Nursing certificates and pathways
The traditional path to becoming a registered nurse (RN) is a 4-year university degree. Many variations exist, but the bachelor’s degree provides a solid foundation for those who want to practice nursing. It can also lead to eventual advancement in the healthcare field.
Salary and duties vary based on the type of position and certification you have. There are many specialties and subspecialties within the field of nursing. An RN may rotate between several departments, whereas an obstetrics and gynecology nurse (OBGYN) would work exclusively in their specific department.
Degree options exist for those who wish to extend their current education level or use their degree to get certified in a specific area of healthcare. A nursing certificate might be an option if you didn’t study a nursing-related field in your undergraduate education.
There are also undergraduate and graduate options that can supplement your current certifications. Staying up to date with industry standards is vital in healthcare, and professionals must regularly renew their certificates.
Basic types of nursing education
There are many certifications available in this field. Here we describe the most common positions and titles. We’ll start from the most basic nursing certificate and work our way up to advanced degrees. The necessary privileges for each certification are universal in their region.
Certified Nursing Assistant (CNA) – Vocational schools, community colleges, and some medical facilities provide the necessary training and coursework to become a CNA. Some programs can be completed in a matter of months. This is also called a vocational nursing certificate.
Nursing assistants, or techs, can assist RNs and LPNs with daily tasks. This may include taking patients’ vitals, recording medical information, and changing wound dressings.
Licensed Practical Nurse (LPN) – A licensed practical nurse can take the National Council Licensure Examination, known commonly as NCLEX-PN, after meeting the eligibility requirements and registering for the exam. Most LPN programs take up to 1 year to complete. After completing the program and passing the NCLEX-PN, you’ll be ready to start nursing.
Registered Nurse (RN) – A registered nurse has at least a 2-year associate’s degree in nursing and has passed the board certification exam. The American Nurses Credentialing Center provides the NCLEX-RN for those who wish to become registered nurses.
Practical nursing vs. registered nursing
The designations practical and registered connote the professional and educational background of nurses. Licensed practical nurses generally have less formal education in nursing and fewer analytical responsibilities on the job than registered nurses.
This doesn’t mean that LPNs don’t have many duties. They can administer medication, chart medical records, and take vital signs in many cases. Still, they will need to report to an RN when there are significant changes in a patient’s status.
Another significant difference between RNs and LPNs is their work settings. Many LPNs work in long-term care facilities, whereas the majority of RNs work in hospitals. RNs have a host of decisions to make, while LPNs focus on practical tasks. Both RNs and LPNs support the medical team in their facility. Registered nurses often have a 4-year degree and work in general or private hospitals. LPNs generally have up to a year of formal education and a certificate to practice nursing.
Associate’s degree in nursing (ADN)
This 2-year degree allows its holders to apply for the NCLEX-RN or NCLEX-PN after meeting the eligibility requirements. These programs generally cost between $12,000 and $35,000. The candidate can practice as a nurse after passing one of these national exams.
The associate’s degree program covers the general knowledge that students need to know to pass the national exam and practice nursing. Prerequisites include courses like microbiology, chemistry, psychology, anatomy and physiology, and statistics. Most associate’s programs include foundations in nursing, pharmacology, behavioral health, and related courses. They will provide the foundational knowledge students need to enter the field.
This degree doesn’t cover advanced nursing methodologies or research-intensive courses. The associate’s degree is the minimum amount of education required to take the NCLEX in most cases. You should have an officially accredited degree for your education to be recognized by employers.
Bachelor of science in nursing (BSN)
The BSN is a staple degree that provides students with a specialized 4-year qualification. These programs vary greatly in price, costing between $25,000-$100,000 depending on the school. Each focuses on the scientific principles and fields behind nursing, including chemistry, biology, and fundamental analytical skills.
The prerequisites for entering into a BSN program include chemistry, anatomy/physiology, and psychology. Each program has its own GPA and SAT/ACT requirements and prerequisites.
BSN courses feature topics ranging from research methodology and anatomy, mental health nursing, and nursing leadership. Fundamentals in nursing are also a vital component of BSN programs.
Candidates with a high school diploma can expect to complete the program in 4 years. Clinical rounds, labs, and internship opportunities are often an integral part of these programs.
