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?

[MaritesaRN]

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.

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.

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.

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 :banghead:

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.

I too am contemplating higher education ---- but I need to know what specialty I really could apply it to. I just do not want to get a masters degree just to have that title....If I have to produce and finish a thesis, it'd better be one of my lifes passion, otherwise it is just a paper thing.

In answer to the frustrations of non applicable credits between schools , I believe the schools make more money this way . It is sad , but it is the money trail. Now talk about NP's ---You would think that by now they will have an NP program , specializing in Geriatrics !!! Baby boomers , (including me - LOL) will be leading the market , or greatly affecting the Medicare arena, since we will be collecting our well deserved social security and using the Medicare benefits that we have paid into all this years.

[>30yrsRN]

There are Geriatric programs and there are many other here in Florida of course

we have a higher retirement rate of course

The state colleges are usually about supply and demand

we have so many Nursing programs springing up here that even UOP has lower it prices according to zip code in FL

[Moogie]

I too am contemplating higher education ---- but I need to know what specialty I really could apply it to. I just do not want to get a masters degree just to have that title....If I have to produce and finish a thesis, it'd better be one of my lifes passion, otherwise it is just a paper thing.

I am so with you! I was actually told in my MSN program that it didn't matter if one's thesis was one's life passion. The whole idea was to produce something, no matter if it was of interest or not. Just do it! (Since when did the school's mission statement get replaced with a Nike shoe ad?) I think education is much more than getting a piece of paper---but I think my values were rather different from the places I did my grad work.

If I'm going to devote that much time and energy to a thesis or dissertation, it had better be in an area in which I not only have interest but also clinical experience. I also am idealistic enough to want to produce research that will be relevant to clinical and/or educational practices. I'm not so grandiose as to think I will publish Moogie's Grand Theory of Life and Nursing the first semester of my doctoral program (I'll wait until the second semester, LOL!) But, seriously, I would rather invest my time researching something that I think contributes to our profession rather than something that might look "good" to other academics but be totally out of touch with actual nursing or educational practices.

In answer to the frustrations of non applicable credits between schools , I believe the schools make more money this way . It is sad , but it is the money trail. Now talk about NP's ---You would think that by now they will have an NP program , specializing in Geriatrics !!! Baby boomers , (including me - LOL) will be leading the market , or greatly affecting the Medicare arena, since we will be collecting our well deserved social security and using the Medicare benefits that we have paid into all this years.

My cynicism is showing, but, yes, I think schools do stand to profit from making transfer students repeat courses similar to those they've already successfully taken. I spoke with a student who had transferred from a pre-med program in a private college to a BSN program in a state school and the state school refused to accept her advanced science courses that were at a higher level than those required for admission to the BSN program at the state school because they weren't exactly the same classes. :icon_roll I think someone who has a 4.0 in all his/her science courses in a pre-med program should not have to repeat those classes, especially if the pre-med courses were more advanced than those required for the BSN program. BTW, the student had transferred because there was a wait list for the nursing program at her private college and she thought she could get into the BSN program at the public school much more quickly and for less money.

There are programs that offer Gerontological Nurse Practitioner tracks. Like you, I would like to see more of these types of programs. One program in my geographical area offers a Gerontological CNS track as well. I love teaching and I want to teach gerontology in baccalaureate or graduate program if and when I get my PhD but if I were to ever consider a NP track instead, I would want to specialize in gerontology. I really love gero!

[VickyRN, MSN, DNP, RN]

I too am contemplating higher education ---- but I need to know what specialty I really could apply it to. I just do not want to get a masters degree just to have that title....If I have to produce and finish a thesis, it'd better be one of my lifes passion, otherwise it is just a paper thing.

In answer to the frustrations of non applicable credits between schools , I believe the schools make more money this way . It is sad , but it is the money trail. Now talk about NP's ---You would think that by now they will have an NP program , specializing in Geriatrics !!! Baby boomers , (including me - LOL) will be leading the market , or greatly affecting the Medicare arena, since we will be collecting our well deserved social security and using the Medicare benefits that we have paid into all this years.

There may be only a few direct entry Masters programs that offer a gerontological advance practice degree, but such programs do exist. Information about the Gerontological Nurse Practitioner advance practice role:

Gerontological Nurse Practitioner

Gerontological Advance Practice Nurses Association

Gerontological Nurse Practitioner Programs (in US)

Direct entry Masters programs offering a gerontological advance practice degree:

University of Pennsylvania School of Nursing

Seattle University College of Nursing

Marquette University College of Nursing

There are also Gerontological Clinical Nurse Specialist programs. Here is some more information on the Gerontological Clinical Nurse Specialist role. An example of such a program is here and here.

Marquette University College of Nursing offers a direct entry route to gerontological clinical nurse specialist.

Hope this helps and best wishes to you! :)

[Anise1]

The info about the gerontological NP programs was fascinating. I've worked with that population, but my first love will always be psych. If I do the NP route in a couple of years, I'm pretty sure that it will be at Oregon State, because my brother will be in Portland, but I would still love to hear about other psych NP programs if anyone has any words of wisdom to share (and of course, if anyone knows anything about the OSHU program, that would be great!) :)

[kenni]

I too thought about persuing one of these programs until someone explained to me that if you don't complete it, you don't have an MSN, BSN, or an RN.

[Anise1]

I too thought about persuing one of these programs until someone explained to me that if you don't complete it, you don't have an MSN, BSN, or an RN.

That's good to know, but... if you don't complete any program, doesn't that mean that you don't have whatever it was you went in for? How is a DE MSN program different from the others?

