Peter Teboh, RN, MBA, MPHPeter Teboh, RN, MBA, MPH

The ever-increasing nursing shortage and the need for more nurses of color who can provide culturally competent care to an increasingly multicultural population has prompted colleges and universities to create alternative pathways into the nursing field. One such pathway is the master’s entry program in nursing (MEPN), an accelerated MSN program that enables people with non-nursing degrees to complete the requirements for RN licensure and earn a master’s degree in a clinical specialty, allowing them to become advanced practice nurses in two to four years (depending on their specialty).

In the first “bridge” phase of the program, students combine classroom study with practice of clinical skills in laboratory and real-life settings. At the end of this time, they are eligible to take the NCLEX-RN® and move on to the master’s phase of the program. The philosophy behind these programs, which essentially bypass the traditional BSN degree, is: If students have already completed their prerequisites by earning a degree in another field, why make them start from scratch and earn another bachelor’s degree in nursing?

Not that MEPN programs are new. The first was established at Yale University in 1974 as a three-year program for non-nursing majors. Since then, the number of schools offering similar programs has grown steadily.

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“In 1999, there were about 10 or 12 programs of this kind across the country,” recalls Sharon Sanderson, director of recruitment at Yale School of Nursing. “There are now close to 40, and they’re all a little different.”

These differences run the gamut from the schedule and time frame required for completion of the RN and master’s courses to the name of the program itself. For example, at some schools MEPN programs may be called graduate entry pre-specialty in nursing (GEPN), direct-entry MSN or accelerated pre-specialty MSN.

Whatever academic institutions choose to call them, most MEPN programs require that prospective students have a bachelor’s degree in a field other than nursing (although some will accept students without a degree if they have completed a specified number of prerequisite courses). Admissions decisions are based on a combination of grade point averages, professional/life experience and Graduate Record Examination (GRE) scores. And because many schools are aiming toward a more culturally diverse student population that will ultimately lead to a more diverse nursing workforce, they are actively recruiting people of color and men for these accelerated programs.

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Growing the Numbers

According to the Bureau of Labor Statistics, the health care industry will need to find more than one million new and replacement registered nurses over the next decade. To meet these projections, nursing schools must increase their number of both traditional and nontraditional students. The average ratio of minority students in MEPN programs tends to range from 11% to 28%, and a growing number of schools are trying to increase that percentage. For example, Vanderbilt University School of Nursing in Nashville, which instituted its two-year Pre-Specialty Entry for Non-Nurses program in the 1980s, began targeted recruitment of students of color in 1993.

Jose Pares-Avila, MA, LMHCJose Pares-Avila, MA, LMHC

“The nursing school received an academic enhancement grant from the Health Resources and Services Administration,” explains Jana Lauderdale, PhD, MSN, RN, assistant dean for cultural diversity at Vanderbilt. “Since then, each of our grants has always had a focus on minority recruitment as a part of the grant. For instance, there are a couple of training grants this year that are targeting minority students in areas of the United States that don’t have access to a master’s degree in nursing program.”

Partnerships with local agencies, professional associations, middle and high schools, and other universities can also help nursing schools attract students from underrepresented populations who might not have thought of an MEPN program as an option. “We involve all school stakeholders in recruitment efforts and in providing individualized follow-up to prospective students,” states Carolyn Chow, MA, director of admissions and multicultural student affairs at the University of Washington School of Nursing in Seattle. “We’ve also increased our involvement, partnerships and networking with minority affairs offices on campus and at other schools and with professional, academic and community organizations in communities of color.”

Catching students’ interest early is also important. “We work with health professions advisers, who are the people at colleges who encourage students to go on to other areas of health care,” notes Sanderson. “The majority are biology or physical science teachers.”
Unfortunately, these advisers often point students toward medicine instead of nursing, a choice that Sanderson feels is based on a skewed vision of the nursing profession. “It’s imperative that we change the image of the nurse from someone who’s subservient to an MD to someone who’s on the same health care team as the MD,” she emphasizes.

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Learning at a Faster Pace

Diversity is the name of the game in master’s entry nursing programs. Students come from a broad range of cultures, educational and professional backgrounds, age groups and life experiences. Their previous education may have been in any field, from sociology to photography, and their degree levels vary from bachelor’s to master’s to doctoral. Although some MEPN students enter the program directly after completing their undergraduate degree, most are career changers who are in their mid 20s or older.

Janelle ZamoraJanelle Zamora

Peter Teboh, RN, MBA, MPH, went into the Graduate Entry Program for Non-Nurses at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland with a background in biology, chemistry, business and public health. Married with three children, Teboh–who is originally from Cameroon–had worked in public health for a number of years but decided he wanted to move into direct patient care. He is now in his last year of study to become a geriatric nurse practitioner.

“You have to know what you want,” he advises prospective MEPN students. “The program is extremely challenging, and you have to put [the rest of] your life on hold. It takes a lot of advance planning and family support.”
The intensive academic load is universal in accelerated programs, and MEPN students need to have excellent study skills, a clear idea of what they want to accomplish and a strong dedication to their chosen field. As a former student and current faculty member (Foundations of Nursing course) in Vanderbilt’s pre-specialty program, Shawanda Clay, MSN, APRN-BC, has first-hand knowledge of the amount of work involved from both sides of the fence.

“The accelerated program is different than what students experienced in undergraduate school,” she explains. “BSN students complete nursing courses in four semesters, but this program allows students to complete them in three. The students have to be well organized and self-disciplined.”

