Nursing Education: From BSN to MSN to DNP, There's Always More to Learn


Nursing Education: From BSN to MSN to DNP, There's Always More to Learn

By Elizabeth Hanink, RN, BSN, PHN
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Do you remember stories of what nursing education used to be? It was very similar to an apprenticeship. You lived at the hospital or in a residence close by, and worked the long hours of a regular staff nurse. In many cases you were the staff nurse. Tuition costs were minimal. Classroom instruction was hit-or-miss, frequently conducted by physicians. Yes, some few nurses went to college. Fewer still earned advanced degrees. You couldn’t be married, and strict rules of deportment governed your every minute.

Important Trends

How things have changed! Today almost every nurse is college-educated, whether with an associate’s degree (ADN) or a four-year bachelor’s. Very few hospital-run three-year programs still exist; most continue to evolve into college affiliates. Even more significant, advanced degrees among nurses are no longer uncommon. Some nurses who wish to remain at the bedside earn doctoral degrees specifically geared to clinical practice.

The National League for Nursing, the nursing organization that has the most influence on education, recently identified 10 trends affecting the future of nursing education:

1.   Changing demographics and increasing diversity
2.   Technology explosion
3.   Globalization
4.   More educated consumers, alternate therapies, palliative care and genomics
5.   Increasing complexity of care and shift to population-based care
6.   Rising healthcare costs and the challenge of managed care
7.   Changing health policy and regulation
8.   Growing need for interdisciplinary education and collaborative practice
9.   Nursing shortage and workforce development opportunities
10.  Significant advances in nursing science and research

What the trends show is that today’s nurses practice at every level, from clinics to highly sophisticated research projects. All this progress is possible due to the change in nursing practice but, most of all, to the change and advancement in nursing education. Today’s nurses have a real choice.

Pass the NCLEX, You’re a Professional Nurse

Take, for instance, nurses whose entry into practice is based on an ADN. They can begin to work as nurses as soon as they pass the NCLEX and will perform the same job functions as a colleague who graduated from a BSN program. If they choose, these associate degree nurses can continue their education, but for many jobs they have what they need with that first degree.                         Supervisory positions may be more elusive, and some employers may not be open to them; but, especially in rural areas, they will be able to climb the same career ladder as nurses who spent more time in school. Many federal and state requirements that mandate set levels of education for certain positions are waived in underserved areas.

For other nurses, the job they have simply does not require a degree that they have no desire to pursue. Florann Ramsey, RN, a 1981 graduate of El Camino Community College in Los Angeles says “I know in order to teach, I would need a BSN.”

But, as she points out, in her job as the nurse in a busy internal medicine practice, she functions with considerable autonomy, has many opportunities for patient advocacy and teaching, and has been able to participate as a co-coordinator of a drug research project. Her skills have increased over time, especially since the office contracts with the county for personnel screening, and this requires the staff to be certified in multiple areas.

More Education, More Job Opportunities

Still others have a real desire to move up the career ladder and are willing to spend considerable time, money and energy to get higher degrees.

Naola Miller Vershay, RN, MSN, is an example of a nurse who started out with an ADN degree (one that really took two years) and then, over time, earned her RN. The former director of a large home health agency, she now teaches at Mount St. Mary’s College in
Los Angeles, a school with ADN, traditional BSN, and accelerated BSN programs.

Early on, she saw her four-year degree as the key to a greater variety of job opportunities, “a way to maybe try school nursing or something like public health.” Knowing the rationale behind clinical decisions is something she credits to her baccalaureate studies, but without those studies she was still a professional nurse.

Now, as she shepherds traditional BSN students through demanding clinical rotations, Vershay appreciates even more the skills in interdisciplinary collaboration that she gained from her broader education.
Exciting Options in Advanced Practice

A bachelor’s degree is not the terminal degree in nursing. There is a whole field of advanced practice with clinical nurse specialist, nurse practitioner, nurse anesthetist and nurse-midwifery to explore. Multiple programs exist to help even a candidate with a bachelor’s degree in an area completely removed from nursing to advance to a master’s degree in nursing.

Most schools offer several options, but each has its niche. According to Michelle Mohr, assistant director of admissions at the Graduate School of Nursing, Loma Linda University is the only program in this area that offers admission straight from a BSN to an MSN without requiring nursing experience. Classes are clustered on one day a week to accommodate working nurses. Other programs have other options. Some provide good access to clinical sites; others require you to arrange a substantial amount on your own.

Nurses need to assess where they are and seek out the program that fits best. They might want to consider fitting themselves to a program that has openings, since the competition can be fierce. But consider the range of many paths to explore.

Nursing education today is flexible, and as nursing schools take advantage of technology advances, it often doesn’t matter where you live. With email, Blackboard, and off-site mentors it is quite possible to earn a master’s degree from an excellent school without ever needing to attend class on the brick and mortar campus.

Doctor of Nursing Practice

Different degree paths are emerging as organizations push for changes in entry to practice requirements. The newly-developed doctorate in clinical nursing is an example. Until recently, if you wanted a degree at the doctoral level you needed to pursue a Ph.D, or a DNSc. — degrees that took you away from clinical nursing and into the realm of research, administration, and education.

Now you can elect to study for a doctoral-level degree in Clinical Nursing and obtain a DNP, or Doctor of Nursing Practice.

Luckily, several schools exist here in California. Loma Linda University offers both a Ph.D and a DNP. Susan Lloyd Ph.D, RN, CNS, director of the newly-instituted DNP program explains, “the focus of the DNP is really to prepare a clinical scholar…taking the evidence and utilizing it to improve patient care.”

The Loma Linda DNP program takes advanced practice nurses who are prepared at the master’s level and offers them a three-year path to the DNP. Some work is completed online, and students are required to travel to campus once a quarter for a 3-5 day intensive seminar. The third year features a capstone project that is pursued primarily at the candidate’s place of employment.

The goal of the American Association of Colleges of Nursing (AACN) is to have doctoral preparation for all advanced practice nurses by 2015. Realistic or not, that goal has provided some of the impetus for the new programs. To date, 120 schools currently enroll 5,165 students. Both Mohr and Lloyd point out that at Loma Linda, the number of highly-qualified applicants has resulted in a much larger opening class than originally planned.

Factoring Costs

Financing education is an issue for everyone, and most graduate programs are designed for students who plan to keep working while in school. Many specialty groups offer scholarship help and some employers provide assistance.

There is also the entire student loan program to look at, starting with filling out the FAFSA (Free Application for Federal Student Aid). The stimulus package and the healthcare reform bill both promise funding for higher nursing education, especially education with teaching as the end goal.

One thing to consider, among many others, is convenience: private and public options have advantages and disadvantages in terms of cost and availability of courses. If low-cost means impacted programs and crowded classes, it is not a bargain. Tuition costs will be recouped soon enough. Recent statistics show that DNP-prepared practitioners earn $7,688 more than master’s-prepared on a yearly basis.

So whether you are just starting out in nursing or you are a seasoned practitioner, there is more education just for the asking. Understand what you want from your career as a nurse and go for it.  

Elizabeth Hanink, RN, BSN, PHN is a freelance writer with extensive hospital and community-based nursing experience.

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