Why Get Your Master’s Degree in Nursing?
We’re going to talk about how this can lead you on your career in a very meaningful way. So, with so much pressure right now for nurses to remain marketable in the industry, it’s very important for us to always stay ahead with our education and the Master’s Degree is a wonderful way to do so. So let’s talk a little bit more about our program and how it can help lead you to some of these additional opportunities. One of the opportunities that you have with our Master’s of Science in Nursing generalist degree is to earn your Clinical Nurse Leadership certification. Now, the Clinical Nurse Leadership certification opens up the door for a very wide amount of opportunities and I’m here today with Dr. Enna Trevathan. Dr. Enna Trevathan, are you available?
Dr. Trevathan: Yes, I am, Staci, how are you?
Staci Bell: I am doing great, thank you. I have a question that I often get and that is: How does the Clinical Nurse Leader role fit into the future of health care? So let’s talk a – let’s start with that.
Dr. Trevathan: Okay, let’s, you know, start with that and let me tell you that the evolution in practice base of the Clinical Nurse Leader role has made considerable progress since its inception in 2003. So from 2003 to now we have seen quite a growth in the Clinical Nurse Leader role in the field of nursing. So what are some of the things that we can do and what do we qualify for and what are we called? We are called advanced nurse practice generalists and this is actually the first new role in nursing over the past 40 years and that role focuses on transforming care at the point of care. So I think that is a wonderful picture for us and a wonderful opportunity for nurses who wish to be a nurse at the bedside and really want to take care of their patients and really want to make a difference in patient care. So the whole focus for us is to improve standard of care and for us to really look at our patient population and improve their care.
Staci Bell: Wonderful. And that’s just one of the opportunities. What about care managers? Can you tell us more about that?
Dr. Trevathan: Oh, for care managers actually that is wonderful. Because if you take a patient population and, for example, if you want to take a look at people that may have diabetes, for example, and you want to manage that population, and you start taking a look and see what sort of patients come to your hospital or come to your institution and what are some of the common grounds? What are some of the areas such as their comorbidities that tend to increase the cost of health care? So we could take a look and see how we could help the patient manage their care at home and we know, according to several research that has been conducted, if a patient can manage their care at home and not having to come into the hospital all the time, they have better care to start with, cost is less because we are teaching them to self-manage their care and therefore we can definitely see some benefits in cost effectiveness of care and also in the higher quality of care that they can receive. So that’s an area where a Clinical Nurse Leader can highly be effective.
Staci Bell: Another title I’ve heard about is the Clinical Care Coordinator. What about that? How can this certification help me in that role?
Dr. Trevathan: You know, as a Clinical Care Coordinator a Clinical Nurse Leader is trained to interact with several other interdisciplinary peers. For example, if they need to coordinate care with the provider, coordinate care with the physical therapist or even when we are sending the patient back home into their community, a lot of times when a patient is discharged from a hospital we don’t know who is going to be doing their follow-up care with them. We don’t know if they’re going to be seeing their physician. We don’t even know if they’re going to have a postop or a post-hospitalization appointment set up for that patient. So one of the roles that we play as a Clinical Nurse Leader, as soon as the patient enters our institution we start planning and talking about the care with the different members of the community to see what is the best way to care for that patient. How do we get the patient back to a basic where they could get back home and live a quality life, for example. So that is where we are very effective. We train our Clinical Nurse Leaders to know to communicate and how to navigate through the intricacies of coordinating care with other nurses, with doctors, home health nurses, for example – sometimes the patient may be going to a nursing home instead of going home so we will be coordinating the care as well with the nursing home center. So that is a very nice aspect of what we do.
Staci Bell: Great. Now a question I’m wondering about is: Is there an opportunity that we can use this certification to educate the nurses? In other words who makes sure that care is consistent on the floor?
Dr. Trevathan: Well, the Clinical Nurse Leader is like the glue. You know, the way a Clinical Nurse Leader is trained is to be able to navigate through the different aspects of health care, for example. With all the changes that are happening in health care right now, if we start looking at the Affordable Care Act, for example, we could see all of the aspects where a Clinical Nurse Leader can be effective. So, for example, we know that care is being transitioned more from the hospital to primary care and nurses are playing a huge role in primary care as care managers, case managers, educator and also we are so well prepared to be able to handle the ambulatory care aspect of care. So we are very well positioned to help transitioning those patients from inpatient care or sick care, for example, to more wellness of care. So that’s an area where really, really we could make a difference.
