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A Master of Science in Nursing (MSN) provides RNs with an educational foundation in advanced health assessment, pharmacology, and pathophysiology, positioning them for the respect, autonomy and higher pay that comes with becoming an advanced clinician. The MSN is a highly customizable degree that is also available with a focus in advanced nonclinical areas like informatics, teaching, administration, research, patient advocacy and more.
Despite being home to the largest number of midwives (450) and nurse practitioners (10,310) of all states in the nation (US Department of Labor, 2014), New York still struggles with an acute shortage of primary healthcare providers. In fact, the US Department of Health and Human Services has identified 179 separate regions in the state that have been identified as primary care health professional shortage areas.
To ease the strain on an already taxed healthcare system, New York has moved closer to aligning with national consensus, which calls for allowing advanced practice RNs to practice and prescribe to the full extent of their knowledge and training. Though New York is still a long way from granting advanced practitioners full autonomy, in 2015 legislators implemented a new law that limits the length of time advanced clinicians must maintain a written collaborative agreement with a physician to just 3,600 hours.
State Certification Requirements for Advanced Nurses in New York
In order to qualify to practice in one of the four Board-recognized advanced clinical roles, registered nurses in New York must meet these requirements
- Hold a current, unencumbered RN license issued through the NYSED Office of the Professions or from another state with similar RN licensing requirements
- Complete an accredited graduate program with a clinical focus in an advanced clinical role
- Take and pass a national certification examination in the same clinical focus (optional in New York, but generally expected)
Registered nurses who meet these qualifications may qualify for state certification/registration through the New York State Education Department (NYSED), Office of the Professions in one of four distinct advanced clinical roles:
- Nurse practitioner
- Clinical nurse specialist
- Midwife or nurse-midwife
- Nurses who provide anesthesia
The focus of an RNs graduate degree program and national certification would always align with the role they are being state certified in.
Nurse practitioners – NPs must be registered/certified with the New York State Education Department (NYSED) to practice. To be eligible for this, candidates must:
- Have a valid New York RN license (be registered and licensed as an RN in New York)
- Complete a course in pharmacotherapy that is approved by the NYSED – all recent graduates from MSN programs in New York automatically fulfill this requirement
- Graduate from an NYSED-approved nurse practitioner education program
- Become nationally certified by one of these organizations (although generally considered optional for advanced clinical certification/registration in New York, national certification is a universally recognized way to distinguish nurse practitioners based on specialty and patient population focus):
- American Academy of Nurse Practitioners (AANP)
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- American Association of Critical-Care Nurses Certification Corporation (AACN)
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- Acute Care Nurse Practitioner Adult (ACNPC) – not aligned with APRN Consensus Model
- National Board for Certification of Hospice and Palliative Nurses (HPCC)
- Advanced Certified Hospice and Palliative Nurse (ACHPN)
- National Certification Corporation (NCC)
- Women’s Health Care Nurse Practitioner-Board Certified (WHNP-BC)
- Neonatal Nurse Practitioner-Board Certified (NNP-BC)
- Oncology Nursing Certification Corporation (ONCC)
- Advanced Oncology Certified Nurse Practitioner (AOCNP)
- Advanced Oncology Certified Nurse (AOCN)
- Pediatric Nursing Certification Board (PNCB)
- Pediatric Nurse Practitioner Primary Care (CPNP-PC)
- Pediatric Nurse Practitioner Acute Care (CPNPAC)
- Pediatric Primary Care Mental Health Specialist (PMHS)
New York recognizes nurse practitioners that have been certified to practice in these specialty practice areas (population foci):
- Adult health
- Family health
- Gerontology
- Neonatology
- Obstetrics
- Oncology
- Pediatrics
- Perinatology
- Psychiatry
- School health
- Women’s health
- Holistic care
- Palliative care
The NYSED issues these two credentials to qualified applicants:
- Nurse practitioner certification – valid for life under most circumstances
- Nurse practitioner registration certificate – permission to practice, which must be renewed periodically
Clinical nurse specialists – CNSs must be registered/certified with the New York State Education Department (NYSED) to practice. To be eligible for this, candidates must:
