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The educational standard for Ohio’s advanced practice registered nurses (APRNs), clinical leaders, and nonclinical professionals in nurse education, administration and informatics is the Master of Science in Nursing (MSN). Through specialized didactic coursework and clinical sequences, MSN programs prepare aspiring APRNs in Ohio for national certification and state licensure as nurse anesthetists, clinical nurse specialists, nurse midwives, or nurse practitioners, while other MSN specialty tracks are specifically designed to prepare the state’s next generation of nurse educators, administrators, informaticists and more.
Job growth for Ohio’s advanced clinical practitioners in the four distinct roles is at an all time high. In the two-year period from June of 2013 to June of 2015, the Ohio Board of Nursing reported issuing more certificates of authority to practice for APRNs than in any other two-year period in the Board’s history:
- 2,014 new nurse practitioners
- 971 new clinical nurse specialists
- 24 new nurse anesthetists
- 24 new nurse midwives
Perhaps the biggest testament to the value of Ohio’s APRNs is their annual salaries they earn, which often span well into the six-figure range. The U.S. Bureau of Labor Statistics (BLS) reported the following salaries for APRNs in Ohio in May, 2014 (salaries are listed as median annual salary, top 25%, and top 10%)
- Nurse practitioners: $91,570; $103,530; $118,550
- Nurse anesthetists: $144,930; $167,440; equal to or greater than $187,199
- Nurse midwives: $94,390; $109,110; $120,260
Certificate of Authority to Practice for the APRN Roles Recognized in Ohio
To earn a certificate of authority to practice as an APRN through the Ohio Board of Nursing, nurses must meet these basic requirements:
- Hold an unencumbered Ohio RN license
- Earn a master’s or higher degree with a focus on one or more of the four APRN roles
- Earn national certification from a board-recognized certification agency
The Ohio Board of Nursing recognizes four distinct APRN roles for the issuance of a certificate of authority to practice:
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
- Certified Nurse Practitioner (CNP)
CNPs and CNSs focus both their education and national certification in one or more of the following patient population foci:
- Women’s health
- Family-individual across the lifespan
- Psychiatric-mental health
- Adult-gerontology
- Primary or acute care
The Ohio Board of Nursing recognizes the following national certifying bodies as granting the role and patient population focus certification needed to meet the requirements for a certificate of authority to practice as an APRN in the state:
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Adult acute and critical care CNS
- American Nurses Credentialing Center
- Adult psychiatric-mental health CNS
- Family psychiatric-mental health CNS
- Gerontology CNS
- Adult health CNS
- Public/Community Health CNS
- Hospice and Palliative Credentialing Center
- Advanced Certified Hospice and Palliative Nurse (ACHPN)
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
Certified Nurse Practitioner (CNP)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- American Academy of Nurse Practitioners
- Adult nurse practitioner
- Family nurse practitioner
- Gerontologic nurse practitioner
- American Nurses Credentialing Center
- Acute care nurse practitioner (adult/gerontology)
- Adult nurse practitioner
- Family nurse practitioner
- Gerontological nurse practitioner
- Pediatric nurse practitioner
- Adult psychiatric and mental health nurse practitioner
- Family psychiatric and mental health nurse practitioner
- Hospice and Palliative Credentialing Center
- Advanced Certified Hospice and Palliative Nurse (ACHPN)
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care
- Pediatric nurse practitioner acute care
- National Certification Corporation
- Women’s health nurse practitioner
- Neonatal nurse practitioner
Earning a Master of Science in Nursing (MSN) in Ohio
While Ohio is home to numerous campus-based MSN programs, aspiring APRNs in the state often elect to pursue their degree through online programs. By taking coursework in an online format, nurses are able to continue their education without sacrificing work obligations. To fulfill clinical requirements, students work with a program advisor to find placement in a local medical facility. In most cases, graduate nursing students are able to complete clinical requirements with their current employer.
The Ohio Board of Nursing requires graduate programs that prepare APRNs to be accredited by an agency recognized by the United States Department of Education.
