Entry into Practice: Direct Entry MSN Programs

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. Nurses Announcements Archive Article

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Entry into Practice: Direct Entry MSN Programs

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?

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VickyRN

About VickyRN, MSN, DNP, RN

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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Yes ,I agree Two Years SENTENCE to General bedside Nursing sounds about right. ( I said that becuase that how some of the MSN would see it,LOL) They need to get a grasp of reality Nursing first... Before they are DX,RX,Educating and Managing Nursing and being the Primary Care giver with a sign outside their office with the MSN and or ARNP. I seen to many MSN and or ARNP without any common sense lack of critical thinking and to even grasp the Basics of Nursing ... sad but true!

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I attended a graduate program in nursing that combined "traditional" students like myself (experienced RNs) with a direct-entry program. Basically, I joined the direct-entry students after they had completed their first, "basic nursing" year, and both groups completed the traditional, two-year Master's program together. In discussions with my direct-entry classmates, I discovered that none of them were licensed as RNs yet, because the program was set up for them to take the NCLEX after they completed the second year of the program, the first year of the MSN program. I was puzzled by this; it seemed like asking for trouble to me, since they had moved on to an entirely different focus of study from what the NCLEX would be testing them on and it's a bad enough idea to postpone the NCLEX for a full year in any case, let alone a situation where you're studying something completely different full-time during that year ...

None of my classmates could explain the rationale for this to me, it's just how they were told the program was set up, so I asked started asking faculty -- the faculty members I asked were clearly reluctant to discuss this with me, but one of my professors (who was not a fan of the direct-entry program there -- it was v. controversial among the faculty) finally explained to me that the reason for this was because there weren't enough clinical hours in the first year for the students to be eligible for the NCLEX -- so the school counted all the clinical hours from the second year, the first year of the Master's specialization, which had nothing to do with entry-level bedside nursing, in reporting to the BON the number of clinical hours the students had completed, which was really cheating which was why no one wanted to talk about that ...

I'm pretty skeptical of direct-entry programs, but that's just my personal opinion.

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What a timely post! I recently received the wonderful news that I have been accepted to an entry-level MSN-FNP program and many of us applicants have been discussing this very issue (among others). To give you some background on me to help set the stage..., moving into health care is a mid-life career change for me. I spent 4 years as an environmental planner and 10 as an environmental attorney before deciding that I wanted to pursue what I feel is my true talent: helping people in a very personal, therapeutic way. It actually represents a full-circle decision for me as I was actually pre-med going into college after high school.

So, with that backdrop, what I would ask those of you who are skeptical of ELMSN programs: what else should people like I do instead? I am certain that I will want to be in advanced practice at some point and, with my wife and I wanting to have children, I would like to get my school out of the way now rather than put off the MSN. 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'm most interested in what everyone might advise here because this decision is very much on my mind!! Thanks.

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By the way, here is the specific curriculum for the program I am considering: http://www.samuelmerritt.edu/nursing/fnp_nursing/curriculum#elmsn-fnp.

Does anyone have any comments? It seems like the first four semesters prior to NCLEX focus on nursing, not APN. What do you think? I do think it's notable that the SMU NCLEX pass rate for its ELMSN students is pretty respectable: http://www.samuelmerritt.edu/nursing/fnp_nursing/curriculum#elmsn-fnp. Am I missing something here? Thank you, again!

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Specializes in allergy and asthma, urgent care.

I am a recent graduate of a direct entry MSN program and I feel that I was adequately prepared to be a novice FNP upon graduation. We were held to very rigorous standards and would not have been allowed to graduate had we not met these standards. Would some time time working as an RN have been valuable? Absolutely, but I don't think it's imperative. I've only been working a few months as an FNP, but I had no trouble getting a job, and am well respected by my colleagues (RNs, NPs, and MDs) and patients. I certainly don't know everything and of course, never will, but I believe I give my patients very good care and I'm not afraid to ask questions of those with more experience. Don't be too quick to discount direct entry programs. Let the performance of the individual speak for her(or him)self. It may not be the traditional path to an MSN, but it is certainly a viable one.

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Thank so much, BCgradnurse! Did you see my posts and do you have any comments for me specifically? I'd be very interested in your opinion of the curriculum at Samuel Merritt and how it compares to your alma mater's. Also, do you mind if I ask from which school you obtained your degree (in Canada perhaps)?