- Have a current, valid New York RN license (be registered and licensed as an RN in New York)
- Earn a master’s degree in a clinical nurse specialty area and become nationally certified by one of these organizations (although generally considered optional for advanced clinical certification/registration in New York, national certification is a universally recognized way to distinguish nurse practitioners based on specialty and patient population focus):
- American Nurses Credentialing Center (ANCC)
- Adult Health Clinical Nurse Specialist-Board Certified (ACNS-BC)
- Adult-Gerontology Clinical Nurse Specialist-Board Certified (AGCNS-BC)
- Adult Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-Board Certified (PMHCNS-BC)
- Gerontological Clinical Nurse Specialist-Board Certified (GCNS-BC)
- Home Health Clinical Nurse Specialist-Board Certified (HHCNS-BC)
- Pediatric Clinical Nurse Specialist-Board Certified (PCNS-BC)
- Public/Community Health Clinical Nurse Specialist-Board Certified (PHCNS-BC)
- American Association of Critical-Care Nurses Certification Corporation (AACN)
- Clinical Nurse Specialist; Wellness through Acute Care (Adult-Gerontology) (ACCNS-AG)
- Clinical Nurse Specialist; Wellness through Acute Care (Pediatric) (ACCNS-P)
- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal) (ACCNS-N)
- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal (CCNS) – not aligned with APRN Consensus Model
- Oncology Nursing Certification Corporation (ONCC)
- Advanced Oncology Certified Clinical Nurse Specialist (AOCNS)
Clinical nurse specialists can be certified to practice in the following specialty practice areas (population foci):
- Adult health
- Oncology
- Pediatrics
- Psychiatry/mental health
Once the NYSED has approved the application it will issue two statuses:
- Clinical nurse specialist certification – valid for life under most circumstances
- Clinical nurse specialist registration certificate – authorization to practice that must be periodically renewed
Nurse-Midwives – RNs who are also licensed through the NYSED as midwives may refer to themselves as nurse-midwives. As of January 1st, 2011 all RNs applying for midwife licensure in New York must meet these requirements:
- Have a master’s degree or higher in nurse-midwifery or a related field like women’s health
- Pass the exam sponsored by the American Midwifery Certification Board (AMCB) to earn the Certified in Nurse-Midwifery (CNM) credential
- Be of good moral character and at least 21 years of age
Nurse Anesthetist – New York does not specifically license, register, or certify nurse anesthetists. However, this role is permitted for RNs through the rules regarding what is allowable within an RN’s scope of practice. These rules state that New York RNs may administer intravenous anesthetic agents if they have advanced education, training, experience, and/or licensure in this area of medicine. The New York State Education Department (NYSED) states that these advanced qualities may be applied to individuals who have demonstrated competencies in the following:
- Airway management
- Intubation of patient’s airways
- Pharmacology and the use of anesthetics
- Recognition and treatment of side-effects and complications
The NYSED specifies that RNs can acquire the skills and knowledge required to work as a nurse anesthetist through the following means:
- Completing a master’s or higher degree program in nurse anesthesia
- Qualifying for national certification through the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) to earn the Certified Registered Nurse Anesthetist (CRNA) credential
- Gaining education and experience that is deemed to be qualifying based on medical orders, or by serving in a role that involved being medically responsible for units such as emergency rooms, operating rooms, or intensive care units
The New York State Board of Nursing has also stated that conscious sedation with Propofol (Diprivan) should only be done by CRNAs, with an exception provided for RNs in a critical-care setting.
Earning a Master of Science in Nursing (MSN) in New York
RNs who want to pursue advanced career opportunities almost always start by earning an MSN. Online MSN programs have become the preferred option for many RNs since the flexibility of these programs allows working nurses to maintain career obligations while completing graduate work. These programs also often offer the convenience of a part-time option that allows even more flexibility when it comes to scheduling. Universities offering online MSN degrees strive to develop partnerships with medical facilities in New York, allowing students to complete clinical segments at a nearby location without the need to relocate. In most cases, graduate nursing students can complete their clinical requirements at their current place of employment.
