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Registered nurses intent on earning the respect, independence and earning power that comes with becoming an advanced practitioner, as well as those interested in making a career change by taking on nonclinical roles in such areas as administration or education, all start by earning a Master of Science in Nursing (MSN).
Of the 128,750 active RN licenses in Pennsylvania in 2014, fewer than 4,000 were advanced practice registered nurses (APRNs) serving as certified registered nurse practitioners and clinical nurse specialists.
Currently, APRNs in Pennsylvania are required to enter into a collaborative agreement with physicians in order to practice, but the state continues to move toward allowing APRNs to practice independently within the full scope of their education in accordance with the larger national movement to align practice guidelines with the APRN Consensus Model. In 2015, legislation was introduced that would allow advanced practice registered nurses in Pennsylvania to gain independent practice rights and be recognized as primary care providers on insurance plans. Stakeholders are optimistic, though as of January 2016 the legislation was still pending.
According to the U.S. Health Resource and Services Administration (HRSA), the number of primary care nurse practitioners nationwide is expected to increase from 55,400 in 2010 to 72,100 by 2020, a 30% jump. Concurrently, a marked shortage of about 20,400 primary care physicians is expected by 2020. Recent legislation seeks to ensure more autonomy for highly trained advanced practice registered nurses, which would allow them to better stem the shortage of primary care providers in Pennsylvania and around the nation.
State Certification Requirements for the Advanced Practice Nursing Roles Recognized in Pennsylvania
RNs seeking APRN certification through the Pennsylvania State Board of Nursing (PSBN), must first earn an MSN degree through a program accredited by an agency recognized by the U.S. Department of Education.
The Pennsylvania State Board of Nursing (PSBN) recognizes two distinct APRN roles:
- Certified Registered Nurse Practitioner (CRNP)
- Clinical Nurse Specialist (CNS)
Students must designate a patient population focus in their educational program and become nationally certified in their role and patient population focus of choice. Patient population foci options are family/individual across the lifespan, pediatrics, neonatology, psychiatric/mental health, women’s health, and adult-gerontology primary or acute care.
The Board also grants certified nurse-midwife licenses independent of APRN certification to RNs who have earned a master’s or higher degree in nurse-midwifery through an accredited program and national certification through the American Midwifery Certification Board.
After earning an MSN or other advanced degree, aspiring nurse practitioners and clinical nurse specialists must seek national certification in the APRN role and patient population focus that aligns with their master’s education. The PSBN recognizes several different national certification agencies as being able to grant the credentials necessary for RNs to qualify for APRN state certification:
Certified Registered Nurse Practitioner (CRNP)
- American Nurses Credentialing Center
- 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
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)
- American Nurses Credentialing Center
- Adult Health CNS
- Adult-Gerontology CNS
- Adult Psychiatric-Mental Health CNS
- Child/Adolescent Psychiatric-Mental Health CNS
- Gerontological CNS
- Home Health CNS
- Pediatric CNS
- Public/Community Health CNS
- Orthopedic Nurses Certification Board
- Orthopedic CNS
- Oncology Nursing Certification Corporation
- Oncology Certified Nurse
- Certified Pediatric Hematology Oncology Nurse
- Advanced Oncology Certified Clinical Nurse Specialist
Pursuing a Master of Science in Nursing (MSN) in Pennsylvania
Pennsylvania offers a wide variety of in-state, accredited and board-approved MSN programs, however, accredited online programs have become very popular among working RNs. Many working RNs appreciate online content as it more easily conforms to a professional schedule. Though theory content and didactic coursework is completed online, all programs will still have an extensive requirement of clinical hours, which would be logged in hospitals, private clinics, and physician’s offices close to home.
The Pennsylvania State Board of Nursing (PSBN) requires programs for nurse practitioners, clinical nurse specialists and nurse midwives to be accredited through a national accrediting body recognized by the US Department of Education (DOE).
Pennsylvania Requirements for APRN and Nurse-Midwife Graduate Programs
All accredited graduate programs for advanced practitioners (nurse practitioners, clinical nurse specialists) and certified nurse-midwives include an academic core in:
- Advanced pathophysiology/physiology
- Advanced health assessment
- Advanced pharmacology, including pharmacokinetics, pharmacodynamics, and pharmacotherapeutics of broad categories of agents
The Pennsylvania State Board of Nursing (PSBN) requires master’s programs that prepare certified registered nurse practitioners, clinical nurse specialists and certified nurse-midwives to include:
- A minimum of three hours of Department of Human Services approved training in child abuse recognition and reporting
- At least 45 hours of coursework in advanced pharmacology (required for prescriptive authority)
Nurse Practitioner and Clinical Nurse Specialist Programs
According to the PSBN, APRN graduate programs for nurse practitioners and clinical nurse specialists must conform to the following regulations:
- Programs must educate the RN in a particular specialty
- Programs must prepare the RN to diagnose, prescribe, and apply corrective measures to patients in collaboration with a physician
In order to become a certified APRN in Pennsylvania, nurses must graduate from an accredited, board-approved program. The PSBN publishes a list of approved programs for both CRNPs and CNSs, broken up by patient population focus.