Staci Bell: Okay, wonderful. Now a question that I often get and one of the first opportunities that comes to mind for many people is: If I get an MSN does that mean that I have to be a manager? I mean, looking at these roles it sounds like these people don’t necessarily have to be managers or have to be directors at all.
Dr. Trevathan: Well, you know, this is interesting, Staci, because some of the students that comes to us may be nurse managers already, some of them are assistant nurse managers, some of them are charge nurses, some of them are nurses on the floor – staff nurses, for example – so we have a variety of students that are pursuing their Master’s in Nursing Administration. So if you do not wish to become a nurse manager you don’t have to because most of our training is done at the microsystem level which means at the basic, at the unit level, where you can continue to provide your care and provide leadership at the bedside, for example. But if you already are a nurse manager there’s no reason you cannot remain as a manager, there’s no reason why you cannot advance as a director. I’ve had several students that have graduated from our RN to MSN program who are not directors – they are directors of ER, director of risk management, but we have several other students that decide; “Well, management is not for me, not that kind of management, I don’t want to become a manager vertically.” Well you could stay horizontally and manage that way so this is like the best for everyone because your Master’s that you are obtaining in Nursing Administration prepares you for all of that but the extra that you receive as a Clinical Nurse Leader helps you to hone in on what really makes the difference in nursing which is at the point of care. So therefore you are prepared for any of those avenues.
Staci Bell: That’s wonderful. It sounds like this degree would be very versatile for a variety of individuals, people looking to manage, teach, work in the clinical environment, at the bedside or in research as well.
Dr. Trevathan: Yes, I would agree with that because, like I stated before, this is an advanced nursing generalist and that role is sorely needed in this nation of fragmented care. I think we are making headway with the ACA where we could start looking at a complex, costly, and highly technical health care system that requires a nurse to be able to juggle a lot of that. So what our program does is prepare our nurses to be able to handle the different aspects, looking at patient’s safety, for example, looking at, as a Patient Care Coordinator, for example, you might want to be taking a look at patient satisfaction and the quality of care. For example, if a patient comes to your hospital or you’re looking at the population of elderly patients that are checking into your institution, and you have several falls. A lot of your patients are falling so one of the things that our Clinical Nurse Leaders are trained for is to start looking at common grounds – why are those patients falling? Is it due to medication? Is it due to dementia? What can we do – what kind of preventive measures can we take to prevent those falls? Or what can we do make it better if the patients already had a fall, how could we prevent future falls or how could be make it better for the patient? So that is one aspect that a Patient Care Coordinator really gets into – looking at the quality of care and also making it a safe place, not just for the patient but also for the nurses because nurses sometime get hurt. If a patient falls all the time they try to get the patient and try to catch the patient, the nurse has the possibility of getting injured as well. So now both the nurses and the patient become our customers and we make sure that our customers are satisfied. If a patient is satisfied with our care and their quality of care is top notch when they are at our institution, then we know they’re going to do well when they get discharged and we know as well that when we get our patient satisfaction score after the patients get home and they receive their survey, our survey is going to be very positive because they would have received the best care that they could at our institution at that time. So that’s another aspect where our Clinical Nurse Leaders are trained and to also share that information with nursing assistants or licensed vocational nurses, other nurses – we really look at the human resource factor of providing care as a Patient Care Coordinator. And, you know, there we have the ability to use a lot of our management skills to delegate, to officiate the different types of care that are rendered to the patient and then also looking at what skills do those health care providers, which may be our peers, can use in order to provide better care. So we do make a big difference at that level as well.
Staci Bell: And from what I understand there are people who are specifically charged with quality leadership as well as risk managers. In fact, can you tell us a little bit more about Risk Managers?
