Direct Entry MSN VS DNP

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Hi all,

I'm a 29 year old currently setting the groundwork for a career as a nurse practitioner. I'm taking prerequisite classes and soon will volunteer a considerable amount of time in the health care setting to further bolster my resume and all that. A confusion that I'm running into is that I'm looking at programs in Boston, some other cities in the east, and my current transitory home of Seattle. The programs are REALLY different.

The east coast programs are all 2-3 years in lengths and the application process seems fairly cut and dry. In Seattle, UW doesn't even offer a direct entry program, and to become a nurse practitioner starting from nothing seems like it would take 5+ years (accelerated bsn and then a DNP). I've heard that SU is changing their direct entry immersion program to a DNP degree, which will add two years to the program, bringing it also to nearly 5 years. This imbalance of time, and ultimately money in both lost income and tuition, makes little sense to me.

How can the same working title, nurse practitioner, but obtained in 2 years and yet Seattle schools require 5 years of schooling for the same job? Who would even apply to these Seattle programs? Am I missing something? I also think it's a fair point to note that 5 years is a year longer than MED school. Why would a mid level practitioner need more schooling than a doctor?

Can someone add some insight to my confusion?

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Specializes in Forensic Psychiatry.

I'm curious as to why you would choose the NP option over the PA option if you wanted to go direct to midlevel? UW doesn't have an entry level MSN NP program because there are other schools in the area that offer that program, however UW does have a really good PA program. PA programs are usually 24 - 27 months and require the same prerequisites as BSN programs (along with 2,000 hours of hands on healthcare experience that can be gained as a EMT, CNA, RN, RRT ect).

The advantage to getting the ABSN and then transitioning to the DNP is that you would be licensed as a BSN level RN after the ABSN portion and could work through the DNP program. So you would actually start making money sooner and many brick & mortar APRN programs are arranged so that you can work as an RN full time while attending the program.

If you actually look at Seattle University's degree program they say they'll be transitioning to a DNP making their total degree time 3 years +1 semester. Currently they are only 2 years +1 semester. However, just looking through the prerequisites it doesn't look like it will give you any RN background at all and has one of those abridged RN programs mixed with an NP program. So you can't actually sit for the NCLEX until you've completed the entire program. Meaning you'd be earning income a lot faster with UW and will at least have floor experience as an RN - which is invaluable for programs because the NP job market is getting really competitive on the west coast, you have a lot of professions competing for the same jobs and there can be a bias against entry level NP's.

I'm not seeing a "5 year entry level DNP" at all from either of the schools you've mentioned.

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Thanks for your response, JustKeepDriving. If my tone comes off as contentious, I don't intend it to at all! I'm just looking for answers and I don't know anyone in the field.

My hesitation with pursuing a PA program is the very 2,000 hour requirement that you mentioned. Also, (and I'll be the first to admit I could be wrong) but PA's seem a bit more pigeonholed career-wise. The 5 year schooling would be if I did the accelerated BSN and then applied and got into the DNP programs at UW. It would end up being about 5 years with wait times included. 5 lost working years for a *chance* at getting a $80-90k-whatever job in, as you said, a stiff job market does not seem like that great an opportunity.

Frankly I think you'd have to be crazy to pursue it from nothing. If you already have a BSN, that's a different story.

I guess my main point is the clear timeline discrepancy between most prominent east coast schools' direct entry programs and the schools in the Seattle area. To be perfectly honest, I don't want to spend a large period of time working as an RN, even while in school. I'd rather have more schooling and not work at all so I can get out in the NP market sooner. Every article I read says that there is little overlap between the two job's responsibilities, and it seems like most people who are proponents of a RN-NP progression feel that way simply because that's what they did with their own careers. Why would I go through all of these lengthy, arduous hoops when I can be in-and-out of an equal if not greater institution in 2 years time and be a practicing NP whilst the corresponding Seattle cohort is still in the first semester of a DNP program? Because, correct me if I'm wrong, but most of the sources I've read say that a national mandate for DNP is a long, long way off and may never even happen.

I don't know what to do and it seems like no two people have the same opinion!

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My 2 sense on the whole DNP topic - if you want to be a nursing professor, the DNP is faster than a PhD. If you want to be a clinician, the DNP has zero return on the time and money investment vs. getting a MSN.

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Specializes in Forensic Psychiatry.

The NP job market is a lot easier to navigate when you have the RN job experience. Anecdotal but I do know direct entry NP grads and many of them are not currently employed (and they graduated 3 years ago) and others that have their scope of practice limited by the facility where they work.

