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A Master of Science in Nursing (MSN) remains the most widely accepted educational path for RNs looking to become advanced practice clinicians and clinical nurse leaders, as well as for those looking to pursue non-clinical roles in nurse education and administration. Advanced practice nursing offers a wider scope of practice, a more prestigious salary, and more opportunities for independent practice.
As of 2012, the US Bureau of Labor Statistics (BLS) found there to be 57,270 active RN licenses in Wisconsin, while there were far fewer licenses for advanced clinicians in the various advanced practice roles: 2,140 nurse practitioners, 510 nurse anesthetists, and only 100 nurse midwives.
This elite group of advanced clinicians was well compensated for their advanced education and clinical training. In fact, in 2012 Wisconsin was the third highest paying state for nurse anesthetists in the nation (BLS, 2014):
- Nurse anesthetists: $214,150
- Nurse midwives: $93,640
- Nurse practitioners: $93,170
According to a 2012 Wisconsin Hospital Association (WHA) report, the employment rate for advanced clinicians in Wisconsin’s hospitals grew by 55% in the two years from 2009 to 2011. The WHA expects that number to continue growing as the state’s population ages—24% of the population will be 65 or older by 2035 according to WHA data, requiring a higher number of high-skill primary care providers and specialists. Although advanced practice registered nurses are not yet recognized as independent practitioners in Wisconsin, they fulfill many vital primary care needs for patients while working under collaborative practice agreements with the state’s physicians.
Wisconsin State Certification Requirements for Advanced Practice Nurses
Advanced practice nurses in Wisconsin are referred to as advanced practice nurse prescribers (APNPs). Though Wisconsin’s advanced practice nurses are required to enter into a collaborative agreement with a physician, they do have full prescriptive privileges, which allows them to provide patients with more comprehensive care services. Wisconsin is also counted among the 25 Nursing Licensure Compact (NLC) states, which permits advanced practitioners to practice freely in all other NLC states under their Wisconsin APNP license.
In order to become state certified as an advanced practice nurse prescriber (APNP) through the Wisconsin State Board of Nursing (WSBN), RNs must earn an MSN degree from an accredited program and become nationally certified in a recognized advanced practice role. After becoming certified through a national certifying body in their role and patient population, advanced practice nurse prescribers can practice within the following advanced practice roles:
- Nurse practitioner (NP)
- Certified nurse-midwife (CNM)
- Certified registered nurse anesthetist (CRNA)
- Clinical nurse specialist (CNS)
In order to become licensed to practice as an APNP, the candidate’s graduate program must include at least 45 contact hours in pharmacology. APNPs in Wisconsin are required to register as prescriptive authorities with the Drug Enforcement Agency (DEA).
NP and CNS students are required to designate a patient population focus in their educational program and become nationally certified in that role and patient population. Patient population foci options for CNS and NPs include family/individual across the lifespan, pediatrics, neonatology, women’s health, and adult-gerontology or acute care.
CRNA and CNM students are also required to become nationally certified as either certified registered nurse anesthetists or certified nurse midwives, respectively, in order to become licensed APNPs in the state.
Candidates seeking advanced practice status in Wisconsin may seek national certification through one of several national certifying agencies recognized by the WSBN. The WSBN recognizes the following national certifying agencies and certifications for the purpose of APNP state certification:
Nurse Practitioner
- American Academy of Nurse Practitioners (AANP)
- Family Nurse Practitioner
- Adult Nurse Practitioner
- American Association of Critical Care Nurses Certification Corporation (AACCN)
- Adult Acute Care Nurse Practitioner
- National Certification Corporation for Obstetric, Gynecologic & Neonatal Nursing (NCC)
- Ob/Gyn Nurse Practitioner (Women’s Health Care Nurse Practitioner)
- Neonatal Nurse Practitioner
- Pediatric Nursing Certification Board (PNCB)
- Pediatric Nurse Practitioner
- American Nurses Credentialing Center (ANCC)
- Family Nurse Practitioner
- Adult Nurse Practitioner
- School Nurse Practitioner
- Gerontological Nurse Practitioner
- Pediatric Nurse Practitioner
- Acute Care Nurse Practitioner
Clinical Nurse Specialist
- American Nurses Credentialing Center (ANCC)
- Community Health CNS
- Home Health CNS
- Gerontology CNS
- Medical/Surgical CNS
- Adult Psychiatric and Mental Health CNS
- Child & Adolescent Psychiatric &Mental Health CNS
- American Association of Critical Care Nurses Certification Corporation (AACCN)
- Clinical Nurse Specialist Acute and Critical Care
Certified Nurse Midwives
- American College of Nurse Midwives (ACNM)
- Certified Nurse-Midwives
Nurse Anesthetists
- National Board on Certification & Recertification of Nurse Anesthetists (NBCRNA)
- Certified Registered Nurse Anesthetists
Nursing Licensure Compact
As a member of the Nursing Licensure Compact (NLC), licensed APNPs in Wisconsin are able to practice across state lines without obtaining additional licensure. Twenty-three other states are also part of the NLC as of 2016:
As of 2016, six more states are in the process of passing legislation to join the Nursing Licensure Compact. Other states will likely join the compact in the future as leaders in the field raise awareness of the importance of creating uniform nursing licensure standards across state borders.
