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Department: LEARNING CURVE

What to consider when choosing a graduate nursing program

Valiga, Theresa M. “Terry” EdD, RN, CNE, ANEF, FAAN; Thornlow, Deirdre PhD, RN, CPHQ

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doi: 10.1097/01.NURSE.0000527614.67902.8e
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DUE TO INCREASING emphasis on preventive care, the explosion of knowledge and technology, and dramatic changes in where and how care is provided, nurses are returning to graduate school earlier in their careers than had been the case historically to meet the new demand for advanced practice nurses.1 This can be attributed to several factors: being “well-seasoned” as a clinician before returning to school is no longer an expectation, the increase in online or hybrid programs makes it easier to pursue advanced education while continuing to work and/or raise a family, and more employers in our field are requiring or giving preference to candidates who have a graduate degree. But whether you begin a graduate program after many years in the field or immediately after completing a baccalaureate degree, you need to consider the following issues to ensure that you select the most appropriate program.

What's your motivation?

Why do you want to go to graduate school? If the answer is to “escape” bedside nursing, to earn more money, or to be counted among the still relatively small group of nurses who've earned graduate degrees, you may want to reconsider. Graduate education is designed to expand and challenge your thinking, push you to explore concepts in depth, help you begin to develop an area of expertise, challenge you to become increasingly familiar with the literature and leaders in our own and related fields, enhance your communication and public speaking skills, and reflect on your values and beliefs and how they impact your actions. It's an endeavor that prepares you to be a leader and to consistently bring a scholarly perspective to your practice, whether as a clinician, educator, manager, informaticist, or scientist.

As a graduate student, you'll be expected to build on the knowledge, skills, and values developed in your previous educational program(s); read extensively and identify trends or inconsistencies; make presentations to peers and others, such as legislators; and write in a scholarly way. You should expect to be challenged to be succinct, present a powerful argument for or against an issue of significance, and interact with faculty and fellow students in collegial, collaborative ways.

If this is how you're looking to grow as a nurse, a professional, and a human being, then graduate school is for you. You next need to consider what kind of graduate program is best for your goals.

Graduate program types

Today, nurses have the option of enrolling in master's, DNP, PhD, EdD, or DrPH programs, all of which are at the graduate level. Programs that offer the BSN-to-DNP or BSN-to-PhD options typically are designed to meet master's-level competencies “on the way” to the doctoral degree. Some students enroll in master's-level courses first, then continue with doctoral education. Others may enroll in master's-level courses initially, then take master's and doctoral courses concurrently, and conclude with doctoral coursework and the dissertation. For those with diplomas or associate degrees in nursing, some programs offer RN-to-MSN options that enable nurses to earn an advanced practice nursing degree while integrating baccalaureate essentials, thereby saving time and money and helping the nurse “fast-forward” into an advanced practice nursing career.2

Master's programs are designed to prepare you for an advanced role as a clinician—nurse practitioner (NP), clinical nurse specialist (CNS), nurse midwife (CNM), or nurse anesthetist (CRNA)—or as a nurse educator, nurse manager, or nurse informaticist. All such programs typically include a core of courses taken by all students that may focus on evidence-based practice, research methods, role transitions, team collaboration, healthcare issues, population health, or leadership. The focus then shifts to the unique knowledge and skill needed for a particular role and includes field experiences in which the nurse implements the role under the guidance of an appropriately prepared preceptor.1 Upon graduation, nurses who've prepared for an advanced clinical practice role (NP, CNS, CNM, CRNA) must pass a certification exam and be licensed as an advanced practice registered nurse according to individual State Board of Nursing requirements; graduates of other types of majors, such as education, typically have to meet no such certification or licensure requirement in order to practice in the new role.

