Take a Direct Path to Nurse Leadership. Find Your RN to MSN Now.
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Learn MoreWhen It Comes to Your MSN, You Have Options. Explore Them All Now.
Learn MoreThe Registered Nurse to Master of Science in Nursing (RN to MSN) is an advanced post-graduate degree for registered nurses. Currently, there are more RN to MSN programs available than ever before — where only 70 programs existed in 1994, this number has more than tripled. By 2015, there were 214 programs available for registered nurses to pursue their MS degrees, with 31 new programs in the works. [1]
The RN to MSN is designed for registered nurses seeking to study according to medical specialty areas, pursue a nursing educator career or advance to management or administrative positions. This degree provides the opportunity for registered nurses with associate degrees to become advanced practitioners while studying baccalaureate coursework embedded into the master’s program. [1]
An MSN is an advanced post-graduate nursing degree providing an array of avenues for career development. This degree serves to improve a nurse’s ability to provide quality patient care while contributing to a more educated workforce, lowered mortality rates, quality treatment, and fewer medication errors. Students earning this degree can seek management-level nursing roles or nurse educator positions, or they can move on to a doctorate-level nursing program. Because the MSN offers several career paths, it is helpful for students to have a basic understanding of the specialty they would like to pursue before beginning their program.
The skills learned in this program can be applied to a range of critical medical procedures, enabling graduates to work as nurse practitioners, nurse-midwives, clinical specialists, and nurse anesthetists. [2]
An MSN can also provide a stepping stone to teaching careers, providing a basis for doctoral preparation. Because of this, professionals seeking to supplement their clinical duties with teaching roles — such as those interested in a nurse educator position — may complete an MSN degree.
Students who take this educational path will study different areas and can select a variety of specializations. This degree typically takes two to three years to complete, during which time advanced practice nurses can select certain specialty areas to focus on. This enables them to learn key skills in several crucial areas of medical practice. For example:
The RN to MSN is designed for registered nurses seeking to advance their skills and prepare for a more specialized role in the nursing community. An MSN degree can also help prepare nurses for management and administrative positions, as well as provide a base for doctoral educating. If you’re an RN looking for a direct path toward earning the skills you need to advance in your career, the RN to MSN is a solid option.
This degree can provide a bridge to a range of specific advanced practice registered nursing roles, including: [3]
Before seeking out a master’s program, you should hold a state registered nurse license. This can help provide a basis for study and help inform a choice on specialization. It’s important that you seek to educate yourself and identify your skill strengths. Because the MSN is applicable to a number of specialty areas, having a certain career path in mind ahead of beginning the program is crucial.
While more than 62% of nurses are employed in hospital settings [4], earning an MSN degree can provide a pathway to a range of other practice roles, including those within:
Earning potential
Advanced skills can help prepare nurses for several different roles with attractive salary benefits. For instance, nurse practitioners holding an MSN can earn as much as $113,325 annually, and psychiatric nurse practitioners can earn up to $122,999 a year. Registered nurses that pursue this degree can increase their salary to $97,477 annually. [7]
Advancement and career opportunities
Students who advance their skills with an MSN have considerable opportunities for advancement available to them. From research and education roles to management and administrative positions, MSN-trained nurses are able to leverage their degree in a number of ways. [3]
What’s more, due to the current shortage of registered nurses and rising health care needs of the baby boomer generation, employment opportunities for registered nurses — especially those with advanced training and degrees such as the MSN — will only increase over the next few years. In fact, the Bureau of Labor Statistics predicts that there will be more than 1 million job openings for nurses by 2022. [8]
Licensure and certification
Licensure is a requirement to practice clinical nursing. A minimum of a Bachelor of Science in Nursing is required in most states, but an MSN may facilitate the licensure process. There are several governing bodies that provide licensure and certification for advanced practice nurses, including the National Council of State Boards of Nursing. [9]
Curriculum and specializations
As noted, due to the range of specialty areas to which this degree can be applied, it is helpful for registered nurses to have an understanding of their skill strengths. This will help provide a basis for their decision pertaining to the specialty they would like to pursue.
It’s also imperative to understand that the curriculum and requirements will vary depending upon students’ past experience and coursework. What’s more, baccalaureate-level content typically taught during the associate level is built into MSN studies.
