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The minimum educational requirement for RNs interested in advancing their careers to become advanced registered nurse practitioners remains the Master of Science in Nursing (MSN).
Iowa’s advanced registered nurse practitioners (ARNPs) have made great strides in recent years as Iowa legislature continues to acknowledge their importance in healthcare delivery for Iowa’s citizens. For example, in 2013, the Iowa Supreme Court confirmed that nurse practitioners could supervise fluoroscopy. The American Nurses Association called the ruling a victory for Iowa residents, who now have broader access and choice when making their healthcare choices.
All ARNPs in Iowa hold an MSN at minimum and practice independently within their specialty area without a collaborative physician agreement. This clears the way for ARNPs to practice to the full extent of their education and training, while increasing the number of primary healthcare providers Iowa residents have access to.
According to the Iowa Center for Nursing Workforce, the total number of ARNPs in the state has more than doubled since 2004. Between 2013 and 2014, the total number of ARNPs increased by nearly 9 percent. The most significant increase between 2013 and 2014 was among nurse practitioners, who saw an increase of 238 licenses.
State Registration Requirements for the Recognized ARNP Roles in Iowa
Iowa RNs pursuing ARNP registration must earn an MSN with a concentration in their particular ARNP role and national certification in that role. The Iowa Board of Nursing recognizes the following ARNP roles:
- Certified Nurse-Midwife (CNM)
- Clinical Nurse Specialist (CNS)
- Certified Nurse Practitioner (CNP)
- Certified Registered Nurse Anesthetist (CRNA)
MSN programs for nurse practitioners (CNPs) and clinical nurse specialists (CNSs) provide an additional focus on one or more population focus aligned with national certification:
- Adult
- Family Across the Lifespan
- Gerontology
- Acute Care
- Primary Care
- Women’s Health-Gender Related
- Neonatal
- Pediatric
Nurse midwives (CNMs) and nurse anesthetists (CRNAs) do not focus their education on a particular population group, as all CNMs are dedicated to women’s health and neonatal care as implied by the role, while CRNAs are able to work with all population groups.
The Iowa Board of Nursing recognizes the following national certifying agencies and designations for the purpose of ARNP registration:
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)
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)
- Home Health CNS
- Public/Community Health CNS
- Gerontological CNS
- Oncology Nursing Certification Organization
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)
Earning a Master of Science in Nursing (MSN) in Iowa
In addition to campus-based programs, many institutions now offer their accredited nursing graduate programs in an online format, thus appealing to working RNs and students not within close proximity to a campus program. These programs often allow students to complete the didactic requirements of their program through online study and then complete the clinical requirements of their program at clinical sites close to home.
According to the Iowa Center for Nursing Workforce, the number of students in Iowa admitted to a master’s program more than doubled from 2011 to 2014. The Center reports that the increase of master’s students in Iowa is due largely to the rise in online graduate programs.
The Iowa Board of Nursing recognizes MSN and other ARNP graduate programs accredited by a nursing accrediting body recognized by the U.S. Secretary of Education and/or the Council for Higher Education Accreditation (CHEA).
The following national accrediting bodies accredit nursing programs in the U.S. at the graduate level for the respective ARNP roles:
Nurse Practitioner and Clinical Nurse Specialist Programs – The Accreditation Commission for Education in Nursing (ACEN) accredits post-secondary and higher nursing education programs, including master’s/post-master’s certificates. There are no ACEN-accredited programs in Iowa.
The Commission on Collegiate Nursing Education (CCNE) is an accrediting agency for nursing programs at the baccalaureate, graduate, and residency levels. There are seven CCNE-accredited programs in Iowa, located in the following cities:
- Iowa City
- Sioux City
- Waterloo
- Des Moines
- Cedar Rapid
Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs. There is one COA-accredited program, located in Iowa City.
Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwives programs. There are not ACME-accredited programs in Iowa.
Iowa Board of Nursing Requirements for MSN Programs that Prepare Advanced Registered Nurse Practitioners
The Board requires candidates for ARNP registration to graduate from a master’s program that prepares graduates with specialized practitioner skills specific to their specialty role.
Accredited programs are those that meet the curricular and clinical requirements for national certification:
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 (reproductive health care, pregnancy and birth)
- Care of the normal newborn
Nurse Practitioner: The National Task Force on Quality Nurse Practitioner Education requires accredited nurse practitioner programs to include at least 500 hours of supervised clinical experiences and prepare students in 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
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: 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
Graduates of an accredited MSN or post-graduate certificate program must earn national certification that aligns with the ARNP role and population focus of their graduate program.
Scope of Practice and Iowa State Laws Governing Advanced Registered Nursing Practice
Iowa ARNPs in all roles may perform the following services and functions:
- Assessment of health status
- Obtain a relevant health and medical history
- Perform physical examinations
- Order preventive and diagnostic procedures based on the patient’s age and history
- Formulate differential diagnosis
- Develop treatment plans
- Develop patient education plans
- Maintain hospital privileges
ARNPs in Iowa may provide direct supervision of fluoroscopy, provided they complete an educational course that includes content in:
- Radiation physics
- Radiobiology
- Radiological safety
- Radiation management applicable to the use of fluoroscopy
Prescriptive Authority for ARNPs in Iowa
ARNPs in Iowa may deliver, distribute, or dispense prescription drugs, devices, and medical gases when engaged in their nursing specialty.
ARNPs that want to receive authority to prescribe controlled substances must register as a practitioner with the DEA and the Iowa Board of Pharmacy.
The APRN Consensus Model and Independent Practice in Iowa
Iowa has aligned itself with the APRN Consensus Model—a national effort to align the standards and titles in advanced practice nursing—in many areas. For example, Iowa ARNPs practice independently without a collaborative physician agreement or other type of supervision or oversight, and they have prescriptive authority for legend drugs and controlled substances.
The Iowa Board of Nursing also recognizes all four roles of advanced practice nursing: CNM, CNP, CRNA, and CNS.
Continuing Education Requirements for ARNPs in Iowa
The expiration of ARNP registration in Iowa coincides with the expiration of RN registration. Maintaining national certification in the ARNP’s area of practice satisfies the continuing education requirements for ARNP registration renewal, with the following exceptions:
- ARNPs performing fluoroscopy must complete an annual radiological safety course that includes study in time, dose, distance, shielding, and the effects of radiation
- ARNPs who regularly examine, attend, counsel, or treat children or adults in Iowa are required to complete training related to the identification and reporting of child/dependent adult abuse. ARNPs performing direct, hands-on care of any kind are deemed to be mandatory reporters and must therefore complete 2 hours of training every 5 years.