Cons of master's entry NP programs?

Jules A, MSN · Aug 11, 2011

The cons I can offer as someone who has worked with several new graduate CNLs as floor nurses is they are really behind the curve with regard to clinical skills and staff aren't too pleased that the new person with so much training in delegation hasn't ever given an injection. :rolleyes: Personally I just can't imagine being ready to prescribe medications without at least a few years working in the field but I know these programs are cranking out degrees to anyone who pays the tuition. Hopefully some people who have been through it will write and share their experiences but my take is I argue that getting some nursing experience prior to going for NP is preferrable.

Trauma Columnist · Aug 13, 2011

Agree with above posters. My comments come from someone who has NOT worked with direct entry NPs. Heck, even the experienced APNs can't get jobs in my neck of the woods - lol.

I think that you are going to have a hard time directing care of floor nurses if you have no clue how things are done. Just my $0.02.

Annaiya, NP · Aug 13, 2011

I think another thing to consider is being an NP is tremendous amount of responsibility and NP education has not been set up to provide you with all of the training you need if you don't have experience. I'm not sure what steps the direct entry programs take to remedy this, but my NP classes assume we all have a solid RN foundation to build on. It would be much harder to learn everything you need to know if you don't already have a good handle on the basics. I think you have to consider your personality and background to determine if this type of program suits you. My guess is it is much more stressful and demanding of the students than the traditional route of starting as an RN and then getting your NP degree.

Adenium · Aug 14, 2011

Just keep in mind that different programs have different set-ups. I attended one which prepared you for the NCLEX in the first year. Everyone then went into the work force (had no more problems finding jobs than local BSN or ADN grads) and got some experience. Some are now completing the Master's coursework with 1-3 years experience, some decided to remain in bedside nursing.

No one had any particular problem adjusting. There were some folks from local community colleges that happened to have more experience putting in Foleys, etc. who enjoyed pointing this out on occasion, but really it's the luck of the draw as to what comes up when you're in school. By the end of my program I was taking 4-pt assignments, doing all care, all meds except IV pushes, calling the docs and families, giving report, etc. I felt pretty well prepared to be on the floor. When a skill came up that I hadn't done, I asked to have someone show me or watch me and then that was it....you know for the future. Many students these days aren't allowed to do much because of liability decided upon by the hospital or school or both, so I feel lucky to have gone through when I did. When students came onto my former floor they could hardly do anything, which is a shame....but it's not because they were in an accelerated program. They're in regular ADN/BSN programs.

My program gave us three master's-level courses so those credits count if we continue at the same school, and we were automatically admitted if we had greater than a B or B+ in all classes. For me, as a career changer with limited funds and time, it worked out very well. I might have some limitations if I went into some of the military branches as they cannot think outside the box and accept only BSN, but that's not my goal. I'm starting my FNP program and then it won't even matter. Most hospitals around me consider the BA+RN to be equal to the BSN. It fulfills their need for the "professional" level and proof of a well-rounded liberal arts background in addition to the nursing knowledge. I paid my dues with 18 different elective requirements in my undergrad, and I wasn't going to pay thousands of dollars more just to tack on BSN.

The reality is that most of your nursing skills will come from experience working as a nurse. You learn what you can in school, and continue to read and learn and ask questions once you're working. That's what really lets you become valuable to your patients and confident in yourself.

Adenium · Aug 14, 2011

Another thing - there's a huge difference depending on what track of Master's you want to pursue. I imagine being an FNP in an office is quite different from working as a nurse on the floor....you're not putting in catheters and IVs and changing out chest tube atriums, etc. I work in an ICU, and you can bet that if I were planning on going into Acute Care I'd be working there for longer before continuing my education. We've had direct-entry students rotate through, with no nursing experience, and it was very painful. The nurses pick up on it, because it's obvious they're floundering....and they march right over to the experienced NPs and ask what order they want. They have to, because they know better. Some of these students are planning on working as nurses after completing their programs, which seems backwards.