Dr. Trevathan: Yes, one of the courses that our Clinical Nurse Leaders do take is a course as the CNL role as an outcome manager. So that is when our Clinical Nurse Leaders learn and they get the skills to either look at, for example, if at the hospital we start seeing a negative trend of patients having nosocomial infections, for example, we could take a look at it – that’s a risk management issue. That is something that our Clinical Nurse Leaders can take a look at. We train our Clinical Nurse Leaders to start looking at failure mode analysis and also looking at root cause analysis and also looking at or could they deliver the care by using Lean methodologies and other methodologies that are available to us. So what we tell our Clinical Nurse Leaders is: “What kind of skill do you need in your tool kit?” So those are some of the tools that you would learn and that you would add to your tool kit to manage risk, how to avoid the risk. It’s not just taking care of an issue after it has happened. What we are more concerned with is how do we prevent an event from happening. If we’re looking at medication errors, how could we prevent medication errors from happening? Is it a system problem? Is it a personnel problem? Is it coming from Pharmacy? Is it coming from once that the drug has been delivered to the floor? Is it that the patient doesn’t know what medication they are on? So those are aspects of risk management that a Clinical Nurse Leader will be trained on being able to handle in the future. And we’re doing it right now, not just the future but we are doing it right now. Our graduates are able to work as risk managers in the Risk Management department, for example, or in Quality Management.
Staci Bell: It really is about looking at the whole picture. It sounds like this is a very holistic movement in how we’re handling health care – very collaborative. And, you know, one of the individuals that can – the next role that we wanted to talk about was Case Managers because, from what I understand, these people can even apply their expertise to an area specialty, even as a generalist, maybe such as cancer?
Dr. Trevathan: Exactly. As a generalist our Clinical Nurse Leaders can take the birds-eye view, for example, of what’s happening in health care or what’s happening in a patient population. So if you’re looking at the population of patients that have cancer or population of patients that have asthma, for example, how do we help those patients to optimize their care? Because this kind of illness are usually long term based. So how do you spread that across? It’s not just a patient that you’re getting in the institution and they have surgery for orthopedic, for example, and it’s acute, you take care of it right there and then, you help them restore back to their health, they get their physical therapy and within six months to a year they’re back to normal. But we also have some illnesses or some diagnoses that do not go away that fast. You know, people live with then for a long, long time. Maybe a patient with lung cancer, maybe a patient with breast cancer or maybe somebody with asthma or CHF, for example. So we are very well tooled to be able to manage those patients. Again, teaching them how to do self care is a huge aspect of the care that we provide to our patients which takes it back again to the patient education. So, as you can see, all of those roles kind of play off of one another and what’s beautiful about it is that our nurses sometimes flow from one to another. Some people might become more – stay in one area, for example Risk Management because that’s what they like, or we may have some nurses that say: “Well, I like the aspect of case managers better.” Or “I like the patient education concentration better.” But as a nurse generalist, being trained as a nurse generalist, you can very fluidly go from one of those aspect to another. It’s like, definitely it’s what you like, what you’re most comfortable with and, you know, that’s what I really like about the generalist idea.
Staci Bell: Wonderful. Now we’ve talked about the professional development that this degree can provide, what about the financial opportunities?
Dr. Trevathan: That’s a great aspect. Nurses in general – we tend to make a little bit more money than the general population if you are looking at administrative assistant, for example. But we all know when you just enter the profession you have a base salary and, you know, it ranges, depending on where you live – if you’re on the East Coast or if you’re in the South or if you’re in Midwestern American and if you happen to be in California, you know, the rate tends to be a little higher than the middle of the country, for example. But I could tell you, using myself as an example, when I started as a new nurse, quite a few years back, I think I was making about $18 an hour and then suddenly I said: “Well, that was great.” I was able to do that with my ADN, I decided to pursue my BSN and the moment that I graduated with my BSN I jumped up another $20,000 more a year. So that really made me happy. It’s not just the money is the only motivator but it’s kind of nice to be paid the right rate when you are performing, you know, your professional services. So then I decided, Ah-ha, a Master’s Degree would even give me more flexibility and also more accountability, more responsibility and I was ready to step up to a leadership position. So I decided to pursue my Master’s Degree. And by the time I get to my Master’s Degree I was in the six figures and that really made me happy. Now we’re talking about California. It might be slightly different, you know, depending on what region that you’re working at but I would say for sure you would see a difference from 20-60 thousand dollars more on your salary, depending on where you live, by obtaining your Master’s Degree. And that’s from anywhere in the country and by you having the additional skills and also by having a certification after your name. The CNL is added bonus, you know, not only when you finish this program you have an MSN which is your Master’s in Nursing Administration but you could sit for certification exam before you even graduate and if you earn that certification, if you pass that exam, you’ve earned the right to have CNL after the MSN and that also gives you additional money from the institution because as we know these days, most magnet hospitals are looking for nurses who have advanced degrees and also certification. That is one of the requirements for magnet. Even for the hospitals that do not want to go magnet, they are mimicking what magnet hospitals are doing. So this is a win-win situation. I don’t see it as a win-lose or lose-win; this is win-win all the way around.
