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Obtaining a Master of Science in Nursing (MSN) is widely regarded as the standard educational step to becoming an advanced practice registered nurse (APRN) in any of the advanced roles recognized in Utah. APRNs fill vital roles at every level of care in a variety of different practice settings: nurse midwives care for mothers and neonates from pre-conception to post-birth stages; nurse practitioners often serve as primary care providers, establishing strong and lasting relationships with their patients; nurse anesthetists are critical to successful surgical procedures; and clinical nurse specialists work to affect change from within the clinical setting.
The highly customizable MSN is also available with tracks for RNs that want to work outside a clinical setting, where they would further medical research, educate the next generation of nurses, or work in nursing administration.
Because of their blend of practical training and in-depth education, APRNs are a valued part of Utah’s health care system. Utah faces many health care challenges, often related to the significant portion of state residents who live in rural communities. Rural communities struggle with clinician shortages and reduced access to health care, particularly as it relates to psychiatric and mental health services. The Utah Medical Education Council reports that as of 2011, 11% of APRNs practice in a rural setting even though 15% of Utah’s population resides in a rural community. The state also struggles with a lack of primary care clinicians.
Additionally, Utah faces an aging workforce. Because of this, the US Department of Labor predicts a remarkable increase in demand for APRNs in all roles during the ten-year projection period leading up to 2022. Most notably, Utah expects a 47% increase in the number of nurse practitioners and a 38% increase for certified nurse anesthetists.
Utah respects the autonomy of APRNs, allowing them to practice independently and obtain prescriptive authority with few restrictions.
Licensing Requirements for the Advance Practice Registered Nursing Roles Recognized in Utah
APRNs in Utah are licensed through the Division of Occupational and Professional Licensing (DOPL) in one of four roles (shown here with patient population focus and specialty options for each role):
- Nurse Practitioner (NP)
- Acute Care (ACNP)
- Adult (ANP)
- Family Practice (FNP)
- Geriatric (GNP)
- Neonatal (NNP)
- Oncology (ONP)
- Pediatric (PNP)
- Psychiatric/Mental Health (PMHNP)
- Women’s Health (WHNP)
- Clinical Nurse Specialist (CNS)
- Acute Care (ACCNS)
- Adult (ACNS)
- Family Practice (FCNS)
- Geriatric (GCNS)
- Neonatal (NNCNS)
- Oncology (OCNS)
- Pediatric (PCNS)
- Psychiatric/Mental Health (PMHCNS)
- Women’s Health (WHCNS)
- Certified Nurse Midwife (CNM)
- Certified Nurse Anesthetist (APRN-CNA)
- APRN-CNA license differ slightly from the APRN license in that they are recognized separately and cannot hold full prescriptive authority (see section on Prescriptive Authority for more information). CNAs must complete a nurse anesthesia program approved by the Council on Accreditation of Nurse Anesthesia Educational Programs (Utah Nurse Practice Act, 58-31b-302, subsection (4)(e)(ii))
To become an APRN in Utah, an individual must meet several requirements:
- Hold a valid, active RN license in the state of Utah
- Complete a master’s or higher level program designed to prepare RNs for advanced practice nursing
- Obtain a national certification in their role and population focus (if applicable) from a Board-approved certification agency
The Utah Board of Nursing (BON) recognizes certifications from the following national credentialing agencies:
American Nurses Credentialing Center
Pediatric Nursing Certification Board
- Nurse Practitioners
American Association of Nurse Practitioners
- Nurse Practitioners
- ANP
- FNP
- GNP
National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties
American Midwifery Certification Board
National Board of Certification and Recertification for Nurse Anesthetists
Earning a Master of Science in Nursing (MSN) in Utah
To become an APRN in Utah, RNs must complete a master’s level (or higher) program designed specifically for their advanced practice nursing role of choice. The program must be Board-approved and/or accredited through one of the following:
- Nurse Practitioner and Clinical Nurse Specialist Programs – Accrediting Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE)
- Nurse Anesthetist Programs – Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
- Nurse-Midwifery Programs – Accreditation Commission for Midwifery Education (ACME)
For some programs not accredited through these agencies, the Board may grant temporary approval.
