Making the decision to pursue a career in nursing is a great first step. The next choice is, what kind of nurse? If you look at the nametags of nurses at the office, you will notice a plethora of letters – RN, NP, BSN, MSN, etc. These represent the many different areas of practice in the field of nursing, all related yet diverse and displaying varying levels of education and certification. The path you choose to follow can determine the progression of your career and the options available along the road.
An introductory map for prospective nursing students
Let’s begin by learning about educational levels for nurses and the different career pathways that each educational level can led to.
Associate degree in nursing (ADN)
The first degree that you can get is an ADN, which is a program that can be completed within 20-24 months. The ADN program is offered at many colleges and community colleges across the country. It is also offered online, and at some vocational high schools. Typically, this program is highly focused on technical clinical tasks and day-to-day care, such as monitoring patients, administering procedures and updating charts.
ADN nurses often earn a slightly lower starting salary, although this can depend on the individual workplace. Nurses with an ADN can take the NCLEX examination to become a registered nurse, but they cannot specialize without a bachelor’s degree in nursing (BSN). This means that they practice general nursing in a hospital setting, rather than being eligible to work in a clinic, such as a pediatric clinic. However, there are RN to BSN programs that nurses can choose to enroll in at any point if they decide to specialize.
This degree may appeal to you if want to finish school faster and enter the workforce, or if you prefer a curriculum based on clinical skills and are not looking to specialize. The negatives associated with this degree choice include the lower ceiling on potential earnings, the inability to specialize, and the fact that a bachelor’s degree is sometimes preferred by employers. In addition, your job responsibilities are limited. With an ADN, you can choose to be a licensed practical nurse (LPN) or a registered nurse (RN).
Bachelor of science in nursing (BSN)
The next degree possibility is a BSN, which can be attained either as a declared major chosen in undergraduate school, or as a post graduation transitional program. Generally, program length is 36 months, although there are also accelerated programs that can be completed in 12-16 months. The BSN program is more comprehensive than the AND program and focuses on developing:
- clinical skills
- research training
- management and leadership skills
This broader program provides a more holistic and reality-based understanding of the roles and responsibilities of a professional nurse.
BSN nurses enjoy increased autonomy in decision making on the job, with increased knowledge and understanding of RN specialties and skills. They earn a higher starting salary and as they can progress to specialties, this allows for career advancement possibilities. You may want to pursue this degree if you desire a fuller nursing curriculum, and if you are not deterred by the cost and duration of the education program.
Master of science in nursing (MSN)
The MSN is a graduate degree that prepares nurses to act as independent practitioners in their specialty field and prescribe medications. The degree comes with the potential to own and operate a private practice. MSN nurses can specialize in the field of their choice, for example obstetrics and gynecology, or anesthesiology.
The MSN degree offers options in non-direct patient care —education, management, or health information systems— or direct patient care. Completing an MSN program generally takes 2-3years. The prerequisites to the program are.
- an active nursing license in your state
- at least a year of nursing experience
Some schools offer an accelerated MSN program, where you can earn your BSN and MSN simultaneously in approximately 15 months. These accelerated programs are typically rigorous and selective. Students who are considering their MSN are often encouraged to gain some work experience prior to enrolling in the program.
The MSN can be a good fit if you are currently a practicing nurse with a desire to specialize or open your own practice. MSN nurses earn a higher salary than nurses with a BSN. The cost of education and the greater length of time in school may be deterrents. Note, some hospitals provide scholarships for nurses to continue their education by earning an MSN.
Doctor of nursing practice (DNP)
A DNP is a doctorate degree in nursing is the highest educational level in the field. Similar to an MSN degree, a DNP can prepare nurses to sit for certification as Advanced Practice Registered Nurses in a variety of clinical specialties. The DNP is mostly geared towards nurses who desire a leadership position and aspire to use their knowledge of nursing for education or healthcare policy reform.
Practice-based DNP programs focus on 7 key areas of instruction:
- scientific underpinnings for practice
- advanced nursing practice
- organization and system leadership – management, quality improvement
- analytic methodologies related to the evaluation of practice
- utilization of technology and information for the improvement and transformation of healthcare
- health policy development, implementation, and evaluation
- interdisciplinary collaboration for improving patient and population healthcare outcomes
DNP nurses can work as independent practitioners with complex patients. They are trained to employ advanced critical thinking skills and utilize evidence-based practice and care. They are able to implement new healthcare strategies, influence healthcare policies, initiate healthcare research and projects, and act in expanded communication liaison roles such as between medical device companies and pharmaceutical companies.
An MSN is geared towards nurses who are looking to specialize clinically, while a DNP is geared toward nurses seeking leadership positions that incorporate a more systematic approach to care that can expand beyond the bedside.
Prerequisites for a DNP are the same as for an MSN. Note that a DNP replaces an MSN, hence an MSN is not required for a DNP program. However, with an MSN the program is 2 years, and without, the program is 3-4 years. There are also 2-year accelerated DNP programs without a master’s degree available.
While the DNP and the MSN may seem almost interchangeable, there are some key distinctions. An MSN is geared towards nurses who are looking to specialize clinically, while a DNP is geared toward nurses seeking leadership positions that incorporate a more systematic approach to care that can expand beyond the bedside. The baseline salaries for nurses with both degrees are the same. As currently no advanced specialties require a DNP, most of the same options are open to nurses with either degree.
