The transformation of the health-care system is taking place as you read this, and it can be seen even today in the most common areas.

A mother brings her child into a clinic for treatment of an earache. Instead of a physician, a nurse practitioner provides the care.

A patient is readied for surgery. A variety of specialists move about the surgery room, but it's not a specially trained physician administering the anesthetic--it's a certified nurse anesthetist.

During the recovery from an acute illness, it's decided that the patient no longer needs to stay in the hospital but isn't well enough to return home. It's decided that the best place to continue the recovery is an intermediate-care facility. Who makes that decision? A clinical nurse specialist. Who oversees the physical and emotional rehabilitation programs at this facility? Another clinical nurse specialist.

These health-care professionals are all advanced practice nurses (APNs). All have graduate-level degrees, and they serve as proof that the demand for nurses with master's and doctoral degrees for advanced practice, clinical specialties, teaching, and research will double the supply.

Another study estimated that the U.S. could save as much as $8.75 billion annually if APNs were used appropriately in the place of physicians. As more and more of the restrictions on APNs succumb to legislative or economic forces, the demand for graduate-level nurses is expected to remain high.

Educational Core for APN

A master's degree in nursing is the educational core that allows advanced practice nurses to work as nurse practitioners, certified nurse midwives, certified clinical nurse specialists, and certified nurse anesthetists.

Nurse practitioners conduct physical exams, diagnose and treat common acute illnesses and injuries, administer immunizations, manage chronic problems such as high blood pressure and diabetes, and order lab services and x rays.

Nurse midwives provide prenatal and gynecological care, deliver babies in hospitals and private settings such as homes, and follow up with postpartum care.

Clinical nurse specialists provide a range of care in specialty areas, such as oncology, pediatrics, and cardiac, neonatal, obstetric/gynecological, neurological, and psychiatric nursing.

Nurse anesthetists administer anesthesia for all types of surgery in operating rooms, dental offices, and outpatient surgical centers.

Master's degrees in nursing administration or nursing education are also available.

There are more than 330 master's degree programs accredited by the Commission on Collegiate Nursing Education (CCNE) or by the National League for Nursing Accrediting Commission (NLNAC). The wide spectrum of programs includes the Master of Science in Nursing (M.S.N.) degree, Master of Nursing (M.N.) degree, Master of Science (M.S.) degree with a major in nursing, or Master of Arts (M.A.) degree with a nursing major. The specific degrees depend on the requirements set by the college or university or by the faculty of the nursing program. There are accelerated programs for RNs, which allow the nurse with a hospital diploma or associate degree to earn both a baccalaureate and a master's degree in a condensed program. Some schools offer accelerated master's degree programs for nurses with nonnursing degrees and for nonnursing college graduates. There are joint-degree programs, such as a master's in nursing combined with a Master of Business Administration, Master of Public Health, or Master of Hospital Administration.

Master's Curriculum

The master's degree builds on the baccalaureate degree to enable the student to develop expertise in one area. That specialty can range from running a hospital to providing care for prematurely born babies, from researching the effectiveness of alternative therapies to tackling social and economic causes of health problems. It is an opportunity for the student who has assessed personal career goals and matched them to individual, community, and industry needs. What students can do with their APN degrees is limited only by their imagination.

Full-time master's programs consist of eighteen to twenty-four months of uninterrupted study. Many graduate school students, however, fit their master's-level studies around their work schedules, which can extend the time it takes to graduate.

Master's-level study incorporates theories and concepts of nursing science and their applications, along with the management of health care. Research is used to provide a foundation for the improvement of health-care techniques. Students also have the opportunity to develop the knowledge, leadership skills, and interpersonal skills that will enable them to improve the health-care system.

Classroom and clinical work are involved throughout the master's program. In class, students spend less time listening to lectures and taking notes and more time participating in student- and faculty-led seminars and roundtable discussions. Extended clinical work is generally required.

Graduate-level education in many programs includes courses in statistics, research management, health economics, health policy, health-care ethics, health promotion, nutrition, family planning, mental health, and the prevention of family and social violence. When students begin to concentrate their study in their clinical areas, any number of courses that support their chosen specialty may be included. For example, a nurse wanting to specialize in pediatrics may take courses in child development.

A clinical nurse specialist can focus on acute care, geriatrics, adult health, community health, critical care, gerontology, rehabilitation, and cardiovascular, surgical, oncological, maternity/newborn, pediatric, mental/psychiatric, and women's health nursing. Areas of specialization in nurse practitioner programs include acute care, adult health, child care, community health, emergency care, geriatric care, neonatal health, occupational health, and primary care.

Admission Requirements

The admission requirements for master's programs in nursing vary a great deal. Generally, a bachelor's degree from a school accredited by the Commission on Collegiate Nursing Education or by the National League for Nursing Accrediting Commission and a state RN license are required. Scores from the Graduate Record Examinations (GRE) or the Miller Analogies Test (MAT), college transcripts, letters of reference, and an essay are typically required. Nonnurses and nurses with nonnursing degrees have special requirements. The profiles and in-depth descriptions of colleges and universities in this publication will give you an idea of each school's specific requirements.

