MSN direct entry/CNL/NP questions

  1. Hello,

    I'm currently planning on attending UCLA for the direct entry MSN program. This certifies me as a CNL. I'm hoping to receive more information and advice about this position.

    As a student completing a non-nursing bachelor degree 2014, what would be my best option? I am more interested in an accelerated MSN program in comparison to BSN program, given I would have my masters. What would I do as a CNL, are there many jobs as a CNL?

    If I'm interested in becoming an NP down the road, I see there are post-masters certificates, would I be able to do these programs? The average length I'm looking at seems to be around a year, is this accurate?

    Any information and insight would be greatly appreciated. I would be more than happy to elaborate as needed.

    Thank you so much for your input!
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    About neatblue

    Joined: May '13; Posts: 4; Likes: 2
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  3. by   neatblue
    I don't have an interest in CNL. I hope to work as a bedside RN/ ultimately become a Nurse Practitioner. From what I've seen, a lot of people aren't recommending a program that is direct entry NP.

    So- if my aspiration is to one day go back and become an NP. Would it be best for be to do an ABSN program or still the direct-entry MSN, CNL program? I would be fine working as a bedside RN after completing that program. Would pay be different because I had a masters?

    Would it be easier to later become an NP if I went through the direct-entry MSN program now rather than ABSN? To my understanding, if I already had my MSN I would just have to later get a FNP certificate for example, after I've practiced as an RN for awhile?

    Sorry- still new to all of this. Was considering PA school for awhile but am deciding this is what I would rather do. Thanks!
  4. by   WoundedBird
    I'm starting a grad entry CNL program in a month and here's why I chose the CNL focus when applying. I have a background in sports medicine at the high school level and a strong desire / passion / interest in trauma and emergency medicine. Even with this desire I still was very unsure if I could handle constant pediatric trauma or if I would be better off in an adult setting. There was also a feeling of what if I fall in love with L&D during our pre-licensure would I be able to switch to a more appropriate focus (we have to petition to change and only if there are openings)? Our CNL program doesn't pigeon hole me into one focus like a neonatal NP or FNP track would and that was a major draw for me.

    As for becoming a NP down the road, yes you can do a Post-Masters program to satisfy the NP requirements. The length depends on what type of NP you're going for. I believe our FNP is a semester longer than the peds NP but can vary based on the program.

    Hopefully some of this is helpful. Don't hesitate to ask more questions!
  5. by   UVA Grad Nursing
    We have had a Master's Entry CNL program at the University of Virginia since 2005, and have graduated ME:CNL's since 2007. Many of these have gone on to further education (PhD, DNP, NP, CRNA, etc).

    If you have not discovered yet, there is no uniform pathway in nursing education. Even though our CNL grads have earned a MSN degree, not all universities have admitted them into a Post-Master's certificate program. Some schools have required that they re-do a MSN degree.

    Most of our own graduates have worked for 2-3 years before going on for the specialty certification program. For most, the first 12 months after NCLEX is to work beyond the pure novice stage to advanced novice. Year Two is when everything 'clicks' and mastery of a specific field (or subspecialty) develops. Our CNL alum report that at the end of Year Two has been the best time to then start a specialty NP, CNS or CRNA program. Two years of working full-time as a RN has also allowed them to pay down any student loan debts before taking out any more for the next stage of their careers.
  6. by   neatblue
    @KAR813 thanks for your input! I feel similar to your thoughts in many ways. Just because I'm having a hard time understanding still.. would you plan to work as a bedside RN for awhile following this then? I'm confused as to the difference of a bedside RN verses a CNL then between us having an MSN in comparison to nurses with a BSN or simply RN associate programs.

    I want to get into nursing in a way that will most easily allow me to become licensed as I'm
    1. a non-nursing degree holder
    2. I want to be in a position that's easy/easiest to advance if I chose to later do so and become ARNP
    3. Money is a factor, whether it be paying for MSN/ABSN/RN community college schooling. And what my pay would be coming out of those programs.

