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Master of Science in Nursing (MSN) in North Dakota for Nurse Practitioners and Other APRNs

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A growing number of RNs in North Dakota are pursuing a Master of Science in Nursing (MSN) to prepare for a career in advanced clinical practice, or to take on influential roles as clinical leaders, educators, administrators, patient advocates, medical writers, informaticists and more.

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North Dakota’s advanced practice registered nurses (APRNs) are nationally certified in one of four roles (nurse midwives, clinical nurse specialists, nurse practitioners, or nurse anesthetists) and have a broad scope of independent practice that allows them to provide care to patients with few restrictions. The state’s APRNs may also earn independent prescriptive authority, allowing them to serve as primary care providers capable of diagnosing conditions and creating treatment plans that include pharmacotherapeutics.

The respect and autonomy that North Dakota’s APRNs enjoy is reflected in the salaries they earn, which are consistently much higher than salaries for the state’s RNs (shown here as median salaries; U.S. Bureau of Labor Statistics (BLS), 2014):

  • RNs – $57,190
  • Nurse Practitioners – $87,390
  • Nurse Midwives – $108,380
  • Nurse Anesthetists – $176,590

Licensing Requirements for the APRN Roles Recognized in North Dakota

North Dakota RNs with licenses in good standing can qualify for APRN licensure through the North Dakota Board of Nursing by earning a Master of Science in Nursing and national certification specific to one of the four recognized APRN roles:

  • Certified Nurse Midwife (CNM)
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
  • Certified Registered Nurse Anesthetist (CRNA)

NPs and CNSs would also specialize their education and certification according to a patient population group of choice:

  • Family-individual across the lifespan
  • Neonatal
  • Adult-gerontology (primary or acute care)
  • Women’s health
  • Psychiatric-mental health

CRNAs serve all patient population groups, while CNMs provide neonatal and women’s care.

The North Dakota Board of Nursing recognizes the following national certifying bodies for the purpose of APRN licensure in the respective roles and population foci:

Nurse Practitioner

Clinical Nurse Specialist (CNS)

Certified Registered Nurse Anesthetist (CRNA)

Certified Nurse Midwife (CNM)

Earning a Master of Science in Nursing (MSN) in North Dakota

With only three graduate-level nursing programs in North Dakota recognized by the North Dakota Board of Nursing, a growing number of nurses are enrolling in out-of-state online MSN programs to further their education. Online programs allow nurses to satisfy their coursework through flexible web-based study, making them a popular option among working RNs.

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The Board approves a number of online programs, which are nationally certified by the following bodies:

North Dakota Board of Nursing Requirements for Programs that Prepare MSNs

The North Dakota Board of Nursing requires all graduate-level programs educating students in the state to be accredited by national or regional accrediting agencies that are recognized by the United States Department of Education.

The Board of Nursing sets forth requirements for in-state and online graduate-level nursing programs that prepare North Dakota nurses including, but not limited to:

  • Programs must prepare students for national certification in one of the Board’s four recognized APRN roles and six recognized population foci
  • Program curriculums must include the following:
    • An advanced practice nursing core, including legal, ethical, and professional responsibilities of the advanced practice registered nurse
    • Advanced physiology and pathophysiology courses, including those that cover general principles that apply across the lifespan.
    • Courses in advanced health assessment, including assessment of all human systems, advanced assessment techniques, concepts, and approaches
    • Courses in advanced pharmacology, including pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents
    • Supervised clinical experience opportunities related to role and population focus that include pharmacotherapeutic management of patients

MSN programs are structured to prepare students for national certification in APRN roles and population foci.

Certified Nurse Midwife (CNM) Program Requirements

The American College of Nurse Midwives (ACNM) requires all CNM programs to prepare RNs for the core competencies for basic midwifery practice, including

  • Components of Midwifery Care: Professional responsibilities of CNMs
  • Components of Midwifery Care of the Newborn
  • Hallmarks of Midwifery
  • Components of Midwifery Care: Midwifery Management Process
  • Components of Midwifery Care of Women
  • Components of Midwifery Care: Fundamentals

Programs must offer courses in the following areas to prepare CNMs for the fundamental components of midwifery care:

  • Anatomy and physiology, including pathophysiology
  • Psychosocial, sexual, and behavioral development
  • Pharmacokinetics and pharmacotherapeutics
  • Normal growth and development
  • Basic epidemiology
  • Clinical genetics and genomics
  • Bioethics related to the care of women, newborns, and families
  • Nutrition
  • Principles of individual and group health education

The ACNM also defines the clinical experience requirements for all CNM programs. These requirements include:

  • An AMCB-certified CNM or APRN who has clinical expertise and didactic knowledge commensurate with the content taught must supervise the clinical practice
  • Attainment of clinical skills must meet Core Competencies for Basic Midwifery Education
  • Management of sexually transmitted infections in male partners
  • Care of the normal newborn
  • Management of primary care for women throughout the lifespan, including reproductive health care, pregnancy and birth

Clinical Nurse Specialists (CNS) Program Requirements

The National Association of Clinical Nurse Specialists requires all master’s CNS programs to meet criteria in the five areas, including:

  • CNS Program Resources: Faculty, Clinical, and Institutional
  • Student Admission, Progression and Graduation
  • Program Organization and Administration
  • CNS Curriculum
  • CNS Program Evaluation

CNS programs must also prepare RNs in the following core competencies:

  • Coaching Competency
  • Consultation Competency
  • Ethical Decision-Making, Moral Agency and Advocacy Competency
  • Direct Care Competency
  • Research Competency
  • Collaboration Competency
  • Systems Leadership Competency

Each competency has its own set of behavioral statements, found in detail on the Association website.

