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?

[Anise1]

BCGRADNURSE

If you want to see examples go to any Medical College Hospital settimg and See even the New MD starting in June each year. As you stand there and watch the Live Reality you will see all the Mistakes they make and what they have not grasp or been exposed to before. You will see their Peers, yes their Peers come and rescue the patient. DO no Harm! I do not know how you have a conscious to think a new EFP can hit the office acting as ARNP in Family Practice. We all Feel the same.

I was in Risk Management for Years and still work in Critical Care Arena I can not begin to tell the you Incidences that ARNP and MD have made and the other hand the Great Achievements they made.

I do not trust the medical judgement ENP practicing right out of college with no Healthcare experiance as a PA or RN or MD. FIU has a Program for Physician MD to BSN then MSN ARNP.This is my final note on the topic with you with input from a very wise and Intelligant Group of Nurses and a NUC MED Manager.GB >30yrsRN

Well-- I really hope that this isn't your final note on this topic, because I think there are plenty of questions to still be answered if you would be willing to share from your experience. :wink2: For instance, the OSHU DE program is for psychiatric (and midwife) NP's only. (Midwifery isn't my area of interest, though, so I'm not even going to try to speak to that.) Even without knowing much about it and coming from an MSW's POV, I might agree with you about the MD example. I really don't know enough to say. I will have to leave it for others to judge and to speak to. But it seems to me that in any case, this would not apply in the same way to psych NP's-- not for those who already have considerable psych experience, and I am a psychiatric social worker. I think that there may be a reason why OSHU does it this way, although I can't say anything about what other programs do. But even if we say just for the sake of argument that your objections to other programs are valid, why paint the OSHU type of program with the same brush as the others?

[kimiij]

You have a very professional-looking blog!

Thanks! I just redesigned it a couple months ago.

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?

I graduated from college several years ago. I was working in my field but somehow (I don't remember the precipitating factor) I got really interested in pregnancy, childbirth, natural living, etc. I became a Lamaze childbirth educator and at first, I thought I wanted to be a physician (OB/GYN). However, while I was applying to and preparing for medical school, I couldn't shake the idea that the philosophies I was teaching through Lamaze exemplified optimal maternity care and that modern obstetrical care was lacking. Through my experiences and training I became more convinced that the midwifery model of care was superior and so I switched my focus to midwifery.

My program is a 3-year DE APRN program. Among the roughly 87 students- 12-15 of us are future midwives. The remaining students are future FNPs, ACNPs, PNPs, and more. The first year is focused on nursing. My school is very direct and let us know that they are providing us the information that is crucial for Advanced Practice Nursing. Makes sense because upon completion of our program, we will be employed APRNs, not RNs. This school does not award a BSN- only an MSN. The second and third years are the specialty years during which your clinical hours are focused on your specialty.

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.

Don't worry- I have no interest in trying to change your mind.

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.

And this is what I think it comes down to - RNs and traditionally trained APRNs feeling Intimidated. I can't understand the sentiment as I am not in your shoes. But, from where I am standing, IMO it doesn't make sense. We should be able to work together even though we had different educational pathways.

I can't speak for the other APRN specialties, but from my limited observational experience, it doesn't seem as though being a midwife is "the next step up" from being an L&D nurse. They are two different things. Two different roles and in my experience L&D nurses are often more aligned (in terms of philosophy) with OBs. And as we know, midwives are not OBs.

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

Thanks

[Moogie]

Oh, you keep the license absolutely. You just don't have a degree to support it. There are a handful of people from my program that aren't planning to go further at this point. One of them is now enrolled in another program to get her BSN. It's an odd position to be in to be a nurse, but to not have a BSN or associate's degree. I feel like many programs keep you from getting a BSN simply so they don't lose you. For example, my program was very expensive. When I started, I definitely wanted to go the Master's route since I already have a bachelor's. So even though traditional BSN programs were cheaper, my school seemed the better choice. By the time I completed phase one of my program, I had at least the equivalent of a BSN since I already had 4 years of college and research behind me, but I wasn't given a BSN. Had I chosen to stick with bedside nursing and not take out more loans to complete phase 2, then I would be stuck...licensed, but degree-less. And with more debt than I would have had from a BSN program (already).