Those that prefer a fulltime campus-based experience will find Board-approved MSN programs located in:
- Syracuse
- Binghampton
- Rochester
- Brockport
- Garden City
- Brookeville
- Rockville Centre
- Stony Brook
- West Bronx
- New York City
- Riverdale
- Brooklyn
- Staten Island
- New Rochelle
- Dobbs Ferry
- Newburgh
- Orangeburgh
- Pleasantville
- New Paltz
- Albany
- Troy
- Utica
- Rome
- Amherst
- Buffalo
RNs pursuing advanced practice nursing registration/certification in New York must complete graduate programs that have been properly accredited in order to meet the requirements for national certification and state certification/registration through the NYSED:
- Nurse Practitioner and Clinical Nurse Specialist Programs – The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the two most prominent accrediting agencies for graduate nurse practitioner and clinical nurse specialist programs
- Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for all nurse anesthetist programs
- Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting agency for nurse midwife programs, and is specifically approved by the New York State Education Department (NYSED)
Curriculum Requirements for MSN Programs that Prepare Advanced RNs and Midwives
The New York State Education Department (NYSED) along with role-specific certifying agencies and national education standards organizations set the requirements for MSN programs that prepare advanced clinicians in the four roles:
Nurse Practitioner Curriculum – The NYSED specifies that the in-state nurse practitioner graduate programs it approves must meet the following requirements:
- Classroom and supervised clinical segments designed to prepare nurse practitioners to diagnose illnesses and physical conditions, as well as the performance of therapeutic and corrective measures within a specialty area of practice and population focus
- A pharmacology class that is at least three semester credits and includes coverage of drug management for clients in a specific population focus, as well as state and federal prescribing laws
- At least one semester credit of a supervising preceptor experience with a nurse practitioner or physician who specializes in the same population focus and area of practice
The National Task Force of Quality Nurse Practitioner Education describes national nurse practitioner curriculum standards as follows:
- The curriculum 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
- The curriculum must meet the standards for national certification in a population-focused area of practice
- Nurse practitioner role/population core competency objectives must be included in the curriculum
- 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
- At least 500 hours of supervised direct patient care clinical hours must be included
Clinical Nurse Specialist Curriculum – The NYSED specifies that in-state clinical nurse specialist graduate programs must include at least 500 hours of clinical experience that is supervised by a similarly-practicing nurse practitioner, clinical nurse specialist, or physician.
The National Association of Clinical Nurse Specialists (NACNS) describes nationally recognized 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 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 CNS credentialing requirements
- Master’s-level clinical course preparation must include at least 500 supervised clinical hours
Nurse-Midwife Curriculum – The New York State Education Department (NYSED) specifies the graduate curriculum for midwifery programs must cover the following:
- Biology
- Embryology, human, development, and genetics
- Chemistry
- Microbiology
- Human anatomy and physiology, including pathophysiology
- Ppsychology
- Sociology or cultural anthropology
It also specifies that the curriculum must include didactic courses accompanied by supervised clinical experiences in the following areas:
- Technical health care skills
- Preconceptional, antepartum, intrapartum, and postpartum care
- Physical assessment, diagnosis, treatment, and management of health problems of women
- Primary care of women, including preventative care
- Neonatal care
- Family planning and gynecological care of prepubescent through postmenopausal women
- Professional, legal, and ethical aspects of midwifery practice
- Nutrition related to the practice of midwifery
- Pharmacology
Nurse Anesthetist Curriculum – Because there is no defined advanced nursing role for nurse anesthetists in New York, the NYSED does not specify course requirements for this role. However, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) specifies that the didactic curriculum for nurse anesthesia graduate programs must cover:
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
- 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 clinical correlation conferences
- At least 45 hours covering the professional aspects of the practice of nurse anesthesia
- At least 30 hours covering nurse anesthesia research
For the clinical segment, the COA requires students to complete 2,000 hours of supervised clinical training and at least 600 separate clinical cases. The entire program must be at least 24 months in length, or its part-time equivalent.