Clinical Nurse Specialist/Nurse Practitioner Programs – The Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are the two recognized national certifying bodies for CNS and NP graduate-level nursing programs. There are three ACEN-accredited graduate programs in Ohio, located in the following cities:
- Cleveland
- Steubenville
- Youngstown
The CCNE accredits 19 MSN programs in Ohio, located in the following cities:
- Akron
- Athens
- Canton
- Cedarville
- Cincinnati
- Cleveland
- Columbus
- Dayton
- Kent
- North Canton
- Pepper Pike
- Sylvania
- Toledo
- Urbana
- Westerville
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized certifying body for CRNAs. The COA accredits seven schools in Ohio, located in the following cities:
- Akron
- Cincinnati
- Cleveland
- Sylvania
- Westerville
- Youngstown
Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body for nurse-midwifery programs. The ACME accredits three programs in Ohio, located in the following cities:
- Cincinnati
- Cleveland
- Columbus
Selecting the Right Type of Program Based on Current Education
Aspiring APRNs in Ohio would apply to programs specifically designed to accommodate their current level of education, whether an ADN, BSN, or existing master’s:
- RNs with an Associate’s Degree in Nursing: Associate’s prepared RNs would apply to RN-MSN programs to earn a BSN and MSN in one accelerated program.
- RNs with a Bachelor of Science in Nursing (BSN): BSN-prepared nurses would enroll in traditional terminal MSN programs, specializing in an APRN role and population focus.
- RNs with a Master of Science in Nursing (MSN): Nurses who already hold an MSN would pursue a post-graduate certificate program specific to their APRN role and patient population focus of choice.
- Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Aspiring APRNs who hold a bachelor’s degree in an area other than nursing would pursue an MSN through direct-entry (or entry-level) programs. The curriculum of these programs prepares students for RN licensure en route to their master’s degree.
Scope of Practice and Ohio State Laws Governing Advanced Practice Registered Nursing
The Ohio Nurse Practice Act outlines the scope of practice for APRNs in each of the four roles:
Nurse Practitioner Scope of Practice – In collaboration with one or more physicians or podiatrists, CNPs may provide the following services within their patient population focus and specialty:
- Preventive and primary care services
- Services for acute illnesses
- Patient evaluation
- Wellness promotion
When collaborating with a podiatrist, a CNP’s scope of practice is limited to the procedures the podiatrist is approved to perform.
Clinical Nurse Specialist Scope of Practice – In collaboration with one or more physicians or podiatrists, CNSs may manage the care of patients and provide care to patients with complex health problems. The care must be consistent with the CNS’s education.
When collaborating with a podiatrist, a CNS’s scope of practice is limited to the procedures the podiatrist is approved to perform.
Nurse-Midwife Scope of Practice – CNMs may provide and manage antepartum, intrapartum, postpartum, and gynecological care consistent with their education and training provided they do so in collaboration with one or more physicians. CNMs may additionally perform the following acts:
- Perform episiotomies
- Perform normal vaginal deliveries
- Repair vaginal tears
CNMs are prohibited from performing external cephalic version, delivering breech or face presentation, using forceps, doing any obstetric operation, or treating any other abnormal condition during non-emergency situations.
Registered Nurse Anesthetist Scope of Practice – CRNAs may only practice under the supervision and in the immediate presence of a physician, podiatrist, or dentist who is actively practicing in Ohio. Under such circumstances, CRNAs may provide services consistent with their education and training including, but not limited to:
- Performing anesthesia induction, maintenance, and emergence supervision
- Performing preanesthetic preparation and evaluation, postanesthesia care, and clinical support functions
CRNAs’ scope of practice is limited to the scope of practice of their supervisor. CRNAs may not administer general anesthesia in a podiatrist’s office, even under the supervision of the podiatrist.
Prescriptive Authority for APRNs in Ohio
CNMs, CNPs, and CNSs may earn restricted prescriptive authority, provided they meet the qualifications set forth by the Ohio Board of Nursing.
