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Nurses Have Myriad Educational Options

Monday April 12, 2010
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Perusing the alphabet soup of acronyms following the names of a cohort of RNs is an easy way to view a vast number of advanced educational options for nurses. Deciding which of those numerous degrees to pursue requires some career trajectory analysis.

Experts emphasize that there is no inherently “right” or “wrong” educational path for an RN. The key is to find one that fits your needs and allows you to reach your career goals.

Don’t put off your decision too long, advises Fay Raines, RN, PhD, president of the American Association of Colleges of Nursing and dean of the college of nursing at the University of Alabama in Huntsville. “If the purpose of advanced education is to prepare you to practice better,” she explains, “then the quicker one gets there, the quicker one gets to one’s career goal.”

Setting a Course
Raines asks prospective students a series of questions to help them clarify their career goals: What are the parts of nursing that you like? What parts don’t you like? What types of settings do you like? Do you want hands-on patient care, or a more administrative or educational role? Where would you like your career to be in 10 years?

Then research the programs in your area to see which match your interests and goals, she advises.

Patti R. Zuzelo, RN, EdD, ACNS-BC, ANP-BC, president of the National Association of Clinical Nurse Specialists as well as the DNP program director and CNS track director at La Salle University in Philadelphia, suggests a decision-tree of sorts.

Do you want advanced nursing practice or advanced practice nursing (APRN)? The advanced nursing practice route likely would take you through an MSN program with an emphasis in informatics, education or administration (among other options), with further education available through a nursing doctoral degree such as a PhD, DNS or DNSc.

The APRN route gives you four role options: nurse practitioner, clinical nurse specialist, nurse midwife or nurse anesthetist. Students can pursue any of these roles through a master’s program or a DNP. Nurses with an interest in midwifery or anesthesiology have a clear-cut path to take, getting a master’s or a DNP as a certified nurse midwife or a certified nurse anesthetist.

Students trying to decide between the CNS or NP roles should consider what role they want to play in patient care, Zuzelo says.

Although clinical nurse specialists may do direct patient care, they often practice more as a “nurses’ nurse,” Zuzelo says, because “the conceptual framework of clinical nurse specialist is someone who influences a change in outcomes and best practices at the patient level, the nurse level, the department level or system level.”

So although they may see individual patients within their specialty (such as oncology or diabetes), “they are also working with nurses to teach them how to improve their practices. They are evaluating programs of care. They are setting up educational programs related to their area of expertise.”

The role of nurse practitioner, says JoEllen Wynne, RN, MSN, FNP-BC, associate director of education for the American Academy of Nurse Practitioners, “developed because there was a need for primary care providers, particularly in underserved areas. It’s evolved from there.”

Although many NP specialties exist (such as acute care, gerontology, family health, neonatology, pediatrics and mental health), nurse practitioners are the only healthcare providers with increasing numbers pursuing primary care roles. NPs, Wynne says, focus on disease prevention, health promotion, health education and counseling, and have some level of prescriptive privileges in all 50 states and Washington, D.C.

Programs to Consider
Generally, the first step in graduate education is the master’s degree, requiring a bachelor’s degree as a prerequisite. (Note that some programs, such as the increasingly popular RN-to-MSN programs, embed baccalaureate content in their programs and provide education in the requisite competencies for a BSN. Baccalaureate-to-doctoral programs also exist, with 71 research-focused programs in place nationwide, according to AACN.)

Nursing master’s and doctoral degrees prepare graduates in either advanced nursing practice or as APRNs. According to AACN's recent "Survey of Institutions with Baccalaureate and Higher Degree Nursing Programs," master’s degrees outpace doctoral degrees in terms of RN enrollment and graduation. In 2009, more than 77,000 nurses were enrolled in master’s programs, compared with about 4,100 in research-focused doctoral programs and about 5,100 in practice-focused doctoral nursing programs. Graduations that same year numbered 19,063 in MSN programs, 567 in research-focused doctoral programs and 660 in DNP programs.

But the doctorate has become increasingly popular with nurses. Between 2008 and 2009, the number of nursing students in doctoral programs increased by almost 21%.

Choosing an area of interest — research, patient care or teaching — can help narrow down which doctoral degree to pursue.

“The PhD is a research-focused degree,” Raines says. Other research-focused doctoral degrees include the DNSc and the DNS. “Twenty-five years ago, almost all the nurses with PhDs were in faculty positions. Many healthcare systems now have nurse researchers” to further evidence-based practice. According to AACN, nationwide there are 120 research-focused doctoral programs (including PhD, DNSc and DNS), with another eight programs in development.

Although other doctoral degrees can qualify you for academia, the EdD focuses specifically on educational theory, rather than research or practice. When Debra A. Sansoucie, RN, EdD, NNP-BC, clinical associate professor and director of the neonatal nurse practitioner program at Stony Brook (N.Y.) University, was considering a doctoral degree, she decided on the EdD because she felt she was already a clinicalexpert but not an educational expert. “I wanted to get an education in becoming an educator — in educational principles, in teaching and learning theory,” she says.

Another doctoral option is the DNP, a clinically focused doctorate that rapidly has been gaining popularity. According to AACN, 120 DNP programs exist in 35 states, with another 161 in development.

Requirements on the Horizon
In 2004, AACN published a position paper calling for the clinical doctorate to be the entry level into advanced practice nursing by the year 2015. Although that is just a target date, potential students should take that trend into account when considering nurse practitioner education programs, Sansoucie says.

The National Association of Neonatal Nurses published a position statement in 2008 supporting the DNP as one option for graduate nursing education but not as entry into practice. “This position is being revisited this year at NANN’s annual faculty summit in fall,” Sansoucie says. “It is definitely the movement of the future. Whether it will become entry into practice by 2015 is still not certain, but I think it will definitely at some point happen.” She notes that the requirement to become an NP was completion of a certificate program at the time she completed her nurse practitioner education. But knowing that the master’s requirement was on the horizon, she opted for the master’s degree instead.

“At this point, I’d go for the DNP if I were a young nurse going into advanced practice, as it provides an excellent foundation for practicing in today’s complex healthcare environment,” she says.

The bottom line, Raines says, is to enroll in a program that helps you meet your career goals, whatever those might be. “We need nurses with a huge spectrum of preparation and backgrounds,” she says.

Anne Federwisch is a contributing writer.


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