Selecting the Right Type of MSN Program Based on Current Education
MSN programs are structured in a number of different ways to accommodate RNs and non-nursing professionals with different degrees:
- RNs with a Bachelor of Science in Nursing (BSN) can apply to conventional MSN programs, which take around two years to complete
- RNs with an Associate Degree in nursing (ADN) can apply to RN-to-MSN bridge programs, which result in a BSN and MSN in one accelerated program that takes about three years to complete
- Non-nursing professionals with a bachelor’s degree in an area other than nursing can apply to direct-entry MSN programs, completing any outstanding prerequisites and then moving on to core-MSN nursing subjects; these programs can take around three years to complete and result in an RN license and MSN
Registration Renewal for Midwives, CNAs and NPs in New York
Nurse-midwives, clinical nurse specialists, and nurse practitioners must renew their registrations every three years with the New York State Education Department (NYSED). They must therefore keep the NYSED updated with their most current address to ensure renewal cards are received in a timely manner. Maintaining national certification is not a requirement for registration renewal.
Nurse practitioners and clinical nurse specialists must also keep their traditional RN registrations up to date in order to renew their specialized nursing registrations.
Scope of Practice and New York State Laws Governing Advanced Nursing and Nurse-Midwifery
New York State laws, rules, and regulations pertaining to nurses in advanced clinical roles can be found here:
- Midwives – Article 140 of the Education Law Title VIII
- Nurse practitioners – Article 139, section 6910 of the Education Law Title VIII
- Clinical nurse specialists – Article 139, section 6911 of the Education Law Title VIII
- Nurse practitioners and clinical nurse specialists – Part 64 Nursing of the Commissioner’s Regulations
- Nurses who work with anesthesia – NYSED practice information
The New York State Education Department (NYSED) describes the scope of practice for RNs working in the various advanced roles:
Nurse Practitioner Scope of Practice
- Work independently, and be held independently responsible, for the diagnosis and treatment of patients
- Manage the medical and nursing care of patients
- Diagnose illnesses for patients within the nurse practitioner’s population focus
- Prescribe treatments, including medications when approved, for patients within the nurse practitioner’s population focus
Clinical Nurse Specialist Scope of Practice
- Provide expert nursing services for patients with complex healthcare needs
- Provide, coordinate, and supervise patient care
- Evaluate the quality and effectiveness of patient care
- Provide clinical consultations to other health care personnel
- Become involved with health care management, health systems improvement, health care policy development, and clinical research
- Cannot determine medical diagnosis
- Cannot prescribe medications, order medical treatments, or diagnostic tests
Midwife Scope of Practice
- Manage normal pregnancies and child births
- Provide postpartum care as well as primary preventive reproductive health care of healthy women
- Provide newborn evaluations and resuscitation
- Provide referrals for infants
- Order laboratory tests which are limited to the practice of midwifery
- Once authorized, midwives can prescribe and administer drugs, immunizing agents, diagnostic tests, and devices
Nurse Anesthetist Scope of Practice
Certain elements of the general registered nurses scope of practice can be highlighted for RNs who administer anesthesia:
- Only provide services for which the RN is competent to perform
- Only trained anesthesia providers are competent to administer anesthetic agents; competency to administer anesthesia is judged by virtue of licensure, education, training, and experience
- The use of IVs to administer anesthetic agents should be limited to anesthesia providers who have competency and training in airway management, intubation of a patient’s airways, pharmacology, and the use of these anesthetic drugs
Advanced Nurse and Nurse-Midwife Collaborative Agreements in New York
Nurse Practitioners – As of 2015, nurse practitioners must work within a collaborative practice agreement for their first 3,600 hours of practice. This agreement must be established with a physician who practices in a similar area, and should not be interpreted as a supervising agreement. The collaborative practice agreement must contain a written practice agreement as well as written practice protocols, both of which must address the following subjects:
- Patient consultation and referral
- Coverage for emergency absences of the collaborating physician or nurse practitioner
- Methods of resolving conflicting prognoses and treatments – if a specific situation is not addressed, the physician’s orders will trump the nurse practitioner’s
- How the nurse practitioner will be peer-reviewed, at least every three months
- Practice protocols within which the nurse practitioner must work – these are often developed by national professional organizations
NPs and physicians can collaborate in person, by phone, or in writing. Once the 3,600 hours of practice has been successfully completed, nurse practitioners may practice with full independence.