The BSN is designed to give candidates the necessary practical and theoretical knowledge to practice safely and effectively. It’s a general degree with a focus on research and practice.
Clinical practicum and internship
The practicum or internship portion of the BSN allows students to use the knowledge they acquire in the classroom in a practical setting. The practicum or internship may take different forms depending on the program and its requirements.
Both practicums and internships involve logging hours to complete academic coursework requirements. The number of hours varies by program, but many require between 50-60 credits hours.
The majority of internships/practicums are unpaid, but some internships are paid. Salary is at the discretion of the employer.
Another key difference is that practicums focus more on academic knowledge and application of that knowledge, whereas internships are like a part-time job.
Additionally, internships include more autonomy, and practicums require more supervision from a faculty member or team leader. That means your role in a practicum will be mostly support, whereas you’ll have more independence with an internship.
Practicums involve job-shadowing with professionals in the field to gain an understanding of the practical aspects of the work. An internship may encompass more duties and higher responsibility than a practicum, but both focus on the practical application of coursework in the field.
Generally, LPNs doing a bridge program can complete practicum hours at their local hospital or workplace. Bridge programs provide an opportunity for practicing nurses to further their education and position in the field.
Clinical practice hours will often include lab simulations. Many courses in the nursing curriculum include labs. Tasks vary depending on the course that the lab accompanies. Some involve dissection and practical skills that are essential to nursing. Others, like chemistry, involve measurement and observation.
Regardless of background and education, all nurses must pass the NCLEX-RN or the NCLEX-PN to practice as a registered nurse or licensed practical nurse in the U.S.
The National Council of State Boards of Nursing administers these national board examinations.
NCLEX-PN and NCLEX-RN
The NCLEX (National Council Licensure Examination) is the national exam that certifies individuals to practice as a nurse. The exam consists of 75-145 graded items. It holistically tests an individual’s nursing knowledge and abilities with a customized test content plan based on the candidate’s aptitude and the jurisdiction they are testing in.
The NCLEX-RN, the exam for becoming a registered nurse, consists of 75-145 graded items and 15 pretest questions from 4 content categories that pertain to the overarching framework of client needs:
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial integrity
- Physiological integrity
The categories of “Safe and Effective Care Environment” and “Physiological Integrity” include 6 subcategories as follows:
- Management of care
- Safety and infection control
- Basic care and comfort
- Pharmacological and parenteral therapies
- Reduction of risk potential
- Physiological adaptation
The NCLEX-PN, for those who want to be practical nurses, includes 75-145 graded items from the same client needs categories listed above. It also has 15 pretest questions.
The test utilizes computerized adaptive testing (CAT) methods to deliver a personalized exam to each candidate. It uses computer technology and measurement theory to automatically adjust each item to the candidate’s ability as the test progresses. Due to its relatively strict eligibility requirements, the NCLEX has a high pass rate of over 80% for first-time testers.
You will receive an authorization to test (ATT) email after registering for the NCLEX and are deemed eligible. An NCLEX registration is valid for 365 days. You can take the exam at certified testing location centers.
Many nursing students pursue financial aid to assist them with the expenses of higher education. Visit the Federal Student Aid website to find general information about the different types of financial support available to students in the U.S. On this website, you can complete the FAFSA form, which is a free online application form for federal financial support for students. Eligible students generally have a reply to their application within a few weeks that indicates whether they have been approved and, if so, the amount of aid they will receive.
Graduate and post-graduate education
A master’s program continues to add to the knowledge you acquired in your undergraduate program, and expands the skills and qualities needed to be an effective educator
Master’s of science in nursing (MSN)
A master’s in nursing opens up a wide range of opportunities for those willing to work on multidisciplinary teams. There are many specializations and focus areas for this degree. Various programs provide it as a bridge degree.
You can use an MSN to expand your work as an RN in a number of departments such as urgent care, obstetrics and gynecology, surgery, recovery unit, and long-term care. Leadership positions on nursing teams and in-hospital management are also a possibility with this degree.
Bridge programs are common and prevalent among nursing degrees. They are an efficient way for experienced healthcare professionals to continue learning and to stay up to date.
