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A specialized Master of Science in Nursing (MSN) provides the educational foundation RNs need to enjoy the independence, respect and increased earning power that comes with becoming an advanced practice registered nurse (APRN) certified as a nurse practitioner, clinical nurse specialist, nurse anesthetist, or nurse midwife. Aspiring nursing graduate students with their sites set on nonclinical roles enroll in MSN programs with specialty tracks in areas like informatics, administration and education.
According to the U.S. Department of Health and Human Services, 55 counties in Oklahoma were considered primary care federal shortage areas as of January 2016. To help stem this shortage, Oklahoma medical practices, hospitals and integrated health systems hired an average of 3,400 new nurses every month during 2015, many of which were advanced practice registered nurses capable of serving as primary care providers according to Kyle Springer of the Oklahoma Department of Commerce. In fact, the Oklahoma Board of Nursing reported that there were a total of 2,891 active APRN licenses for nurse practitioners, clinical nurse specialists, nurse-midwives and nurse anesthetists in the state in 2015, a significant increase from the 2,376 reported in 2013.
As Oklahoma’s healthcare system faces a number of challenges that include an aging nursing workforce and a shortage of physicians, APRNs are seen as being an instrumental part of the solution, in the state’s underserved areas, and beyond.
Licensing Requirements for the APRN Roles Recognized in Oklahoma
The Oklahoma Board of Nursing requires all APRN candidates to complete graduate education and achieve national certification in one of four recognized roles:
- Certified Nurse-Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Nurse Practitioner (NP)
NPs and CNSs are also educated and certified in one or more patient population foci (psychiatric-mental health; adult-gerontology acute or primary care; women’s health; family-individual across the lifespan; pediatric acute or primary care; or neonatal).
To qualify for APRN licensure through the Oklahoma Board of Nursing, those interested in working in any APRN role are required to:
- Have a current, unrestricted RN license issued by the Oklahoma Board of Nursing
- Earn a master’s-level education specific to the role (nurse-midwife, nurse anesthetist, nurse practitioner, or clinical nurse specialist) and additional patient population focus as applicable
- Become nationally certified in the role (and, as applicable in a patient population focus) through a Board-recognized national certifying body
The Oklahoma Board of Nursing recognizes the following national certifying bodies as granting the credentials necessary for state APRN licensure:
Certified Nurse-Midwife (CNM)
Certified Registered Nurse Anesthetist (CRNA)
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
Registered Nurse Practitioner (RNP)
- 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
- 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 Oklahoma
With few graduate nursing programs physically located in Oklahoma, many of the state’s RNs enroll in online MSN programs, which offer both full-time and part-time study options. Online programs have become especially popular among working RNs, since they allow them to further their education without sacrificing current work obligations. For clinical sequences, students work with a program advisor to find placement in local Oklahoma medical facilities. In most cases, students are able to complete clinical sequences at their current place of employment.
The Oklahoma Board of Nursing requires that all APRNs graduate from a program that is recognized by the U.S. Secretary of Education or the Council for Higher Education Accreditation. This means the program must hold accreditation, pre-accreditation, applicant status, or candidacy for accreditation from one of the following organizations:
- Commission on Collegiate Nursing Education
- National League for Nursing Accrediting Commission
- The American Association of Nurse Anesthetists’ Council on Accreditation of Nurse Anesthesia Educational Programs
- American College of Nurse-Midwives Division on Accreditation
Clinical Nurse Specialist/Nurse Practitioner Programs – The Commission on Collegiate Nursing Education (CCNE) is the recognized national certifying body for CNS and NP graduate-level nursing programs. The CCNE accredits four graduate programs in Oklahoma, located in Bethany, Edmond, Shawnee and Oklahoma City.
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized certifying body for CRNAs. There are no COA-accredited programs in Oklahoma.
Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body for all nurse-midwife programs. There are no ACME-accredited programs in Oklahoma.