Utah has two ACEN accredited MSN programs, located in Orem and Ogden. CCNE accredited four MSN programs in state, one in Provo and three in Salt Lake City. There are currently no COA or ACME accredited MSN Programs in Utah.
Accredited online MSN programs are becoming increasingly popular among RNs or other health care individual seeking to gain their APRN license because of the many advantages they have over traditional on-site programs. Online programs offer flexibility in class scheduling and relieve the student of the need to commute to class or relocate to complete their degree. Online programs also allow the student to complete their program at an accelerated pace. Online programs work to place students locally, allowing them to complete their required clinical hours in a local facility. In many cases, this can be accomplished at the student’s current place of employment.
Utah Board Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
The Utah BON adheres to the MSN program requirements defined by each role’s credentialing body or other standards setting organization.
Utah complies with the APRN Consensus Model in basic MSN curriculum requirements:
- Three separate, graduate-level courses in
- Advanced physiology and/or pathophysiology
- Advanced health assessment
- Pharmacology
- A preceptorship to provide clinical practice
- Minimum of 500 hours of supervised direct patient care clinical practice
- Clinical hours must be directly related to chosen role and population focus
- Curriculum that contains both clinical and didactic education
Certified Nurse Midwife MSN Program Requirements – ACME requires that MSN programs for the role of CNM include several core competencies:
- Professional Responsibilities of CNMs
- Midwifery history and legal basis for practice
- National and international issues and trends in women’s health and maternal/newborn care
- Development of leadership skills and participation in self-evaluations and peer reviews
- Midwifery Management Process
- Understanding of the seven sequential steps of the midwifery management process
- Fundamentals of Midwifery Care
- Anatomy and physiology
- Normal growth and development
- Clinical genetics
- Nutrition
- Psychosocial, sexual, and behavioral development
- Basic epidemiology
- Pharmacokinetics and Pharmacotherapeutics
- Primary Health Care of Women
- Health promotion and disease prevention
- Preconception care, gynecologic care, and peri/post-menopausal care
- Management of common health problems
- Childbearing Family Care
- Independent management of care of female patient during pregnancy, childbirth, and postpartum period
- Newborn Care
- Maternal and fetal risk factors and bonding attachment theory
- Primary health screening, health promotion, and assessment of growth for first 28 days of life
- Facilitating lactation
Clinical Nurse Specialist MSN Program Requirements – National Association of Clinical Nurse Specialists (NASCNS) developed the National CNS Competency Task Force to identify necessary CNS program components (Task Force is endorsed by CCNE).
The NASCNS defines several core competencies:
- Direct Care
- Direct interaction with patients, families, and groups of patients, characterized by a holistic perspective
- Conducting comprehensive and holistic wellness and illness assessments, including data collection about context and etiologies and identifying patient risk factors
- Application of evidence-based clinical practices
- Selecting appropriate interventions
- Consultation
- Patient, staff, or system-focused interaction skills, tools, and approaches in which the consultant is recognized as having specialized knowledge and experience
- Systems Leadership
- Managing change and empower others to influence clinical practices
- Collaboration
- Assessing quality and effectiveness of interdisciplinary and intra/inter-agency communication and collaboration
- Establishing relationships across departments
- Coaching
- Skillful guidance and teaching to advance care and health education of patients, families, groups of patients, and communities
- Research
- Practicing thorough and systematic inquiry
- Analyzing and integrating data and research findings and applying conclusions to clinical practice
- Evaluating clinical practice
- Ethical Decision-Making, Moral Agency, and Advocacy
- Identifying and taking action on ethical concerns at every level of health care
- Fostering professional accountability and engaging in self-evaluations