Staci Bell: Wonderful. So as far as, if I’m a BSN, a student holding a BSN degree currently and I’m thinking about earning a Master’s Degree, what type of increases are we looking at? Is it going to make sense for me to make this investment in my Master’s Degree?
Dr. Trevathan: Absolutely. Most of the positions that are posted nowadays are asking for Master’s, either required or Master’s preferred. So it is very hard for anyone to move into clinical ladder positions; if you want to go from a Nurse II to a Nurse III or from a Nurse III to a Nurse IV, not necessarily as a manager, but even if you want to go to manager position, it does usually say most places, Master’s preferred. So it puts you in that higher pool of applicants, for example. It gives you an edge and by having an MSN and a CNL it gives you a double edge above everyone else. So definitely it is worth it. You will see your salary doubled with an MSN.
Staci Bell: Wonderful. So it really sounds like that there truly is an increased need for Master’s prepared nurses and not only Master’s prepared nurses but ones that are flexible and versatile and can work in a variety of different settings. You know, many students often think that if they want to stay at the bedside they have to get an NP and there’s a lot of gray area there with students’ perception of the FNP and so what are some of the key differences between our program with the CNL certification and the FNP program?
Dr. Trevathan: You know the FNP programs vary across the different states and for the state of California and for our school, for example, we are following the trend of what is happening in health care in general across the United States. And as you are pursuing an advanced degree the FNP – a lot of universities are still holding their FNP’s at the Master’s level but most universities are moving the FNP to a DNP program because it is going to be required, or the movement is in that to become an advanced practitioner and that’s the difference, an advanced generalist versus an advanced practitioner. An FNP is an advanced practitioner and FNP could be trained and can also write prescriptions. Now it depends on the states. Some states, California, allow FNP’s to write prescriptions. There are other states that do not allow FNP’s to write prescriptions. But they could diagnose, they could do a lot of other things. So you have to check on the state where you’re at, where you decide to practice. Now as the Clinical Nurse Leader we are considered advanced generalists and what we usually make differences are not – the only difference is actually diagnosing or writing a prescription. That’s the main difference between an FNP and a CNL. But the CNL can make a difference at other levels. We make differences at the patient’s safety level, we also make a difference at the quality of care level, we look at patient outcomes, how the patient is treated in the hospital or what changes can be made to provide safe care and high quality of care and also to provide that care at a quality and affordable price. So those are the main differences between the two. So if someone wants to be able to write prescriptions, FNP is for you. If you don’t want to be able to write prescriptions, then an MSN with a CNL certification, that is the right way to go.
Staci Bell: Wonderful. I mean it sounds like being a Master’s prepared nurse makes a lot of sense. In fact, even just the amount of savings if we were to put that into an amount, I’ve heard that the U.S. could actually save up to 8.75 billion if MSNs were used appropriately instead of physicians. Is that true?
Dr. Trevathan: That’s absolutely true. There is so much we can do. You know, let’s take for example if you have care managers and case managers in the community, you know, teaching the patients and teaching all of – you know, teaching mothers, for example, or young mothers how to breast feed their child or how to take care of their children with asthma, for example – those are significant savings. You don’t have to go to a doctor’s office each and every time for everything that’s happening in your life or every single crisis. We teach patients how to manage their asthma crisis, for example, without having to go in, if they know how to take care of their medications properly. We teach mothers how to breast feed properly and, you know, have well fed babies. We have nurses going into the new mother’s home, for example, and teach them how to better take care of their newborn. So all of those aspects – those are aspects where nurses are very good at and one of the best things that nurses can do is patient education. That is an area that physicians cannot take away from us. We are good at it, that’s what we do best, that’s what we’ve been trained to do and by us being able to do that we – when we interact with a patient, we take a look at the entire patient. We’re not just taking care of a diagnosis, just that little symptom that the patient is showing us at the time, where physicians tend to do that, they just either surgically remove that or give you a pill to take care of that where the nurse takes care of the whole patient. We look at the wholeness, not just the onesy, twosy diagnosis that the doctors take care of separately. So if we could take care of a whole patient and have the patient live a more active, more prepared life that could take him through the ages, for example, to take him from being a child to an adolescent and young adulthood and looking all the way to the geriatric patient we could save millions of dollars over time, you know, billions of dollars if you exponentially do it across the state, if you do it nationwide – yeah, we can make that kind of a difference if we are used properly and this is what is going to happen with ACA.
