Entry-level master's programs in nursing for non-nursing college graduates have grown substantially in the past decade. Although some of these programs graduate nurses with a specialization in an area of nursing (e.g., advanced practice nurses), others aim to graduate as advanced generalist nurses. Within the master's in nursing programs that train advanced generalist nurses, some plan to produce a clinical nurse leader (CNL). Others produce a generalist nurse, but do not mention the CNL role. In 2007, 70 schools surveyed by the American Association of Colleges of Nursing (AACN) identified offering a CNL master's major area of study and 21 identified offering a generalist major. By 2017, 91 schools identified as offering a CNL master's major area of study and 41 identified as offering a generalist master's degree—a 42% and 95% increase, respectively (Fang, Li, Trautman, & Turinetti, 2018). The aim of this article is to describe the programmatic features of master's entry into nursing programs in the United States— specifically those targeted at individuals with a baccalaureate degree in another field—that produce an advanced generalist nurse. These data will provide clarity about a growing segment of nursing education programs.
The variety of academic preparations for the same clinical credential differentiates nursing from other health professions in the United States. Currently, educational options that prepare individuals to sit for licensure as an RN include a 3-year associate degree program, a 3-year hospital training program, a 4-year baccalaureate degree, and accelerated baccalaureate and graduate degrees. Despite the call in 1965 (Committee on Nursing Education & American Nurses Association, 1965) for the baccalaureate degree to be the minimum level of education for entry to practice, the majority of participants taking the NCLEX-RN® are associate degree graduates rather than bachelor degree holders (Salsberg, 2015). In addition, rather than condensing and simplifying entry to practice, options for entry to nursing have expanded in the past decades. Some argue that having multiple entry points into nursing promotes diversity and ameliorates nursing shortages. In a statement, the National League for Nursing (2018) responded to the AACN draft vision statement for the future of nursing education. Others posit that consistency in educational standards and competencies is critical to ensuring quality in nursing, and improved patient outcomes are linked to nurses prepared at the baccalaureate nursing (BSN) degree and higher levels (AACN, 2019).
Nursing programs for non-nursing college graduates are among the newer options for entry into practice. Although these programs have existed since the 1970s, they have proliferated in the past 25 years in response to a shortage of nurses, the desire to increase the number of BSN-prepared nurses, and attracting non-nursing college graduates to the field (AACN, 2019). The majority of programs for non-nursing college graduates admit students with a baccalaureate or higher degree in another discipline without previous nursing experience and earn a BSN (AACN, 2019). Because students come into these programs with previous experience in the humanities and sciences, the curriculum is focused on nursing science, skills, and leadership. The programs are often described as accelerated because they are designed to be completed in a shorter time frame (e.g., 12 to 24 months) than traditional 4-year BSN programs and offer limited breaks or vacation time.
More recently, accelerated nursing programs for non-nurse college graduates that require a Master of Science in Nursing as an entry into practice have gained popularity. These programs initially focused on preparing students for practice in a clinical specialty, such as a nurse practitioner or clinical nurse specialist role. Currently, many master's programs for non-nurse college graduates prepare students for entry-level positions in nursing and provide training for a advanced generalist nurse or CNL role, rather than an advanced practice role.
One potential point of confusion about these programs is the difference between a program that results in an CNL-focused Master of Science/Master of Science in Nursing (MS/MSN) as an entry to practice versus a program that results in a MS/MSN as an entry to practice but does not focus on the CNL role. The CNL role was introduced by the AACN (2004). CNLs are described as nurses who can provide leadership by combining evidence-based research, instruction, and clinical assistance at the bedside. The goal is to prepare a generalist nurse, but with the ability to understand and lead quality improvement initiatives and quickly assume a leadership role in health care settings (Bender, 2014, p. 110). Initially, the AACN provided three model frameworks for CNL programs: (a) a master's degree designed for BSN graduates, (b) a master's degree designed for associate degree in nursing graduates, and (c) a master's degree program for individuals with a baccalaureate degree in another discipline. In 2014, AACN expanded to a five-model framework, adding a master's degree for BSN graduates that includes a post-BSN residency award and a post-master's certification for those who have a master's degree in a another area of study.
