1. Ponte, Patricia Reid DNSC, RN, NEA-BC, FAAN

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GIVEN THAT continuous lifelong learning is a central characteristic of all professional nurses, nurses must think carefully about advancing their educational preparation. Deciding to return to school for a graduate degree is a significant decision. Knowing what degree to pursue and what college or university to attend, and deciding on time frames for initiating and completing the degree, are three high-priority questions nurses should consider. This article offers insights and perspectives for baccalaureate-prepared nurses exploring next steps in their education.


Find the answers

Answers to several key questions can provide important guidance regarding which degree is the best fit. Nurses should ask themselves:


* What about nursing provides you with the greatest sense of joy and meaning? Is it relationship-building and engagement with patients and families or sharing knowledge with them as they prepare for self-care or discharge? Do you enjoy working in an interdisciplinary team? Is the orientation and preceptorship of colleagues really exciting to you? Do you like "being in charge" in situations, such as assuming the charge nurse role or managing projects? Do you enjoy implementing evidence-based practice (EBP) standards or seeking to improve processes in care delivery and monitoring outcomes?


* What do you want to accomplish by completing a graduate degree? More knowledge and confidence to do your current job? A different kind of work? A position of more responsibility?


* Do you see yourself in a clinical setting in the next 5 to 10 years? If so, would that be as an educator, advanced practice nurse, administrator, or nurse scientist?


* Can you picture yourself in other settings? If so, where? For instance, running a home care or staffing business, in the policy arena, in research and development or information technology firms, with insurance companies, working in the state or federal government, in public health, or in a college or university as a faculty member?



Nurses who intend to remain in the clinical setting providing care as an RN but not as an advanced practice registered nurse (APRN) may want to consider a master's degree with a focus in one of several specialty areas. These include programs that focus on healthcare system management or nursing administration, nursing informatics, and nursing education. Another avenue to consider is a master of health administration, business administration, or public health degree.


The nurse should think about not only his or her broader goals for pursuing graduate education, but also the practicalities of pursuing particular programs offered by specific higher education institutions within a type of degree. Examples of factors to consider include program length; full- or part-time options; delivery modes, such as online, classroom, or hybrid; cohort models (where groups of students admitted at the same time proceed through the course sequence in a program together) versus individual tracking; faculty expertise and areas of clinical and research interests; and reputation and quality indicators of the university or college offering the degree.


Master's degrees in nursing

Programs in nursing administration provide specialty content focused on managerial and leadership competencies in nursing-care delivery, such as leadership theory, healthcare finance, budget management, staffing and scheduling, human resource management, environment of care, practice environments, shared governance, regulations, quality and safety, innovation, EBP, ethics, and health policy.


Some schools offer the clinical nurse leader (CNL) concentration in their master's degree programs. This concentration provides specialty knowledge in the competency areas of clinical care coordination; population health and outcome management; risk assessment; clinical leadership; and operational management, EBP, and quality management and improvement. Utilization of the CNL role has been regional and healthcare system-specific, so relatively few of these programs are available nationwide.


Similar programs with a focus in nursing informatics are available in many schools of nursing, as are programs that focus on nursing education in the practice setting, integrative or holistic nursing, and innovation and entrepreneurship. The courses in these programs and the competencies addressed are similar to nursing administration and CNL degree programs, but the specialty coursework is focused on informatics, adult learning and pedagogy, integrative nursing, and innovation.


Master's degrees in nonnursing disciplines

Many health administration programs are offered nationally. Competencies include healthcare system management, executive and managerial leadership, organizational behavior, healthcare financing and accounting, quality and safety, ethics, policy and interdisciplinary teamwork, physician practice management, communication, business plan development, and program evaluation. These programs are geared toward nurses who want to focus their careers in healthcare delivery at the managerial or executive leadership level.


Master of business administration (MBA) degree programs focus on competencies related to establishing, leading, and managing a business enterprise in any industry, exposing students to examples and strategies drawing heavily from the for-profit sector. Courses in these programs include leadership and organizational theory and practice, business strategy, the science of management, finance, accounting, marketing, business ethics, and customer relations. Many of these programs use case presentation and analysis as a major teaching method.


Keep in mind that the master of health administration degree is focused entirely on the healthcare business enterprise, whereas an MBA is a more generic degree focused on business strategy. The course content can clearly be applied in a healthcare setting, but the overall goal is to prepare business leaders for a broad array of industries.


A master of public health degree is typically geared toward individuals who are interested in the management of community health services, such as health education and outreach either nationally or globally, public service in government or nonprofit agencies, regulation, and grant writing for advancing public policy.


APRN master's and doctoral degree programs

If the nurse's career intention is to provide care as an NP, nurse anesthetist, certified nurse midwife, or clinical nurse specialist (CNS), he or she can consider a master of science in nursing (MSN) degree with an advanced practice specialty. However, not all schools of nursing have programs in every specialty area; for example, very few programs in the United States offer the CNS focus.


Nurses seeking information about doctor of nursing practice (DNP) APRN degrees should investigate the school of nursing's trajectory related to long-term program plans. No consensus has been reached about when all APRNs will be required to have a DNP degree to practice. In the case of nurse anesthetist programs, however, a 2025 deadline has been set by the American Association of Nurse Anesthetists.


When making a choice, nurses must carefully consider the pros and cons of each program. Although the MSN degree program is shorter than the DNP degree program for a bachelor's-prepared nurse to complete (about 2 years versus 3 years), the DNP degree prepares APRNs to both practice and lead healthcare delivery in the future.


The overall nursing doctoral education model that's emerged over the past decade in the United States is one consisting of two terminal degrees: the clinical doctorate (DNP) and the research doctorate (PhD). Nurses who are unsure about their ultimate career goal should ask themselves the following questions: "Do you see yourself wanting to develop new knowledge through your own program of research as a nurse scientist in the future?" "Do you see yourself wanting to teach at a university or college in the future?" Nurses who answer yes to these questions should consider an advanced practice degree with a long-term plan to pursue a PhD in the future. On the other hand, if they see themselves in the clinical setting as a care provider and leader, pursuing the DNP degree makes sense.


The direction ahead

Nurses are versatile in their capabilities and talents as healthcare professionals. For this reason, they can pursue a range of career paths and specialty areas. As nurses decide which graduate degree program to choose, they should consider the aspects of their professional, community, and personal life that provide them with the highest level of engagement, joy, and passion; where they want to contribute the most; and what outcomes and impact they hope to have over the lifetime of their career. Making a decision based on current values will drive nurses in the right direction.