Madison, Wisconsin Guide to Advanced Degree Programs Roberta Pawlak, Associate Professor and Graduate Program Director at Edgewood College, authored a thorough guide to graduate nursing programs in Wisconsin. The two-part guide was published in Nursingmatters in April and May 2013. Also included here is a table guide to Wisconsin graduate nursing programs. Confused about Advanced Degree Programs in Nursing? Here s Help (Part 1) Graduate Nursing Programs in Wisconsin Where To Find Them (Table) Choosing the Best Program for You Graduate Programs in Nursing (Part 2)
Confused about Advanced Degree Programs in Nursing? Here s help Part 1 Roberta Pawlak, PhD, RN If your education path has awarded you a BSN, and your career goals include advance practice, leadership, research, or a promotion in your organization, you might be considering an Advanced Degree Program in Nursing. Choosing the best program option, however, might be confusing and overwhelming. As an advisor in a Nursing Graduate Program at Edgewood College, I receive many inquiries from individuals who are considering going back to school for an Advanced Nursing Degree, but don t know what steps to take next. Varied program options are difficult to navigate when deciding which program is right for you. Here s some help. First, let s start with some descriptions. Graduate degrees in Nursing can lead to many different career opportunities. To pick the best fit an individual should consider their interest, the type and location of a program, and also give some consideration as to where they want to practice at the completion of their Graduate Degree. Not all healthcare systems employ all of these roles. Practicing in some of these roles may require relocation to find the perfect job that allows someone to use their preparation. Let s examine the various programs (and roles) that exist: Direct Practice Nursing Roles Clinical Nurse Leaders (CNLs) are advanced generalists and facilitate direct care for patients of various age groups who have many different disease processes or surgeries. CNLs work with the clinical staff that are involved in the care of the patients and focus on outcomes-based practice as part of the leadership team. For example, CNLs provide support and assessment of patients who have complex healthcare, discharge, and rehabilitation needs. Certain health systems such as the Veterans Health Administration utilize CNLs in their care delivery systems. Advanced Practice RN (APRNs) take many forms, provide a role in direct care, and are generally regarded as specialists within a particular area of practice. They often practice with a team of providers. Examples of APRNs including Nurse Practitioners (NPs), Clinical Nurse Specialists (CNS), s, Nurse Midwifery and Certified Registered Nurse Anesthetists (CRNAs). APRNs have greater knowledge in pharmacology, pathology, and an advanced skill set in physical assessment. Nurse Practitioner programs available in Wisconsin include: Family NP, Adult NP, Geriatric (or Older Adult) NP, Adult-Gerontology NP, Pediatric Acute Care NP, Pediatric Primary Care NP, and Psychiatric Mental Health NP. Clinical s (CNEs) are APRNs who may or may not be [inpatient] unit based. They are not usually involved in the direct care of patients, nor do they have a defined patient caseload. They are responsible for providing orientation and staff education, facilitating certification programs for staff in their defined areas, and developing new educational initiatives designed to improve clinical practice. CNEs are often the link between a unit and the schools of nursing who place students for clinical experience. CNEs also help ensure education related to regulatory standards is available to nursing staff. 1
Clinical Nurse Specialists (CNSs) are also considered APRNs. CNSs focus on a specific client group such as geriatrics, pediatrics, cardiology, or oncology patients, and often provide educational support to the nursing staff of the specialty units for which they are assigned. CNSs sometimes work as CNEs, so it is important to clarify what type of role you are interviewing for when looking at either of these positions. CNS programs available in Wisconsin include: Adult, Older Adult, Pediatric, Medical-Surgical, and Psychiatric Mental Health. Nurse Practitioners (NPs) are the largest segment of the APRN workforce, and often have roles in primary and acute care. NPs are important in providing access to quality health care in underserved areas. They also practice in rural and urban areas, in ambulatory and specialty care. Their comprehensive roles include taking health histories, performing physical examinations and health assessments; diagnosing, treating, and managing patients with acute and chronic conditions. Their care encompasses health promotion, disease prevention, health education, counseling and disease management. Diverse practice areas can include pediatrics, geriatrics, family practice, psychiatric/mental health, and women s health. Certified Nurse Midwives (CNMs) are APRNs that