Programs that produce a CNL are expected to meet the criteria delineated in AACN's CNL curriculum framework and prepare nurses with the competencies and curricular expectations identified in AACN's Competencies and Curricular Expectations for Clinical Nurse Leader SM Education and Practice (AACN, 2013). Only individuals who graduate from a CNL master's education program or who are a student in their last term of a CNL education program that meets these criteria are eligible to sit for the CNL certification examination (AACN, n.d.). Although there is far less written about the role of the advanced generalist nurse without a CNL than with a CNL, both programs that produce a CNL and those that produce an advanced generalist nurse without a CNL aim to train advanced generalist nurses. Thus, we chose to combine data from both programs in our data collection and analysis. Disagreement may exist about whether the CNL is a nursing specialty or generalist degree. Some programs in our review identified the CNL as one of their specialty tracks. However, despite the availability of a CNL certification examination, both AACN ( https://www.aacnnursing.org/CNL) and the International Clinical Nurse Leader Association ( https://cnlassociation.org/) describe the CNL as an advanced generalist degree. To our knowledge, there are no published analyses of curricular or outcome differences between master's in nursing programs that result in a CNL major versus a generalist major.
As entry-level master's programs have proliferated, it has become increasingly important to understand the characteristics of these programs and the similarities and differences. The purpose of this review is to describe the programmatic features of entry-level master's programs that produce a generalist nurse and are targeted at individuals with a baccalaureate degree in another discipline (see AACN's model C above).
We were unable to find a comprehensive list of entry-level master's programs in nursing for non-nurse college graduates that produce an advanced generalist nurse. There are two nursing accreditation agencies for master's programs in nursing, but we were not able to locate a list of master's programs by eligible candidates (e.g., nurse versus non-nurse) or nursing roles for which graduates are prepared (e.g., generalist versus specialist). The authors concluded that the most comprehensive list would be available through the AACN, and in March 2017 they requested a custom report of accredited schools with entry-level master's programs that result in a generalist degree. The list included 69 schools. Then, we compared this list against a list of master's programs accredited by the Accreditation Commission for Education in Nursing (2013). Two additional schools that met our definition were identified. The authors reviewed each school's website to determine whether their program met the following inclusion criteria: (a) programs that prepare individuals with a baccalaureate degree in another field for entry-level, generalist, and RN roles, (b) are accredited as master's programs, and (c) make general programmatic information available on their website. In some cases, schools identified specialties within their MSN tracks; if one of those was generalist or CNL-focused, the school was included. We did not include programs that exclusively prepared graduates to be nurse practitioners, to be certified nurse specialists, or to specialize their practice with a specific subpopulation. We excluded one program because the website did not provide any programmatic details. Ultimately, 34 schools were included in Table A (available in the online version of this article).
Programmatic Features of Sample
Two of the three authors were assigned as primary or secondary reviewers for each included school. We created a spreadsheet with variables of interest and drop-down menus to track school information. Data were initially entered by the primary reviewer and then confirmed by the secondary reviewer; when the two did not agree, the item was discussed as a group.
Our team collected data on the following variables:
- University/college name and state.
- Program title nomenclature and presence of CNL language.
- Admission requirements, including perquisite courses, required grade point average (GPA), and whether graduate record examinations (GRE) were required.
- Program length was quantified in both months and semesters, based on what was listed on program websites. It was assumed that semesters were held for a duration of 14 weeks.
- Clinical hours were noted when available.
- The number of credits required for program completion was noted when available.
- NCLEX completion which was recorded as either after completion of the program or at some point during program progression.
Data analysis and descriptive statistics including frequencies, percentages, and means were calculated using Excel®.
