I'm a marketing/pr professional, hoping to start an entry-level MSN program in the fall (God willing). I know these types of programs are relatively new. My question is for those of you who have completed such a program or you nurses who have coworkers from these programs, how are the nurses received in the work environment? I guess what I'm trying to see is if there's any type of tension or animosity directed toward those who enter into the field with an entry to nursing MSN degree. I know the "Clinical Nurse Leader" role has yet to fully materialize in hospitals and all of us will start off as entry-level RNs due to he lack of experience, regardless of the degree behind us, but I'm wondering how other nurses view those that have taken this route.
My ultimate goal is to become a neonatal NP, but I know I have to (and I want to) pay my dues first and get all of the experience I can as an RN. Other than allowing me to go back in a few years to get a post-masters certificate in neonatal NP, I have yet to fully comprehend what the MSN Clinical Nurse Leader degree will mean to my career starting off, and how I will be accepted and viewed by other nurses and administrators. But this is the best option available to career changers with ba/bs degrees in other fields, so I'm going with it.
Kanzi Monkey, I would like to add to your (very good) post that I do believe it's important for someone planning to teach nursing or do research also have some experience in direct patient care. It's important for nurse educators to have a foundation in direct care because they're teaching aspiring nurses to think and to do. Contrary to the adage "those who can't do, teach", it's fundamental for nurse educators to be able not only to teach (and some cannot teach) and to be able to do in order to teach the physical skills required for nursing as well as the theoretical foundations that underlie why these skills are performed as they are. I also think it's important for nurse researchers to have bedside experience so that their research can be made relevant to nursing practice. I don't doubt for a moment that someone can go from a BSN to a PhD and become an accomplished nurse researcher. However, the point of doing research is NOT simply to do research for it's own sake---it is to add to a knowledge base and impact upon nursing PRACTICE. How can anyone who is unfamiliar with nursing PRACTICE expect to contribute anything meaningful and relevant to nursing practice?
BTW, I would certainly trust an NP who was a graduate of a ELMSN program with my own health, regardless of whether or not he/she has practiced as a bedside nurse. I would also find it fascinating to teach in such a program, but core courses only, not anything specific to NP practice as that is not my area of expertise and probably will never be as I don't have a burning desire to become an NP.
its funny that many people think that NPs should have all of this beside experience before they become an NP, but just think about MDs. Most of them haven't even looked at a patient until they enter their residency and at that point they are already Doctors.
its funny that many people think that NPs should have all of this beside experience before they become an NP, but just think about MDs. Most of them haven't even looked at a patient until they enter their residency and at that point they are already Doctors.
This make sense, I think an NP is just like a PA right? Which are both LIKE an MD? I guess though any experience helps, but not necessary...
its funny that many people think that NPs should have all of this beside experience before they become an NP, but just think about MDs. Most of them haven't even looked at a patient until they enter their residency and at that point they are already Doctors.
They intern first, before their residency. Yes they are already doctors, but they for the most part don't practice independently for many years. Physicians get a lot of supervised hands on experience after obtaining their licenses. Internships, residency and fellowship programs are harder to come by for NPs. Many new NPs start out working in a fairly unsupervised capacity. Mentor/mentee relationships are somewhat laissez faire for NPs, whereas for MDs they are par for the course. Think about an intern on her first day of work after graduating from med school. Now imagine that she has no supervisor--no 3rd or 4th year residents, no attending--guiding her through the chaotic reality of patient care. You would not want to be in a position to follow orders from her knowing that her work is being virtually unchecked by anyone with more experience in the physician role. Say your new hospitalist is an NP fresh from a direct entry program whose only experience is from the 700-900 or so clinical hours she completed in school (that includes RN and graduate clinical hours). She is not unlike an intern set loose on patients without a guide (the only difference is that of education, which is an entirely separate discussion :) ). Take the same new NP hospitalist, add 30 years of school nursing to her resume--does it change anything? Not really. Now lets say she's a new NP in a community health center taking care of the primary health needs in a poor, rural setting. Add 30 years of critical care nursing in a large teaching hospital--still not making her any more ready to make diagnostic/treatment decisions for her patient population.
I defend direct entry NP programs because I truly don't believe that RN experience necessarily prepares you to work in the advanced role. I DO kind of have an issue with NP programs in general in that they don't automatically include a system for mentorship upon licensure. Working as an RN before becoming an NP is not equivalent to being mentored as an already licensed NP.
As a new direct entry NP myself, I feel the responsibility to practice safely is up to me. The expectation that I will be ready to hit the floor running is there in every job I have looked at. So, it's up to me to pick a position that I feel will help foster my growth in the NP role--which has made it kind of hard for me to find the right job. This--to be perfectly honest--is a little frustrating right now, especially since I am starting to pay back my exorbitant student loans.
I am not changing my tune here. For any experienced nurse who thinks s/he is automatically more qualified than a direct entry nurse to become an NP, regardless of specialization--well, I have no idea why you think this considering any NP job is fundamentally different from an RN job. But I can't say I don't wish NPs were expected to have more training as NPs before working on their own. Obviously, if that were the standard, newly licensed NPs would have similar opportunities for internships/residencies, etc as our newly licensed physician colleagues.
As a CNL I am currently in a New Grad program with others. Most of them have associate degrees and many of them are still waiting to take their NCLEX. I am okay with this and I am very glad that I am given this opportunity. Sometimes I feel like i should know much more than these guys (all) but really thats not the case. many of these guys are smart.Some of them know stuff I dont even know and some will probably do better than me in exams. But I have a great advantage in the long run and everyday I am seeing this. my education has really prepared me for a stronger future in nursing.
