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A Master of Science in Nursing (MSN) provides the educational foundation required for RNs to become licensed as advanced practice registered nurses (APRN). Entering advanced practice gives nurses a greater level of autonomy, a great deal of respect in the professional community and the opportunity to earn a much higher salary.
In addition to fulfilling the minimum education requirement for APRN roles, an MSN can also qualify graduates to pursue careers in teaching, clinical leadership, and upper-level management at large hospitals or within nursing departments.
As of 2014, Maine was home to the highest concentration of nurse practitioners in the nation, and in general, APRNs here were also among the best paid. For example, nurse anesthetists in rural northeast Maine earned the fourth-highest average annual salary among CRNAs in all rural areas of the country. Statewide average earnings for APRNs in each of the four roles (US Department of Labor for Maine, 2014):
- Registered Nurses – $63,320
- Nurse Practitioners – $94,400
- Nurse Midwives – $97,530
- Nurse Anesthetists – $170,830
The news that the number of APRN jobs in Maine is projected to increase dramatically is no secret, as reported in a 2015 Portland Press Herald article titled “Want a Top Job in Maine? Think Health Care for Best Opportunity and Pay.” The Herald piece included the Maine Workforce Outlook’s ten-year projections through 2022, indicating that 80 percent of the best-paying and highest-growth careers are in healthcare. This includes APRNs, and nurse practitioners in particular.
Licensing Requirements for the APRN Roles Recognized in Maine
The Maine State Board of Nursing recognizes four roles for APRN licensure:
- Certified Registered Nurse Anesthetist (CRNA)
- Nurse Practitioner (NP)
- Certified Nurse Midwife (CNM)
- Certified Nurse Specialist (CNS)
RNs with licenses in good standing would meet the requirements for APRN licensure by earning a master’s in nursing specific to their APRN role, before going on to become nationally certified in that role.
NPs and CNSs further specialize by becoming educated in a specific patient population focus (for example, family-individual across the lifespan; adult-gerontology primary or acute care; neonatal; women’s health; psychiatric-mental health). To add multiple specializations to an APRN license, candidates can complete an Application for an Additional Specialty once they have completed their education.
The Maine State Board of Nursing recognizes national certification through these certifying organizations for the purpose of APRN licensing. Candidates become eligible for national certification once they complete their MSN in a specific role (and population focus for NPs and CNSs) and pass the sponsoring organization’s national exam:
Nurse Practitioner and Certified Clinical Nurse Specialists
- American Nurses Credentialing Center
- National Board of Pediatric Nurse Associates and Practitioners
- National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
- American Academy of Nurse Practitioners
Certified Nurse-Midwives
- American College of Nurse-Midwives
- American College of Nurse-Midwives Certification Council
Certified Registered Nurse Anesthetists
- Council on Certification of Nurse Anesthetists
APRNs licensed in compact states can become licensed in Maine by having their license verified through Nursys or the NCSBN (National Council of State Boards of Nursing).
Earning an Master of Science in Nursing (MSN) in Maine
Since legislation that came into effect on January 1st of 2006, all APRNs in Maine must have a master’s degree that includes preparation for their specific APRN role.
Maine residents are increasingly choosing to complete their MSN online because of the added convenience these programs offer. In addition to options for accelerated and part-time completion, online MSN programs also allow students to continue working full-time while advancing their education. Online MSN programs strive to create clinical partnerships within Maine’s local healthcare education community so students do not have to relocate to complete clinical rotations.
