Journal of Nursing Education

Major Article 

Integrative Review of Graduate Entry Programs in Nursing

Linda Honan Pellico, PhD, APRN, CNS-BC; Eileen Terrill, PhD, RN, ANP; Patricia White, PhD, ANP-BC; Janet Rico, MSN, MBA, NP-BC

Abstract

In this integrative review, the authors report on, summarize, and analyze research conducted on non-nurse college graduates enrolled in master’s degree programs in nursing in the United States and Canada, leading to preparation for advanced practice nurse roles. This review demonstrated that non-nurse college graduates successfully develop into registered nurses and advanced practice registered nurses (APRNs) or certified nurse-midwives (CNMs). What is conspicuously absent in the literature is articulation of the process whereby college graduates become nurses and APRNs or CNMs. Given the expansion of graduate entry programs for non-nurse college graduates, along with the recent clarion call to move advanced practice nursing to the postgraduate level, it is time to examine the process. Understanding the process will help faculty refine pedagogy and curricula to support students’ transition from non-nurse to both nurse and APRN or CNM.

Abstract

In this integrative review, the authors report on, summarize, and analyze research conducted on non-nurse college graduates enrolled in master’s degree programs in nursing in the United States and Canada, leading to preparation for advanced practice nurse roles. This review demonstrated that non-nurse college graduates successfully develop into registered nurses and advanced practice registered nurses (APRNs) or certified nurse-midwives (CNMs). What is conspicuously absent in the literature is articulation of the process whereby college graduates become nurses and APRNs or CNMs. Given the expansion of graduate entry programs for non-nurse college graduates, along with the recent clarion call to move advanced practice nursing to the postgraduate level, it is time to examine the process. Understanding the process will help faculty refine pedagogy and curricula to support students’ transition from non-nurse to both nurse and APRN or CNM.

Dr. Pellico is Associate Professor of Nursing, and Director, Graduate Entry Pre-Specialty in Nursing, Yale University School of Nursing, New Haven, Connecticut; Dr. Terrill is Assistant Professor and Director, Graduate Entry Pathway, University of Massachusetts Worcester Graduate School of Nursing, Worcester, Dr. White is Professor of Practice, and Ms. Rico is Director, Family Nurse Practitioner Program, Simmons School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Linda Honan Pellico, PhD, APRN, CNS-BC, Associate Professor of Nursing, and Director, Yale University School of Nursing, Graduate Entry Pre-Specialty in Nursing, 100 Church Street South, New Haven, CT 06536-0740; e-mail: linda.pellico@yale.edu.

Received: February 26, 2011
Accepted: October 19, 2011
Posted Online: November 30, 2011

For myriad reasons, college graduates are choosing advanced practice nursing; many are seeking a second career and others are fulfilling a lifelong dream that was waylaid for a variety of causes. As a result, programs specifically designed for non-nurse college graduates to enter specialty practice at the master’s level have expanded exponentially. Most of the 65 schools of nursing currently offering graduate entry programs also maintain bachelor’s degree in nursing (BSN) programs (AACN, 2010). Instituting graduate entry programs presents challenges to nurse educators, who have been accustomed to sustaining programs designed for traditional undergraduate preparation. It is important for educators to reexamine the generic curricula, aims, and andragogy for the mature college graduate. The purpose of this integrative review is to summarize and critique the literature on the preparation of the graduate entry student as both a nurse and an advanced practice registered nurse or certified nurse-midwife from the student and faculty perspectives to better inform future program development. Information about the passage from non-nurse to nurse, including demographics, student characteristics, curricula, andragogy, measures of success, outcomes, skill sets, employment, licensing, and certification examinations, were assessed.

Procedure

One of the more challenging aspects of preparing this article was finding data on these students, programs, processes, and outcomes. Master’s degree nursing programs do not publish data that separates nurse versus non-nurse on entry, nor do accrediting bodies provide this detail. In addition, each school of nursing seeks to create a separate and distinct name for the program. Examples include graduate entry program in nursing; second-degree program; accelerated pathway; master’s entry program; accelerated master’s in nursing; non-nurse master’s entry program; and graduate entry pre-specialty in nursing. For the remainder of this article, all programs described will be referred to as “graduate entry.” The following Medical Subject Heading terms were selected: nursing education, graduate level; curriculum; students, nursing; teaching; licensure, nursing; and certification. Additional terms we used were accreditation, achievement, entry into practice, forecasting, non-BSN, non-nurse, accelerated program or nontraditional program, nontraditional student, and career choice. Databases included MEDLINE, PREMEDLINE, CINAHL®, PsycINFO®, Web of Science, Lexis Nexis®, Academic Universe, ERIC, and Education Abstracts. Dissertations Abstracts Online and Educational dissertations were accessed. A secondary review of citations in published articles proved valuable.

The period from 1956 through 1979 was selected for Archived Cumulative Index and extended to 2011 for electronic literature sources in an effort to secure as many studies as possible. A timeline of 4 years before the opening of the first master’s entry program (1960) provided the opportunity to assess early literature describing the then-novel educational idea.

Despite the extensive time period, a dearth of research articles were found that specifically assessed graduate entry programs at a master’s degree level. We accessed a total of 27 studies and analyzed and compared them for purpose, method, sample, findings, and limitations. An additional 21 articles were found that could be classified as opinion pieces, curricular blueprints, recruitment efforts, or personal experiences and were incorporated in this review to support, refute, or expand the research findings, when appropriate.

Results

Three distinct areas were addressed in the 27 research studies: the raw material—the graduate entry student; the end product—the newly graduated master’s prepared nurse; and, to a lesser extent, the passage—the route from non-nurse to nurse. Refer to the Appendix (available as supplemental material in the PDF version of this article) for a detailed summary of the studies.

The Raw Material

Graduate entry students are primarily women, ranging from 86% (White, Wax, & Berrey, 2000) to 97% (Kakosh, 1967) of the total reported enrollments. Many of the authors commented that there were higher percentages of men in the graduate entry programs, compared with the national rate of approximately 7% (HRSA, 2010). The range of male students extended from 8.3% to 9% (Vinal & Whitman, 1994) to 15% (Smith & Shoffner, 1991). The mean age of these students on entry varied across the studies, but ranged from 23 (Kakosh, 1967) to 26.6 years (Munro & Krauss, 1985; Smith, 1989). The widest range of ages occurred in the study by White et al. (2000), with a range of 24 to 54 years. Anecdotally, Schraeder (1988), in her review of six graduate entry programs in the United States and Canada, and Anderson (2002), in an editorial, commented that these students are young but academically and experientially gifted.

