Master's Education in Nursing and Areas of Practice
Graduates with a master’s degree in nursing are prepared for a variety of roles and areas of practice. Graduates may pursue new and innovative roles that result from health reform and changes in an evolving and global healthcare system. Some graduates will pursue direct care practice roles in a variety of settings (e.g., the Clinical Nurse Leader (CNL), nurse educator). Others may choose indirect care roles or areas of practice with an aggregate, systems, or organizational focus, (e.g. nursing or health program management, informatics, public health, or clinical research coordinator). In addition to developing competence in all nine of the Essential core areas delineated in The Essentials of Master’s Education in Nursing, each graduate will have additional course work in an area of practice or functional role. This coursework may include more in-depth preparation and competence in one or two of the Essentials or in an additional/ supplementary area of practice. For select areas of practice, specialty nursing organizations have developed nationally recognized competencies and curricular recommendations, which are required for certification and practice in these identified areas. Information regarding these areas of practice and linkages to the appropriate documents or competencies are included in the table below. Brief descriptions are presented of the major areas of practice for which master’s graduates are currently prepared.
Direct Care Roles
Clinical Nurse Leader
The Clinical Nurse Leader or CNL is a master’s prepared nurse and clinical leader in the healthcare delivery system in all settings in which care is delivered. The role may vary depending upon the setting and patient population. The CNL is educated with a focus on improving quality of care delivered at the microsystem or unit level. The CNL applies advanced competencies in nursing leadership, interprofessional communication, care environment management, integration and coordination of care, risk assessment, implementation of evidence-based practice, and evaluation of clinical outcomes. Nationally recognized competencies for the Clinical Nurse Leader (CNL) are delineated in the White Paper on the Education and Role of the Clinical Nurse Leader (AACN, 2007).
Students in a CNL program are eligible to sit for CNL certification offered by the Commission on Nurse Certification (CNC) immediately prior to or after graduation from an approved CNL master’s or post-master’s program. Eligibility criteria and additional information regarding the certification process and resources can be found at http://www.aacn.nche.edu/cnl/cnc.
The AACN Preferred Vision of the Professoriate in Baccalaureate and Graduate Nursing Programs (2008) states that “courses in the nursing program will be taught by faculty with graduate-level academic preparation and advanced expertise in the areas of content they teach.” There is national recognition, however, of the growing shortage of nursing educators to fill faculty and other educator roles within the healthcare delivery system. Master’s programs that prepare graduates for nurse educator roles are designed to meet these needs. Nurses with a master’s degree may teach patients and their families and/or student nurses, staff nurses, and a variety of direct-care providers. As outlined in Essential IX, all master’s-prepared nurses will develop competence in applying teaching/learning principles in work with patients and/or students across the continuum of care in a variety of settings. However, as recommended in the Carnegie Foundation report (2009), Educating Nurses: A Call for Radical Transformation, those individuals who choose a nurse educator role, as do all master’s graduates, require preparation across all nine Essential areas, including graduate-level clinical practice content and experiences in an area of nursing practice.
A program preparing individuals for a nurse educator role, in addition to focusing on the competencies in all nine Essential areas, should include course work in curriculum design and development, teaching methodologies, educational needs assessment, and learner-centered theories and methods. The master’s prepared nurse educator differs from the baccalaureate nurse in depth of his/her understanding of the nursing discipline and nursing practice in addition to the added pedagogical skills. Further, in order to teach students, patients, and caregivers regarding health promotion, disease prevention, or disease management, the master’s curriculum for the nurse educator builds on baccalaureate knowledge with graduate-level content in the areas of health assessment, physiology/pathophysiology, and pharmacology to strengthen the graduate’s scientific background and facilitate his/her understanding of nursing and health-related information. In addition, the master’s student who is being prepared for the educator role needs additional content in an identified area of nursing practice and opportunities in the practice environment to integrate this new knowledge and skills into one’s nursing practice. Those master’s students who aspire to faculty roles in baccalaureate and higher degree programs will be advised that additional education at the doctoral level is needed (AACN, 2008).
The National League for Nursing (NLN) has identified specific competencies related to the educator role as well as tasks associated with each of these competencies. These competencies can be accessed at http://www.nln.org/profdev/corecompetencies.pdf. A certification for academic nursing educators is also available; additional information regarding the certification criteria can be found at http://www.nln.org/certification/index.htm.
Advanced Practice Registered Nursing (APRN) Roles
In 2004, the member schools affiliated with the American Association of Colleges of Nursing (AACN) voted to endorse the Position Statement on the Practice Doctorate in Nursing. This decision called for moving the current level of preparation necessary for advanced nursing practice from the master’s degree to the doctorate-level by the year 2015. This transition is moving forward rapidly. As of April 2011, 153 DNP programs were enrolling students at schools of nursing nationwide, and an additional 160 DNP programs were in the planning stages. DNP programs are available in 37 states plus the District of Columbia. Despite this rapid transition of APRN programs to the doctorate-level, it is recognized that for a variety of reasons not all programs will be transitioned by 2015. Master’s degree nursing programs preparing graduates for any of the four APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or nurse practitioner (NP), must include preparation in all nine Essential areas and must include three separate graduate-level courses in the following areas: advanced physiology/pathophysiology, advanced health assessment, and advanced pharmacology. These three courses, identified as the APRN Core, must meet the criteria delineated in the 2008 Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education. In addition the expected outcomes for each of these three APRN core courses are delineated in The Essentials of Doctoral Education for Advanced Nursing Practice.