So, programs that offer the BSN are nice in that you have that flexibility. As far as I know, all DE MSN programs are painfully expensive. I will be in debt for many years.

Will your classmates who are not going on to Phase 2 of your program be able to get their master's degrees at some point, either from your school or another, if they choose to continue their education? And if they choose to go elsewhere for their master's degrees, would they have to do an RN to MSN program? It sounds as if one would NOT want to drop out of a program like this unless one decides not to pursue a career in nursing.

I'm also curious---does your school offer a traditional or accelerated BSN and do the students in the DE MSN take any of the same courses?

I admire your dedication and gumption to go through what sounds like a very difficult program. When do you expect to graduate?

[kanzi monkey]

Will your classmates who are not going on to Phase 2 of your program be able to get their master's degrees at some point, either from your school or another, if they choose to continue their education? And if they choose to go elsewhere for their master's degrees, would they have to do an RN to MSN program? It sounds as if one would NOT want to drop out of a program like this unless one decides not to pursue a career in nursing.

I'm also curious---does your school offer a traditional or accelerated BSN and do the students in the DE MSN take any of the same courses?

I admire your dedication and gumption to go through what sounds like a very difficult program. When do you expect to graduate?

I'm not sure what the plan is for those that decided not to complete phase 2--I know one is entering another program to get a BSN, and some are just working as RNs at the moment. I imagine most will eventually return to the program if they want to go into advanced practice since having a degree-less RN license may be confusing for other graduate programs. I know when I completed phase 1, I definitely felt as though I was "in the snare"--because it IS really difficult to move on without completing the program. But it is an excellent school, and I have no regrets for finishing. Yes, there is a traditional BSN program at my school (it's pretty big), and during phase 1 most of my classes were combined with BSN students. I took every nursing course that the BSN students took, and did as many clinical hours.

Oh, and I graduated last spring and got my NP license in July :)

Just looking for a new job at this point!

[Moogie]

Thanks! I just redesigned it a couple months ago.

I graduated from college several years ago. I was working in my field but somehow (I don't remember the precipitating factor) I got really interested in pregnancy, childbirth, natural living, etc. I became a Lamaze childbirth educator and at first, I thought I wanted to be a physician (OB/GYN). However, while I was applying to and preparing for medical school, I couldn't shake the idea that the philosophies I was teaching through Lamaze exemplified optimal maternity care and that modern obstetrical care was lacking. Through my experiences and training I became more convinced that the midwifery model of care was superior and so I switched my focus to midwifery.

What you say makes a tremendous amount of sense. I agree with you about the midwifery model---it seems more empowering for women and much more family friendly. Thank you for sharing what got you started on your journey. I think the families you serve will be fortunate to have you.

My program is a 3-year DE APRN program. Among the roughly 87 students- 12-15 of us are future midwives. The remaining students are future FNPs, ACNPs, PNPs, and more. The first year is focused on nursing. My school is very direct and let us know that they are providing us the information that is crucial for Advanced Practice Nursing. Makes sense because upon completion of our program, we will be employed APRNs, not RNs. This school does not award a BSN- only an MSN. The second and third years are the specialty years during which your clinical hours are focused on your specialty.

I can't speak for the other APRN specialties, but from my limited observational experience, it doesn't seem as though being a midwife is "the next step up" from being an L&D nurse. They are two different things. Two different roles and in my experience L&D nurses are often more aligned (in terms of philosophy) with OBs. And as we know, midwives are not OBs.

Again, what you say makes sense. Your role will be completely different from that of an RN working in a hospital-based L & D environment and, as you know this is what you want. I think you would be wasting your time to do a more traditional educational route and to work in a hospital-based situation before going on to become a CNM.

My curiosity is piqued because I am a nurse educator, not currently working because I'm headed back to school myself. I do find it fascinating to look at the history of nursing education and I am definitely open to new ideas and new options, especially for those who are pursuing the nurse practitioner route. I also want to be as open-minded as possible because someday I might be teaching students in similar programs.

