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Career advancement, a broader scope of practice, the freedom to practice independently and better pay are important motivations for RNs that make the decision to earn a Master of Science in Nursing (MSN). Additionally, earning an MSN in an area other than clinical practice can lead to a career in higher education, research, nursing administration, medical writing, or nursing informatics.
Of the 44,370 RNs licensed in Colorado as of 2014, only a select few were counted among the state’s master’s-prepared advanced practice registered nurses (APRN). The U.S. Bureau of Labor Statistics (BLS) recorded the number of nurses practicing in APRN roles in Colorado that year and found that 2,070 were nurse practitioners, 120 were nurse-midwives, and 120 were nurse anesthetists.
Even in Colorado where RNs enjoy some of the best salaries in the nation at an average of $69,600, the value of an MSN becomes clear when comparing that to the average salary for advanced practice registered nurses in the state (US Bureau of Labor Statistics, 2014):
- $95,350 for nurse practitioners
- $96,970 for nurse midwives
- $153,780 for nurse anesthetists
In 2010, 11% of Colorado’s population was living in medically underserved areas according to the National Women’s Law Center. This is a strong predictor for considerable job growth in all APRN roles, as nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists are increasingly seen as the solution to the shortage of primary care providers in Colorado’s medially underserved areas. In addition, the Colorado Rural Health Center (CRHC) reported that 73% of all of Colorado’s counties were classified as rural, making rural health an extremely important area of focus for the state. In a state that respects the autonomy of APRNs, allowing them to practice to the full extent of their training and education, advanced practice registered nurses are recognized as being key to filling the gaps in healthcare in the rural and medically underserved areas of Colorado.
Licensing Requirements for APRNs in Colorado
In order to become an APRN in Colorado, RNs must earn a Master of Science in Nursing with a focus in their chosen role, in addition to becoming nationally certified in that role.
The Colorado State Board of Nursing (CSBN) licenses APRNs in four distinct roles:
- Certified Nurse Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
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; pediatric; women’s health; psychiatric-mental health). Nurse midwives do not select a patient population group since their patient focus is implied in the definition of the role. Nurse anesthetists work with all patient groups without the need to specialize.
As a condition for APRN licensure, after earning an MSN or higher degree candidates must become certified in the role and patient population focus consistent with their graduate-level education. The CSBN recognizes these national certification agencies as granting the credentials necessary to practice in the various APRN roles and patient population foci (additional specialty certifications are available, but are not required for becoming licensed):
Registered Nurse Practitioner (RNP)
- American Nurses Credentialing Center
- Acute Care NP
- Adult Nurse NP
- Adult-Gerontology Acute Care NP
- Adult-Gerontology Primary Care NP
- Adult Psychiatric-Mental Health NP
- Family NP
- Gerontological NP
- Pediatric Primary Care NP
- Psychiatric-Mental Health NP
- School NP
- Diabetes Management—Advanced
- Emergency NP
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology
- Acute Care Nurse Practitioner Adult
- American Academy of Nurse Practitioners
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- Pediatric Nursing Certification Board
- Pediatric Nurse Practitioner Primary Care
- Pediatric Nurse Practitioner Acute Care
- Pediatric Primary Care Mental Health Specialist
- National Certification Corporation
- Women’s Health Care Nurse Practitioner
- Neonatal Nurse Practitioner
Certified Nurse-Midwife (CNM)
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Clinical Nurse Specialist; Wellness through Acute Care
- Clinical Nurse Specialist; Wellness through Acute Care (Pediatric)
- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal)
- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist
Nursing Licensure Compact
Colorado is one of 25 Nursing Licensure Compact states. This allows Colorado APRNs the opportunity to practice in multiple states without obtaining additional licensure. When applying for their initial APRN license, nurses must apply for the compact license to allow them to practice across state lines. After obtaining the compact license, APRNs will be able to practice not only within Colorado, but within the 24 other states listed in the Nursing Licensure Compact:
Pursuing a Master of Science in Nursing (MSN) in Colorado
For many RNs, an online program is the preferred format for earning an MSN. Accredited online programs allow graduate students to complete coursework online and log required clinical hours in geographically accessible locations. Online programs maintain partnerships with healthcare facilities throughout the country to ensure graduate students are able to complete clinical sequences without the need to relocate.
In order to qualify for APRN licensing through the Colorado State Board of Nursing, RNs must receive their MSN or higher degree from a board-approved program.
The Board approves NP and CNS programs accredited by one of two agencies:
OR
The Board requires CRNA programs to be nationally accredited through the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), while CNM programs must be nationally accredited through the Accreditation Commission for Midwifery Education (ACME).
The CSBN keeps an updated list of approved programs with campus locations in the state that meet the requirements of higher nursing education. Out-of-state online programs that meet the requirements for national certification and state licensure are not shown on this list.
