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?

[>30yrsRN]

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.

yes it foreign physcian yes I think it a ABSN program

FIU and has online to!

[jillgilli]

Thanks for the question it is well stated.

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.

I place pediatric nurse practitioners at children's hospitals and clinics nationwide and I work with a lot of direct-entry MSN students. There are a lot of very good reasons why a person would pursue a direct entry degree. The graduates I work with are very well educated and prepared through coursework and clinical experience. The place where a direct entry graduate can find it hard to get a job is when they want to work in a specialty care unit but they do not have any experience in that unit as a RN. You cannot work in a critical care unit if you do not have critical care experience. That is true for a PNP who has 20 years nursing experience in a non-critical care environment or a direct entry candidate who has very little RN experience. That being said, there is a difference between a RN who is recently graduated and certified as a PNP with 4-6 or more years RN experience and one who has graduated with no RN experience. One is considered an experienced PNP by most hospitals and one is not.

I strongly encourage anyone in a direct entry program to work as a RN as soon as they can in a hospital. Additionally, I encourage them to work in a unit that they think they might want to continue to work in as an advanced practice nurse. If the program takes 3 years and a student receives their BSN after 1 year, they will have 2 years of RN experience by the time they graduate. Many times I encourage new graduates from a direct entry program to continue or start a RN position until they get a job. That could be another 2 years but they are getting the experience necessary to be an effective nurse practitioner in a hospital environment. In one of the comments, working as an RN was referred to as doing time. I would look at it as a gift of being able to learn to provide the best care possible for your patients in the specialty area of your choice.

One of the exceptions to this can be in a clinic or ambulatory hospital situation. It is possible for a direct entry graduate to receive a job offer as a Nurse Practitioner in a clinic and some ambulatory hospital settings. The overall preparation does prepare a graduate to work successfully as a Nurse Practitioner but cannot possibly prepare every student in every specialty area of the hospital. That is why working in as a hospital RN, especially in a specialty area, is strongly encouraged to build necessary experience for a new graduate. From, Jill Gilliland, President Melnic Consulting Group.

[MaritesaRN]

direct entry masters in nursing programs offer a rapid entrance into both the profession of nursing and advanced nursing practice. these unique programs are also known as entry-level or alternate entry nursing masters programs. this type of education is specifically tailored for people with a baccalaureate or higher degree in another discipline who seek a new career as advance practice nurses.

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?

references

accelerated programs: the fast-track to careers in nursing

accelerated bsn and msn nursing programs

hi vicky , i think before going into any advance studies , a student must have a leg at least in clinical and years of experience as nurses..........otherwise this accelererated program will be just in theory ----theory becomes alive when bundled w/ understanding by experience........otherwise the study is not going to be practical , and in reality just another paper if unable to apply the knowledge. :typing

[hiddencatRN, BSN, RN]

If PA's are ok to practice without being nurses first, I certainly don't have a problem with DE MSN programs. The NPs I've had as PCPs or have worked with have a role that is more similar to that of a physician than that of a nurse. It seems appropriate that the bulk of their clinicals are at an advanced practice level since that is the level at which they will be practicing.

Experience as an RN would certainly be valuable, but not essential.

[briang30]

I just started a direct entry program. Our first year is focused solely on the BSN aspects of nursing. We are 5 weeks in and already in our second week of clinicals. We will do about 500 hours of clinicals as students during our first year. In addition to doing RN duties, we are also doing a lot of work that is often delegated to nursing assistants.

In June and July we will do a 250 hour internship working 4 days a week on a floor. We take our NCLEX in the fall. During our last two years of school, we are required to work a minimum of 500 hours a year while taking master's level courses.

So while we will not have 2 full years of RN nursing under our belt by the time we graduate, we will have seen our share. I believe that this will prepare us adequately. There are also two nurses on my floor who are graduates of my program. While not working as NPs, they obviously are able to perform at the level required for a acute care floor.

[manchmedic]

I have a different perspective on this, one that hasn't been discussed in this forum. And I think it at least merits being heard.

