In 2010, the Institute of Medicine and the Robert Wood Johnson Foundation led the way in the Future of Nursing: Leading Change, Advancing Health report, which highlights the need for a higher educated nursing workforce. Over the last 5 years, the Robert Wood Johnson Foundation, in partnership with American Association of Retired Persons and professional associations such as the American Nurses Association and state associations, cocreated state-level action coalitions to lead this charge at a grassroots level. As more nurses are considering master's degrees, many similar questions arise surrounding the types of degrees, different study concentrations, and areas of practice. In addition, financial costs, requirements for program entry, time commitments, and personal sacrifices are all important aspects of graduate school planning. It is valuable to have a full understanding of the expectations and rigor required before returning to college for a master's degree. The better prepared one is for graduate school, the increased likelihood of a successful educational experience.

BACKGROUND

With the Patient Protection and Affordable Care Act,1 health care is being transformed by delivering care in a more cost-effective way. The Patient Protection and Affordable Care Act has a significant impact on nursing practice in and out of the traditional hospital setting. More and more individuals will be seen through clinics and home health care owing to the increased focus on preventative care and because of less costly and easier access to services. This increase in preventative care services will require more nurses with graduate degrees, such as nurse executives and advanced practice registered nurses (APRN).

Graduate nurse practitioners (APRNs) and registered nurses (RNs) have the additional education that provides a holistic treatment when treating patients. The 2010 Institute of Medicine2Future of Nursing report also notes that all APRNs and RNs should work to the extent of their full practice authority and are now being asked to work at the top of their competency level. This is a great time in history for RNs to advance in the professional practice of nursing as the demand for higher educated and advanced practice nurses is on the rise.3 Specifically, using nurse practitioners (NPs) and advanced practice nurses rather than physicians, in appropriate places, may save the United States approximately $8.75 billion annually.3

Master's degree programs started in 1923, when nursing education as a whole took a turn away from apprenticeship education (hospital based) to being more university based. The Goldmark Report of 1923, Nursing and Nursing Education in the United States,4,5 affirmed that nursing education should be based on an educational plan as opposed to hospital service needs. A few decades later, The Nurse Training Act of 19646,7 led to the W.K. Kellogg Foundation nursing advisory report noting the importance of increasing the number of master's-prepared nurses. Some universities had already started to offer master's degrees, such as Columbia University School of Nursing in 1956, when it began to grant a master's degree in a clinical nurse specialty.

Nurses were found to seek higher degrees and were more motivated if their work organizations offered incentives and rewards such as tuition reimbursement, forgivable loans, and Web-based or work site classes.8 Kovner et al9 found that graduate-prepared nurses are more likely to develop higher job satisfaction.

ACCREDITATION

There are more than 500 schools of nursing in the United States, which offer more than 2000 different nursing programs.10 Many graduate schools also offer master's degrees with a direct transition into doctoral degrees. With a plethora of possibilities, it is important for students to choose graduate programs that meet their personal goals and objectives post graduation.

It is also important to choose a graduate school of nursing that is accredited by the US Department of Education. Only these schools are eligible for federal financial aid assistance and other potentially needed resources. Equally important is that many graduate-level programs will not accept transfer credits from a nonaccredited program. This is a key element when considering graduate programs because if you eventually want to earn a doctoral degree, you may have difficulty gaining entrance if your undergraduate or master's degree is from a nonaccredited school.

There are several regional and national bodies that are approved by the US Department of Education to accredit graduate-level nursing education. The 2 main national accrediting bodies (for graduate nursing education) include the National League for Nursing Accrediting Commission, Inc, and the Commission on Collegiate Nursing Education. To determine if your school is accredited, visit the US Department of Education Database of Accredited Postsecondary Institutions and Program11 at this Web site: http://ope.ed.gov/accreditation/.

The Commission on Collegiate Nursing Education and/or the National League of Nursing accredits more than 330 master's degree programs in the United States.3 Nurses now have a wide range of opportunities to earn an advanced degree, such as the master's of science in nursing (MSN), the master's of science (MS), the master's of nursing, and the master's of arts. In addition, within those programs, there may be many degree tracks from which to select. There may also be specific entrance requirements such as taking the Graduate Record Exam (GRE; http://www.ets.org/gre) or a specific grade point average (GPA) from a previous degree. Understanding how to navigate through the information to find the right program takes time but may prove to be invaluable.