    Would I be payed more to work as a bedside RN if I had my MSN compared to a BSN or simply RN?
  7. by   WoundedBird
    I do plan on being at the bedside at the completion of my CNL program because my ultimate career goal is to be a flight nurse which does require critical care or emergency department experience before applying. Where I am in the mid-west, the CNL position is just beginning to emerge so it's difficult for me to answer how we would differ from BSN grads when entering the workforce. Personally, I have no issue being clumped into a normal new grad program at a hospital at the beginning of my career because I will have about the same amount of clinical experience (maybe an extra semester and a half). As I make my way through my program I will learn more about my job outcome.

    I'm also not too worried about how much more I might be paid off the bat by having a MS as my entry level degree. If it helps me, great. If not, I can figure out a way to make it benefit me in the future. For me, I want to begin my career as a nurse, begin my family, and THEN worry about advancing my education if I see fit at that point. I know that this isn't the path for everybody, but for me and my hubbs, this is our happy medium.
  8. by   UVA Grad Nursing
    For us, we tell our CNL students from day one that they will be applying for the same entry-level positions as our traditional BSN grads. The nursing system is structured that everyone starts as a novice. However, we are seeing that CNL grads are rising faster up the clinical ladder than BSN (or community college grads) when employers see their enhanced skill set.

    Some employers are loving CNLs. The UCSD Health System just last week awarded their Nurse of the Year award to one of our Master's Entry CNL grads from 2008.
  9. by   neatblue
    Thanks for your input!

    @KAR813 Thank you so much for your input! I really feel like I can relate to your thoughts and reasoning behind the MSN program and I really appreciate your input in helping me make a decision.

    UVA Grad Nursing, so if I'm just trying to get into the field as an RN in an accelerated program (with possible advancement in the future)- you would recommend the MSN over BSN programs? I still am trying to figure out program costs. My big concern is that if I pay a little more for an MSN program compared to BSN program that it will be worth it down the long wrong/I'll be able to pay off those loans. Because I'd be getting my MSN/CNL/RN would that hurt me to not have a BSN? Or not because I'd have an RN? Sorry, still new to all of these different roles and ways to get into the field and trying to figure out what's best for me.
  10. by   WoundedBird
    Glad I could provide some helpful views and I wish I had all the answers about life after nursing school as a CNL for both of us! I just went through my orientation and most of what was covered was what we need to know for the first week of classes and not so much on after we've made it through. But that will come in time.
  11. by   the healer's art
    I debated this myself. I applied to MSN-CL and direct enty programs and ABSN programs and didn't decide until I got into all of them. I decided on ABSN because most people are more familiar with a bachelor's in nursing. I went with a really good school (Duke I start this fall) that I knew would really prepare me to be an awesome nurse. I definitely think you need experience as an RN before becoming an NP so that's why I didn't pick the direct entry programs I got into. I didn't go with the MSN-CNL because it was two years and I wanted to graduate earlier. But actually the MSN would have been cheaper for me because there are more scholarships and federal loans available for graduate degrees than for undergraduate degrees. It was a hard choice. Good luck! I say apply to both. I only knew my true feelings when I was accepted to all of them. Also ask future employers at places you want to work what they would prefer to hire or are familiar with.
  12. by   anonymous219
    the healer's art, I am in the exact same boat. Are you happy with your decision to do the ABSN? Would you do anything differently?
  13. by   the healer's art
    Yes I am really happy with my decision to do the ABSN. I'm almost done! I haven't gotten the impression that a generalist master's gives you an advantage. I'll be entering the work field sooner than my CNL friends. I'm more interested in becoming a NP than going into management so the CNL certificate wouldn't be that useful to me.
  14. by   kate_m
    Ahhhhhh! So I understand I am exactly 3 years late in posting but for anyone that stumbles across this post with the same question, I want to clear something up.