provide a range of primary health services which include gynecologic and obstetric care, assisted childbirth, and care of the newborn. CNMs focus the majority of their care on primary and preventive services which may include addressing reproductive health issues. The site of care for CNMs practice is diverse and can include hospitals, birthing centers, ambulatory care settings and private homes. Certified Registered Nurse Anesthetists (CRNAs) are APRNs that provide anesthesia care for individuals. They may be sole anesthesia providers in rural hospitals, or work on a team of anesthesia providers (including Anesthesiologists) in larger facilities. All the roles described above are direct practice roles. Historically, educational preparation for these roles was at the master s degree level, or obtained through a certification exam. Many master s degree programs for these roles still exist (see Table 1: Graduate Programs in Wisconsin). Certification for these roles often is obtained after the degree is completed, and after some clinical time is logged. With the exception of Clinical Nurse Leaders (CNLs), all the advanced practice roles in nursing can also be obtained through a terminal degree, the Doctor of Nursing Practice (DNP). Some schools have extended their curriculum to post-master s DNP programs, and some schools have eliminated master s programs altogether, replacing them with the DNP. Although the American Association of Colleges of Nursing (AACN) position is to promote the terminal degree (DNP) for advanced nursing practice, the market realities (and pressure from some nursing professional organizations) have resulted in the continuation of both master s and DNP programs for advanced nursing practice degrees. Both levels of programs (master s and DNP) continue to be accredited, and will be in existence for many years to come. Indirect Nursing Practice Roles In addition to direct care roles, there is a critical need for nurses to be educated for indirect practice in management, leadership, and executive roles in healthcare systems. The Council on Graduate Education in Administration for Nursing (CGEAN) promotes the master s degree in nursing 2
administration (or leadership) for entry or middle-management positions in nursing. CGEAN further supports the Doctor of Nursing Practice (DNP) in Leadership for advanced leadership or executive roles. These are all indirect care programs, and are not required to contain the curriculum bundle 3 P s: pharmacology, pathophysiology or physical assessment. Instead, population health or epidemiology, informatics, healthcare finance, leadership, quality & safety and evidence-based practice are several areas seen in the indirect care DNP curriculum. At the master s level, the indirect care program is often in Nursing Administration. At the DNP level, the indirect care program is often a DNP in Leadership, Systems Leadership, Advanced or Executive Nursing Leadership. Nursing Administration is a master s program that typically focuses on management and leadership theory, healthcare finance, the role of the health services (nursing) manager or director, regulatory agencies, business communication and ethics, quality and safety, interprofessional team work and personnel development. Some schools have dual MSN/MBA choice. The MSN in Nursing Administration degree prepares an individual for entry, middle and beginning executive level management, and would benefit anyone who is a coordinator or program manager in all areas of healthcare (acute, chronic, public health, global health). Doctor of Nursing Practice in Leadership. A degree in indirect care, this is sometimes titled DNP in Systems Leadership, Advanced or Executive Nursing Leadership. The curriculum is distinctively different than a DNP in direct care. For example, a direct care provider (i.e. Nurse Practitioner) would need to have expertise in physical assessment. In contrast, an indirect care provider (i.e. Nurse Leader) would need to have expertise in population health, health policy, informatics, healthcare finance, leadership, quality & safety and evidence-based practice. The competencies acquired with this degree can be applied in many roles, and address the cornerstones of our health systems. The Research Doctorate Doctor of Philosophy (PhD). The PhD is a research-focused doctorate. It is the highest level of formal education for a career in research and the scholarship of discovery. It is critical that nursing have individuals enter, complete and apply this preparation, as this is the cornerstone of the advancement of nursing science. Attainment of the PhD requires strong scientific emphasis within the discipline of nursing, and understanding of the sciences of related disciplines, as well as the dissemination of new knowledge. In addition to programs of research, PhD-prepared nurses often teach in Schools of Nursing. Although master s and DNP-prepared nurses also provide expertise in the education of nurses in Schools of Nursing, there may be a distinction on tenure-track and clinical-track responsibilities in the respective college or university. Key is the discipline of nursing needs PhD prepared nurses to advance the science of nursing. Certificate Programs Certificate Programs are offered at some colleges and universities, most often as post-master s options. They are a 12-18 credit bundle of courses that focus on a specific specialty area, and can 3
