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For nurses, an MSN can open up career possibilities that include APRN licensure, upper-level management positions, teaching opportunities and more. With advanced education and career progression also comes a generous increase in base pay. While the average salary for New Mexico’s RNs was $65,790 as of 2014, nurses in advanced clinical and nonclinical roles earned much more (US Department of Labor, 2014):
- Registered nurses –Nurse practitioners – $100,490
- Nurse anesthetists – $130,460
- Nurse midwives – $95,900
- Medical and health service managers (nurse administrators) – $104,480
- Post-secondary nursing instructors and teachers – $66,650
With the US Department of Health and Human Services identifying 100 areas in New Mexico as having a shortage of primary healthcare providers, the demand for advanced practice registered nurses (APRNs) skilled in pathophysiology, advanced health assessment and advanced pharmacology, is only projected to increase. The New Mexico Department of Labor projects strong job growth during the ten-year period leading up to 2022 for a number of advanced practice clinicians:
- Nurse practitioners – 26 percent growth
- Nurse anesthetists – 11 percent growth
- Nurse midwives – 22 percent growth
Licensing Requirements for the APRN Roles Recognized in New Mexico
The New Mexico Board of Nursing licenses APRNs in three different roles, shown here with the board’s current number of licensees as of 2016:
- Certified nurse practitioner (CNP) – 1,692 active licensees
- Clinical nurse specialist (CNS) – 132 active licensees
- Certified registered nurse anesthetist (CRNA) – 416 active licensees
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; and psychiatric-mental health).
To be eligible for an APRN license, candidates must meet these requirements:
- Have a New Mexico RN license or an RN license from a compact state
- Complete at least a master’s-level nursing program designed for the APRN’s role and population focus
- Become nationally certified by a national organization
Prospective certified nurse midwives must also meet these requirements, however, the New Mexico Board of Nursing licenses them independent of APRNs.
Having completed all the steps to become an APRN except national certification, students can apply for a temporary permit that allows for restricted practice for a limited time until national certification has been obtained.
Becoming nationally certified means passing an organization’s national certification exam. Approved national certification organizations that the New Mexico Board of Nursing recognizes for credentialing APRNs and certified nurse-midwives are as follows:
- Nurse Anesthetists – the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) is the only board-recognized organization that provides certification for nurse anesthetists
- Nurse Practitioners and Clinical Nurse Specialists – the following represent the national organizations that provide NP and CNS certifications, including national certification for specific population foci:
- Nurse-Midwives – the American Midwifery Certification Board (AMCB) is the only board-recognized organization that certifies nurse midwives
Earning an Master of Science in Nursing (MSN) in New Mexico
Local MSN programs can be found in cities like Portales and Las Cruces. Prospective students can also find MSN programs online, which are flexible enough to allow nurses to keep working while completing their education. Many programs offer added flexibility that includes part-time enrollment and accelerated completion options. Online schools establish partnerships with hospitals and universities in New Mexico to maximize their students’ local options for completing the clinical segment of the MSN program. In most cases, students can complete their clinical requirements with their current employer.
When choosing an MSN program, prospective APRNs and nurse midwives must ensure it has the right accreditation. National certifying organizations only consider students who have graduated from a properly accredited MSN program. The following list shows nurse midwife and APRN roles paired with their appropriate accrediting bodies:
- Nurse Practitioner and Clinical Nurse Specialist – the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the two most prominent accrediting agencies for nurse practitioner and clinical nurse specialist programs at the graduate level
- Nurse Anesthetist – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting body recognized by the NBCRNA
- Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) is the accrediting body recognized by the AMCB
Curriculum for MSN Programs that Prepare APRNs and Nurse Midwives
Details about MSN curricula are provided by national professional nursing organizations:
Nurse Practitioners – The National Task Force of Quality Nurse Practitioner Education describes nurse practitioner graduate curriculum requirements as follows:
- Being continuously updated by current nurse practitioner faculty members
- It must meet the standards for national certification in a population-focused area of practice
- The didactic and clinical curriculum plan are consistent with nationally-recognized population-focused competencies
- Nurse practitioner population core competency objectives must be included in the curriculum
- The curriculum must prepare prospective nurse practitioners to sit for a national certification exam that corresponds with their population focus
- Didactic coursework must be reinforced by clinical coursework
- At least 500 hours of supervised direct patient care clinical hours must be included
Clinical Nurse Specialist – The National Association of Clinical Nurse Specialists (NACNS) describes the clinical nurse specialist academic requirements and curriculum as follows:
- The CNS graduate program’s curriculum must be clearly aligned to address the care of a specific population, and be in line with state requirements and nationally-recognized competencies
