledge and skills in the delivery of nursing services within a healthcare system that provides for consultation, collaborative management, or referral as indicated by the health status of the client.
Certified Nurse-Midwives: CNMs oversee the management of women’s healthcare with a focus on pregnancy, childbirth, the postpartum period, care of the newborn, family planning, and gynecological needs of women within a healthcare system that provides for consultation, collaborative management, or referral as indicated by the health status of the client.
Services provided by CNMs include (but are not limited to):
- Evaluating the health status and risk factors of patients based on a health history and physical examination/assessment
- Prescribing, administering, and providing therapeutic measures, tests, procedures, and drugs
- Formulating a diagnosis, developing a treatment plan, and evaluating/modifying treatment plans
- Counseling and teaching individuals and families about the prevention of illness and health maintenance/restoration
Certified Registered Nurse Anesthetists: CRNAs are concerned with any act involving the determination, preparation, administration, or monitoring of any drug used to render an individual insensible to pain for surgical and other therapeutic or diagnostic procedures. CRNAs function under the direction of a physician licensed to practice medicine, or a dentist who is currently available.
Clinical Nurse Specialists: CNSs has advanced knowledge and practice skills in a specialized area of practice; however, CNSs may NOT do the following:
- Perform delegated medical acts or engage in collaborative practice
- Perform any of the functions of a certified registered nurse practitioner or a certified nurse midwife
Continuing Education Requirements for APNs in Alabama
All APNs in Alabama must complete at least 24 continuing education contact hours every two years (even-numbered years) to maintain their APN certificate to practice advanced practice nursing. APNs in Alabama must renew their APN certificate at the same time as their RN license or their national certification, whichever occurs first.
Acceptable continuing education content may include:
- Clinical technology, procedures, and nursing implications
- Specialty areas of nursing practice
- Nursing practice related to care of the patient
- Administration, management, and supervision in healthcare delivery
- Social, legal, and ethical aspects of nursing
- Nursing education
- Nursing theory, research, and practice issues
- Quality improvement and management, accrediting standards, and processes
- Academic credit earned from liberal arts, sciences, business, and general education courses obtained after initial licensure from an institution accredited by an educational accrediting body
- Professional conduct
Implementation of the APRN Consensus Model, Collaborative Practice and Prescriptive Privileges in Alabama
The APRN Consensus Model was created to align accreditation, education, certification, and licensure across all states and jurisdictions. The APRN Consensus Model ultimately seeks clarity and consistency that benefits nurses and enhances patient care.
Although Alabama is still in the earliest stages of conforming to the APRN Consensus Model, according to the National Council of State Boards of Nursing’s Implementation Status Map, Alabama’s governor signed Senate Bill 229 in 2013, which now permits CRNPs and CNMs to prescribe certain schedules of controlled substances.
The law calls for written collaboration with a physician and designates the Board of Medical Examiners as the certifying board for the registration and approval of a CRNP or CNM in obtaining or renewing a Qualified Alabama Controlled Substances Registration Certificate.
Collaborative Agreement
Because CRNPs and CNMs in Alabama are eligible for prescribing authority, they must enter into a formal relationship with a physician (doctor or medicine or doctor of osteopathy) before they can begin practicing advanced practice nursing. The term collaboration does not require direct, on-site supervision by the collaborating physician. However, it does require professional oversight and direction.
The collaborating physician and CRNP/CNM must practice in a site together at least 10 percent of the CRNP/CNM’s scheduled work hours if the CRNP/CNM has less than two years of collaborative practice experience consistent with the physician’s specialty.
Standard protocols for CRNPs and CNMs regarding collaborative agreements, by population focus, are found here.
CRNAs and CNSs in Alabama are not eligible for prescribing authority and are therefore not required to submit a collaborative practice agreement for ABN approval.
Prescriptive Authority
CRNPs and CNMs that engage in collaborative practice with physicians may be granted prescriptive authority, provided they have completed an academic course in pharmacology or can show evidence that their CRNP/CNM curriculum integrated pharmacology theory and clinical application.
CRNPs and CNMs with prescribing authority may:
- Prescribe legend drugs
- Initiate call-in prescriptions
- Administer legend drugs
When prescribing legend drugs, Alabama CRNPs and CNMs must:
- Receive authorization in an approved protocol signed by the collaborating physician
- Only prescribe and administer drugs listed on the formulary recommended by the joint committee and adopted by the State Board of Medical Examiners and the Board of Nursing
CRNPs and CNMs with prescriptive authority must earn 6 contact hours of pharmacology content specific to prescriptive practice in the approved area of collaborative practice as part of the 24 hours of continuing education contact hours required for license renewal.
CRNAs must earn 6 contact hours of pharmacology education as part of the 24 hours of continuing education contact hours required for license renewal.
Controlled Substances Certificate
CRNPs and CNMs may apply for a Qualified Alabama Controlled Substances Certificate (QACSC) through the Alabama Board of Medical Examiners, which grants them prescriptive privileges for Schedules II, IV, and V. Prescribing protocols are found here.
All applicants for a QACSC must first complete the course: Pharmacology and Prescribing of Controlled Drugs, a 12-hour course provided by the Medical Foundation of Alabama.
A QACSC requires registration with the DEA and the Prescription Drug Monitoring Program through the Alabama Department of Public Health. CRNPs and CNMs must submit a separate QACSC for each collaborating practice agreement.
CRNPs and CNMs in Alabama must renew their QACSC annually on December 31. DEA registration and registration to access the Prescription Drug Monitoring Database must be current to renew a QACSC.