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The Master of Science in Nursing (MSN) remains the educational standard for RNs interested in becoming advanced practice registered nurses (APRNs), as well as those interested in taking on advanced nonclinical roles as nurse educators, patient advocates, nurse informaticists, administrators and more.
Through advanced clinical preparation in health assessment, pathophysiology and pharmacology, MSN programs prepare RNs to serve as advanced clinicians in one of four roles that align with graduate program specialty tracks – nurse anesthetist, clinical nurse specialist, nurse midwife, or nurse practitioner.
On January 29, 2016, a bill was put before the West Virginia legislature that would align West Virginia nursing laws with the national APRN Consensus Model. Passing of this bill would allow APRNs to practice independently to the full extent of their education and clinical training, which would include the ability to qualify for prescriptive authority without having to enter into a collaborative practice agreement with a physician.
The bill, which is promoted by the West Virginia Nurses Association, would implement a number of measures to ensure the state eliminates APRN practice barriers, including:
- Developing a fact sheet to educate new legislators on misinformation regarding advanced practice nursing
- Increasing media coverage on APRNs’ role in serving West Virginia’s medically underserved areas
- Creating a grassroots campaign consisting of at least 135 APRNs for every one legislator
Licensing Requirements for the APRN Roles Recognized in West Virginia
The West Virginia Board of Examiners for Registered Professional Nurses issues APRN licenses for advanced clinicians in four distinct roles:
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
- Nurse Practitioner (NP)
Qualifying for APRN licensure in West Virginia requires candidates to:
- Hold a current, unrestricted RN license issued by the West Virginia Board of Examiners for Registered Professional Nurses or another state licensing authority
- Earn a master’s or higher degree from a program that includes an emphasis in one of the four APRN roles
- Become nationally certified in one of the four APRN roles
Those preparing for the NP or CNS role would also focus studies and become nationally certified in one or more patient population focus areas (family-individual across the lifespan, adult-gerontology primary or acute care, neonatology, psychiatric-mental health, women’s health, pediatrics).
The Board recognizes national certifying bodies that are accredited by the American Board of Nurse Specialties or National Commission for Certifying Agencies. These bodies and their certifications for each role include:
Clinical Nurse Specialist (CNS)
- AACN Certification Corporation
- Adult acute and critical care CNS
- American Nurses Credentialing Center
- Adult psychiatric-mental health CNS
- Family psychiatric-mental health CNS
- Gerontology CNS
- Adult health CNS
- Public/Community Health CNS
Certified Registered Nurse Anesthetist (CRNA)
Certified Nurse-Midwife (CNM)
Nurse Practitioner (NP)
- AACN Certification Corporation
- Acute Care Nurse Practitioner Adult-Gerontology (ACNPC-AG)
- American Academy of Nurse Practitioners
- Adult nurse practitioner
- Family nurse practitioner
- Gerontologic nurse practitioner
- American Nurses Credentialing Center
- Acute care nurse practitioner (adult/gerontology)
- Adult nurse practitioner
- Family nurse practitioner
- Gerontological nurse practitioner
- Pediatric nurse practitioner
- Adult psychiatric and mental health nurse practitioner
- Family psychiatric and mental health nurse practitioner
- Pediatric Nursing Certification Board
- Pediatric nurse practitioner primary care
- Pediatric nurse practitioner acute care
- National Certification Corporation
- Women’s health nurse practitioner
- Neonatal nurse practitioner
Earning a Master of Science in Nursing (MSN) in West Virginia
With few campus-based locations that offer MSN programs in West Virginia, many of the state’s aspiring APRNs elect to enroll in accredited online programs. Through these programs, students are able to complete curricular coursework online without sacrificing current work obligations. Clinical sequences are completed at approved facilities in the area, which students would be placed in with help from a program advisor. In many cases, students are able to complete the clinical component of their graduate program at their current place of employment.
Regardless of the role-specific emphasis of the graduate program, it must include the standard core for all graduate programs that prepare advanced nurse clinicians:
- Didactic components that prepare nurses for their APRN role
- Pharmacology
- Advanced physical assessment
- Advanced pathophysiology
- Clinical management of disease and differential diagnosis
The programs must additionally include supervised clinical experience opportunities that incorporate application of all the didactic components.
Qualifying for APRN licensure in West Virginia starts by completing a graduate-level nursing program that is recognized by the West Virginia Board of Examiners and accredited by an agency recognized by the United States Department of Education (USDE) or the Council for Higher Education Accreditation (CHEA):
Clinical Nurse Specialist/Nurse Practitioner Programs – The Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) are the two recognized national accrediting bodies for CNS and NP graduate-level nursing programs. There are two ACEN-accredited graduate programs in West Virginia, located in Huntington and Buckhannon. The CCNE accredits two MSN programs in West Virginia, located in Morgantown and Wheeling.
Certified Registered Nurse Anesthetist Programs – The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) is the nationally recognized accrediting body for CRNAs. The one COA accredited school in West Virginia is located in Charleston.