Accreditation
Groups including the Commission on Collegiate Nursing Education (CCNE), the Accreditation Commission for Education in Nursing (ACEN), and the National League for Nursing Commission for Nursing Education Accreditation (CNAE) provide accreditation to master’s nursing programs based on specific standards and criteria. In addition, some medical organizations also offer accreditation pertaining to specialty areas of study. Because the CCNE focuses on graduate nursing degrees and is officially recognized by the U.S. Secretary of Education, accreditation through this organization is typically preferred for RN to MSN program graduates. [24]
Faculty
Especially for students seeking to become educators, it’s imperative to select a course supported by faculty with robust clinical and teaching backgrounds. It can be helpful to look for information about educators’ past experience and degrees when choosing a program. In support of online courses, many faculty members make themselves available to students via phone, email, instant message or video conference.
Delivery method
Due to the different areas of specialization, many MSN students have more individualized studies than those seen in other medical degrees. The American Association of Colleges of Nursing (AACN) pointed out that many of today’s MSN programs are focused around training in classroom settings [3]; however, some programs also provide access to online courses, enabling students to blend on-campus classes with online learning. Each student will differ in his or her learning style preferences, so it’s important to select a program that aligns with your needs and your schedule.
Program length and credit hours
Your time to completion may differ in length depending upon how many courses you elect to take per term, as well as your schedule. Full-time master’s programs, for instance, typically involve up to two years of uninterrupted study [2], but this schedule can be lengthened to accommodate jobs or other obligations. For this reason, students should be prepared to devote the necessary time to their studies, whether or not they are employed or have other priorities in addition to their education.
Cost
The dollar figure associated with your education is an important factor. At the same time, though, an MSN degree provides avenues for considerable salary increases, enabling many graduates to pay off their education in just a few years. [10]
Success of previous students
The success of other students can be a telling metric to help gauge your own educational efforts. Many schools will offer statistics on graduation rates, post-graduation employment, and other benchmarks that might help influence your decision.
The American Nurses Association explains that advanced practice registered nurses (APRN), such as graduates of MSN programs, are at the forefront of primary and preventative care and can hold positions including nurse practitioner, clinical nurse specialist, nurse-midwife, nurse anesthetist, and beyond. [11] These are registered nurses that may also have had specialty education related to a specific medical area in addition to their foundational training.
There is a misconception that the purpose of an RN or APRN is to assist the physician. In actuality, many APRNs independently practice and provide care to patients. [4] What’s more, APRNs are able to apply their skills and education to a range of industries including home care, the military, research facilities, outpatient offices, public health agencies, and mental health organizations.
Students pursuing their MSN degree will learn a number of critical skills, depending upon the specialty area they select. Advanced practice nurses that complete their MSN program should be trained in: [2]
This helps prepare advanced practice nurses to work a variety of different positions within the medical industry. This includes positions like: [3]
The RN to MSN degree is considered an entry-level graduate program for registered nurses with associate degrees. There are a variety of programs available at this and other levels within nursing education that allow graduate students to select the course of study that best aligns with their career goals:
In addition to these, there are also certain accelerated programs offered to help support the need for registered nurses. According to the Bureau of Labor Statistics, by 2018, more than 580,000 registered nurse positions will be available. Fast-track programs like accelerated BSN and generic master’s programs are being developed across the country, adding to the more than 295 accelerated programs currently being offered. [15]
The MSN and other degrees suited for advanced practice nurses are becoming increasingly critical in the health care industry. The RN to MSN program is best suited for registered nurses with experience, including those that have been practicing in health care settings.
