APRNs are being recognized more and more for their ability to keep health systems running at peak performance. Their background in registered nursing earns them a unique level of clinical credibility among nursing staff and also seems to contribute to their focus on the patient experience. At the same time, their extensive clinical experience and advanced education and training means they also have a seat at the table alongside physicians and hospital administration. In this way, APRNs serve as the bridge that helps span the divide between leadership and nursing staff, all the while ensuring patients are getting the best care available.
APRNs manage patient care at an advanced level as certified nurse practitioners (CNPs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs), or certified nurse-midwives (CNMs).
Nurses working in these expanded roles improve health care at every level as leaders who influence healthcare policy, conduct research, and ultimately implement evidence-based solutions in providing patient-centered care.
Although each APRN role is distinct, the path to national certification and state licensure is largely similar, requiring an education at the master’s or post-master’s level.
APRN Graduate School Requirements: Core Knowledge and Roll-Specific Training
A graduate degree serves as the educational foundation that prepares advanced practice nurses for clinical mastery in each of the four recognized APRN roles. The two accrediting agencies for MSN degrees—the Commission on Collegiate Nursing Education (CCNE) and the National League for Nursing Accrediting Commission (NLNAC)—accredit more than 330 nursing master’s programs offered through schools throughout the U.S.
Master’s degrees in nursing for advanced practitioners may go by a number of titles, but all share a similar core:
- Graduate Nursing Core: Foundational curriculum content essential for all students
- Direct Care Core: Essential content for providing direct patient services at an advanced level
- Functional Area Content: Clinical and classroom learning experiences identified by the professional nursing organization and certification bodies for specific nursing roles or function
Of course, study at the graduate level would incorporate the theories and concepts of nursing science, but these programs also work to make it all real by guiding students in the way these concepts are applied in the clinical environment. The idea is to literally show students how evidence is used to inform decisions in the clinical environment and how doing so works to improve patient outcomes, rather than simply teaching the concept of evidence based practice.
The goal is to help students develop the expertise, leadership skills, and interpersonal skills needed to improve healthcare systems from every angle – from the bedside all the way up to the boardroom.
All nursing master’s programs include components designed to produce graduates who can both lead and practice in complex healthcare systems:
- Graduate study in the sciences and humanities
- Organizational and systems leadership
- Quality improvement and safety
- Translating and integrating scholarship into practice
- Informatics and healthcare technologies
- Healthcare policy and advocacy
- Interprofessional collaboration
- Clinical prevention and population health
These programs consist of between 18-24 months of full-time study, although many graduate students today are working nurses who fit their master’s degree around their busy work schedules, so it’s common for the degree program to take longer to complete.
According to the Consensus Model for APRN Regulation, APRN graduate programs must include clinical and didactic content that is specific to an APRN role and population focus:
- Certified Nurse Practitioner (CNP)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Nurse Specialist (CNS)
- Certified Nurse-Midwife (CNM)
- Family/Individual Across the Lifespan
- Psychiatric/Mental Health
- Women’s Health/Gender-Related
Every APRN program is expected to contain the essential components for developing foundational clinical competencies in addition to teaching practice fundamentals for the respective APRN role.
Gaining an understanding of certain psychological principles, as well as developing critical thinking, inductive reasoning, problem solving, and active listening skills is also vital for anybody that is being looked to as a clinical leader.
Although specific coursework varies according to the APRN role and population focus, every APRN is prepared to assume responsibility and accountability in the clinical setting – from health promotion and maintenance, to the assessment, diagnosis, and management of patient problems.
An APRN education must include separate and comprehensive graduate-level courses in three areas:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Health assessment, including the assessment of all human systems, and advanced assessment concepts, approaches, and techniques
- Pharmacology, includes pharmacokinetics, pharmacotherapeutics, and pharmacodynamics
It must also include appropriate clinical experiences (minimum 500 clinical hours).
APRN Clinical Experiences: Applying Theory to Real World Situations
As clinical leaders, APRNs are often the ones making the call on the best course of action in tense situations and often have a hand in developing patient care plans. This means that graduate courses and clinical experiences are designed to help provide an understanding of the principles of clinical decision-making when it comes to both snap judgments and carefully considering treatment options.
