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Registered nurses interested in entering advanced practice so as to enjoy a greater level of independence, prescriptive authority, and higher salaries, set their sits on earning a Master of Science in Nursing (MSN). As of 2014, some 31,050 RNs were licensed and practicing in Oregon according to the U.S. Bureau of Labor Statistics (BLS). Among these, only a small percentage held advanced practice registered nurse (APRN) certification: 1,360 as nurse practitioners and 210 as nurse anesthetists.
RNs that go on to earn an MSN without a clinical focus have the opportunity to pursue non-clinical careers in the fields of education, nursing administration, medical writing, or nursing informatics, among other areas.
Master’s-prepared advanced nursing practitioners are seen as the solution to the primary care provider shortage that is being felt in Oregon and throughout the nation. In fact, during the ten-year projection period from 2012 to 2022, the number of nurse anesthetists practicing in the state is expected to rise by 19% just to keep pace with demand (BLS).
Earning a master’s degree en route to advanced practice licensure also brings the assurance of higher earnings. While the average annual salary for Oregon’s RNs was $82,940 in 2014, APRNs earned considerably more:
- Nurse practitioners: $111,160
- Nurse anesthetists: $162,500
Oregon has long been recognized as one of the most progressive states when it comes to practice privileges for advanced nursing professionals. In 1979, long before most states, Oregon began allowing APRNs prescriptive authority, and in the 1980s it was one of the first four states to allow APRNs broader authority within their scope of practice. Furthering this trend, in 2016 insurers became required to reimburse Oregon’s independently practicing nurse practitioners at the same rate as physicians for the same healthcare services. Today, Oregon remains one of the best states to practice as an APRN, as these advanced practitioners enjoy full independent practice authority, prescriptive authority and pay that is commensurate with a physician’s rate.
Meeting Oregon State APRN Licensing Requirements
Becoming an APRN in Oregon starts by earning an MSN degree and national certification specific to the APRN role.
The Oregon State Board of Nursing (OSBN) recognizes three distinct APRN roles:
- Nurse Practitioner (NP)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
RNs who seek to become nurse practitioners and clinical nurse specialists must choose a patient population to study and become nationally certified in (family/individual across the lifespan, pediatrics, neonatology, psychiatric mental health specialist). Nurse practitioners may also choose nurse-midwifery as a patient population focus.
For the purpose of APRN licensure through the OSBN, the Board recognizes the following national certification agencies and the corresponding patient population certifications:
Registered Nurse Practitioner (RNP)
- American Nurses Credentialing Center
- Acute Care NP
- Adult Nurse NP
- Adult-Gerontology Acute Care NP
- Adult-Gerontology Primary Care NP
- Family NP
- Pediatric Primary Care NP
- Psychiatric-Mental Health NP
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology
- Acute Care Nurse Practitioner Adult
- American Academy of Nurse Practitioners
- Adult Nurse Practitioner (ANP)
- Family Nurse Practitioner (FNP)
- Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP)
- Pediatric Nursing Certification Board
- Pediatric Nurse Practitioner Primary Care
- Pediatric Nurse Practitioner Acute Care
- National Certification Corporation
- Women’s Health Care Nurse Practitioner
- Neonatal Nurse Practitioner
- American Midwifery Certification Board
- Certified in Nurse-Midwifery (CNM)
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Clinical Nurse Specialist; Wellness through Acute Care
- Clinical Nurse Specialist; Wellness through Acute Care (Pediatric)
- Clinical Nurse Specialist; Wellness through Acute Care (Neonatal)
- Acute/Critical Care Clinical Nurse Specialist (Adult, Pediatric & Neonatal)
Certified Registered Nurse Anesthetist (CRNA)
Pursuing a Master of Science in Nursing (MSN) in Oregon
Many of Oregon’s advanced degree-seeking RNs choose from one of the many online degree programs offered throughout the country, citing benefits that include flexible scheduling that accommodates working hours and more options for patient population foci not available through campus based institutions in the state. In addition, universities that host online programs allow students to complete clinical hours in hospitals and physician’s offices close to home.
Oregon Requirements for APRN Graduate Programs
The OSBN publishes separate education requirements for each APRN role, shown here in combination with requirements set by accrediting agencies and professional associations for each of the respective roles:
- NP programs must be at least one year in length
- Curriculum must contain theory and clinical experience specific to the student’s chosen patient population focus
- The number of contact hours of clinical experience must be equal to or greater than the number of contact hours of nurse practitioner theory
- Must include courses in physical assessment, pathophysiology, and pharmacological content
The National Task Force on Quality Nurse Practitioner Education sets the standards for accredited nurse practitioner programs in the U.S.
- Ethics Competencies
- Health Delivery System Competencies
- Independent Practice Competencies
- Leadership Competencies
- Policy Competencies
- Practice Inquiry Competencies
- Quality Competencies
- Scientific Foundation Competencies
- Technology and Information Literacy Competencies
Certified Registered Nurse Anesthetist
A candidate applying for APRN licensure as a certified registered nurse anesthetist with prescriptive authority must complete a master’s or higher degree with courses in physical assessment, pathophysiology, and pharmacological content.