Nationally recognized competencies for each of the APRN roles have been established by the profession and are listed in the table on Graduate Roles and Advanced Role Competencies (p. 44). In addition to the role competencies, the APRN graduate must be prepared with nationally recognized competencies in at least one of six population foci. The population-focused competencies for the family/across the lifespan, pediatric acute care and pediatric primary care, neonatal, women’s health, and psychiatric/mental health NP are under revision and should be available by early 2012. The population-focused competencies for the Adult-Gerontology Primary Care NP, Adult-Gerontology Acute Care NP and the Adult-Gerontology CNS are available at http://www.aacn.nche.edu/education-resources/competencies-olc.
The components of the APRN curriculum are shown here:
Indirect Care Roles or Areas of Practice that Focus on Aggregates, Systems, or Organizations
Public Health Nurse
Specialist level competencies in public health nursing reflect preparation at the graduate degree level, which traditionally has been recognized at the master’s degree level. Graduate education for advanced public health nursing practice is in transition. In 2007, the Association of Community Health Nursing Educators (ACHNE) published a statement that supports the national movement toward the practice doctorate as a terminal degree for advanced nursing practice. The document also addresses titling, challenges to the public health nursing workforce, characteristics of graduate prepared public health nurses, and educational content in a graduate public health nursing program. Public health nursing is recognized as the preferred title; this designation differentiates this area of population-focused nursing practice from other practices that are community-based but are not population-focused. ACHNE also recognizes that the transition to the DNP degree may require the development of a variety of collaborative education models and will require the development of specific competencies for the doctorally prepared advanced public health nurse.
Public health nursing competencies have been delineated by the Quad Council, which is an alliance of the four national nursing organizations that address public health nursing issues: the Association of Community Health Nurse Educators (ACHNE), the American Nurses Association’s Congress on Nursing Practice and Economics (ANA), the American Public Health Association-Public Health Nursing Section (APHA), and the Association of State and Territorial Directors of Nursing (ASTDN). The approach utilized by the Quad Council builds on the core competencies for all public health professionals and differentiates those aspects that are unique to public health nursing practice. Public health nurses are population-focused; however, these nurses also practice at the individual and family level.
Public health nurse educated at the master’s degree level are prepared across all of the nine Essential areas with more in-depth preparation in Essential VIII (Clinical Prevention and Population Health for Improving Health). The master’s graduate in advanced public health nursing would also demonstrate achievement of the competencies delineated by the Quad Council (2003).
The TIGER or Technology Informatics Guiding Education Reform initiative represents a collaborative of leaders and organizational advocates focused on nursing’s role and responsibility in informatics. In addition to developing a minimum set of informatics competencies that all nurses need to have to practice in the current health care system, the TIGER vision recognizes the need for developing leaders in management and informatics. The beginning-level for specialty education in nursing informatics is recognized as the master’s degree level. In addition to preparation with the outcome competencies in all nine Essential areas, the graduate would receive more in-depth content and experiences in Essential V, Informatics and Health Care Technologies.
Clinical Research Coordinator
The clinical research coordinator is educated to work with the doctorally prepared nurse or health professional researcher. The clinical research coordinator is prepared to provide support on and coordinate a variety of types of nursing or other health related research. In addition to preparation in all nine Essential areas, more concentrated coursework or further development of the knowledge and skills embedded in Essential IV, Translational Scholarship for Evidence-Based Practice, are needed to prepare the nurse to manage research projects for nurse scientists and other healthcare researchers working in multi-professional research teams. As in all master’s degree nursing education programs, students should have formal clinical/practice experiences within the program to further develop and integrate new knowledge and skills in an area of nursing practice. Currently, no nationally recognized competencies and curricular recommendations exist for this specific master’s education track.
Nurse Administrator or Manager
Preparation of the nurse administrator or manager is at the graduate level, either the master’s or doctoral level. Individuals with graduate level preparation in nursing management or administration are needed to fill a variety of roles across the healthcare delivery system. In addition to preparation in the nine Essential areas, more in-depth preparation in Essential II, Organizational and System Leadership, will provide knowledge useful for nursing management roles. The Council on Graduate Education for Administration in Nursing (CGEAN) and the American Organization of Nurse Executives (AONE) have developed nationally recognized competencies for the educational preparation of nurse executives. These competencies can be accessed at http://www.aone.org/resources/leadership. In addition, two separate certifications are offered by AONE for graduates with a focus on nursing administration or management: Certified in Executive Nursing Practice (CENP) and Certified Nurse Manager and Leader (CNML). Graduates with a master’s or higher degree with a focus on nurse executive practice plus two years of experience are eligible for the CENP. Graduates of BSN or higher degree programs with two or more years of experience in a nurse manager role are eligible to sit for the CNML, offered in partnership with the American Association of Critical Care Nurses. Additional information regarding eligibility and certification in these two areas can be found at http://www.aone.org/resources/certification/about_certifications.shtml.