Due to a rise in health care needs related to the Baby Boomer generation; an overall increase in national population; and a need for more educated, skilled nursing staff, advanced degrees that enable nurses to focus on certain specialty areas are needed now more than ever. The Bureau of Labor identified registered nursing as one of the leading occupations for job growth. [8] At the same time, however, there is a considerable shortage of trained and certified individuals to fill these roles. The American Journal of Medical Quality’s Registered Nurse Workforce Report Card and Shortage Forecast predicted that by 2030, there will be more than 918,000 unfilled registered nursing positions in the United States. [16]
The RN to MSN degree, in particular, can also provide an important stepping stone for a career within the nursing education field. This program enables students to make the necessary preparations for doctoral courses, laying the groundwork for registered, practicing nurses to teach in clinical and entry-level nursing courses. [1]
In addition to stating a goal of increasing the share of nurses with baccalaureate-level degrees to 80% by 2020, the Institute of Medicine also sought to double the number of nurses with doctorate training by the same year. [18]
The number of RN to MSN programs being offered in the United States has doubled during the last 15 years. Where only 70 programs were available in 1994, there were a total of 277 schools supporting RN to master’s programs by 2015. [14] What’s more, 31 new RN to MSN programs are being planned currently. [1]
There are several important aspects to consider about these available programs that can be beneficial in students’ decisions:
Students can now choose from online-supported education programs, including those that meet within virtual classrooms at the same time each week — known as synchronous learning. There are also more flexible asynchronous courses, where students aren’t required to meet on set schedules. These are offered so student nurses can maintain employment alongside their educational pursuits. [2] Some schools have begun providing blended format delivery, which hinges upon both on-campus classroom clinical learning with online study.
It’s important to understand that selecting an RN to MSN program does not mean that students will skip baccalaureate-focused content. In fact, this training and education is inherent in RN to MSN coursework, helping ensure that students are adequately prepared for their master’s level studies as well as their accreditation exams. [1]
In today’s nursing industry, there is a projected shortage of trained, certified health care professionals, which is expected to grow as patient needs increase. [8]
As a registered nurse or advanced practice nurse, the occupational opportunities available are significant. The Bureau of Labor Statistics rated registered nursing as one of the top occupations poised for job growth from 2012 to 2022. The need for new and replacement registered nurses is expected to surpass 1 million by the same year. [27]
Opportunities also abound for advanced practice nurses, including those working in nurse anesthetist, nurse-midwife, and nurse practitioner roles. The Bureau of Labor Statistics forecasted a 31% increase in job availability from 2014 to 2024. [19]
Due to an array of nursing roles available to graduates with advanced practice degrees, there are several settings in which MSN degree holders are able to practice. This includes:
Available areas of specialization for individuals with a master’s-level nursing degree include:
The settings in which MSN degree holders work largely depends on the specialization they choose. This specialty area will also help determine students’ coursework during their graduate program.
Depending upon their chosen concentration, registered nurses can leverage the RN to MSN degree to prepare for specialized career paths. The American Association of Colleges of Nursing recommends having a specific career path in mind before applying for the master’s program. [2] This will help inform the types of coursework and clinical, experiential learning that each student will participate in.
Some of the most common career paths for MSN degree holders include:
Advanced practice nurses in these roles can expect to make a yearly salary of $104,740 on average, or just over $50 an hour, according to information from the Bureau of Labor Statistics. [19]
While examining the curriculum, nurses should seek courses that align with the specific area of study they are looking to pursue. In addition, it’s imperative that programs provide both classroom and clinical experience to support certification preparedness. Regardless of specialty, RN to MSN students will study:
Other courses and areas of study are offered according to specialty areas. Studying nurse practitioners may also choose courses related to: [2]
Within these courses, students will learn skills that align with the Commission on Collegiate Nursing Education standards, including training to improve patient care, manage administrative tasks and prepare for doctoral education. With the background these courses can provide, graduates can work in a range of capacities, like clinical nursing roles, administrative and management positions, as well as within the research or education fields.
With hundreds of available programs offered at universities across the country, students seeking to earn an RN to MSN degree have considerable choice. These include generic and accelerated programs aimed at students without a previous degree in nursing. These styles of study are also on the rise: In 1990, there were 12 generic master’s programs being offered, and by 2013, that number had increased to 65. [15]
The availability of programs also means students are able to select a program that aligns with their specific needs. For instance, registered nurses can choose online-only classes or take advantage of a blend of on-campus and online learning. [1] This helps ensure that even if students decide to work while pursuing their degree, they can choose a program that fits their employment schedule.
The RN to MSN degree includes multiple unique areas of focus, including a range of specialty studies. Because this degree prepares nurses for a variety of roles within the nursing industry, coursework will largely depend upon the concentration students select. Master’s programs like the RN to MSN provide an opportunity for advanced practice nurses to examine their overall career goals and select a specialty area of study that aligns with their vision of educational and professional growth.