[jd2nurse]

I too thought about persuing one of these programs until someone explained to me that if you don't complete it, you don't have an MSN, BSN, or an RN.

The DE program I will be starting in January is a 3-year MSN-FNP program. The first two years are spent on RN courses and obtaining your RN license. So, while you don't receive a BSN degree as an interim step, you do indeed get your RN. So if you chose to quit at that point, while you would not take away a BSN or MSN, you would keep your RN. I would imagine that is typical of DE programs that do not confer a BSN in addition to the MSN.

[VickyRN, MSN, DNP, RN]

The DE program I will be starting in January is a 3-year MSN-FNP program. The first two years are spent on RN courses and obtaining your RN license. So, while you don't receive a BSN degree as an interim step, you do indeed get your RN. So if you chose to quit at that point, while you would not take away a BSN or MSN, you would keep your RN. I would imagine that is typical of DE programs that do not confer a BSN in addition to the MSN.

Thank you, jd2nursing, for reinforcing this important point. It is the same in the direct entry MSN program at my college of nursing. If one quits the program after receiving RN licensure and does not go on the attain the MSN, the RN licensure is not rescinded. The student simply has no academic degree with the RN. My college's program does not award a BSN at the halfway point.

[Moogie]

Thank you, jd2nursing for reinforcing this important point. It is the same in the direct entry MSN program at my college of nursing. If one quits the program after receiving RN licensure and does not go on the attain the MSN, the RN licensure is not rescinded. The student simply has no academic degree with the RN. My college's program does not award a BSN at the halfway point.

This is something I want to check into myself before I start my BSN to PhD program (hopefully in January, IF I get accepted.) Many of the classes for the BSN to PhD track are the same as what one would take at this school's traditional MSN program. I am definitely committed to getting my degree but I see a disadvantage in that I probably would not be able to teach at a program that requires instructors to have master's degrees. If I end up having to complete my MSN, at least I'd be able to teach at a program while finishing up the doctorate. (On the other hand, if I do get into the program of my choice, I am most likely not going to work but am going to take as full a credit load as I can so I can graduate sooner and get back into the workforce.)

I think every nursing program, regardless of what sort of educational preparation it provides, requires commitment but it's really a pain when life circumstances cause someone to have to stop out of the educational process for a while and that person ends up in limbo. The perfect example here is the DEMSN student who, for whatever reasons, might not be able to finish the master's part of the program at that time, is an RN but does not have the academic credentials of either a BSN or an MSN. Obviously someone who would decide that advanced practice nursing was not his/her path would be better off to transfer to a BSN program rather than stopping at the RN part of the DEMSN program. But the person who has to stop for other reasons is stuck in a pretty difficult situation.

I have a question for the DEMSN students here: do you find that your programs are good at student retention? Do you feel that the faculty is mostly supportive? The reason I ask is because on AN, there are often so many horror stories about students, usually in entry-level programs, who fail out of their programs by half a percentage point, sometimes in their very last semester, or get dropped because of minor transgressions like wearing the "wrong" shoes to clinical or being five minutes late to clinical when policy stated that they had a ten-minute window. When I taught, I knew some instructors who almost seemed proud of the number of students that they failed; they seemed to think the students weren't "tough enough" to become nurses. I certainly understand weeding out those students who have little aptitude for nursing and am sure that there are, in every program including DEMSN, some students who probably should not be there. And obviously, a student who should not be a nurse should not be a nursing student. But sometimes, especially considering how competitive admission to nursing programs can be, I wonder if faculty is doing everyone a disservice by trying to "weed out" students all the way until they finish. For those of you who are DEMSN students or graduates, do you feel that the program you attend (or attended) tried to keep students in the program or have you also had to fight faculty who seemed hell-bent on getting students out of the program rather than helping them to succeed? (I would certainly think that if a student has the intelligence, maturity and commitment to get into a DEMSN program, that student probably is indeed "tough enough" to be a nurse, KWIM? And if you aren't familiar with the "weeding out" process to which I am referring, do please look at some of the student threads to see some examples---that is, if you have the time!) Thanks in advance for your input.

[BCgradnurse, MSN, RN, NP]

43 started out in my DE program and only two left-1 for grade issues and 1 for personal reasons. I think the faculty were pretty supportive and certainly did not try to make people fail. They told us they did not accept any student who they did not think would be successful in the program. And it's not like they were begging for applicants-my class had over 500 applications for the 43 spots. We had to maintain at least an 84 average our first year, and there were plenty of resources to help us, if you chose to use them. We didn't have any silly rules about clinical either. If you missed a clinical, you had to make it up, but nothing about stupid things like shoes..lol. That being said, it was a tough program that required a huge commitment, and there wasn't much handholding at all. The one person who did not make the cut because of grades was certainly intelligent, but lacked the commitment and maturity needed to focus. I don't understand why professors/programs would "try" to flunk students. I would think that would be a poor reflection on the school and discourage future students from applying.

[VickyRN, MSN, DNP, RN]

The students in my college's direct entry MSN program are treated professionally. The retention rate is very high in this student-friendly program.

Moogie, in my very limited experience as faculty, I have found ADN programs to be the least supportive to students and most likely to use the "weeding out" philosophy with draconian expectations of students. The vast majority of ADN programs are supportive of their students; I'm just saying that the "Nurse Ratched's" of the educational world are more likely to be found in these type programs.

Generally, the higher up the educational "food chain," the more respect is afforded to students. Most BSN or MSN programs try very hard to be student-friendly and retain their students.

Of course, mean-spirited and abusive individuals in faculty roles may be found anywhere. They just tend not to last very long in institutes of higher learning.