- It must be accredited by a nursing education organization that is recognized by the US Department of Education
- The CNS program must be led by a CNS who has at least a master’s degree in the particular area and population focus of the CNS program
- There must be an adequate number of faculty instructors and preceptors to ensure there is direct and indirect supervision during clinical courses
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the licensure requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Nurse Anesthetist – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the CRNA curriculum to include the following didactic elements:
- Advanced pharmacology
- Ultrasound and radiology
- Advanced healthcare assessment
- Advanced physiology and pathophysiology
- Nurse anesthesia research – 30 hours
- Clinical correlation conferences – 45 hours
- Professional aspects of the practice of nurse anesthesia – 45 hours
- Physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice – 105 hours total
- Concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs – total 105 hours
- Pathophysiology, anatomy, and physiology – total 135 hours
Students must also complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Nurse-Midwife – The Accreditation Commission for Midwifery Education (ACME) specifies that nurse-midwifery graduate program curriculum must cover:
- Professional responsibilities of nurse midwives and the components of midwifery care
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
- Management of common health problems
- Promotion of family-centered care
- Core-competencies of midwifery
- Fundamentals of midwifery care
- Midwifery management process
- Primary health care of women
- Childbearing family
- Newborn care
Nurse midwives must also complete a course on advanced pharmacology according to regulations from the New Mexico Board of Nursing.
The clinical sequence must cover all of these core competencies listed above, which is usually accomplished in not less than 500 hours.
Selecting the Right Program Based on Current Education
MSN programs are structured in a variety of ways in order to admit RNs from all types of educational backgrounds:
- RNs with a Bachelor’s of Science in Nursing (BSN) – these students can apply directly to terminal MSN programs, which take about two years to complete
- RNs with an Associate’s degree in nursing (ADN) – these students can apply to RN-to-MSN bridge programs, which may be completed in as little as three years
- RNs with a Bachelor’s degree in an area other than nursing – these students can apply to entry-level or direct-entry MSN programs which allow for enrollment that is contingent upon completion of prerequisites; these programs can take around three years to complete
Scope of Practice and New Mexico State Laws Governing APRNs and Nurse Midwives
The laws and regulations that pertain to the practice of APRNs can be found in the following sources:
Those pertaining to nurse midwives can be found in the NMAC Title 16, Chapter 11 – Part 2.
The New Mexico Board of Nursing defines APRN and nurse midwife scopes of practice as follows. All APRNs can perform the following activities:
- Make independent decisions regarding the health care needs of clients
- Make independent decisions when carrying out health care regimens
- Perform specific procedures which are beyond the APRN’s education and certification, provided these are performed with skills that have been obtained from a recognized institution or organization, and provided that the APRN has arranged all necessary supervision and contingencies
- Prescribe medications and controlled substances within their role and population focus if prescriptive authority has been granted
- Collaborate as necessary with other healthcare providers, including about subjects related to diagnoses and treatments
Certified Nurse Practitioner Scope of Practice
- Provide primary, acute, chronic, long-term, and end-of-life care
- Work with populations that include individuals, families, and communities
- Provide medical care in any health care setting
Certified Registered Nurse Anesthetist Scope of Practice
- Provide pre-operative, intra-operative, and post-operative anesthesia care and related services
- Order diagnostic tests
- Work within the guidelines established by the American Association of Nurse Anesthetists
Clinical Nurse Specialist Scope of Practice
- Make independent decisions in a specialized area of nursing practice
- Employ knowledge about the health care needs of the individual, family, and community to make effective decisions
- Perform therapeutic treatments in a specific area of specialty
Certified Nurse Midwife Scope of Practice
- Independently provide a full range of primary health care services for women from adolescence to beyond menopause
- Provide services that include primary care, gynecologic care, family planning, pre-conception care, care during pregnancy, childbirth care, postpartum care, care of the normal newborn, and treatment of male partners for sexually transmitted diseases
- Provide initial and ongoing comprehensive assessments, diagnoses, and treatments
- Conduct physical examinations
- Independently prescribe, distribute, and administer dangerous drugs, devices, contraceptive methods, and controlled substances Schedules II-V
- Admit, manage and discharge patients
- Order and interpret labor and diagnostic tests
- Promote health, prevent diseases, and provide wellness education and counseling
- Work in diverse settings that can include ambulatory care clinics, private offices, community and public health systems, homes, hospitals, and birth centers
- A nurse midwife who expands beyond their professional core competencies to incorporate new procedures that improve care for women and their families must comply with the guidelines developed by the American College of Nurse-Midwives
Prescriptive Authority for APRNs in New Mexico
The APRN scope of practice includes prescriptive authority if APRNs apply for and are granted this authority.
