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A Master of Science in Nursing (MSN) provides the educational foundation RNs need to enter advanced practice, which comes with a greater level of autonomy, a great deal of respect in the professional community and the opportunity to earn a much higher salary. This is particularly important in Florida as the state struggles with a shortage of primary care providers. In fact, according to the Robert Graham Center, Florida will require an additional 4,671 primary care physicians over the next 15 years just to maintain the current primary care physician (PCP) ratio of 1531:1—a ratio that is already higher than the national average.
When the Florida House of Representatives began looking for ways to address this issue during their 2014 session, the solution was obvious: Florida’s advanced registered nurse practitioners (ARNPs) could fill the void, provided the State removed the restrictive laws that prevent them from providing care independently. Florida currently has the most restrictive laws in place governing advanced practice nursing.
Florida’s ARNPs and Clinical Nurse Specialists (CNSs)—who possess, at a minimum, a Master of Science in Nursing (MSN) and national certification in an ARNP role and population focus—deliver safe, cost-effective, high-quality care. According to the Institute of Medicine, modernizing laws and allowing ARNPs to practice to the full extent of their education and training increases primary care access and reduces costs, particularly in rural and underserved areas.
According to the Florida Center for Nursing’s Statewide Status Report on Nursing Supply, Demand, and Education July 2013, there were 12,656 ARNPs and CNSs licensed in the state as of 2009. By 2011, the number of ARNPs and CNSs increased by more than 11 percent to 14,103.
State Certification Requirements for the Advanced Practice Nursing Roles Recognized in Florida
The Florida Board of Nursing recognizes the following advanced practice nursing roles:
- Clinical Nurse Specialist (CNS)
- Advanced Registered Nurse Practitioner (ARNP)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
RNs interested in advancing their scope of practice and becoming an ARNP or CNS must complete an MSN or post-graduate program in their chosen role. Those interested in becoming a nurse practitioner or clinical nurse specialist would also choose a population focus:
- Adult
- Family – across the Lifespan
- Gerontology
- Neonatal
- Pediatric (primary/acute care)
- Women’s health – gender related
Once candidates for ARNP licensure complete an accredited program, they would then go on to obtain national certification in the ARNP or CNS role and population focus that coincides with their MSN degree. The Florida Board of Nursing recognizes these national certifying bodies as granting the credentials necessary for state certification as a CNS or APRN in the respective roles:
Registered Nurse Practitioner (RNP)
- American Academy of Nurse Practitioners
- Adult nurse practitioner (ANP)
- Family nurse practitioner (FNP)
- 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)
- Oncology Nursing Certification Corporation
Certified Nurse-Midwife
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
Certified Registered Nurse Anesthetist (CRNA)
- National Board of Certification and Recertification for Nurse Anesthetists
- Certified Registered Nurse Anesthetist (CRNA)
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)
- Oncology Nursing Certification Corporation
- Hospice and Palliative Credentialing Center
Maintaining certification requires certificate holders to fulfill the continuing education requirements established by the respective agencies. Continuing education providers like Florida Medical Educational Services (FMES.net) provide access to online modules that make it easy to stay in compliance.
Earning a Master of Science in Nursing (MSN) in Florida
In addition to campus-based programs, many institutions now offer MSN programs in partially or fully online formats. These programs allow students to complete the program’s classroom requirements through online study and then complete the clinical requirements at sites close to home.
RNs in Florida with their sights set on pursuing an MSN must complete a program that has received accreditation through an accrediting body that is recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA):
Nurse Practitioner and Clinical Nurse Specialist Programs
The Commission on Collegiate Nursing Education (CCNE) accredits nursing programs at the baccalaureate, graduate, and residency levels. There are 18 CCNE-accredited programs in Florida, in the following cities:
- Miami Shores
- Boca Raton
- Fort Myers
- Miami
- Lakeland
- Tallahassee
- Jacksonville
- Lauderdale
- Pensacola
- Orlando
- Gainesville
- Coral Gables
- Tampa
The Accreditation Commission for Education in Nursing (ACEN) accredits master’s/post-master’s ARNP certificates. There are two ACEN-accredited programs in Florida, located in:
- Tampa
- Tallahassee
Certified Registered Nurse Anesthetist Programs
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accredits nurse anesthetist programs. There are 10 COA-accredited programs in Florida, located in:
- Tampa
- Panama City
- Orlando
- Naples
- Coral Gables
- Fort Myers
- Hollywood
- Jacksonville
- Miami
Certified Nurse-Midwifery Programs
The Accreditation Commission for Midwifery Education (ACME) accredits nurse-midwives programs. There is one ACME-accredited program in Florida.
Florida Board of Nursing Requirements for MSN Programs that Prepare Advanced Registered Nurse Practitioners
The Florida Board of Nursing requires CNS and ARNP programs to contain coursework and clinical requirements that align with national certification requirements:
Advanced Registered Nurse Practitioner (ARNP)
Nurse Practitioner: The National Task Force on Quality Nurse Practitioner Education requires graduates of accredited nurse practitioner programs to possess the following competencies:
- Health Delivery System Competencies
- Scientific Foundation Competencies
- Quality Competencies
- Leadership Competencies
- Ethics Competencies
- Technology and Information Literacy Competencies
- Independent Practice Competencies
- Practice Inquiry Competencies
- Policy Competencies
All programs must include at least 500 hours of supervised clinical experience.