It is recommended that registered nurses take the time to examine and investigate their available options to select the path that aligns with their strengths. This specialty focus will help determine the required classes each student will take during their RN to MSN program.
Common specializations include:
This role focuses on primary and acute care, as well as ongoing management of chronic conditions. Nurse practitioners learn to take detailed health histories, complete physical examinations, diagnose and treat patients, and help prevent disease. Nurse practitioners can be independent or practice as part of a family practice, pediatric, geriatric, mental health, or women’s health facility.
Students explore anesthesia care as it relates to surgery, outpatient, and dental procedures. Certified registered nurse anesthetists are the sole providers of anesthesia in rural hospital settings. [3]
This role enables registered nurses to learn more about gynecological and obstetric care, as well as childbirth practices within hospitals and private or home settings. Studies here include maternal and newborn care, reproductive health, and primary and preventative care, which accounts for 90% of all certified nurse-midwife visits. [3]
This is a particularly specialized concentration that enables nurses to provide care in several specialty areas like oncology, pediatrics, neurological, psychiatric, neonatal, and cardiac nursing.
An RN to MSN degree can also provide a stepping stone to a teaching career in the nursing industry, offering a first step for doctoral preparation and for teaching roles. A doctoral degree is needed before nurses can move on to nurse faculty roles in educational institutions. [1]
This concentration focuses on science as it applies to health care services, and it prepares students to complete research with the goal of improved patient services. Nurse researchers study to identify research questions, analyze health-related data, and address clinical issues. [3]
The above-described specialty study areas are just a few of the most popular concentrations — more details about available career paths and focused studies are available from each educational institution.
According to information from the Bureau of Labor Statistics, nurse anesthetists, nurse-midwives, and nurse practitioners are among the most popular roles for advanced practice nurses currently. Through 2024, the job market for these positions will grow by more than 30%, much faster than average. [19] These roles can earn an advanced practice nurse more than $104,000 in annual salary, or an average of more than $50 an hour.
Alongside required coursework, students also may have the option to take elective classes that may help supplement their health care training. Choice of electives will depend upon whether or not students select an accelerated RN to MSN program.
Within the medical and health care fields, there are opportunities available for experiential learning to supplement skills studied in the classroom. In some concentrations, there are requirements for clinical hours that enable student nurses to take a more hands-on and active role in their medical training.
Some universities also offer field placement courses, wherein students earn credits for work in real-world settings. In many cases, clinical hours falling under experiential learning are required.
Clinical hours are an important part of advanced practice nurses’ educational efforts. Within master’s nursing programs like the RN to MSN, clinical hours are typically required. [2] These serve to support the skills and information students are taught during classroom lectures, seminars, and online courses.
The number of clinical hours required will vary depending upon the concentration students select. For example:
Take a Direct Path to Nurse Leadership. Find Your RN to MSN Now.
Learn MoreBuild Your Nursing Skills Without Leaving Work with Your RN to MSN.
Learn MoreWhen It Comes to Your MSN, You Have Options. Explore Them All Now.
Learn MoreThe length of an online master’s degree program can depend on a number of variables, perhaps the most prominent of which is the pace at which you choose to study. You can finish a typical master’s degree program in about two to three years if you choose to study full-time, although some accelerated programs may be able to help you finish more quickly.
Online master’s degree programs tend to offer flexibility suitable for students who choose to study part-time. This option will likely extend your time to completion, but it can allow you to study while fulfilling your familial, social, and professional obligations.
You can find more information on this topic at our program length overview page.
There are also different requirements for the number of clinical hours you’ll be asked to perform, depending on your concentration. These requirements can have an impact on the length of study. More information on these requirements can be obtained from the individual college or university you choose to pursue your advanced graduate degree.
While each program will set its admissions requirements based on its own criteria, many requirements are universal across all programs. No matter where you apply, you can expect to provide items like transcripts from previous degrees or coursework; standardized test scores; a personal statement or essay; letters of recommendation; and an overview of relevant work experience.
In certain cases, some of these requirements may be waived.
For more information about admissions, please visit our admission requirements page.