TYPES OF PROGRAMS

There are many different types of master's degrees in nursing. Typically, many nurses opt for a master's degree that results in the ability for the RN to become certified as an APRN. There are 4 APRN roles: NP, clinical nurse specialist, certified nurse anesthetist, and the certified nurse midwife.

There are also advance nursing practice roles for which nurses obtain master's degrees, such as nursing management/leadership or education. These degree options do not end in the ability for an RN to become certified. However, nurses may sit for the individual discipline certification examinations. For example, the certified nurse educator has its own certification examination.

The nursing profession needs RNs in all areas of advance practice to meet the demands of nursing, health care, and patients in the future. It is easy to become confused when weighing the many options for a master's degree. A good strategy is to consider what you love about a specific area of nursing practice and where you want to be in your future practice role.

You do not always have to have a baccalaureate of science in nursing (BSN) to earn a master's degree in nursing. There are many programs that offer RN (eg, associate degree or diploma degree) to master's degrees in nursing. These types of programs may or may not offer students to earn their BSN on the pathway to their master's degree. If the plan of study allows for an undergraduate BSN to be earned, then the time to graduate may be longer, typically 36 to 40 months. It might be a good idea to check your organizations nursing degree requirements and your state's nurse practice act for more information on BSN and advanced degree requirements.

Typical degrees earned include the MSN, MS, or the master's of nursing, depending on the university. In addition, for a specialized focus, the degree will include additional credentials. For example, for a master's degree in nursing leadership, the credential earned might be MSN-L, and for an educational focus, the credential might read MSN or MS-ED.

There is also the availability of participating in dual-degree programs. These are longer programs in length, typically 3 to 4 years, but culminate in 2 master's degrees in less time and money than if you obtained them separately. Examples of dual-degree combinations include: MSN and master of public health, MSN and master of health administration, and MSN and master of business administration.

PROS OF A MASTER'S DEGREE/FINANCIAL CONSIDERATIONS

Earning a master's degree in nursing opens up a plethora of opportunities, including teaching, leadership and management, and advance practice. Health care has advanced, and the education is keeping pace. Master's programs with an educational pathway focus on the planning of undergraduate curriculum, clinical requirements, and benchmarking. A graduate program that has a more administrator or financial emphasis would center curriculum on leadership, budgets, financial oversight, and human resource management. And a master's degree in NP advanced practice role would provide you with the tools and skills sets to diagnose and treat acute illnesses, write prescriptions, and order treatments/diagnostic tests. Positives to all graduate programs, regardless of the focus, is on the importance of advancing nursing through knowledge and understanding and the ability for the professional nurse to work at the top of the professional competency.

Another positive to earning a master's degree is the likelihood that your financial position after graduation will improve. The US Census Bureau indicates that the average master's-prepared employee earns approximately 15% higher, or $8000 a year or $400 000 more than those employees with bachelor's degrees over the course of their lifetime.12-14 The average bachelor's degree employee may earn $2.1 million during a lifetime of working, but the master's-prepared employee may earn $2.5 million during the work history period according to Best Value Schools.15

CONSIDERATIONS

A typical master's program takes between 18 months and 2 years of full-time study, or 3 years of part-time, for a non-APRN role and usually 2 to 3 years if obtaining a degree that allows an RN to be certified in an APRN role. A full-time graduate student should expect to take 9 credit hours, which translates to 27 hours of time spent outside the classroom (eg, studying, papers, and projects). To determine the number of hours per course, a good standard rule of thumb is taking the course credit hours and multiplying it by 3. This calculation gives you the amount of time out-of-class that you will need to study for the course. So, if you are taking one 3-hour course, then take 3 times 3, and you will be studying an additional 9 hours outside the regular class time. So, this one 3-hour course will be a minimum of a 12-hour-per-week commitment.

ONLINE VERSUS CLASSROOM

One great way to compare graduate nursing education programs is through the US News and World Report Education,16 which ranks both traditional and online graduate nursing programs and provides detailed information and links for the hundreds of existing programs. Explore the following Web site for more information: http://www.usnews.com/education. Online programs are separated from traditional programs, so make sure you search for both.