Matching education to nurse specialization
Read on to learn about nursing types and specializations so that your choice of degree aligns with your career goal. This list is compiled based on the amount of education required, starting with the least time spent studying.
Certified nursing assistant (CAN)
A CNA is an entry-level position that functions as a steppingstone to other healthcare professions. CNAs help patients with direct healthcare needs, often under the supervision of a nurse. They work directly with patients and nurses, and assist in the many physical and complex tasks related to patient care. Responsibilities include:
- turning or moving patients
- gathering medical supplies
- bathing and grooming patients
- feeding patients
- documentation of food and liquid intake
- checking vital signs such as blood pressure and heart rate
- answering patient calls
- documenting information
- cleaning rooms and bed linens
- stocking supplies
- assisting with some medical procedures
- safety procedures
- transporting patients
- taking care of wounds
CNAs can work at hospitals, long-term residential facilities, nursing homes, rehabilitation centers, adult daycare centers, and sometimes clinical facilities.
Educational requirements for CNAs vary by state, but often include a 4-8 week state-approved training program. This program covers caring for patients, basic medical skills, and important ethical and moral considerations. The program often incorporates hands-on skill elements to prepare students to work with actual patients. The certification can include a written or oral exam, as well as a demonstration exam where students show their ability to perform certain tasks. This exam is called the National Nurse Aide Assessment Program (NNAAP).
This may be the right choice if you want to get a taste of nursing to ensure that you enjoy patient care before becoming a registered nurse. It is also a great experience to add to a professional resume when applying to further nursing positions. It functions as a steppingstone toward a career in nursing or other healthcare areas, while providing the opportunity to interact with patients and practice care while under supervision. CNAs are paid by the hour, rather than being on a salary.
Licensed practical nurse (LPN)
LPNs are also known as licensed vocational nurses. LPNs graduate with either a diploma in nursing or an ADN. To become licensed, they must pass the NCLEX-PN exam. LPNs must be supervised by a registered nurse to provide care. Typically, they focus on providing basic nursing care such as checking vital signs, inserting catheters, and comforting patients. LPNs often do not specialize, instead working in long-term care centers, outpatient clinics, or medical-surgical units at a hospital.
Becoming an LPN may be ideal if you prefer working closely with others under supervision, if you are inclined towards any of the areas of practice listed above, or if you want to start practicing as soon as possible with the least amount of certification. Also, if you are pursuing nursing as a second career, this could be a great place to start.
Registered nurse (RN)
The most chosen field in nursing, RNs graduate with either an ADN or BSN. To become licensed, they must pass the NCLEX-RN which is similar to the NCLEX-PN, but with a stronger concentration on knowledge of medication and medical conditions, rather than clinical care.
The Institute of Medicine currently recommends that 80% of the nursing workforce have a BSN degree.
The scope of RN responsibilities includes administering medications, determining nursing diagnoses, and providing extensive patient education. RNs often pursue a specialty area and are found in settings such as emergency rooms, critical care units, and psychiatric hospitals. The Institute of Medicine currently recommends that 80% of the nursing workforce have a BSN degree. Some states, including New York State, have a law in place that stipulates that all nurses earn a BSN within 10 years of receiving their RN license.
Deciding to become a RN can appeal if you prefer independent work in a team structure without direct supervision, are interested in medication administration, and want the possibility to specialize. With the changing standards in nursing, it can also ensure that your position will be secure, and no further education will be required.
Advanced practice registered nurse (APRN)
The next progressive step is to become an APRN. These nurses graduate with either an MSN or DNP. The scope of practice is the broadest for APRNs, and includes the assessment, diagnosis, and treatment of medical conditions. APRNs can prescribe medication, order and interpret diagnostic exams such as blood work and MRIs. They can open their own practice, and generally earn a higher salary.
There are 4 types of APRNS specializing in certain patient population such as pediatrics, geriatrics, neonatal, or mental health:
1. Nurse Practitioner (NP)
Although NPs can practice in any field, they are required to specialize in a patient population yet retain the option to subspecialize. Some specialties include adult-gerontology acute care, adult-gerontology primary care, family, neonatal, women’s health-gender related, pediatric primary care, pediatric acute care, psychiatric mental health, dermatology, oncology, emergency, palliative care, and orthopedics. They have virtually the same capabilities and independence as medical doctors, aside from the restrictions on performing surgery. They hold the highest distinction in the field of nursing.
2. Nurse Midwife (CNM)
Nurse midwives deliver infants, provide prenatal and postpartum care, newborn care, and some routine care (such as gynecological exams) for women. Similar to a women’s health nurse practitioner, yet CNMs are more involved in childbirth and the processes surrounding it.
3. Nurse Anesthetist (CRNA)
Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. There is a national certification examination for this specialty, and recertification is required on a biennial basis.
4. Clinical Nurse Specialist (CNS)
Clinical nurse specialists are expert clinicians with advanced education and training in a specialized area of nursing practice. They work in a wide variety of healthcare settings. They can work in the same fields as RNs, and provide diagnosis, treatment, and ongoing management of patients. They also provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout the organization, and ensure the use of best practices and evidence-based care to achieve the best possible patient outcomes. They often function as shift managers and are the go-to for inquiries and supervision of other nurses, especially LPNs.
With these guidelines outlining the degrees and specific careers involved in the field of nursing, you will be better informed and prepared to decide which one is right for you. Regardless of your choice, there is always room for advancement to the next level as nursing opens up a world of possibilities to care for patients and make a valuable impact on the world.