Staci Bell: It sounds like expert clinicians sure do a lot more than just write script.
Dr. Trevathan: Right, we do that – we have a little bit more skills in our tool kit.
Staci Bell: Yes, a lot more versatility, a lot more flexibility and great preparation if one day you do want to pursue these opportunities at the doctoral level, I would say.
Dr. Trevathan: That’s right. And, you know, I should tell you that CNL or Master’s in Nursing with certification as a Clinical Nurse Leader transitions very well into the doctorate in nursing practice. So even if one of our graduates, for example, decides, okay, I would like – I worked as a clinical nurse for awhile and I do want to become an FNP and at the University of San Francisco our FNP’s are doctoral prepared; they could go straight into the FNP program and just have to take the additional classes that they need at the doctoral level. So they transition very well.
Staci Bell: Wonderful. Now MSN and advanced practice nurses are in especially high demand in medically underserved areas. I’ve been hearing a lot about that right now with the Affordable Care Act and everything that’s going on in health care. Can you speak a little bit more on that?
Dr. Trevathan: For sure. Our Master’s prepared students or graduates, they have learned to expand their knowledge and evidence-based about their advanced practice nursing role. So by knowing how to look for the evidence and applying the evidence to providing care to a patient population, the Clinical Nurse Leader has the ability to work with nursing and other inter-professional teams to coordinate the care and the accountability of the practices of patient care and outcomes. So that kind of process really works in the mitigation of triple threats of cost, quality and access. And that is something that is definitely in high demand in medically underserved areas. If we take a population with – now, you know, certain states have adopted the ACA and certain states have not adopted the ACA and the states that have adopted the ACA where we have a large population of patients with Medicare or patients that could not qualify for Medicare or, as we know, not every provider accepts the Medicaid coverage, for example, and that segment of the population falls in the gap of no care. Yeah, they have care but they may have to go into the Emergency Room in order for them to activate that care. That is not primary care. So what we are looking at where a Master’s prepared graduate can really make a difference is in that underserved population and then being able to have more primary care available in the community where those patients live. So as more care has become available through Medicaid or Medi-Cal – it depends on what part of the nation that you live at – this is where we’re going to be the most effective because we are going to be able to address those demands, we are going to be able to do patient education, we are going to be able to do population education and that’s going to lower the cost of primary care and open the door for primary care to come to this area because they’re going to be supported by nurses, all the burden is not going to be falling on the physician’s lap which you don’t have enough physicians to take care of all these patients in the first place. So we are going to be covering the gap of the lack of physicians to take care of all those patients that are going to be entered into the marketplace. So that’s an area that we really can shine.
Staci Bell: That’s wonderful. You know, it really reminds me of why this is such an important degree. It’s about providing meaningful care. It’s about providing preventative care. It’s not just always about putting a Band-Aid on it every time but rather treating the patient. Correct?
Dr. Trevathan: That’s correct. I think this is finally we are getting to that point where we stop putting the Band-Aid because the Band-Aid is such – it could be a quick fix but it’s such a temporary fix. We want to be able to put permanent fixes and be able to move our health care to where it should be and for us to be able to do that our patients are going to have to be satisfied and also we’re going to have to be satisfied in the care that we provide. We’re going to have to be satisfied as a professional because if we start providing good care, safe care and cost effective care we’re going to start feeling better about ourselves as nurses and what we’re doing because it’s going to have more meaning. So I see for us as nurses and the future of nursing as Master’s prepared nurses, we are well situated to have a more meaningful life, a more fruitful life for us and also for the people that we’re going to be providing the care to.
Staci Bell: That’s wonderful. So a Master’s Degree really enables you both to provide better and more comprehensive care to each patient while ensuring adequate care by filling in for scarce physicians.