At the master’s level, the RN to MSN isn’t the only option available to nursing students. While the RN to MSN degree programs build baccalaureate-level content into their curricula, RNs also can pursue their RN to BSN or their RN to DNP, which prepare them for a bachelor’s or a doctorate, respectively.
Those who already have earned their bachelor’s also have the option to pursue the BSN to MSN. This is one of the more traditional education paths at the master’s level in nursing, according to the American Association of Colleges of Nursing. [3] The program directly follows undergraduate content and study experience, and it enables students to earn their Master of Science in Nursing over the course of two years. This degree requires students to have studied entry-level nursing previously and to hold a baccalaureate degree.
Some schools also offer options for dual master’s degree programs, which combine graduate-level material with in-depth concentration in a complementary field. Currently, there are 120 dual master’s degree programs available, including those that combine nursing with business (MSN/MBA), health administration (MSN/MHA), public health (MSN/MPH), and other areas. [3]
Regional accreditation is the most prestigious type of accreditation that an online or traditional college or university can receive. It is granted only after careful consideration by private, not-for-profit organizations tasked with evaluating educational quality.
Regional accreditation is particularly important if you anticipate that you might want to transfer credits from one online RN to MSN degree program to another or use those credits to pursue another degree. Most regionally accredited schools will only accept credits from other regionally accredited institutions of higher learning.
You can learn more on this topic at our regional accreditation page.
There are specific types of accreditation to look for when considering nursing programs, including those from federal- and regional-level organizations. Within the nursing industry, the Accreditation Commission for Education in Nursing is responsible for accrediting master’s, baccalaureate, and associate programs.
In addition, the Commission on Collegiate Nursing Education provides accreditation for master’s and baccalaureate nursing programs. When selecting a program, it’s critical to choose a school that has accreditation from one or both of these institutions.
Before practicing in a professional health care setting, nurses must receive certification from the National Council Licensure Examination, administered by the National Council of State Boards of Nursing. [22] This is a basic requirement and allows individuals to receive the designation of registered nurse.
Students applying to graduate study programs like the RN to MSN have already completed this requirement. Before graduating from the RN to MSN program, however, additional licensing exams are required. These will depend upon each registered nurse’s concentration, and there may be added requirements depending on the state in which advanced practice nurses study and work. Below are some examples of leading nursing roles and their licensing requirements:
Depending upon the specific career role, advanced practice nurses may also be required to maintain certification through continued education and periodic exams.
Licensing and certification processes enable nurses to obtain gainful employment while supporting the education and training they received during their master’s program. Certification is a requirement for employment in the nursing and health care sectors.
Currently, state-level nursing boards, including the 59 boards included in the National Council of State Boards of Nursing, enable the licensing of more than 3.2 million active registered nurses and advanced practice registered nurses in the U.S. [26]
The role of advanced practice registered nurses and nurse practitioners is growing increasingly important in today’s medical community, but its origins can be traced back to the 19th century and young graduate nurse Lillian Wald.
Wald, who studied at the New York Training School, spearheaded the establishment of the Henry Street Settlement (HSS) in Manhattan’s Lower East Side. [12] Wald and her associate Mary Brewster worked to create processes for home visits by nurses, caregiving for European immigrants, and referrals to physicians and local hospitals.
During this time, demand for health care considerably increased. By 1900, Wald’s HSS employed 12 nurses, who completed more than 26,000 home visits. Known for their black leather bags, these nurses provided prescriptions and home remedies obtained from HSS’s own medical storage.
With the passage of the 1906 Food and Drug Act, however, the disbursement of medical prescriptions and treatments would vastly change. The act demanded that the inclusion of certain ingredients within treatments be disclosed. This shift spurred Wald to oversee the establishment of a medical advisory committee, which would help more closely regulate the medical and nursing processes and provide counseling.
The HSS continued to expand, and by the early 20th century, visiting nursing groups were being established in cities across the country, including in Boston, Chicago, Philadelphia, and Seattle. At the same time, HSS nurses were providing more home visits, and by 1926, nurses were treating pneumonia, influenza, tuberculosis, and other illnesses throughout their 300,000 yearly on-site appointments.
