Entry into Practice: Direct Entry MSN Programs

[VickyRN]

Direct entry MSN programs are approximately three years in length. They provide basic nursing curricula during the first year or so of the program (pre-licensure phase), with graduate core courses and specialty course work during the remainder of the program (graduate nursing concentration phase).

The first masters program for non-nurse college graduates was instituted at yale university in 1974. These programs have grown slowly over the ensuing years. In 2008, the American Association of Colleges of Nursing reported 56 direct entry MSN programs.

Entry-level MSN programs are very demanding, as they not only provide students with a general foundation in nursing, but masters-level courses for leadership or advanced practice as well. These programs are fast-paced, usually involving five-days a week intense study, with a combination of classroom theory and clinical coursework interwoven throughout.

Some programs award learners a BSN at the halfway point of the program, and then an MSN at the end of the program; others only confer one degree: an MSN upon graduation from the program. In the latter case, students forgo a second bachelor's degree. In either type program, students must pass the NCLEX-RN after successfully completing the pre-licensure component, before progressing to the graduate-level courses offered during the second half of the program. Following program completion, students are then eligible to sit for national certification exams for advance practice nursing specialties.

Areas of study in direct entry MSN programs include nurse practitioner, clinical nurse specialist, clinical nurse leader, executive nurse leader, nursing administration, health care systems leadership, and certified nurse midwife. I have even heard of some programs offering nurse anesthesia by way of direct entry. An example is Georgetown university direct entry to advanced practice program. Another surprise is nursing education, which is offered in some direct entry programs.

A big controversy remains concerning entry-level MSN programs: are graduates adequately prepared for advanced practice nursing? What is the job market for advanced practice nursing graduates from these programs? Are they taken seriously by prospective employers? Many people are of the opinion that advanced practice nursing is just that - advanced practice. Critics assert that registered nurses need at least 2 years' experience at the bedside before entering into advanced practice.

What do you think?

[elkpark]

Some of you may not realize that during phase 2 (graduate classes), we are working as RN's gaining experience. Some of the advanced practice programs at our school require 2 years of experience before starting, so you are taking core classes while working. So I do feel that we are gaining the experience we need to be advanced practice. I do think that working as a RN first before working as a advanced practice nurse is important. This distinguishes us from a PA or MD. I will be starting my nursing career on Sept 14 and working on my graduate work as I gain my RN experience. Best of luck to all that are starting direct-entry programs!

I'm not trying to be argumentative, but just want to point out that this is not true of all programs. At the school from which I graduated, the direct entry students are not even eligible for licensure until they've completed the second year of the program, and, at the time I was there, none of the direct entry students I knew worked even a single day as an RN during the third year of school (the program was so rigorous and demanding that few students worked at all). They all graduated and went directly into advanced practice (those who could find jobs, that is -- quite a few them had trouble finding jobs). In fact, at that particular school, many of the direct entry students were quite open about how they had no interest whatsoever in nursing in the larger sense, and were certainly never going to work as bedside nurses (I was always amused to note that many of them could hardly bring themselves to say the word "nurse," they insisted they were going to be "clinicians," not nurses.) But, hey, it was a kinda weird place. I got an excellent graduate education in my specialty, which was what I was there for and really all I cared about. :)

[Jubilayhee]

Well considering the fact that NP's dont practice nursing, they practice medicine, so yes I support direct direct MSN programs. Much like I support PA's who usually dont have nursing experience, I support direct entry NP's.

[Moogie]

In fact, at that particular school, many of the direct entry students were quite open about how they had no interest whatsoever in nursing in the larger sense, and were certainly never going to work as bedside nurses (I was always amused to note that many of them could hardly bring themselves to say the word "nurse," they insisted they were going to be "clinicians," not nurses.) But, hey, it was a kinda weird place.

Something I find troubling---not only in ELMSN students but in many nursing students who aspire for advanced practice roles and graduate education---is that many don't seem to care a whit about nursing. I can't tell you how many graduate students I've met who say they really don't care whether they become nurse educators, NPs, CNSs, managers, whatever---their primary reason for going to graduate school for an advanced practice role is because they "hate" nursing, particularly bedside nursing. They want better hours. They want more prestige. They want more pay. While those motivations are certainly understandable, those should never be the ONLY reasons someone wants to assume an advanced practice nursing role. There has to be an underlying desire to be a NURSE and respect for and interest in the issues of the profession.