be one avenue of preparation for sitting for a certification exam (degree completion and experience can be other avenues). Now that you have a road map for the distinction of graduate degrees in nursing, please use this tool to assist you in determining your future career path. It is the intent that this provides some clarity to the various options available to nurses. To assist further, the author has compiled a table of graduate degree programs available in the State of Wisconsin (Table 1). This table outlines master s, doctoral and certificate programs. Some of these programs are distinct, and some are early-entry (BSN to MSN, BSN to DNP, or BSN to PhD). It is recommended you contact the program website for specifics on program entry. Further, Part 2 of this series reviews important considerations when choosing a program. The author acknowledges components of the degree descriptions are taken from the American Association of College of Nursing (AACN) publications as well as Monaghan, H.M. (2011). Clarifying the clinical nurse leader role, American Nurse Today, 6(4), 2011. Roberta Pawlak, PhD, RN is an Associate Professor and Graduate Program Director at Edgewood College. She also sits on the Board of Directors for the Council on Graduate Education for Administration in Nursing (CGEAN). Inquiries can be sent to rpawlak@edgewood.edu or 608-663-3391. 4
Table 1. Graduate Nursing Programs in Wisconsin where to find them Masters Degree Nursing Tracks (Masters) Nursing Certificates Other (non-nursing) Alverno College Milwaukee Clinical Nurse Specialist Post-master s certificate: Nursing Education Family Nurse Practitioner Bellin College of Nursing Green Bay Family Nurse Practitioner Cardinal Stritch University Milwaukee Concordia University-Wisconsin Mequon Edgewood College Madison Family Nurse Practitioner Adult Geriatric Nurse Practitioner Nursing Administration MSN/MBA dual degree Post-master s certificates: Family Nurse Practitioner Adult Gerontology Nurse Practitioner Post-master s certificates: Nursing Education Nursing Administration Marian University Fond du Lac Adult Gerontology Nurse Practitioner Marquette University Milwaukee Older Adult Acute Care Nurse Practitioner Older Adult Primary Care Nurse Practitioner Older Adult Clinical Nurse Specialist Pediatric Primary Care Nurse Practitioner Pediatric Acute Care Nurse Practitioner Nurse Midwifery Clinical Nurse Leader System s Leadership & Healthcare Quality Post-master s certificates: Older Adult Acute Care Older Adult Primary Carer Pediatric Acute Care Pediatric Primary Care Nurse Midwifery Family Nurse Practitioner beginning fall 2013 MSN/MBA dual degree Eau Claire Adult Gerontologic Health Family Health Nursing (both with functional role Educator preparation) La Crosse Nurse Anesthesia (Franciscan Healthcare Mayo Clinic Health System) Madison None- moved to DNP curriculum Post-master s certificate: Psychiatric Mental Health Nursing Clinical Nurse Leader (CNL) Post-master s certificates: Certificates: MS/MPH School Nurse Certificate
Milwaukee Family Nurse Practitioner Public Health Health Professional Education Applied Gerontology Oshkosh Viterbo University La Crosse Clinical Nurse Leader Adult-Gerontology Nurse Practitioner Family Nurse Practitioner Post-master s certificates: Clinical Nurse Leader Terminal Degrees: DNP and PhD Concordia University Mequon Edgewood College Madison Marquette University Milwaukee Eau Claire Madison University of Wisconsin- Milwaukee Degree Type/Concentrations Doctor Nursing Practice (DNP) Direct Care Advanced Practice Nurse Indirect Care Leadership Doctor Nursing Practice (DNP) Indirect Care Leadership* PhD Doctor Nursing Practice (DNP)- Direct Care Pediatric Primary Care Pediatric Acute Care Adult Older Adult Acute Care Adult Nurse Midwifery Doctor Nursing Practice (DNP) Health Systems Leadership - Indirect Care Doctor of Nursing Practice (DNP) Indirect Care Leadership PhD Doctor of Nursing Practice (DNP) Direct Care Adult/Gerontology Pediatrics Psychiatric Mental Health PhD Doctor of Nursing Practice (DNP) Indirect Care
University of Wisconsin- Oshkosh Viterbo University La Crosse DNP/MBA Doctor of Nursing Practice (DNP) Direct Care Family Nurse Practitioner Doctor of Nursing Practice (DNP)- Indirect care Advanced Nursing Administration Doctor of Nursing Practice (DNP) Direct Care** Information obtained from Accreditation organization and respective University/College websites (March, 2013). Programs vary in format: Face to Face, Hybrid, on-line. Check with Web sites for specifics. *Fall 2013 pending approval, Higher Learning Commission. ** Recently approved, Higher Learning Commission, 2013.
