At this point, everybody knows the factors in play – political wrangling over national healthcare coverage … a growing number of Americans living with chronic diseases … an aging Baby Boomer population … All these things have been piling on to further burden an already over-taxed healthcare system.
The result? Not enough physicians to meet the growing demand. In fact, the Association of American Medical Colleges projects a total physician shortfall of between 40,800-104,900 by 2030. As it stands now, we’re already seeing that many areas of the country (particularly low-socioeconomic urban and rural areas) are chronically underserved.
But these challenges have given way to a new realization, and within that may very well be the solution. Both the medical community and state and federal regulatory agencies have gradually come to recognize that nurses — namely, advanced practice registered nurses (APRNs) certified as nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists — are the only hope of addressing the shortfall and filling the gap.
The result: Nurses with an advanced level of education are no longer relegated to the sidelines. In fact, these capable members of the healthcare team, nurse practitioners in particular, are quickly stepping up to serve as primary care providers and taking on a bigger role in nearly all healthcare settings.
From obstetrics and pediatrics to critical care and primary care, nurses that hold a Master of Science in Nursing (MSN) are taking up the slack, often working as independent practitioners capable of doing everything from ordering tests to prescribing medications.
But their value doesn’t stop there. Outside of the clinical setting, MSN nurses are providing clinical education, filling leadership roles both in and out of the clinical environment, and identifying new ways to streamline healthcare delivery and improve patient outcomes.
Where can a Master of Science in Nursing (MSN) take you?
Clinically Focused MSN Nurses: Advanced Practice Registered Nurses (APRNs)
You want to be on the front lines of healthcare delivery. You want to be the hands-on, in-the-trenches healthcare provider who applies your advanced level of knowledge and skills to the delivery of optimal healthcare. You are the advanced practice registered nurse (APRN).
APRNs are registered nurses who, through an advanced level of education and training, professional certification, and state licensure, are qualified to provide direct patient care in a specific role and patient population. The four APRN roles and patient population focus areas are identified as:
- Certified Nurse Practitioner (CRP)
- Family/Individual Across the Lifespan
- Women’s Health/Gender-Related
- Psychiatric/Mental Health
- Clinical Nurse Specialist (CNS)
- Family/Individual Across the Lifespan
- Women’s Health/Gender-Related
- Psychiatric/Mental Health
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse-Midwife (CNM)
Most master’s programs in nursing are designed to prepare you for one of these APRN roles and, in the case of the NP and CNP, one of six patient population foci. Once you’ve completed the appropriate master’s-level education (likely an MSN or post-master’s program), you are then prepared for national certification and state licensure.
Here’s a closer look at each of the four APRN roles:
Certified Nurse Practitioner (NP)
Certified nurse practitioners are the largest APRN role, with more than 234,000 NPs currently licensed in the U.S. The largest percentage of NPs (62.4 percent, according to the American Association of Nurse Practitioners) serve families in private group practice, followed distantly by:
- Adults in hospital outpatient care (16.2 percent)
- Acute inpatient care (6.6 percent)
- Primary care pediatrics in outpatient settings (4.8 percent)
- Women’s health in private group practice (3.5 percent)
- Psychiatric/mental health – family in mental health facilities (2.4 percent)
- Adult gerontology – acute care in inpatient settings (2.4 percent)
- Gerontology in long term care facilities (2.3 percent)
- Psychiatric/mental health – adult in mental health facilities (1.8 percent)
As an NP, you provide independent care that is focused on diagnosing and managing acute and chronic diseases. The scope of your job also includes health promotion, disease prevention, health education, and counseling. You may provide primary or acute care, and in addition to a focus on one of six populations, you may also specialize in any number of sub-specialties, such as neurology, cardiovascular, orthopedics, allergy/immunology, and orthopedics, among many others.
While all NPs can provide patient care, education, and counseling, your state board of nursing still dictates the scope of your practice in terms of acting as an independent practitioner.
For example, if you live in states like Maine, Washington State, Alaska, and Maryland, and Washington D.C., you enjoy full practice authority, which means that you can treat patients, order and interpret diagnostic tests, and prescribe medication under the exclusive licensure of your state board of nursing.
If you live in states like Pennsylvania, New York, Ohio, and Illinois, you have reduced practice authority. In most cases, this means that you must enter into, and abide by, a collaborative agreement with a physician to provide patient care, diagnose and prescribe.
If you live in states like Florida, Texas, and California, you have the fewest liberties. In most cases, this means that you must provide patient care under the in-person/in-facility supervision of a physician.
