masters degrees without ever working at the bedside?!

subee, MSN, CRNA · Nov 12, 2012

This has been the case for decades. It's nothing new. Also, remember that physicians graduate from medical school, PA's graduate, etc. without having practiced at the bedside all the time -- except for the experience they get as a student. So do airline pilots, attorneys, etc. You go to school, you join the workforce as a novice.
Your worries about such people practicing in advanced roles are grounded in the belief that such new grads are immediately given advanced positions -- without any supervision -- immediately after graduation. That is not the intention of such direct-entry master's programs and it rarely happens in real life. Such nurses do not enter a world of independent practice. They work for employers ... and it is the employer's responsibility to assure that the people they hire are appropriate for the responsibilities they are being given. A responsible employer will choose to hire someone appropriate for the job and provide sufficient resources/supervision of those employees.
No reputable school would hire a new grad (regardless of their academic preparation) as a clinical instructor. No decent hospital would hire one as a manager, CNS, etc. Those graduates usually get jobs appropriate for their level of experience (often as staff nurses or in some other role where they will have the resources & supervision necessary to support their role transition) ... but move quickly into more advanced positions once they successfully make that transition. Their advanced education streamlines their career progression, but it does not eliminate the need for them to get some experience before they
are ready to lead.

MD's just out of medschool are not analagous to graduates of direct-entry NP programs. A new doc grad can do NOTHING without internship and residency. Our "residencies" are the years we spent practicing nursing before we enter school to become an "advanced practice" nurse. How can you be an advanced practice nurse without the opportunity to learn that enormous body of knowledge we learn on the job(called "the basics").I have no respect for direct-entry programs I see an NP for my regular medical care (doctor doesn't see healthy patients. She takes my BP, 12-lead EKG, gets useless blood work but the only really useful thing she does that I like, is take the wax out of my ears. Is this ADVANCED practice? This is all stuff I can do myself but to get prescriptions filled I have to do this dance once a year.

elkpark · Nov 12, 2012

what a crock of crayons!!! how can you be a "master" of a field you have never worked in??

In lots of (most?) other disciplines/fields, a graduate degree is the minimum credential for entry into the field. How many PhDs in psychology, chemistry, physics, etc., have worked in those fields prior to taking their degrees? In most sciences and academic disciplines, there isn't any kind of "meaningful" employment you can get in the field without the advanced degree (or, at least, while you're working on the advanced degree). The advanced degree is the minimum for entry, as with medicine or law. Nursing is the outlier, I guess because our entry to practice is at the undergrad level, in thinking that a Master's degree implies (and should require) prior working experience in the field.

Anoetos, BSN, RN · Nov 12, 2012

In lots of (most?) other disciplines/fields, a graduate degree is the minimum credential for entry into the field. How many PhDs in psychology, chemistry, physics, etc., have worked in those fields prior to taking their degrees? In most sciences and academic disciplines, there isn't any kind of "meaningful" employment you can get in the field without the advanced degree (or, at least, while you're working on the advanced degree). The advanced degree is the minimum for entry, as with medicine or law. Nursing is the outlier, I guess because our entry to practice is at the undergrad level, in thinking that a Master's degree implies (and should require) prior working experience in the field.

Is this because nursing is an "applied science"; that is, it's really all about doing things with actual people, whereas chemistry and physics and so on are not? Like medicine, there is always a practicum for that reason. Mid-level providers are extensions of these, I can see how it would make sense to expect some direct preparation.

That said, Ilg's remarks above are superb.

agvfc · Nov 13, 2012

Thankyou for bringing the question up. A nurse is a nurse, is a nurse. I don't thinkthat the State Board of Nursing should issue a license to practice in nursing,as the BON is there to protect the public. Every nurse should be heldaccountable and we cannot protect the public if the MSN nurse has no skills. An advanced practice nurse will have the skills to practice, therefore this is ok in my view. No employer will hire someone without pratcicing skills.

mariebailey, MSN, RN · Nov 13, 2012

I am quoting myself from another thread. Please read this to better understand the Direct-Entry Master's/Clinical Nurse Leader Program.

I want to clarify some misconceptions regarding the role of the CNL:

The CNL is not an administrative/management role. The CNL will practice at entry level in a variety of settings right alongside the BSN, from acute care to public health. Their scope of practice is the same.
Their unique educational preparation is intended to better equip them forfuture positions of formal leadership and provide them with insight as to how to be an informal leader in the interim.
People with CNL certification are coming into the healthcare industry with a wide variety of career, life, and educational experiences that have likely provided them with opportunities to develop leadership skills and critical-thinking skills that will aid their professional development as nurses.
Entry-level MSNs ARE employable.
There appears to be a lack of familiarity with the curriculum & slow acceptance of the role among other nurses, although it is still a relatively new program

fromtheseaRN, BSN, RN · Nov 13, 2012

this isn't something i'm overly concerned with, as many states mandate how many years experience a nurse must have in order to teach. i did go through my associate's program with a friend who was going to go directly into a master's program after graduation(she had a bachelor's in another area, so qualified for the rn-msn program). the hospital who hired her advised against this, as hospitals already spend so much to train new nurses, they said they would have a hard time justifying paying even more to train a new grad nurse who holds a master's degree. i wonder how many hospitals would actually choose a new grad with a msn over a new grad with a bsn due to the cost.

amygarside · Nov 13, 2012

This is an interesting question. Thanks for voicing them out.

DizzyLizzyNurse · Nov 13, 2012

When I was on a cruise 6 months ago, I met a CNM at my dinner table. She had gone through school, gotten her BSN and went right for the CNM without any bedside experience. She never worked as an RN. She said she had some catching up to do with the RN's who had L&D experience but otherwise didn't have any trouble and got a job right out of school. This interested me because I really want to do L&D and I think I'd be interested in being a CNM some day. I wish I could start school to get it out of the way, but didn't think I should without L&D experience. But it will probably take me years to get a job doing that, due to seniority rules and people never leaving their L&D jobs once they are there. Took me a year and a half after I graduated to even get a med/surge job.

mindlor · Nov 13, 2012

I was in the direct enty program at Columbia University in NYC. Their position is that being an ARNP had absolutely nothing to do with being a bedside nurse.

To make a long story short....I left the program, am getting a year of bedside exp, and then going to a different school for my ARNP......

canadiandude · Nov 13, 2012

Completely Disgusting!!! Somebody needs to do something about these people

ThePrincessBride, MSN, RN, NP · Nov 13, 2012

There is something to be said about earning your stripes. I have more respect for nurses who've worked as CNAs and NPs who worked as nurses for a couple years before.

Editorial Team / Admin · Nov 13, 2012

this isn't something i'm overly concerned with, as many states mandate how many years experience a nurse must have in order to teach. i did go through my associate's program with a friend who was going to go directly into a master's program after graduation(she had a bachelor's in another area, so qualified for the rn-msn program). the hospital who hired her advised against this, as hospitals already spend so much to train new nurses, they said they would have a hard time justifying paying even more to train a new grad nurse who holds a master's degree. i wonder how many hospitals would actually choose a new grad with a msn over a new grad with a bsn due to the cost.

Most hospitals, unless the MSN allows an expanded scope of practice (such as NP), would not differentiate between the degree. An RN working a bedside position as an RN would be paid the same regardless of diploma, ADN, BSN, or MSN degree. Some places may offer a small differential (most I've heard is $1, many offer nothing) for a BSN or higher, so the cost of training isn't really going to be different.