Nurse Practitioner MSN Program Requirements – The American Association of Collages of Nursing (AACN) and the National Organization of Nurse Practitioner Faculties (NONPF) formed a task force to set the criteria for NP educational programs. Endorsed by the CCNE, these criteria prepare an RN for advanced nursing as an NP in their chosen population focus:
- Scientific foundation competencies
- Data analysis and integration
- Translating research from other knowledge areas
- Developing new practice approaches
- Coursework in pathophysiology, pharmacology, physiology, genetics, and communication skills
- Leadership competencies
- Leadership, change, and management theories
- Collaboration skills
- Business development skills
- Quality competencies
- Quality Safety Education in Nursing (QSEN) principles and content
- Evaluation of outcomes to improve care
- Cost-benefit analysis
- Implementation of quality interventions
- Practice inquiry competencies
- Clinical investigation strategies
- Use of electronic databases
- Translation of new knowledge to practice
- Technology and Information Literacy competencies
- Use of technology available in practice
- Electronic resources
- Technological delivery systems
- Telehealth
- Templates for documentation
- Use of technology available in practice
Additional Board Requirements for APRNs in Psychiatric Mental Health Nursing – APRNs with a psychiatric mental health nursing population focus seeking licensure in Utah must meet additional educational requirements (found on page 5 of the Utah Nurse Practice Act Rule):
- Complete a minimum of 4,000 hours of supervised psychiatric mental health nursing education and clinical practice, including mental health therapy
- 1,000 hours must be completed in an approved education program intended to prepare APRNs for psychiatric mental health nursing
- The remaining 3,000 hours must be completed after obtaining the appropriate national certification, within five years of graduation
- The 3,000 hours must be completed within a two year time period
- 1,000 hours must be dedicated to mental health therapy practice
- 2,000 clinical practice hours must be completed under the supervision of a qualified APRN specializing in psychiatric mental health nursing or a designated licensed mental health therapist
- Clinical practice hours completed outside of Utah may count if the applicant demonstrates the training is equivalent in all respects to Utah Board training requirements
Certified Nurse Anesthetist MSN Program Requirements – COA outlines the program requirements for the role of CNA:
- Coursework in
- pharmacology of anesthetic agents and adjuvant drugs
- Concepts in chemistry and biochemistry
- Anatomy, physiology, and pathophysiology
- Professional aspects of nurse anesthesia practice
- Basic and advance principles of anesthesia practice
- Physics
- Equipment
- Technology and pain management
- Research
- Clinical correlation conferences
- Radiology and ultrasound
- pharmacology of anesthetic agents and adjuvant drugs
- Provides experiences in the perioperative process
- Clinical curriculum must include a minimum of 600 clinical cases and 200 clinical hours, in including a variety of procedures, techniques, and specialty practice
Selecting the Right Program Based on Current Education
An individual must select an MSN program based on their current educational level. Most who enter into an MSN program are RNs with a BSN, but many programs exist for those who don’t hold a BSN or even an RN license.
- BSN-to-MSN: These programs are for individuals who completed a Bachelor of Science in Nursing and hold an RN license. BSN-to-MSN programs are the traditional education track for RNs seeking APRN licensure. These programs take about two years to complete.
- Direct entry/pre-licensure programs: Direct entry programs are for individuals who completed their Bachelor degree in an area other than nursing. Direct entry/pre-licensure programs allow students to earn their RN license and their MSN in one comprehensive, accelerated program.
- ADN-RN to MSN bridge programs: MSN bridge programs are for RNs who hold an Associate’s Degree in Nursing. These programs allow an RN to complete both their BSN and their MSN in one accelerated program. They typically require three years to complete.
Scope of Practice and State Laws Governing Advanced Practice Registered Nursing in Utah
APRNs retain RN scope of practice while branching out into other practices appropriate to their role and population focus. According to the Nurse Practice Act Rule, an APRN who wishes to extend their scope of practice outside of their primary focus must obtain approval from the DOPL and provide documentation of their on-going competency within the expanded scope of practice.