Program Title Nomenclature and CNL Language
Most of the programs used the words master's and entry in their titles, common examples included Master's Direct Entry Program, Entry-Level Master's Degree, and Master's Entry Into Practice. CNL nomenclature was included in 35% (n = 12) of the program titles. Examples of such titles included CNL Direct Entry into Nursing, Clinical Nurse Leader—MSN and Clinical Nurse Leader—MS, and Graduate Entry Clinical Nurse Leader Program. The CNL role was mentioned but not included in the title of 44% (n = 15) of the programs and was not present at all in 21% (n = 7) of the program websites.
Prerequisites. Programs required similar prerequisite coursework. The majority required anatomy and physiology, microbiology, statistics, and a psychology course before matriculation. On the other end of the spectrum, prerequisite courses that were mentioned only once included economics, research methods, critical thinking, and precalculus or finite mathematics.
The anatomy and physiology and microbiology courses often included laboratories, which were listed as separate courses. The communication courses were usually writing based; one school required public speaking, and four of the seven schools requiring a communication course were located in California. Anthropology and sociology were most commonly the required social science; three of six schools requiring these courses were in California.
Graduate Record Examination. The GRE examination was required by just under one third of schools (n = 10; 29%) in the sample. The same number of schools (n = 10; 29%) only required the GRE under certain conditions, such as a previous cumulative GPA below a 3.0. Over one third (n = 13; 38%) did not require the GRE examination. One school requires the Test of Essential Academic Skills rather than the GRE. Table 1 presents required prerequisite courses.
Prerequisite Courses and the Percentage of Entry-Level Master of Science in Nursing Programs Requiring Them
The reviewed entry-level master's programs ranged in duration from 15 to 36 months, with an average of 22 months. Sixteen schools (47%) had programs of 24 months and longer and seven programs (20%) were 16 months or shorter. The average program length was 22.4 months.
We were able to determine the credits required for graduation of 32 of the 34 schools investigated. The range was 52 to 107 credit hours, with an average of 73.2 credit hours.
About one third of schools (n = 11; 32%) reported how many clinical hours are required of students. The total ranged from 500 to 1,395, with an average of 1,091 hours per program.
The NCLEX is taken after completion of all course work in the majority (68%) of the programs. Seven programs (21%) had students take the NCLEX before graduation from the program. We were unable to determine when students took the NCLEX in two of the programs. Table A presents the features described above in each program included in the sample.
Although accelerated master's entry into nursing programs have been around for decades, entry-level master's programs that result in a generalist degree rather than an advanced practice degree are a relatively new phenomenon. To our knowledge, this is the first article to describe the characteristics of these programs.
Among our most striking findings was the significant variation in length, credits, and clinical hours among the programs. The programs reviewed varied in length from 15 to 36 months. The number of credits required to graduate also varied from 52 to 107. Only approximately one third of the schools reported how many clinical hours were required for graduation, with totals ranging from 500 to 1,395. The substantial difference between the programs suggests that the graduates may have significantly different skills and/or expertise. Although some of the difference in program length may be accounted for by length of break times and number of prerequisite courses, it seems unlikely that programs with such different time lines and clinical hours are producing similarly skilled graduates. Because there are no available analyses of how length, credit, or clinical hours affect student, nurse-, or patient-level outcomes, it is unknown whether the additional time and resources add value.
Because CNL programs are required to meet the curriculum criteria mandated by the AACN for accreditation (e.g., a minimum of 400 clinical hours), it is possible that if we included only the programs that prepared CNLs, rather than also master's generalists, we would have found less variance. However, it remains notable that programs advertised as producing advanced generalist entry-level nurses with the same degree could have such markedly different requirements. These differences also underline the need to distinguish between a CNL or master's-entry nurse without a CNL focus. Are these programs producing the same or different outcomes? Future analyses of competencies of graduates from these programs are needed so that consumers (both students and potential employers) can better understand these degree programs.
