There are several routes into the nursing profession, and once someone is qualified as a nurse they have the option of advancing their career in one of many ways. A licensed practical or vocational nurse can continue their education to become a registered nurse and then a nurse practitioner or specialize in one of a variety of areas of nursing.
If you’d like to become one of the three million people working in this hugely rewarding and challenging career, you’ll need to earn a nursing license. There are several routes to licensure.
When choosing a nursing program, it’s important to consider the length of time the course takes, your budget, and whether you plan to study full or part-time. Some would-be nurses may feel full-time nursing school is the best way to earn a nursing degree and be happy to spend a few years in an academic setting in order to ‘get their education out of the way’.
For others, the financial and time commitment of earning a nursing degree may seem too large, and a quicker route such as a vocational qualification or an associate’s degree could be more appealing. After all, there’s always the option of taking a bachelor’s degree part-time at a later date.
The variety of programs available, from LPN certificates to ADN, BSN, and master’s programs makes nursing a relatively accessible profession. Nursing students can head straight into the workforce as a nursing assistant and continue their education to become nurse practitioners, clinical nurse specialists, or educators at a later date.
Those who are already fairly confident in their career goals have the option of enrolling in a course that takes them straight into their desired specialism, such as midwifery or becoming a family nurse practitioner. For others, a standard RN qualification allows them to gain clinical experience and keep their options open.
Would-be nurses have several options for starting their career, depending on how long they wish to spend in education before being allowed to operate in a health-care setting. The quickest route into health care is through the LPN Certificate, but this is not a degree program and the scope of practice of a Licensed Practical Nurse is limited.
There are many degree options that allow students to sit the NCLEX-RN examination, and that offer a wider choice of careers upon graduation.
Would-be nurses have a choice of several educational options, depending on their current experience and education, and the level at which they’re hoping to work in the field. Those options include:
It’s possible to become a registered nurse with just an associate’s degree, however, in many parts of the country nurses are expected to pass the BSN if they wish to practice long-term. This is because nurses who hold a bachelor’s degree have been found to offer a higher standard of patient care, leading to better long-term patient outcomes.
Those who are serious about nursing as a long-term career will find more employment options open to them if they complete a bachelor’s degree, and will also be able to command higher salaries.
The nursing diploma and associate degrees in nursing are the two shortest routes to becoming a Registered Nurse. Both programs lead to licensure, but only the ADN provides a college degree upon completion.
Someone who has passed the diploma may be able to transfer over some credit from the course should they wish to complete the ADN at a later date, or even enroll in a BSN course. Those who are likely to want to continue their education should look for a diploma issuer that is affiliated with a college or university so their prior studies are more likely to be accepted.
Upon earning a Registered Nurse license, many career options open up, including jobs in:
The average salary of a Registered Nurse is $73,300 per year, although this assumes that the nurse has completed the BSN. A nurse with a diploma or an associate’s degree will likely earn slightly less than this.
Some people who have been working in the nursing profession for a long time after earning a diploma or associate’s degree, or who have some prior experience in allied health professions, can take an accelerated BSN qualification to earn their bachelor’s degree more quickly than the traditional BSN route.
A registered nurse has many career options open to them, depending on the specializations they would like to pursue.
The most common route is to enroll on a Master’s degree in nursing, often with a focus on a specific area such as neonatal care, midwifery, or informatics. Earning an MSN degree opens up many new jobs within the nursing profession, such as:
The MSN takes two years if studied part-time, and can often be completed online.
After the MSN, the next step is the DNP, or Doctor of Nursing Practice. This takes two more years and opens up advanced roles such as research, informatics consulting, or leadership positions.
Salaries in the healthcare professional vary dramatically, even among those who hold the title of ‘nurse’. Nursing assistants earn the least, but training to become one is a relatively quick and easy process. Those with postgraduate qualifications have the highest earning potential.
The salary earned by a nurse depends on many factors, including experience, qualifications and where they work. As a rough guide, the average salaries for workers in various nursing professions are:
Nurses who invest in their education and professional development can expect to earn far more than those who took a shorter course before entering the profession.
There are many reasons for rewarding those with a higher level of education. Nurses who have completed more rigorous courses not only have the opportunity to work in areas where they have a broader scope of practice and are able to work more autonomously and employ critical thinking skills and judgment in their patient care, they have been found to deliver a higher standard of care too.
BSN educated nurses have lower patient mortality rates and deliver better patient outcomes than their diploma-holding counterparts. BSN holders are believed to have higher levels of critical thinking, leadership, and case-management skills and as such can perform better in high-pressure environments.