It is important to remember that admission officers look at a student's transcripts, clinical work, and letters of reference together. A low grade point average is not an automatic knockout--admissions officers are after a composite package. Also, some specialties require specific courses. Students in the nurse anesthetist program, for instance, must have an upper-level college course in biochemistry.

A Master's That's Best for You

Most nurses who think of entering a master's program already have been practicing nursing. They have a good idea what they want to specialize in before they apply for admission. It is crucial to know what you want to study before you enter a master's program.

The best way to ensure success in a master's program is for you to understand your individual strengths and career desires and then find the faculty and college setting that are best suited to help you develop those strengths. Students must make an effort to educate themselves as to the strength of the faculty in each college's master's program. That's the best thing to look for: a strong faculty in one specialty.

This can be tricky. One university's master's program may be rated reasonably high in all fields. Another program might not be rated as high overall, but its cardiovascular program, for example, may be one of the best due to its access to facilities or the fact that its faculty is in the process of developing an innovative new treatment.

This type of information is not hard for the master's candidate to discover; it just takes time. Such information is available from each school's admissions office, which should be more than happy to promote its nursing faculty and support its opinion with proof, such as the research papers that faculty members have published in journals or the number of degrees each faculty member carries.

This type of research is the best way to find a program that meets your needs. The profiles of master's nursing programs in this book should help. If you can, narrow the list to three or four graduate schools and then write each school's admissions department for catalogs and other information. Visit the schools and take time to talk to a guidance counselor from the nursing program.

Other key questions to consider when applying for a master's program are: Does the school offer financial aid, such as loans, scholarships, fellowships, or teaching posts? How much clinical work is needed? Does the clinical work meet your needs, and does the type of clinical work involved match what you understand the health-care system will be using when you graduate? Is the course work flexible? Can you work part-time and still progress toward a master's degree? This is important to know. A majority of master's program students continue to work while they pursue the degree. Therefore, master's degree programs may present a flexible offering of short courses to meet the student's schedule demands.

Some programs require a thesis, whereas others provide another type of culminating experience, such as a comprehensive examination.

The Master's Trends

Today's master's programs have increased the amount of clinical practice that students engage in so that graduates enter the job market ready for certification. There is also a greater emphasis on applying new research findings to methods of patient care. This might involve students' reading literature about new treatments and then incorporating the appropriate changes.

All master's program candidates should consider courses in cost-benefit analysis. As managed-care systems become predominant in the industry, health-care workers will be asked to justify the expense of their treatment as well as its effectiveness. This leads to the crucial issue of quality. There will always be a strong effort to minimize costs in every health-care procedure, but that cannot compromise the quality of care. It's safe to say that discharging a newborn too soon from a hospital due to shortsightedness can be quite costly.

Depending on the specialty, master's candidates entering the job market may be expected to oversee auxiliary-care providers, such as nurses aides or other unlicensed employees. They may work in a team structure, and, in this capacity, the nurse specialist may be expected to manage, motivate, and steer the group. This requires team-building as well as other management techniques.

While everyone in the health-care facility will have a part in ensuring patient satisfaction, nurses, particularly advanced practice nurses, will shoulder a great deal of this load. Developing interpersonal and communication skills, as well as having an understanding of human behavior, will make it easier for the advanced practice nurse to help patients to understand modern health-care procedures, which no doubt will improve their feelings of satisfaction.

Finally, nurses at all levels should be aware of the need for flexibility. Many health-care organizations are reducing the number of beds in hospitals, transferring the care of a growing number of patients to other types of facilities or settings. In light of this trend, it's best for the master's program student to gain experience in a variety of places, such as homes, clinics, and community-based settings.

The demand for high-quality care will continue to grow. Medical innovations and technological advances will continue. The quality and effectiveness of health care will continue to improve, and nurses with graduate degrees will play an active role in this trend.

The Hot Employment Spots

The health-care industry has undergone such radical transformation in the last five years that administrators feel they cannot predict whether any one geographic region will have more hirings than another. Generally, nurses with master's degrees will be in demand in all regions of the country, in both the U.S. and Canada.

Industry trends indicate that along with continuing opportunities in hospitals, more and more nurses will also work outside the hospital in outpatient clinics and community settings and even in businesses. As patients spend less and less time in hospitals, there is a need for nurse specialists to oversee home-care settings and ensure that the quality of care there is high. In this vein, some nurses are taking the initiative and running their own businesses as health-care providers, offering services as they see fit in whatever locations are appropriate.

Immediate Rewards

Advanced practice nurses right out of school can expect annual salaries ranging from $60,000 to $90,000, depending on geographic location and previous experience. However, some rural county health clinics start their nurse practitioners at salaries as low as $40,000 per year.

Certified nurse anesthetists and certified nurse midwives, however, draw larger salaries. Nurse midwives, for example, can draw first-year salaries as high as $90,000 per year. Areas such as the Northeast and the West Coast tend to have nurses in these fields at the higher end of the salary scale. After five years of practice, the salary range for APNs stretches from $60,000 to $100,000 a year. Again, it depends on location. After five years, nurse midwives earn salaries ranging from $65,000 to $120,000 annually.