March Forward in your Nursing Career

Florence Nightingale proposed that nursing practice involved being in “charge of the personal health of somebody…to put the patient in the best condition for nature to act upon him.” Nursing has evolved into a multi-layered profession since Nightingale wrote these words.  Any career path development requires an understanding of how these layers fit with one another.

LPN/VN:  The National Council of State Board of Nursing (NCSBN) defines a Licensed Practical or Vocational Nurse as ”an individual who has completed a state-approved practical/vocational nursing program, passed the NCLEX-PN® exam, and is licensed by a state board of nursing to provide patient care.” This front line nursing care provider works under the supervision of a RN, Advanced Practice Registered Nurse (or APRN), or physician.  The position is hands-on patient care oriented with some medication delivery involved. The educational program ranges between 75-150 hours of class and practice time.  The average salary is $40,380 per year (or $19.42 per hour) according to the Bureau of Labor and Statistics.

RN:  The NCSBN defines the registered nurse (R.N.) as “an individual who has graduated from a state approved school of nursing, passed the NCLEX-RN® exam and is licensed by a state board of nursing to provide patient care.” There are three educational pathways to achieving this level of nursing licensure:  Diploma, Associate degree, or a Baccalaureate degree. Salaries for a starting R.N. vary significantly based on location within the country.  According to the Bureau of Labor and Statistics, the average annual salary for an RN is $64,690, which is $31.10 per hour.  Most starting salaries do not adjust for educational level.  Let’s look at ways to achieve an R.N.:

1. Diploma Program:  There are fewer than 100 diploma programs left in the US at this time.  This two-to-three year-long program is most often housed in an acute care facility.  The general education requirements are commonly completed at a nearby educational system.
2. Associate Degree (ADN): This is a 2-year degree nursing program.  This program commonly has a more technical nursing focus and is housed within community college systems.  This program can be used as a stepping stone toward a BSN or can be the completion of a nurse’s education.  If a nurse would like to progress to an advanced practice degree the ADN or Diploma would not be accepted; a BSN would need to be completed either separately or within the masters’ program.
3. Baccalaureate Degree: This is a 4-5 year nursing program.  It is most commonly housed within colleges and universities. This degree is considered by some to be the best entry level into nursing practice and is the stepping stone to any advanced practice position.

Advanced Practice Nurse (APRN):  An advanced practice nurse is defined by the NCSBN as “an R.N. who has a graduate degree and advanced knowledge.” There are four categories of advanced practice nurses: certified nurse practitioners, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists.  Some education programs—typically CNRA programs—require a GRE before acceptance, and some programs require a minimum number of years of practice before admittance.  Let’s take a closer look at these four specialties…

1. Certified Nurse Practitioners come in many varieties:  family, pediatric, mental health and geriatric to name a few.  They have increased their exposure to the general population since 1960 mainly because of the shortage of family physicians. The NPs in most states practice collaboratively with a physician.  Their scope of practice is defined by each state, but overall allows for diagnosis, treatment, prescriptive authority, and autonomous billing.  In many areas of the country underserved by the medical community these primary health care practitioners are the first line of care. The length of the educational program varies across the country but the average is one to two years full time. The average starting salary according to AACN is $60-90,000/year.
2. Clinical Nurse Specialists can be found on acute floors, and in geriatric, pediatric, adult health, and transplant units, to name a few. These specialists are advanced practice nurses who are clinical experts in a specialty area.  They are most commonly found in hospital and care facilities.  They bridge the gap between evidenced-based practice research and bedside care.  Commonly nurse specialty master’s programs last 18-24 months full time and require a minimum number of years in practice.  The average starting salary is $73,000 according to salary.com.
3. Certified Nurse Midwives care for women across their lifespan, but the biggest part of the midwives’ care is holistic natural delivery of babies.  The length of schooling varies with each program, and a nurse can begin without a master’s in some programs.  At the completion of the program a nurse will achieve a doctorate or masters ranking depending on the program.  The average salary for a CNM is $90,000/year according to AACN.
4. Certified Register Nurse Anesthetist:  According to the American Association of Nurse Anesthetists this group of advanced practice nurses is the oldest specialty nurses’ group, and has been in existence since 1877. The responsibility of the nurse anesthetist is the management of pain and anesthesia in varied settings. In some states they have autonomous practice, and in others they practice in collaboration with an anesthesiologist. Prior acute care experience is required, and the length of schooling is 24-36 months according to allnurses.com. The starting salary quoted on the Anesthesia Zone  website is $110,000/year.

There are other master’s tracks that can be completed in many institutions across the country. These additional advanced nursing degrees can also lead to dual degrees in education (M.Ed.) or business (MBA).   Specialties for these other advanced degrees are nursing education, nursing administration, and public health.

The final level of nursing programs consists of what are known as terminal degrees.  Recently, there has been much discussion about the state of terminal degrees for nursing. The current climate is focused on bringing all terminal degrees in nursing under two categories:  the Ph.D. in Nursing and the DNP.

1. Ph.D. in Nursing:   Advanced practice nurses with this degree will primarily focus on research to establish best practices in varied and creative areas of nursing.  These positions are most commonly found in higher education institutions. The length of the program is dependent on the education level of the nurse, but averages 2 years.
2. DNP in Nursing: This is the terminal degree for practice nurses.  DNPs also do research, but are mainly working as faculty using the global understanding of the profession along with research to put into practice the evidence-based research.  The length of a program depends on the level of education the nurse brings to the program, but is usually between 1-3 years full time.

How far we’ve come since the days of Florence Nightingale!  The listing of degrees above highlights broad descriptions of nursing education levels.  The beauty of a nursing career is that it has the ability to evolve to combine and create tracks that meet clients’ needs, global health care needs, and our needs as nurses who strive for the ultimate in professional fulfillment.