There are many other health careers that offer greater status, better pay, better hours and less stress. If someone "hates" nursing but still wants to remain in a health care field, why get an advanced degree in NURSING? Why not become a pharmacist or physical or occupational therapist, a social worker? I think a nurse should only get an advanced degree in nursing if he/she LOVES nursing. Now, that's not to say that every person needs to be enamored with the bedside role. Bedside isn't everyone's cup of tea, and, even for those who truly love being at the bedside, there often comes a day when the physical demands become too great on the aging or injured body. Also, even those who love bedside nursing often find the stresses are too much after so many years. Those nurses don't leave the bedside because they "hate" it but because they need a different direction in their careers.

If a student nurse at ANY level, without any nursing experience whatsoever, goes into a program "hating" nursing, he/she is doing the profession no favors. If students have disdain for being called nurses and want to be called clinicians, why not become physicians' assistants instead?

I also think that when people who "hate" nursing get into advanced practice roles, they contribute to this nasty sniping and one-upmanship that hurts our profession---the MSN vs. BSN, BSN vs. ADN or diploma, RN vs. LPN/LVN, everyone dump on the CNA crap. I've seen a lot of managers and educators who "hated" nursing do a tremendous amount of damage to their staff and students. I've also had to deal with nurses who "hate" nursing in graduate school (a traditional program, not ELMSN or even RN to MSN). Let's just say that, as a student, I didn't feel a whole lot of camaraderie among my classmates and it made my experience not as positive as it could have been. Sorry, but I think if someone truly "hates" nursing, do everyone a favor and find a different profession in which one might be happier.

[Bree124, BSN, RN]

I finished the pre-licensure phase of my direct entry MSN program in August, and am currently going part time through the grad portion to become a CNM.

The majority of students in my cohort are planning to go part-time through the graduate portion in order to get some experience at the bedside. This isn't required by our program, but strongly encouraged. There are only about 3-4 people that I know of who don't plan to work as an RN for at least two years while finishing the program. Most direct entry programs strongly encourage or require RN work during the grad phase, so I find that the "but they have nooooo experience!!" argument does not tend to be relevant.

As for finding a job with this type of degree - I would say that my classmates are having about the same amount of luck finding RN jobs as the traditional BSN grads from my school. Jobs are scarce right now, so everyone is struggling a little bit. Grads who have finished the MSN work and are seeking positions as NPs in this area have not had trouble finding jobs.

[BCgradnurse, MSN, RN, NP]

Moogie,

I completely agree with you. No one should be at any level of nursing if they hate it. I am very proud to be a member of the nursing profession and always correct people if they call me doctor. I love the nursing philosophy and approach to patient care, and that's why I went the NP, and not the PA route.

[Moogie]

I interviewed one FNP who works in the ER where I volunteer, and she said that after finishing her ELMSN she worked for 4 years as an ER nurse before rising to the FNP role. I could definitely see myself following a similar path. Is it the wrong way to go?

I was thinking a little more about your post, JD2nurse. FNPs are well-equipped to serve those areas in which access to health care is limited because of distance. I realize that the colleague with whom you spoke worked as an RN in the ER for four years even though she had completed her FNP. You know, if it works into your schedule and if you can sit for NCLEX before graduating, it might be a good move for you to work part-time in the ER (as an RN) while you're finishing your program. I think that right now, because so many people who lack primary care providers go to the ER for non-emergency care, the clients you see will be quite similar to those you would serve as an FNP. Moreover, FNPs are often the providers on call in rural emergency rooms that don't have enough physicians on staff. Depending on what kind of setting you might prefer, working in a rural health clinic and taking ER call might be a great option for you.

The only caution I would raise regarding an NP working in a staff nurse role is that one would need to be very careful not to overstep the scope of one's practice in the role. I also know that an RN who is employed in an LPN role is accountable as an RN, not an LPN, and any nurse who works in a CNA/PCT role is accountable as a nurse, not as an unlicensed direct care worker. Do you know if NPs who work as staff nurses would be held to the standards of NPs rather than staff nurses? Just something to consider.

Here's to you and a great career ahead of you! *wine

[kimiij]

I am currently in a DE MSN program- the oldest one in the country in fact. So, needless to say, I support DE programs. I literally just started this past week and I feel confident that I will be well-prepared. Whether or not RNs or APRNs judge me prior to seeing my performance, the bottom line is that I honestly don't have time to worry about that.