DNP programs are designed to prepare you to lead systemwide, evidence-based change in organizations. They require students to identify a gap or problem in their practice settings; find and judge the strength of evidence related to that problem; use that evidence to design an intervention to fill the gap or address the problem; and evaluate the effectiveness of that intervention. In essence, DNP students design, implement, and evaluate quality improvement projects under the guidance of faculty and in collaboration with clinical partners. Some DNP programs are designed to help students develop these skills while also preparing for an advanced clinical role; nurse anesthetist preparation, for example, follows this model.

Research doctoral programs (PhD, EdD, DrPH) are designed to prepare nurse researchers. They include a heavy emphasis on research design and methodology, statistics, philosophy of science, writing, team science, grant writing, and professional presentations. These programs also prepare graduates to lead in the discovery of new knowledge with guidance from an accomplished researcher who serves as their mentor. These research doctorate programs differ from the practice doctorate programs (DNP) in that their focus is to prepare graduates who will generate new knowledge, whereas DNP program graduates are prepared to translate knowledge into practice. Generally, DNP-prepared clinicians and PhD-prepared nurses work together to formulate questions in need of study and interpret how results of research efforts can be used to enhance practice.

Finding the best fit

Many types of graduate programs are available, so investigate the focus of those you're considering in order to make a decision that's a good fit for you. Thinking about what kind of work gives you great satisfaction will help you make the best choice. For example, consider the following:

  • If you find direct patient-care rewarding, you might consider a master's program with a clinical focus. Some areas of focus are caring for patients/families with acute physical or mental health problems; caring for patients/families with chronic physical or mental health problems; helping patients/families remain healthy; and helping students design, implement, and evaluate programs of care for populations or communities.
  • If you find great satisfaction in helping others grow and learn, you might consider a program that prepares you for a teaching position in an academic or clinical setting.
  • If you enjoy directing groups to identify goals and implement change to meet those goals and achieve new visions, a program in nursing management might be for you.
  • If you love working with data and details, organizing and managing information, and working with healthcare IT systems and electronic health records, consider a nursing informatics program.
  • If your goal is to influence systems and the processes/practices that occur within them, and to do so in a systematic and evidence-based way, then a DNP program might be best for you.
  • If you enjoy the rigors of the scientific process, searching for answers to difficult questions, and working with a team to find answers, a research-focused doctoral program will help you develop skills in those areas.

Once you've decided on the type of program that will best fit with your goals and passions, you then need to decide on the particular program to explore.

Selecting your program

Deciding on which graduate school of nursing to attend involves weighing many factors. First, look for a graduate program that's accredited by the American Association of Colleges of Nursing's Commission on Collegiate Nursing Education, the Accreditation Commission for Education in Nursing, or the National League for Nursing's Commission for Nursing Education Accreditation.3-5Accreditation is an indication that the program has met national standards related to its curriculum, faculty and resources, and other program components. (Note that research doctorate programs, such as the PhD, typically undergo rigorous internal reviews to ensure quality, but existing accrediting bodies in nursing don't accredit PhD programs.)

Also consider the cost of the program and what kind of financial aid might be available to you. Schools may offer their own scholarships, loans, graduate assistantships or teaching assistantships, or they may distribute scholarships and loans (such as the Nurse Faculty Loan Program) made available through the federal or state government, or through other organizations or foundations. Explore whether a school has staff to help students find, negotiate, and manage loans from community organizations, philanthropic organizations, local or state governments, or other resources. You may also want to explore whether a school has a financial aid office and the extent to which it supports its students.1

Another factor to consider is the format in which the program is offered. Do you prefer a traditional in-person educational environment, or does the flexibility of an online program more closely align with your personal and work commitments and preferred way of learning? Or perhaps you'd prefer a hybrid program that combines both online and face-to-face learning. It's worth noting that some programs tailor their courses to attract working nurses, even when offered in more traditional, on-site formats; for example, several courses may be offered in 1 day or on each of 2 consecutive days so that students traveling from out of town can make local arrangements to stay overnight, rather than drive back and forth several days each week. In light of the many program format options, you should be able to find a program that's both practical and in sync with your learning preferences.6

Certainly, you'll want to investigate whether the faculty teaching in the program are experts in the areas they teach. Review the school's website carefully to find faculty academic credentials, specialty certifications, areas of interest, publications, research foci, professional involvement, and so on. When choosing a program, consider the diversity of the faculty in terms of their educational preparation, clinical background, and areas of expertise.