At least in the city where I currently reside a lot of places will not hire direct entry NP grads. No RN experience is not the same as NP experience but all of the conditions that I diagnose and manage as an NP Student I've seen as an RN. I've administered the medications I prescribe, I've gotten orders for the meds I prescribe, I've implemented plans for the conditions I diagnose and although as an RN I wasn't working off the DSM (I'm in psych) to create diagnosis, I've seen all these conditions before and seen how they are managed. Taking the RN experience to the advanced practice level makes everything easier (and I have a psych background from another life with an additional bachelor's degree - it's still did not grant the same knowledge as working as an RN).

They're looking at it this way. MD with clerkships and subintern years + residency comes out with about 40,000 hours of clinical time. PA does 2,000 hours before getting accepted and during school comes out with 4,000 hours of healthcare experience. My NP school requires RN practice before getting admitted and provides about 2,000 hrs of clinical rotations at an academic teaching hospital so we have at minimum 4000 hours and most of us with much more than that (I think all together as an RN and with the NP program I'll have something like 12,000 hours). A direct entry NP has about 700 hours of healthcare time, none of it as as a working, independent provider (meaning not being watched by faculty, and not getting the complete immersion into the healthcare environment).

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Specializes in Assistant Professor, Nephrology, Internal Medicine.

I see the value in the comments left here prior to mine. Though I am studying to be an NP and about 7 months away from graduation and boards, why would you not just save the money and go PA? The only reason the PA route is a pigeon hole is that they will probably never have independent prescription rights. The new APRN consensus is pushing for all NPs to have universal independent rights in each state. My big question is: why are you worried about the time rather the actual practice differences between the PA and NP?

I would also second the statement that JustKeepDriving said, RN experience makes finding an NP job MUCH easier. Why is that? I will tell you my experience. First off, 99% of what I learned about assessments, clinical decision making, and clinical medicine came from my first year as a staff nurse. I can honestly say, from where I was, I would've had insufficient skills and knowledge to be a provider. My clinical medicine classes through NP school have gone so much more smoothly now that I've gained the clinical skills and knowledge. Second, I have met countless physicians now that have offered me jobs, or at the very least have stated they will want to discuss jobs with me when I am done with school.

I originally got into NP school immediately following nursing school, and I planned to go straight through with minimal RN clinical hours. However, speaking to many of the NPs and PAs that I knew told me getting RN experience was one of the important factors in determining success in NP school. Don't get me wrong, I know a few NPs that have NEVER worked a day as a staff nurse and they are great providers. The majority of people really need that experience to build their knowledge and skills up first. I know that there are ways to work during NP school, as I am doing that too. However, most places were new grad RNs can work desire these applicants to be full time. Let me tell you, I would NEVER have been able to start my career as an RN AND start NP school at the same time. Both are very rigorous and draining when you start, it would be a disservice to you as a RN, future NP, current patients and future patients for you to take on two important tasks at once.

Here is how I did it: Nursing school- 1 year working- NP school while working part time.

Just my 2 cents. I hope you find the answers you are looking for.

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I would argue that you are more pigeon-holed as an NP than PA. You are required to choose a population area to specialize in as an NP - family, adult, pediatric, neonatal, etc. For instance, if you specialize as an Adult-Gerontology NP, you'd have to go back to school again if you changed your mind and wanted to treat kids. I think the PA route is way more flexible, and the program arguably much more rigorous with about 2000 hours of clinical rotations compared to around 700 in an NP program. I've never heard of any NP program requiring 2000 hours of clinical rotations.

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Veigar points out an important difference. As a NP you will be a trained in a specialty and expected to work in that specialty area, as a PA you trained as a generalist and can work in almost any field. PA requires more hours overall, but they are scattered across a large number of specialties and receive relatively very little clinical experience in any one area relative to a NP.

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Specializes in ER.

PA requires more hours and get a lot experience in several specialties. They also have fellowships that both NP and PAs can attend. I have been an ER nurse for 8 years and will be applying to a post grad NP program. If I wasn't a nurse already I would do the PA program.... Especially if I didn't have any experience. The more hours the more confident you will be in my opinion. It's crazy to me how everyone that's interested in the direct entry program want the shortest route with the least amount of clinical hours. And we are thinking of letting them practice independently. This is extremely concerning to me.

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Specializes in Family Nurse Practitioner.

I just graduated from a 4 year BSN-DNP program. If I were starting today I would go the PA route. I like their curriculum over ours and the fact that they do receive general training. Many are hired in specialties where they make more money. I feel my curriculum had many courses that will never help me in practice. I graduated with 1200 clinical hours in placements that I had to find myself. That is another point, PAs do not find their own placement for clinicals. Many students become desperate for a preceptor that they accept anyone that says yes. That does not mean they will receive the best clinical experience just that the hours will be completed.

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