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Earning a Master of Science in Nursing (MSN) fulfills the minimum education requirements RNs need to enter advanced clinical practice and other vital nursing careers in clinical leadership, education, administration, informatics, patient advocacy and more. In virtually all respects, an MSN allows for a greater level of independence and advanced opportunities that bring higher pay.
The number of active advanced practice registered nurse (APRN) licenses in the four roles recognized by the Minnesota Board of Nursing are shown below along with the average salary for each (US Department of Labor, 2014):
- 3,961 certified nurse practitioners, who earned an average annual salary of $102,640
- 1,769 certified registered nurse anesthetists, who earned an average annual salary of $161,790
- 464 clinical nurse specialists (no salary statistics available)
- 269 certified nurse midwives, who earned an average annual salary of $94,690
According to the Minnesota Board of Nursing’s Annual Licensure Report, the total number of active APRN licenses throughout the state in these four roles has increased from 5,253 in 2011 to 6,463 in 2015. Minnesota’s hospitals and integrated health systems are recognized leaders in offering employment opportunities and competitive pay for MSN-prepared APRNs (US Department of Labor, 2014):
- Rochester is home to the highest number of nurse practitioners of all metro areas in the nation
- The Minneapolis-St. Paul area is home to the second-highest number of nurse anesthetists
- The Minneapolis-St. Paul area is home to the third-highest number of nurse-midwives
- Duluth and Rochester rank among the top-10 cities in the nation with the highest average annual salaries for nurse anesthetists
While the demand for advanced clinicians in Minnesota is expected to continue well into the future, there is also a critical and growing demand for qualified nurse educators. In fact, the American Association of Colleges of Nursing (AACN) reported that in 2014 nearly 69,000 qualified BSN and MSN students throughout the country were turned away due to insufficient faculty.
Licensing Requirements for the APRN Roles Recognized in Minnesota
The Minnesota Board of Nursing issues APRN licenses specific to the four recognized advanced clinical roles:
- Certified Nurse Practitioner (CNP)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Certified Nurse-Midwife (CNM)
Nurse practitioners and clinical nurse specialists further specialize by becoming educated and nationally certified in a specific patient population focus recognized by the state board:
- Family and individual across the lifespan
- Adult Gerontology
- Neonatal
- Pediatrics
- Women’s and gender-related health
- Psychiatric and mental health
To be eligible for APRN licensure through the Minnesota Board of Nursing, candidates must meet these requirements:
- Have a current RN license (Minnesota is not part of the RN compact agreement, however it does grant RN licenses based on reciprocity)
- Earn a master’s-level education in the APRN’s specific role (nurse-midwife, nurse anesthetist, nurse practitioner, or clinical nurse specialist)
- Become nationally certified by a board-recognized national certification organization in the APRN’s specific role
The Minnesota Board of Nursing recognizes the following national certification organizations as granting the credentials necessary for APRN licensure in the respective roles:
- Nurse-Midwives – American Midwifery Certification Board (AMCB)
- Nurse Anesthetists – National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
- Nurse Practitioners and Clinical Nurse Specialists (in addition to the APRN roles these national organizations also certify for specific population foci):
Earning an Master of Science in Nursing (MSN) in Minnesota
An increasing number of Minnesota RNs are choosing to earn their MSN degrees through fully accredited online programs. Online programs offer preferred scheduling accommodations that are often better suited to working clinicians. Online schools develop clinical partnerships with local healthcare facilities, hospitals, and universities that allow the clinical segment of an online program to be completed locally, often with a student’s existing employer.
Local MSN and other graduate-level nursing programs approved by the Minnesota Board of Nursing are located in the cities of:
- Minneapolis (four programs)
- Saint Paul (three programs)
- Rochester (two programs)
- Saint Louis Park
- Mankato
- Duluth
When evaluating an MSN program, prospective students must ensure it is accredited by a recognized agency to ensure their education will prepare them for national certification. The Minnesota Board of Nursing and the national certification organizations recognize graduate nursing programs accredited by the following accrediting agencies respective to each role:
- Nurse Practitioner and Clinical Nurse Specialist – The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the most prevalent accrediting agencies for nurse practitioner and clinical nurse specialist programs, however other accrediting agencies recognized by the Council for Higher Education Accreditation (CHEA) and the US Department of Education may also be accepted
- Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs
- Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwife programs
Minnesota Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
It is standard for all graduate programs designed for advanced clinicians to include core content in:
- Advanced pathophysiology/physiology
- Advanced health assessment
- Advanced pharmacology
Specific curricular standards for MSN programs that prepare APRNs for licensure in the four roles are determined by national professional nursing organizations, certifying bodies and educational task forces:
Nurse Practitioner Programs – The National Task Force of Quality Nurse Practitioner Education states that the nurse practitioner graduate curriculum must:
- Meet the standards for national certification in a population-focused area of practice
- Be continuously updated by nurse practitioner faculty members
- Be consistent with nationally-recognized population-focused competencies
- Include population-focus core competency objectives
- Prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the NP’s role and population focus
- Be reinforced by clinical coursework
- The clinical segment must include at least 500 hours of supervised direct patient care
Clinical Nurse Specialist Programs – The 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, must be clearly aligned to address the care of a specific population, and must 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 population focus
- Students must have an RN license throughout their studies
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the CNS/APRN licensure or certification requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) specifies that the nurse-midwifery graduate program curriculum must cover:
- Hallmarks of midwifery, including the promotion of family-centered care
- Professional responsibilities of nurse midwives and the components of midwifery care
- Midwifery management process
- Fundamentals of midwifery care
- Primary health care of women
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
- Management of common health problems
- Childbearing family
- Newborn care
- The clinical segment must also cover all these core-competency areas, which is usually accomplished in at least 500 supervised hours
Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the CRNA graduate curriculum to include the following didactic elements:
- Pathophysiology, anatomy, and physiology – 135 hours
- Concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs – 105 hours
- Physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice – 105 hours
- Professional aspects of the practice of nurse anesthesia – 45 hours
- Clinical correlation conferences – 45 hours
- Nurse anesthesia research – 30 hours
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
CNS students must complete 2,000 hours of supervised clinical training and study at least 600 clinical cases. They also need at least one year of experience in a critical-care setting.