Pursuing a Master of Science in Nursing (MSN) in Wisconsin
Although Wisconsin does offer several in-state, accredited MSN programs, online MSN programs are the preferred option for RNs seeking a graduate degree. Many working RNs appreciate the flexibility of an online program that better accommodates their job schedule.
All MSN programs require a certain amount of theory hours and an extensive clinical sequence that involves observation and training hours in physician’s practices, hospitals, and clinics. In an online MSN program, didactic work is completed online while clinical hours are completed in hospitals and clinics that are approved by the university and accessible to the student. Often, clinical hours can be completed at a student’s current place of employment.
Wisconsin Requirements for APNP Educational Programs
The WSBN requires all graduate programs that prepare APNPs to include these core courses:
- Pathophysiology
- Advanced pharmacology
- Physical evaluation/assessment
Because advanced practice nurses in Wisconsin must apply for APNP state certification with prescriptive authority, candidates are required to complete a minimum of 45 contact hours in pharmacology. At time of completion, the candidate is required to submit proof of completion of pharmacology hours to the WSBN.
To qualify for national certification and state APNP certification, candidates must earn a Master of Science in Nursing (MSN) through an accredited program in a specialty track specific to their role:
Nurse Practitioner and Clinical Nurse Specialist Program Accreditation
The WSBN approves NP and CNS master’s programs accredited by the Accreditation Commision for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE). The ACEN publishes a list of approved programs, and the AACN also publishes a list of approved educational programs. These programs may vary in coursework and clinical requirements.
Certified Registered Nurse Anesthetist Program Accreditation
The WSBN approves CRNA programs accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA). Approved CRNA programs are listed on the COA website.
Certified Nurse Midwife Program Accreditation
In order to become certified as a nurse-midwife through the WSBN, nurses must complete an educational program approved by the Accreditation Commission for Midwifery Education (ACME). The ACNM publishes a list of ACME approved educational programs, including MSN programs.
Selecting the Appropriate Type of MSN Program Based on Current Education
Students seeking an MSN degree must select the appropriate program based on of their current level of education:
- RNs with an Associate Degree in Nursing must obtain both a BSN and an MSN to become an advanced practice nurse in Wisconsin. 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 (also called direct-entry) MSN programs, which allow candidates to earn an RN license and MSN degree in preparation for advanced practice certification in Wisconsin.
Laws Concerning Independent Practice for APNPs in Wisconsin
APNPs in Wisconsin are not considered independent practitioners. Rather, they are required to enter into collaborative agreements with supervising physicians. However, APNPs are allowed to prescribe medications and controlled substances to patients without direct supervision, meaning that all advanced practice roles hold prescriptive authority. Ultimately, the physician is responsible for overall patient health and is required to supervise most aspects of care other than prescriptions given by APNPs.
Implementation of the APRN Consensus Model in Wisconsin
The APRN (advanced practice registered nurse) Consensus Model is a nation-wide model designed to bring uniformity to advanced practice legislation, education, and licensing. Although Wisconsin has not fully conformed to the model, the prescriptive authority assigned to all advanced practice roles in 1995 is a step towards independent practice for advanced nurse clinicians in the state.
More recently, legislation has been introduced to give APNPs in Wisconsin more independent authority over patient practice in order to help fill primary care gaps. In 2014, the Henry J. Kaiser Family Foundation published research indicating that Wisconsin required more primary care physicians in order to fill a shortage. If APNPs in the state were granted the ability to practice independently, Wisconsin could meet the needs in most health care shortage areas throughout the state.
APNP Certification Renewal and Continuing Education Requirements in Wisconsin
All licensed APNPs in Wisconsin, regardless of advanced practice role, must complete a minimum of eight contact hours per year in clinical pharmacology/therapeutics. Contact hours must also be relevant to the APNP’s patient population focus and role. APNPs are required to annually submit proof of contact hours to the state board.
The WSBN does not publish guidelines regarding which organizations may sponsor the continuing education hours. Contact hours can be logged in the form of nursing education workshops, seminars, conferences, and training classes for the purpose of continuing education in advanced practice nursing.
In addition to the WSBN requirements, all APNPs and nurse midwives will be required to complete continuing education hours through their national certifying body. Depending on the certifying body, requirements will vary. Some continuing education plans require advanced practice nurses to complete online modules, as well as attend workshops, seminars, and other approved mediums for continuing education hours. Most programs will require submission of continuing education hours every two years. APNPs must consult with their national certifying body to verify continuing education requirements.
APNPs will be required to renew their license online through the WSBN every two years on September 30th of even-numbered years. Because the APNP certification involves prescriptive authority, it must be renewed separately from the RN license. In addition, the RN license must be kept current (renewed every two years) in order to allow the APNP to keep practicing in an advanced practice role.