I am also looking at a DEMSN program, specifically the program at the University of New Hampshire. Currently I'm taking the required pre-req's so that I will be able to apply for admission in the next 12 months. My perspective? I'm a Paramedic. In addition to the BS degree I have in Computer Science, I've been registered and licensed as an EMS provider for the past 17 years, and as a Paramedic since 2003. I am also certified as a Critical Care Paramedic and work on an ALS/CCT truck for one of the EMS services that covers the Greater Boston area.

I'm looking at this for a couple of reasons. First, while it is a good thing to have, whether or not it is advanced practice personally really doesn't matter to me; it is an entry into the nursing profession. Second, I want to take this and use it to further my career, continuing to work in Critical Care, whether it is in an ICU setting or continuing to do CCT from the nursing perspective, which likely means I'd have to pursue the appropriate advanced certifications as well (CCRN of CFRN). Third, I've been looking for a reason to go to graduate school. In my opinon, this is a valid one as it sort of kills two birds with one stone, so to speak.

I've read a great deal about the issue of clinical experience in this forum and whether or not someone coming out of a DEMSN program would have enough experience to be effective. Not having been there yet, I don't know the answer to that question, although the 4 nurses I know that have graduated from the program I'm talking about have done well for themselves. I do know, however, that my background as a pre-hospital medical provider (yes, Paramedics are indeed medical providers, contrary to what some may think) would likely influence the way I look at such a program. And I would also hope that my background would at least be taken into consideration where experience is concerned. Whether or not this is true obviously remains to be seen.

Feedback is welcome.

[Anise1]

Hi Vicky , I think before going into any advance studies , a student must have a leg at least in clinical and years of experience as nurses..........otherwise this accelererated program will be just in theory ----theory becomes alive when bundled w/ understanding by experience........otherwise the study is not going to be practical , and in reality just another paper if unable to apply the knowledge. :typing

I agree with what has been said along these lines, BUT... this is what I wonder about... I am a psychiatric social worker and I do have experience with the severely and persistently mentally ill population from that POV. Is any of this taken in consideration in any way as something that "counts" towards being a psych NP? Obviously, I don't mean as far as actual credit (for classes, clinical hours, or anything similar), but I think y'all know what I mean... would this cause people to put it towards the credit side of my having some kind of background with this population instead of just starting from Ground Zero??

[CuriousGeorgia]

Hello all! I graduated from a direct-entry program, however, it was not for advance practice. I obtained my certification as a clinical nurse leader (a new role defined by AACN), but am not considered advanced practice. My program was 16 months (4 semesters) and was crazy intensive. For me, it was not only the fastest way to get into nursing, but I already had 2 bachelors degrees and threes a crowd.

I tend to keep the fact that I have my MSN underraps because many of my nursing peers are wary of it. The biggest difference I see is that I tend to focus a bit more on EBP and am more knowledgeable about pathophysiology and the overall care (ie: why give this med vs. another med). At this point in my life, I do not see myself becoming an advanced practice nurse, but I am glad I have my masters.

[jillgilli]

I would definitely believe it counts. What I find is that employers are looking for experience with the patient population. That is exactly what you have.

[Moogie]

Hello all! I graduated from a direct-entry program, however, it was not for advance practice. I obtained my certification as a clinical nurse leader (a new role defined by AACN), but am not considered advanced practice. My program was 16 months (4 semesters) and was crazy intensive. For me, it was not only the fastest way to get into nursing, but I already had 2 bachelors degrees and threes a crowd.

I tend to keep the fact that I have my MSN underraps because many of my nursing peers are wary of it. The biggest difference I see is that I tend to focus a bit more on EBP and am more knowledgeable about pathophysiology and the overall care (ie: why give this med vs. another med). At this point in my life, I do not see myself becoming an advanced practice nurse, but I am glad I have my masters.

CuriousG, I am very curious about your role as a CNL. It's something new and I'm having trouble envisioning how it works in a hospital setting. Then again, it's been a couple of years since I've worked in a hospital setting! How does your role differ from that of a nurse manager (though I suppose you're not as focused on budgetary concerns...) and a unit-based nurse educator? Do you function as a team leader or do you take patients like any other RN?

And how does the CNL work in a setting in which there are clinical ladders, that is, an RN with more education and/or clinical expertise might be acknowledged by the institution for which he/she works? Do experienced nurses without graduate education ever get into CNL roles or is this a unique role specific for only one educational route?