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), as the accrediting agency for CRNA programs in the U.S., outlines the basic nurse anesthesia academic curriculum and prerequisite courses focus on coursework in anesthesia practice:
- Anatomy, physiology, and pathophysiology (135 hours)
- Basic and advanced anesthesia practices (105 hours)
- Professional aspects of nurse anesthesia practice (45 hours)
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry (105 hours)
- Research (30 hours)
- Clinical conferences (45 hours)
- Radiology and ultrasound
The OSBN requires that approved CNS programs must be one year or more in length and include a clinical practicum of at least 500 hours.
The National Association of Clinical Nurse Specialists oversees the National CNS Competency Task Force, which outlines the requirements for CNS-accredited programs. All CNS programs must prepare students in the following core competencies:
- Direct Care Competency
- Consultation Competency
- Systems Leadership Competency
- Collaboration Competency
- Coaching Competency
- Research Competency
- Ethical Decision-Making, Moral Agency and Advocacy Competency
Selecting the Appropriate MSN Program Based on Current Education
Students seeking an MSN degree must select a program according to their current level of education:
- RNs with an Associate’s Degree in Nursing (ADN): RNs with an associate degree must obtain a BSN en route to earning an MSN and becoming licensed as an APRN in Oregon. Several RN-to-MSN bridge programs are available that confer both a BSN and an MSN in one accelerated program.
- RNs with a Bachelor of Science in Nursing (BSN): RNs who already have earned a BSN will complete a traditional two-year MSN program specific to their chosen role and patient population focus.
- Professionals with a Bachelor’s Degree in an Area Other than Nursing: Select MSN programs allow non-nursing professionals to enroll in direct-entry programs that result in a BSN, RN license and MSN in one accelerated program.
Laws Concerning Prescriptive Authority and Independent Practice for Oregon’s APRNs
According to the OSBN’s Nurse Practice Act, Oregon APRNs are allowed full practice authority in the state and are allowed to hold prescriptive authority without physician supervision or the need to enter into a collaborative agreement.
While all APRNs in Oregon are considered independent practitioners, the scope of practice varies by role:
Nurse Practitioner Scope of Practice:
According to the OSBN, nurse practitioner scope of practice includes:
- Assessment
- Diagnosis
- Development of a plan
- Intervention
- Evaluation
- Prescribing, administering and dispensing medication
Certified Registered Nurse Anesthetist Scope of Practice:
The OSBN defines the CRNA scope of practice as including:
- Performing pre-anesthetic assessment of patients
- Requesting diagnostic studies of patients
- Administering pre-anesthetic medication to patients
- Counteracting problems within anesthesia care
- Administering post anesthesia care
Clinical Nurse Specialist Scope of Practice:
According to the OSBN, the CNS scope of practice is defined as:
- Providing advanced nursing care to clients while helping patients achieve their health goals
- Providing clinical expertise, evidence-based practice, and leadership.
The CNS practices within three spheres (CNS may practice within one or more spheres):
- Individual clients and populations
- Nurses and other multidisciplinary team members
- Organizations
Prescriptive Authority
In Oregon, nurse practitioners are the only APRNS who are required to qualify for, obtain and maintain prescriptive authority.
Clinical nurse specialists and certified registered nurse anesthetists are permitted, though not required, to apply for prescriptive authority.
APRNS may apply for prescriptive authority through the OSBN website, provided they have completed 45 contact hours of APRN-level pharmacological content.
Implementation of the APRN Consensus Model in Oregon
The APRN Consensus Model, developed by the National Council of State Boards of Nursing (NCSBN) with input from 40 other stakeholders in advanced practice nursing, seeks to achieve consistency in accreditation, education, certification and licensing for APRNs in all states and jurisdictions. The APRN Consensus Model is primarily concerned with moving APRNs toward being able to practice independently without physician oversight.
Oregon’s progressive stance on independent practice for APRNs allows NPs, CNSs and CRNAs full prescriptive authority as well as authority to treat and diagnose patients within the scope of their advanced practice role and patient population focus.
APRN Continuing Education Requirements in Oregon
In addition to the OSBN’s requirements for continuing education as described below, all APRNs are required to complete the certification maintenance requirements for their advanced practice credentials.
In Oregon, APRN renewal is required every two years, and is divided into two types:
APRNs without prescriptive authority – CRNAs who do not hold prescriptive authority are required to document proof of current certification from the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and submit it to the OSBN.
CNSs and NPs who do not hold prescriptive authority are required to document at least 40 contact hours of CEs in the two-year renewal period. The CE hours are divided into two sections:
- 50% of the CE hours must be completed as a structured activity
- The other 50% of hours is counted by current national certification in a specific patient population
APRNs with prescriptive authority – In addition to meeting all the CE requirements named above, APRNs who have applied for and hold prescriptive authority are required to show documentation of at least 150 hours of practice that involves prescribing medicine during each two-year renewal period.