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A Master of Science in Nursing (MSN) with specialized tracks in the various advanced practice roles gives RNs an educational foundation in advanced health assessment, pharmacology, and pathophysiology, allowing them to enjoy the respect, autonomy and higher pay that comes with becoming licensed as nurse practitioners, clinical nurse specialists, certified nurse-midwives or certified registered nurse anesthetists. RNs interested in moving into advanced nonclinical roles in academia, administration, research, patient advocacy, informatics and more, will also find MSN programs offering specialized tracks specifically designed to prepare them for these roles.
A significant change occurred in 2015 when the Rhode Island Board of Nurse Registration and Nursing Education moved to fully implement the APRN Consensus Model, allowing the state’s advanced practice registered nurses (APRNs) the ability to practice and prescribe independently without physician oversight or a collaborative agreement. This policy change has helped to make primary and specialized healthcare services more accessible in a state that has been dealing with a significant physician shortage.
Rhode Island’s advanced clinicians can expect to be well compensated for their extensive training and advanced clinical skills as is apparent when looking at median salaries for the three Board-recognized APRN roles (US Bureau of Labor Statistics, 2014):
- Certified Nurse Practitioner: $101,130
- Clinical Nurse Specialist: $97,448 (sourced from the International Business Machines Corporation, 2016)
- Certified Registered Nurse Anesthetist: $153,800
Requirements for APRN Licensure Through the Rhode Island Board of Nurse Registration and Nursing Registration
The Rhode Island Board of Nurse Registration and Nursing Education issues advanced practice licensure to qualified RNs in three distinct APRN roles:
- Certified Nurse Practitioner (CNP)
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
To be eligible for APRN licensure through the Rhode Island Board of Nurse Registration and Nursing Education in one of these three roles, candidates must:
- Have a current unrestricted Rhode Island RN license
- Complete a master’s or higher degree with a concentration in one of the recognized APRN roles and patient population foci
- Become nationally certified in the chosen APRN role and patient population focus through a board-recognized certifying body
Nurse practitioners and clinical nurse specialists also focus their education and become nationally certified in a specific patient population focus (family and individual across the lifespan; adult/gerontology acute or primary care; neonatal; pediatric; women’s health/gender specific; psychiatric/mental health). Beyond these three roles and six population foci, nurse practitioners and clinical nurse specialists may also choose further specialty certifications, which include but are not limited to orthopedics, oncology, critical care, older adults, palliative care, and nephrology.
In most states, certified nurse midwives (CNMs) are licensed through the state’s Board of Nursing. However, in Rhode Island CNMs are licensed through the Rhode Island Department of Health, Advisory Council on Midwifery. In order to become licensed in Rhode Island, RNs interested in becoming CNMs are required to earn a master’s or higher degree in nurse-midwifery through an accredited program and become nationally certified through the American Midwifery Certification Board (AMCB).
The state of Rhode Island is part of the Nurse Licensure Compact, which allows advanced practice registered nurses originally licensed in Rhode Island to also practice in the other participating states without having to get a new license or certification.
The Rhode Island Board of Nurse Registration and Nursing Education recognizes the following certifying agencies as providing the role and patient population-specific certification in the three respective Board-recognized APRN roles:
Registered Nurse Practitioner (RNP)
- American Academy of Nurse Practitioners Certification Program
- American Association of Critical Care Nurses
- American Nurses Credentialing Board
- Pediatric Nursing Certification Board
- National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
Clinical Nurse Specialist (CNS)
Certified Registered Nurse Anesthetist (CRNA)
Earning a Master of Science in Nursing (MSN) in Rhode Island
APRNs have been allowed total freedom in terms of independent practice and prescriptive authority, allowing them to offer care to the full extent of their training and education. All MSN programs designed to prepare nurses for national certification and state licensure in the respective APRN roles include a core in:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced health assessment, including the assessment of all human systems, concepts and approaches, and advanced assessment techniques
- Advanced pharmacology, including pharmacokinetics, pharmacotherapeutics of all broad categories of agents and pharmacodynamics
MSN degrees are offered in a traditional, on-campus format, but online programs are quickly becoming the preferred format among working RNs looking to earn a graduate degree with minimal interruptions to work life. Online programs would allow graduate nursing students in Rhode Island access to specialty tracks in all APRN roles. Clinical sequences would be completed locally, and in many cases can be done in the student’s current place of employment.
APRN candidates must graduate from accredited programs in order to qualify for national certification and state licensure:
- Nurse Practitioner and Clinical Nurse Specialist Program Accreditation – the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are two predominant accrediting agencies for nurse practitioner and clinical nurse specialist programs, however other accrediting agencies recognized by the Council for Higher Education Accreditation (CHEA) and the US Department of Education may also be accepted
- Nurse Anesthetist Program Accreditation – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency recognized by the NBCRNA
- Nurse-Midwife Program Accreditation – the Accreditation Commission for Midwifery Education (ACME) is the accrediting agency recognized by the AMCB
Rhode Island Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
The Rhode Island Board of Nurse Registration and Nursing Education requires all graduate programs designed to prepare nurses for advanced clinical practice in one of the three Board-recognized APRN roles to adhere to the following standards laid out by the Rules and Regulations for the Licensing of Nurses and Standards for the Approval of Basic Nursing Education Programs, which states that the APRN general core must include the following topics in line with national standards:
- Physiology and pathophysiology, with courses that address patients across the lifespan
- Health assessment, including assessment of all human systems and advanced techniques
- Pharmacology, pharmacodynamics, pharmacokinetics, and pharmacotherapeutics
- Preparation for decision making in the APRN role
- Courses specific to one of the six population foci
- Courses specific to the core competencies of CNRAs, CNS, and CNPs
- Training in diagnosis and treatment of diseases across the lifespan and in all systems
- Legal, ethical, and professional responsibilities
Students in APRN graduate programs must hold a valid Rhode Island RN license. APRN candidates must complete a minimum of 500 clinical hours supervised by licensed professionals. These clinical hours must be specific to the ARPN role and population focus in which the student will be licensed.