Clinical Nurse Specialist (CNS)
As a clinical nurse specialist, your role includes providing direct patient care, though it often also encompasses clinical supervision, consulting, teaching, research, and patient advocacy. What makes you unique is that your focus can be on a specific population (women’s health, pediatrics, etc.), type of care (rehabilitative, psychiatric, etc.), type of problem (pain management, wound care, etc.), disease or medical subspecialty (diabetes, oncology, etc.), or setting (critical care, operating room, etc.).
You design and implement solutions that transform healthcare systems, with a focus on quality, cost-effective patient care. One of the key identifiers of the CNS role is illness diagnosis and treatment, meaning that your goal is the prevention and early detection of disease and illness.
According to a 2016 National Association of Clinical Nurse Specialists (NACNS) census, CNSs are most likely to work in an acute care hospital setting. In fact, about 80 percent of these APRNs work in these settings. In an acute care setting, about 18 percent are responsible for one unit, but nearly 24 percent are responsible for two or more units, revealing a strong likelihood of working in a leadership/administrative capacity. Another 22 percent of respondents are responsible for an entire sytem, while another 36 percent are responsible for an entire hospital system, along with at least one specific unit.
The largest responsibilities of CNSs include:
- Provide direct patient care (22 percent)
- Teach nurses/staff (19.8 percent)
- Consultation to nurses/staff (19.5 percent)
- Lead evidence-based practice projects (14.6 percent)
- Assist other nurses/staff with direct patient care (11 percent)
The vast majority (74.8 percent) of CNSs specialize in adult health/gerontology, followed by:
- Pediatric (7.1 percent)
- Family/individual across the lifespan (6.4 percent)
- Psychiatric/mental health (4.1 percent)
- Women’s health (3.8 percent)
- Neonatal (3.6 percent)
About 62 percent of all CNSs hold an MSN, followed by an MS (16.2 percent), DNP (8.4 percent), and PhD (6.9 percent).
Similar to other APRNs, your job scope will depend on the state in which you live. If you live in states like Washington State, Arizona, Oklahoma, Maine, and North Carolina, you enjoy independent practice authority. In states like Texas, Ohio, Illinois, and Tennessee, you’ll be required to work under physician supervision or a collaborative agreement.
Just 1 in 5 CNSs are permitted to prescribe medications; and among those states that grant them prescriptive authority, 92 percent require the completion of a pharmacology course and another 53 percent require the completion of graduate supervised clinical hours.
Certified Nurse Midwife (CNM)
If you are a certified nurse midwife, you are one of about 11,500 in the U.S., according to the American College of Nurse-Midwives (ACNM). You practice as a primary care provider for women, although most of your time is likely focused on attending births and providing reproductive care.
In fact, according to the ACNM, nearly 54 percent attend births and identify reproductive care as their main responsibilities, while 33 percent identify primary care as their main responsibility.
While the nurse-midwife evokes images of home births, the vast majority (94.2 percent) of CNMs attend births in hospitals, while just 3 percent and 2.7 percent attend births in freestanding birth centers and homes, respectively.
And though CNMs often work independently, the ACNM reports that more than 50 percent list physician practices or hospitals/medical centers as their primary employer.
About 82 percent of CNMs hold a master’s degree, and nearly 5 percent hold doctorate degrees – the highest proportion among all APRN groups.
Your job duties can include any and all primary healthcare services for women, throughout their lifespan. This means that you are qualified to provide prenatal and postpartum care, gynecological care, preconception care and, of course, childbirth care. But beyond that, you may also provide care of the newborn (during the first 28 days of life) and family planning services.
You are focused on health promotion, disease prevention, and health education, and you promote the importance of continuity of care. You also recognize that menarche, pregnancy, birth, and menopause are natural processes, so you advocate for non-intervention unless there are complications.
In many states, such as Minnesota, Iowa, Kentucky, and Oklahoma, you are free to practice as an independent provider, while in states like Texas, Louisiana, Pennsylvania, and Ohio, you are required to enter into a collaborative physician agreement. Just a few states—California, Florida, Nebraska, Virginia, North Carolina, and South Carolina—require direct physician supervision. CNMs can prescribe medication in all 50 states, although in some states, this will be part of an overall physician oversight plan.
Certified Registered Nurse Anesthetist (CRNA)
According to the American Association of Nurse Anesthetists (AANA) 2016 Practice Profile Survey, as a CRNA, you are one of more than 50,000 throughout the U.S. who administer more than 43 million anesthetics every year. You provide anesthetics in every practice setting for virtually any surgery or procedure. In rural hospitals and other underserved areas, you are likely the sole provider of anesthesia. And for men and women in the U.S. Armed Forces, you are the main provider of anesthesia.