However, the decision may come down to what university is closer in living proximity, total financial cost, and/or the commitment to independent learning. Regardless, there are a variety of options for all types of adult learners today. There are the traditional brick and mortar campuses and a number of online universities that offer a variety of master's nursing degree programs to meet the needs of adult students. There are, however, some differences in on-campus and online programs to consider before applying.

There are advantages and challenges to both types of programs. A brick and mortar university and college campuses are generally in every state of the United States but may not be within driving distance for you as a commuting student. A large university may seem intimidating for you, whereas to others, the campus may be exciting and stimulating. Traditional universities and colleges offer classes during the day, evening, and weekend hours, creating some flexibility. Many students like the face-to-face contact with professors and other students that a university campus offers. Graduating from a traditional campus program may provide the real college experience that may have been missed in a previous diploma- or propriety-based program. Difficult weather may make it challenging to get to and from classes, and there might be added expenses such as public transportation, fuel for a personal car, wear and tear on the car, and meals.

Online nursing programs are also attractive to returning students, but for different reasons. You may be working, married, raising children, and have a busy personal life, which may make it difficult to travel to a campus or attend classes at specific times during the day, night, or weekend. Students in rural areas of the country may not have close access to a university campus, making online programs more attractive. An advantage of an online program is that you may do the course work anytime and anywhere. Often, online students take only 1 to 2 classes at a time and therefore are not paying the tuition all at 1 time, but over a longer period. Because of fewer classes, at any given time, online students may not feel as overextended.

Conversely, to meet the needs of adult learners who want flexibility but still like the face-to-face contact that a brick and mortar campus provides, some graduate programs offer a mix of campus classes and online courses, as well as synchronous (live) lectures or asynchronous (anytime) lectures. These may also be referred to as hybrid programs. There is a wide variety in hybrid type programs, so you should investigate carefully the requirements for class attendance as some may require that you attend classes during the day when you might be required to work, during the evening when you may have family responsibilities, or on weekends. Consider the best option for your personal and career goals.

PERSONAL COMMITMENT

Before applying to a graduate school, there are 3 main points that will need to be considered: overall financial cost, personal time obligation, and dedication to do the study. Additionally important is a strong support person/s who will hold you accountable, lift you up in times of frustration, and share in the joy of your success.

Financial Cost

The cost of graduate school can be significant. Some colleges/universities charge per credit hour, meaning a 3-credit-hour course at a cost of $345 per credit hour will total $1035 for the course. Schools may charge for a package of courses (eg, 2 courses equals $2500). There are innovative programs that allow monthly payment plans and in place of credit hour fees charge by a 6-month period. Often, there are additional student charges, including copying, extracurricular, and facilities fees. These additional fees are billed to students regardless if an online or a campus student.

Whereas the average graduate degree tuition for a public university is $30 000, private universities average $40 000 and higher.17 FinAid.org18 estimates that the typical cost of attending graduate school to be between $30 000 and $120 000. However, there are many great educational bargains if you are willing to do some searching. Many universities offer online programs that are much more affordable with the tuition cost of $13 000 to $18 000 for an average 24- to 36-month program completion.19

If planning to live on campus, you might expect to pay an additional $5000 to $7000 per year for room and board and meal plans. The tuition cost may be higher if you are considering attending a school that is out of your residing state and will incur out-of-state tuition fees.

The average master's degree student will need to earn 30 credit hours of study, but the number may be higher depending on the field of study and program selected.20 Online graduate programs may be less expensive when you factor in there is no transportation cost, and some universities wave out-of-state fees to be competitive and attract students. Although short-term debt may be incurred, you want to avoid high long-term debt or obtaining loans with high interest rates. If you can, try to avoid a large debt and remember that it is possible to obtain a great education at the lowest possible cost.

There are various ways to pay for your graduate education. Some organizations will help employees financially, including tuition, grants, and scholarships. Employees will be required to commit to continued employment for a period of time. Before accepting employer financial assistance, it is a good idea to fully understand the expectations.

In addition, there are also nursing organizations that offer scholarships and grants and government and private organizations that provide loans for graduate degrees. There are opportunities where loans or debts may be forgiven if you are willing to work in a high-needs or underserved area of the country. In addition, some universities offer monthly payment plans that reduce the need for a loan.