When looking at these programs, I imagined that they really design them differently to make up for the fact that their students aren't coming in with experience. From what I've seen, beyond the initial certificate year they take the same classes as a regular Master's student. There's no extra help or special design - the objective of the school is generally to make money. As much as possible. As quickly as possible. :mad:

Look carefully at the programs available to you, and talk to graduates as well as local employers. I spoke to folks who'd done my program, working as nurses and as NPs. They gave me the good and the bad so I was able to make an educated decision.

Sorry to drone on but it's a pet peeve of mine when folks hop all over the direct-entry or career-changing nurses without understanding how the various programs are set up. Yes, some produce an acting NP who's never worked with patients, but not all. And some of those with no prior experience seem to do well anyway......they have to be dedicated and do a lot of self-learning but they may do better than a nurse with experience who's a bit lazier. For me, I wanted the experience and the money I could earn before going back. I don't regret it, and I'm lucky my program was designed for that.

t_heart · Aug 14, 2011

Thanks, everyone, for all your contributions so far! Your feedback has been helpful. I'm ultimately hoping to become a pediatric nurse pracitioner. I think I'm now leaning towards accelerated BSN programs, getting a year or more of experience, and then going for the NP degree. I will be applying to the master's entry PNP program at UCSF, which has a good reputation, just in case I change my mind in the next couple months. I wish I could speak to someone who has was a graduate of a direct-entry master's program.

Adenium · Aug 15, 2011

Those full-on direct entry graduates are around but I think they sometimes hide because they are not necessarily well received. If you're applying to UCSF could the program director put you in touch with some graduates?

Good luck in your plans!

UVA Grad Nursing · Aug 15, 2011

UCSF has an excellent program, and I am sure that their graduates do well after they graduate.

The Direct Entry NP graduates of other programs may not fare as well. Several hospitals here in Virginia hire those Direct Entry NP graduates as novice nurses (Clinician I) - the same level that new ABSN graduates are hired. After 2-3 years of experience, these Direct Entry NP grads can then apply for NP positions at these hospitals.

gettingbsn2msn, MSN, RN · Aug 15, 2011

3 years of floor experience has helped me tremendously. I am also an older second degree student. I do not think it is necessary to do more than 2 years. It just helps to build on a good foundation. You will feel more confident. This is just my 2 cents.

Jules A, MSN · Aug 16, 2011

Sorry to drone on but it's a pet peeve of mine when folks hop all over the direct-entry or career-changing nurses without understanding how the various programs are set up. Yes, some produce an acting NP who's never worked with patients, but not all. And some of those with no prior experience seem to do well anyway......they have to be dedicated and do a lot of self-learning but they may do better than a nurse with experience who's a bit lazier.

The one I have experience with absolutely does admit students in the NP program with little or no nursing experience in the speciality and their coursework is exactly the same. :rolleyes: Speaking from what I have seen most of them will be unprepared which to me is frightening. Although as you wrote "some of those with no prior experience seem to do well anyway" I don't think that justifies graduating so many that won't and frankly when it comes to prescribing medication I'd much rather take my chances with that experienced but lazy nurse.

allnurses Guide · Aug 16, 2011

I'm a Direct Entry grad (2009). I had no problems finding an NP job, and I've done just fine, thank you very much. Also, Direct Entry programs do not take anyone who can pay the tuition. These programs are highly competitive and only admit a very small percent of applicants. They are not degree mills. My program was very intense and we were held to very high standards. Everyone in my program worked their butts off to ensure that we were prepared to enter the workforce as novice NPs.

I work in the outpatient setting, so very little of what I learned in the RN portion of my program is applicable to my job. I am not trained to work as a hospitalist. I think you do need bedside RN experience to work in the acute care setting.

Deciding to go the direct entry vs. the RN/BSN route is up to the individual. Some people prefer and perhaps need time as an RN before moving ahead with the MSN. Others prefer to go the direct route and are very successful. Two different paths, but neither is wrong.