The graduate entry students are predominately Caucasian, ranging from 78% (Pellico, Friedlaender, & Fennie, 2009) to 100% (Smith & Shoffner, 1991; White et al., 2000), and predominantly single (D’Antonio et al., 2010), with ranges of 40% (Smith & Shoffner, 1991) to 77% (Ezer, MacDonald, & Gros, 1991). Several authors reported a trend for their graduate entry programs to attract students from out of state or from other countries (Kakosh, 1967; Munro & Krauss, 1985; Smith, 1989; Smith & Shoffner, 1991). These students tended to be well traveled and bilingual, with many having Peace Corps experience (Schraeder, 1988; Slavinsky, Diers, & Dixon, 1983).

Many graduate entry students reported having met with opposition from family, friends, and counselors when they decided on nursing as a professional goal (Kakosh, 1967; Pellico, 2004; Slavinsky et al., 1983). Slavinsky et al. (1983) spoke of the students’ need to respond to the frequently posed statement, “You’re too smart to be a nurse” (p. 374). Some students (17%) had an intimate view of nursing because their mothers were nurses (Kakosh, 1967); others decided on it via a “lateral arabesque” (Slavinsky et al., 1983, p. 374) from medicine to nursing (Vinal & Whitman, 1994). Still others discovered nursing later in their academic, work, or personal lives (D’Antonio, et al., 2010; Slavinsky et al., 1983; Vinal & Whitman, 1994). Some returned to their original waylaid goal of becoming a nurse (Schraeder, 1988; Slavinsky et al., 1983; Vinal & Whitman, 1994). The researchers described graduate entry students as highly motivated, self-directed, flexible, assertive, educated individuals who are dedicated to helping people, populations, or systems (D’Antonio et al., 2010; Diers, 1976, 1987; Kakosh, 1967; McNeish, 2011; Munro & Krauss, 1985; Pellico, 2004; Rico, Beal, & Davies, 2010; Schraeder, 1988; Slavinsky et al., 1983; Smith & Shoffner, 1991; Ventura, 1979; Vinal & Whitman, 1994; Wright, 1988).

Financing their education required obtaining personal loans for 59% of graduate entry students (Kakosh, 1967). A majority of the researchers noted securing finances as a major problem for students (D’Antonio et al., 2010; Diers, 1987; Kakosh, 1967; Rogers & Healy, 2002; Schraeder, 1988; Slavinsky et al., 1983; Smith, 1989; Smith & Shoffner, 1991; Wassem & Sheil, 1994; Wink, 2005). A call for increased funds, scholarships, and traineeships was noted throughout the studies (Diers, 1987; Ezer et al., 1991; Kakosh, 1967; Schraeder, 1988; Smith, 1989).

Academically, these students had higher Graduate Record Examination (GRE) scores than traditional graduate nursing students who enter the profession as nurses (Cook, Becker, & Weitzel, 1996; Smith, 1989). Combined GRE scores ranged from 1000 to 1190 (Kakosh, 1967; Leuner, 1994; Munro & Krauss, 1985; Ventura, 1979). Equally high GPAs with ranges of 3.0 to 3.68 on a 4-point scale emerged in the studies (Ezer et al., 1991; Kakosh, 1967; Munro & Krauss, 1985; Smith, 1989; Smith & Shoffner, 1991; Vinal & Whitman, 1994). Anderson (2002) described similar GRE scores and GPAs between 3.5 and 4.0 in a cohort of 35 second-degree students. Using the Watson-Glaser Critical Thinking Appraisal tool, Leuner (1994) found that graduate entry students had a mean score greater than those of BSN, MBA, and medical students.

Undergraduate preparation varied across the programs, with 77% having a bachelor of arts degree (Pellico et al., 2009) to 75% having a bachelor of science degree (Ezer et al., 1991), whereas the researchers who studied the program at Virginia Commonwealth University (White et al., 2000) reported that 48% of their students had a bachelor’s degree in life sciences (primarily biology), 10% in social science, and 41% in liberal arts, education, or business. Rogers and Healy (2002) noted that after 12 years of experience admitting graduate entry students, “undergraduate major does not matter” (p. 192). In summary, the raw material has not changed dramatically over the years. Graduate entry students are predominantly Caucasian women with higher-than-average entry credentials, strong personal characteristics, and diverse educational backgrounds and experiences. One could argue that the educational preparation of graduate entry students correlated to the number of prerequisites required for each school’s unique admission criteria. For example, at Yale University where the only prerequisite is a bachelor’s degree, the student population had a high percentage of bachelor’s of arts graduates (Pellico, 2004), whereas McGill University (Ezer et al., 1991), which requires 24 credits primarily in the sciences before enrolling in their graduate entry program, had a higher percentage of students with backgrounds in the sciences. In this review, financial constraints and career opposition from supporters were balanced with a strong desire to pursue, or return to, a lifelong dream.

The Passage

Eighteen of the 27 researchers’ reports were based on the philosophical premise that accepting college graduates into nursing at an advanced level was not only feasible, but also desirable (Cook et. al., 1996; Diers, 1987; Ezer et al., 1991; Fullerton, Shah, Schechter, & Muller, 2000; Kakosh, 1967; Munro & Krauss, 1985; Pellico, 2004; Plummer & Phelan, 1976; Rogers & Healy, 2002; Schraeder, 1988; Slavinsky & Diers 1982; Slavinsky et al., 1983; Smith, 1989; Smith & Shoffner, 1991; Ventura, 1979; Vinal & Whitman, 1994; Wassem & Sheil, 1994; Wright, 1988). Faculty developed the graduate entry programs not simply as a means to speed up the process of becoming an advanced practice nurse, but based upon certain philosophical beliefs. One such tenet was that students prepared in other disciplines outside of nursing would add richness to the nursing profession (D’Antonio et al., 2010; Ezer et al., 1991; Kakosh, 1967; Plummer & Phelan, 1976; Rogers & Healy, 2002; Schraeder, 1988; Slavinsky et al., 1983; Ventura, 1979; Wright, 1988). The only shared prerequisite across all programs was a bachelor’s degree, predicated on the notion that college graduates are expected to have achieved a basic level of competency in processes such as analyzing complex material, transferring learning, decision making capability, communicating, and leadership ability (Munro & Krauss, 1985; Pellico, 2004; Plummer & Phalen, 1976; Schraeder, 1988; Smith & Shoffner, 1991; Ventura, 1979; Wright, 1988; Ziehm, Uibel, Fontaine, & Scherzer, 2011).