Personal Obligation

The long-term time commitment of earning a degree will take 18 months to 3 years to complete. The short-term time commitment will be to complete each course. A good standard rule of thumb is taking the course credit hours and multiplying it by 3. This calculation gives you the amount of time out-of-class that you will need to study for the course. So, if you are taking one 3-hour course, then take 3 times 3, and you will be studying an additional 9 hours outside the regular class time. So, this one 3-hour course should be a minimum of a 12-hour-per-week commitment. This does not count any practicum or clinical requirements that graduate courses might have.

Furthermore, you will need to make personal investments such as short- and long-term time commitments. You will need to think about the long-term gain for the short-term pain. There may be times that you miss social engagements or school functions for your children. You may have to give up some social commitments that you are currently engaged in while you are earning your degree. There are times when you will have to make a choice about working on a paper or going to a movie with the family. You may need to stay up later or get up earlier to complete course work so you can spend time with family and friends.

Vacations or special purchases may need to be postponed, shortened, and/or changed during this short period in your life. If you have a family, make sure you sit down and truthfully explain some of the sacrifices, challenges, and changes that may need to be made while you are earning a graduate degree. However, it is also important that everyone understands the benefits that earning the degree will bring to you personally and to the family. Include the family and/or friends in making alternative social plans and help them to understand that this will be a short period, not forever.

You can be, and most likely will be, an inspiration to others so your attitude and behavior will be monitored. You will at times have periods of stress, question why you are doing this, have moments of frustration, and probably experience some guilt. However, you will also develop new skills, meet new people, challenge yourself, gain confidence in your ability to succeed, and be an inspiration and motivator to others.

Obligation to the Work

You will need to have a true obligation to complete the weekly course work assignments, individual courses, and the overall graduate program. Being knowledgeable of the program requirements, knowing how you work best, and focusing on short term goals (eg, individual course) are strategies for success.

A thorough knowledge of the program requirements will help you make the appropriate adjustment with your personal obligations while planning accordingly for school. A helpful tip is to have your overall plan of study completed ahead of time so that you are aware of what course/s are required for which semester. This makes course registration stress-free. In addition, having the entire plan of study outlined will identify the graduation date, keeping that long-term goal insight.

Because there are many graduate school requirements, it can be easily overwhelming. Staying focused on the current course is one way to combat feeling overwhelmed. Developing study habits that enhance your learning is vital. First, set aside a specific study time. For some, this may be in the morning, before the family gets up or it may be after the kids go to be. Whatever time you determine this to be, keep it special and even put it on your calendar. Second, have a sacred place to study, which may be at the library, at a coffee shop, or perhaps converting a closet to a study space. This space becomes your go-to study space. Third, create a to-do list and check things off when you do them. For busy graduate students, this is essential. Having a course to-do list helps prioritize what the course requirements are while breaking them down in easier, more manageable items. An extra added bonus is a sense of satisfaction when one item is marked off as "done!" Fourth, schedule time in for workouts, sleep, fun, and relaxation. Having a balanced life will prevent resentfulness to your studies. Lastly, eliminating the expectation of perfection will allow a much more enjoyable graduate experience. Graduate nursing students often expect an "A" out of a course. Although it true that most graduate programs expect students to earn a grade of "B" or better, learning the content is equally important. Graduate students have busy personal lives. So do not stress out if you earn less than an "A" or even have to repeat the course. The focus is on the learning of the material, understanding its application while achieving the completion of the degree, and eventually graduating.

HOW TO APPLY

Applying to a master's program is a step-by-step process. First, carefully read the institution's entrance requirements. Second, sealed official transcripts must be obtained from all previous schools, colleges, and universities. Most universities charge a transcript processing fee. Transcripts are generally sent directly to the desired institution, but on occasion, the applicant will need to forward the transcripts to the school. If transcripts are sent to directly to you, do not open the envelope. Transcripts will be considered void if opened by the applicant. Only transcripts opened by a school representative will be considered valid. Schools have strict deadlines for graduate applications; therefore, allow sufficient time to gather all required documents. Consider obtaining a transcript for your own records so that know your GPA. This is important because most graduate programs require a specific GPA for consideration into the program. Third, request letters of recommendations. These letters should come from professional nurses that attest to your abilities, commitment to graduate studies, work habits, and work ethics. Letters should not address personal issues. Fourth, an applicant letter or paper may be required upon entry. Programs are determining your ability to write.

