There is little doubt that we need to create a more highly qualified nursing workforce that can better handle the rigors of a demanding and ever expanding healthcare system.
The American Association of Colleges of Nursing (AACN), the Institute of Medicine, the Robert Wood Johnson Foundation, the Tri-Council for Nursing, and the Carnegie Foundation for the Advancement of Teaching all agree: Nurses must strive for higher levels of education to enhance the quality of care available to our nation’s varied patient population groups and to make skilled healthcare services more accessible.
Our healthcare system, which is increasingly placing an emphasis on managed care, prevention, and cost efficiency, demands clinicians with leadership skills capable of implementing advanced evidence-based solutions, as well as nurses in nonclinical roles with the kind of insight that can only come from first hand knowledge of healthcare delivery. Common among them is a Master of Science in Nursing (MSN).
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The Master of Science in Nursing is a highly customizable degree with specialty tracks available in advanced clinical practice and vital nonclinical roles:
- Direct patient care (advanced practice registered nurses)
- Nurse Practitioners (NP)
- Certified Nurse-Midwives (CNM)
- Certified Registered Nurse Anesthetists (CRNAs)
- Clinical Nurse Specialists (CNS)
- Non-clinical roles
- Nurse Administrators
The Master of Science in Nursing (MSN): Curriculum Requirements
The Association of Colleges of Nursing (AACN) developed the Essentials of Master’s Education in Nursing, designed to reflect the transformative thinking and evolutionary changes taking place in the field of nursing.
Master’s education prepares nurses to assume leadership roles and implement critical action within any number of changing systems—certainly within the healthcare system, but also in educational and organizational systems.
The Essentials document ensures that all master’s degree programs prepare nurses with the skills and knowledge needed to promote health, lead change, and elevate care in any number of nursing roles and settings. According to the AACN, a master’s nursing education must prepare graduates to:
- Lead change to improve quality outcomes
- Advance a culture of excellence through lifelong learning
- Build and lead collaborative interprofessional care teams
- Navigate and integrate care services across the healthcare system
- Design innovative nursing practices
- Translate evidence into practice
Master’s degree programs, like the Master of Science in Nursing (MSN), should build upon the baccalaureate nursing practice and prepare graduates to engage in higher-level practice and leadership.
The Essential Graduate Core of a Master’s Degree in Nursing
The Essentials outlines a core for all master’s programs in nursing and delineates expected outcomes for graduates of master’s nursing programs, regardless of the nursing role, focus, or practice setting.
The Essentials consists of nine essential core areas, which include:
- Clinical prevention/population health
- Evidence-based practice
- Interprofessional collaboration
- Organizational and systems leadership
- Policy and advocacy
- Program evaluation for improving patient and population outcomes
- Quality and safety
The specific content within a master’s nursing program may vary based on the specific area of focus and nursing role.
Additional content related to the nine essential core areas may include:
- Interprofessional teamwork
- Policy and advocacy
- Research design and methodology
- Root cause analyses of clinical or system error
The essential graduate core for an APRN core curriculum focuses on the following areas:
- Health promotion and disease prevention
- Healthcare financing
- Healthcare policy
- Human diversity and social issues
- Organization of the healthcare delivery system
- Policy, organization, and financing of healthcare
- Professional role development
- Theoretical foundations of nursing practice
In addition to developing competency in all of the nine essential core areas, MSN programs must provide students with additional coursework in their area of practice or functional role. Each nursing specialty has developed nationally recognized competencies and curricular recommendations, which are required for certification and practice as described below:
MSN Degrees for Advanced Practice Registered Nurses (APRNs)
All APRN programs must include study in the nationally recognized competencies for their respective role, as well as study in at least one population focus.
The four recognized APRN roles are:
- Certified Nurse Practitioner (CNP)
- Clinical Nurse Specialist (CNS)
- Certified Nurse-Midwife (CNM)
- Certified Registered Nurse Anesthetist (CRNA)
The six population-focused competencies include:
- Family/Individual Across the Lifespan
- Adult-Gerontology (Acute care/primary care)
- Women’s health/gender-related
- Pediatrics (Acute care/primary care)
- Psychiatric/mental health
In the case of CNMs, the population focus is implicit in the primary role, as all CNMs work with women and neonates. CRNAs work with individuals across the lifespan without the need to concentrate studies on a particular population group.
APRNs can further specialize their role by choosing a focus of practice linked to healthcare needs, such as nephrology, orthopedics, oncology, palliative care, and more.