Wide variability existed related to requirements for prerequisite coursework before entry into graduate entry programs. The authors were unable to obtain the information to determine the rationale for prerequisites. An interesting study by Ventura (1979) analyzed 2 years of graduate entry students at Pace University according to their undergraduate degrees and success on National League for Nursing (NLN) Testing and State Board Examination. Ventura found no correlation between undergraduate degree and comparable nursing course. For example, psychology majors did not score higher than liberal art students on psychiatric nursing examinations, nor did biology majors score higher in medical–surgical nursing. Indeed, Ventura (1979) concluded the best preparation for nursing and advanced practice nursing was a bachelor of arts degree. He reasoned that these students were prepared to seek multidisciplinary approaches and had a holistic philosophy, which provides a good fit with nursing. It is interesting to consider that for all but one graduate entry program, prerequisite course work predominantly in the sciences, not the arts, was required for admission. However, regardless of prerequisite coursework, the schools without requirements reported student success (Kakosh, 1967; Pellico, 2004; Rogers & Healy, 2002; Schraeder, 1988; Slavinsky et al., 1983; Vinal & Whitman, 1994).

The majority of programs profiled in these 27 research studies offered master’s degrees in a variety of advanced specialty practice roles (n = 25) with the exception of New York Medical College and McGill University in Canada. The program created at the New York Medical College continues today at Pace University, where specialty practice options are now available. McGill’s model of nursing did not lend itself to specialty practice, as Canada’s model of health care delivery did not at that time use nurse practitioners (NPs).

Admission rates of 31% to 41% were seen in the applications to graduate entry programs in the 1980s (Diers, 1987). A few years later, Vinal and Whitman (1994) stated that in 1991, there were 105 applications for 30 seats in their program at the University of Virginia, which equated to a 28.6% acceptance rate for the graduate entry program. Wassem and Sheil’s (1994) analysis of 14 second-degree programs (six of which were graduate entry programs) revealed that applications and subsequent admissions to BSN programs were higher than for graduate entry programs. However, in the most recent study included in this review, Ziehm et al. (2011) noted that more than 600 applications were received for the 84 seats in their graduate entry program. On the basis of the most recent studies, graduate entry programs continue to remain a strong career choice for college graduates.

The programs were predominantly full time; however, two schools offered both full-time and part-time enrollment options (Fullerton et al., 2000; Vinal & Whitman, 1994). If schools of nursing have traditional undergraduate and accelerated master’s degree programs, students could move between curricula and adjust their plans of study if desired (Wink, 2005). The length of all but two programs was 3 years of full-time study; New York Medical College, now Pace University, was 2 years plus a summer session (Kakosh, 1967; Ventura, 1979), whereas Fullerton et al. (2000) described the State University of New York Health Science Center, which offered an option of a 1-year postbaccalaureate certification program or a 2-year master’s degree, both of which were approved by the American College of Nurse-Midwives for non-nurse candidates as direct entry certified midwives. Completion of the basic curricula was recognized with certificates of completion or a bachelor’s degree in nursing; graduate entry students were then eligible to sit for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®).

Five of the studies discussed class size. Graduate entry enrollment ranged from 20 to 84 students annually, with the exception of Pace University, which at its peak admitted 50 students twice per year (Diers, 1987; Pellico et al., 2009; Schraeder, 1988). Faculty at the University of Virginia rationalized 30 as the optimal graduate entry class size (Vinal & Whitman 1994), based on student-to-faculty ratio and faculty obligations to other programs. However, it should be noted that the authors of that report defined neither the ratio nor the obligations. Overall, attrition rates in graduate entry programs are typically low; the rates in this review range from zero (Diers, 1987; Fullerton et al., 2000; Ziehm et al, 2011) in three schools surveyed to a high of 15% as reported by Ventura (1979). There were no further data regarding withdrawal or dismissal rates in these studies.

Graduate entry programs were expensive to run, compared with typical undergraduate programs. The increased cost was related to the faculty-to-student ratio of 1:5 (Schraeder, 1988) and 1:6 (Pellico, 2004), compared with the typical undergraduate ratio (at the time of the studies) of 1:8 or 1:10. Schraeder (1988) also considered the costs associated with retaining doctorally prepared faculty, as well as the need for individualized learning plans for a diverse student body. Diers (1987) called for an examination of curricula by nursing leaders. If the aim is to continue to admit bright and talented students, the educational experience must be attractive for them (Diers, 1987, p. 1635). A dearth of this type of analysis is noted in the literature. In fact, the 48 articles selected for our study addressed the topic of curricula superficially.

Some programs integrated graduate entry students with pre-existing undergraduate nursing students (Rogers & Healy, 2002; Wassem & Sheil, 1994), whereas others had unique curricula for this population (Diers, 1976; Munro & Krauss, 1985; Wink, 2005; Ziehm et al., 2011). Diers (1976) noted that faculty designed the first-year graduate course content by building backwards; that is, faculty “defined what they expected their graduate students to know upon entry to the specialty programs” and planned curricula accordingly (pp. 95–96). The pedagogical methods noted for this population of students included case studies, clinical stories, clinical immersion, reflective journaling, role-playing seminars, simulation, skills laboratory training, and emphasis on research, dialogue, and development of specific materials appropriate for these students (Fullerton et al., 2000; McNeish, 2011; Pellico, 2004; Rico et al., 2010; Schreier, Peery, & McLean, 2008; Schraeder, 1988; Vinal & Whitman, 1994; Wright, 1988). The enduring merit of clinical experiences to prepare graduate entry students for advanced practice nursing emerged as a prominent finding in the literature (Kakosh, 1967; McNeish, 2011; Pellico, 2004; Plummer & Phelan, 1976; Rico et al., 2010; Wright, 1988; Ziehm et al., 2011), with particular importance related to quality preceptorships, practicum assignments, opportunities for scientific problem solving, highlighting provision of comprehensive care, and ability to function as a team member.

As noted earlier, graduate entry students were adults who already achieved success at an undergraduate level. The students expected to be successful in this new endeavor; however, they quickly recognized that this educational experience was different from their previous academic encounters (Diers, 1976; McNeish, 2011; Pellico, 2004; Slavinsky et al., 1983; Vinal & Whitman, 1994). McNeish (2011) described the differences as “high stakes learning situations,” in which graduate entry students were experiencing fast-paced physical work and patients’ lives hung in the balance (p. 199). In addition, the level of intimacy and intensity of hospital nursing, which has been depicted as a “foreign country” (McNeish, 2011, p. 200), left students feeling “awkward and transparent” (Pellico, 2004, p. 134). Graduate entry students exhibited the need for reassurance that they would be prepared adequately to enact nursing roles (Cook et al., 1996; D’Antonio et al., 2010; Diers, 1976; Kakosh, 1967; McNeish, 2011; Pellico, 2004; Rico et al., 2010; Wright, 1988). Clinical hours, courses, or both were added to curricula to support students’ sense of mastery (Kakosh, 1967; Fullerton et al., 2000). Interestingly, Fullerton et al. (2000) noted similar needs for opportunities to learn, reinforce, and practice basic skills for both entering novice RNs and non-nurse entry students (p. 47).