To earn prescriptive authority for controlled substances Schedule II-V, APRNs must take these steps:
- Obtain a letter of authorization from a preceptorship
- Submit an affidavit for prescriptive authority to the New Mexico Board of Nursing
- Apply for a controlled substance license from the New Mexico Board of Pharmacy
- Register with the Drug Enforcement Administration (DEA)
- Maintain a formulary of dangerous drugs and controlled substances that may be prescribed by the APRN – these must be directly related to the APRN’s role, population focus, and scope of practice
APRNs can obtain a letter of authorization by entering into a preceptorship, a type of collaborative arrangement, with a physician or other experienced APRN. During the 400-hour preceptorship, the candidate must demonstrate workplace competence that involves prescribing dangerous drugs.
The letter of authorization is issued at the beginning of the preceptorship, which must be completed within six months. If the APRN candidate is coming from another state they may fulfill the preceptorship requirement by having 400 hours of work experience that involves prescribing dangerous substances.
Nurse Midwives – Nurse midwives are permitted to prescribe medications. They may not prescribe Schedule I controlled substances, and may prescribe Schedule II-V controlled substances if they apply for a controlled substance license from the New Mexico Board of Pharmacy and then register with the Drug Enforcement Administration (DEA). When prescribing controlled substances for the management of pain, including chronic pain, nurse midwives must exercise caution. This is especially true when a patient has been physically dependent on or tolerant of pain medications previously, or is suspected of being so in the present.
Independent Practice and Implementation of the APRN Consensus Model in New Mexico
The scope of practice for all APRNs and nurse midwives in New Mexico states that these medical professionals can serve as independent primary health care providers, and are not required to enter into collaborative practice or supervising agreements with physicians. Independent practice is a critical achievement for APRNs and nurse midwives, which allows them to fill the healthcare shortage void that exists in 100 areas throughout the state, especially in rural New Mexico.
In large part, the independence of APRNs and nurse midwives in New Mexico is thanks to lobbying efforts from organizations like the New Mexico Nurse Practitioner Council (NMNPC). The NMNPC notes that through the efforts of one lobbyist, nurse practitioner advancements circa 2016 have included:
- Ability to declare and sign death certificates
- Maintenance of APRN independence, countering the efforts of physician groups that wanted to have more influence over the APRN scope of practice
Ongoing efforts by the NMNPC and other local advocacy groups include working towards full implementation of the Consensus Model for APRN Regulation. The goals of this model are to standardize the licensing procedures and scopes of practice for APRNs throughout the nation, which will in turn improve the quality of and access to healthcare for consumers. Two groups developed this model:
- APRN Consensus Work Group
- National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee
New Mexico’s APRN environment comes close to resembling full implementation of the APRN Consensus Model. The biggest change that must be implemented in order for New Mexico to fully align with the APRN Consensus Model is to classify certified nurse midwives as a fourth Board-recognized APRN role.
Continuing Education Requirements for APRNs in New Mexico
An APRN license must be renewed every two years. To be eligible to renew the APRN license, candidates must maintain their national certification and RN license.
Within the two-year period, nurse practitioners and clinical nurse specialists must additionally meet these continuing education requirements, which may not be substituted by national certification:
- 30 hours of continuing education to maintain the RN license
- 15 hours of continuing education in APRN pharmacology – those who are registered with the DEA must obtain five of these hours in non-cancer pain management
- 5 hours of APRN-specific continuing education
Nurse Midwives – this license expires at the same time as the traditional RN license. To be eligible for renewal, candidates must maintain their RN license and national certification with the AMCB. They must additionally participate in a quality management program that involves peer review.
Nurse midwives also need to have earned 30 hours of continuing education in the preceding two years. This must include 15 hours related to pharmacology, including at least five hours that relate to:
- Chronic pain management
- Pharmacology and risks of controlled substances
- Pharmacology problems relating to abuse and addiction
- State and federal regulations for prescribing controlled substances – at least two hours