Certified Nurse-Midwife: The ACNM Core Competencies for Basic Midwifery Practice include:
- Components of Midwifery Care of the Newborn
- Components of Midwifery Care of Women
- Components of Midwifery Care: Fundamentals
- Components of Midwifery Care: Midwifery Management Process
- Components of Midwifery Care: Professional Responsibilities of CNMs
- Hallmarks of Midwifery
Clinical experiences should include:
- Management of sexually transmitted infections in male partners
- Management of primary care for women throughout the lifespan
- Care of the normal newborn
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 experiences should allow students the opportunity to:
- Apply knowledge to clinical problems
- Test theory
- Learn anesthesia techniques
Clinical Nurse Specialist (CNS)
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
MSN programs are structured in different ways to coincide with the different levels of education RNs may have:
- Terminal BSN-to-MSN programs for RNs with a BSN: The traditional MSN requires RNs to possess a Bachelor of Science in Nursing (BSN).
- RN-to-MSN programs for RNs with an ADN: RN-to-MSN programs are designed for RNs that possess an associate’s degree in nursing. These programs (often called bridge programs) combine the components of both the BSN and MSN into one, accelerated program.
- Entry-level MSN programs for professionals with a bachelor’s degree in an area other than nursing: 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 result in a BSN, RN license and MSN.
- Post-Graduate Certificate Programs: Post-graduate certificate programs are designed for RNs that already possess a Master of Science in Nursing (MSN), but are seeking specialized education for initial certification as an ARNP or CNS in Florida.
Scope of Practice and Florida State Laws Governing Advanced Registered Nurse Practitioners and Clinical Nurse Specialists
Advanced Registered Nurse Practitioner Scope of Practice
According to the Florida Board of Nursing, ARNPs may:
- Monitor and alter drug therapies
- Initiate appropriate therapies
- Order diagnostic tests and physical and occupational therapy
ARNPs may also perform the following acts within their specialty:
CRNAs:
- Determine the health status of patients as it relates to the risk factors of anesthetic management
- Determine, with the consent of the responsible physician, the type of anesthesia within the framework of the protocol
- Within the framework of the protocol, order pre-anesthetic medication
- Within the framework of the protocol, perform anesthesia administration procedures
- Order and perform monitoring procedures related to the healthcare management of the patient
- Support life functions during anesthesia healthcare
- Recognize and take appropriate action during abnormal patient responses to anesthesia or other forms of therapy
- Recognize and treat cardiac arrhythmia during anesthesia care
- Manage patient during post-anesthesia recovery
CNMs:
- Perform minor surgeries
- Manage patient during labor and delivery
- Order, initiate, and perform anesthetic procedures
- Perform postpartum exams
- Order appropriate medications
- Provide family planning and well-woman care
- Manage the normal obstetric patient and initial care of the newborn
NPs:
- Manage select medical problems
- Order physical and occupational therapy
- Initiate, monitor, and or alter therapies for acute illnesses
- Monitor and manage patients with chronic diseases
- Establish behavioral problems and diagnoses and make treatment recommendations
Clinical Nurse Specialist Scope of Practice
Clinical nurse specialists deliver and manage advanced practice nursing care to individuals and groups. This includes performing the following:
- Assessing the health status of individuals and families in the appropriate population and area of practice
- Diagnosing human responses to actual or potential health problems
- Planning for health promotion, disease prevention, and therapeutic intervention in collaboration with a patient or client
- Implementing therapeutic interventions based on the area of expertise
- Coordinating healthcare as necessary to evaluate the patient or client
Dispensing Authority for ARNPs in Florida
Clinical nurse specialists (CNS) and advanced registered nurse practitioners (ARNP) with dispensing authority are authorized to sell medicinal drugs to patients within a practitioner’s office. CNSs and ARNPs interested in dispensing medication must submit an application for dispensing authority to the Board.
ARNPs and CNSs are not allowed to prescribe controlled substances. All prescriptions for controlled substances must be written and signed by a licensed physician.
The APRN Consensus Model and Collaborative Practice in Florida
For years, ARNPs in Florida have fought against restrictive practice and licensure laws, seeking full practice authority in accordance with the APRN Consensus Model developed by the National Council of State Boards of Nursing (NCSBN) along with more than 40 other organizations and advocacy groups related to advanced practice nursing. The Florida Medical Association and other groups have consistently opposed the current Independent Practice Registered Nurse Bill (PCB SCHCWI 14-01), citing the reasons within a published fact sheet.
As of 2016, Florida ARNPs must practice under the supervision of a physician. This requires ARNPs to have a protocol on record at every location in which they pracitce that details the parameters under which the ARNP can practice. Both the ARNP and the physician supervisor must sign the protocol.