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With a growing percentage of Mississippians growing older, in addition to those gaining access to health insurance outright, the demand for MSN-educated advanced practice registered nurses (APRNs) is also increasing. A Master of Science in Nursing (MSN) provides RNs with training in advanced health assessment, pharmacology, and pathophysiology, allowing them to enjoy the respect, autonomy and higher pay associated with advanced practice nursing. RNs interested in moving into advanced nonclinical roles in academia, administration, research, patient advocacy and more, also pursue a graduate level education.
APRNs are seen as particularly important in Mississippi’s notoriously medically underserved rural areas, which have struggled for years with a shortage of primary care providers, though this problem extends into the state’s most populated areas as well. Even as Mississippi is recognized as having the second highest concentration of nurse practitioners in the nation, the Mississippi Association of Nurse Practitioners has found that major hospitals and integrated health systems are hiring more advanced practice registered nurses than ever before as a solution to the growing shortage of physicians in the state.
The Mississippi Board of Nursing’s 2014 annual report showed a total of 3,488 active APRN licenses statewide that year, distributed among the three Board-recognized APRN roles:
- Certified nurse practitioner – 2,754
- Certified registered nurse anesthetist – 734
- Certified nurse midwife – 33
State Certification Requirements for the APRN Roles Recognized in Mississippi
The Mississippi Board of Nursing issues APRN certifications to qualified RNs in one of three advanced practice roles:
- Certified Nurse Practitioner (CNP)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
Nurse practitioners further specialize by becoming educated and certified in a specific patient population focus, such as family-individual across the lifespan, adult-gerontology primary or acute care, neonatal, women’s health, or psychiatric-mental health.
To be eligible for APRN certification, candidates must meet these requirements:
- Hold a valid, unencumbered RN license (Mississippi is an RN compact state)
- Complete a specialized MSN program
- Become certified by a board-approved national organization
The national certification organizations approved by the board are:
- Nurse-Midwives – American Midwifery Certification Board (AMCB)
- Nurse Anesthetists – National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA)
- Nurse Practitioners (while not a comprehensive list, these national organizations also certify for specific population foci):
An MSN is also a minimum education requirement for RNs who want to work as clinical nurse specialists. While not an APRN role recognized by the board, RNs can qualify to use the title “clinical nurse specialist,” if they have an MSN in a specific population focus such as those outlined for nurse practitioners. Unlike APRN roles recognized by the board, clinical nurse specialists in Mississippi are not required to obtain national certification.
Earning an Master of Science in Nursing (MSN) in Mississippi
Any prospective APRN in Mississippi must earn a master’s degree or higher in a nursing clinical specialty. Board-approved MSN programs are located in the cities of:
- Columbus
- Natchez
- Cleveland
- Jackson
- Hattiesburg
In addition to campus-based locations, many RNs choose to complete an online MSN program. This is often due to the added convenience afforded by these programs, which allow RNs to keep their job while completing normal, accelerated, or part-time MSN programs at a suitable pace. Online MSN programs partner with local hospitals and universities, often allowing students to complete clinical sequences with their current employer or at a facility nearby.
Prospective APRNs who cannot find their desired program in-state, or who find an appealing out-of-state online/campus-based MSN program must ensure the program they choose is properly accredited. National certification organizations only consider candidates who have graduated from an accredited program:
- Nurse Anesthetist Programs – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs
- Nurse-Midwife Programs – the Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwife programs
- Nurse Practitioner and Clinical Nurse Specialist Programs – the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are two of the most prominent accrediting agencies for nurse practitioner programs; in some cases clinical nurse specialist programs may also fulfill the education requirements to become a nurse practitioner in Mississippi
Mississippi Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
To have an idea of what to expect in an APRN curriculum, prospective students can consider the following guidelines established by national professional organizations:
Nurse Practitioners – the National Task Force of Quality Nurse Practitioner Education describes nurse practitioner graduate curriculum as follows:
- The curriculum must prepare the prospective nurse practitioner to sit 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 be continuously updated by current nurse practitioner faculty
- The didactic and clinical curriculum plan 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
- Nurse practitioner role and population core competency objectives must be included in the curriculum
- The clinical segment must involve at least 500 hours of supervised direct patient care
Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) details that a nurse-midwifery graduate program curriculum must cover the following topics:
- Fundamentals of midwifery care
- Midwifery management process
- Primary health care of women
- Professional responsibilities of nurse midwives and the components of midwifery care
- Hallmarks of midwifery, including the promotion of family-centered care
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
- Management of common health problems
- Childbearing family
- Newborn care
- The clinical segment must cover all of these core competencies, usually including at least 500 hours of supervised direct patient care
Nurse Anesthetist – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) specifies a CRNA graduate curriculum must include following didactic elements:
- At least 135 hours covering pathophysiology, anatomy, and physiology
- At least 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- At least 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- At least 45 hours covering professional aspects of the practice of nurse anesthesia
- At least 45 hours covering clinical correlation conferences
- At least 30 hours covering nurse anesthesia research
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
Students must also 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 may admit RNs from all types of educational backgrounds:
- RNs with a Bachelor of Science in Nursing (BSN) – Nurses with a BSN can apply directly to MSN programs, which take around two years to complete.
- RNs with an Associate’s Degree in Nursing (ADN) – RNs with an ADN can apply to RN-to-MSN bridge programs, with accelerated programs capable of being completed in around three years.
- Professionals with a bachelor’s degree in an area other than nursing – Professionals with a bachelor’s degree in another field can apply to MSN programs, with admission being contingent on prerequisites. Referred to as direct-entry or entry-level MSN programs, these programs can be completed in around three years.