Curriculum Standards for Master’s Programs that Prepare APRNs
All programs that prepare RNs for APRN licensure must offer a curriculum that prepares them to practice in a recognized APRN role and patient population focus. The Oklahoma Board of Nursing defers to national standards for program curriculum requirements:
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
- Hallmarks of Midwifery
- Components of Midwifery Care: Professional Responsibilities of CNMs
- Components of Midwifery Care of Women
- Components of Midwifery Care of the Newborn
- Components of Midwifery Care: Midwifery Management Process
- Components of Midwifery Care: Fundamentals
Programs must offer courses in the following areas to prepare CNMs for the fundamental components of midwifery care:
- Nutrition
- Anatomy and physiology, including pathophysiology
- Psychosocial, sexual, and behavioral development
- Principles of individual and group health education
- Clinical genetics and genomics
- Normal growth and development
- Pharmacokinetics and pharmacotherapeutics
- Basic epidemiology
- Bioethics related to the care of women, newborns, and families
The ACNM also defines the clinical experience requirements for all CNM programs. These requirements include:
- Care of the normal newborn
- Attainment of clinical skills must meet Core Competencies for Basic Midwifery Education
- An AMCB-certified CNM or APRN who has clinical expertise and didactic knowledge commensurate with the content taught must supervise the clinical practice
- Management of primary care for women throughout the lifespan, including reproductive health care, pregnancy and birth
- Management of sexually transmitted infections in male partners
Clinical Nurse Specialists (CNS) Program Requirements
The National Association of Clinical Nurse Specialists requires all master’s-level CNS programs to meet established criteria in five areas:
- CNS Curriculum
- CNS Program Resources: Faculty, Clinical, and Institutional
- CNS Program Evaluation
- Program Organization and Administration
- Student Admission, Progression and Graduation
CNS programs must also prepare nurses in the following core competencies:
- Consultation Competency
- Research Competency
- Coaching Competency
- Collaboration Competency
- Ethical Decision-Making, Moral Agency and Advocacy Competency
- Direct Care Competency
- Systems Leadership Competency
Each competency has its own set of behavioral statements, found in detail on the Association website.
Certified Registered Nurse Anesthetist (CRNA) Program Requirements
The curriculum standards for nurse anesthesia programs are governed by the Council on Accreditation of Nurse Anesthesia Educational Program (COA). Programs must include coursework in the following areas:
- Anesthesia practice
- Research
- Preanesthetic preparation and evaluation
- Pharmacology of anesthetic agents and adjuvant drugs including concepts in chemistry and biochemistry
- Clinical correlation conferences
- Postanesthesia care
- Professional aspects of nurse anesthesia practice
- Anesthesia induction, maintenance and emergence
- Perianesthetic and clinical support functions
- Anatomy, physiology, and pathophysiology
- Basic and advanced principles of anesthesia practice including physics, equipment, technology and pain management
Programs must also offer students clinical experience opportunities that allow for the following:
- Application of knowledge to clinical problems
- Learning of anesthesia techniques
- Testing of theory
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:
- Leadership Competencies
- Practice Inquiry Competencies
- Health Delivery System Competencies
- Technology and Information Literacy Competencies
- Independent Practice Competencies
- Quality Competencies
- Ethics Competencies
- Scientific Foundation Competencies
- Policy 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.
Selecting the Right Type of Program Based on Current Education
Aspiring APRNs in Oklahoma would apply to MSN programs structured specifically to build on their current level of education:
- RNs with an Associate Degree in Nursing: ADN-prepared RNs would apply to RN-to-MSN bridge programs, which offer both a BSN and MSN curriculum. These programs are typically offered in an accelerated learning format and take between 2 and 3 years to complete.
- RNs with a Bachelor of Science in Nursing (BSN): RNs with a BSN would enroll in a traditional, terminal MSN program, allowing them to prepare for a career in a recognized APRN role and patient population focus in about 2 years.
- 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: Aspiring APRNs with a bachelor’s degree in an area other than nursing would apply to direct-entry MSN programs (also known as entry-level programs), which include coursework that prepares students for RN licensure en route to an MSN.