Selecting the Right Type of MSN Program Based on Current Education
Aspiring APRN graduate students would select an MSN program designed to accommodate their current level of education, whether an ADN, BSN or bachelor’s degree in an area other than nursing:
For RNs Who Have Completed a Bachelor of Science in Nursing – Traditional BSN to MSN programs are available for nurses who have already received a bachelor degree in nursing. These programs consist of between 40-60 credits, and students are typically able to complete them in about 18-24 months. Accredited traditional on-campus programs are available in the following Rhode Island locations:
- Pawtucket
- Providence
- Kingston
For RNs with an Associate’s Degree in Nursing – Practicing RNs who have earned an associate degree in nursing can apply to accelerated RN-to-MSN bridge programs, which upon completion result in both a BSN and MSN degree. These accelerated programs typically take between 2-3 years to complete when taken as a full-time program.
For Students with a Bachelor’s Degree in a Non-Nursing Discipline – Students who have completed a bachelor’s degree in a non-nursing field can still earn their MSN degrees by enrolling in a direct-entry MSN program. Direct-entry programs allow individuals from other career fields to take the necessary nursing prerequisites and graduate level nursing courses required for APRN licensure. These accelerated programs can typically be completed in 16-24 months. There are currently no Rhode Island campuses offering direct-entry programs; however, there are accredited direct-entry programs available in a fully online format.
State Laws Governing Advanced Practice Registered Nursing in Rhode Island
Rhode Island is one of the twelve U.S. states in which the National Council of State Boards of Nursing (NCSBN) APRN Consensus Model has been fully integrated as of May 2015. The Consensus Model is an initiative that seeks to standardize the regulations for APRNs in all states. This model grants APRNs the ability to move freely among nurse license compact states with uniform regulations and practice standards without the need to gain further permissions. The Consensus Model also seeks to align the following elements across the nation:
- Prescriptive Authority
- Independent Practice (no requirement for collaborative agreements with physicians)
- State recognition of CNSs, CNPs, CNRAs, CNMs
- Licensure as an RN and APRN
- Certification at advanced levels of practice
- Graduate education requirements
According to the rules and standards of the APRN Consensus Model set in place by the National Council of State Boards of Nursing (NCSBN), the scope of practice of APRNs of all kinds includes the following:
- Conducting advanced assessments
- Ordering tests, diagnostics, procedures, and interpreting results
- Introducing primary and differential diagnoses
- Prescribing and administering medications and treatments
- Delegating therapeutic measures to other medical personnel
- Consulting with medical professionals in other disciplines, providing referrals to other providers and resources
- Other various responsibilities in which the APRN has been trained via a graduate education and continuing education throughout their career
Prescriptive Authority and Independent Practice
In many U.S. states, APRNs are required to be joined in a collaborative agreement with a physician. This limits an APRN’s ability to make decisions independently regarding interventions, treatment plans and the administering of pharmacological agents, and often slows down the treatment process due to the need for physician supervision or consultation. Because the APRN Consensus Model has been fully implemented in Rhode Island, APRNs in this state are fully authorized to practice independently.
An APRN licensed by The Rhode Island Department of Health may have prescriptive authority if they have completed an approved educational program that includes courses in pathophysiology, pharmacology, and physical assessment. Because the APRN Consensus Model has been fully integrated, The Board of Nursing has granted APRNs in Rhode Island full prescriptive authority to prescribe, dispense, and furnish medications and treatments based on their own diagnoses. This includes all legal substances, controlled substances, and medical equipment, and it also allows APRNs to plan and implement full treatment plans for patients including nutrition plans, hospice, and physical or occupational therapy. The distribution of all drugs is to be done within the scope of DEA laws and regulations.
Continuing Education Requirements for APRNs in Rhode Island
The Rhode Island Department of Health mandates that every two years after an APRN’s initial license is issued, they must submit evidence that they have completed ten continuing education hours during the preceding two-year period. Continuing education hours must consist of coursework that has been approved by the Rhode Island State Nurse Association, one of the Board-recognized national certifying organizations, or another professionally recognized nursing organization. Courses are available in both live and online formats.
At the time of license renewal, each APRN is required to present documentation showing they have completed their continuing education hours. If an individual is unable to complete their continuing education requirements, the Rhode Island Department of Health may choose to grant one six-month extension to those with extenuating circumstances. Documents proving the completion of continuing education hours must be presented along with a license renewal fee every two years by March 1st. Proof of continuing education documents should be kept for at least four years, as random auditing can occur during this time.