Prospective APRNs can find locally-based MSN programs offered through colleges and universities in:
- Bangor
- Augusta
- Standish
- Orono
- Portland
No matter where a student decides to pursue an MSN it is important to make sure the graduate program is accredited by an organization that is also recognized by that APRN’s national certification agency. National certification agencies only consider graduates of programs accredited by these organizations:
- Nurse Practitioner and Clinical Nurse Specialist are accredited through the Commission on Collegiate Nursing Education (CCNE), the Accreditation Commission for Education in Nursing (ACEN), and the National League of Nursing
- Nurse Anesthetist programs are accredited through the Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
- Nurse-Midwife are accredited through the Accreditation Commission for Midwifery Education (ACME)
Maine Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
The Maine State Board of Nursing recognizes MSN programs that prepare APRNs according to nationally-recognized standards. As such, students can expect their curriculum to include the following elements:
Nurse Practitioners – the National Task Force of Quality Nurse Practitioner Education describes nurse practitioner graduate curriculum as follows:
- It must be continuously updated by current nurse practitioner faculty members
- It must include graduate NP role/population core competency objectives
- The didactic and clinical curriculum must be consistent with nationally-recognized population-focused competencies
- The curriculum must meet the standards for national certification in a population-focused area of practice, and prepare the NP to sit for a national certification exam
- 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 National Association of Clinical Nurse Specialists (NACNS) describes clinical nurse specialist academic requirements as including:
- A curriculum that is accredited by a nursing education organization which is recognized by the US Department of Education
- A curriculum that is clearly aligned to address the care of a specific population, and is congruent with state requirements and nationally-recognized competencies
- The CNS program must be led by a CNS instructor who has at least a master’s degree in the particular area of focus
- Students should have RN licenses throughout their studies
- The faculty-student ratio is ideally 1:1 or 1:2
- Clinical courses must give students many opportunities to develop skills in key areas and meet the CSN/APRN licensure or certification requirements
- The clinical segment must include at least 500 supervised hours
Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) specifies that the nurse-midwifery graduate program curriculum must cover:
- Fundamentals of nurse midwifery
- Promotion of family-centered care
- Professional responsibilities of nurse midwives
- Components of midwifery care
- Midwifery management process
- Primary health care for women
- Gynecologic care, perimenopausal, and postmenopausal care
- Common health problem management
- Care for the childbearing family
- Newborn care
ACME specifies that nurse-midwife programs must cover each of these core competencies during clinical training. This is usually accomplished in not less than 500 hours of supervised clinical experience.
Nurse Anesthetist – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the CRNA graduate program curriculum to include the following didactic elements:
- 135 hours relating to pathophysiology, anatomy, and physiology
- 105 hours relating to concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- 105 hours relating to physics, pain management, equipment, technology, and basic-through-advanced principles of anesthesia practice
- 45 hours relating to the professional aspects of the practice of nurse anesthesia
- 45 hours relating to clinical correlation conferences
- 30 hours relating to nurse anesthesia research
- Ultrasound and radiology
- Advanced pharmacology
- Advanced healthcare assessment
- Advanced physiology and pathophysiology
Students must complete 2,000 hours of supervised clinical training and study at least 600 clinical cases. Additional requirements of an APRN nurse anesthetist program include:
- 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
- The term “anesthesia” must be referenced in the title of the degree for master’s-level programs
Selecting the Right Program Based on Current Education
Maine RNs can select from MSN programs designed for all levels of education, including those who have:
- Bachelor’s of Science in Nursing (BSN) – RNs with a BSN can apply to conventional two-year MSN programs
- Associate’s degree in nursing (ADN) – RNs with an ADN can apply to RN-to-MSN bridge programs, which will result in earning a BSN along the way; these accelerated programs take around three years to complete
- Bachelor’s degree in an area other than nursing – RNs who earned their undergraduate degree in a field other than nursing can apply to direct-entry or entry-level MSN programs, which typically result in a degree in about three years
Scope of Practice and Maine State Laws Governing Advanced Practice Registered Nursing
APRNs must practice within their authorized scope of practice, which must be consistent with their graduate education, clinical preparation and national certification. They are independently responsible and accountable for their actions within this scope of practice. According to the Rules for State Board of Nursing Chapter 2 Section 380 VIII, the scope of practice for each APRN role is as follows:
Certified Nurse Practitioner Scope of Practice:
- Obtaining a complete health database, including physical examination and health history
- Interpreting health data
- Diagnosing and treating common diseases
- Counseling individuals and families
- Consulting and collaborating with other health care professionals
- Referring clients to other health care providers and community resources
Certified Nurse-Midwife Scope of Practice:
- Case management and primary health care of women during pregnancy, childbirth, and the postpartum
- Primary health care for infants up to one year of age
- Treatment of sexually transmitted diseases
- Provision of gynecological care and family planning services
Certified Registered Nurse Anesthetist Scope of Practice:
- Pre-anesthetic assessment
- Informed consent verification
- Corrective actions and adjustments as needed
- Administration of medical anesthesia
Certified Clinical Nurse Specialist Scope of Practice:
- Intervention in human responses to complex health and illness problems
- Case management services to coordinate health services
- Client progress evaluation
- The Certified Psychiatric Clinical Nurses Specialist can independently assess, therapeutically intervene, and diagnose complex mental health problems
APRN Independent Practice and Collaborative Agreement in Maine
As a general rule APRNs can work in Maine independently within their scope of practice. The exception to this is a 24-month supervision requirement for newly-licensed NPs.
