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Delaware’s advanced practice registered nurses just took a big step toward aligning with the APRN Consensus Model. The passage of Substitute No. 1 for Senate Bill 101 and Senate Bill 57 changed the formal title from Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN) and eliminated the need for collaborative practice agreements for APRNs with more than 2 years of APRN experience.
The adoption of the APRN Consensus Model in Delaware removes barriers to practice, brings greater access to care, improves quality and patient outcomes, and reduces the cost of healthcare for Delaware’s citizens.
Delaware’s master’s-educated and nationally certified APRNs provide immediate, cost-effective care and work to resolve the primary care physician shortage, amid an aging population and a greater number of patients suffering with more chronic conditions. Thanks to their graduate-level education and advanced clinical knowledge, APRNs can provide direct patient care.
Other MSN-prepared nurses in Delaware often include nursing administrators, researchers, educators, and informaticists, among others.
Licensing Requirements for the APRN Roles Recognized by the Delaware Board of Nursing
The Delaware Board of Nursing recognizes the following advanced practice registered nursing roles:
- Certified Nurse-Midwife (CNM)
- Certified Nurse Practitioner (CNP)
- Certified Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
Board-recognized population foci for APRNs in the CNP and CNS roles include:
- Women’s health/gender related
- Psychiatric/mental health
- Pediatric
- Neonatal
- Family/individual across the lifespan
- Adult/gerontology
CRNAs and CNMs do not choose a population focus. CNMs provide women’s and neonatal healthcare as is implied by the role and CRNAs provide care to all patient population groups.
Candidates for APRN licensure in Delaware must achieve national certification in the APRN role (and population focus, if applicable) that coincides with their MSN education. The Delaware Board of Nursing recognizes the following agencies as granting certification in the APRN roles and population foci necessary for state licensure:
Registered Nurse Practitioner (RNP)
- American Academy of Nurse Practitioners
- Adult nurse practitioner (ANP)
- Family nurse practitioner (FNP)
- Gerontologic nurse practitioner (GNP)
- Adult-gerontological primary care nurse practitioner (AGPCNP)
- 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)
- Adult-gerontological acute care nurse practitioner (AGACNP-BC)
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care (CPNP-PC)
- Pediatric nurse practitioner acute care (CPNPAC)
- National Certification Corporation
- Women’s health nurse practitioner – Board certified (WHNP-BC)
- Neonatal nurse practitioner – Board certified (NNP-BC)
Certified Nurse-Midwife
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
- American Academy of Nurse Practitioners
- Adult nurse practitioner (ANP)
- Gerontologic nurse practitioner (GNP)
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
- 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)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
Earning a Master of Science in Nursing (MSN) in Delaware
The Delaware Board of Nursing requires all candidates for APRN licensure to graduate from a graduate or post-graduate program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA).
In addition to campus-based programs, a number of nursing schools throughout the U.S. offer accredited online programs. These programs allow students to complete part or all of their didactic coursework through web-based study, while satisfying their clinical requirements at partner sites close to home. Online programs are often the solution for RNs in small states like Delaware, where campus-based MSN programs are not always plentiful.
Currently, the following accrediting agencies accredit campus-based and online APRN programs in the U.S.:
Nurse Practitioner Programs:
The Commission on Collegiate Nursing Education (CCNE) is an accrediting agency for nursing programs at the baccalaureate, graduate, and residency levels. There are three CCNE-accredited programs in Delaware, located in:
- Newark
- New Castle
The Accreditation Commission for Education in Nursing (ACEN) accredits nursing education programs—post-secondary and the higher degree—that offer, among others, master’s/post-master’s certificates. There is one ACEN-accredited program in Delaware, located in Dover.
Nurse Anesthetist Programs:
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs. There are no COA-accredited programs in Delaware.
Nurse-Midwife Programs:
The Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwives programs. There are no ACME-accredited programs in Delaware.
Delaware Board of Nursing Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
The Delaware Board of Nursing requires master’s programs in all APRN roles to include the following:
- Graduate or post-graduate program accredited by a nursing accrediting body that is recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA)
- The completion of three, separate, graduate-level courses in:
- Advanced physiology and pathophysiology
- Advanced health assessment
- Advanced pharmacokinetics and pharmacotherapeutics of all broad categories of agents
- A role and population focus
Accredited MSN programs for APRN roles and population foci are always structured as to meet the clinical and curriculum requirements for national certification. Therefore, the Board of Nursing defers specific educational requirements to the respective national certifying agencies:
Nurse Practitioner: The National Task Force on Quality Nurse Practitioner Education requires accredited nurse practitioner programs to teach students in the following competencies:
- Independent Practice Competencies
- Practice Inquiry Competencies
- Quality Competencies
- Scientific Foundation Competencies
- Technology and Information Literacy Competencies
- Leadership Competencies
- Ethics Competencies
- Health Delivery System Competencies
- Policy Competencies
Certified Nurse-Midwife: The ACNM Core Competencies for Basic Midwifery Practice outlines the required curriculum for CNM programs:
- Anatomy and physiology
- Epidemiology
- Nutrition
- Normal growth and development
- Clinical genetics and genomics
- Pharmacokinetics and pharmacotherapeutics
Certified Registered Nurse Anesthetist: The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the academic curriculum and prerequisite courses of nurse anesthesia programs to include:
- Anatomy, physiology, and pathophysiology
- Research
- Clinical conferences
- Basic and advanced anesthesia practices
- Professional aspects of nurse anesthesia practice
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry
- Radiology and ultrasound
Clinical Nurse Specialist: The National CNS Competency Task Force requires all CNS-accredited programs to prepare students in the following competencies:
- Direct Care Competency
- Consultation Competency
- Systems Leadership Competency
- Collaboration Competency
- Coaching Competency
- Research Competency
- Ethical Decision-Making, Moral Agency and Advocacy Competency
Selecting the Right Program Based on Current Education
Since RNs may hold either an associate’s degree in nursing or bachelor of science in nursing, MSN programs are structured in different ways to accommodate RNs at different stages of their education:
- RNs with a Bachelor of Science in Nursing (BSN): RNs that possess a BSN are eligible to pursue a Master of Science in Nursing (MSN), a two-year program.
