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The Louisiana State Board of Nursing’s annual report in 2014 revealed that eight percent (4,469 professionals) of the state’s RNs are licensed as advanced practice registered nurses (APRN), up 35 percent from the number of APRNs in 2010. As of the publication of the 2014 report, the breakdown of APRNs in each of the four recognized roles was as follows:
- 2,773 (63 percent) were nurse practitioners
- 1,272 (29 percent) were certified registered nurse anesthetists
- 127 (3 percent) were clinical nurse specialists
- 32 (0.7 percent) were certified nurse midwives
Signaling the need for more advanced practice nurses amid a growing shortage of primary care providers, the Board’s report also found that a significant portion of the state’s APRN workforce is approaching retirement age, with 20 percent age 50 and older, and 14 percent age 60 and older.
Licensing Requirements for the APRN Roles Recognized in Louisiana
The Louisiana State Board of Nursing 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; women’s health; psychiatric-mental health).
To gain APRN status, Louisiana’s RNs must:
- Earn an MSN or higher degree in their specific role and patient population focus through an accredited program
- Provide at least 800 hours of supervised patient care
- Become nationally certified in their APRN role and patient population focus through a board-recognized organization
The following national certification organizations are recognized by the Louisiana State Board of Nursing as providing certification in the respective APRN role and patient population focus necessary for APRN licensure in the state:
Certified Nurse Midwife (CNM)
- American Midwifery Certification Board
Certified Registered Nurse Anesthetist (CRNA)
- National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA)
Clinical Nurse Specialist (CNS)
- American Association of Critical Care Nurses (AACN)
- American Nurses Credentialing Center (ANCC)
Nurse Practitioner (NP)
- American Academy of Nurse Practitioners (AANP)
- American Association of Critical Care Nurses (AACN)
- American Nurses Credentialing Center (ANCC)
- National Certification Corporation (NCC)
- Pediatric Nursing Certification Board (PNCB)
Earning a Master of Science in Nursing (MSN) in Louisiana
Earning a Master of Science in Nursing specific to an APRN role and patient population focus is the first step to becoming a nurse practitioner, certified nurse-midwife, clinical nurse specialist or certified registered nurse anesthetist. Earning an MSN can also prepare nurses for teaching faculty positions as well as advanced management and supervisory positions.
Many prospective MSN graduate students choose to apply to online programs, which allow them to maintain their career while earning an advanced degree. Students opting for online studies work with a faculty advisor to identify clinical study sites within Louisiana so as to avoid long commutes or the need to relocate. In many cases, clinical hours can be completed at an RN’s current place of employment. Online MSN programs make a concerted effort to maximize convenience in terms of academic schedule and placement for clinical sequences.
Students looking for an in-state campus location can find board-approved MSN programs in:
- Grambling
- Thiboaux
- Lake Charles
- Hammond
- Lafayette
- New Orleans (two programs)
- Shreveport
- Baton Rouge (two programs)
To be eligible for national certification in the respective APRN roles and patient population foci, and to qualify for APRN licensure through the Louisiana State Board of Nursing, candidates must earn their MSN through a program accredited by one of these agencies:
- The American Midwifery Certification Board recognizes MSN programs that are accredited by the Accreditation Commission on Midwifery Education (ACME)
- The National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA) recognizes MSN programs that are accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
- The American Association of Critical Care Nurses (AACN), the Pediatric Nursing Certification Board (PNCB), and the American Nurses Credentialing Center (ANCC) recognize MSN programs that are accredited by:
- The American Academy of Nurse Practitioners (AANP) and the National Certification Corporation (NCC) recognize MSN programs that are accredited by any accrediting agency recognized by the US Department of Education.
Louisiana State Board of Nursing Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
According to the rules and regulations delineated in the Louisiana Professional and Occupational Standards, MSN programs for all APRN roles must adhere to these general standards:
- The MSN program must meet the educational requirements of the APRN’s specific national certifying body
- The MSN program must allow prospective APRNs to work under the instruction and guidance of a qualified instructor or preceptor
- Prospective APRNs must complete at least 500 supervised clinical hours in direct nursing/client care
- MSN programs that include multiple specializations or age-group foci must include additional clinical hours
- MSN programs must include education regarding advanced pathophysiology, advanced assessment, and advanced pharmacology (at least three semester credits each)
The specific academic requirements for each APRN role can be determined by examining the detailed curriculum standards of the following professionals organizations:
Nurse Practitioner – National Task Force of Quality Nurse Practitioner Education describes nurse practitioner graduate curriculum as including:
- Didactic and clinical segments must be continuously updated by current nurse practitioner faculty members
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused competencies
- Graduate, APRN, and NP role/population core competency objectives must be included
- The curriculum must prepare the prospective nurse practitioner for a national certification exam that corresponds with the NP’s role and population focus
- Didactic coursework must be reinforced by clinical coursework
- The curriculum must meet the standards for national certification in a population-focused area of practice
- At least 500 hours of supervised direct patient care clinical hours must be included
Clinical Nurse Specialist – National Association of Clinical Nurse Specialists (NACNS) describes clinical nurse specialist academic requirements as follows:
- The curriculum must be accredited by a nursing education organization that is recognized by the US Department of Education
- The curriculum must be clearly aligned to address the care of a specific population, and be congruent with state requirements and nationally-recognized competencies
- The CNS program must be led by a CNS who has at least a master’s degree in the particular area of focus of the CNS program
- Students should have RN licenses throughout their studies
- There must be an adequate number of instructors to ensure there is adequate supervision during clinical courses, recommended; ideally a 1:1 or 1:2 faculty-student ratio
- Clinical courses must give students many opportunities to develop skills in core areas and meet the CSN/APRN licensure or certification requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Nurse-Midwife – Accreditation Commission for Midwifery Education (ACME) specifies that nurse-midwifery graduate program curriculum must cover:
- Essentials of nurse midwifery and the promotion of family-centered care
- Professional responsibilities of nurse midwives
- Midwifery management process
- Components of midwifery care
- Primary health care of women
- Gynecologic care, perimenopausal, postmenopausal and care for other aging stages
- Management of common health problems
- The childbearing family
- Infant and newborn care
ACME does not specify an hour requirement for clinical sequences, only that nurse-midwife graduate programs must cover all of these core competencies during clinical training. This is usually accomplished in not less than 500 hours of supervised clinical experience.
