Maryland’s Advanced Practice Registered Nurses (APRNs) are licensed by the Board of Nursing. There are five recognized roles:
Most of the above are standard roles recognized in a majority of U.S. jurisdictions; the “Nurse Psychotherapist” designation is not commonly used outside Maryland, though advanced practitioners with psychiatric training work under other designations.
An advanced practice nurse must hold an RN license, either in Maryland or in another nurse compact state.
Advanced practice status is granted on the basis of education and certification. Certification will vary by specialty. Some advanced practice roles are broad, encompassing a number of possible sub-specialties. The licensing agency has somewhat more flexibility in accepting clinical nurse specialist certifications than certifications in other advanced practice roles.
There have been a number of recent changes, including passage of the Full Practice Authority Act of 2015, a law impacting the practice of nurse practitioners.
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Currently, a nurse practitioner must complete a Board approved nurse practitioner program and pass a Board approved examination. The Board has provided a list of approved programs (http://mbon.maryland.gov/Pages/adv-prac-nurse-practitioner-index.aspx). The list includes programs from around the nation.
A program that is not currently on the list may apply and be approved if it meets a set of published standards (http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.07.htm). The program must be accredited through an entity recognized by US Department of Education or the Council for Higher Education Accreditation. It must follow established standards and include coursework in areas such as pharmacology and physical/ health assessment.
A nurse practitioner is designated in a particular area of specialization. The NP may pursue certification focused on any of multiple populations, among them, family, adult acute care, neonatal, women's health or adult-geriatric.
The nurse practitioner must hold a certification that is both nationally recognized and Board recognized. Currently, the Board cites four organizations: the American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the Pediatric Nursing Certification Board, and the National Certification Corporation. Not all certifications offered by approved organizations are accepted for nurse practitioner licensure. Application materials note approved certifications. In late 2015, the Board is creating regulations to implement the new licensing law. Nurse practitioner application forms may not yet reflect new standards. However the “Nurse Psychotherapist” application packet includes a list of all accepted nurse practitioner certifications. All information is subject to change. Applicants can call the licensing agency with their questions.
A nurse practitioner who seeks to practice in areas outside those that his or her original NP program offered preparation for will need to submit documentation of additional education/ training.
A nurse midwife is expected to earn a degree at the master’s level or higher. However, there are provisions in place for nurse midwives who completed programs prior to July 1, 2014. In this case, an educational program can be accepted if it is recognized by the American Midwifery Certification Board (AMCB).
Maryland regulations state that a nurse midwife must earn certification through AMCB or other organization that may be approved; without a master's degree, certification must be through the AMCB (http://www.dsd.state.md.us/comar/comarhtml/10/10.27.05.02.htm).
A nurse anesthetist must hold a master's degree unless the qualifying program was completed by January 1, 2008 (http://mbon.maryland.gov/Pages/adv-prac-nurse-anesthetist-index.aspx).
Maryland regulations stipulate that the nurse anesthetist will maintain certification through the Council on Certification of Nurse Anesthetists or other entity that may be approved by the Board.
Maryland has two pathways for clinical nurse specialists: certification and alternate certification (http://www.dsd.state.md.us/comar/comarhtml/10/10.27.27.02.htm).
A prospective clinical nurse specialist must earn a degree at the master's level or higher; it is to be one that offers preparation for the intended role.
The individual will take and pass a national certification exam and then maintain certification. Application materials cite two approved programs and a total of eight approved certifications. They are as follows:
The licensing agency notes that certifications through other organizations will be evaluated individually. Applicant should be aware that the certifications themselves are offered by third parties and availability is subject to change. Some CNS certifications that have been approved by the Maryland Board are no longer available to new applicants.
An individual seeking alternate certification under COMAR 10.27.27.02 must have practiced as a CNS. Education and certification requirements are somewhat less stringent. The candidate will need a master's degree in nursing as well as some form of certification. The certification may be as a nurse specialist or may be the highest level of certification available in the nurse’s subspecialty or area of practice.
To become a nurse psychotherapist authorized for independent practice, a nurse will need to complete a master's degree in psychiatric mental health nursing or another master's program judged equivalent (http://www.dsd.state.md.us/comar/comarhtml/10/10.27.12.03.htm).
Regulations state that the prospective independent nurse psychotherapist must earn American Nurses Credentialing Center (ANCC) psychiatric mental health certification (or other approved certification). The application packet lists ANCC Clinical Specialist in Adult Psychiatric and Mental Health and ANCC Clinical Specialist in Child and Adolescent Psychiatric and Mental Health as the current options.
A nurse who meets educational requirements for advanced practice may be authorized work under graduate status. The graduate will need supervision by an appropriate professional. In most cases, this will be an advanced practitioner who practices in the same category. The individual will need to submit an application.
Applicants will find application materials on the page of the respective advanced practice role (http://mbon.maryland.gov/Pages/advanced-practice-index.aspx).
The applicant will submit an official transcript and a copy of a qualifying certification. The licensing agency will also seek a copy of the RN license (issued by Maryland or another nurse compact state).
A nurse applying for alternate certification as a CNS will need to provide additional materials, including work history, curriculum vitae, professional recommendations, and course descriptions, as well as documentation of any specialty examinations passed.
Applications are to be accompanied by a nonrefundable $50 fee. A professional applying for a second advanced practice credential pays $25.
Advanced practitioners must document current certification. A nurse midwife will provide documentation that he or she is enrolled in the appropriate certification maintenance or continuing competency program (http://www.dsd.state.md.us/comar/comarhtml/10/10.27.05.08.htm).
The Maryland Board of Nursing is the source for current information about advanced nursing practice (http://mbon.maryland.gov/Pages/default.aspx). Applicants are invited to call 410-585-1930 or 410-585-1960. They may also email the Board with their questions; there are two advanced practice email contacts (http://mbon.maryland.gov/Pages/advanced-practice-index.aspx).
The state’s professional associations serve as additional professional resources:
Maryland Academy of Advanced Practice Clinicians https://maapconline.enpnetwork.com/
Nurse Practitioner Association of Maryland http://www.npamonline.org/
Maryland Association of Nurse Anesthetists http://crnasofmd.org/
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