Sponsored School(s)
A Master of Science in Nursing (MSN) provides RNs with the educational foundation necessary to enjoy the respect, autonomy and higher pay associated with entering advanced practice. RNs interested in moving into advanced nonclinical roles in academia, administration, research, patient advocacy and more, also pursue a graduate level education.
Advanced practice registered nurses (APRNs) have gained the authority to practice independently in Vermont, a development that could not have come at a better time as the demand for primary healthcare providers skilled in advanced health assessment, pathophysiology has never been greater.
In a rural state like Vermont the need for master’s-prepared nurses could not be more pronounced. According to the US Department of Health and Human Services in 2016, Vermont is home to 30 regions designated as health professional shortage areas for primary-care providers. APRNs serving as nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists are recognized as being key to filling these healthcare coverage gaps.
Licensing Requirements for the APRN Roles Recognized in Vermont
The Vermont Board of Nursing licenses APRNs in four distinct roles and corresponding population foci:
- Nurse practitioner – multiple population foci (adult, clinical, family, pediatrics, gerontology, women’s health, medical/surgical, psychiatric/mental health, acute/emergency care, and school)
- Clinical nurse specialist – population foci in psychiatric or mental health
- Nurse midwife – population focus in midwifery
- Nurse anesthetist – population focus in anesthesiology
To be eligible for an APRN license in Vermont, candidates must meet these requirements:
- Have a current and unencumbered Vermont RN license
- Have a degree or certificate from a master’s-level nursing program
- Have national certification from a board-approved organization that is specific to the APRN role and population foci
The following list shows Board-approved national certification organizations, listed with the APRN role they certify. The Vermont Board of Nursing recognizes these organizations as granting the national credentials needed for an APRN license in Vermont:
- Nurse Practitioners and Clinical Nurse Specialists – the following national organizations certify these professionals in their APRN role and population focus:
- Nurse-Midwives – the American Midwifery Certification Board (AMCB) certifies nurse midwives (it does this in association with the American College of Nurse-Midwives)
- Nurse Anesthetists – the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) certifies nurse anesthetists
Earning an Master of Science in Nursing (MSN) in Vermont
Many RNs interested in earning an MSN opt for the convenience of accredited online programs. Flexibility is one of the driving factors behind this decision, with online MSN programs allowing RNs to maintain their work schedule while simultaneously completing their education and not having to relocate. Some colleges and universities also offer the option of accelerated and part-time MSN programs. Online programs strive to establish partnerships with hospitals and universities in Vermont to give their students local options when it comes to completing the clinical segment of a program.
In state, campus-based Board-approved MSN programs are located in the cities of Burlington and Northfield.
When selecting an MSN program, students should ensure an accrediting body that is recognized by their national certification organization accredits the program. Accrediting bodies are listed as follows along with the types of APRN programs they accredit:
- Nurse Practitioner and Clinical Nurse Specialist – the Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) are the two most common accrediting agencies for nurse practitioner and clinical nurse specialist programs
- Nurse Anesthetist – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the accrediting agency for nurse anesthetist programs, recognized by the NBCRNA
- Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) is the accrediting agency for nurse-midwife programs, recognized by the AMCB
Vermont Requirements for MSN Programs that Prepare Advanced Practice Registered Nurses
The Vermont Board of Nursing specifies that an MSN program for APRNs must cover the following general subjects:
- Biology, behavior, social sciences, and medicine
- Pharmacotherapeutics as they relate to practice as an APRN
- Prescriptive authority for the APRN role and population focus
- Legal, ethical, and professional responsibilities of APRNs
- Supervised clinical practice that is relevant to the APRN role and population focus
- Advanced pharmacotherapeutics, advanced patient assessment, and advanced pathophysiology
The specific curriculum content is defined according to APRN role by the following professional organizations:
Nurse Practitioners – the National Task Force of Quality Nurse Practitioner Education describes the nurse practitioner graduate curriculum as follows:
- The didactic and clinical curriculum plan must be consistent with nationally-recognized population-focused competencies
- The curriculum must meet the standards for national certification in a population-focused area of practice