In contrast to length, credit, and clinical hours, the programs were more similar in admission requirements with most requiring the prerequisite courses of anatomy and physiology, microbiology, statistics, and psychology. In addition, nearly half of the schools either do not require or only require the GRE for students with lower GPAs. This suggests that master's entry programs are evenly divided in terms of the importance they place on standardized test scores. Nurse educators may be drawing from evidence that GRE scores did not predict future academic success (Katz, Chow, Motzer, & Woods, 2009; Moneta-Koehler, Brown, Petrie, Evans, & Chalkley, 2017). In addition, anecdotal evidence suggests that requiring the test may negatively impact applicants who have limited financial resources and may be a barrier to application to a program. At a time when nursing and other health professions are attempting to attract a more diverse student base, the GRE trade-off may not be merited.
A substantial majority of master's-entry students cannot take the NCLEX until they complete their program. This has implications in terms of faculty-to-student ratio during their education and the range of activities the student can perform. Given that most students are not licensed until after the program, they may graduate with limited experience making clinical decisions on their own. The AACN master's essentials in nursing require that graduates have preparation in “graduate-level clinical practice content and experiences.” (AACN, 2011, p. 1). If master's-entry programs are indeed meeting the AACN master's essentials, which include masters-level nursing practice, schools of nursing may need to consider whether the timing of the NCLEX adequately permits the development of those critical decision-making skills.
Although programs that identified with the CNL role were common, there were also many master's-entry programs that did not appear to mention the CNL or mentioned it only in a limited way. We do not have data to understand the reason why a school might gravitate toward or away from the CNL. Reports have shown improved care quality outcomes after introduction of the role into a health care system; however, CNL nurses are still struggling to delineate their roles (Bender, 2014, p. 115). Anecdotally, we have heard issues related to the reluctance of nurses who have worked for many years to accept new graduates as “nurse leaders.” Whether this has affected the acceptance of the role into new master's-entry programs is unknown.
Also of note is how difficult it was to navigate the language and terms used to describe the programs. Our team of authors included three doctoral-prepared nurse educators with extensive curricular and programmatic experience, yet it was difficult to determine which programs met our inclusion criteria. This is in part because there are many different models of entry-level master's programs that need to be distinguished from each other and use the same language in their titles. A prospective student with a bachelor degree in another field who is seeking to become a generalist nurse through a master's-entry program in nursing must sort through programs that target students with associate and bachelor degrees, as well as those that result in advanced practice degrees. In addition, as mentioned previously, there may be disagreement or confusion about what constitutes a specialty versus generalist program in nursing. Some master's-entry programs do not offer specialization but note that the master's-entry program is a generalist degree. Other programs offer a master's-entry program with a specialization (e.g., in public health or nursing administration) yet others advertise a master's-entry program with a specialization in the CNL role. Although variety in program offerings has the advantage of being responsive to different students and communities, a lack of clarity about target students, role outcomes, and how they fit within the profession may cause confusion. Given the difficulty we had in deciphering the program nomenclature, the struggle for prospective students and the public to understand differences between these programs and the nurses they educate would be even more challenging.
This review has several limitations. First, websites are not always up to date or accurate, which is an issue because they serve as the primary source for prospective students. Second, we did not validate the findings with each program director. However, prior to submitting for publication, we sent our findings to program directors and admissions offices to verify our data and heard from 12 programs. Of the 12 who responded, 10 had corrections to make. This suggests that the online program information is not always reliable or up to date. In addition, inclusion criteria and findings were determined by the authors. It is possible that others might disagree with our assumptions and interpretation of website information. Finally, given that there is not an official list of programs that fit our inclusion criteria, it is possible that we missed some eligible programs.
Entry-level master's programs in nursing have grown substantially in the past 25 years with variation among program titles, admission requirements, program length, clinical hours, and credits. This comprehensive evaluation highlights the need for more discussion and evaluation to promote clarity for potential students and employers. In addition, as the nursing profession continues to grow, it will be important to rigorously assess the student outcomes for these programs.
