IF YOU ARE FASCINATED by the art and science of providing quality health care and feel compassion for individuals who suffer from health problems, a career as a nurse may be a great fit for you.
There are multiple academic pathways into the nursing profession, "which is both a good thing and something that does cause lots of confusion," says Stephen Ferrara, associate dean of clinical affairs and an associate professor of nursing with the Columbia University School of Nursing.
Kelly Jo Wilson, a transplant quality nurse with the University of Pittsburgh Medical Center who is also an adjunct faculty member at Carlow University in Pittsburgh, notes that nursing is a profession where someone's job prospects are influenced by the type of license he or she has.
"Nursing is a profession that requires licensing; therefore, the initial prospects are determined by the type of license," Wilson wrote in an email.
A nurse with a registered nurse license can assess and treat patients, and has more independence and autonomy than a nurse with a more limited nursing license, such as a licensed practical nurse or licensed vocational nurse.
Practical and vocational nurses work as part of a health care team, providing assistance to other more highly trained health care providers. They need only about a year of training via an accredited nursing certificate program, while training for an RN license typically takes longer.
Christina Le, the chief nursing officer at Wound Care Advantage, a company that provides management and consulting services to outpatient wound care centers, describes the LPN and LVN licenses as "entry-level" nursing credentials.
A job as an LPN or LVN "can be a good start for those who would like to test out the nursing profession if they are unsure," Le wrote in an email.
Wilson notes that an RN credential opens the door to a greater variety of nursing jobs than an LPN or LVN license.
"Registered nurses have a license that provides opportunities in a vast array of specialties," she says. "Often RNs start in the hospital, where they can develop their skills while working three 12-hour shifts. Licensed practical nurses have limitations on their licenses and often work in nursing homes, home health, or doctor’s offices."
There are multiple viable approaches to qualifying for an RN license, nursing experts say.
Catherine Burger, an RN who is a media and brand specialist for RegisteredNursing.org, notes that a few schools offer a diploma in nursing rather than an associate's or bachelor's degree. Diploma programs can help prepare students to pass NCLEX-RN, the national licensing exam for registered nurses, Burger says.
Another possibility is to pursue an associate's or bachelor's degree in nursing, either of which can provide preparation for the NCLEX-RN.
"An Associate Degree in Nursing (ADN) can typically be completed in 2-3 years and is offered at many junior or community colleges where the focus of the degree is on nursing skills," Burger wrote in an email. "A Bachelor of Science in Nursing (BSN) includes the skill training of the ADN and adds leadership training along with the other courses completed in a bachelor's program."
Ferrara, executive director of The Nurse Practitioner Association New York State – a nonprofit organization that supports high-standard health care delivery by empowering nursing professionals – recommends that aspiring nurses start their journey by pursuing a bachelor of science degree in nursing. He says that BSN programs provide the technical expertise necessary to become a registered nurse, plus additional professional development such as training in appropriate patient management.
There are also direct-entry master of science in nursing, or MSN, programs designed for individuals who have an undergraduate degree in a non-nursing field but who wish to become nurses.
Plus, nurses who already have RN credentials can build on them by pursuing graduate education. The additional training could enable them to become advanced practice registered nurses, or ARPNs – nurse practitioners, nurse anesthetists and nurse midwives – who are able to write prescriptions.
Graig Straus, a nurse practitioner and president of Rockland Urgent Care clinic in New York, says he chose to pursue advanced practice nursing after working as an RN and LPN because he wanted to do more for his patients. Straus has associate's, bachelor's and master's degrees in nursing and is pursuing a doctorate in the field.
"I wanted to take the next step and become a provider and advocate for my patients," he says. "And the way to do that, I felt, was to become a nurse practitioner."
A master's or doctorate is typically necessary to qualify for an advanced-practice registered nursing certification within a particular nursing specialty area such as pediatrics or geriatrics.
In fact, there are multiple kinds of nursing graduate degrees, including master's degrees and several types of nursing doctorates: Doctor of Nursing Practice, or DNP; Doctor of Nursing Science, or DNS; and Ph.D. degrees.
The DNP is a clinical practice doctorate that aims to teach a nurse how to provide the best possible care to patients, whereas the DNS and Ph.D. are designed to teach future nurse scholars how to conduct influential research.
"Because pre-licensure (undergraduate) education in the U.S. prepares nurse generalists, specialization into advanced clinical, leadership, or educational roles happens at the graduate level," Darrell Spurlock Jr., a professor in the Ph.D. in nursing program at Widener University School of Nursing in Pennsylvania, wrote in an email.
"So, a nurse wishing to become a Family Nurse Practitioner (FNP) will need to complete a MSN or DNP program with a focus in that area," notes Spurlock, who also directs Widener's Leadership Center for Nursing Education Research.
The credentials necessary for a fulfilling nursing career depend partly on the job market where an aspiring nurse wishes to practice, Spurlock says.
"In the more populated, urban areas of the country, the BSN degree has become the standard for hiring new graduate nurses – even in acute care hospital settings," he says. "Many hospitals are hiring experienced nurses who lack a BSN but stipulate that the BSN must be completed within a number of years after hire. In areas of the country with a stronger shortage of nurses or in rural areas, the ADN degree may be an acceptable credential for new nurses."
"The best advice," Spurlock concludes, "is to assess the local job market by speaking with nurses working in the area and by looking at job listings for nurses to see what the requirements are."