Master of Science in Nursing as a Path to Advanced Practice Licensure

A Master of Science in Nursing (MSN) provides a broad-based education for the aspiring Advanced Practice Registered Nurse (APRN).

MSN programs for APRNs are designed specific to one of the four APRN roles (Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife) and at least one of the six population foci (women’s health, adult-gerontology, neonatal, pediatrics, family/individual across the lifespan, and psych/mental health).

MSN programs encompass the following:

    • At least three, separate and comprehensive graduate-level courses in:
      • Advanced physiology/pathophysiology, including general principles across the lifespan
      • Advanced health assessment, including the assessment of all human systems, advanced assessment techniques, and concepts and approaches
      • Advanced pharmacology
    • Comprehensive clinical and didactic coursework sufficient enough to prepare graduates to practice in the APRN role and population focus
    • Direct and indirect clinical supervision that is congruent with current national specialty organizations and nursing accreditation guidelines
    • Additional content, specific to the role and population

Beyond this core curriculum, MSN program content varies depending on the APRN role and the population focus the program covers:

Master of Science in Nursing for Nurse Practitioners (NP)

Nurse practitioners provide care in an independent capacity in a number of settings and in one of six patient populations (women’s health, adult-gerontology, neonatal, pediatrics, family/individual across the lifespan, and psych/mental health).

The scope of their work includes health promotion, disease prevention, health education, and counseling, as well as the diagnosis and management of acute and chronic diseases. They may serve as primary care NPs or acute care NPs, and they may provide care in family practice, internal medicine, pediatrics, geriatrics, and women’s health.

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MSN programs for nurse practitioners vary widely based on the patient population; therefore, students interested in becoming a nurse practitioner may choose to focus their degree on one of the following NP practice areas:

      • Acute care
      • Adult primary/acute
      • Gerontology primary/acute
      • Emergency care
      • Family care primary/acute
      • Neonatal primary/acute
      • Pediatric primary/acute care
      • Psychiatric
      • Women’s health

Coursework within these programs differ based on the chosen nurse practitioner specialization. For example:

Family Nurse Practitioner

      • Nurse practitioner role with healthy individuals and families
      • Nurse practitioner role with individuals and families with complex or chronic health problems
      • Nurse practitioner role with children and families
      • Nurse practitioner role with pediatric populations

Adult Gerontology Acute Care

      • Adult gerontology acute care nurse practitioner role
      • Pharmacology for acute care nurse practitioners
      • Health assessment of the adult gerontology population in acute care

Primary Care Pediatric Nurse Practitioner

      • Advanced pediatric pharmacotherapeutics
      • Advanced practice nursing in pediatric primary care
      • Practicum in primary health care of children
      • Scientific underpinnings for advanced nursing practice
      • Current issues in the delivery of advanced pediatric care

Acute Care Pediatric Nurse Practitioner

      • Advanced pediatric pharmacotherapeutics
      • Practicum in acute health care of children
      • Advanced practice nursing in pediatric acute care

Nurse Practitioner Core Competencies

Certified nurse practitioners provide initial, ongoing, and comprehensive care that includes health promotion, disease prevention, health education, and counseling, as well as the diagnosis and management of acute and chronic diseases.

The National Organization of Nurse Practitioner Faculties (NONPF) identifies core competencies that are relevant for all NPs irrespective of their patient population or specialty areas. Through education and clinical patient care practice, NPs gain the knowledge and skills to provide care in an independent clinical practice arena.

In 2011, the NONPF combined the core competencies of master’s prepared NPs with those expected of doctorate prepared NPs in an effort to ensure that all practitioners have the same level of knowledge and skill. Each of the following nine competencies includes several component elements and, in total, provide a good overview of the skills and proficiencies of a highly-trained independent nurse practitioner.

    • Scientific Foundation
    • Leadership
    • Quality of Health Care
    • Practice Inquiry
    • Technology and Information Literacy
    • Health Policy
    • Health Delivery Systems
    • Ethics
    • Independent Practice

Master of Science in Nursing for Clinical Nurse Specialists (CNS)

Clinical nurse specialists (CNS) oversee the diagnosis and treatment of patients with a focus on disease management, health promotion, and the prevention of illness among individuals, families, groups, and communities.

They may focus their area of clinical expertise according to a:

      • Population (e.g., women’s health, pediatrics, geriatrics, etc.)
      • Setting (e.g., primary care, critical care, emergency care, etc.)
      • Disease or medical subspecialty (e.g. oncology, diabetes, etc.)
      • Type of care (e.g., rehabilitation, psychiatric, etc.)
      • Type of health problem (e.g., pain, wounds, stress, etc.)

The curriculum of CNS programs varies based on the chosen specializations. For example:

CNS Adult/Gerontology Clinical Nurse Specialist

      • Principles of adult gerontology acute care
      • Role of the clinical nurse specialist
      • Primary care: diagnosis and management of adults across the lifespan
      • Family focused primary care of the middle-aged and older adult

CNS Women and Children’s Health

      • Managing acute care conditions in women and children
      • Health promotion for women and children
      • Managing chronic conditions in women and children

CNS Psychiatric Mental Health Adult

      • Psychiatric mental health nursing practicum
      • Psychiatric mental health for advanced practice nursing: adult, individual, and family
      • Psychiatric mental health for advanced practice nursing: group, organization, and community
      • Theories for advanced psychiatric mental health nursing
      • Neurobiology and psychopharmacology of major psychiatric disorders

Clinical Nurse Specialist (CNS) Core Competencies

Clinical nurse specialists integrate care across the healthcare continuum and through what are referred to as the three spheres of influence: patient, nurse, and system. The primary goal of the CNS is to continuously improve patient outcomes and nursing care. The key elements of the CNS practice include mentoring and systems change.