Another notable individual in the history of nursing is Mary Breckenridge, who in 1925 established the Frontier Nursing Service with the intent to impact maternal and infant mortality rates. The group included certified nurse-midwives who eventually worked from a series of decentralized clinics, providing medical services and care over a nearly 80-square-mile area in the Appalachian Mountains.
These women laid the groundwork for the nurse practitioner and advanced nurse practitioner roles that we now know today. These positions were even more firmly cemented in 1965. According to the American Association of Nurse Practitioners, it was at this time that Dr. Loretta Ford and Dr. Henry Silver created the first nurse practitioner program within the higher education community at the University of Colorado. [13]
In 1967, Boston College launched one of the earliest known master’s programs, establishing the foundation specialty studies. Federal agencies, sensing the importance of these educational programs, began providing needed funding. By 1987, $100 million in financial support had been provided by the federal government to support nurse practitioner education.
The establishment of the American Academy of Nurse Practitioners in 1985 was a significant turning point. By the end of that year, the group would have 100 members. Over the next few years, the group would prove instrumental in the creation of its Certification Program, Corporate Advisory Council, and other connected organizations.
Today, the AANP has more than 50,000 members, and by 2014, there were more than 192,000 registered nurse practitioners in the United States. In addition, more schools are providing access to registered nurse to master’s programs: As of 2015, there were 227 programs available at universities across the country. [14] These schools support the education of registered nurses seeking to become advanced practice nurses while increasing their specialty knowledge surrounding several key medical nursing professions.
Registered nurses applying for RN to MSN programs have a number of available options for financial aid. In addition to federal aid obtainable through the Free Application for Federal Student Aid, or FASFA, individual schools also provide a variety of scholarship, loan, and repayment programs.
The American Association of Colleges of Nursing highlighted: [28]
The American Association of Colleges of Nursing also lists other avenues graduate and post-graduate students can seek out for financial support, including aid, scholarship opportunities, and loan repayment and forgiveness programs.
Resources
[1] http://www.aacn.nche.edu/media-relations/fact-sheets/degree-completion-programs
[2] http://www.aacn.nche.edu/education-resources/msn-article
[3] http://www.aacn.nche.edu/publications/brochures/GradStudentsBrochure.pdf
[4] http://www.aacn.nche.edu/students/your-nursing-career/facts
[5] http://www.aacn.nche.edu/news/articles/2015/enrollment
[6] https://www.bls.gov/ooh/healthcare/registered-nurses.htm
[7] http://www.payscale.com/research/US/Degree=Master_of_Science_in_Nursing_(MSN)/Salary
[8] http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
[9] https://www.ncsbn.org/6568.htm
[10] http://nurse.org/articles/89/nursing-degrees-which-one-is-right-for-you/
[11] http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses
[12] http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Historical-Perspectives-Expanded-Role-Nursing.html
[13] https://www.aanp.org/all-about-nps/historical-timeline
[14] http://www.aacn.nche.edu/leading-initiatives/research-data/RNMSN.pdf
[15] http://www.aacn.nche.edu/publications/issue-bulletin-accelerated-programs
[16] http://journals.sagepub.com/doi/full/10.1177/1062860611416634
[17] http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
[18] https://asu-ir.tdl.org/asu-ir/bitstream/handle/2346.1/30018/Synchronous_Versus_Asynchronous_Online_Courses.pdf?sequence=2
[19] https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm
[20] http://www.aacn.nche.edu/education-resources/MasEssentials96.pdf
[21] http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000003821/Gap-Analysis-ACME-and-ICM-Global-Education-Standards.pdf
[22] https://www.ncsbn.org/nclex.htm
[23] http://www.amcbmidwife.org/amcb-certification/why-amcb-certification-
[24] http://www.aana.com/ceandeducation/becomeacrna/Pages/Nurse-Anesthetists-at-a-Glance.aspx
[25] https://www.aanp.org/education/aanp-certification-program
[26] https://www.ncsbn.org/LicensureandTelehealth-2014_06.pdf
[27] https://www.bls.gov/news.release/ecopro.t08.htm
[28] http://www.aacn.nche.edu/media-relations/fact-sheets/funding-resources
[29] http://www.aacn.nche.edu/ccne-accreditation