Nurse Practitioner Program Requirements

The National Task Force on Quality Nurse Practitioner Education sets the standards for NP programs. Programs must offer courses that prepare students for the nine core competencies of professional practice, including:

  • Ethics Competencies
  • Health Delivery System Competencies
  • Technology and Information Literacy Competencies
  • Scientific Foundation Competencies
  • Quality Competencies
  • Policy Competencies
  • Independent Practice Competencies
  • Leadership Competencies
  • Practice Inquiry Competencies

Programs must also prepare students for the NP Core Competencies based on population focus.

NP programs are also required to offer clinical experience opportunities that include a minimum of 500 supervised direct patient care clinical hours overall.

Certified Registered Nurse Anesthetist (CRNA) Program Requirements

The standards of graduate nurse anesthesia programs are governed by the Council on Accreditation of Nurse Anesthesia Educational Program (COA) governs. Programs must include coursework in the following areas:

  • Anatomy, physiology, and pathophysiology
  • Basic and advanced principles of anesthesia practice including physics, equipment, technology and pain management
  • Clinical correlation conferences
  • Professional aspects of nurse anesthesia practice
  • Anesthesia practice
  • Perianesthetic and clinical support functions
  • Research
  • Preanesthetic preparation and evaluation
  • Pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry
  • Anesthesia induction, maintenance and emergence
  • Postanesthesia care

Programs must additionally offer RNs with clinical experience opportunities that allow for the following:

  • Application of knowledge to clinical problems
  • Testing of theory
  • Learning of anesthesia techniques

Rules Regarding Out-of-State Programs and Clinical Practice

Nurses who enroll in out-of-state online MSN programs will work with a program coordinator to complete the clinical practice portion of their education at a North Dakota medical facility. The coordinator must submit information regarding the program’s credentials and curriculum to the North Dakota Board of Nursing within 60 days of the student’s clinical practice.

Selecting the Right Type of Program Based on Current Education

Aspiring nursing graduate students would select from terminal MSN programs, bridge programs, graduate certificate programs or direct-entry programs based on their current level of education:

  • RNs with an Associate’s Degree in Nursing: RNs who have earned their associate’s degree must earn their Bachelor of Science in Nursing (BSN) and their MSN to be eligible for licensure as an APRN. Through RN-MSN programs, nurses may earn both degrees at the same educational institution through an accelerated learning format.
  • RNs with a Bachelor of Science in Nursing (BSN): Bachelor’s-prepared RNs would be eligible to pursue the traditional MSN degree in an APRN role and specialty.
  • RNs with a Master of Science in Nursing (MSN): MSN-prepared nurses can further their credentials through certificate programs dedicated to APRN roles and specialties.
  • Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Professionals who have earned a bachelor’s degree outside of nursing would apply to entry-level or direct-entry MSN programs, which provide both a BSN and MSN curriculum.

Scope of Practice and North Dakota State Laws Governing Advanced Practice Registered Nursing

The North Dakota Nurse Practices Act defines the scope of nursing practice in the state as “continually evolving and responding to changes within health care patterns and systems.” According to the North Dakota Board of Nursing, all APRNs in the state may perform acts consistent with their education and training including, but not limited to:

  • Assessing client’s physical and psychosocial health
  • Prescribing therapeutic regimens of health care
  • Managing nursing interventions that may be performed by others
  • Working within the context of a health care team
  • Teaching and counseling clients on health-related issues
  • Utilizing client information management systems
  • Teaching nursing theory and practice
  • Conducting and analyzing nursing research
  • Implementing research findings and outcomes in practice

Prescriptive Authority for APRNs in North Dakota 

North Dakota is one of 11 U.S. states to have adopted all major components of the national APRN consensus model, a uniform set of advanced practice nursing rules designed with input from over 40 nursing organizations. These components include:

  • APRN title
  • Roles
  • Education
  • License
  • Certification
  • Independent practice
  • Independent prescribing

The North Dakota Board of Nursing sets forth the regulations for APRNs with prescriptive authority in the state. These rules include, but are not limited to:

  • APRNs must adhere to all state and federal regulations
  • APRNs must obtain a DEA number
  • APRNs may prescribe, administer, sign for, and dispense the following:
    • Over-the-counter substances
    • Legend substances
    • Controlled controlled substances
  • APRNs may procure pharmaceuticals and pharmaceutical samples
  • APRNs must include their APRN status in signatures on all documents related to prescriptive practice
  • APRNs who diagnose a patient with a sexually transmitted disease may prescribe and dispense antibiotic drugs to that patient’s partner, without examining the partner first

Continuing Education Requirements for APRNs in North Dakota

APRNs in North Dakota who have not been granted prescriptive authority are required by the Board to complete at least 12 approved contact hours of Continuing Education (CE) every two-year license cycle. APRNs with prescriptive authority must complete 15 approved contact hours of CE, all of which must related to pharmacology.

The Board recognizes CE hours that have been approved by either a health care regulatory board or a professional organization of any state that has national or international accreditation to approve CE.

As a point of reference, the Board provides a table outlining approved CE activities from 2013-2014 on their website.

In addition to meeting state CE requirements, APRNs must complete one of the following every two-year license cycle:

  • Submit proof of national certification in APRN role with at least one population focus
  • Take part in a Board-approved competence maintenance program

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