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By the way, my NCLEX link was a typo. Here is the correct link: http://www.rn.ca.gov/schools/passrates.shtml

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I have been going back on forth with this idea for over a semester and I have decided to continue pursuing an ADN....practice as a nurse for a year and then go back for my masters. I have a nonmedical BS, so I could go for it right away, but I don't feel I would be prepared for it and I do not know what my specialty would be.....I need to go through clinicals before I decide on that! I only wish the petition process at my local tech college wasn't so backwards....it will end up taking longer to get this ADN than it would to get my MSN...I know that much for sure.

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Specializes in Gerontological, cardiac, med-surg, peds.
I have been going back on forth with this idea for over a semester and I have decided to continue pursuing an ADN....practice as a nurse for a year and then go back for my masters. I have a nonmedical BS, so I could go for it right away, but I don't feel I would be prepared for it and I do not know what my specialty would be.....I need to go through clinicals before I decide on that! I only wish the petition process at my local tech college wasn't so backwards....it will end up taking longer to get this ADN than it would to get my MSN...I know that much for sure.

Have you possibly considered an Accelerated BSN Program, JGuenther? I don't want to sound discouraging, but as a former ADN instructor I know it sometimes can take years to get into an ADN program. With the expenditure of time waiting and taking co-reqs ahead of time and jumping through all the hoops, you could have pursued a BSN. You also would receive credit for your former Bachelor's degree. Just some food for thought. I discuss the pros and cons of ADN programs in this blog. Whatever you decide, I wish you the best.

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Specializes in Gerontological, cardiac, med-surg, peds.
I am a recent graduate of a direct entry MSN program and I feel that I was adequately prepared to be a novice FNP upon graduation. We were held to very rigorous standards and would not have been allowed to graduate had we not met these standards. Would some time time working as an RN have been valuable? Absolutely, but I don't think it's imperative. I've only been working a few months as an FNP, but I had no trouble getting a job, and am well respected by my colleagues (RNs, NPs, and MDs) and patients. I certainly don't know everything and of course, never will, but I believe I give my patients very good care and I'm not afraid to ask questions of those with more experience. Don't be too quick to discount direct entry programs. Let the performance of the individual speak for her(or him)self. It may not be the traditional path to an MSN, but it is certainly a viable one.

Thank you for sharing your experience, BCgradnurse. Hearing from people who have actually completed these programs relate their personal career experiences is invaluable.

When I was a new graduate, the FNP who made rounds for one of the physicians in my tiny community hospital was a graduate from a direct entry MSN program. In her former life, she was a school teacher. She never had bedside experience as an RN. However, she was much respected by the people in the service area, by the RNs at the hospital, and by all the physicians in town. She had a large practice (many devoted clients who saw her regularly as PCP) at the physician's office.

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I'm a recent DE grad also. It took me 5 years from BA-->RN-->MSN. 1st year was all pre-reqs, so doesn't technically count, but I count it since I needed those 6 classes. To get my RN, I took 18 months of basic nursing courses with clinicals. All of the courses and clinicals corresponded to the BSN program--we just didn't take anything else since we already had our pre-reqs and the basic college level studies that are normal in most bachelor's degrees. After 18 months, we took the NCLEX, then found work as an RN (this was mandatory for my program--since we weren't awarded BSNs, finding a job was a little tricky, but everyone managed). The program required 6 months full-time work as a nurse--as far as I know, everyone is still working as a nurse, and that was 2 and 1/2 years ago. I've been working part-time and took 2 more years to complete my graduate course work and clinicals. Now I'm interviewing for an adult NP position while I continue working as a nurse.

So, basically, I've done the direct entry program AND gotten over 2 years experience as an RN. Working as an RN has helped me prepare in many ways--mostly just exposure to many many different patients and conditions. At this point, I feel ready to move on since I can't grow as an NP in my current position, and I don't have an NP mentor. But 2 years was really a perfect amount of time for me. When I interview, I don't worry about lack of experience.

So, the minimum time to complete my DE program was 4 years (not including pre-reqs--min for FNP or anesthesia is 5 years). Most people who started with me are taking more time.

-Kan

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