DEMSN programs answer the call for leaders
Direct-entry master of science in nursing (DEMSN) programs aim to address critical challenges in healthcare and nursing education. For example, Tamata and Mohmmadnezhad describe how the ongoing shortage of qualified nurse and healthcare leaders continues to significantly impact patient safety and outcomes.
DEMSN programs may have different names across institutions, but they all serve the same purpose—helping individuals from various disciplines transition into the nursing profession. Jones and colleagues describe how these programs build on students’ previous academic knowledge and professional experience, reinforcing essential skills such as communication, critical thinking, and problem-solving.
By integrating foundational nursing coursework with advanced practice concepts, DEMSN programs can streamline the educational process, allowing students to efficiently earn their RN licensure and MSN degree. This accelerated model enables graduates to transition into the workforce quickly and contribute meaningfully to patient care and healthcare improvement. In addition, Meyer and colleagues note the financial benefits of such a program. For instance, many second-degree students may have maxed out their undergraduate student loans, and a DEMSN pathway offers them an opportunity to obtain graduate-level funding. However, the U.S. Department of Education’s decision not to include nursing as a professional degree will impact federal loan limits, placing graduate education out of reach for some individuals.
To help meet the demand for highly skilled nurses, Gwynedd Mercy University, a small private suburban institution in the Northeast United States, developed a DEMSN program. It serves as an alternative to its existing accelerated BSN program for the student with a non-nursing bachelor’s degree seeking a graduate-level degree rather than earning a second bachelor’s.
According to Lee and Song, the first accelerated BSN programs, which allowed students to complete their nursing degree in about half the time required for traditional students, were introduced in the United States in the 1970s. Wehner describes these students with prior life experience as typically more mature than traditional students. They performed well academically and achieved National Council Licensure Examination for Registered Nurses (NCLEX-RN) pass rates above the national average.
The DEMSN program’s accelerated curriculum fosters diversity, academic rigor, and personal growth among highly motivated students. Graduates obtain education in quality, safety, leadership, and evidence-based practice. The first cohort of Gwynedd Mercy’s DEMSN program graduated in August 2024.
Upon program completion, graduates are eligible to take the NCLEX-RN. Additionally, earning an MSN opens pathways to various advanced roles, such as clinical nurse leader, nurse educator, nurse administrator, or researcher.
Although some advanced practice roles, such as nurse practitioner, require additional certification, an MSN alone qualifies graduates for leadership and educator positions. (See Beyond the MSN.)
Beyond the MSN
The Gwynedd Mercy University direct-entry master of science in nursing (DEMSN) program graduates students as MSN generalists, without a designated specialty. If students wish to pursue further specialization, they can complete a post-master’s certification program, which involves a gap analysis by the admitting institution.
Post-master’s certificate programs typically require fewer credits than BSN-to-MSN specialty programs, and employers frequently cover associated costs. The gap analysis, which includes reviewing previous transcripts, helps the admitting school of nursing determine which additional courses the student needs for certification in a specific specialty area. Although an individual can obtain only one MSN degree, they can pursue multiple certifications throughout their careers. For example, a nurse may first obtain certification as an adult nurse practitioner (NPs), later pursue certification as a family NP, and eventually earn a nurse educator certification. Most specialty certifications require passing a credentialing exam.
Curriculum challenges and changes
Gwynedd Mercy’s initial DEMSN had a clinical nurse leader (CNL) focus. The American Association of Colleges of Nursing (AACN) introduced the CNL role in 2004. Although not advanced practice RNs (APRNs), CNLs learn to use evidence-based leadership skills at the point of care. According to the American Organization of Nurse Leadership, CNLs have been shown to improve patient outcomes. Graduates of a CNL program can sit for a certification exam after completing the required coursework and leadership clinical hours as specified by the AACN.
A strategic assessment conducted by the university midway through the first cohort revealed challenges in enrollment, with numbers falling short of cost-effective benchmarks. The evaluation indicated limited interest among pre-licensure students in the CNL role. Many opted for alternative RN pathways that required less time and fewer clinical obligations. Additionally, students expressed concerns about insufficient hands-on patient care experience, leaving them feeling underprepared for the transition to clinical practice.
In collaboration with graduate faculty, university administration approved a curriculum redesign, removing CNL-specific courses and changing the curriculum to a generalist MSN program. Additional credits were allotted to some courses such as fundamentals, health assessment, behavioral health, and gerontology, based on feedback from students and an indicated need for more classroom time in these areas. Direct patient-care clinical hours also were increased, giving students more time to master required skills and competencies.
The current DEMSN curriculum integrates foundational nursing courses that equip students with the essential knowledge and skills needed for nursing practice and NCLEX-RN eligibility. These courses include pathophysiology, pharmacology, health assessment, global health, and fundamentals of nursing care. Building on this foundation, advanced nursing courses focus on specialized areas of practice, such as medical-surgical nursing, pediatric nursing, psychiatric-mental health nursing, community health nursing, and maternal-newborn nursing. Each course aligns with the graduate-level competencies outlined in the AACN Essentials, ensuring rigorous academic preparation and the development of advanced nursing knowledge and clinical skills.
Clinical, lab, and simulation experiences provide students with hands-on training in various healthcare settings under the supervision of clinical faculty. These experiences allow students to apply theoretical knowledge in real-world settings and to demonstrate essential competencies.
DEMSN students also complete several courses required for APRNs, including research, nursing leadership and theory, ethics, advanced pathophysiology, advanced pharmacology, and advanced health assessment. Even with the removal of the CNL-specific courses, the program remains rigorous, equipping students for nursing leadership roles. The original CNL curriculum consisted of 79 credits; the revised curriculum offers 72.