Dr. Trevathan: Oh, yes. And I think, if we could take a look and see, again, positioning ourselves when we are planning – you know, what I love about nursing and the reason I became a nurse was to have that choice. I do not feel – I’ve never been boxed into one position; from the time that I was a staff nurse I was able to go to Med-Surg, from Med-Surg to Oncology, from Oncology to Ambulatory Care covering different subspecialties and specialties so I love that aspect of nursing that allows me that variety. I can go from one area to another and still be satisfied, you know, and still fill my curiosity and fill my needs for professional self development. At the same time, every time that I go into one of those units or one of those subspecialties or special areas I’m learning more and I’m providing more care and by having the different degrees from going from ADN to my BSN to my MSN and to my DNP it has exponentially opened the world for me. Now I don’t have any type of restrictions of positions that I can apply for. The restriction is of my own – it depends on where I want to concentrate and what I want to do. So that’s why I really like going for the additional nursing knowledge and obtaining a higher degree because it opens so many doors. You feel so open and so free to try different roles in nursing – it’s wonderful. It’s tremendous opportunity.
Staci Bell: Wonderful. So this is about identifying problems and implementing institutional change while improving the health care delivery system, managing the health care delivery system.
Dr. Trevathan: That’s correct.
Staci Bell: So one of the names, items – I know that students who are looking at pursuing higher education, they really want to know that the degree itself has become – is worth their while, you know, that this is something that is going to make sense for them at the end of the day and it’s important, I think, to search for an accredited school that offers your preferred career path. You know, it’s not enough sometimes to just get the paperwork. I think it’s important to really put the value on the education itself and to look for online courses that are also designed for working full time nurses. So you need a quality program. You need one that’s flexible and realistic for working nurses and at the same time we do have resources that are available to help make that possible. Some of these resources are everything from financial aid to outside external scholarship options specifically for graduate nurses, there’s payment plan options – a lot of great ways to make…
Dr. Trevathan: The thing that I want to speak to, Staci, not to cut you off, dear, but….
Staci Bell: Oh, no, that’s great.
Dr. Trevathan: If a nurse decides to go into – if they decide to teach in clinical areas or teach or work in underserved populations, there are – it varies from state to state and there are sometimes national loan repayment programs that a student can qualify for. If they go into teaching in the clinical areas in nursing, for example, there are often loan repayment guarantees if they are working in those areas so it’s also something else to think about when we are pursuing a Master’s Degree.
Staci Bell: Absolutely. You don’t necessarily have to sacrifice quality in obtaining your Master’s and I don’t feel that you should. I think that you can have it all. You can have one that is flexible, high quality, we’re ranked in the top 50 best nursing schools in the country by US News and World Report, I see on a regular basis. So you really can truly have a program that works for your needs while still meeting your budget.
Dr. Trevathan: That’s correct. I mean I could use myself as an example for that situation, as well. I was able to qualify – it’s called SNAPLE, which is the state of California loan repayment program, because I went into teaching after I obtained my BNP so part of my loan has been paid by the state of California for actually to be an instructor right now. So, yes, I do pay the price and I’m still paying part of my loan but I got a part of it repaid, three years in a row. So that is another aspect that, you know, we should really take into consideration. Not just the initial investment that you’re making but this is an investment for the future. This is an investment that lasts you a lifetime.
Staci Bell: It’s more than just a title and a piece of paper that come along with it, that’s for sure. (laughter)
Dr. Trevathan: That is for sure (laughter). I can attest.
Staci Bell: So I am here. I am one of the advisors. By the way myself along with LaTonya Boyce are both enrollment advisors on the program. We are here to answer your questions, to better clarify the program information, so I’m hoping that everyone listening to this today will contact us directly with your questions and our role is really to help make this process as pain free as possible for you. Right now we have an application deadline approaching of December 16th and that is for classes that are starting in our spring semester, the start of our 2014 season and those classes will start January 21st. There is still time to complete your application so it’s very important that if you are interested and would like to know how to make this possible for yourself in 2014, contact myself, contact LaTonya today. We’re here to make this as easy as possible.
I want to thank you for your time, Dr. Trevathan.
Dr. Trevathan: Oh, you are very welcome. It is a pleasure.
Staci Bell: Thank you. Have a great day.
Dr. Trevathan: Bye, bye, everyone.
Staci Bell: Bye, bye.