Really, we all just want to provide the best care for our patients. it is not who is better.
As a new direct entry NP myself, I feel the responsibility to practice safely is up to me. The expectation that I will be ready to hit the floor running is there in every job I have looked at. So, it's up to me to pick a position that I feel will help foster my growth in the NP role--which has made it kind of hard for me to find the right job. This--to be perfectly honest--is a little frustrating right now, especially since I am starting to pay back my exorbitant student loans.
I am not changing my tune here. For any experienced nurse who thinks s/he is automatically more qualified than a direct entry nurse to become an NP, regardless of specialization--well, I have no idea why you think this considering any NP job is fundamentally different from an RN job. But I can't say I don't wish NPs were expected to have more training as NPs before working on their own. Obviously, if that were the standard, newly licensed NPs would have similar opportunities for internships/residencies, etc as our newly licensed physician colleagues.
Frankly, I think that would be an excellent idea. I see that many jobs advertised for nurse practitioners are in specialty areas such as oncology or cardiac care. While certainly a background as an RN in such areas would be helpful for the NP wishing to work in a specialty, I think a residency in a specialty would be far more useful. (BTW, I consider being a hospitalist as a specialty, too.)
Kanzi (and others) do you think an internship or residency in a general care setting would also be helpful for the new NP? Or do you think that it would be better to maybe get in more clinical hours during your educational preparation program?
BTW, and this is sheer speculation on my part, but I can see a future in which today's CNL is tomorrow's clinical educator or nurse manager. Yes, to assume a position of leadership at the bedside requires clinical expertise that can't be accomplished solely in any program, but it seems to me that the advanced assessment/critical thinking skills and emphasis on advanced theory and applications of research to practice would be helpful for roles like clinical educator or manager. Currently most facilities require their educators and managers to have at least bachelor's degrees and some are encouraging the master's. So I am curious to see if the DEMSN students, particularly those in CNL tracks (as opposed to NP tracks) also see this in the future or if I'm off the wall here.
I think an NP residency/internship is a wonderful idea. I have senn a few such programs, but very few indeed. I would have jumped at such an opportunity after graduation. I don't have a formal mentor at my job, but one of the reasons I took it was because there are always other NPs or MDs there to ask questions of and learn from. Most of the MDs are just out of residency, so we've all kind of bonded over being "newbies". The MDs don't think they're better than the NPs, and it makes for a very supportive environment. It's a shame that the administration doesn't really value their providers, so most move on after a couple of years (but that's a vent for another time!). A residency would really help build the skills of new NPs, regardless of their backgrounds.
Kanzi (and others) do you think an internship or residency in a general care setting would also be helpful for the new NP? Or do you think that it would be better to maybe get in more clinical hours during your educational preparation program?
If I could choose one, it would be internship/residency. In this position the NP would be fully licensed and responsible for her/his decisions, but would benefit from the supervision and training. It is truly an amalgamation of learning and practice. I wouldn't object to more clinical hours either--but clinical time is specifically dedicated teaching time. There is always the chance that a student may be slightly coddled in this environment as the student and preceptor focus on what the student needs to understand to pass a board examination. We all know that passing the boards simply means that, in theory, the test taker has obtained and retained enough knowledge to begin practice as a novice.
It's that whole period....you know, the novice to expert period....where I think NPs kind of get left to fend for themselves.
i have a question about these direct entry MSN (CNL) programs. Is it designed that you don't take your NCLEX until after you finish the entire program and obtain your masters or is there a prelicensure phase in which you must obtain your RN license before moving into the MSN? I am not familiar with the CNL programs but where i am from there are direct entry programs for those with bachelors degrees in a different field. In these programs you could chose to be a NP or a CNS, but there was a one year prelicensure phase, before going on for the MSN. You then had to obtain part-time employment and work as an RN while finishing up the MSN. I was a career changer and although I did not choose this route (they only offered it in private schools which were just too expensive for me, so i took the ADN route so that I could work and then go back and have employer assistance) it seems to me that this particular program was a very practical way of transition a second career person by allowing them to get two years of RN experience (or more if they are going part-time) while pursuing the MSN. Its too bad that the OP doesn't have this option where she is from. Does anyone know exactly how the CNL works? (OP you could probably answer this question since you were looking into it for yourself).
My program mandated that we pass NCLEX and obtain RN licensure before we could start any NP clinicals. There was no requirement that we work as RNs while finishing the MSN portion. My program was strictly for NP or CNS-there was no CNL option.
The CNL programs in California, are usually 2-3 years and yes you have to wait until the end of the entire thing to take the NCLEX and get CNL certification. I have never heard of a CNL program that does pre-licensure work, make you pass the NCLEX and then continue with CNL Masters portion.
And to the OP, are you in SoCal did you say? Cal state Long Beach has an amazing entry level msn program...awared BSN/MSN/ and NP certification after 3 years. Or Cal State Los Angeles. It was really hard to sort through the programs in California, they are all over the place a total mess I think. We've got CNL's direct-entry NP's, 2 or 3 year general masters programs without CNL, I agree that its a full time job just researching all this stuff.
Great thread! I'm so happy I found this, everyone here is really interested in discussing these issues, and are well researched in the subject matter.
MiahMSN, MSN, RN
310 Posts
Well said, Moogie!!!