Selecting the Right Program Based on Current Education
Minnesota RNs can choose an MSN program that is right for them based on the level of education they have already attained:
- RNs with a Bachelor of Science in Nursing (BSN) can apply directly to conventional terminal MSN programs, which take about two years to complete
- RNs with an Associate Degree in Nursing (ADN) can apply to RN-to-MSN bridge programs, which often offer fast-track completion options in as little as three years
- Professionals with a bachelor’s degree in an area other than nursing can apply to entry-level (sometimes called direct-entry) MSN programs which result in an RN license and MSN in one accelerated program that takes about three years to complete
Scope of Practice and Minnesota State Laws Governing Advanced Practice Registered Nursing
Regulations that pertain to APRNs can be found in Minnesota’s Nurse Practice Act.
The Minnesota Board of Nursing defers to the national professional nursing organizations to define the specific scope of practice for each APRN role. Generally, the board reports the APRN scope of practice to include the following:
- Performing acts of advanced assessment
- Functioning as a primary or direct care provider
- Diagnosing, prescribing, and ordering medications
- Functioning as a case manager, researcher, consultant, or educator
Scope of Practice for Nurse Practitioners:
- Perform comprehensive health assessments
- Order and interpret diagnostic procedures and tests
- Use differential diagnoses to reach a medical diagnosis
- Provider, order, and interpret intervention outcomes
- Meet the psychological and physiologic needs of patients with serious health conditions
- Provide continuous and comprehensive care for patients in a variety of settings
Scope of Practice for Clinical Nurse Specialists:
- Diagnose, manage, and treat those with chronic or acute diseases/illnesses
- Facilitate inter-professional safe practices through collaboration
- Support and encourage the rights of patients and their families
- Translate best evidence into clinical practice
- Establish and maintain a healthy work environment
- Educate, assess, and refer patients
Scope of Practice for Nurse Midwives:
- Provide a full range of primary health care services for women, from adolescence to post-menopausal
- Services include primary care, gynecological care, preconception care, pregnancy care, and family planning services
- Care also includes that provided during the childbirth and post-partum periods, as well as newborn care
- Provide initial and ongoing comprehensive assessments, diagnosis, and treatments
- Treatments can be offered for all types of this care, including those for male partners with sexually transmitted diseases
- Health promotion, disease prevention, and wellness education
Scope of Practice for Nurse Anesthetists:
- Performance of a pre-anesthetic assessment and evaluation of the patient
- Development and implementation of an anesthetic plan
- Practices that induce general, regional, local, and sedation
- Selection, application, and insertion of noninvasive and invasive monitoring equipment for the evaluation of a patient’s status
- Continued management of a patient’s anesthesia
- Facilitation of the emergence and recovery of a patient from anesthesia
- Providing post-anesthesia follow-up evaluations and care
Independent Practice for APRNs in Minnesota
Minnesota’s APRNs, especially nurse midwives and nurse anesthetists, can practice and write prescriptions independently within their scopes of practice. The same holds true for nurse practitioners and clinical nurse specialists, but with one exception: new CNSs and NPs must practice within a collaborative management agreement for 2,080 hours after initial licensure.
This collaborative management agreement must be made between the CNS/NP and a physician, an experienced NP, or an experienced CNS, who must have experience working within the CNS’s/NP’s population focus. The collaborative agreement must specify:
- The scope of collaboration management between the CNS/NP and physician
- The scope of practice for CNSs/NPs
- CNS/NP procedures which are not authorized
- The name, license number, and contact information of the physician
During the period of collaborative management, CNSs and NPs may exercise their full independent prescriptive authority.
After completing the 2,080-hour requirement, CNSs and NPs may also work independently within their scope of practice without maintaining a collaborative agreement.
Prescriptive Authority for APRNs in Minnesota
Minnesota APRNs in all four roles can prescribe, dispense, and administer therapeutic devices, drugs, and controlled substances (Schedule II-V). To be eligible to engage in these activities with controlled substances, APRNs must register with the Drug Enforcement Administration (DEA).
Additional requirements for nurse anesthetists – nurse anesthetists may also prescribe medications to help patients manage acute and chronic pain. When prescribing within this context, the nurse anesthetist must work in collaboration with a licensed physician, utilizing a written plan that specifies:
- Scope of collaboration that is necessary to help the patient manage acute or chronic pain
- Specific delegated responsibilities
- The physician and nurse anesthetist must work in the same health care facility
Implementation of the APRN Consensus Model in Minnesota
Minnesota has recently taken important steps towards full implementation of the National Council of State Boards of Nursing’s (NCSBN) APRN Consensus Model. The goal of this initiative is to achieve consensus on practice standards and licensing requirements among all state boards of nursing to make it easier for APRNs to practice in multiple states, and by doing so improve healthcare access and quality.
New legislation came into effect in Minnesota as of January 2015 that mandates the following, in line with the APRN consensus model:
- The four recognized APRN roles have licensing requirements that are defined specifically, and distinct from an RN license
- APRNs can practice independently without a collaborative management plan or written prescribing agreement, with minor caveats for CNSs and NPs
Minnesota could move to fully implement the APRN Consensus Model by removing the requirement for CNSs and NPs to practice within a collaborative agreement for the first 2,080 hours after licensing.