Graduate entry students spoke of the challenges of learning the kinesthetic skills that at first glance appeared to be simple (Diers, 1976; McNeish, 2011; Pellico, 2004; Slavinsky et al., 1983; Vinal & Whitman, 1994; Wright, 1988; Ziehm et al., 2011). These students have been described as just as awkward and needy as high school learners (Kakosh, 1967), more interesting and demanding (D’Antonio et al., 2010; Ventura, 1979), and impatient if they perceive the course is unrelated to clinical nursing (Diers, 1987; Vinal & Whitman, 1994; Wright, 1988; Ziehm et al., 2011). Fullerton et al. (2000) observed the success of keeping the nontraditional students as a cohort early on in the program as a means of bolstering their “knowledge, skills, and confidence” (p. 48). In addition, although there is limited evidence to support a cohort model for graduate entry programs, it has been noted by faculty educators that these students require specific types of support during the prelicensure and advanced practice portion of the curricula. Further study will assist in clarifying the best approaches to educating these accelerated students at various stages of their preparation.

Several researchers suggested the students’ need for encouragement, balanced criticism, and hands-on learning (Kakosh, 1967; McNeish, 2011; Pellico, 2004; Vinal & Whitman, 1994; Wright, 1988). Graduate entry students would ask questions that appeared on the surface to be basic or elemental to the subject under discussion, yet their queries related to the practical, applied side of science. Even the students who majored in the sciences could not answer what appeared at first to be a simple question (Ventura, 1979). When teaching science courses, Dubin (1982) encouraged graduate entry program administrators to hire a scientist committed to the special needs of this population of students, rather than “farm out” courses to a variety of departments where one might reasonably expect redundancy and extraneous material. In addition, she cautioned that the educator must “select from all the scientific disciplines not only what is relevant, but what may someday be relevant” (p. 38). To do so requires a scientist who can distill the relationship of various scientific disciplines to nursing science.

The need to choose faculty wisely for these students was noted by the researchers (Cook et al., 1996; McNeish, 2011; Pellico, 2004; Rico et al., 2010; Schraeder, 1988; Vinal & Whitman, 1994; Wink, 2005; Wright, 1988). Qualities the researchers considered to be necessary for faculty included the need to be clinically expert, open, patient, and passionate, and possess a well developed sense of humor, as these students are challenging and continually questioning (Diers, 1987; Pellico, 2004; Rico et al., 2010; Schraeder, 1988; Slavinsky et al., 1983; Smith, 1989; Ventura, 1979; Vinal & Whitman, 1994; Wright, 1988). According to Vinal and Whitman (1994), principles of andragogy (i.e., adult learning principles) “are easier to preach than they are to practice” (p. 40). The authors elucidated issues of contradictions within this graduate entry student body, such as students’ desire to be treated as colleagues by the nursing instructors, despite their novice status. The need to be stimulated appears to co-exist with the need to be “spoon fed.” Students wanted balanced criticisms, yet were harshly honest with faculty (Vinal & Whitman, 1994; Wright, 1988). Vinal and Whitman (1994) commented on the “unanticipated and somewhat startling issue that arose [that] involved faculty frustration over poor evaluations received from this group of students” (p. 40). Slavinsky and Diers (1982) also noted the graduate entry students’ harsh criticism of faculty and speculated that it was related to the students’ present role conflict. Faculty accustomed to teaching traditional undergraduate nursing students may experience frustration in teaching this cohort for these reasons. Student and faculty perceptions and expectations are important to understand, and researchers are starting to explore these issues.

Rico et al. (2010) described six themes that emerged in their study of graduate entry students’ perceptions of best faculty teaching practices. Faculty characteristics that enhanced learning included appreciating graduate entry students as adult learners, challenging and motivating students while supporting them, and communicating a passionate interest in the profession. Thus, it appears that personal interest in each student, combined with passion for the profession, facilitated learning. In addition, these students noted faculty “who have their foot in practice” as those whom they regard highly, as this characteristic facilitates sharing of patient care cases (p. 153). Finally, faculty who varied their teaching style in the classroom and clinical settings and who use the Socratic method for case presentations were also characterized as having the greatest effect on learning.

Schraeder (1988) described the challenge of recruiting and retaining faculty in a study of five graduate entry programs: “It takes an open, highly competent, self-assured faculty with a well developed sense of humor to establish a supporting milieu” (p. 38). Faculty must be adept at both advanced practice and general bedside care (Schraeder, 1988; Wassem & Sheil, 1994; Wright, 1988). Yet, according to Wassem and Sheil’s study (1994) of 14 second-degree programs (and of those, six were graduate entry), only one program was using separate faculty to teach the second-degree students. However, if a school of nursing maintained both types of programs (generic baccalaureate and accelerated master’s program), Wassem and Sheil (1994) noted a cost–benefit ratio for faculty simultaneously teaching in both generic and second-degree option programs. Of note, these researchers also noted faculty work overload as a barrier to second-degree nursing program development and implementation, noting that sufficient faculty time and resources need to be devoted to these programs and that the teaching and administration of the curricula need a dedicated full-time faculty effort.

Authors of six of the studies demonstrated that at specific points in the graduate entry programs, no differences were noted between the graduate entry students and the traditional RN graduate students (Fullerton, 2000; Munro & Krauss, 1985; Smith, 1989; Smith & Shoffner, 1991; Ventura, 1979; Vinal & Whitman, 1994). Ventura (1979) noted that at the 1-year mark, one could not distinguish the graduate entry from the traditional master’s degree nursing student. Munro and Krauss (1985) demonstrated no differences on academic or theoretical grades when comparing graduate entry students to traditional RN master’s students at the end of the first and second years of their specialty program. This finding was supported by Fullerton et al. (2000), who found no statistical difference in the students’ ability to complete midwifery modules. In Pellico’s (2004) thematic analysis of graduate entry students journals, the theme “masquerading and identifying” detailed the trajectory from impostor to nurse that occurred during the first year of nursing school. It appears that the first year may be the pivotal time period for graduate entry students to begin to see themselves as nurses.