Digging deeper

You might want to ask about student:faculty ratios and relationships. How many students typically are in a class? How many are in a clinical/practice group? How many advisees does a faculty member typically have? Is the number of faculty adequate to advise students on their DNP projects or PhD dissertations? Do students have opportunities to work one-on-one with a faculty member on an independent study or individually designed project? Do students and faculty publish together? Do students have opportunities to participate in research projects that are led by the faculty, or participate in other professional initiatives? Even in an online program with limited face-to-face interactions between students and faculty, questions such as these are important to consider as they tell a story about the educational environment.

Nearly all graduate programs integrate some type of field experiences; therefore, you should consider the extensiveness and richness of the partnerships and field experiences offered by the school. In what kind of settings do students have clinical learning experiences, complete preceptorships, implement quality improvement projects, or conduct research? These experiences foster your ability to put classroom learning into action, synthesize all that you've learned throughout the program, and collaborate with a designated preceptor and others already practicing in the role for which you're preparing.

Regardless of the degree or program you pursue, you may want to explore what other programs the school offers and whether it provides opportunities for students from various programs to work together on learning projects, serve together on committees, participate in research with one another, or practice together in the lab (simulations) or practice sites. Such opportunities can strengthen the nursing team and enhance appreciation for the valuable contributions made by each team member.

Consider visiting the school to meet with faculty and students to get a feel for the program and its delivery options. Come prepared to ask questions so that you can make an informed decision. While the cost of education is important, the overall quality of the educational experience is also critical. Meet with financial aid officers to discuss sources of support, meet with technology support staff to determine how they support students who may be at a distance, talk to current students about their experiences in the program, and talk with faculty about course workload, advisor support, program flexibility, and any issue that concerns you.

Finally, search the website or ask about attestations or testimonials from program graduates. How successful are graduates on certification exams and in securing positions for which the program has prepared them? What kind of professional accomplishments (awards/honors, significant leadership roles, publications) have graduates achieved?

Final considerations

Deciding to go to graduate school and choosing a program that's right for you requires deep thought and personal reflection. Consider whether the timing is right to begin and commit to completing a graduate program. Do you have support from your family to begin and complete the journey? Do you have the flexibility in your work commitments that will allow you to attend class (or on-campus intensives that may be part of a hybrid program) and to complete field experiences? Will you have the time and environment in which to read extensively and do scholarly writing? Do you have the financial resources needed, and—perhaps most important—are you absolutely certain that the new role for which you want to prepare is the right one for you?

It's a wonderful achievement to complete a graduate program in nursing. And that achievement is even sweeter when the journey has been positive and you feel prepared to take on a new role. So, think carefully, make your own decisions, don't be swayed by what others think you should do, and engage fully throughout the program. Good luck in your search to find your ideal graduate program.

REFERENCES

1. Thomas CM, McIntosh CE, Mensik JS. Strategies for pursuing a master's degree. Dimens Crit Care Nurs. 2016;35(3):147–153.
2. American Association of Colleges of Nursing. AACN Essentials. 2017. http://www.aacnnursing.org/Education-Resources/AACN-Essentials.
3. American Association of Colleges of Nursing. CCNE Accreditation. 2017. http://www.aacn.nche.edu/ccne-accreditation.
4. Accreditation Commission for Education in Nursing. 2017. http://www.acenursing.org.
    5. National League for Nursing. Overview: National Leagues for Nursing Commission for Nursing Education Accreditation. 2017. http://www.nln.org/accreditation-services.
    6. Sherrod BC, Sherrod D. Is online education right for you. Nurs Manage. 2013;44(4):40–45.
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