Scope of Practice and Oklahoma State Laws Governing Advanced Practice Registered Nursing
The Oklahoma Nursing Practice Act outlines the rules that define APRN scope of practice in the state.
Nurse-Midwife Scope of Practice – CNMs may practice in accordance with the practice standards set forth by the American College of Nurse Midwives (ACNM). This practices includes managing care of normal newborns and women in the antepartal, intrapartal, postpartal stages, as well as managing care of women’s gynecological needs. The practice must take place in a health care system that meets the standards set forth by the American Midwifery Certification Board (AMCB) and provides medical consultation and medical management or referral.
Registered Nurse Anesthetist Scope of Practice – CRNAs may administer anesthesia under the supervision of one of the following professionals, who must be available for timely onsite consultation:
- Medical doctor
- Osteopathic physician
- Podiatric physician
- Oklahoma state-licensed dentist
Clinical Nurse Specialist Scope of Practice – CNSs in Oklahoma may perform acts including, but not limited to:
- Practicing as an expert clinician
- Managing patient care
- Utilizing competencies of clinical practice, consultation and research to enhance patient care
- Referring patients to other services
Nurse Practitioner Scope of Practice – NPs may deliver services that are consistent with their education in an area of specialty.
Prescriptive Authority for APRNs in Oklahoma
All APRNs in Oklahoma must have physical supervision from a supervising physician to prescribe any controlled substances. APRNs may earn prescriptive authority provided they meet the following provisions set forth by the Board:
- Nurses must obtain a DEA number
- Nurses must obtain a permit from the Oklahoma Bureau of Narcotics and Dangerous Drug Control
- Nurses must enter into a written agreement with a licensed Oklahoma physician that includes:
- Details regarding communication between physician and APRN, including referral and consultation methods
- Details regarding the physician’s availability to physically supervise the APRN’s prescribing practices
- Within three years of applying for prescriptive authority, CNSs, NPs, and CNMs must complete a minimum of 45 Board-approved contact hours or three academic credit hours of in the following areas:
- Pharmacotherapeutics, clinical application, and use of pharmacological agents in the prevention of illness
- The restoration and maintenance of health in a program
- Within two years of applying for prescriptive authority, CRNAs must complete a minimum of 15 CE units in advanced pharmacology related to the administration of anesthesia. The hours must be recognized by the American Association of Nurse Anesthetists.
Oklahoma and the APRN Consensus Model
The APRN Consensus Model was designed through a collaborative initiative between more than 40 nursing organizations in an effort to set forth uniform rules for advanced practice nurses across the U.S. Under the Model, APRNs are able to practice to the full extent of their education in advanced health assessment, pathophysiology and pharmacology, allowing them to assess patient health, develop treatment plans and prescribe drugs as needed without having to be supervised by a physician.
As of January 2016, Oklahoma had adopted the following major components of the model:
- APRN title
- Roles
- Education
- License
- Certification
- Independent practice (but not prescriptive authority) for CNMs, CRNAs, and NPs
Other than the supervision required for prescriptive privileges, CNSs, NPs, and CNMs in Oklahoma are allowed to treat patients independently without the supervision of a practicing physician. CRNAs must practice at all times under the supervision of a medical doctor, osteopathic physician, podiatric physician, or dentist.
Continuing Education Requirements for APRNs in Oklahoma
CNSs, NPs, and CNMs with prescriptive authority must complete 15 Board-approved contact hours or one Board-approved academic credit hour every two-year license cycle. The hours must be in the following areas:
- Pharmacotherapeutics, clinical application, and use of pharmacological agents in the prevention of illness
- The restoration and maintenance of health in a program
CRNAs with prescriptive authority must complete 8 units of CE in advanced pharmacology that relates to the administration of anesthesia every two-year license cycle. The CE must be approved by the Council on Certification and Recertifcation of Nurse Anesthetists.