Wassem and Sheil (1994) wrote of practical obstacles encountered by faculty when developing these programs, such as competition for clinical sites, whereas others noted a significant barrier of hostility directed at the graduate entry students from RNs, clinical preceptors, and traditional graduate students (Cook et al., 1996; Pellico, 2004; Rogers & Healy, 2002; White et al., 2000; Wright, 1988). Several authors noted the challenge in marketing these programs when considering the image of nursing (Diers, 1987; Pellico, 2004; Schraeder, 1988; Slavinsky et al., 1983). A graduate of an accelerated master’s degree program for non-nurse college graduates responded to the question, “What does it mean for a woman with options to choose a traditionally female career?” illustrating the struggles many of the students faced when entering nursing (Shaw, 2000). The image of nursing in a culture that views the profession without professional status remains an ongoing challenge for the student population. However, given the sheer volume of non-nurse college graduates entering advanced practice nursing, it appears it is a challenge they are willing to take up.

The authors of these studies reported the bachelor’s degree as the universal prerequisite for graduate entry education. Regardless of the students’ educational or life histories, their experiences in nursing education were different than those they brought from other programs. Students often presented with a variety of contradictions and experienced the first year as a crucial period. Despite wide variation in educational preparation, prerequisite work, and curricular design, nontraditional students succeeded in graduate entry programs. The exact skill set for educators that facilitates learning in that first year and evidenced-based research on curricular design has yet to be elucidated.

The End Product

The graduate entry students demonstrated success when defined in terms of NLN test scores, RN licensure and certification examinations, grade point average, critical thinking measures, and employee satisfaction. Klakovich and dela Cruz (2006) reported that 90% of graduate entry programs were using a variety of NCLEX-RN preparation resources; they found a mixed response regarding their predictive value, quality, and worth. Achievement rates of 100% pass on RN licensure examinations were not unusual; in fact, graduate entry students’ scores were higher than those of traditional baccalaureate graduates in Plummer and Phelan’s study (1976). Fullerton et al. (2000) noted that some RNs withdrew or were dismissed from the midwifery program, whereas all the non-nurse students were successful. Furthermore, no differences existed between science and non-science students on NLN and RN licensure examination results as reported for two separate classes at Pace University. This finding warrants a review of science elective prerequisites required for admission (Leuner, 1994; Ventura, 1979).

In Vinal and Whitman’s (1997) study of University of Virginia graduate entry students (N = 17), all scored above the 95th percentile on the Mosby Assess Test and 100% successfully passed the NCLEX-RN. Munro and Krauss’ (1985) ex-post facto study of theoretical and clinical grades revealed no differences at the end of the first year of specialty and graduation between traditional graduate and graduate entry students (N = 435). Similarly, no differences were noted in ongoing testing related to key nursing concepts and role identity, compared with traditional master’s students (Vinal & Whitman, 1994). Researchers have demonstrated that both the graduate entry students and traditional graduate students were well prepared for their roles (Ezer et al., 1991; Fullerton et al., 2000; Plummer & Phelan, 1976; Rogers & Healy, 2002; Smith, 1989; Smith & Shoffner, 1991). Smith and Shoffner (1991) found few differences between traditional and graduate entry family nurse practitioners (FNPs) (N = 48) in their academic success, readiness for clinical practice, and employment status. It would be interesting to reassess preparation for practice given the increased complexity of patient management, national call for NP residencies, and expanding roles for NPs (Campo, McNulty, Sabatini, & Fitzpatrick, 2008).

Evidence also exists that graduate entry students stay in nursing (Schraeder, 1988; Slavinsky et al., 1983; Smith & Shoffner, 1991). Ezer et al. (1991) reported that 87% of the students surveyed (N = 48) were satisfied with their career choice. Smith and Shoffner (1991) revealed that 97% of the graduate entry students (N = 48) were employed, compared with 89% of the traditional educational group (N = 43). The concern that graduate entry students would not align themselves with the nursing profession noted by researchers appears to be unfounded (Cook et al., 1996; Slavinsky et al., 1983; Slavinsky & Diers, 1982; Vinal & Whitman, 1994; Ziehm et al, 2011). In Vinal and Whitman’s (1994) study, graduate entry students’ 5-year goals pertained to patient care, whereas traditional students were drawn to education and administration along with patient care. It is interesting to consider that graduates of accelerated master’s entry programs continue to work as clinicians in larger numbers than do traditional RN-to-master of science in nursing (MSN) graduates.

The literature highlighted challenges for the graduates, teachers, the profession, and administration of graduate entry programs. The graduates, who were novices to nursing, relied strongly on faculty’s suggestions of routes to clinical expertise (Cook et al., 1996; Pellico, 2004; Rico et al., 2010; Wright, 1988). Some researchers reported faculty members’ preoccupation with students’ completing 1 year in hospital nursing before beginning professional life as advanced practice nurses (Cook et al., 1996; Vinal & Whitman, 1994), a sentiment that is often shared by other health care providers (Rich & Rodriguez, 2002; Rich, Jorden & Taylor, 2001). Several authors described faculty members’ desire for graduate entry students to seek staff nurse positions as their initial employment for 1 year because they were novice clinicians (Cook et al., 1996; Kakosh, 1967; Vinal & Whitman, 1994). Graduate entry students who initially entered acute care nursing described their experiences as similar to a hazing; however, they came to a state of comfort, confidence, and satisfaction with their work (Cook et al., 1996; White et al., 2000; Ziehm et al., 2011). White et al. (2000) reported that 14% of the participants of a program that prepares only NPs were working as RNs, yet 83% of the participants did not believe that working as an RN was necessary to be an NP. Plummer and Phelan (1976) and Ventura (1979) reported similar findings from their studies of Pace University’s Graduate School of Nursing. Although the Pace students were encouraged to assume positions as FNPs initially, many students chose to take entry positions in hospitals or community agencies. No actual numbers or percentages were provided by Ventura (1979), although 45% of the 97 participants in Plummer and Phelan’s (1976) study were employed as RNs. During the time Plummer and Phelan conducted the study, Pace University changed its program to offer specialty practice; therefore, the numbers are not unexpected. It is clear that the majority of graduate students did indeed work as advanced practice nurses.

Cook et al. (1996) challenged the prevailing notion that graduate entry graduates should begin their practice in the general hospital. These authors argued that the nostalgic reasons for completing the year no longer exist; hospitals are not generalized, but rather are unit specific. This finding was supported in a study by Rich et al. (2001), who concluded that prior nursing experience might not necessarily be an important component of successful entry into advanced practice. In today’s acute care setting, the knowledge, skills, and technology required for one nursing unit are not necessarily transferable from unit to unit. Each unit is its own unique system within a larger system. In fact, in a more recent study on graduate entry students versus traditional graduate nursing students, Rich (2005) noted a significant negative correlation between years of experience as an RN and NP skills as assessed by the NPs’ collaborating physicians.