The AACN encourages all nurses who are planning on being in the profession long-term to pursue a BSN at the very least. Those who wish to specialize in a specific area of nursing then have the option to learn on the job and achieve certification in that area through a significant amount of clinical experience or pursue postgraduate qualifications.
Pay levels for nurses with a postgraduate education can be far higher than those for registered nurses. Those who are qualified as Advanced Practice Nurses, Nurse Practitioners, or clinical specialists command high salaries.
There is, of course, some difference depending on where the nurses work. For example, nurses employed in commercial hospitals or in a consulting role can expect to earn more than those employed in a nonprofit setting. However, there are some perks to working for not for profits, such as the possibility of being able to take part in student loan forgiveness programs.
Would-be nurses should consider their long term plans. Do they want to work in their hometown, or are they willing to move elsewhere for their careers? Do they want to work in a hospital, clinic, care home or outside of direct health care settings?
All of these considerations will influence their education choices and may help them decide what level of qualification to pursue in the short term.
Nursing is a varied career path that offers many opportunities for advancement and for people to pursue areas of special interest. Through continuing education and postgraduate qualifications, nurses can move into areas including informatics, anesthesia, pediatrics, neonatal ICU, midwifery, family practice, and public health.
Some of these job opportunities offer the chance to travel or work in the private sector. Some allow a nurse to work in education or to take a leadership role, stepping back from the demands of patient care. Other roles mean a nurse can focus on a specific type of patient, making a difference in an area of nursing they are particularly passionate about.
Among the career options available to Registered Nurses who decide to specialize are:
A nurse practitioner is a registered nurse who has additional training and education, usually in an area such as pediatrics or family medicine. This allows them to, within a limited scope of practice, diagnose and prescribe. Nurse practitioners often work in primary care settings and serve as the first point of contact for patients, recording vitals and assessing minor ailments before referring those who need additional care to a doctor or other specialist.
Nurse educators may work in hospitals or in a nursing college, training the next generation of nurses. They also help nurses who are currently licensed improve their skills and work toward their new specialisms. Some nurse educators work in healthcare settings and may still have some exposure to patients, but others work in academic settings where they have the opportunity to do research and review new patient care literature and studies.
Midwifery specialists work alongside midwives, neonatal specialists, and other medical professionals. They work closely with pregnant women in the months leading up to the birth of the child. Some nurses like this kind of work because it provides them with the ability to focus on a smaller group of patients, rather than the rapidly moving and changing world of an emergency ward.
The field of informatics is a varied one. Some people who move into informatics work in hospitals providing support for nurses and helping them use computer systems. Others work on reports and data analysis. Individuals with a programming and technical background can develop software to improve patient care and the efficiency of the health care system.
Informatics nurses can work directly in a healthcare environment, in education, or for a health-adjacent software company in development or consulting role. These varied options mean informatics is a good choice for those who are looking for travel or to get out of patient-facing positions later in their careers.
Senior nurses have the option of becoming nurse leaders and taking on a managerial position within their departments. Nurse leaders oversee working schedules, manage the flow of patients and guide the nurses under their supervision, stepping in where needed if junior RNs need assistance. Nurse leaders fill a primarily back-office role but are working in a hospital or clinical setting.
Working in the ICU or on an emergency ward is a demanding job that requires specialist training and some expertise in managing the machines used for patient care. Nurses can learn a lot of this role on the job, or study a master’s degree with a focus on emergency nursing and ICU.
There are sub-specializations here, such as neonatal ICU, allowing nurses to focus their work even further. These nurses are highly respected and have a lot of autonomy.
Nurses who enjoy working with children can choose this as a specialization. These nurses learn about child development and also how to advocate for the children in their care. Pediatric nursing requires communication skills, an understanding of child psychology, and how to assess, evaluate and care for patients who may struggle to communicate their issues.
Pediatrics nurses learn about diseases and conditions common in children and may work with a patient for many years before they age into the mainstream health system. These nurses have the opportunity to get to know the patients in their care, and their families, becoming well-respected members of their local community.
A nurse who focuses on anesthesiology may work alongside surgeons, dentists, or other health care professionals, preparing patients for anesthetic, managing and administering doses, and monitoring the patient’s vitals. These nurses have a high level of expertise in a fairly narrow field and have the ability to make a lot of important decisions within their scope of practice.
The public health specialization can include outreach, education and also policy research, and health promotion. Some public health nurses work out in the community, speaking to groups, visiting schools, and working to promote a healthy lifestyle. Others research public health issues and write documents to inform policymakers or for use in health promotions.
Many parts of public health nursing are office-based, rather than patient-facing, but this is an important role that can make a difference to the overall health of the population.