- The curriculum must be continuously updated by current nurse practitioner faculty members
- Nurse practitioner population-focus core competency objectives must be included in the curriculum
- The curriculum must prepare the prospective nurse practitioner to sit for a national certification exam that corresponds with the their population focus
- Didactic coursework must be reinforced by clinical coursework
- Clinical coursework must include at least 500 hours of supervised direct patient care
Clinical Nurse Specialist – the National Association of Clinical Nurse Specialists (NACNS) describes the clinical nurse specialist academic requirements as follows:
- The CNS graduate program’s curriculum must be clearly aligned to address the care of a specific population, and align with state requirements and nationally-recognized competencies
- The program must be led by a CNS who has at least a master’s degree in the particular population focus of the CNS program
- The curriculum must be accredited by a nursing education organization that is recognized by the US Department of Education
- Faculty-student rations must be adequate to support robust supervision during the clinical experience
- Clinical courses must give students ample opportunities to develop skills in key areas and meet the CNS licensure or certification requirements
- Clinical courses must include at least 500 supervised clinical hours
Nurse-Midwife – the Accreditation Commission for Midwifery Education (ACME) specifies that nurse-midwifery graduate program curriculum must cover:
- Hallmarks of midwifery, including the promotion of family-centered care
- Professional responsibilities of nurse midwives and the components of midwifery care
- Midwifery management process
- Fundamentals of midwifery care
- Primary health care of women
- Gynecologic care, perimenopausal, postmenopausal and care for other aging periods
- Management of common health problems
- Childbearing family
- Newborn care
The clinical segment of the program typically includes at least 500 hours of supervised experience with patients.
Nurse Anesthetist – the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires CRNA graduate program curriculum to include the following didactic elements:
- At least 135 hours covering pathophysiology, anatomy, and physiology
- At least 105 hours covering concepts in chemistry and biochemistry, pharmacology of anesthetic agents and adjuvant drugs
- At least 105 hours covering physics, pain management, equipment, technology, and basic-to-advanced principles of anesthesia practice
- At least 45 hours covering clinical correlation conferences
- At least 45 hours covering the professional aspects of the practice of nurse anesthesia
- At least 30 hours covering nurse anesthesia research
- Ultrasound and radiology
- Advanced physiology and pathophysiology
- Advanced healthcare assessment
- Advanced pharmacology
Students must also complete 2,000 hours of supervised clinical training and study at least 600 clinical cases.
Selecting the Right Program Based on Current Education
Students seeking an MSN can choose from programs designed for their specific educational background:
- RNs with a Bachelor’s of Science in Nursing (BSN) can apply directly to MSN programs, which take around two years to complete
- RNs with an associate’s degree in nursing (ADN) can apply to RN-to-MSN bridge programs, which can be completed in as little as three years
- RNs with a bachelor’s degree in an area other than nursing can apply to entry-level or direct-entry MSN programs that allow for enrollment that is contingent upon completion of prerequisites; these programs may take around three years to complete
Scope of Practice and Vermont State Laws Governing Advanced Practice Registered Nursing
The rules and laws that regulate nurse practitioners, nurse midwives, clinical nurse specialists and nurse anesthetists in Vermont are described in the following documents:
- Vermont Statute Title 26, Chapter 28, Subchapter 2
- Part 8 of the Vermont Board of Nursing Administrative Rules
The Vermont Board of Nursing’s administrative rules define the general scope of practice for APRNs as follows:
- It includes all aspects of an RN’s scope of practice
- Medical diagnosis acts such as ordering and interpreting diagnostic tests and procedures
- Prescriptive authority for medications
- Prescriptive authority for medical, therapeutic, or corrective measures
- Giving written or verbal orders to other health care providers
- Managing and evaluating care
APRN Collaborative Agreement in Vermont – Transition to Practice
APRNs in Vermont can practice with full independence with one exception: they must practice within a collaborative agreement with a licensed medical professional if they are inexperienced according to either of the following:
- APRNs who have less than 2,400 hours of advanced practice experience in the past 24 months
- APRNs who have less than 1,600 hours of advanced practice in the past 12 months
The collaborating medical professional must practice in the APRN’s role and population focus, and must be a medical doctor (MD), doctor of osteopathic medicine (DO), or other experienced APRN who can practice independently. This collaborating medical professional must have worked in their area for at least four years.