The time commitment required means that most students find it difficult, if not impossible, to hold down jobs while they’re going through their pre-specialty year. Those with partners, children and other family commitments face the challenge of juggling those responsibilities along with the heavy course work.

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Clefondrus Ashford, RN, was an LPN with a bachelor’s degree in biology before she entered Case Western’s graduate entry program. Now in her third year of the program (her specialty is geriatrics/adult care), she went to her instructors and adviser early on when outside family and financial commitments made completing course work difficult.

“When I first started the program, I was working because the financial aid wasn’t enough,” Ashford recalls. “Eventually I stopped because it was just too hard. Then two family members became ill, and the school worked with me so I could drop a class and retake it the following semester. The faculty were very understanding, and they can be flexible if you let them know right away that you have a problem.” Addressing problems early can help prevent a snowball effect that might make it impossible for a student to catch up with regular assignments.

To avoid burnout, students need to carve out time for relaxation and personal “downtime.” “We have classes six days a week, three of which are clinical days (nine- to 12-hour shifts),” says Janelle Zamora, a University of Washington student who is in the third quarter of her prelicensure program. She previously earned a bachelor’s degree in comparative religion and will now be working toward a master’s degree in community health systems nursing.

“It’s a balancing act,” she continues. “In my first quarter, I dropped everything and focused solely on the program, but at the quarter’s end I realized that there was more to life than just school. I learned that I have to take time for myself–spend time with my family, go to the gym, have dinner with friends. Self-care, that’s the mantra. And with only 20 students in our program, we’re really able to support each other. We have great cohesiveness.”

Perhaps because of the relatively small class sizes and the mutually supportive atmosphere common to MEPN programs, many students of color don’t seem to have as much of a sense of isolation as they would in other types of programs with similar minority ratios. “I’ve never felt marginalized,” states Marie Gonzalez, who has an undergraduate degree in interdisciplinary studies and is a second-year student at Vanderbilt University who will graduate in December with an MSN in nurse-midwifery. “My father and his family are from Cuba and my mother is from Florida. It actually feels like my input is more valued because of my background.”

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Zamora’s classmate José Pares-Avila, MA, LMHC, a licensed mental health professional who worked in hospital- and community-based HIV programs for 15 years before deciding to pursue advanced practice nursing, has also found the friendships forged in his first year an important source of support. “I’m Latino, I’m one of three men in the group, I’m the only gay person and I’m older, so the feeling of isolation varies,” comments Pares-Avila. “I’m also new to Seattle, so there’s the matter of relocating to a new city and leaving my life in Boston behind. But my classmates are amazing, and I’ve become close friends with many of them.”

Providing Support

Because master’s entry nursing programs are so demanding, all of the schools interviewed for this article provide some sort of mentoring, networking or support groups for students. Some of these resources are designed specifically for minority students, while others are open to everyone; some are available exclusively within the school of nursing, and some are university wide.
 

  • The mentors available for students in Case Western Reserve’s graduate entry program include faculty advisers, alumni and current classmates, who provide peer mentoring. In addition, each class has a student representative who takes any identified concerns about the program to administration.
     
  • The University of Washington’s nursing school puts current and prospective students of color in contact with key minority leaders and health professionals in the community so they have access to professional support and mentoring outside of the school. As for on-campus support, minority graduate and doctoral students from across the university can participate in a support group that holds seminars and monthly meetings and provides networking opportunities.
     
  • Vanderbilt’s nursing school has developed an infrastructure of minority faculty, staff and alumni mentors to support minority students from their initial program inquiry through graduation. Such support can range from information sharing to academic counseling.
     
  • One of the goals of Yale School of Nursing’s Diversity Action Committee is to increase the number of minority faculty so students of color will be able to have mentors from similar backgrounds.
     
  • The University of San Diego’s Master’s Entry Program in Nursing has a Big Brother/Big Sister program in which all entering students are paired with a second- or third-year MEPN student who acts as a mentor.
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Financial assistance can be a trickier subject. Master’s entry students are often ineligible for scholarships that are available to traditional BSN students. However, once MEPN students complete their pre-specialty work and enter the master’s phase of the program, they usually have the same opportunities as other MSN students. [Editor’s Note: The Minority Nurse Magazine Scholarship Program recently expanded its eligibility criteria to include students in MEPN programs.]

“Almost all of our students have to take out some loans for the first year of the program because they really can’t work,” says Sally Hardin, PhD, RN, FAAN, dean of the University of San Diego’s Hahn School of Nursing and Health Science. “We have a large grant from the Dickinson Foundation which is focused specifically on the MEPN program, and we have a series of loans and endowments that also are used to help the MEPN students. We’ve also just introduced a paid externship for students in the last semester of the program. We work with students and local clinical agencies so the externship can be done in a place the students choose, where they would like to get more clinical experience or think they might want to work.”

Although master’s entry nursing programs aren’t for everyone, they are continuing to gain popularity as an option to help increase cultural diversity in the nursing profession. Not only do they open doors to people who might not have the time or inclination to follow the traditional BSN route, they are also increasing minority and male students’ access to advanced practice nursing careers as clinicians, researchers and educators.

Despite the sacrifices involved, MEPN students all seem to agree that these accelerated programs are helping them fulfill what has become their mission in life. “You wouldn’t be in [this program] if you didn’t really want to be an advanced practice nurse,” says Clefondrus Ashford. “I knew this was my calling. I’m in it because that’s where my heart is.”

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