There are many other potential specializations for nurses. It’s not uncommon for career nurses to try many different specializations over the course of their working lives. Some nurses start in a hospital then move into a clinic or a managerial position when they’re a little older and are looking for a slower-paced working environment.
Nursing is a broad occupation, and there’s plenty of time to decide what aspects of the profession you’d like to focus on. Newly qualified nurses can take their time exploring the opportunities open to them and gaining experience before investing in further education or training.
Nurses with a passion for a specific area of care (such as pediatrics or working with cancer patients) can move swiftly into that specialization. Those coming to nursing from a different background, such as a STEM career, could combine the two and work in informatics or education. There’s something for everyone in this field.
Some things to consider include whether you want to work directly in health care, or for a health-adjacent company such as a software company that makes tools for managing patient records. Are you looking to work on award, or in a long-term care facility? Do you want to stay in your home town, or move to an area with hospitals that have departments related to your specialization?
Young nurses may enjoy the demands of the emergency room, while nurses with families and other commitments may prefer more predictable hours and a slower working environment. Some people may want to be hands-on, and be happily certifying as a licensed practical nurse, while others may want to train to be a nurse researcher or educator and contribute to health care in a different way.
Going to nursing school is a big commitment, so it’s important you find a university or college that works for you. The time and money required to train to be a nurse is significant, and there’s an additional expense in the form of the licensure examination at the end. If you’re planning on enrolling on an associate’s degree you’ll have other considerations too, such as how easy it is to upgrade to a BSN later.
For many people, the price of a nursing degree program will be an important consideration. The average cost of a nursing associate’s degree in the United States is $3,000 to $10,000 per year, with most degrees taking two years. Fees for Bachelor’s degrees are usually higher, with the full cost of a bachelor’s being between $40,000 up to $100,000.
Many universities offer scholarships to help those who would struggle with tuition fees pursue a degree in nursing. Duke University, for example, has scholarships for their ABSN, MSN, and DNP courses. These scholarships won’t cover the full cost of the course, but it is often possible to receive support from multiple organizations and this, plus student loans, can make tuition at such a high-caliber institution much more affordable.
Younger students may also wish to take into account the location of the university when studying. Moving away from home to study can be intimidating, but having a good social network at the university helps a lot, as does living in a city that is centralized and rich in amenities. Be sure to research accommodation and travel options before making any decisions about where you go to study for your associate degree or BSN.
Whether you’re planning on enrolling in a BSN program, the ADN, or a Master’s degree, it’s important to consider the cost of the degree and the study options.
Will you be able to afford the tuition fees? If not, are there scholarships or bursaries available to make the cost more accessible? If you’re planning on working while you study, does the study plan make this easy?
Another thing to consider is where the course is being offered, and the licensing arrangements they have. Online nursing degrees often allow you to take the licensure exam in any state you wish, but bricks-and-mortar nursing colleges might expect you to sit the NCLEX-RN offered by their state board.
This may not be an issue for you if you live in that state and plan to pursue a career there. However, if you’re traveling to study you may end up having to take a second NCLEX-RN exam in the state where you decide to seek employment. The additional cost is only a few hundred dollars, but there’s also the stress of a second examination to take into account.
If you’re hoping to continue your nursing studies as a postgraduate, or top up an ADN to a BSN, make sure that the university or college you’re working with is one that is widely recognized so that you can get recognition for prior learning. This is particularly important for those considering nursing diplomas who want them considered as prerequisite courses or partial credit for a BSN.
A nursing program makes sense for anyone who wants to become a registered nurse and who plans on staying in the profession for a long time. It may be tempting to follow the LPN route, but taking the time to earn at least an associate degree opens up far more career opportunities.
Pursuing a nursing education puts you on the path towards highly rewarding careers both financially and in terms of the difference that you make to those you serve. Whether you decide to stay at the RN level or become an Advanced Practice Nurse or Doctor of Nursing Practice, you’ll become a part of the valued medical professional.
Nursing degrees are academically rigorous and require an understanding of chemistry, anatomy and physiology, psychology, leadership, and ethics. As you find your feet in the profession and pursue specializations, you’ll find that you can focus your studies on the areas you’re most interested in.
Not everyone is in the position to study full-time. You may find that earning your ADN and then working as an RN for a few years before studying to upgrade your qualifications is the best option, and in some cases, this route could allow you to find a sponsor for your qualifications.
If you’re not sure if the degree route is right for you, consider attending some nursing college open days or talking to nurses in your area. Many nurse educators are happy to talk about the different routes into the profession, how they got started, and what their experience is like.
There are pathways for those who enjoy the academic route and for those who want to do a lot of on-the-job training, so if you’re sure that a career in nursing is for you, there will be a way for you to enter this challenging and rewarding profession.