First, nurses must apply for an externship certificate that allows them to prescribe drugs and therapeutic devices when one or more physicians are providing supervision. To receive approval for this externship, nurses must complete a course of study in advanced pharmacology at least three years prior to submitting their application. The course must meet qualifications set by the Board including, but not limited to:
- The course must consist of a minimum of 45 hours and include a minimum of 36 contact hours of instruction in advanced pharmacology that include:
- Pharmacokinetic principles
- Clinical application and the use of drugs and therapeutic devices in the prevention of illness and maintenance of health
- The course content must be specific to the nurse’s advanced practice role
- The course must provide instruction in the following areas:
- Fiscal and ethical implications of prescriptive authority
- Ohio laws regarding prescriptive authority
- Topics specifically related to Schedule II controlled substances
During the externship, the APRN will be evaluated on their prescriptive practices. Upon completion of the externship, the APRN may apply for a certificate to prescribe.
The Ohio Board of Nursing sets forth rules for APRNs with a certificate to prescribe including, but not limited to:
- Nurses may only prescribe in collaboration with a physician or podiatrist
- Nurses may only prescribe drugs and substances listed under Ohio Code
- Nurses’ prescriptive authority must not exceed the authority of their collaborating physician or podiatrist
- Nurses may only prescribe Schedule II controlled substances in the locations listed in 481 of Ohio Code, or in other approved medical practices under the following restrictions:
- The patient must have a terminal illness and a prescription from the collaborating physician
- The nurse may only prescribe the amount necessary for a 24-hour period
- Nurses may personally administer only the following substances:
- Antibiotics
- Antifungals
- Scabicides
- Contraceptives
- Prenatal vitamins
- Antihypertensives
- Drugs and devices used in the treatment of diabetes
- Drugs and devices used in the treatment of asthma
- Drugs used in the treatment of dyslipidemia
CRNAs in Ohio are not required to obtain a certificate to prescribe in order to provide anesthesia to patients.
Collaborative Practice in Ohio
All Ohio CNMs and CNPs must enter into a standard care arrangement with a collaborating physician.
CNSs must enter into a standard care arrangement with a collaborating physician, unless the CNS specializes in mental health or psychiatric mental health and does not hold a certificate to prescribe.
All standard care agreements must include information including, but not limited to:
- Services provided by the APRN
- Description of scope of prescriptive practice
- Details on incorporating new technology or procedures consist with the APRN’s scope of practice
- Biennial quality assurance provisions, including reviews of the APRN’s practice
- Criteria for referral of a patient by the APRN to the collaborating physician or podiatrist
- Details regarding the consultation process between the APRN and the collaborating physician or podiatrist
- Details regarding coverage in the absence of either the APRN or collaborating physician
CRNAs must practice under the supervision of an active Ohio physician, podiatrist, or dentist. To apply anesthesia, the CRNA must be in the immediate physical presence of his or her supervisor.
Ohio and the APRN Consensus Model
The APRN Consensus Model was developed in 2008 through a collaborative effort between more than 40 nursing organizations with the goal of providing a uniform set of rules for APRNs across the U.S. As of February 2016, Ohio had adopted the following major components of the model:
- APRN title
- APRN roles
- APRN education requirements
- APRN certification requirements
The Ohio Board of Nursing does not grant independent practice authority and independent prescriptive authority to APRNs consistent with the Consensus Model. Additionally, the Board does not license APRNs independent of RN licensure, but rather grants RNs a certificate of authority to practice as an APRN.
Continuing Education Requirements for APRNs in Ohio
APRNs in all roles must complete a minimum of 24 hours of Continuing Education (CE) approved by the Ohio Board of Nursing every two-year renewal cycle for their certificate of authority to practice. At least one hour must be related to the rules and statutes of Ohio nursing. A list of approved CE providers may be found on the Ohio Board of Nursing website.
APRNs may apply the CE hours they complete as mandated by their national certifying body for national certification maintenance to the 24 hours required by the Ohio Board of Nursing.
APRNs with prescriptive authority are required to complete an additional 12 contact hours of CE in advanced pharmacology.