    Being a CNL might have been the best decision of my life! (Aside from my decision NOT to go to medical school!)

    I love my job! Not every now and then, not when I save a patient life, not because my units are the best ever or I work at some ridiculous, iconic hospital or live in a great I LOVE MY JOB. I LOVE MY ROLE. I LOVE WHAT I DO ON A DAILY BASIS. And here is the thing....I work in the exact same critical care units that I worked in before with the exact same people in the same frustrating, low performing, Midwestern megaplex that I have worked in forever. And being an RN there got really old. I spent the first 7 years of my career thinking I had made the worst mistake of my life (becoming a nurse) after making the best decision of my life (not going to medical which I was accepted too).

    See here is what makes the difference between RNs, NPs/CNSs, MDs, PAs, DOs, and any other direct provider and a CNL. We are all at the bedside/frontlines, but while everyone else helps their patients, I help the entire patient population of my units, my department, and my hospital. What is more.....staff - all staff....LOVE this role. I aM more accepted, more welcomed, more sought out than any other person or role in my area. The nurse managers come to me, the physicians come to me, the surgeons, the staff, SW, Cas management, even people who aren't in my units! You know why? Because CNLS have the knowledge and skill set to get **** done and get it done fast, right, and impressively better than any other individual.

    The CNL is an advanced medical GENERALIST not a specialist like NPs or CNSs. But that doesn't mean we have less value or competency. In fact in many cases we have more knowledge and competency because we have been taught to think outside the box, being people togethee, rapidly absorb, synthesize, and analyze info, and we are right there at the bedside with patients and providers. Have a physician who needs to prone a patient but has no idea what timing to use, what labs need monitoring, what prophylaxis is needed, or what the criteria is? Guess what? That is me.

    Need to arrange a family meeting to discuss end of life care with a belligerent family? Guess what? I get it done, align with the family and guide everyone through it peacefully.

    Have a high rate of hospital acquired infections or conditions? Guess what? Also me.

    CNLs are a jack of all trades with the advanced knowledge to speak the language of all other disciplines, dig down to the root of the problem, solve it right then and there, and is the big money shot....we take that knowledge and when it starts trending as an ongoing systems or process problem, we measure it, we fix it, and we fix it permanently.

    The only downside of my job is I AM IN SUCH HIGH DEMAND that I need more help. Other CNLs. We are supposed to be one per unit. I have an entire critical care department. I carry more patients that our 3 ICU teams combined (I see recovery, psych, and acute medicine patients all that overflow into our units). I have 190 RN staff. I have 6 nurse managers/anms, roughly 40 attending physicians, 6 chief physicians, an NP, a PA, 6 CRNAs, 6 CNAs, 9 RN students, 2 graduate students, 12 to 16 interns and residents, 3 fellows, AND every ancillary clinical service that touches my patients.

    But I LOVE my job.
    And the people who work with me, LOVE MY ROLE.
    And patients love me.

    And it isn't just me or my personality. We have one in med surg, one in primary care, and one in psych. And although we almost have VERY different personalities and styles, we all do the same thing.

    Clinical....patient centered...evidence that focuses on improving the quality, safety, and value of care at the point-of-care.

    There isn't a CNL that I know....that is not passionately in love with their job.

    The reason people "don't get" what a CNL is or they throw out some half assed, ill informed or biased answer is because they have read or heard something about the role, and they have tried to pull together this image of what that looks like using traditional ideas or nursing.

    For example....they hear evidence-based practitioner and they imagine their old, out-of-touch, hasn't practiced in 20 years, nursing professor.

    And then they read that we improve quality and cost of care and they assume CNLs also look a bit like their nurse manager or QI officer who is always breathing down their neck.

    Or they read that we are advanced generalist and thus envision some sort of glorified charge nurse who think they are too good to work the floor anymore.

    When you put all that together, you get a very ugly and off-putting, nowhere close to the truth picture of what people think a CNL is.