According to the Utah Nurse Practice Act, all APRNs share a basic scope of practice:
- Maintain and promote health and prevention of disease
- Diagnose, treat, correct, consult, and refer for common health problems
- Prescribe or administer prescription drugs or devices including:
- Local anesthesia
- Schedule IV-V controlled substances
- Schedule II-III controlled substances in accordance with a collaborative agreement
APRN-CNAs scope of practice extends further and differs in prescriptive authority:
- Provide preoperative, intraoperative, and postoperative anesthesia care and related services at the request of a licensed health care professional
- Perform pre-anesthesia preparation and evaluation
- Pre-anesthetic patient assessment
- Order and evaluate appropriate lab tests and other studies to determine the health of the patient
- Select, order, and administer appropriate medications
- Perform anesthesia induction, maintenance, and emergence
- Select and initiate planned anesthetic technique
- Select and administer anesthetics and adjunct drugs and fluids
- Administer general, regional, and local anesthesia
- Provide post-anesthesia follow-up care
- Evaluate patient’s response to anesthesia and implement corrective actions
- Select, order, and administer appropriate medications and studies
- Other related services within the scope of practice of a CNA as established in the Utah Code
- Provide emergency airway management
- Provide advanced cardiac life support
- Establish peripheral, central, and arterial invasive lines
Nurse Practitioners
- Provide acute and primary direct patient care across different settings
- Practice autonomously in family practice, pediatrics, internal medicine, geriatrics, and women’s health care
- Diagnose and treat patients with undifferentiated symptoms
- Diagnose and treat patients with established diagnoses
- Provide initial and ongoing comprehensive care
- Take full medical histories
- Perform physical examinations and other health assessments and screening activities
- Order, perform, supervise, and interpret laboratory and imaging studies
- Prescribe medication and durable medical equipment
- Make appropriate referrals for patients and families
- NP Scope of practice grows more specific according to population focus
Certified Nurse Midwives
- Provide primary health care services to women throughout the lifespan
- Gynecologic care
- Family planning services
- Preconception care
- Prenatal and postpartum care
- Childbirth
- Care of the newborn
- Treating the male partner of female patients for sexually transmitted disease and reproductive health
- Care may be provided in diverse settings
- Home
- Hospital
- Birth center
- Variety of ambulatory care settings
- Private offices
- Community and public health clinics
Clinical Nurse Specialists
- Integrate care across three “spheres of influence:” patient, nurse, and health care system
- Continuously improve patient outcomes and nursing care
- Implement evidence-based practices to
- Alleviate patient distress
- Facilitate ethical decision-making
- Respond to diversity among patients
- Diagnose and treat health and illness states
- Manage disease and promote health
- Prevent illness and risk behavior across individuals, families, groups, and communities
Independent Practice and Prescriptive Authority
The APRN Consensus Model, developed by NCSBN, seeks to create uniformity across all states in all APRN rules, regulations, requirements, licensing procedures, and autonomy of practice. Since the Consensus Model was introduced in 2008, Utah has achieved 100% compliance, allowing APRNs to practice and prescribe independently to the full extent of their training and education.
APRNs achieve independent prescriptive authority when the DOPL grants APRN status, with some restrictions:
- To prescribe controlled substances, APRNs must pass an additional controlled substance exam. Prescriptions of Schedule II-III controlled substances require a collaborative practice agreement
- According to the Nurse Practice Act, a collaborative agreement must be made with a physician, surgeon, or osteopathic physician
- Collaborative agreement must include a consultation and referral plan
- APRN-CNAs can’t obtain full prescriptive authority, and can only prescribe drugs for anesthetic care.
Continuing Education Requirements for APRNs in Utah
Utah APRNs are not required to maintain their RN license, only to renew their APRN license. Licenses must be renewed every two years. To be eligible for renewal, APRNs must hold current certification from a Board-approved agency. At the time of renewal, the APRN must submit evidence of their certification to the DOPL/BON.
APRNs specializing in psychiatric mental health nursing must have completed the DOPL clinical practice requirement hours by the time of their renewal, or they must provide sufficient evidence of satisfactory progress towards completion of the clinical practice requirements.