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?

[VickyRN, MSN, DNP, RN]

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

Thank you for sharing your experience, kanzi monkey. In the DE MSN program at my college of nursing, employment opportunities seem to be the same as for other advanced practice nurses in the area. They are taken seriously by employers and by allied health peers. During the pre-licensure phase, the students actually have more clinical hours than our traditional BSN program. The students are required to work full-time as RNs before taking any advanced practice clinical courses. By the time the students graduate from my college's program, they have 3-4 years of bedside RN experience under their belts.

[JGuenther]

Thank for you the reply. I am in my last semester of pre-reqs right now and very worried about how long it will take to get into the nursing program. The way the petition process is run, I will not be eligible to get in next semester due to the deadlines of the petition as well as the necessity of having my complete grade(for the final pre-req) posted before petitioning.

My friend Shannon had to wait 3 full semesters before being accepted and she is a 4.0 student who scored in the 99th percentile on the NLN. Maybe I should cut my losses now and sign up at UWM. A lot of my friends go there and after all the pre-reqs I have taken, along with my former college credits, I can't see their program taking any longer than the one I am currently enrolled in!

Thanks again, I'm going to look into this right now.

[>30yrsRN]

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.

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

[Moogie]

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.

JD2nurse, you sound like a very focused, intelligent individual who knows what he wants and you will be an asset to the nursing profession, whatever you end up doing. I think you are the kind of person who will succeed in an ELMSN program. One of my objections, however, to ELMSN is that not every student seems to be as focused as you. Some---not all but some---seem to have a vague notion that they want to be in nursing but have no idea what specialty they prefer, what kinds of nursing they want to do---they just know they don't want to do bedside nursing and want to start at the top of the career ladder rather than at a lower rung. You have a goal---you want to be a FNP. I'm concerned about the students who say they want to be nurse practitioners but have little idea of what NPs do, what specialties are available for NPs and how an NP's role differs from the role of the physician assistant or other advanced practice nurses. I think students who are not focused and don't have very specific goals in mind might be better served by doing either an accelerated BSN program or becoming PAs instead.

BTW, I do understand that some institutions offer residency programs for beginning nurse practitioners. Whether one is a graduate of an ELMSN or a more traditional MSN-NP or DNP program, I think the residencies are a great idea, helping the new graduate become more familiar with the role and the type of practice as well as providing specialty training. I know, there's a collective sigh of disgust over the idea of yet one more hoop over which one must jump in order to achieve one's career goals but I think residency programs sound very worthwhile.

My other main objection to ELMSN is not students who wish to get into the NP role but those students who want to go directly into roles as nurse educators, clinical nurse specialists and clinical nurse leaders. Those roles require levels of clinical expertise that cannot be obtained through book-learning or nursing school clinicals. A CNS or CNL is considered to be a nurse LEADER, a resource person who can help troubleshoot difficult patient situations and help in the most complex cases. How can any nurse be a credible leader if he/she with entry-level experience and education? Moreover, a clinical specialist or leader who is not clinically competent will not be respected and he/she will be rendered ineffective as a leader. For nurse educators, the need for clinical expertise may be even more critical. Even nurse educators who teach theory courses or skills labs need to have relevant, practical experience with real, live patients in order to help their students bridge the knowledge gap between theory and practice. Those who cannot bridge the theory-practice gap do no favors to their students, who may learn about theory in school but aren't able to translate what they learned about theory into real life practice. Educators without clinical experience also lack credibility. I had an instructor in the mental health component of my BSN program who had gone directly from her own BSN program into an MSN program. Some of us in the class were experienced RNs and when we discovered that she had never, ever, not once worked in mental health nursing, she lost all credibility with our class. She couldn't share with us stories about her own clinical experiences as she had none. She couldn't relate to the experiences the students had in clinicals because she had never worked in a psychiatric setting.