Certified Nurse-Midwife Programs – The Accreditation Commission for Midwifery Education (ACME) is the national accrediting body nurse-midwives programs. There are no ACME-accredited programs in West Virginia.
Selecting the Right Type of Program Based on Current Education
MSN programs are structured in a variety of ways to accommodate both ADN and BSN-prepared RNs:
- RNs with an Associate Degree in Nursing: Associate’s-prepared RNs would enroll in RN-MSN bridge programs to earn both a BSN and MSN in one accelerated program. These programs typically consist of between seven and nine semesters of study.
- RNs with a Bachelor of Science in Nursing (BSN): RNs who hold a BSN would pursue traditional MSN programs, which typically take between 18 and 30 months to complete.
- Professionals with a Bachelor’s Degree in a Subject Other Than Nursing: Direct-entry (or entry-level) MSN programs cater to aspiring APRNs who hold a bachelor’s degree in an area other than nursing. Through these programs, students may earn both an RN license and MSN degree, typically over a three-year period.
Scope of Practice and West Virginia State Laws Governing Advanced Practice Registered Nursing
APRNs in West Virginia may perform acts consistent with their education and national certification. The West Virginia Board of Examiners for Registered Professional Nurses lists the criteria for determining the scope of practice for the state’s licensed nurses on its website.
- CNMs must practice in accordance with the standards set forth by the American College of Nurse Midwives.
- CRNAs must practice in accordance with the American Association of Nurse Anesthetists’ current guidelines and standards for nurse anesthesia practice.
- CNSs must practice in accordance with their population focus and area of further specialization, defined by the national certifying body from which they received their certification
- NPs must practice in accordance with their population focus and area of further specialization, defined by the national certifying body from which they received their certification
Prescriptive Authority for APRNs in West Virginia
APRNs in West Virginia may apply to earn limited prescriptive authority, provided they have completed a minimum of 45 contact hours in graduate-level pharmacology. A minimum of 15 of these hours must be completed within two years of initial APRN licensing.
The written collaborative agreement between West Virginia APRNs and licensed physicians must include the following details regarding prescriptive authority:
- The guidelines and protocols for the APRN’s prescriptive authority
- The periodic and joint evaluation of prescriptive practice
- The individual and shared responsibilities of the APRN and physician
- The periodic and joint review and updating of the agreement’s guidelines and protocols
The West Virginia Board of Examiners for Registered Professional Nurses lists the following restrictions regarding APRN prescriptive authority in the state:
- APRNs may not prescribe Schedule I and Schedule II substances, as defined in the Uniform Controlled Substances Act
- APRNs may not prescribe antineoplastics, radiopharmaceuticals and general anesthetics
- APRNs may only prescribe MAO Inhibitors within a collaborative agreement with a psychiatrist
- APRNs may only prescribe 72-hour supplies of Schedule III substances and benzodiazepines, and the prescriptions must be without refill
- APRNs may only prescribe phenothiazines for up to a 30-day supply and with no refills
- APRNs may prescribe Schedule IV-V drugs for only up to a 90-day supply and with only one refill
- Schedule IV-V drug prescriptions written by APRNs must expire within six months
Independent Practice, Collaborative Agreements, and Implantation of the APRN Consensus Model in West Virginia
With the exception of CNMs, APRNs in West Virginia may diagnose, treat, and refer patients without a physician’s collaborative agreement, although such an agreement is required for APRNs with prescriptive authority.
CNMs must enter into a collaborative relationship with a physician practicing in obstetrical and gynecological patient care, regardless of whether the CNM has prescriptive authority.
In 2008, over 40 nursing organizations collaborated to establish the APRN Consensus Model, a proposed uniform set of rules for APRNs across the U.S designed to remove significant practice restrictions. As of February 2016, West Virginia had adopted the following major components of the model:
- Title
- Role
- License
- Education
- Certification
- Independent practice for NPs
If passed, House Bill 4334, which was presented to the West Virginia Legislature in January 2016, would align West Virginia nursing laws with all components of the national model.
Continuing Education Requirements for APRNs in West Virginia
To maintain licensure as an APRN in West Virginia, nurses must complete the Continuing Education (CE) requirements for both their RN license and APRN license.
RN License Renewal Each Year
To maintain RN licensure, APRNs must complete 12 contact hours of CE every annual renewal cycle.
APRN License Renewal Every Two Years
To maintain APRN licensure, APRNs must complete 24 contact hours of CE every two-year renewal cycle. The CE must consist of 12 hours in pharmacotherapeutics (eight of which may be used for renewal of prescriptive authority) and 12 hours in the clinical management of patients. APRNs may use 12 of these 24 hours towards the renewal requirements for their RN license.
APRNs with prescriptive authority must complete an additional eight hours of CE in pharmacology or pharmacotherapeutics each two-year license renewal cycle. APRNs must also maintain proof of national certification in their respective role to present to the Board when applying for license renewal, and at the Board’s request in the event of an audit.
The Board lists CE provider resources on its website.