According to the AACN’s Essentials of Master’s Education for Advanced Practice Nursing, a master’s nursing curriculum in an APRN role should include the following, in addition to the Essential Core:
- Direct Care (Advanced Practice Nursing) Core: The essential content required to provide direct patient services at an advanced level
- Functional Area Content: The clinical and didactic learning experiences identified by professional nursing organizations and certification bodies
The Direct Care (APRN) Core
APRNs must complete three, separate, and comprehensive graduate-level courses (called the APRN core) in:
- Advanced physiology/pathophysiology, including general principles that apply across the lifespan
- Advanced health assessment, including the assessment of all human systems, concepts and approaches, and advanced assessment techniques
- Advanced pharmacology, including:
- Pharmacotherapeutics of all broad categories of agents
Functional Area Content
All APRN programs must include clinical and didactic learning experiences identified by the respective professional nursing organizations and certification bodies associated with the APRN role:
Nurse Practitioners serve as primary advanced practice nurses, diagnosing and treating a variety of illnesses. Some of their job duties include:
- Conducting physical exams
- Diagnosing and treating common and acute illnesses and injuries
- Providing immunizations
- Ordering and interpreting x-rays and other lab tests
- Counseling patients on adopting healthy lifestyles and healthcare options
The National Organization of Nurse Practitioner Faculties’ Nurse Practitioner Core Competencies outlines the competencies essential to all nurse practitioners. Nurse practitioner graduates, regardless of their population focus, must demonstrate the following competencies:
- Scientific foundation competencies: Able to analyze data and evidence, translate research, and develop new practice approaches for improving advanced nursing practice
- Leadership competencies: Able to assume advanced leadership roles, advocate for improved healthcare access and quality, and provide/demonstrate leadership
- Quality competencies: Able to use the best available evidence to improve clinical practice, evaluate organizational structure, care processes, financing, and marketing/policy decisions, and anticipate variations in practice
- Practice inquiry competencies: Able to provide leadership when translating new knowledge into practice
- Technology and information literacy competencies: Able to integrate technologies for knowledge management, translate technical and scientific health information, and demonstrate information literacy skills in complex decision-making
- Policy competencies: Able to demonstrate an understanding of policy and practice and advocate for ethical policies
- Health delivery system competencies: Able to apply knowledge of organizational practices and complex systems to improve the delivery of healthcare
- Ethics competencies: Able to integrate ethical principles into decision-making and evaluate the ethical consequences of decisions
- Independent practice competencies: Able to function as an independent licensed practitioner
All programs must include at least 500 hours of supervised clinical experience.
Certified Nurse-Midwives (CNM) provide primary care with a focus on women’s health services, including:
- Family planning
- Gynecological exams
- Prenatal care
- Labor and delivery
- Newborn care
The American College of Nurse-Midwives’ Competences for Master’s Level Midwifery Education are a list of competencies expected of nurse-midiwives:
- Evaluate and apply clinical knowledge into best practice models to achieve the best outcomes
- Use research to provide evidence-based, quality healthcare and to improve the practice of midwifery
- Identify gaps that exist between evidence and practice and find solutions for bridging those gaps
- Use information systems to improve the safety of patients and the quality of care
- Serve as an effective team member and promote positive change in the practice
- Analyze health policy development, including the impact of policy on the nurse-midwifery practice
- Identify theories that relate to midwifery practice or scholarship
- Evaluate healthcare finance and identify ways to manage a healthcare practice
- Explore areas of interest within midwifery scholarship
Clinical experiences should include:
- Management of sexually transmitted infections in male partners
- Management of primary care for women throughout the lifespan (reproductive health care, pregnancy and birth)
- Care of the normal newborn
Clinical Nurse Specialists (CNS) provide patient care in an area of specialty nursing related to one or more of the following:
- Setting (e.g., acute care, critical care, emergency care, etc.)
- Population (e.g., geriatrics, pediatrics, women’s health, etc.)
- Type of care (e.g., rehabilitation, cardiac, psychiatric, etc.)
- Disease or medical subspecialty (e.g., diabetes, oncology, etc.)
- Specific types of medical problems (e.g., wounds, pain, etc.)
The National CNS Competency Task Force’s Clinical Nurse Specialist Core Competencies outlines the entry-level competencies and behaviors expected of graduates of master’s and post-master’s programs that prepare CNSs:
- Direct Care Competency: Engages in direct interaction with patients, families, and groups of patients as to improve quality of life and promote health and well-being
- Consultation Competency: Interacts with patients and staff in a consultant capacity
- Systems Leadership Competency: Manages change and empowers other to influence clinical practice and political processes
- Coaching Competency: Guides and teaches so as to advance the care of patients, families, groups of patients, and the profession of nursing
- Research Competency: Actively participates in research and uses evidence in clinical practice and quality improvement
- Ethical Decision-Making, Moral Agency, and Advocacy Competency: Identifies and takes action regarding ethical concerns
- Collaboration Competency: Works jointly with others to optimize clinical outcomes
Certified Registered Nurse Anesthetists provide care related to the delivery of anesthesia before, during, and after surgical, diagnostic, therapeutic, and obstetrical procedures.
According to the American Association of Nurse Anesthetists’ Scope of Nurse Anesthesia Practice, the scope of nurse anesthesia practice is determined by education, experience, state and federal law, and facility policy.