Moreover, a nurse cannot do credible research unless that nurse has some understanding of clinical realities. Please, let me share with you my own experience. I had been out of nursing for several years due to being a SAHM and doing something outside of nursing. When I went back for my master's for nursing education, one of my professors urged me to get back into clinical nursing for a while, to re-learn some of my skills that were rusty and to get a better feeling for topics in nursing research that might appeal to me. She was right. I had a lot of difficulty figuring out what sorts of areas of interest I had for nursing research and I did feel uncomfortable, even teaching in a skills lab, when it had been so long since I'd performed many of these skills. It was a pain in the neck (okay, lower...) to go back to a clinical setting for a while, but I learned so many things and I would not hesitate to return to clinical nursing in the future if I felt I needed a little reality check or to brush up on my skills.

Having said all this, I guess it frustrates me when I hear people wanting to go ELMSN (or, for that matter of fact, directly from a BSN program into a MSN program) for nursing education because I think they're really cheating themselves by not having at least some clinical expertise. I also think they're shortchanging their students.

To JD2nurse, congratulations on getting accepted into the program of your choice and good luck to you on your educational journey! Please keep us posted on how it goes for you.

[Moogie]

Thank for you the reply. I am in my last semester of pre-reqs right now and very worried about how long it will take to get into the nursing program. The way the petition process is run, I will not be eligible to get in next semester due to the deadlines of the petition as well as the necessity of having my complete grade(for the final pre-req) posted before petitioning.

My friend Shannon had to wait 3 full semesters before being accepted and she is a 4.0 student who scored in the 99th percentile on the NLN. Maybe I should cut my losses now and sign up at UWM. A lot of my friends go there and after all the pre-reqs I have taken, along with my former college credits, I can't see their program taking any longer than the one I am currently enrolled in!

Thanks again, I'm going to look into this right now.

I really hope you are able to get into an accelerated BSN program. You sound like an excellent candidate and it seems to me that it would be very frustrating to go through all that work, end up with an ADN, only to have to go through more work and more schooling to become a BSN or MSN. Good luck to you, too!

[butterfly journey]

Oh thank you for posting this. I too am a non-medical post-bac student (actually I have an MBA as well) and have wanted to ask this question. I am primed to either program. Where I live the pre-req's are the same for both with the exception of one class. I've read other posts similiar to this one, but most of the replies seemed to be non-NP that just wanted to put their 2 cents in about how an NP without the extra nursing years experience would be worth squat. I am currently pursuing the traditional BSN, but my school also offers the MSN after one year of experience (actually, it appears they will let you start the non-clinical classes immediately after you graduate BSN but you can't take the clinical courses until you've had a years worth of experience) So I think that's the way to go simply because I've heard such negativity on these boards concerning the Direct Entry MSN.

I hope more people will post about this topic.

[misplaced1]

As far as not being able to do nursing research without doing lots of clinical practice I beg to differ. One of the best researchers around was a woman at JHU who had a doctorate in another field. She brought a unique perspective to nursing. This is what nursin misses. If you go into a medical school you will see people with PhDs in all sorts of other fields doing MEDICAL research. Computer people, psychologists, all kinds of chemists and biologists. They come at the research from different perspective and this is what nursing is missing. I am very familiar with this because I have actually been there.

I don't understand this contest between people with "years of experience" and people that are newly graduated of have little or medium amounts of experiences, or people with experience from another field that they bring. I feel nursing has been very teritorial in the past, like people that have been isolated on an island. That is not the way to progress. People with other backgrounds especially help to move things forward.

I also want to point out that if someone went right into and industrial research setting hospital experience may help in some ways but mostly its a different animal. Again, been there so I know what I am talking about here.

I am in total agreement however that a nursing instructor, teaching a clinical nursing class should definitely have nursing experience. How can you teach something you have not done?

[kanzi monkey]

Oh thank you for posting this. I too am a non-medical post-bac student (actually I have an MBA as well) and have wanted to ask this question. I am primed to either program. Where I live the pre-req's are the same for both with the exception of one class. I've read other posts similiar to this one, but most of the replies seemed to be non-NP that just wanted to put their 2 cents in about how an NP without the extra nursing years experience would be worth squat. I am currently pursuing the traditional BSN, but my school also offers the MSN after one year of experience (actually, it appears they will let you start the non-clinical classes immediately after you graduate BSN but you can't take the clinical courses until you've had a years worth of experience) So I think that's the way to go simply because I've heard such negativity on these boards concerning the Direct Entry MSN.