Colorado State Board of Nursing Requirements for APRN Graduate Programs
The Colorado State Board of Nursing publishes its own guidelines, which align with those of the accreditation agencies named above:
- Be recognized by the United States Department of Education as eligible for national nursing accreditation
- Be consistent and compliant with the Nurse Practice Act as well as the CSBN’s rules and regulations
- Provide clinical experience and clinical simulation
- Consist of a minimum of 750 clinical hours
- Each clinical course must include a combination of clinical experience and clinical simulation
- Consist of a minimum of 450 theory hours
- Courses must include didactic instruction in nursing and clinical practice
Specific requirements for each role are established and maintained by accrediting agencies and other industry organizations:
Nurse Practitioners:
- The curriculum must be updated by current nurse practitioner faculty members
- It must meet standards for national certification in a population-focused area of practice
- It must include nurse practitioner role/population core competency objectives
- It must prepare prospective nurse practitioners to sit for a national certification exam that corresponds with the NP’s role and population focus
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused core skills
- Didactic coursework must be reinforced by clinical coursework
- The clinical segment must include at least 500 hours of supervised direct patient care
Clinical Nurse Specialist:
- The CNS graduate program’s curriculum must be clearly aligned to address the care of a specific population, and be consistent with state requirements and nationally-recognized competencies
- Students should have RN licenses throughout their studies
- The curriculum must be accredited by a nursing education organization that is recognized by the US Department of Education
- Clinical courses must give students ample possibilities to develop skills in key areas that meet the CSN licensure or certification requirements
- The clinical segment must include at least 500 supervised hours
- The ideal clinical student-faculty ratio is recommended to be 1:1 or 2:1
Nurse-Midwife:
- Essentials of nurse midwifery, including the promotion of family-centered care
- Professional responsibilities of nurse midwives and the components of midwifery care
- Midwifery management process
- Perimenopausal, postmenopausal and care for other aging periods
- Management of common health problems
- Fundamentals of midwifery care
- Primary health care of women
- Gynecologic care
- Midwifery and health care for the childbearing woman and family
- Newborn care
During the clinical segment the nurse-midwife curriculum must cover all of these core competencies. Clinicals typically consist of at least 500 hours of supervised practice.
Nurse Anesthetist:
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
- At least 135 hours covering pathophysiology, anatomy, and physiology
- At least 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- At least 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- At least 45 hours covering clinical correlation conferences
- At least 45 hours covering the professional aspects of the practice of nurse anesthesia
- At least 30 hours covering nurse anesthesia research
- 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
For the clinical segment, the COA also requires that students complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Selecting the Right Type of MSN Program
Master’s programs in nursing are structured as conventional terminal master’s programs, RN-MSN bridge programs, or direct entry programs designed to accommodate and build off of professionals’ current education:
- RNs with an Associate Degree in Nursing: RNs with an associate degree must obtain both a bachelor’s and a master’s degree to become an APRN in Colorado. Several RN-to-MSN bridge programs offer both a BSN and an MSN in one accelerated program that takes about three years to complete.
- RNs with a Bachelor of Science in Nursing (BSN): RNs with a BSN would complete a traditional two-year terminal MSN program.
- Professionals with a Bachelor’s Degree in an Area Other than Nursing: Select MSN programs (referred to as direct-entry programs) allow candidates with a bachelor’s degree in an area other than nursing to earn an RN license and MSN degree in the course of about three years.
Laws Concerning Prescriptive Authority and Independent Practice for Colorado’s APRNs
The Colorado State Board of Nursing recognizes APRNs as independent practitioners within the performance of independent nursing functions and delegated medical functions. According to the Nurse Practice Act, nursing practice must be:
- Within the field of nursing
- APRN must possess the specialized knowledge, judgment and skill requirement to complete the job/task undertaken
- While individual facilities or physicians may create policies requiring physician supervision, the CSBN does not place these restrictions upon APRNs
The CSBN has stated that APRNs may decide what is within their scope of practice by answering the following questions with a “yes”:
- Was the required skill taught in my nursing education?
- If it was not taught in the nursing education, was it taught in a training and clinical program that I have completed in addition to a nursing education program?
- Is this task routine within nursing practice?
- Is the skill explained within the agency’s procedure manual?
- Does carrying out the skill pass the “reasonable and prudent” standard for nursing?
Colorado APRN Prescriptive Authority
All Colorado APRNs, including nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists, and clinical nurse specialists, have the opportunity to apply for prescriptive authority, provided they have completed 4 quarter hours in the following courses:
- Pathophysiology
- Pharmacology
- Physical Assessment
Upon applying, the APRN will be granted Provisional Prescriptive Authority, which will allow the nurse to prescribe medications to patients within their specific APRN role. Within three years of receiving provisional authority, APRNs are required to complete the following:
- A 1000 hour mentorship with either a physician or APRN with full prescriptive authority
- A plan for safe prescribing
After the initial three years of Provisional Prescriptive Authority, provided that the above requirements are met, APRNs are eligible to receive Full Prescriptive Authority through the CSBN, allowing them to prescribe medication to their patient population without the supervision of a qualified mentor.
Implementation of the APRN Consensus Model in Colorado
The APRN Consensus Model is a nation-wide model developed by the National Council of State Boards of Nursing (NCSBN) with the support of 40 other stakeholders in advanced practice nursing that seeks to regulate advanced practice nurses in all roles under similar legislation in all states. The APRN Consensus Model seeks to achieve consistency in accreditation, education, certification and licensing for APRNs in all states and jurisdictions. The APRN Consensus Model is primarily concerned with moving APRNs toward independent practice without collaborative involvement of physicians.
Colorado has chosen to fully implement the APRN Consensus Model. The CSBN identifies APRNs as independent practitioners, which means they are not required to enter into collaborative agreements with supervising physicians and can independently treat patients and prescribe medication.
Colorado’s Continuing Education Requirements for APRNs
APRN license expiration coincides with RN license expiration, which expire on September 30th of either even or odd years, depending on the date of issuance. Thus, both RN and APRN licenses in Colorado must be renewed every two years, but must be renewed separately.
While no continuing education hours are required to renew the RN license in Colorado, APRNs must pass national certification every two years in order to reapply for licensing. Each certification agency sets specific requirements. The APRN license is renewed when the nurse provides verification of current national certification.
National certification maintenance requirements vary, but most agencies require a certain number of continuing education hours to be verified.