Graduate entry students described their role according to their advanced specialist practice position (e.g., primary care provider, certified nurse-midwife, NP) (Smith & Shoffner, 1991; Ventura, 1979), not as an academic or administrator, which are the roles frequently described by traditional RN graduate students (Smith, 1989, Smith & Shoffner, 1991). Smith and Shoffner (1991) demonstrated that 67% of the graduate entry students’ first positions were in the specialty for which they had prepared, as compared with only 49% of traditional RN graduate students. This finding was supported by Smith’s (1989) earlier study in which 60% of graduate entry students sought positions as FNPs, compared with only 30% of traditional RNs who sought that option. Her findings revealed that even though the graduate entry students sought specialty practice, more than 50% assumed positions as staff nurses as their first positions, whereas 43% began as NPs.

When graduate entry students accept positions as staff RNs, techniques used to brace themselves for ward life during the novice year were positive self-talk, seeking favorable managers, and wanting to be treated as an RN and not an MSN (Cook et al., 1996). These students felt ill-prepared for the technology in acute care facilities and the obstacles encountered in the health care system (Cook et al., 1996; White et al., 2000; Ziehm et al., 2011). This finding is not surprising if one considers that the majority of programs in this review were designed to educate graduate entry students for primary care, not acute care. In the survey by Ziehm et al. (2011) of graduate entry students who opted to step out of their advanced practice preparation to gain RN experience (rates annually ranged from 0% to 59%), nurse managers favorably reviewed the graduate entry students’ performance in terms of initiative, resourcefulness, advocacy, and communication. However, they also noted weakness in performance of clinical skills, but clarified that it was not unlike their experience with traditional RN graduates. The managers also noted the graduate entry students were fast learners, compared with traditional RNs. It is important to consider that although many nurse educators believe that working as RNs is important for the students’ development, many of these graduate entry students did not concur and sought positions in the clinical area in which they were primarily educated—primary care.

An additional challenge for administrators and faculty is student satisfaction with their preparation. Seventy-seven percent of students in the study by White et al. (2000), 78% of the graduates in the study by Ezer et al. (1991), and 76% of the students in Smith and Shoffner’s (1991) research felt their programs prepared them for their profession. Although these ratings are certainly gratifying, there is room for improvement.

Graduate entry students were indistinguishable from traditional students on exit from their nursing program. Despite variability in geographical area, public or private setting, prerequisites, length of program, specialties offered, or experience within these graduate entry programs, evidence suggests that educators and students are successful in transforming a non-nurse college graduate into both an RN and an advanced practice nurse.

Discussion

The findings of this integrative review should be viewed with a skeptical eye. For a period of nearly 40 years, a mere 27 research articles were found relating to this once unique student body and program of study. However, there is some merit for viewing the findings of these studies as more conclusive than the limited numbers might suggest. The findings are all complementary to one another and support many of the opinions and anecdotes of other authors, as well as researchers, who focused their studies on nontraditional students in undergraduate programs. To demonstrate, in a more recent study of 19 graduates of a second-degree baccalaureate nursing program, Cangelosi (2007) detailed students’ high motivation and impatience with curricular components termed as “busy work” and adherence to “sacred cows” of nursing education that distracted them from the path to clinical competency (p. 95).

Despite the paucity of research with this population, it was clear that this student body’s demographics have been analyzed at a remarkable level. Graduate entry students are diverse in age and educational preparation, with a propensity to help others and a strong sense of social justice. Their backgrounds are in the arts and the sciences; they present themselves both with and without the assumed prerequisites and have demonstrated success on standard examinations, college transcripts, and job performance. In addition, these students are generally not financially secure but are willing to go into debt for their dream. Typically, graduate entry students seek education mostly in primary care and, specifically, desire the skill set that will demonstrate to themselves and others their competency, technically and theoretically. Impatient with unrelated academic content, these students are honest and direct and often present as contradictions. Harsh feedback of their faculty is a given, yet faculty are expected to temper their criticism of students’ progress. Easily frustrated, graduate entry students need intellectual, emotional, and spiritual assistance to bolster them during their educational process.

The route to nursing was the second area we analyzed, and multiple points need to be examined. We found conflicting evidence in our review related to the cost of developing and maintaining graduate entry programs. For example, if Ventura’s (1979) findings that college graduates with bachelor of art degrees be accepted without any science prerequisites are adopted, then schools of nursing will by necessity have to teach science courses to the non-scientists. The difficulties in finding the seasoned teacher who can keep the science major interested and challenged, while not frustrating or speaking over the heads of the non-science students, are significant. It is easy to understand why so many schools opt out of creating personalized courses and instead require prerequisites. However, when students have college credits from numerous distinguished universities or community colleges, are educators able to validate that the graduate entry students all have the same baseline knowledge? Dubin (1982) argued for scientists to be housed within schools of nursing where they can witness the level of knowledge needed for practice and commit to the special needs of graduate entry programs. Groer (1992) described the successful use of integrated science modules for graduate entry students as a novel approach. In addition, prerequisites are costly to the students both in terms of time and expense. Given the Institute of Medicine’s (2011) call to create seamless academic progression in nursing, the current status of widely divergent requirements for prerequisite course work bears scrutiny.

Researchers also noted that novice students require more “time and…many more safety cues while performing such skills as administering medications and changing sterile dressings” (Nordgren, Richardson, & Laurella, 1998, p. 27); further, they require faculty who are adept at both clinical skills and teaching.

The ratio of one faculty member to five students, as outlined by Schraeder (1988), is expensive. It is worrisome that administrators, university boards, deans, and program directors will potentially see non-nurse college graduates as a market share they have not yet tapped and ponder opening programs without considering these students’ unique needs and abilities. Programs such as these cannot be contemplated simply as an add-on without consideration of the costs, such as the faculty-to-student clinical ratio and time needed to develop program materials specific to this student body.

Finding the right mix of doctorally prepared faculty who are both clinical and educational experts is challenging and requires increases in salaries to keep them. Given the dramatic expansion of graduate entry programs, continued assessment of new programs’ end products is necessary to maintain the public’s trust and ensure maintenance of professional standards. An additional concern is that despite the sparseness of research on these programs, educators, and students, contemporary nursing is moving toward the Doctor of Nursing Practice level (AACN, 2006) based on limited research. Yet, as Benner et al. (2009) asserted in the recent Carnegie report, an overhaul in nursing education at the fundamental level is an essential priority for all programs. Student-focused learning experiences that integrate classroom and clinical pedagogies, encourage self-reflection and curiosity, and facilitate acquisition of clinical reasoning, psychomotor skills, and moral aptitude are integral to the transformation of non-nurses to nurses as they advance in their education.