You are qualified to work in any setting in which anesthesia is delivered. This means you may work in hospital surgical suites, ambulatory surgical centers, delivery rooms, and physician’s offices (e.g., plastic surgeons, podiatrists, and dentists). You are also qualified to provide anesthesia care, which includes pre-anesthesia care, preparation, and evaluation, peri-anesthetic support, and post-anesthesia care. You are often responsible for performing the pre-anesthesia patient evaluation and ordering all required medications and fluids.
You develop and implement anesthetic plans, which includes the anesthetic technique and the type of general, regional, and local anesthesia and IV sedation.
Because of the high degree of autonomy and responsibility, CRNAs earn some of the highest salaries among all APRNs ($176,000 annual average salary, according to a 2016 Medscape APRN Salary Report).
But like other APRN roles, in some states, such as Texas, Florida, Arizona, and Ohio, CRNAs must practice under a collaborative physician agreement. In other states, such as California, Virginia, Washington State, and North Carolina, you are free to practice as an independent practitioner without any supervisions or conditions on the extent of your practice.
Clinical Nurse Leaders
The clinical nurse leader, while not an APRN role, is often held by NPs and other APRNs, so it deserves a spot on our list of MSN clinical nurses.
The CNL role is a fairly new one in relation to other nursing roles, as it was developed by the American Association of Colleges of Nursing (AACN) in 2003 in response to a need for nurses who could plan and coordinate complex care associated with a growing number of Americans dealing with multiple acute and chronic diseases and other health conditions.
The AACN identifies CNLs as master’s educated nurses who can practice across the continuum of care in any healthcare setting. While they are considered healthcare generalists, their advanced level of education allows them to work alongside other members of the healthcare team (physicians, social workers, pharmacists, etc.) to ensure that patient care is coordinated and integrated. The goal of these nurses is to ensure that a comprehensive treatment plan is in place and implemented.
It’s important to note that the job of CNLs is not administrative in nature—they are hands-on clinicians who design, implement, and evaluate healthcare delivery to ensure that patient outcomes are maximized. In other words, these advanced practitioners provide care at the ground level.
Unlike APRNs, CNLs are not state licensed beyond their RN license, though NPs commonly work in this role.
Beyond the Bedside: MSN Nurses in Roles Other Than Direct Patient Care
While many MSN nurses choose to focus their careers on a clinical role, an MSN degree can also take you to areas beyond direct patient care. Unlike clinical roles that require specific national certification and state licensure requirements, non-clinical roles have no state requirements to practice, although professional certification (though voluntary) is common.
Nurse Administrators/Executive Leaders
Nurse administrators are the behind-the-scenes change makers who oversee nursing personnel, patient care, and the facilities where nurses work. As a nurse administrator, you ensure that resources are properly distributed and utilized, that safety policies are followed, that the facility operates in an efficient and cost-effective manner, and that the nursing staff is properly managed.
In short, nurse administrators—often referred to as executive leaders—address any and all matters and issues related to finances, quality/safety, and regulations.
Just some of the titles of nurse administrators include chief nurse executive, nurse manager, director of nursing, and director of patient services, among others.
Nurse educators are registered nurses (RNs) and sometimes APRNs who are able to apply their clinical background and advanced education to nursing education. As a nurse educator, your MSN degree prepared you to work in both the classroom and in the clinical setting.
Depending on your clinical background, you may teach everything from pediatrics to gynecology to neurology. You may teach in junior colleges, four-year universities, teaching hospitals, and even online institutions.
Regardless of the material you teach or the setting in which you teach, you are responsible for designing, implementing, and evaluating content for aspiring or current nurses. This includes advising students, developing lesson plans, and teaching courses.
You may even go beyond education to engage in scholarly research, serve as an active member of professional associations, and present at nursing conferences, among others.
Nursing informatics is part nursing science, part information science, and part computer science. It’s at the intersection of clinical practice and technology.
Nurse informaticists design computer-based information systems for healthcare organizations. Thanks to nurse informaticists, patient outcomes are improved, costs are lowered, and new tools are created for improving the practice of nursing.
In the simplest of terms, if you’re a nurse informaticist, it’s your job to identify, collect, and process data that supports the practice of nursing, as well as research, education, and the expansion of knowledge related to nursing. Chances are you’re an RN with an advanced level of education—usually an MSN or MS.
According to the American Nurses Association’s Nursing Informatics Scope and Standards of Practice, a nurse informaticist (otherwise known as an informatics nurse specialist – INS) is an RN who has been formally prepared at the graduate level in informatics or a related field.
You may go by a number of titles, including systems analyst, project manager, applications manager, and medical informatics coordinator. You may work in government and civilian settings, and in inpatient or outpatient settings. You may also work for insurance companies, software vendors, and healthcare device manufacturers.