Scope of Practice and Mississippi State Laws Governing Advanced Practice Registered Nursing
The laws that pertain to APRNs can be found in two documents:
Regarding the general scope of practice for APRNs, the Mississippi Board of Nursing specifies that APRNs:
- May diagnose, treat, and manage medical conditions, including with prescriptive authority
- May practice within the standards and guidelines determined by their national certification organization
- Must establish and collaborative/consultative relationship with a physician whose practice is compatible with the APRN’s
Scopes of practice for the specific APRN roles are detailed by the board as follows:
Nurse Practitioner Scope of Practice – In general nurse practitioners may:
- Diagnose and treat medical conditions in patients within the APRN’s population focus
- Provide treatment of patients in a variety of healthcare settings
- Work within the scope of practice determined in the collaborative/consultative relationship with a physician
Emergency Department – the Mississippi Board of Nursing has defined the emergency department scope of practice for the nurse practitioners according to their population focus:
- Family nurse practitioner (FNP) – provide primary care services in an emergency department clinic to patients with non-emergent problems (not including the trauma area unless the FNP has additional specialized education)
- Acute care nurse practitioner (ACNP) – provide care for patients with acute, critical, and chronic health conditions, including those with rapidly changing conditions (may work in the trauma area if certified for adults and children)
In an emergency department, FNPs, ACNPs, and the following NPs can practice independently if there is a collaborative physician who is on-call, and these NPs have completed training for the treatment of emergent conditions:
- Pediatric nurse practitioner (PNP) – may treat pediatric patients only
- Adult nurse practitioner (ANP) – may treat adult patients only
Aesthetics – the Mississippi Board of Nursing has determined that, when duly qualified, NPs can provide aesthetic services that include microderabrasion, chemical peels, laser procedures, fillers, and sclerotherapy. However, the following NPs may not provide these services:
- Psychiatric nurse practitioner
- Acute care nurse practitioner
- Neonatal nurse practitioner
Nurse Anesthetist Scope of Practice – Nurse anesthetists must follow board-approved guidelines regarding:
- Pre-anesthesia preparation and evaluation
- Anesthesia induction, maintenance, and emergence
- Post-anesthesia care
- Peri-anesthetic and clinical support functions
- Clinical privileges and guidelines for practice must be established with the collaborating/consulting physician
Nurse anesthetists may provide anesthetic services to women during childbirth provided they adhere to these guidelines:
- Must be aware of the fetal status before induction of anesthesia
- Airway management equipment for the mother and infant must be available
- While analgesia and anesthesia is being administered, the nurse anesthetist must be immediately available as defined by institutional policy
- A qualified healthcare provider other than the nurse anesthetist must be available to provide neonatal assessment and resuscitation, if required
- Must ensure post-anesthetic care for the mother is consistent with institutional policy
Nurse Midwives Scope of Practice – The nurse midwife scope of practice is detailed by the by the American College of Nurse-Midwives:
- 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
- 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
APRN Collaborative Agreement in Mississippi
Advanced practice registered nurses must practice in a collaborative/consultative relationship with a physician. This will specify a standing protocol or practice guidelines within which the APRN must operate. The agreement must include a quality assurance and improvement program that details:
- Physician’s review of patient charts who have been seen by the APRN
- APRN’s patient history and their outcomes
- When a quality assurance meeting will take place between the physician and APRN – this must be at least once per quarter
This above definition of collaboration/consultation is legislatively distinct from direct and indirect supervision.
Prescriptive Authority for APRNs in Mississippi
Mississippi allows its APRNs to have full prescriptive authority once they complete the following:
- A separate pharmacology course as part of the APRN’s MSN program
- Work as an APRN for at least 720 hours
- Request prescriptive authority on the APRN certification application
- Register with the Drug Enforcement Administration (DEA)
Prescriptive authority includes the option to prescribe controlled substances, Schedule II-V. The details regarding prescriptive authority must be demarcated in the APRN’s collaborative/consultative agreement with a physician.
APRNs must establish a good faith assessment of patients before prescribing drugs with addictive properties. Any prescription of diet medications that are Schedule III-V anorectics must be made with caution and only to supplement caloric-reduction weight treatment regimens.
Nurse midwives and nurse anesthetists may only exercise their prescriptive authority in a licensed healthcare facility.
To renew prescriptive authority on each biannual APRN certification renewal application, candidates must have completed at least two hours of continuing education related to the prescription of controlled medications.
Implementation of the APRN Consensus Model in Mississippi
While legislative changes have made it easier for APRNs to practice and prescribe medications, complete independence for these activities still eludes full implementation. The National Council of State Boards of Nursing (NCSBN) APRN Consensus Model calls for full autonomy in practice and prescriptive authority, with the ultimate goals of improving healthcare as well as APRN mobility.
The Mississippi Association of Nurse Practitioners continues to push for legislative changes that would realize the goals of the NCSBN’s APRN Consensus Model. Examples of changes the Association is petitioning for include:
- Creation of the APRN role of clinical nurse practitioner
- Separate licensing process for APRNs, distinct from the RN license
- Full practice independence without a collaborative/consultative relationship
- Immediate prescriptive authority for licensed/certified APRNs
Continuing Education Requirements for APRNs in Mississippi
APRNs must maintain their national certification to renew their state APRN certification. The board also requires that APRNs complete 40 hours of continuing education by every biannual certification renewal period, which takes place October through December of even-numbered years.
While maintaining and renewing their APRN certifications, nurses must also do the same for their traditional RN license.