Before final application submission, re-read the application carefully and check for thorough completion, addressing each criteria and requirement. A copy of your current RN license and a criminal background check will likely be required. It is important to note that most programs charge a nonrefundable application fee. Special attention to how the application is to be submitted, online, by mail, or hand delivered, is vital. Review the school's Web site on how long the application review process will take. Within a reasonable period, you can inquire about the status of your application. Common reasons that applications are not considered are incomplete applications, not adhering to the submission due dates, lower than required GPAs, and questionable criminal histories.

If not admitted because of a low GPA, consider that some programs will admit a student on probation or require a student to pass a specific number of classes to raise the GPA. If the criminal background check comes back positive, it may be helpful to write a letter explaining the nature of the offense, if it was corrected, and what you are doing to ensure that it will not occur in the future.

GRADUATE RECORD EXAM

The graduate program you have selected may also require that you take the GRE (http://www.ETS.org/gre, 2016). The GRE is similar to the Scholastic Assessment Test, which you might have taken before gaining college admittance for an undergraduate degree program. The GRE is a comprehensive examination assessment of critical thinking, analytical, writing, verbal reasoning, and quantitative reasoning skills that helps universities determine if you will be successful in a graduate degree program.21 There are 3 main parts to the GRE, the analytical writing, verbal, and, quantitative sections.21 You may take the examination in more than 1000 testing centers in more than 160 countries worldwide on the computer or by paper (2016). You should plan approximately 3 hours to take the examination and may retake it once every 21 days for up to 5 times in a 12-month period (2016). You must register and pay the required fees before establishing a testing date for the examination. Test centers will also request you to show proof of your identification using specific required forms of identification. Verification of your identification may also require you to submit to fingerprinting, thumb-printing, signature comparison, voice identification, or photographing (2016). It is highly advisable to study before taking the GRE. This can be accomplished by purchasing a GRE study book, using online study material, and taking sample study examinations. There are many options available both in print and online to help you be well prepared for the GRE. The GRE results are sent to you and the university program you have identified within 10 to 15 days after test completion. The GRE may be 1 of several entrance evaluation methods that graduate programs use to determine if you are suitable for the rigors of graduate school programming. It is wise to review the entrance requirements for the programs you are interested in applying and best fits your career goals and personal needs.

POSTGRADUATION

Once a graduate degree is earned, there are so many opportunities that are available, including teaching, at the undergraduate and graduate level. With a graduate degree, you are the expert in your field, both didactically and in the clinical setting. If you choose education, you can teach in a variety of educational settings, including community-based schools of nursing or higher education. You might even develop your own educational company. If a hospital or long term-care setting is more your calling, then you can be an educator in an acute care or long-term care facility, even overseeing an educational department. In addition, your new degree will open a world of possibilities across the care continuum! Although you may have focused your clinical practice in an acute care setting, do not be afraid to move into a primary or long-term care environment, entrepreneur ventures, research, or schools!

SUMMARY

When you are considering earning a graduate degree consider this simple 3-step process. First, is the degree required or desired? You may determine that this is a lifelong personal goal, or required if you are seeking career advancement. Second, determine how you learn best. Are you self-motivated and self-directed, or do you need the structure and collaboration that a face-to-face class offers? Third, how is a graduate degree going to impact your personal life and career goals? As previously mentioned, as a student, you will need to prioritize your time, finances, and family and work commitments to be successful. Overall, only you can determine if a graduate degree is important to you personally and professionally and if you have the determination and ability to be successful. The graduate degree is not a means to an end. Once you have earned your degree, a plethora of opportunities may unfold professionally.

Although a graduate degree may appear to be costly and seem out of reach, there are many affordable options from brick and mortar and online universities. Registered nurses with graduate degrees are in demand and there are career opportunities now more than at any other time in history. Consider carefully what your current interests are and where you might want to practice in the future. Be sure to have a serious discussion with your family and friends about the sacrifices that may need to be made during the period of time you are in school. Appoint a good friend or family member to hold you accountable, lift you up, and celebrate your success. Plan carefully for the financial aspect, the time, and the personal commitment you will need to make. Most of all, enjoy the time of learning, develop new friends, and seek new opportunities that your master's degree will afford you.

References