Both the MSN generalist and the CNL curriculum prepared nurses at the advanced generalist level, meaning they hold an MSN without a clinical specialty. Rather than focusing on a specific population or advanced clinical practice area, MSN generalists function across a broad range of healthcare settings in leadership, education, quality improvement, and systems-based roles. Morris describes MSN generalists as those who integrate evidence-based practice, systems leadership, and health policy knowledge to improve patient care and organizational outcomes. Not limited to bedside care, these professionals operate across microsystems (such as a hospital unit), mesosystems (such as departments), and macrosystems (such as healthcare organizations or communities).
The curriculum revisions required significant time for redesign and institutional approval. The first two cohorts of the university’s DEMSN program received education under the CNL model; the revised generalist DEMSN curriculum implementation began with the third cohort. The program duration was shortened from six semesters to five, making it only 4 months longer than the accelerated BSN program. (View curriculum details )
Although the CNL course content and certification hold significant value, informal questionnaires and discussions with admissions recruiters found that these programs appealed more to practicing nurses rather than prelicensure students.
As a result, the CNL component has transitioned to a post-master’s certificate option. In the future, the university also may offer it as a standalone MSN program for students with BSNs.
Methods for success
Key priorities within the university’s strategic plan include student success and retention, with the primary goal of supporting students in completing the program, passing the NCLEX-RN, and obtaining meaningful employment after graduation. The original curriculum had an average cohort size of 9.5 students, with two cohorts having graduated thus far (19 students in total). The first cohort achieved a 91.6% NCLEX-RN first-time pass rate; one student passed on the second attempt, and all are currently employed. The second and final cohort of the original CNL curriculum sat for the NCLEX-RN after graduating in August 2025. They had a 100% pass rate.
The first cohort (22 students) of the revised curriculum, which launched in Fall 2024, graduated in May 2026. One student has successfully passed the NCLEX-RN; the others are currently waiting for their testing dates. Most have either accepted jobs or are in the interviewing process.
Since its implementation, the program has experienced a 130% increase in enrollment, with an average cohort size of 22 students. To promote student success, the program employs several evidence-based strategies, including rigorous admission standards and comprehensive student support systems, including coaching.
Admissions
Admission to the highly selective DEMSN program focuses on leadership potential. Requirements include a minimum GPA of 3.2, prerequisite course grades of B- or higher, a personal statement, and letters of recommendation. Applicants also must complete prerequisite courses including anatomy and physiology, chemistry, psychology, statistics, and nutrition.
Coaching
The university’s program uses a coaching model to support academic and professional success. Thompson and colleagues describe this model as one in which faculty meet individually with students to identify challenges and provide targeted support to help them stay on track. Faculty offer study strategies, connect students with resources, and provide encouragement to promote success. All students engage in multiple one-on-one meetings with faculty each semester. Students identified as being at high risk for academic difficulty or NCLEX-RN failure based on assessment results receive more frequent and intensive support interventions.
Faculty continue to follow up with students after graduation. They offer guidance and encouragement as students prepare for licensure, seek employment, and transition into professional nursing practice.
Transition to practice
The final clinical course in the university’s DEMSN program includes a dedicated education unit (DEU). According to Musallam and colleagues, this innovative approach to clinical education enhances student learning. In a DEU, a university and a clinical setting collaborate to create a designated unit in which students complete their clinical education. This model reduces the need for clinical faculty to split their time across multiple units and provides students with consistent, on-site learning experiences.
Nurses on the unit receive training to serve as mentors to small groups of students who rotate through the unit over several weeks. Mentors attend an orientation held by the faculty members in charge of clinical placement. Student learning outcomes are discussed, and university faculty make site visits to evaluate the clinical experience. Faculty are available via phone 24/7 for any student issues that may arise.
Each student receives targeted instruction and guidance from their mentor. This allows students to develop a strong, supportive relationship with clinical faculty and nurses, helping to foster a smooth transition into practice.
DEMSN recommendations
Schools of nursing considering the development of a DEMSN program should prioritize recruiting students from diverse educational and professional backgrounds, as these individuals bring valuable perspectives and experiences to the nursing profession. Successful program implementation requires careful curriculum design that balances accelerated prelicensure content with graduate-level competencies, robust student support services, and strong clinical partnerships to ensure adequate placement opportunities.
Programs also should establish early academic risk assessment and remediation strategies, provide comprehensive NCLEX-RN preparation, and maintain ongoing evaluation processes to monitor student outcomes and program effectiveness. By fostering diversity and implementing evidence-based educational practices, DEMSN programs can help address workforce shortages while preparing nurses to deliver high-quality, culturally responsive care.
Prepared for success
The DEMSN program at Gwynedd Mercy University offers a pathway for individuals from various academic and professional backgrounds to transition into the nursing profession. The program prepares graduates for success in obtaining licensure and advancing their careers by providing a comprehensive curriculum that integrates academic coursework with hands-on clinical experiences. By focusing on student support, creating partnerships with healthcare facilities, and adapting to changing needs, the program contributes to solving nursing workforce shortages and shaping future nursing leaders.
Catherine Razzi is an associate professor and program director for DEMSN at Gwynedd Mercy University in Gwynedd Valley, Pennsylvania.
References
American Association of Colleges of Nursing. Clinical nurse leader (CNL). 2026. aacnnursing.org/cnl
American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education. 2026. aacnnursing.org/essentials
American Organization for Nursing Leadership. CNLs influence outcomes at the bedside and beyond. November 1, 2023. aonl.org/news/voice/november-2023/CNLs-Influence-Outcomes-at-the-Bedside-and-Beyond
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