Information detailed on the collaborative agreement must include:
- Specific client population that will be served – population focus
- Type of care that will be provided – primary care, urgent care, etc
- Description of specialty care that will be provided, if applicable – cardiology, endocrinology, etc
- Quality assurance plan – details about how quality will be assured, such as by retroactive chart review, monthly peer review and evaluation, continuing education to maintain national certification, etc
As long as an APRN is actively working, they must maintain a quality assurance plan. The overall collaborative agreement is also referred to as a, “transition to practice.”
Prescriptive Authority for APRNs in Vermont
All APRNs in Vermont automatically have prescriptive authority. By definition, an MSN program that is approved by the Vermont Board of Nursing includes the necessary courses for prescriptive authority by covering advanced pharmacotherapeutics.
If APRNs want to prescribe controlled substances (Schedule II-IV drugs), they must register with the Drug Enforcement Administration (DEA). APRNs who prescribe opioid drugs to treat chronic pain (except for permanent residents in long-term care facilities) must take specific steps according to new legislation that came into effect in August 2015, including:
- Evaluate the patient’s medical record
- Check for any entries in the Vermont Prescription Monitoring System
- Ask if the patient has recently taken methadone or any other controlled substance
- Take additional precautions if a patient is prescribed opioids for chronic pain for more than 90 days
APRNs may never prescribe buprenorphine for the treatment of opioid dependence.
Practice Guidelines and Independence for APRNs in Vermont
Prior to starting work in a clinical setting – as well as when changing employers or role/population foci – APRNs in Vermont must file practice guidelines with the Board of Nursing and meet approval. The practice guidelines should demonstrate that the APRN is only working within their role/clinical focus, and should include details about:
- The APRN’s role, population focus, and national certification
- The location, name, and contact information for the APRN’s clinical practice site
- A description of an APRN’s quality assurance plan
Once APRNs have filed their practice guidelines and gained the requisite amount of experience through a collaborative agreement or prior employment as an APRN, they may work and prescribe with full independence in Vermont.
Implementation of the APRN Consensus Model in Vermont
The National Council for State Boards of Nursing (NCSBN) developed its APRN consensus model with the goal of achieving uniformity in licensing requirements and scope of practice for APRNs nationwide so as to improve access to quality healthcare services for patients throughout the United States. By extension, the actions called for in the Model would also allow APRNs to move from state to state and practice under a single license.
Vermont is one of the nation’s leaders when it comes to implementing the actions called for in the NCSBN’s APRN Consensus Model. While it could improve implementation of the Model by defining specific scopes of practice for each APRN role, the following policies align Vermont closely with what the NCSBN is calling for:
- Definition of four APRN roles as nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist
- Licensing process for each APRN role that is separate from the RN licensing process
- Complete practice and prescriptive authority that is independent from collaboration or supervision requirements
Renewal Requirements for APRNs in Vermont
The APRN license must be renewed with the Vermont Board of Nursing every two years. As a condition for this, APRNs must meet these conditions:
- Maintain their RN license
- Maintain national certification
- Have practiced as an APRN for at least 400 hours in the past two years, or at least 960 hours in the past five years (this requirement is waived if the candidate earned their MSN in the past two years)
- Collaborative practice agreement, if applicable
- Renew practice guidelines filed with the board, if the APRN is working in a clinical setting