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A Master of Science in Nursing (MSN) provides the educational foundation registered nurses need to become advanced clinical practitioners and clinical nurse leaders, or to begin careers in advanced nonclinical roles in administration, education, informatics and more. Based on the focus of their training and certification, Virginia’s licensed nurse practitioners (LNPs) may be recognized as nurse anesthetists, nurse midwives, or nurse practitioners. Common among all nurses in these various roles are advanced skills in health assessment, pharmacology, and pathophysiology that can only come from earning a Master of Science in Nursing.
Of the 104,494 RN licenses active through the Virginia Board of Nursing as of 2015, only 8,355 were licensed as LNPs. MSN-prepared LNPs are highly sought after and are well compensated for their advanced clinical skills. Average salaries for Virginia’s LNPs in the three recognized roles are shown below in comparison to the average RN salary in the state (U.S. Bureau of Labor Statistics, 2014):
- RNs – $62,610
- Nurse anesthetists $160,400
- Nurse practitioners – $91,830
- Nurse midwives – $88,400
In April of 2015, the Virginia Department of Health published a report on the state’s health professional shortage areas (HPSAs), finding critical shortages in several counties statewide. The Virginia Nurses Association has been an outspoken advocate for expanding practice privileges to allow advanced practitioners to provide services within the full scope of their training and education. This Association recognizes this as being a key step toward providing a solution to the shortage of primary care providers in the state.
Licensing Requirements for the LNP Roles Recognized in Virginia
The Virginia Board of Nursing and Virginia Board of Medicine refer to advanced practice nurses as licensed nurse practitioners (LNP), classifying these advanced clinicians into three distinct roles:
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse Midwife (CNM)
- Nurse Practitioner (NP)
To be eligible for LNP licensure through the Virginia Board of Nursing in one of these three roles, candidates must:
- Have a current unrestricted Virginia RN license
- Complete a master’s or higher degree with a concentration in one of the specific LNP roles
- Gain national certification from a board-recognized organization
NPs further specialize their graduate education and national certification in a specific patient population focus (women’s health; family-individual across the lifespan; psychiatric-mental health; adult-gerontology primary or acute care; neonatal)
The Virginia Board of Nursing recognizes the following national certifying bodies as conferring the credentials necessary for state licensure in each LNP role and patient population focus:
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
Registered Nurse Practitioner (RNP)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- American Academy of Nurse Practitioners
- Adult nurse practitioner
- Family nurse practitioner
- Gerontologic nurse practitioner
- American Nurses Credentialing Center
- Acute care nurse practitioner (adult/gerontology)
- Adult nurse practitioner
- Family nurse practitioner
- Gerontological nurse practitioner
- Pediatric nurse practitioner
- Adult psychiatric and mental health nurse practitioner
- Family psychiatric and mental health nurse practitioner
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care
- Pediatric nurse practitioner acute care
- National Certification Corporation
- Women’s health nurse practitioner
- Neonatal nurse practitioner
Earning a Master of Science in Nursing (MSN) in Virginia
In addition to Virginia’s campus-based MSN programs, there are a number of nationally recognized and fully accredited online MSN programs with specialty tracks in each advanced practice role. Virginia RNs enrolled in online programs work with an advisor to find placement at an approved medical facility in the state. Graduate nursing students are often able to complete clinical sequences in their current place of employment.
All schools that offer nursing programs in Virginia must be approved by the Virginia Department of Education or accredited by an agency recognized by the United States Department of Education:
Nurse Practitioner Programs – The Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are the two recognized national certifying bodies for NP graduate-level nursing programs.
There is one ACEN-accredited graduate program in Virginia, located in Richmond.
There are 11 CCNE-accredited graduate programs in Virginia, located in the following cities:
- Arlington
- Charlottesville
- Fairfax
- Hampton
- Harrisonburg
- Lynchburg
- Norfolk
- Roanoke
- Winchester
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized certifying body for CRNA graduate programs.
There are two COA-accredited school in Virginia, located in Virginia Beach and Richmond.
Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body for nurse-midwifery programs.
The one ACME-accredited program in Virginia is located in Winchester.
Virginia Board of Nursing Requirements for MSN Programs that Prepare Licensed Nurse Practitioners
Master’s programs that prepare LNPs must meet the curricular and clinical requirements set forth by national certifying bodies and education standards agencies in each role.