They utilize the knowledge and skills that students gain in one program to facilitate their advancement and placement in additional programs. Students who wish to study a specialty in nursing often enroll in bridge programs that “bridge” their knowledge and education from one degree to the next (BSN to MSN or Associate’s in Nursing to BSN).
The BSN to MSN provides a path for registered RNs with a bachelor’s degree to specialize and advance their career by learning new skills and participating in research.
Dual degree programs
Dual master’s degrees are increasingly common and offer students a chance to specialize in several areas at once. They increase a candidate’s competitiveness for administrative roles in healthcare. Many schools offer variations on these dual degrees.
Common dual degree programs include the MSN/MHA (master’s of healthcare administration), MSN/MPH (master’s of public health), and MSN/MBA (master’s in business administration).
Doctor of nursing practice (DNP)
Prerequisites and time to completion for a DNP degree vary widely by school and student. A BSN is a common prerequisite. Like most degrees in the field, there are many options, including hybrid, online, full-time, and part-time. A focus on research and clinical practice is prevalent in most programs.
With a DNP, many specialties and professional positions are available. Executive leadership positions such as team lead, clinic manager, and director of nursing are possibilities. A position as a team leader would require that the DNP give orders to RNs and unlicensed assistive personnel (UAP) in the department. Nationwide, high-level positions are growing. There’s a need for advanced healthcare professionals with specialties in family care, mental health, and life-long care.
The DNP has duties similar to those of medical doctors and works in many different settings. They may work in:
- Acute care facilities
- Retirement homes
While DNPs can work in the clinical and hospital settings, they can also use their knowledge and experience to teach courses and colleagues. Education is one of the most critical aspects of healthcare.
The DNP does focus more on practice than teaching and education. DNPs typically take positions in hospitals or clinic management.
A Ph.D. in nursing
This doctorate program focuses on research and teaching. This route is for candidates who wish to further their education while advancing in the field. Those who wish to conduct research and teach nursing should apply.
As these programs are usually research and teaching focused, students should have a desire to participate in research or teach after receiving the degree. A Ph.D. in nursing generally takes up to 3-4 years to complete.
Special topics include substance and abuse disorders, nursing practice, and healthcare and medication management. The scope of nursing research is broad, but Ph.D. candidates are expected to research specific topics like, for example, measurement outcomes in nursing, comparison of rural/urban pressure ulcers and fall rates, or multigenerational challenges. Research should address an important question in the field of nursing.
In addition to the NCLEX examination, which certifies nurses to practice, the American Nursing Association (ANA) provides a host of specialty certifications. Eligibility and renewal requirements vary by specialty and state. Most certifications are valid for 5 years and can be renewed after this period. Candidates have to apply to the nursing regulatory body (NRB) in the region they plan to practice and pass the relevant exams. Not every state requires continuing education, but many do.
Here is a list of some certified specialties available on the ANA website.
- Psychiatric-mental health nursing
- Psychiatric-mental health nurse practitioner, across the lifespan
- Pediatric nursing
- Pain management nursing
- Nursing professional development
- Nursing case management
- Nurse executive
- Nurse executive, advanced certification
- National healthcare disaster certification
- Medical-surgical nursing
- Informatics nursing
- Cardiac vascular nursing
- Care coordination and transition management
- Gerontological nursing
- Adult-gerontology acute care nurse practitioner
- Adult-gerontology primary care nurse practitioner
- Adult-gerontology clinical nurse specialist
- Ambulatory care nursing
Nursing career paths
It’s essential to note that not all professionals begin their careers in academia. This is a diverse profession with a wide range of duties and skills. Although not all nurses begin their careers at university, many have secondary education degrees or experience.
If you have experience in the field, it can help you apply for degrees and vice versa. There is no set path to becoming a nurse beside the overarching certification requirements.
As the field of healthcare expands, opportunities in nursing do too. Nurse practitioners have many of the same responsibilities as medical doctors and work together with physicians and other professionals on versatile teams.
Higher education allows nurses to specialize in their field and gives them access to high-paying jobs. In general, higher-level degrees have higher salaries. However, many master’s dual degree programs give candidates a chance to earn as much as those with a doctorate.