Don't worry- I have no interest in trying to change your mind.

Too late! Seriously, I have learned a lot from the posters on this thread. You all have definitely broadened my thinking in terms of looking at the ELMSN as a legitimate option for many nurses. Certainly not all nurses---I think those who are able to complete these programs are a special breed.

And this is what I think it comes down to - RNs and traditionally trained APRNs feeling Intimidated. I can't understand the sentiment as I am not in your shoes. But, from where I am standing, IMO it doesn't make sense. We should be able to work together even though we had different educational pathways.

Unfortunately, that seems to be a common feeling among nurses---the intimidation and competition that seems rampant between nurses who have different educational levels. If you have a chance, look at some of the threads about LPNs/LVNs feeling put down by RNs. My initial preparation was at the ADN level and many diploma-educated nurses looked down on us because we went through a "lesser" level of education. Those who went directly into BSN programs had it worse, though, because many were looked down upon because they didn't have as much clinical as did the diploma-educated RNs. I've seen many BSNs be treated with outright hostility on the floors because of their education and, after I got my BSN in the first RN to BSN program at my university, I experienced some hostility, too.

I will be honest in saying that sometimes I feel frustrated with the notion of the ELMSN program---not anything against the graduates---but I feel frustrated with the system. There are many people who go through more traditional education and jump through a LOT of hoops. I know of MSN programs that won't even look at an applicant who does not have at least two years of experience as a floor nurse---so maybe you can understand why it seems incongruent that while some programs require experience, others don't and even offer entry-level MSNs to non-nurses. Traditional MSN programs can be difficult to get through and impossible if you need to drop out for any reason. I tried to transfer from one program to another for various reasons (GPA was not one of them---I had a 3.75) but most of my credits would not transfer even though I was in the same state university system. I got horribly burned out with the educational process---and then moved out of the area---so I'm probably going to have to start over if I go the MSN route---unless I get accepted into the BSN to PhD program to which I have applied. I don't understand why there is so much inconsistency in nursing education and I sometimes feel like

I'd be happy to share a little more of my story with you if it helps you to see another side but right now I need to go vacuum the downstairs. I'm stuck between programs right now and have no excuse not to clean the house!

Thank you again for your thoughtful and informative post.

[BCgradnurse, MSN, RN, NP]

Just one more note on the negativity towards DE NPs and then I promise I'll be quiet!!! I have been on the other side of the fence....I worked for many years as a medical technologist prior to going to nursing school. The hospital I worked at had a policy of only hiring people with a BS in Medical Technology who were board certified. Over the last 5-7 years the med tech programs at colleges have disappeared, leaving an aging population of techs with no one to replace them come retirement. Three years ago the lab I worked at took a chance and hired a couple of bio majors and sent them for some training. I never said anything about it (I was thrilled to have new bodies to take some of the weekend/evening shifts!!), but I definitely had my doubts about their ability to succeed. I was pleasantly surprised to see how great these people were. They worked so hard to grasp the technology and theory, and turned out to be some of the best, most conscientious techs in the place. So, that was a lesson learned for me and is part of the reason I'm vocal about the DE programs and their graduates, cause I've been a doubter myself. Alternate educational pathways can be very effective. I think it's up to the individual student to make the most of what they learn and put in the work necessary to succeed.

[Moogie]

I'm not sure what the plan is for those that decided not to complete phase 2--I know one is entering another program to get a BSN, and some are just working as RNs at the moment. I imagine most will eventually return to the program if they want to go into advanced practice since having a degree-less RN license may be confusing for other graduate programs. I know when I completed phase 1, I definitely felt as though I was "in the snare"--because it IS really difficult to move on without completing the program. But it is an excellent school, and I have no regrets for finishing. Yes, there is a traditional BSN program at my school (it's pretty big), and during phase 1 most of my classes were combined with BSN students. I took every nursing course that the BSN students took, and did as many clinical hours.

Oh, and I graduated last spring and got my NP license in July :)

Just looking for a new job at this point!

