285CHAPTER 12

Curriculum Planning for Master’s Nursing Programs

Sarah B. Keating

OBJECTIVES

Upon completion of Chapter 12, the reader will be able to:

OVERVIEW

In the 20th century, as nursing education matured in the academic world and the profession grappled with the issue of defining itself as a discipline, graduate education in nursing evolved. Nursing leaders recognized the need for additional education to be prepared for faculty and administrator roles. Since there was a dearth of graduate nursing programs, nurses often sought degrees in other disciplines such as education, business, and health care administration. Nurses in practice focused their services on clinical specialties such as pediatrics, obstetrics, psychiatric/mental health, medical/surgical nursing, and intensive care; and they too, felt the need for 286additional specialty training; many seeking nondegree certification. In community settings, it was recognized that public health nurses needed knowledge in epidemiology and the public health sciences, and the specialty roles of nurse midwives and nurse anesthetists required advanced educational preparation and clinical practice. Many of these programs were first offered in baccalaureate programs or as certificate programs to expand on knowledge and skills from basic nursing programs; however, all eventually moved into the graduate level.

In the 1970s, schools of nursing in higher degree institutions developed master’s degree programs that focused on the preparation of nursing faculty, administrators, and some of the classic specialties such as pediatrics, maternity, community health, and psychiatric/mental health nursing. These latter specialties became clinical specialties and as they were developing, the advent of the nursing role in primary care began with the introduction of nurse practitioners. With acute care rising in complexity, it became apparent that nurses with blended specialty role preparation were indicated such as the acute care nurse practitioner. More recently, with the implementation of the Affordable Care Act (2014) and the Institute of Medicine’s (IOM’s) (2014) The Future of Nursing, the demand for advanced practice nurses has increased exponentially.

See Chapter 1 for a history of graduate nursing education to gain an appreciation for how nursing evolved in its role in health care to match the needs of the health care system with its growing demands for well-educated providers of care. Out of all of these changes and demands came master’s degrees that focused on the specialties, primary care, management/administration, and education. A review of the master’s level nursing programs in the United States accredited by the Accreditation Commission for Education in Nursing (2014) and the Commission on Collegiate Nursing Education (2014) found approximately 481 accredited master’s nursing programs in the United States in 2013.

Chapter 12 breaks the various master’s level programs in nursing into groups from the RN to MSN, entry-level master’s, advanced generalist, and finally, to the advanced practice specialty and functional roles that are available in today’s graduate programs. Each group is reviewed and its role in graduate nursing and the profession is discussed. Some of the major issues related to master’s level nursing education are discussed throughout.

RN TO MSN PROGRAMS

With the call for higher education for nurses by the IOM’s recommendations on The Future of Nursing (2014) to meet the needs of the U.S. health care system, there is renewed interest in RN to MSN programs. The shortage of nursing faculty adds to this need for nurses with clinical work experience to gain higher education to assume faculty roles. According to the American Association of Colleges of Nursing (AACN) (2014f) and the American Association of Community Colleges (2014), there are more than 173 RN to MSN programs available across the United States and several more in the planning stages.

There are several permutations of curricula for accelerating RNs who have a diploma or associate degree to the master’s degree. One format awards the 287baccalaureate along the way as the RN completes courses equivalent to the upper division level bachelor of science in nursing (BSN). The other format is to not award the BSN but, rather, have the RN complete both upper division baccalaureate and master’s level courses and receive the MSN upon completion of the program. Sometimes, both the BSN and MSN are awarded upon completion of the program. Factors that determine the type of program of study include regional accreditation issues, parent institution standards, and the faculty’s philosophy. For example, awarding the BSN along the way of the program gives students a baccalaureate whose circumstances prohibit them from completing the master’s portion of the program.

The typical patterns for the curricula consist of 1 year accelerated study to complete the baccalaureate upper division level equivalent courses. Following completion of these courses, students enter graduate level courses and depending on the program, may take another 1 ½ to 3 years of master’s level courses depending on the type of master’s degree, with advanced practice degrees spending more clinical hours and theory courses specific to that branch of advanced practice. Some courses are developed to match the experience of the RNs to the level of education indicated and double count toward both the higher level of the baccalaureate and the introductory level master’s courses. Since the large majority of RN students are working, the usual platforms for delivery of the programs are web-based, online, evenings, and/or weekend classes to accommodate their needs.

There are few if any, studies to compare RN to MSN graduates to post-BSN and entry-level master’s programs, thus research is called for. The type of master’s program (advanced practice or functional role) and the platform for delivery of the program (online, nontraditional, or traditional) should be studied for their effectiveness and student, faculty, and employer satisfaction.

ENTRY-LEVEL (GENERIC) MASTER’S DEGREE PROGRAMS IN NURSING

When planning an entry-level master’s program, it is wise to consult with the regional accrediting body and the State Board of Nursing to identify any possible barriers to offering the degree. For example, some regional or state accrediting bodies and Boards of Nursing may require a baccalaureate in nursing prior to earning a master’s degree in the same discipline, even if the person has a baccalaureate in another discipline. There are two major pathways or programs of study for nonnursing college graduates to reach licensure (RN) requirements and a graduate degree in nursing. They are described as follows.

