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Career advancement, professional autonomy, a more inclusive scope of practice and better pay are important motivations for RNs that make the decision to earn a Master of Science in Nursing. A comparison of the average RN salary in Kentucky to that of MSN-educated advanced practice nurses in various roles helps demonstrate the earning power that comes with a master’s in nursing (US Department of Labor, 2014):
- Registered Nurses – $57,980
- Nurse Midwives – $93,080
- Nurse Practitioners – $93,230
- Nurse Anesthetists – $147,910
The Kentucky Board of Nursing’s annual report for 2014 shows the number of advanced practice registered nurses (APRNs) in the four Board-recognized roles practicing in the state that year:
- 3,812 nurse practitioners – up from 2,039 in 2007
- 1,136 nurse anesthetists – up from 1,134 in 2007
- 165 clinical nurse specialists – up from 147 in 2007
- 94 nurse-midwives – staying relatively the same from 95 in 2007
- 5,207 in total
The report went on to show that most clinical nurse specialists work with adult psychology/mental health (69 professionals) and adults (56 professionals), while most nurse practitioners specialize in family health (2,598 professionals).
Licensing Requirements for Advanced Practice Registered Nurses in Kentucky
Earning a Master of Science in Nursing (MSN) is the first step to becoming licensed as an APRN through the Kentucky Board of Nursing.
To be eligible for APRN status in Kentucky, nurses must earn an MSN or higher in their chosen advanced practice role (nurse practitioner, nurse-midwife, nurse anesthetist, or clinical nurse leader) and gain national certification in that role. 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).
The Kentucky Board of Nursing recognizes four APRN roles, listed here with the Board-approved national certifying organizations for each:
Certified Nurse Practitioner (NP)
- American Nurses Credentialing Center (ANCC)
- Pediatric Nursing Certification Board (PNCB)
- National Certification Corporation (NCC)
- American Academy of Nurse Practitioners (AANP)
- American Association of Critical-Care Nurses (AACN)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
Certified Nurse Midwife (CNM)
- American Midwifery Certification Board (AMCB)
Clinical Nurse Specialist (CNS)
- American Nurses Credentialing Center (ANCC)
- American Association of Critical-Care Nurses (AACN)
Earning a Master of Science in Nursing (MSN) in Kentucky
Earning a Master of Science in Nursing (MSN) gives Kentucky RNs the skills they need to become licensed as advanced practice registered nurses, as well as qualifying nurses for leadership positions, upper-level administrative or management roles, and careers in academia.
Accredited online MSN programs offer working RNs the option of a convenient and flexible academic schedule. Online programs work with students from the beginning of their enrollment to find a local hospital or other healthcare facility that is idea for clinical education.
Prospective nurse practitioners and clinical nurse specialists interested in a campus experience can find specialized graduate programs housed in schools located in:
- Louisville (three schools)
- Richmond
- Hyden
- Grayson
- Murray
- Highland Heights
- Bowling Green
Kentucky’s Nursing Incentive Scholarship Fund may further encourage RNs who want to earn an MSN. In 2014 this scholarship fund started off with $361,500 for qualifying students, including those completing ADN-to-MSN and BSN-to-MSN tracks.
Kentucky Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
Kentucky does not legislate a minimum amount of graduate-level credits or clinical hours as requirements to become an APRN. Rather, Kentucky Administrative Regulations stipulate that APRNs must complete a graduate-level education in their area of expertise and become nationally certified by one of the aforementioned organizations. The specifics of the educational program are left up to the approved college or university.
Approved schools are those that have met accreditation standards set by these organizations:
Nurse Practitioner and Clinical Nurse Specialist Programs
- Accreditation Commission for Education in Nursing (ACEN)
- Commission on Collegiate Nursing Education (CCNE)
- Commission on Nursing Education Accreditation (CNEA)
Nurse Anesthetist Programs
Nurse-Midwife Programs
All accredited MSN programs specific to the four APRN roles meet these curriculum standards:
Nurse Practitioner – The National Task Force of Quality Nurse Practitioner Education describes acceptable nurse practitioner graduate curricula as follows:
- 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
- The curriculum must meet the standards for national certification in a population-focused area of practice
- Graduate, APRN, and NP role/population core competency objectives must be included in the curriculum
- The curriculum must 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
- At least 500 hours of supervised direct patient care clinical hours must be included
Clinical Nurse Specialist – The National Association of Clinical Nurse Specialists (NACNS) requires the clinical nurse specialist academic experience to include:
- 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 congruent with state requirements and 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
- Students should have RN licenses throughout their studies
- There must be an adequate number of faculty instructors and preceptors to ensure there is direct and indirect supervision during clinical courses, recommended at a 1:1 or 1:2 faculty-student ratio
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the CSN/APRN licensure or certification requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) requires CNM program curriculum to 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
While ACME does not specify a minimum requirement for clinical hours, nurse-midwife MSN programs must cover all of these core competencies during clinical training. This is usually accomplished in no less than 500 hours of supervised clinical experience.
Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) stipulates that an acceptable program for CRNAs must include the following didactic components:
- Concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs – total 105 hours
- Pathophysiology, anatomy, and physiology – total 135 hours
- Professional aspects of the practice of nurse anesthesia – 45 hours
- Physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice – 105 hours total
- Nurse anesthesia research – 30 hours
- Clinical correlation conferences – 45 hours
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
Students must complete 2,000 hours of supervised clinical training and study at least 600 clinical cases. Additional requirements of an APRN nurse anesthetist program include:
- The program must be at least 24 months in length, or its part-time equivalent
- Student applicants must be registered nurses with at least one year of experience in a critical-care setting
- In a master’s program, the term “anesthesia” must be referenced in the title of the degree
Selecting the Right Program Based on Current Education
MSN programs for future APRNs are designed with all types of candidates in mind:
- RNs with a BSN can apply directly to conventional MSN programs; between 12-24 months in length
- Professionals with a bachelor’s degree in an unrelated field can apply to what is known as direct-entry MSN programs, however before enrollment they must complete any outstanding course prerequisites; between 20-36 months in length
- RNs with an ADN can enroll in RN-to-MSN bridge programs to earn both a BSN and MSN in one accelerated program; between 24-48 months in length
Scope of Practice and Kentucky State Laws Governing Advanced Practice Registered Nursing
APRN scope of practice and state laws governing prescriptive privileges are detailed in Title 201 of the Kentucky Administrative Regulations, Chapter 20.
Kentucky allows APRNs to practice independently without entering into a general collaborative agreement with a physician, however, a collaborative practice agreement is required for prescriptive authority.
The Kentucky Board of Nursing is committed to adopting the NCSBN’s (National Council of State Boards of Nursing) APRN Consensus Model. By doing this, it aims to achieve these goals:
- Establish standards that protect the public
- Improve access to safe, quality APRN care
- Improve APRN mobility
Steps taken thus far to move Kentucky APRNs in this direction have included the official designation of “APRN,” and a numeric APRN license number that is more compatible with other states’ numeric license numbers.
Prescriptive Authority
APRNs are allowed to prescribe medications if they establish one of the following with a supervising physician and have worked as an APRN for at least one year:
- Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Controlled Substances (CAPA-CS)
- Collaborative Agreement for the Advanced Practice Registered Nurse’s Prescriptive Authority for Nonscheduled Legend Drugs (CAPA-NS)
“Collaboration,” is defined by the Kentucky Board of Nursing as the autonomous and cooperative decision-making relationship between a physician and an APRN regarding prescriptions. The collaborative agreement for prescriptive authority includes this information:
- If the APRN will prescribe nonscheduled legend drugs
- If the APRN will prescribe controlled substances/legend drugs
- Confirmation that the supervising physician practices in a similar field as the APRN
After establishing one of these collaborative agreements, APRNs must:
- Maintain a Kentucky All Schedule Prescription Electronic Reporting (KASPER) account
- Register with the federal Drug Enforcement Administration (DEA)
When prescribing medications, APRNs must work within certain guidelines regarding drugs that are prone to abuse:
- Schedule II substances must be limited to a 72-hour supply
- Schedule III substances must be limited to a 30-day supply
- Schedule IV and V substances must be limited to a six-month supply
As the Kentucky Board of Nursing makes further changes in accordance with the APRN Consensus Model, APRNs can expect to gain more prescriptive independence.
Continuing Education Requirements for APRNs in Kentucky
All APRN licenses must be renewed by October 31st of each year (at the same time as the standard RN license). To be eligible for renewal, APRNs must meet these requirements:
- Maintain current RN license in Kentucky or another compact state
- Maintain national certification through an APRN’s specific board-approved national certifying organization – this often involves completing continuing education
- Submit a renewal application for the RN and APRN licenses with the Kentucky Board of Nursing