Certified Nurse Midwife (CNM) Program Requirements
The American College of Nurse Midwives (ACNM) requires all CNM programs to prepare RNs for the core competencies for basic midwifery practice by including:
- Components of Midwifery Care: Fundamentals
- Components of Midwifery Care of the Newborn
- Components of Midwifery Care: Professional Responsibilities of CNMs
- Components of Midwifery Care: Midwifery Management Process
- Components of Midwifery Care of Women
- Hallmarks of Midwifery
Programs must offer courses in the following areas to prepare CNMs for the fundamental components of midwifery care:
- Psychosocial, sexual, and behavioral development
- Anatomy and physiology, including pathophysiology
- Clinical genetics and genomics
- Basic epidemiology
- Nutrition
- Bioethics related to the care of women, newborns, and families
- Principles of individual and group health education
- Normal growth and development
- Pharmacokinetics and pharmacotherapeutics
The ACNM also defines the clinical experience requirements for all CNM programs. These requirements include:
- Attainment of clinical skills must meet Core Competencies for Basic Midwifery Education
- An AMCB-certified CNM or APRN who has clinical expertise and didactic knowledge commensurate with the content taught must supervise the clinical practice
- The clinical practice must teach the following skills:
- Management of primary care for women throughout the lifespan, including reproductive health care, pregnancy and birth
- Care of the normal newborn
- Management of sexually transmitted infections in male partners
Certified Registered Nurse Anesthetist (CRNA) Program Requirements
The standards for graduate-level nurse anesthesia programs are governed by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Programs must include coursework in the following areas:
- Anatomy, physiology, and pathophysiology
- Anesthesia induction, maintenance and emergence
- Basic and advanced principles of anesthesia practice including physics, equipment, technology and pain management
- Pre-anesthetic preparation and evaluation
- Research
- Anesthesia practice
- Perianesthetic and clinical support functions
- Postanesthesia care
- Pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry
- Clinical correlation conferences
- Professional aspects of nurse anesthesia practice
Programs must additionally offer students clinical experience opportunities that allow for the following:
- Application of knowledge to clinical problems
- Learning of anesthesia techniques
- Testing of theory
Nurse Practitioner Program Requirements
The National Task Force on Quality Nurse Practitioner Education sets the standards for NP programs. Programs must offer courses that prepare students for the nine core competencies of professional practice, including:
- Leadership Competencies
- Scientific Foundation Competencies
- Health Delivery System Competencies
- Practice Inquiry Competencies
- Policy Competencies
- Technology and Information Literacy Competencies
- Quality Competencies
- Independent Practice Competencies
- Ethics Competencies
Programs must also prepare students for the NP Core Competencies based on population focus.
NP programs are also required to offer clinical experience opportunities that include a minimum of 500 supervised direct patient care clinical hours overall.
Selecting the Right Type of Program Based on Current Education
Aspiring LPNs in Virginia would select from different types of MSN programs based on their current level of education.
- RNs with an Associate Degree in Nursing: RNs who hold an associate’s degree would apply to RN-MSN bridge programs, allowing them to earn both a Bachelor of Science in Nursing (BSN) and MSN through the same continuous curriculum.
- RNs with a Bachelor of Science in Nursing (BSN): RNs who possess a BSN would pursue a traditional terminal MSN program.
- RNs with a Master of Science in Nursing (MSN): MSN-prepared nurses may further their education through a post-graduate program in a specific advanced practice role and patient population focus.
- Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Professionals who have earned a bachelor’s degree in an area other than nursing would apply to direct-entry (also known as entry-level) MSN programs. These programs allow students to prepare for RN licensure and earn an MSN through the same continuous curriculum.
Scope of Practice and Virginia State Laws Governing Advanced Practice Nursing
LNPs in Virginia must practice within a multidisciplinary team of health care providers who actively function as a unit under the management and leadership of one or more physicians. Within this team, the LNP must practice in a collaborative and consultative manner that is defined by the Virginia Board of Nursing as “the communication and decision-making process among members of a patient care team related to the treatment and care of a patient.” The physician managing the patient care team must have an active license to practice medicine in Virginia.
The written practice agreement between the LNP and the physician must name the specific tasks the LNP may and may not perform in providing direct patient care and include details regarding LNP-physician collaboration during complex care cases, referrals, and emergencies.
LNPs working as medical examiners must practice in collaboration with a licensed doctor of medicine or osteopathic medicine who has been appointed to serve as a medical examiner.
CRNAs must practice under the supervision a licensed doctor of medicine, osteopathy, podiatry, or dentistry. Under such supervision, CRNAs may practice in accordance with the American Association of Nurse Anesthetists’ current guidelines and standards for nurse anesthesia practice.
Prescriptive Authority for APRNs in Virginia
In Virginia, NPs and CNMs who are licensed as LNPs may prescribe Schedule II through Schedule VI controlled substances and devices if such prescriptive authority is indicated within their collaborative agreement with a physician.
The Virginia Board of Nursing sets forth the following rules regarding LNP prescriptive authority in the state:
- The agreement may restrict the substances the nurse practitioner may and may not prescribe
- The agreement may permit the nurse practitioner to prescribe approved controlled substances without collaboration or consultation with the physician while participating in a pilot program
- The nurse practitioner must inform patients that he or she is a licensed nurse practitioner
- Nurse practitioners may obtain and administer professional samples from manufacturers, provided they do so in accordance with Virginia State law
CRNAs are not granted prescriptive authority in Virginia.
Virginia and the APRN Consensus Model
In 2008, over 40 nursing organizations collaborated to form the APRN Consensus Model, a uniform set of rules for NPs, CNMs, CRNAs, and Certified Nurse Specialists (CNSs). As of February, 2016, Virginia has aligned with the education and certification components of the model requiring nurses in recognized APRN roles to complete graduate school and receive national certification within that role. However, Virginia has yet to adopt the following components of the model:
- APRN titles
- Recognition of CNSs as APRNs
- Independent practice for APRNs
- Independent prescribing for APRNs
Continuing Education Requirements for LPNs in Virginia
LNPs with prescriptive authority in Virginia must maintain national certification in their specialty role and complete an additional eight hours of Continuing Education (CE) in pharmacology or pharmacotherapeutics every two-year license cycle. Nurses must maintain documentation that demonstrates completion of their CE for four years following each renewal period. The Virginia Board of Nursing conducts random audits to ensure compliance.
The only CE requirement for LNPs in Virginia who do not hold prescriptive authority is to maintain national certification in their specialty role.