The first program provides basic nursing knowledge and skills courses specifically designed for college graduates and taught at the post-baccalaureate level. Included in the program or required as prerequisites are the usual sciences, social sciences, and liberal arts courses. Examples of classic prerequisites for any entry-level nursing program (associate degree, baccalaureate, and master’s) are anatomy, chemistry, english, genetics, human development, mathematics/statistics, microbiology, nutrition, physiology, psychology, sociology, and speech/communications. Students in the entry-level master’s complete nursing theory and clinical courses at the upper division level, advanced nursing theory and clinical courses at 288the graduate level, and a capstone experience that can be a thesis, project, and/or comprehensive examination. Schools of nursing differ in their preparation of these graduates by offering either an advanced generalist master’s degree for entry into practice or a specialist track to prepare graduates for advanced levels of nursing practice.

The other entry-level curriculum requires students to complete courses equivalent to or the same as existing courses in baccalaureate level nursing programs. They are not necessarily specifically revised for college graduates. As with the first program, students either must have the prerequisite sciences and liberal arts courses or complete them in the program. After completion of the baccalaureate-level courses, students enter into the master’s program to complete either an advanced generalist role such as the CNL, or a specialty, such as case management, clinical specialist, nurse anesthetist, nurse educator, nurse midwife, or nurse practitioner. The track record for the graduates of entry-level master’s programs is excellent. Students in the programs bring life experience, a previously earned higher degree, and most programs require at least a 3.0 GPA in the undergraduate program for admission. NCLEX pass rates exceed 90% (author) for entry-level MSN graduates.

According to the AACN (2014a), there were 68 entry-level (generic) master’s programs in the United States. Descriptions of the programs and the student and graduate characteristics may be found in the accelerated BSN and MSN programs (www.aacn.nche.edu/publications/issue-bulletin-accelerated-programs). AACN (2014c) conducted a survey of member schools that prepare entry-level baccalaureate and master’s degree nurses. One of the purposes of the survey was to identify the employment rates for graduates at the time of graduation and 4 to 6 months later. While the regions of the country varied, with the West lagging somewhat behind the rest of the country, it was found that entry-level master’s graduates enjoyed a higher mean rate of employment compared to entry-level baccalaureate graduates at the time of graduation (56% and 74%) and 4 to 6 months later (42%–79%).

There are several recent articles in the literature relative to entry-level master’s students’ experiences in their educational programs and their performance following graduation that are helpful to programs planning to initiate an entry level master’s or revising the existing one. McNiesch (2011) interviewed 19 entry-level master’s students for their lived experiences during their accelerated educational program. She found that the students were highly motivated and appreciative of the high stakes involved in delivering safe patient care. Her findings resulted in recommendations for types of faculty support for these students as they develop clinical competence and confidence. Klich-Heartt (2010) summarizes the literature on the socialization of entry-level MSN students into the professional nursing role. According to her review of the literature, graduates of these programs take about a year to become comfortable in the role of staff nurse; however their overall scholastic grades and motivation are higher than nurses prepared at the undergraduate levels. She suggests that nursing administrators need to ensure that the accelerated programs’ graduates have support for orientation and socialization into the professional role in health care agencies.

289Ziehm, Cunningham, Fontaine, and Scherzer (2011) conducted a follow-up study of graduates of an entry-level MSN program and their managers in their employment settings. They found that as expected, graduates with more than 1 year of experience reported more confidence in their role than those with less than 1 year. There was a high level of agreement when comparing the graduates’ self-assessment and their managers’ perceptions of job performance that was very positive. Several of the positive characteristics included the graduates’ role as patient advocates, their resourcefulness and strong social skills, and that they were more savvy in their professional relationships. These studies verify the success of entry-level master’s programs in preparing college graduates for the nursing workforce at higher levels of education to meet the demands of the system and the health care needs of the population.

THE CLINICAL NURSE LEADER

The CNL program was developed by the AACN in response to the need for health care providers to manage clients or groups of clients at the point of care. It applies to all settings of health care. The program is at the master’s level and lends itself very well to entry-level master’s programs as well as post-baccalaureate in nursing programs. An overview of the development of the role, its characteristics, and place in the United States and international health care systems is described by Baernholdt and Cottingham (2010).

AACN (2007) provides the following description of the role of the CNL: “The CNL is a leader in the healthcare delivery system in all settings in which healthcare is delivered. CNL practice will vary across settings. The CNL is not one of administration or management. The CNL assumes accountability for patient-care outcomes through the assimilation and application of evidence-based information to design, implement, and evaluate patient-care processes and models of care delivery. The CNL is a provider and manager of care at the point of care to individuals and cohorts of patients anywhere healthcare is delivered. Fundamental aspects of CNL practice include:

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