Should There Be Direct Entry from a BSN Program Into an NP Graduate Program?

Article Outline

• Support for BSN Direct Entry
• Rationale Against BSN Direct Entry
• Copyright

Deborah Becker, PhD, RN, ACNP-BC, assistant professor, is the director of the Adult Acute Care NP Program and the Adult Health CNS Program at the University of Pennsylvania. She is a graduate of Villanova University (BS), Thomas Jefferson University School of Allied Health (BSN), the University of Pennsylvania School of Nursing (MSN and post-master's nurse practitioner certificate), and Drexel University School of Education (PhD). She is a member of the American Association of Critical Care Nurses, the American Heart Association Cardiovascular Nursing Council, and Sigma Theta Tau.

Identity of author withheld by request. The author is a doctorally prepared NP senior faculty member at a university and teaches in an NP program. The author's stance on the issue at hand is in direct conflict with that of the author's employer. We believe the author's concern about jeopardizing his/her employment if name is published is legitimate; therefore, we decided to honor the highly unusual request for anonymity. The need to do so highlights the conflicts within some schools of nursing on this issue where faculty views may be at variance with administration wishes.

This issue is not new but seems to continue to reappear. A physician claiming to have precepted 5 NP students recently posted a blog comment in response to a very positive newspaper article about nurse practitioners (NPs). The physician posting went like this: “Honestly, those coming straight from nursing school into NP training are just plain scary. I could not send them in to see a patient and have more than a 25% chance they would arrive at a reasonable diagnosis and plan…” Is this a harsh and unfair criticism of NP students by a disgruntled physician, or does this physician raise an important point? As the primary care crisis worsens, NPs will likely be called upon to shoulder more responsibility for their patients. Are NP educators ready for the challenge?

What do you think? Contact Section Editor Janet Selway at janet.selway@gmail.com if you would like to comment on this matter.

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Support for BSN Direct Entry 

Deborah Becker

My answer to this question is a resounding yes, and I have two reasons. First, if we have educational programs at the BSN and MSN level that adequately prepare graduates with both the skills and, more importantly, the critical thinking abilities to implement the role, the graduates of these programs should be able to appropriately function as nurse practitioners, whether or not they have previous RN experience. If not, what does that say about our educational preparation of nurses?

Second, no other practice profession requires graduates to practice in the profession before advancing their degrees, so why should nursing? Some may say it has been the tradition to require practice, or that practice adds something to the nurse's abilities, but where's the evidence? We teach our graduate-prepared nurses to practice from an evidence-base, so faculty should too.

There is no evidence showing that nurse practitioners (NPs) with previous nursing experience practice any better or differently than those without experience. Until such time that there is, I say there should be direct entry from BSN into MSN programs preparing NP students.

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Rationale Against BSN Direct Entry 

Anonymous

Nursing, like medicine, is a practice discipline. New BSN graduates benefit from an immediate, mentored immersion into full time professional practice before pursuing graduate study. This is especially important for graduates of accelerated programs, whose rapid-fire pace allows students so little time to absorb the realities of the health care system.

Experience allows a new nurse to solidify recently acquired knowledge, perfect patient assessment and management abilities, develop time and system management skills, and gain the independent clinical judgment that leads to confidence as an RN. Experience is also essential to internalize professional identity as a nurse. It is this nursing identity that differentiates APN practice from that of a physician or physician's assistant. Hallmarks of a nursing identity, a holistic approach, immediate rapport with patients, care coordination, patient education, and support for self-care are some of the added value characteristics found in APN practice. And some roles based on expert practice (eg, CNS) cannot be competently performed without practice experience.

For students entering doctoral programs, the need for practice experience is even greater. Experience provides the maturity and insight to identify the real problems that nurses address. It is the source of problems that should be examined in DNP capstone projects and PhD dissertations. In addition, doctorally prepared nurses are expected to be experts in nursing and to lead the profession. Without experience as a nurse, individuals lack credibility and are unprepared to represent, let alone lead, the profession. Doctorally prepared nurses are called on to teach, but without practice experience, they have no nursing expertise and consequently no qualification to teach. Finally, the belief that basic nursing experience is unnecessary for advanced practice or doctoral preparation is essentially an expression of lack of respect for practice. For a practice profession like nursing, this is just unacceptable.