NPs must initially work for 24 months under one of these circumstances:
- Under the supervision of a licensed physician who works in a similar area of specialization
- Under the supervision of an experienced NP who has practiced at least five years in the same specialization
- In a hospital or clinic that is directed by a licensed physician
To file the supervision agreement, NPs can submit an Application for Approval of a Supervising Relationship. This details:
- Synopsis of the services the NP provides
- The amount of hours the NP works each week
- The name, address, and telephone number of the supervising authority
Upon successful completion of the 24-month period, the NP is awarded an “independent letter,” which means they can practice independently.
Prescriptive Authority for APRNs in Maine
Maine allows NPs and CNSs to prescribe medications, which they can do independently. To be eligible for this, NPs and CNSs must have completed at least three semester credits of graduate study in pharmacology as part of their MSN program. This study must include:
- Coverage of applicable state and federal laws
- Prescription writing
- Drug dosage, selection, and route
- Information resources
- Drug interactions
- Clinical application of pharmacology tailored to the specific APRN role
Some drugs require a higher level of clearance from the Drug Enforcement Administration (DEA). To prescribe Schedule II-V medications, NPs and CNSs must apply for a DEA number and can specify which schedules they would like to prescribe.
To renew prescriptive authority, NPs and CNSs must complete 15 hours of continuing education in pharmacology.
Implementation of the APRN Consensus Model in Maine
The National Council of State Boards of Nursing (NCSBN) ranks Maine 14th in the nation for having taken steps towards the NCSBN’s APRN consensus model. The goal of this model is to improve the access to – and the quality of – healthcare for Maine residents, as well as to improve mobility for APRNs interested in practicing in different states.
The NCSBN ranks Maine in the top 70th-percentile of states because of its rules allowing for independent practice of APRNs, and the relatively broad prescriptive authority the state allows. Maine can improve its ranking once it allows NPs to practice independently without a two-year supervisory agreement.
Continuing Education Requirements for APRNs in Maine
APRNs must renew their license concurrently with their RN license. To be eligible for this, all APRNs must maintain their national certifications and complete 75 continuing education hours in the APRN’s role and population focus during each two-year renewal cycle.
If a CNS or NP is licensed for multiple specializations that are in a similar area of focus (for example, someone who is a psychiatric and mental health CNS and a psychiatric and mental health NP) they need only complete 75 hours in total for one renewal period.
30 hours of this continuing education must be from an organization that is approved by a professional organization such as:
- American Nurses Association Credentialing Center
- American Academy of Nurse Practitioners
- American College of Nurse-Midwives
- Council on Recertification of Nurse Anesthetists
- National Organization of Nurse Practitioner Faculty
- Maine State Nurses Association
- American Psychological Association
- American Medical Association Council of Medical Education
- Accreditation Council for Continuing Medical Education
- Committee of Continuing Medical Education of the Maine Medical Association