I hope more people will post about this topic.

Your decision should be based on what you want to do. In my opinion, if you want to work in acute care as an NP, you will have a very difficult time getting there without some acute care RN experience (ICU, floor nursing in a tertiary hospital, etc). If you want to work in primary care or in an office setting, I think the relevance of nursing experience is negligible. If you're like me, and you find every moment a learning moment, you will benefit from RN experience no matter what. If you are able to learn in an academic setting with a taste of advanced practice through clinicals, you may be alright without working as an RN. The INFORMATION/KNOWLEDGE you get in school is adequate--but there is nothing quite like seeing how this information is manifested in a clinical setting (especially in the acute care arena).

Not all DE MSN programs are the same, however. I finished mine in 4 years and have worked as an RN for more than half that time. I feel prepared to work within an NP scope of practice and to RECOGNIZE when something goes beyond my level of training and I need assistance. I believe that this is where an entry level NP should be--regardless of RN experience.

[kanzi monkey]

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

Perhaps your >30yrsRN experience has given you a skewed view of what training for advanced nursing practice entails. BCGrad's post seems very reasonable. Working as an FNP is not necessarily related to working as a nurse. For me, I learned how to be what I am today from from ALL of my RN and non-RN work experience--paper route, retail, baby-sitting included. These things help me because that's how I am--but not everyone will gather the foundation of their advanced training on every grain of life experience. It's certainly not required.

Also, BC is a highly esteemed institution, and I don't believe it would jeopardize its reputation by graduating NPs who were not adequately prepared. BC also doesn't accept students who are not exceptional prior to beginning their nursing training. Their graduates are quite capable of assuming advanced practice roles--and knowing when to ask for assistance.

So, maybe not a program for everyone. But then again, most people won't get in.

[BCgradnurse, MSN, RN, NP]

"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:

[GoECU]

I am currently in an alternate entry program. I have just completed phase one (pre-licensure). It was 2 semesters and 2 summer sessions that were the most intense schooling I've ever been in (I have a previous bachelors and masters degree). I just took NCLEX-RN and passed! I felt we were well prepared through our classes, clinicals, and independant study. Some of you may not realize that during phase 2 (graduate classes), we are working as RN's gaining experience. Some of the advanced practice programs at our school require 2 years of experience before starting, so you are taking core classes while working. So I do feel that we are gaining the experience we need to be advanced practice. I do think that working as a RN first before working as a advanced practice nurse is important. This distinguishes us from a PA or MD. I will be starting my nursing career on Sept 14 and working on my graduate work as I gain my RN experience. Best of luck to all that are starting direct-entry programs!

[BCgradnurse, MSN, RN, NP]

Congrats on passing NCLEX!! I remember what a relief that was! And rest assured that there are none of those horrible "choose all that apply" questions on the NP boards!!

I find it very interesting that even among DE prgrams there is so much variance. We were not required to work as RNs before starting our MSN portion, but some of my classmates chose to deccelerate their schooling so they could gain some RN experience. Much to their dismay, there were no RN postions available in the area!! I heard this from the BSN grads, too. So, several did an about face and went back to school full time for their NP, and immediately went to work as NPs. Not what they originally wanted, but economics dictated their choice. I had looked into finding a per-diem or part time RN position at the hospital I was employed at during that time (I had worked in the lab part-time while I was going to school), and there was nothing available. I would have worked evenings, weekends, and nights, but there were no openings. So, I stayed in the lab where they were happy to have me for what ever hours I could give them.

I'm not sure how the current economy will affect certain program requirements for DE students to spend time working as an RN. For those of you who did it, did your school help you find a job?

As an aside, my career switch to nursing happened in my mid 40s. People thought I was crazy to "start over" at that "advanced age", but it was the best thing I'd ever done. I think waiting that long gave me a chance to gather a lot of valuable life experience (including mom experience) that has helped make me successful today. If nursing, be it is an RN or NP, or whatever, is your dream, don't let anyone talk you out of it. Go into it well-informed, but turn a deaf ear to the nay sayers and cynics who will try to discourage you. There's nothing cheap or easy about going through a direct entry progam. Those who think we enter these programs to save money or take the easy way to a degree are sorely mistaken.