- Accreditation Commission for Education in Nursing. (2013). Search ACEN accredited nursing programs. Retrieved from http://www.acenursing.us/accreditedprograms/programsearch.htm
- American Association of Colleges of Nursing. (2004). About the CNL/talking points. Retrieved from https://www.aacnnursing.org/CNL/About/Talking-Points
- American Association of Colleges of Nursing. (2011). The essentials of master's education in nursing. Retrieved from https://www.aacnnursing.org/Education-Resources/AACN-Essentials
- American Association of Colleges of Nursing. (2013). Competencies and curricular expectations for clinical nurse leader SM education and practice. Retrieved from http://www.aacnnursing.org/Portals/42/AcademicNursing/CurriculumGuidelines/CNL-Competencies-October-2013.pdf
- American Association of Colleges of Nursing. (2019). Fact sheet: Accelerated baccalaureate and master's degrees in nursing. Retrieved from https://www.aacnnursing.org/Portals/42/News/Factsheets/Accelerate-Programs-Fact-Sheet.pdf
- American Association of Colleges of Nursing. (n.d.). CNL frequently asked questions. Retrieved from https://www.aacnnursing.org/CNL/About/FAQs
- Bender, M. (2014). The current evidence base for the clinical nurse leader: A narrative review of the literature. Journal of Professional Nursing, 30, 110–123. doi:10.1016/j.profnurs.2013.08.006 [CrossRef]24720939
- Committee on Nursing Education, & American Nurses Association. (1965). American Nurses Association's first position on education for nursing. American Journal of Nursing, 65(12), 106–107.
- Fang, D., Li, Y., Trautman, D.E. & Turinetti, M.D. (2018). Institutional profile and program offerings. In American Association of Colleges of Nursing (Ed.), 2017–2018 enrollment and graduations in baccalaureate and graduate programs in nursing (p. 17). Washington, DC: American Association of Colleges of Nursing.
- Katz, J.R., Chow, C., Motzer, S.A. & Woods, S.L. (2009). The graduate record examinations: Help or hindrance in nursing graduate school admissions?Journal of Professional Nursing, 25, 369–372. doi:10.1016/j.profnurs.2009.04.002 [CrossRef]
- Moneta-Koehler, L., Brown, A.M., Petrie, K.A., Evans, B.J. & Chalkley, R. (2017). The limitations of the GRE in predicting success in biomedical graduate school. PLoS One, 12, e0166742. doi:10.1371/journal.pone.0166742 [CrossRef]28076356
- National League for Nursing. (2018). National League for Nursing responds to AACN draft vision statement for future of nursing education. Retrieved from http://www.nln.org/newsroom/news-releases/news-release/2018/06/11/national-league-for-nursing-responds-to-aacn-draft-vision-statement-for-future-of-nursing-education
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Prerequisite Courses and the Percentage of Entry-Level Master of Science in Nursing Programs Requiring Them
|Course||Sample Requiring This Course|
|Anatomy and physiology||100%|
Programmatic Features of Sample
|School||Title||CNL Language||Admission Requirements (GRE)||Length (Months)||Clinical Hours||Credits||NCLEX|
|1||Case Western Reserve University||Graduate Entry||Not mentioneda||Only if requested||20||1,000||72||Mid-program|
|2||Mount St. Joseph University||MSN-MAGELIN: Master's Graduate Entry-level into Nursing||Titleb||No||16||Not stated||64||Not mentioned|
|3||DePaul University||MENP for Non-Nurses (MS)||Not mentioned||Not unless GPA < 3.2||24||Not stated||107||End of program|
|4||Marquette University||MSN: Direct Entry||Descriptionc||Not unless GPA < 3.2||18||1,020||75||End of program|
|5||Metropolitan State University||Entry Level Master of Science in Nursing (ELMSN)||Not mentioned||No||27||Not stated||62||End of program|