Thanks for the info---it sounds like a good program for the right person. It would not have been the right kind of program for me because I went into an AD program immediately after high school. Come to think of it, I'm not sure the route I took would be the best for many people. I was an RN at age 20! (If I had to do it over, I would have either done a direct entry BSN program or I would have done an RN to MSN program had they existed back in the 1980s. I wish I would have had a more traditional college experience---maybe that's one reason I feel drawn to academia.)

And :ancong!: on your graduation. I wish you the very best in finding your job.

[Anise1]

Kimiij, you mentioned that you're in a DE APRN program where a lot of the students are in midwifery... it's not the OSHU program in Portland by any chance, is it?

[>30yrsRN]

Just one more note on the negativity towards DE NPs and then I promise I'll be quiet!!! I have been on the other side of the fence....I worked for many years as a medical technologist prior to going to nursing school. The hospital I worked at had a policy of only hiring people with a BS in Medical Technology who were board certified. Over the last 5-7 years the med tech programs at colleges have disappeared, leaving an aging population of techs with no one to replace them come retirement. Three years ago the lab I worked at took a chance and hired a couple of bio majors and sent them for some training. I never said anything about it (I was thrilled to have new bodies to take some of the weekend/evening shifts!!), but I definitely had my doubts about their ability to succeed. I was pleasantly surprised to see how great these people were. They worked so hard to grasp the technology and theory, and turned out to be some of the best, most conscientious techs in the place. So, that was a lesson learned for me and is part of the reason I'm vocal about the DE programs and their graduates, cause I've been a doubter myself. Alternate educational pathways can be very effective. I think it's up to the individual student to make the most of what they learn and put in the work necessary to succeed.

BCGRAD

Did you go to the Simmons Boston College

I agree with that Program it is THREE Years plus the Prerequisites

that is more like a RN to MSN program or EBSN to MSN

I see you had a BS in Medical Tech now that is a whole other animal

IMO that is a Simmons Boston College is a Outstanding and great program

I thought you said you graduated from MS to MSN in two years program?

IMO that would not me safe for Master to go to MSN

Oh FIU is Florida International Unversity, This is a tough program also RN to MSN or MD to BSN to MSN program

[>30yrsRN]

So let me see if I have this right......nobody right out of school should be allowed to practice because they make mistakes...this includes RNs, MDs, PAs, NPs, PTs, etc. Again, you're not presenting concrete examples. And can I assume you have never made a mistake in your 30+ years of practice? You and your colleagues may be experienced and intelligent, but I don't think you speak for everyone in the nursing/medical world. Being stuck in the past and not being open to change and new ways does a disservice to your patients. I'm not sure where your bitterness and resentment is coming from, since you haven't yet given a specific example of where a DE NP caused harm. However, your attitude has only further inspired me to work harder to be an exceptional NP. Not because I have something to prove to those like you, but because that's what my patients deserve.

Oh you taken what I said out of Context

Did go ro Boston College or Berea College in Berea, KY.?

Boston College ELMSN is a three year program and is Excellant it is a three year program and Plus prereqs.

I thought you wrote you went to Berea College in Berea ,KY ad they do not have ELMSN the last time I check which was 15 minutes ago.

there is are was another Blogger with the same name who graduated from Berea College

BCGrad

[Moogie]

This is a tough program also RN to MSN or MD to BSN to MSN program

MD to BSN or MSN? Pardon my ignorance but would that be for a foreign-educated physician who was not able to obtain a medical license in the US so he/she could practice as an RN or an APRN?

Not to go off on a tangent here but I remember hearing about a Hmong refugee who had been a physician but unable to become licensed when he immigrated, so he was working as a maintenance man in a hospital. This was many years ago and it seemed like such a waste---if he couldn't practice as an MD, it would have been a great option for him to have gotten into an ELMSN program to become an APRN.

[kimiij]

Kimiij, you mentioned that you're in a DE APRN program where a lot of the students are in midwifery... it's not the OSHU program in Portland by any chance, is it?

No, it isn't. OSHU is supposed to have a great midwifery program though! I've heard great things about them :)