[Moogie]

I am currently in a DE MSN program- the oldest one in the country in fact. So, needless to say, I support DE programs. I literally just started this past week and I feel confident that I will be well-prepared. Whether or not RNs or APRNs judge me prior to seeing my performance, the bottom line is that I honestly don't have time to worry about that.

You have a very professional-looking blog!

I hope you don't think I'm nosey but I am curious: what got you interested in midwifery in the first place? Would you mind posting a little bit about your program?

Keep in mind, I am still skeptical of DE programs that prepare non-nurses to become clinical specialists, clinical leaders or nurse educators---but I would like to learn more about the DE NP programs because, for some people, they might be an excellent way to achieve their career goals.

Learning more about the DE NP programs from students actually in those programs might make them a little less intimidating or controversial to those of us who went different educational routes.

Thanks! And the best to you as you start your program.

[Anise1]

There are many other health careers that offer greater status, better pay, better hours and less stress. If someone "hates" nursing but still wants to remain in a health care field, why get an advanced degree in NURSING? Why not become a pharmacist or physical or occupational therapist, a social worker?

Well, one good reason to not become a social worker is to actually be able to work in your profession rather than sending out 60-100 applications without even an interview, which is what happened to almost everyone in my class.

If I could only work with the population I love so much (severely and persistently mentally ill), I would do it for minimum wage. I am applying to every inpatient program in the area in hopes of being able to work as a psychiatric tech, but I will probably work as a CNA. I am overjoyed to have this opportunity; the idea of having a guaranteed job (many offers already) is incredible to me by this point. So I am certainly not thinking about eventually going into one of the accelerated NP programs for the money. Again, if it meant I could work meaningfully with this population, I would work for LESS THAN MINIMUM WAGE, SIXTEEN HOURS A DAY!! (No, I'm not kidding. The recession isn't pretty...) The real point, however, is just how much this means to me. I would give just about anything to be able to do the work I love, and I can't do it right now. It is heartbreaking to see the desperate need and absolutely no mental health social work jobs in this area. If psychiatric NP is a more effective way to go, then I will probably eventually do it.

Anyway... along those lines, does anyone know anything about the accelerated program at Oregon State Health University for psychiatric nurse practitioners?

[kanzi monkey]

The only caution I would raise regarding an NP working in a staff nurse role is that one would need to be very careful not to overstep the scope of one's practice in the role. I also know that an RN who is employed in an LPN role is accountable as an RN, not an LPN, and any nurse who works in a CNA/PCT role is accountable as a nurse, not as an unlicensed direct care worker. Do you know if NPs who work as staff nurses would be held to the standards of NPs rather than staff nurses? Just something to consider.

As a new NP still working as an RN, I'd have to disagree with this. I am definitely NOT accountable for the medical decisions that are made by physicians--unless they make an error which is within an RN scope of practice to catch. That being said, I think I'm kind of PITA to docs these days since I hardly know which "errors" should be caught by any reasonable RN, or wouldn't be noticed without an advanced level of training. I put quotations around "error" since I'm talking about things that may not be "perfect" or acceptable according to practice guidelines, but still things that go unfixed in order to take care of bigger issues. Thus, my being a PITA--in a way, to the docs, I'm kinda like the nurse that runs around behind them saying "oh, you missed a spot".

Anyway, definitely time for me to move on. But I don't believe that my NP license is jeopardized by my fulfilling my role as an RN. If I acted outside of my scope of practice for my job description (which is RN), I'd be liable, and even if the choices I made were good, I would be risking my license(s), my patients, and causing all sorts of problems for people.

[Moogie]

Well, one good reason to not become a social worker is to actually be able to work in your profession rather than sending out 60-100 applications without even an interview, which is what happened to almost everyone in my class.

That's outrageous. Social workers are NEEDED and I'm sure those that are working would report that they're overworked, just like nurses. I've seen gerontologic social workers employed in LTC work twelve hour days consistently and still not have time to get everything done. And of course they were salaried. :angryfire

How many students were in your class?

Very sorry you have hit this roadblock in your career. I wish your story was uncommon, but, as in most helping professions in this economy, it's hard for everyone to find jobs.

[BCgradnurse, MSN, RN, NP]

Please come work with me......my patient population desperately needs the expertise and services social workers provide!! I'd also welcome a psych NP with open arms!!!