Another sacred cow that compels faculty and clinical administrators to engage in thoughtful reflection might be referred to as “the year.” Why did so many of these students go into staff nursing when they were prepared as NPs? The answer seems to be that they were encouraged to do so by their mentors. The question that should be asked is why do graduate entry students who are prepared in specialty practice need to “do the year of medical–surgical nursing in acute care?” How can these students expect to be comfortable in acute care when the focus of their education has been primary care? There is an obvious disconnect between the academic credential and clinical experience. Faculty need to engage in careful consideration of these issues when designing curricula that allow for the right mix of clinical experiences designed to enhance the beginning competence of the advanced practice nurse. Advanced practice nurses are assuming a variety of positions upon completion of their education, including primary care and specialty roles. Researchers need to reconsider curricula designs to assure adequate preparation, as well as the requisite RN experience employers may require for specific practices. Faculty and administrators must consider the issues of advanced practice nurse residencies and formal mentoring programs for these accelerated students.

Researchers also must examine the process of educating graduate entry students with wider dissemination of previous research findings. For example, why are schools of nursing requiring so many prerequisites in the sciences? Some mandate nearly 40 credits in sciences before considering college graduates for admission into graduate entry programs, when 30 years ago Ventura (1979) demonstrated these courses are not necessary. Vinal and Whitman (1994) examined their curricula and noted the overwhelming amount of content these students are required to learn and decided to require an anatomy and physiology course as a prerequisite. They made this decision to lessen program content, not because of a perceived weakness. Yet, they demonstrated in their study the students’ ability to be successful without the prerequisite. Of note, they also restructured their first course to include a 7-week laboratory so students could feel more confident in the clinical arena. It is curious that their perceptions of having the students demonstrate skills in a laboratory translated to increased comfort and competence in the highly complex, rich auditory and contextual environment of hospitals. In their early work, Slavinsky and Diers (1982) revealed that the graduate entry population learns best in the real clinical situation. This finding was later supported by Pellico (2004) and McNeish (2011).

Additional research is also needed to consider the role development and socialization of these students upon graduation and consider whether there are differences in their role transition to the advanced practice role. Alumni and employer feedback would contribute greatly to these compelling questions in the education of these accelerated students.

It seems clear that the quality of clinical and academic faculty are direct determinants of the quality of graduate nursing education; yet, of the 27 studies conducted over nearly 40 years, a mere eight studies specifically included graduate entry students’ voices related to curricula. If we are concerned about scrutinizing our curricular activities to discern facilitators and barriers to learning, it seems reasonable that we cannot really teach better unless we hear the students’ perspective. As noted by Weitzel and McCahon (2008, p. 83), “there is no literature on accelerated nursing students’ perceptions or experiences, the activities that support or inhibit their work, and their recommendations to faculty regarding needs, challenges, supports or teaching/learning strategies.” Perhaps findings from these studies could assist in strengthening curricula about what works best in preparing these students. That said, the research shows that students have been successful and have continued to demonstrate a commitment to the profession. Non-nurse college graduates continue to be interested in nursing, and they have demonstrated success on all standard measures. Clearly, the educational system is working. The question should be: Can we be more innovative? It is necessary to conduct a thorough evaluation of the curricula to find out what works and what does not, what is extraneous, what must be strengthened, and what facilitates learning and what does not. The “what” we need to teach as outlined in the Essentials (AACN, 2006) could benefit from validation studies; however, an examination of the “how” we teach, as described by Tanner (2007), is long overdue.