The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) requires the academic curriculum and prerequisite courses of nurse anesthesia programs to include:
- Anatomy, physiology, and pathophysiology
- Basic and advanced anesthesia practices
- Professional aspects of nurse anesthesia practice
- Pharmacology of anesthetic agents and adjuvant drugs within the concepts of biochemistry and chemistry
- Clinical conferences
- Radiology and ultrasound
Clinical experiences should provide students with the opportunity to:
- Apply knowledge to clinical problems
- Test theory
- Learn anesthesia techniques
MSN Degrees for Non-Clinical Nursing Roles
In addition to the AACN’s nine essential core areas of study, MSN degrees for non-clinical roles must include study in topics identified by the respective professional nursing organizations:
Nurse administrators are managers and leaders in all capacities and all practice environments. These nursing leaders deliver and coordinate workflow and nursing care to ensure the delivery of quality patient care.
The American Organization of Nurse Executives’ Nurse Executive Competencies details the skills, knowledge, and abilities for guiding the practice of nurse leaders in executive practice, regardless of their educational level, title, or setting. The common core set of competency domains for healthcare leadership include:
- Communication and relationship management
- Effective communication
- Relationship management
- Community involvement
- Medical/staff relationships
- Influencing behavior
- Academic relationship
- Knowledge of the healthcare environment
- Clinical practice knowledge
- Delivery models/work design
- Healthcare economics and policy
- Risk management
- Evidence-based practice/outcome measurement and research
- Patient safety
- Performance improvement/metrics
- Foundational thinking skills
- Personal journey disciplines
- Change management
- Career planning
- Personal and professional accountability
- Business Skills
- Financial management
- Human resource management
- Strategic management
- Information management and technology
According to the AACN, in addition to preparation in the graduate core competencies, students of nurse administrator MSN programs receive more in-depth preparation in organizational and system leadership.
Nurse informaticists improve information management and communications in nursing to increase efficiency, reduce costs, and enhance the quality of patient care.
The Healthcare Leadership Alliance’s HLA Competency Directory reveals the competencies all healthcare leaders—including nurse informaticists—should have knowledge of:
- Communication and relationship management: Ability to communicate clearly with both internal and external customers
- Leadership: Ability to inspire individual and organizational excellence
- Professionalism: Ability to align personal and organizational standards with ethical and professional standards
- Knowledge of the healthcare environment.
- Business knowledge and skills
- Financial management
- Human resources
- Organizational dynamics and governance
- Strategic planning and marketing
- Information management
- Risk management
- Quality improvement
According to the AACN, in addition to study in the graduate core competencies, students of Informatics MSN programs receive additional, in-depth study in informatics and healthcare technologies.
MSN-prepared nurse educators are often nursing faculty members within academic settings. However, they may also oversee staff development in healthcare facilities and patient education in healthcare agencies.
The National League of Nursing (NLN) defines eight core competencies expected of all nurse educators:
- Facilitate learning
- Facilitate learner development and socialization
- Use assessment and evaluation strategies
- Participate in curriculum design and evaluation of program outcomes
- Function as a change agent and leader
- Pursue continuous quality improvement in the nurse educator role
- Engage in scholarship
- Function within the educational environment
The AACN recognizes nurse educators as a direct care role; therefore, MSN programs for nurse educators must also include graduate-level content in three, direct care core courses:
- Health assessment
According to the AACN, essential areas of study for nurse educator MSN programs must include:
- Curriculum design and development
- Teaching methodologies
- Educational needs assessment
- Learner-centered theories and methods
MSN Programs Designed for Nurses from Various Educational Backgrounds
The design and structure of MSN degrees vary to accommodate students with different levels of education:
Entry-Level MSN Degrees: Entry-level master’s degrees—also referred to as generic or accelerated programs—are developed for students that possess a bachelor’s degree in a discipline other than nursing. These programs take about 3 years to complete, with baccalaureate-level content and initial RN licensure completed during the first year.
RN to MSN Degrees: RN-to-MSN degrees are designed for RNs that possess an associate’s degree in nursing. Depending on a student’s previous coursework, these programs take about 2 to 3 years to complete. Students complete the baccalaureate content—built into the front end of the program—within the first year.
BSN to MSN Degrees: BSN-to-MSN degrees serve as the traditional, post-baccalaureate MSN program for RNs. Coursework builds upon baccalaureate competencies, thus allowing students to concentrate learning on their chosen focus area. Most of these programs require about 18 to 24 months of full-time study.
Dual MSN Programs: Dual MSN programs allow students to combine their graduate studies, thereby achieving an expanded field of knowledge. Although these programs are still relatively young, the American Association of Colleges of Nurses reports that there are now more than 120 dual MSN degrees. Some of the most popular types of dual MSN degrees include:
- MSN/Master of Business Administration (MBA)
- MSN/Master of Public Health (MPH)
- MSN/Master of Public Administration (MPA)
Post-Master’s Certificate Programs: Post-master’s certificate programs are designed for MSN graduates looking to sharpen their clinical skills and nursing knowledge in a specific area of nursing, such as informatics, education, leadership, or an advanced clinical practice role, among others.
Other options found within many of today’s MSN programs include:
- Part-time Programs: Part-time MSN programs accommodate working RNs who require a slower-paced curriculum.
- Online Programs: While many MSN programs are still offered as traditional, campus-based programs, many schools of nursing have begun offering programs delivered largely online or in a blended classroom/online format.