Nurse-Midwives – Nurse-midwives must always work within a collaborative relationship with one of the following:
- Licensed OB/GYN physician
- Licensed obstetric physician who practices at a general hospital
- A hospital that provides obstetric services
This collaborative relationship should not be interpreted as a supervision agreement. The collaborative relationship should include a written practice agreement and written protocols that delineate the midwife’s professional role, duties, and address contingencies.
Clinical Nurse Specialists – While these professionals can perform advanced nursing services, they have the same independence capabilities as traditional RNs, and must therefore work within the supervision requirements of a traditional RN’s scope of practice.
Nurse Anesthetists – Because nurse anesthetists are actually RNs, they must abide by RN supervision guidelines and always work with a supervising physician.
Prescriptive Authority for Advanced Nurses and Nurse-Midwives in New York
Nurses in each of the following roles operate under a different set of rules governing prescriptive authority (clinical nurse specialists and nurses who administer anesthesia are NOT permitted to prescribe any medications):
Nurse Practitioners are allowed to prescribe medications if they take these steps:
- Obtain a national provider identifier (NPI) from the US Centers for Medicaid and Medicare Services (CMS)
- Obtain authorization to prescribe from the New York State Department of Health’s Bureau of Narcotics Enforcement
- Register for a prescriber number from the Drug Enforcement Administration (DEA)
Nurse-Midwives would be eligible to prescribe medications if they have completed a three-semester-credit course on pharmacology that includes information about:
- Drug management for midwifery clients
- State and federal laws that relate to prescriptions and record keeping
Once eligible, nurse-midwives can apply for prescriptive authority for medications. To be able to prescribe controlled substances classified as Schedule II-V, nurse-midwives must take these steps:
- Obtain authorization to prescribe from the New York State Department of Health’s Bureau of Narcotics Enforcement
- Register for a prescriber number from the Drug Enforcement Administration (DEA)
Implementation of the APRN Consensus Model in New York
The New York State Education Department (NYSED) has a ways to go before it achieves full implementation of the National Council of State Boards of Nursing’s (NCSBN) APRN Consensus Model. The NCSBN’s goal is to make it possible for RNs with specific advanced training to be able to practice independently and enjoy interstate mobility, with the goal of:
- Improving healthcare access for patients, especially those in rural areas
- Improving healthcare outcomes for patients
The NCSBN has established the following goals to achieve these ends, which the NYSED has yet to implement:
- Defining advanced practice registered nursing (APRN) as RNs who have advanced education and national certification in one of four roles: nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist
- Allowing APRNs to practice independently, granting full prescriptive authority
- Establishing a certification or licensing process that is separate from RN licensing for each APRN role
- Defining a specific scope of practice for each APRN role
New York is moving closer to full implementation of the APRN consensus model along with many other states. One of the best examples of this is the state’s Nurse Practitioner Modernization Act (NPMA), which came into effect January 1st, 2015. Prior to the passage of the NPMA, nurse practitioners were required to maintain a written practice agreement with a physician throughout their entire career. This was an impediment to independent practice and the delivery of healthcare services, especially in rural areas of New York. Advocates of the NPMA, like the Greater Rochester Chapter of the Nurse Practitioner Association, cited instances where nurse practitioners had to either move or stop practicing when their physician partner moved away unexpectedly.
This was changed under the NPMA. The law now only requires a written practice agreement for inexperienced nurse practitioners that have worked less than 3,600 hours. NPs with more than 3,600 hours of experience can now practice with complete independence in New York without a written practice agreement or practice protocols.