Certified Nurse-Midwife Programs
Certified nurse-midwife programs include a didactic education component that prepares graduates to provide effective antepartum, intrapartum and postpartum care:
- Psychology for pregnancy
- Female reproductive health
- Labor, birth, and newborn care procedures
- Complicated pregnancies and deliveries
- Advanced integrated midwifery
- Mother and infant bio-statistics
- Multicultural midwifery
- Legal issues and ethics in maternal healthcare
Selecting the Appropriate Type of MSN Program Based on Existing Education
Students seeking an MSN degree must select a program designed to build off of their current level of education:
- RNs with an Associate Degree in Nursing must obtain both a BSN and MSN to become an APRN in Pennsylvania. Several RN-to-MSN bridge programs offer both a BSN and an MSN in one accelerated program that takes about three years to complete.
- RNs with a Bachelor of Science in Nursing would enroll in traditional two-year terminal MSN programs.
- Professionals with a bachelor’s degree in an area other than nursing would pursue entry-level (sometimes called direct-entry) MSN programs, which allow candidates to earn an RN license and MSN degree in preparation for an APRN state certification.
Laws Concerning Prescriptive Authority and Independent Practice for Pennsylvania’s APRNs and Certified Nurse-Midwives
The APRN Consensus Model, supported by more than 40 nursing advocacy groups and certification agencies and spearheaded by the National Council of State Boards of Nursing (NCSBN), seeks uniform legislation in all states regarding APRN education, licensing, certification and practice, with a particular focus on allowing advanced practitioners to practice independently within the full scope of their education and training. Eleven states have already completely implemented the model, allowing APRNs in those states the freedom of independent practice without physician collaboration or supervision.
In Pennsylvania, legislation was introduced in 2015 to allow advanced nursing practitioners the opportunity to practice independently. However, currently APRNs are still restricted by a collaborative agreement requirement.
According to the PSBN’s practice act, APRNs and certified nurse-midwives in Pennsylvania must enter into a collaborative agreement with a physician and may not practice independently.
APRNs and CNMs must fill out a collaborative agreement with their partnering physician and file it with the PSBN.
Prescriptive Authority
APRNs and CNMs in Pennsylvania may apply for prescriptive authority. Nurses must download the application form, pharmacology course verification form, and collaborative agreement form from the PSBN website and send them to the PSBN to initiate the process.
Scope of prescriptive authority is determined solely by the collaborating physician and will vary according to each situation.
Upon terminating a collaborative agreement with a physician or beginning a new contract with a different physician, nurses are required to fill out the Prescriptive Authority Collaborative Agreement Change Form found on the PSBN website.
Prescriptive authority is renewed every two years at the same time as CRNP or CNS certification or CNM licensure.
APRN Certification Renewal and Continuing Education Requirements in Pennsylvania
In Pennsylvania, the RN license, APRN certification, and prescriptive authority (if applicable) will need to be renewed at the same time every two years. The renewal fee for APRN certification is $50.
CRNPs and CNSs must complete at least 30 hours of continuing education during the two-year renewal period in order to renew their certification through the PSBN.
The board randomly audits licensees in order to document proof of continuing education rather than requiring documentation from each individual APRN during each renewal period.
Board-approved CE programs are workshops, classes, seminars, and other educational programs held by:
- Board-approved CRNP programs
- The American Nurses Credential Center’s Commission on Accreditation
- The American Academy of Nurse Practitioner
- The National Association of Pediatric Nurse Practitioners
- The American Medical Association
In addition to PSBN requirements, nurses must also complete continuing education hours dictated by their national certifying body. Hours will vary, but all national certifications will require a certain amount of documented training in the nurse’s specific population focus through seminars, workshops, training classes, and other educational pursuits.
Certified nurse-midwives must maintain certification through the American Midwifery Certification Board (AMCB) without having to meet additional CE requirements to maintain licensure through the PSBN.
All nurse practitioners, clinical nurse specialists and certified nurse-midwives that hold prescriptive authority must complete 16 hours of continuing education in pharmacology. For CRNPs and CNSs, these 16 hours can be part of the 30 total hours required for state certification renewal.