Choosing the Best Program for You Graduate Programs in Nursing Part 2 Roberta Pawlak, PhD, RN Knowing your education options in Nursing is critical before taking the first step and applying to programs. Part I of this article series clarifies the types of programs that exist in Wisconsin. Differentiating your career goals ahead of time can result in a more efficient match to your needs. To help you navigate the process, here is a checklist to take with you when you begin to investigate programs: What are the application requirements (undergraduate grade point, entrance testing, e.g. GRE, writing sample, letters of professional reference, etc.) Is the application rolling or cohort? (some programs only admit in cohort at certain times per year; other programs admit individually at several times per year) How long is the program, what is the credit requirement, and are full and part-time study options available? What is considered full and part time? How soon could I finish the program with either of these options? What is the tuition, and is financial aid available? (Graduate School loan availability differs from Undergraduate). Know if your employer offers tuition reimbursement, and what the requirements are to receive it. Ask the School of Nursing you are applying to about loans, scholarships, and traineeships. Is the Graduate Program in Nursing offered online, face-to-face, and/or in a hybrid format? If face-to-face, what time of day, days of week are classes offered? What is their location? Are the courses taught by faculty or teaching assistants (TAs)? What access do I have to faculty? If TAs exist, how can they help me? Does the faculty expertise match your academic, practice, and research interests? Typically faculty profiles will be available on School of Nursing websites. Check them out. For a PhD program, you will need to match on either method or topic area (or both) with available faculty interests. Other programs (masters and DNP) are typically built around available faculty expertise. What will my project requirements be? What will my practicum/residency look like? How will this be developed? Will I have a faculty advisor? How often can I expect my advisor to meet with me? What are the course sizes? Some students benefit from smaller class sizes, and some students thrive in larger class settings. Know what setting is best for your learning needs. Are Master s and DNP programs accredited by one of the two nationally recognized accrediting bodies for nursing education the Commission on Collegiate Nursing Education (CCNE) or National League for Nursing Accrediting Commission? The majority of graduate 1
nursing programs are CCNE-accredited. PhD programs in nursing, as in other fields, are not accredited by outside bodies. They are overseen by their respective University. What opportunities will you have for application to practice? Is there a practicum, capstone or residency experience, and if so, how is it structured? Are APRN program graduates eligible for certification from one of the national certifying bodies for APRNs? (This would require that a practicing RN met the clinical hours required to sit for the exam.) What type of job might I find after completing program studies? Answering this question also requires you do your homework in your home institution and market, if you are planning on staying there. Taking these degrees into faculty positions in Schools of Nursing. There is a critical need for nursing faculty in the United States. Sometimes nurses who acquire advanced degrees pursue positions in Schools of Nursing. Most all Schools of Nursing hire master s prepared nurses to teach clinical courses and undergraduate theory courses. These individuals would most likely be in a non-tenure, or clinical track position. Terminal degree preparation opens additional opportunities for nursing faculty. It is important to understand what the expectations of a faculty role are before taking a position. These may vary significantly from school to school. Most Schools of Nursing have a strong representation of PhD prepared nurses. These individuals often hold tenure-track positions, and have responsibilities for scholarship and service (in addition to teaching). A PhD prepared nurse in a research institution would be required to develop and maintain a program of research, and may, as a result, have a lighter teaching load. This also impacts a student s relationship with the faculty mentor (for example, in a research institution, students may be part of a research team). Some schools hire DNP prepared nurses in tenure-track positions, and others do not. This variance is not uncommon throughout the US. The main distinction relates to the school s requirements for tenure. Ask for a copy of tenure requirements (sometimes called a scholarship statement ), and have dialogue with the search chairperson or Dean regarding the best fit. Having this conversation before or during the search and application process can save a great deal of time as you match your expertise and interests to the institution s expectations and direction. Further, both PhD and DNP prepared nurses may be able to choose between a tenure-track or non tenure-track position. If pursuing a faculty role in a School of Nursing, be aware of the position requirements, description and role expectations. It may be a great fit, or you may choose a different path or school based on the requirements. Be aware, in the State of Wisconsin, with few exceptions, you must be prepared in nursing at the master s or terminal degree level to hold a faculty position in a School of Nursing. 2
The author acknowledges Your Guide to Graduate Nursing Programs prepared by the American Association of Colleges of Nursing (AACN) in the preparation of this article. Available at: http://www.aacn.nche.edu/publications/brochures/gradstudentsbrochure.pdf Roberta Pawlak, PhD, RN is an Associate Professor and Graduate Program Director at Edgewood College. She also sits on the Board of Directors for the Council on Graduate Education for Administration in Nursing (CGEAN). Inquiries can be sent to rpawlak@edgewood.edu or 608-663-3391. 3