    But it isn't true. And the exact reason nursing has such a hard time envisioning or accepting the new role is because CNLs AREN'T traditional nurses. We work alongside traditional nursing partnership. Same with per disciplines. Our alliance and our alignment are with the patient. Our loyalty lies with them and the microsystem patient population exclusively. Our schedules are flexible, not rigid like the rest of clinical nursing. This is because it NEEDS to be somewhat flexible if we are going to be in the right place at the right time to provide the right care.

    Also, we aren't administrators. We take patient loads. Our patient load is every patient in our microsystem. We aren't always wiping butts, drawing blood, or doing skills....but we are in there...educating, assisting in the facilitation of goals of care, leading family meetings, leading the interdisciplinary rounds, bridging communication gaps, fixing care delivery issues, doing advanced assessments, evaluating the efficacy and side effect profiles of medication regiments, evaluating the effective s's or interdisciplinary plans of care, thwarting errors, supporting staff....all educating them on clinical issues or facility processes that they are struggling with. And i do it all in a timely, compassionate, kind, and HIGHLY RELIABLE way.

    I would caution you in taking advice from people who have never worked intimately with CNLs in the clinical setting or who aren't a CNL themself. If I had listened to all the skeptics, the ill-informed, and the general pot-stirrers then I would have missed out on what I consider a truly great job.

    It has been my experience, and the experience of CNLs across the country, that our greatest barrier to role integration and early adoption has come from our own profession. The evidence on the value of a CNL and the rapid adoption and integration of the CNL role by other disciplines was surprising. CNLs are highly respected and sought after. People from other areas, other departments, even the community, often know me by name before I even have a chance to introduce myself. I think the last place people expected resistance to come from was within nursing itself. Which is unfortunate.

    CNLs may be most closely aligned with patients, but the fill a tremendous gap in nursing and they ease the workload, both directly and indirectly, for all involved, but primarily for nursing. CNLs also have a very supportive role. Again, they are in partnership with nurses, not in authority over them. CNLs coach, guide, educate, and assist nurses in complex care, patient needs, and the implementation and actualization of share governance, unit goals, and personal goals.

    Studies have shown significant improvements in workplace environments, staff satisfaction, and patient satisfaction with the addition of just a single CNL to the area.

    I don't know how many NPs, CNSs, or CRNAs you know that can do all and still perform and publish research at the same time. But this is what a CNL does.

    And anyone who doesn't seriously look into it when considering advanced clinical tracks, is doing themselves and healthcare a disservice.

    If you have a passion for changing and improving healthcare, continued self growth and education, research, EBP, clinical care, and interdisciplinary collaboration, or any combination of these.....or if you simply just want to make a difference....then being a CNL is for you.

    And for the skeptics who believe that speculating about the relevancy, competency, skill set, qualifications, or valye of the role....I can tell you....the evidence and the numbers are already proving them wrong. The federal government was an early adopter of the role while private hospitals and organizations hung back and waited to see what happened. Well that was a decade ago. Within a decade, and despite federal commitment and funding for the role, the private sector has, in the last three year alone, overtaken the federal government in terms of CNL employment. And the gap is widening rapidly.

    I went to an beginner CNL program. A good school, but still, a program that was itself still trying to nail the CNL role down. I have several year experience and a handful of cohort studies published, but from 3 months I have received head hunter calls from those aforementioned iconic, nationally recognized hospitals interested in hiring me.

    The offer is always tempting. ALWAYS. But family commitments require I stay where I am. And I am happy with where I am.

    And that is another thing....I am pretty sure there aren't many NPs who are receiving quarterly calls from MD Anderson, Johns Hopkins, Wakeforest, and UAB.

    So yeah, being a CNL IS awesome. And if you decide you want to be an NP later it isn't like you have to start all over again. 2 of your 3 years of NP program is already done. 1 year and you are done....but with more credentials, an impressive resume, and awesomely powerful skull set.

    Work smarter, not harder.