Nurse Anesthetist – Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires CRNA graduate program curriculum to include the following didactic elements:
- Concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs – total 105 hours
- Pathophysiology, anatomy, and physiology – total 135 hours
- Professional aspects of the practice of nurse anesthesia – 45 hours
- Physics, pain management, equipment, and technology
- Basic, intermediate, and advanced principles of anesthesia practice – 105 hours total
- Anesthesia research – 30 hours
- Clinical correlation conferences – 45 hours
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
Graduate students in CNS programs must complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Selecting the Right Program Based on Current Education
MSN programs that prepare students for APRN licensure in Louisiana are designed with all types of candidates in mind:
- RNs with a BSN can apply for admission directly to conventional terminal MSN programs, which are typically between 35-50 semester credits
- Professionals with a bachelor’s degree in an area other than nursing can apply to direct entry pre-licensure MSN programs; depending on outstanding prerequisite requirements these programs can vary between 40-60 semester credits
- RNs with an ADN can apply to RN-to-MSN bridge programs that grant both a BSN and MSN in one accelerated program; typically requires between 48-96 semester credits
Louisiana State Laws Governing Advanced Practice Registered Nursing
Louisiana laws pertaining to scope of practice, the need for a collaborative practice agreement with a physician, prescriptive privileges and licensure mobility are described in Title 46, Part XLVII of the Professional and Occupational Standards.
Collaborative Practice Agreement
APRNs that practice within the bounds of their specialization and population focus as defined in the Professional and Occupational Standards are not required to have a collaborative practice agreement. However, APRNs that engage in medical diagnosis and management must enter into a collaborative practice agreement with a physician. This agreement includes details about:
- The specific duties an APRN is allowed to perform
- The supervising physician’s availability
- The responsibilities of the supervising physician and APRN
- Clinical practice guidelines
- Hospital admitting privileges
Responsibilities within the collaborative practice agreement include:
- APRNs must consult with their supervising physician as needed; this can be by direct contact or via telephone
- Supervising physicians must make sure that any prescriptions an APRN writes are consistent with the regulations that govern that APRN
Prescriptive Authority
APRNs in Louisiana have the option of obtaining prescriptive authority. To obtain this they must complete the following:
- Three semester credits of graduate education in each of the following subjects: advanced pathophysiology, advanced assessment, and advanced pharmacology
- A collaborative practice agreement that specifies the details about an APRN’s prescriptive authority – a successful review by the Louisiana State Board of Nursing will result in a Letter of Approval
- An Application Packet for Initial Prescriptive Authority
APRNs who want to prescribe controlled substances (schedule II-V drugs) must take these additional steps:
- Complete an APRN Controlled Substance Application and submit this to the Louisiana State Board of Nursing
- Register for a controlled substance license with the Louisiana Board of Pharmacy
- Register with the Drug Enforcement Administration (DEA)
APRNs are never allowed to prescribe medications for the following:
- To oneself or family members
- Treatment for obesity
- Treatment for chronic pain
Each year APRNs with prescriptive authority must earn six hours of board-approved continuing education credits that relate to advanced pharmacology and the APRN’s specific area of focus.
Full prescriptive authority, including that for treatment of chronic pain and obesity, has been an important topic of discussion for the Louisiana State Board of Nursing’s APRN Task Force in the past, and will likely arise again in the future. As Louisiana gets closer to implementing more aspects of the NCSBN’s APRN consensus model, APRNs can expect these current restrictions to change at some point.
APRN Consensus Model
Since at least 2010 the Louisiana State Board of Nursing’s APRN Task Force has been taking steps to bring its APRNs in line with the NCSBN’s (National Council of State Boards of Nursing) APRN Consensus Model. The goal of this initiative is to improve the access to, and quality of, APRN health care services, as well as allow APRNs to have more freedom to practice in different states.
As of January 2016, Louisiana’s APRN Task Force has determined the following in regards to the consensus model:
- Eliminating the issuance of APRN permits and collaborative practice agreements, as advocated by the NCSBN’s consensus model, is contrary to Louisiana State Board of Nursing rules
- The ability to prescribe medication for pain and obesity treatment is advocated by the NCSBN’s consensus model, however APRNs are still not permitted to do this in Louisiana
Continuing Education Requirements for APRNs in Louisiana
APRN licenses must be renewed by January 1st of each year, along with the standard RN license. The Louisiana State Board of Nursing stipulates that to be eligible for renewal, APRNs must maintain national certification with their specific certifying organization. This often involves the completion of continuing education.