References

  • American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf
  • American Association of Colleges of Nursing. (2010). Schools that offer accelerated baccalaureate programs for nonnursing college graduates, Fall 2009 (N = 230). Retrieved from http://www.aacn.nche.edu/leading-initiatives/education-resources/APLIST.PDF
  • Anderson, C. (2002). A reservoir of talent waiting to be tapped. Nursing Outlook, 50, 1–2. doi:10.1067/mno.2002.122217 [CrossRef]
  • Benner, P., Sutphen, M., Leonard, V. & Day, L. (2009). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
  • Campo, T., McNulty, R., Sabatini, M. & Fitzpatrick, J., (2008). Nurse practitioners performing procedures with confidence and independence in the emergency care setting. Advanced Emergency Nursing Journal, 30, 153–170.
  • Cangelosi, P. (2007). Voices of graduates from second-degree baccalaureate nursing programs. Journal of Professional Nursing, 23, 91–97. doi:10.1016/j.profnurs.2006.06.003 [CrossRef]
  • Cook, K., Becker, H. & Weitzel, M. (1996). Integration into professional nursing by graduates of an innovative entry-level MSN program. Journal of Professional Nursing, 12, 166–175. doi:10.1016/S8755-7223(96)80041-X [CrossRef]
  • D’Antonio, P., Beal, M.W., Underwood, P.W., Ward, F.R., McKelvey, M., Guthrie, B. & Lindell, D. (2010). Great expectations: Points of congruencies and discrepancies between incoming accelerated second-degree nursing students and faculty. Journal of Nursing Education, 49, 713–717. doi:10.3928/01484834-20100831-08 [CrossRef]
  • Diers, D. (1976). A combined basic-graduate program for college graduates. Nursing Outlook, 24, 92–98.
  • Diers, D. (1987). When college grads choose nursing. American Journal of Nursing (12), 1631–1637.
  • Dubin, L. (1982). Teaching biomedical science. Journal of Nursing Education, 21, 38–42.
  • Ezer, H., MacDonald, J. & Gros, C.P. (1991). Follow-up of generic master’s graduates: Viability of a model of nursing in practice. Canadian Journal of Nursing Research, 23(3), 9–20.
  • Fullerton, J.T., Shah, M.A., Schechter, S. & Muller, J.H. (2000). Integrating qualified nurses and non-nurses in midwifery education: The two-year experience of an ACNM DOA accredited program. Journal of Midwifery & Womens Health, 45, 45–54. doi:10.1016/S1526-9523(99)00002-1 [CrossRef]
  • Groer, M.W. (1992). Integrated science modules: Preparing non-nurse MSN students in the basic sciences. Nurse Educator, 17(1), 30–32. doi:10.1097/00006223-199201000-00015 [CrossRef]
  • Health Resources and Services Administration. (2010). The registered nurse population: Findings from the 2008 Survey of Registered Nurses. Rockville, MD: Author.
  • Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
  • Kakosh, M.E. (1967). Profile of the college graduate in basic nursing. Nursing Outlook, 15(5), 64–65.
  • Klakovich, M. & dela Cruz, F. (2006). NCLEX preparation for accelerated master’s degree programs (AMDPs) in nursing. Communicating Nursing Research, 39, 345.
  • Leuner, J. (1994). An exploration of the relationship between diagnostic reasoning and critical thinking in nontraditional students in nursing. Unpublished manuscript, Connell School of Nursing, Boston College, Boston, MA.
  • McNeish, S.G. (2011). The lived experience of students in an accelerated nursing program: Intersecting factors that influence experiential learning. Journal of Nursing Education, 50, 197–203. doi:10.3928/01484834-20101029-03 [CrossRef]
  • Munro, B.H. & Krauss, J.B. (1985). The success of non-BSNs in graduate nursing programs. Journal of Nursing Education, 24, 192–196.
  • Nordgren, J., Richardson, S. & Laurella, V. (1998). A collaborative preceptor model for clinical teaching of beginner nursing students. Nurse Educator, 23(3), 27–33. doi:10.1097/00006223-199805000-00013 [CrossRef]
  • Pellico, L.H. (2004). Narrative and aesthetic analysis of non-nurse college graduates’ journals on their entry into nursing. Unpublished manuscript, The University of Connecticut School of Nursing, Storrs, CT.
  • Pellico, L.H., Friedlaender, L. & Fennie, K. (2009). Looking is not seeing: Using art to improve observational skills. Journal of Nursing Education, 48, 648–653. doi:10.3928/01484834-20090828-02 [CrossRef]
  • Plummer, E.M. & Phelan, M.J. (1976). College graduates in nursing: A retrospective look. Nursing Outlook, 24, 99–103.
  • Rich, E.R. (2005). Does RN experience relate to NP clinical skills?The Nurse Practitioner, 30(12), 53–56. doi:10.1097/00006205-200512000-00009 [CrossRef]
  • Rich, E.R., Jorden, M.E. & Taylor, C.J. (2001). Assessing successful entry into nurse practitioner practice: A literature review. Journal of the New York State Nurses Association, 32(2), 14–18.
  • Rich, E. & Rodriguez, L. (2002). A qualitative study of perceptions regarding the non-nurse college graduate nurse practitioner. Journal of the New York State Nurses Association, 33(2), 31–35.
  • Rico, J., Beal, J. & Davies, T. (2010). Promising practices for faculty in accelerated nursing programs. Journal of Nursing Education, 49, 150–155. doi:10.3928/01484834-20100115-01 [CrossRef]
  • Rogers, M.W. & Healy, P.F. (2002) Integrating master’s-level entry education into an established BS and MS program. Journal of Professional Nursing, 19, 190–195. doi:10.1053/jpnu.2002.127572 [CrossRef]
  • Schraeder, B.D. (1988). Entry-level graduate education in nursing: Master of science programs. In: Perspectives in Nursing, 1987–1989: Based on presentations at the Eighteenth NLN Biennial Convention [pp. 33–39, Pamphlet #41-2199]. New York, NY: National League for Nursing.
  • Schreier, A., Peery, A. & McLean, C. (2008). An integrative curriculum for accelerated nursing education programs. Journal of Nursing Education, 48, 282–285.
  • Shaw, E. (2000, Winter). Women’s work. Barnard Magazine, 56.
  • Slavinsky, A., Diers, D. & Dixon, J. (1983). College graduates: The hidden nursing population. Nursing & Health Care, 4, 373–378.
  • Slavinsky, A.T. & Diers, D. (1982). Nursing education for college graduates. Nursing Outlook, 30, 292–297.
  • Smith, P.L. (1989). Nonnurse college graduates in a specialty master’s program: A success story. Nursing & Health Care, 10, 495–497.
  • Smith, P.L. & Shoffner, D.H. (1991). Non-nurse college graduates: A new resource for future nurse practitioners. Nurse Practitioner: American Journal of Primary Health Care, 16 (1), 49–53.
  • Tanner, C. (2007). The curriculum revolution revisited. Journal of Nursing Education, 46, 51–52.
  • Ventura, W.P. (1979). Non-nurses in an MSN program: Comparing liberal arts and science majors. Nurse Educator, 4(5), 28–33. doi:10.1097/00006223-197909000-00002 [CrossRef]
  • Vinal, D.F. & Whitman, N. (1994). The second time around: Nursing as a second degree. Journal of Nursing Education, 33, 37–40.
  • Wassem, R. & Sheil, E.P. (1994). National survey of nursing program options designed for the second degree student. Journal of Nursing Education, 33, 29–30.
  • Weitzel, M.L. & McCahon, C.P. (2008). Stressors and supports for baccalaureate nursing students completing an accelerated program. Journal of Professional Nursing, 24, 85–89. doi:10.1016/j.profnurs.2007.06.017 [CrossRef]
  • White, K.R., Wax, W.A. & Berrey, A.L. (2000). Accelerated second degree advanced practice nurses: How do they fare in the job market?Nursing Outlook, 48, 218–222. doi:10.1067/mno.2000.110408 [CrossRef]
  • Wink, D.M. (2005) Accelerated nursing programs for non-nurse college graduates. Annual Review of Nursing Education, 3, 271–297.
  • Wright, M. (1988). Field analysis of nursing education models designed for college graduates. Unpublished manuscript, The University of Texas at Austin, Austin, TX.
  • Ziehm, S.R., Uibel, I.C., Fontaine, D.K. & Scherzer, T. (2011). Success indicators for an accelerated masters entry nursing program: Staff RN performance. Journal of Nursing Education, 50, 395–403. doi:10.3928/01484834-20110429-02 [CrossRef]
Authors

Dr. Pellico is Associate Professor of Nursing, and Director, Graduate Entry Pre-Specialty in Nursing, Yale University School of Nursing, New Haven, Connecticut; Dr. Terrill is Assistant Professor and Director, Graduate Entry Pathway, University of Massachusetts Worcester Graduate School of Nursing, Worcester, Dr. White is Professor of Practice, and Ms. Rico is Director, Family Nurse Practitioner Program, Simmons School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Linda Honan Pellico, PhD, APRN, CNS-BC, Associate Professor of Nursing, and Director, Yale University School of Nursing, Graduate Entry Pre-Specialty in Nursing, 100 Church Street South, New Haven, CT 06536-0740; e-mail: linda.pellico@yale.edu

10.3928/01484834-20111130-01

Sign up to receive

Journal E-contents