As the saying goes, tell me and I forget, teach me and I might remember, involve me and I learn…
Many consider clinical experiences to be among the most important components of an APRN graduate program. How else can students truly learn to understand, perform, and refine their professional competencies than through experience?
All clinical practice experiences must be supervised and evaluated by faculty.
All graduate students must complete clinical practice experiences that provide them with the opportunity to acquire new knowledge.
The primary goals of clinical learning experiences in APRN programs are to provide students with the opportunity to:
- Build and lead collaborative interprofessional care teams
- Continue to engage in lifelong learning
- Design innovative nursing practices
- Ensure the successful integration of services across the healthcare system
- Lead change to improve quality care outcomes
- Translate evidence into practice
Preceptorships are based on the concept of role-modeling as a way to share acquired knowledge through a process referred to as “knowledge transfer.” Through this process, the student acquires skills and information that will help to develop their professionalism, clinical techniques, and understanding of evidence-based practice.
The preceptor works with nursing students as an extension of the academic clinical instructor by providing a series of clinical rotations that serve to enhance the practical application of knowledge the student has already obtained. The preceptor selects patients that can provide the student with clinical learning experiences in all areas of care, including assessment, diagnoses, and the development of treatment plans. Important components of the relationship include problem-solving discussions related to patient interactions and processes, as well as preceptor consultation at the student’s request or when the preceptor feels the student needs it.
For the student, the experience helps them to more fully assimilate content and theory for a real understanding of how it is applied in a broad range of healthcare settings. Integrating students into the practice setting also provides opportunities to hone critical-thinking, organizational, and management skills.
Healthcare facilities and nursing departments value the fact that clinical experience rotations enhance the relationship among students and full-time staff. Feedback from preceptors and nursing staff is also used to provide schools with an opportunity to refine and improve educational programs and resources.
For the preceptor, there are many rewards that come with the experience, although preceptorships don’t typically involve any monetary compensation for either party. The role can sometimes provide benefits in one or more areas of professional life; for example, academic faculty affiliation and privileges, additional exposure and experience in new healthcare settings, credit hours toward recertification, and an expanded relationship with the academic community.
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Schools Offer APRN Graduate Degree Options for Every Background and Experience Level
Depending on where you are in your career and your current educational level, the type of master’s degree program you choose for completing your APRN education will be different:
Entry-Level/Direct-Entry Master’s Degrees
- Who They’re For: Candidates with a bachelor’s or master’s degree in a discipline other than nursing
- Details: Includes baccalaureate-level content and initial RN licensure, followed by the master’s degree nursing program
- Admission Requirements: A bachelor’s degree from an accredited college or university; many programs also require a minimum undergraduate GPA or minimum GRE scores
- Who They’re For: Nurses with an associate’s degree in nursing and RN licensure
- Details: Requires about 2-3 years of study, with the required bachelor’s level content built onto the front end
- Admission Requirements: An associate’s degree in nursing from an accredited institution and current RN license; many programs also require a minimum GPA or minimum GRE scores and the completion of specific prerequisite courses prior to admission, such as:
- Human Anatomy and Physiology
- Who They’re For: Nurses with a bachelor’s degree and RN licensure
- Details: Completed in 18-24 months of full-time study
- Admission Requirements: Bachelor’s degree in nursing from an accredited college or university; many programs also require a minimum GPA or minimum GRE scores
Post-Master’s Certificate Programs
- Who They’re For: Master’s-prepared RNs
- Details: Allow graduate-prepared nurses to focus their knowledge and clinical skills in an APRN specialty or other specialty area of practice
- Admission Requirements: Minimum GPA in undergraduate and graduate nursing degrees, RN license; most programs require at least a few years of nursing experience
Doctoral Nursing Programs
- Who They’re For: Master’s prepared nurses and APRNs interested in assuming leadership, teaching, or research positions
- Details: Includes
- Doctor of Nursing Practice (DNP) programs (clinical doctoral programs)
- PhD programs (research-based programs for academic and research careers)
- MSN-DNP programs
- Accelerated BSN-DNP programs