- RNs with an Associate’s Degree in nursing: RNs in Arizona that possess an associate’s degree may pursue RN-to-MSN programs, which combine the components of both the BSN and MSN, in an accelerated format.
- Professionals with a Bachelor’s Degree in an Area Other than Nursing: A number of MSN programs—called direct-entry or entry-level MSN programs—allow students that possess a bachelor’s degree in an area other than nursing to earn an RN license and an MSN degree in one, accelerated format.
Scope of Practice and Delaware State Laws Governing Advanced Practice Registered Nursing
To meet the standards of nursing in the advanced role in Delaware, APRNs must:
- Collaborate with other members of the multi-disciplinary healthcare team
- Develop nursing care plans based on current theories and advanced clinical knowledge and expertise
- Evaluate the quality of individual client care in according with quality assurance standards
- Function under the established protocols and/or accepted standards of care
- Initiate and apply clinical treatments based on expert knowledge and technical competency to client populations
- Maintain an accurate written account of the progress of clients
- Perform assessments using appropriate physical and psychosocial parameters
- Perform consultative services for clients referred by other members of the multidisciplinary team
- Use research as a basis for nursing practice decision
In addition to the above standards, APRNs in Delaware are responsible for practicing only at the level and scope defined by their specialty APRN certification.
Generic functions of APRNs include (but are not limited to):
- Assessing and reporting changes in the health of individuals, families, and communities
- Collecting and performing lab tests
- Performing physical examinations
- Taking detailed health histories
- Interpreting laboratory data
Prescriptive Authority and Controlled Substance Registration for APRNs in Delaware
Deleware APRNs that wish to prescribe non-controlled substances must have prescriptive authority, as well as APRN licensure. Candidates for APRN licensure may apply for prescriptive authority at the same time they apply for APRN licensure.
To qualify for prescriptive authority, APRNs must provide evidence to the Board that they have completed the following courses:
- Advanced health assessment
- Diagnosis and management of problems within their clinical specialty
- Advanced pathophysiology
- Advanced pharmacology/pharmacotherapeutics
APRNs with prescriptive authority must maintain competency by completing at least 10 hours of advanced pharmacology and pharmacotherapeutics-related continuing education within the two years prior to applying for independent prescriptive authority.
APRNs that completed their APRN program within the two year period before applying for prescriptive authority do not need to submit proof of any continuing education.
Prescriptive authority alone does not allow APRNs to prescribe controlled substances.
APRNs seeking a controlled substances registration must hold a Delaware APRN license with prescriptive authority before their application for controlled substance registration (CSR) is processed.
A CSR is required in Delware for APRNs who want to prescribe or dispense controlled substances. Once the Delaware CSE is approved, APRNs must then file for a federal DEA registration. APRNs must also complete a one-hour mandatory course on Delaware law, regulation, and programs on prescribing and distributing controlled substances.
Independent Practice Requirements in Delaware
APRNs in Delaware must enter into a collaborative agreement with at least one licensed Delaware physician, dentist, podiatrist, or Delaware healthcare delivery system only if they have practiced as an APRN for less than two years or fewer than 4,000 hours.
A collaborative practice agreement may include (but is not limited to) the written verification of healthcare facility approved clinical privileges or a healthcare facility approved job description of the APRN.
If the collaborative practice agreement is with a licensed Delaware healthcare delivery system, it must also include that the system can supply appropriate medical backup for purposes of consultation and referral.
APRNs must have a collaborative agreement at each business/practice where they practice.
Implementation of the APRN Consensus Model in Delaware
Delaware is making great strides when it comes to aligning with the APRN Consensus Model, a national effort led by the National Council of State Boards of Nursing (NCSBN), designed to align standards and titles among APRNs. If all states accept the requirements for licensure, accreditation, certification, and education outlined in the Consensus Model, healthcare professionals, consumers, and regulators will all benefit.
On September 1, 2015, Delaware Governor Markell signed Senate Substitute No. 1 for Senate Bill 101 and Senate Bill 57, changing the formal title Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN), thus aligning Delaware with this portion of the Consensus Model.
In addition, passage of this bill means that new APRN graduates must only enter into a collaborative agreement during the first two years (or 4,000 hours) of APRN practice and that APRNs no longer need to hold a collaborative practice agreement for prescriptive authority once they have practiced as an APRN for at least two years (4,000 hours).
The new law grants APRNs the following privileges:
- Insurers or healthcare services corporations may designate APRNs as primary care providers
- APRNs can sign death certificates.
Continuing Education Requirements for APRNs in Delaware
APRNs in Delaware must renew their APRN license on a biennial basis. Maintaining national certification satisfies the 20 contact hours of continuing education required for license renewal. APRN licenses in Delaware have the same expiration date as RN licenses. If an APRN holds an RN license in another compact state, the APRN license expires on September 30 of odd-numbered years.