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Career Guide: Registered Nurse

Career Guide: Registered Nurse

Bureau of Labor Statistics

Training, Other Qualifications, and Advancement

The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s degree program. Individuals then must complete a national licensing examination in order to obtain a nursing license. Further training or education can qualify nurses to work in specialty areas, and may help improve advancement opportunities.

Education and training. There are three major educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2006, 709 nursing programs offered degrees at the bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 850 RN programs granted associate degrees. Diploma programs, administered in hospitals, last about 3 years. Only about 70 programs offered diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions.

Many RNs with an ADN or diploma later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2006, there were 629 RN-to-BSN programs in the United States. Accelerated master’s degree in nursing (MSN) programs also are available by combining 1 year of an accelerated BSN program with 2 years of graduate study. In 2006, there were 149 RN-to-MSN programs.

Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2006, 197 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor’s or higher degree in another field.

Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN or MSN program because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with a bachelor’s or master’s degree. A bachelor’s degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, and teaching, and all four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Individuals who complete a bachelor’s receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing care becomes more complex. Additionally, bachelor’s degree programs offer more clinical experience in nonhospital settings. Education beyond a bachelor’s degree can also help students looking to enter certain fields or increase advancement opportunities. In 2006, 448 nursing schools offered master’s degrees, 108 offered doctoral degrees, and 58 offered accelerated BSN-to-doctoral programs.

All four advanced practice nursing specialties require at least a master’s degree. Most programs include about 2 years of full-time study and require a BSN degree for entry; some programs require at least 1 to 2 years of clinical experience as an RN for admission. In 2006, there were 342 master’s and post-master’s programs offered for nurse practitioners, 230 master’s and post-master’s programs for clinical nurse specialists, 106 programs for nurse anesthetists, and 39 programs for nurse-midwives.

All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other health care facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.

Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination or by the endorsement of a license issued by another State. The Nurse Licensure Compact Agreement allows a nurse who is licensed and permanently resides in one of the member States to practice in the other member States without obtaining additional licensure. In 2006, 20 states were members of the Compact, while 2 more were pending membership. All States require periodic renewal of licenses, which may require continuing education.

Certification is common, and sometimes required, for the four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Upon completion of their educational programs, most advanced practice nurses become nationally certified in their area of specialty. Certification also is available in specialty areas for all nurses. In some States, certification in a specialty is required in order to practice that specialty.

Foreign-educated and foreign-born nurses wishing to work in the United States must obtain a work visa. To obtain the visa, nurses must undergo a federal screening program to ensure that their education and licensure are comparable to that of a U.S. educated nurse, that they have proficiency in written and spoken English, and that they have passed either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination or the NCLEX-RN. CGFNS administers the VisaScreen Program. (The Commission is an immigration-neutral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Nurses educated in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom, or foreign-born nurses who were educated in the United States, are exempt from the language proficiency testing. In addition to these national requirements, foreign-born nurses must obtain state licensure in order to practice in the United States. Each State has its own requirements for licensure.

Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.

Advancement. Some RNs start their careers as licensed practical nurses or nursing aides, and then go back to school to receive their RN degree. Most RNs begin as staff nurses in hospitals, and with experience and good performance often move to other settings or are promoted to more responsible positions. In management, nurses can advance from assistant unit manger or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief nurse. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.

Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.


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