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The National Association of Clinical Nurse Specialists (NACNS) recognizes a number of competencies that all CNSs should possess:

  • Direct Care Competency: Includes direct interaction with patients, families, and groups of patients to promote health or well-being and improve quality of life
  • Consultation Competency: Includes interactions between professionals or with patients and staff as a consultant with specialized expertise
  • Systems Leadership Competency: Focuses on the ability to manage change and empower others to influence clinical practice and political processes
  • Collaboration Competency: Includes working with others and collaborating at an advanced level to optimize clinical outcomes
  • Coaching Competency: Includes skillful guidance and teaching to advance the care of patients, families, groups of patients, and the profession of nursing
  • Research Competency: focuses in thorough and systematic inquiry; using evidence in clinical practice, quality improvement, and active participation in research
  • Ethical Decision-Making, Moral Agency, and Advocacy Competency: Focuses on identifying and taking action regarding ethical concerns at all levels

Master of Science in Nursing for Certified Registered Nurse Anesthetists (CRNA)

Clinical registered nurse anesthetists (CRNA) provide anesthetic care for individuals across the lifespan. They provide care in diverse settings, including hospital surgical suites and anywhere else anesthesia is used in performing surgical procedures.

The curriculum of a CRNA program includes:

      • Applied science related to anesthesia
      • Principles of nurse anesthesia practice
      • Evidence-based practice for nurse anesthetists
      • Advanced technologies and clinical decisions in acute care
      • Clinical fieldwork in nurse anesthesia practice

Certified Registered Nurse Anesthetist (CRNA) Core Competencies

According to the American Association of Nurse Anesthetists (AANA), CRNAs deliver high-quality, holistic, evidence-based anesthesia and pain care services for patients across the lifespan, at all acuity levels, and in a variety of settings:

  • Hospital surgical suites
  • Obstetrical delivery rooms
  • Critical access hospitals
  • Ambulatory surgical centers
  • Doctors’ offices
  • Acute care and pain management centers

While a CRNA’s scope of practice is determined by education, experience, state and federal law, and facility policy, the AANA recognizes a CRNA’s competencies as including the following:

  • Arranging and evaluating diagnostic tests
  • Facilitating emergence and recovery from anesthesia
  • Performing point-of care testing
  • Planning and initiating anesthetic techniques
  • Providing acute, chronic, and interventional pain management services, as well as critical care and resuscitation services
  • Providing post-anesthesia care, including medication management, post-anesthesia evaluations, and discharge from post-anesthesia care
  • Requesting consultations
  • Responding to emergency situations using airway management and other techniques

Master of Science in Nursing for Certified Nurse-Midwives (CNM)

Certified nurse midwives (CNM) provide a full range of health services to women across the lifespan. Therefore, the scope of their work is broad, encompassing, prenatal/postpartum care, family services, childbirth, care of the newborn, and gynecologic care.

CNMs provide their services in a wide array of settings, including homes, birthing centers, hospitals, and ambulatory care settings.

The curriculum of a nurse-midwifery MSN program includes:

      • Antepartal care for nurse-midwifery
      • Practicum in primary health care of the adult
      • Skills for nurse-midwifery
      • Nurse-midwifery care of the mother-baby
      • Intrapartum/postpartum care for nurse-midwifery
      • Practicum in intrapartum/postpartum/neonatal nurse-midwifery

Certified Nurse-Midwife (CNM) Core Competencies

Certified nurse-midwives provide a full range of primary healthcare services to women throughout the lifespan. This includes:

  • Care of the newborn
  • Childbirth
  • Family planning services
  • Gynecological care
  • Preconception care
  • Prenatal and postpartum care

Care is provided in settings such as:

  • Ambulatory care settings
  • Birthing centers
  • Community health clinics
  • Homes
  • Hospitals
  • Private offices

The American College of Nurse-Midwives’ (ACNM) Core Competencies for Basic Midwifery Practice details the basic requirements for graduates of nurse-midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME).

Midwifery education is based on an understanding of health sciences theory and clinical preparation that ensures graduates are prepared to provide primary healthcare management to women and newborns.

The ACNM identifies the hallmarks of midwifery as:

  • Recognition of menarche, pregnancy, birth, and menopause as normal physiologic and developmental processes
  • Advocacy of non-intervention in normal processes in the absence of complications
  • Incorporation of scientific evidence into clinical practice
  • Promotion of woman- and family-centered care
  • Empowerment of women as partners in healthcare
  • Facilitation of healthy family and interpersonal relationships
  • Promotion of continuity of care
  • Health promotion, disease prevention, and health education
  • Promotion of a public care perspective
  • Care to vulnerable populations
  • Advocacy for informed choice, share decision making, and the right to self-determination
  • Integration of cultural humility
  • Incorporation of evidence-based complementary and alternative therapies in education and practice
  • Skillful communication, guidance, and counseling
  • Therapeutic value of human presence
  • Collaboration with other members of the interprofessional healthcare team
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Courses in an APRN program in nurse-midwifery are aligned with the fundamental components of midwifery care, which include:

  • Anatomy and physiology, including pathophysiology
  • Normal growth and development
  • Psychosocial, sexual, and behavioral development
  • Basic epidemiology
  • Nutrition
  • Pharmacokinetics and pharmacotherapeutics
  • Principles of individual and group health education
  • Bioethics related to the care of women, newborns, and families
  • Clinical genetics and genomics

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