I think it makes perfect sense for someone with a health care background in a discipline other than nursing or someone with one or more bachelor's (or higher) degrees in other fields to get into an ELMSN program. But because this role is new and I haven't worked with anyone who has this educational preparation, I would really like to know more about what you do if you don't mind. I think learning more about other roles in nursing is the best way to overcome wariness and skepticism and to learn to work TOGETHER as NURSES. Thanks! I am curious as George myself!

[MaritesaRN]

"i am sorry but have to judge this as not good path or safe enough education to take care of patients as a fnp right out of college. i would request a physician instead. oh, i have arnp and md, and lawyers in my family also. if you ask me , we should follow the money trail on this. the cheap and short cut way has always cost this world in every area of expertise. no wonder usa ranks 37 healthcare. the most of public does not know the differance between a cna,lpn,rn,arnp or nursing phd in the first place, god help us.

oh gee,i think i will become a lawyer and work in nj with detox waste law sues is there a two year program for that? rofl"

you are certainly entitled to your opinion, but please tell me about your personal experience with direct entry grads. i'd like to hear some concrete basis for your bias.

i certainly don't regard my direct entry program as the cheap, short cut way. i had to take 3 years of pre-requisites, despite the fact that i have a bs in another health care profession plus an mba, plus my de program. and god knows it wasn't cheap....my huge student loan debt will attest to that. from my experience, my program consisted of highly intelligent, incredibly motivated people (myself included..lol) who were willing to put all else on the back burner to devote themselves to being the best caregivers we could be.

i have to say i'm dismayed at the hostility i've encountered both here and out in the world towards de grads. i never thought the nursing profession would be like that, but maybe i'm naive. i thought only lawyers ate their young....:wink2:

:wink2: lawyers too eat their young???? no kidding !!! :chuckle not really surprising , considering some of them will chase ambulance for a living ! lol. nurses, for some reason have earned that reputation....i too have experienced some nurses who were hostile to me in my student days and at work in some places. mind you , not all are like this. i think these people who pick on the orienties and new graduates have some serious insecurities , how else would they pick on someone that needs help ? there must be other ways to stroke their egos and insecurities aside from " kicking an already lame horse"?

i am just so glad to know , just by this website that there are still some good people ! thank you dear lord! :redbeathe

[VickyRN, MSN, DNP, RN]

I have a different perspective on this, one that hasn't been discussed in this forum. And I think it at least merits being heard.

I am also looking at a DEMSN program, specifically the program at the University of New Hampshire. Currently I'm taking the required pre-req's so that I will be able to apply for admission in the next 12 months. My perspective? I'm a Paramedic. In addition to the BS degree I have in Computer Science, I've been registered and licensed as an EMS provider for the past 17 years, and as a Paramedic since 2003. I am also certified as a Critical Care Paramedic and work on an ALS/CCT truck for one of the EMS services that covers the Greater Boston area.

I'm looking at this for a couple of reasons. First, while it is a good thing to have, whether or not it is advanced practice personally really doesn't matter to me; it is an entry into the nursing profession. Second, I want to take this and use it to further my career, continuing to work in Critical Care, whether it is in an ICU setting or continuing to do CCT from the nursing perspective, which likely means I'd have to pursue the appropriate advanced certifications as well (CCRN of CFRN). Third, I've been looking for a reason to go to graduate school. In my opinon, this is a valid one as it sort of kills two birds with one stone, so to speak.

I've read a great deal about the issue of clinical experience in this forum and whether or not someone coming out of a DEMSN program would have enough experience to be effective. Not having been there yet, I don't know the answer to that question, although the 4 nurses I know that have graduated from the program I'm talking about have done well for themselves. I do know, however, that my background as a pre-hospital medical provider (yes, Paramedics are indeed medical providers, contrary to what some may think) would likely influence the way I look at such a program. And I would also hope that my background would at least be taken into consideration where experience is concerned. Whether or not this is true obviously remains to be seen.

Feedback is welcome.

I have the utmost respect for paramedics. I work part-time at a small community hospital ER and intermingle with some amazing paramedics. It sounds like you have years of direct patient care experience under your belt, which will serve you well in an advanced practice role. I wish you the best in your future career as an advanced practice nurse!