|6||Millikin University||MSN Master's Entry into Nursing Practice||Description||Not unless GPA < 3.0||26||Not stated||81||End of program|
|7||Pacific Lutheran University||Entry Level MSN (ELMSN)||Description||Yes||27||Not stated||85||Mid-program|
|8||Rush University||Generalist Entry Masters (GEM)||Title||Not unless GPA < 3.0||24||1,140||74||End of program|
|9||Saint Louis University||Accelerated MSN (AMSN)||Title||No||21||About 1,000 hours||66||End of program|
|10||Seton Hall||Masters Level Entry Program: CNL||Title||No||24||Not stated||80||End of program|
|11||University of Arizona||Master of Science for Entry to the Profession of Nursing (MEPN)||Not mentioned||No||15||Not stated||56||End of program|
|12||University of Illinois at Chicago||Graduate Entry Master of Science||Not mentioned||Not unless GPA < 3.25||21||Not stated||79||End of program|
|13||University of MD||Clinical Nurse Leader||Title||No||16||>800 hours||65||End of program|
|14||University of Minnesota||Master of Nursing||Not mentioned||Not unless does NOT have graduate degree||16||500 clinical hours||52||Not mentioned|
|15||University of New Hampshire||Direct Entry Master in Nursing||Description||No||20||Not given||71||Mid program|
|16||University of San Diego||Master's Entry Program in Nursing (MEPN)||Description||No||21||Not given||71||End of program|
|17||University of San Francisco||Master of Science in Nursing (ME-MSN) Non-Nurse||Not mentioned||No||24||Not given||68||Mid program|
|18||University of Toledo||Direct Entry Graduate Clinical Nurse Leader Program||Title||Yes||24||660 clinical hours||66||End of program|
|19||University of Virginia||CNL Direct entry into Nursing||Title||No||24||1,000 clinical hours||75||End of program|
|20||Western University of Health Sciences||MSN, Entry Program (MSN-E)||Title||Yes||24||Not at all||61||Not mentioned|
|21||Xavier University||MSN Direct Entry as 2nd Degree: MIDAS PROGRAM||Description||Yes||20||Not mentioned||79||Not mentioned|
|22||Augusta University||MSN: CNL Program||Title||Not unless GPA < 3.25||16||1,120||60||End of program|
|23||California Baptist University||Entry Level Master of Science in Nursing||Not mentioned||No||36||Not mentioned||94||End of program|
|24||Charles Drew University of Medicine and Science||Master's of Science in Nursing-Entry Level Master's Track||Description||Not unless GPA < 3.2||24||1,395 clinical hours||81||After 5th semester|
|25||Columbia University||Master's direct entry||Not mentioned||Yes||15||Not mentioned||72||End of program|
|26||Elmhurst College||Master'sEntry into Practice||Description||No||24||Not mentioned||71||End of program|
|27||Johns Hopkins University||Master's of Science in Nursing: Entry into practice||Not mentioned||No||18||Not mentioned||72||End of program|
|28||Saint Catherine University||Nursing: Entry Level||Not mentioned||Yes||26||Not mentioned||57||End of program|
|29||Ohio State U||Graduate Entry||Description||Not unless GPA < 3.0||36||Not mentioned||Unable to determine||Mid-program|
|30||U of AL at Birmingham||Accelerated Masters Entry to Nursing Pathway (ANMP)||Description||Yes||16||Not mentioned||54||End of program|
|31||U of CA-Davis||Master's Entry Program in Nursing||Not mentioned||Yes||18||1,080 hours||92||End of program|
|32||UCLA||Master's Entry Clinical Nurse (MECN)||Description||No||21||Not mentioned||106||End of program|
|33||U of Louisville||Master's Entry into Professional Nursing (MEPN)||Description||Yes||24||Not mentioned||67.5||End of program|
|34||University of Wisconsin-Milwaukee||Direct Entry MN||Title||Yes||36||Not mentioned||86||Mid-program|