Nationally, nursing is one of the most secure jobs with a high potential for growth. The US Department of Labor reports that in the decade leading up to 2028, the number of RN job openings is projected to increase by 12%; “much faster than the average for all occupations.” That works out to approximately 210,400 job openings every year over that period.
A career in nursing is a natural home for good people motivated to care for others and improve quality of life. Job security, a comfortable salary, and the opportunity for advancement are additional attractive perks that come with the territory. In 2019 the US Department of Labor reported the average annual salary for nurses was $77,460.
While it’s a common perception that nurses work in hospitals, there are also many opportunities for nurses in home health care, nationally with the federal government, and also notably in education. Nurses actually work in a wide range of environments. In 2019 the US Department of Labor reported there were nearly three million nurses employed across America, with most working in the following sectors :
Just looking at the statistics on paper makes it clear that nursing is a great career choice. However unlike many other higher paying jobs, it can be emotionally fulfilling as well.
Becoming a nurse requires a college education and passing exams to earn the desired nursing credential. In a 2019 article, “Building a Career, One Academic Step at a Time,” the New York Times’ John Hanc details the process of advancing as a nurse and how it happens incrementally. The requisite academic degrees and work experience are stackable; they shape and build a career that happens “…one credential, one academic building block at a time.”
Those steps generally progress as follows, and will be detailed below. Each additional level typically requires more education. Work experience can be beneficial but it’s not a requirement to enter the field at any specific educational point:.
- Licensed Practical Nurse (LPN) – requires some academic training, from months to over a year, at or below the associate’s degree level, often in the form of a certificate.
- Registered Nurse (RN) – requires at least a nursing diploma or associate’s degree in nursing (ADN). There’s an ongoing push to make a bachelor’s of science in nursing (BSN) degree a minimum requirement for nurses in the future.
- Professional nurses like executives and managers – requires an RN license and employers typically prefer candidates with related bachelor’s and graduate degrees
- Advanced practice nursing (APRN or APN) – requires an RN license and a relevant graduate degree or graduate certificate in one of the four recognized APRN fields
- Nurse practitioner (NP)
- Clinical nurse specialist (CNS)
- Nurse midwife
- Nurse anesthetist (CNS)
Each state has enshrined into law its own specific licensing requirements for nurses. These include passing the National Council Licensure Examination (NCLEX), and being eligible for the NCLEX means completing an education program from a recognized provider. State-specific Board of Nursing information on licensing and approved schools can be found through your state’s own Board/Department of Nursing.
How to Become a Licensed Practical Nurse (LPN)
Licensed practical nurses (LPNs) are often defined in contrast to registered nurses (RNs) as carrying out nursing duties that require less skill. As a result LPNs often work in skilled nursing facilities and other locations that require general care, as opposed to the more specialized care you might find in an ICU or specialized hospital.
If you plan to work while you study, starting out as an LPN is a great way to get your foot in the door.
LPNs need less education than RNs, such as completion of a one-year certificate program at a community college or vocational school. As with all levels of nursing education, the school where you complete your LPN education must be approved by your state’s Board of Nursing.
Once you’ve fulfilled your state’s LPN education requirements you can apply to take the National Council Licensure Examination for LPNs, the NCLEX-PN. This exam is developed and administered by the National Council of State Boards of Nursing (NCSBN).
The NCLEX-PN takes up to four hours to complete, is offered on a computer, is mostly multiple-choice, and ranges from 60 to 130 items.
Once you pass the NCLEX-PN you can receive your LPN license from your state’s Board of Nursing. This agency will often maintain an online database of licensed LPNs, and once you have your license you can officially launch into your first nursing position.
If you’re already working in a healthcare facility there’s a good chance you can get some-if-not-all of your LPN education funded by your employer if you agree to sign a permanent contract. Many healthcare employers face pressure to raise their statistics for employee education. Scholarships and loan incentives are also commonly offered by state and local authorities keen to fill healthcare shortages.
How To Become a Registered Nurse (RN)
Registered nurses (RNs) are the backbone of our healthcare system. According to the US Department of Labor, RNs “provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families.”
RNs assess patient conditions, operate and monitor medical equipment, administer medications and treatment, help perform diagnostic tests, and much much more.
Becoming an RN means completing an education program approved by your state’s Board of Nursing that will qualify you to take the National Council Licensure Examination for RNs, the NCLEX-RN. This exam is developed and administered by the National Council of State Boards of Nursing (NCSBN).
Qualifying for the NCLEX-RN means completing a diploma or associate’s degree in nursing (ADN). These are typically two to three-year programs, and you can generally apply any previously-earned LPN education to these requirements. Once you’ve earned the qualifying education you can start the NCLEX-RN registration process with your state’s Board of Nursing.
Like the LPN exam, the NCLEX-RN is taken on a computer, is mostly multiple-choice, ranges from 60 to 130 items, and takes up to four hours to complete.
Once you pass the NCLEX-RN you can complete any final state RN licensing requirements and start applying for RN nursing jobs. If you were previously working as an LPN you’ll find having the RN license opens up many more doors for you into more in-depth and specialized verticals of nursing.
And like an LPN education, you’ll find many employers are willing to underwrite the cost of your nursing education on the condition you sign a permanent contract. That even holds true if you plan to go a step beyond the minimum ADN/diploma requirement and earn a bachelor’s of science in nursing (BSN).
In 2016 the National Academies of Sciences, Engineering, and Medicine published a comprehensive report on the future of nursing. It found our aging baby-boomer population was transforming the demands on our nation’s healthcare system. It made key recommendations on how it believed nursing education must rise to the occasion and meet those demands. One of those recommendations was to, “Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.”
In response, industry as well as state legislatures are implementing regulations that incentivize a BSN as the norm for nurses going into the future. And even where not a de-facto requirement, having a BSN can open more career doors and opportunities for advancement.
Nurse Managers, Nurse Executives, and Nurse Educators
As you develop more skills, experience, and education the nursing career pathway of advancement can diverge, with one road going towards more technical practitioner expertise and the other towards more of a management and professional route.
This latter branch is where professionals like nurse managers, nurse executives, and nurse educators come into focus. These are careers that are less the purview of a State Board of Nursing than they are of professional-class standards. While there are no requisite exams to pass, the job market for professional-class nurses is as competitive as it is lucrative.
Business support services and the federal executive branch are the top-two industries for offering the highest average salary to nurses in the nation according to the US Department of Labor, at $92,200 and $90,340 per year, respectively.
Universities realize how important it is for professional nurses to have an edge over their competition, which is why they offer specialized bachelor’s, master’s, and doctoral programs catering to nurse managers, nurse executives, and other professional-class nurses.
When it comes to teaching –and right now nurse educators are sorely needed– generally nurses must have at least a master’s degree in their field. In fact, there is such a demand for nursing professors that a study by the American Association of Colleges of Nursing (AACN) found, “U.S. nursing schools turned away 75,029 qualified applicants from baccalaureate and graduate nursing programs in 2018,” due in significant part to the nursing teacher shortage.
How to Become an Advanced Practice Registered Nurse (APRN/APN)
Demographers have known for decades about the so-called “2030 problem.” This refers to the imminent bottleneck in our healthcare system as the baby-boomer generation becomes elderly and requires more medical services.
Right now there are over 113,000 family and general practitioner physicians working in the United States, along with nearly three million RNs. In 2019 the American Association of Nurse Practitioners reported the following:“In the next 10 years, the number of seniors living out their golden years will nearly double from 37 million to 71 million people. Beginning in 2030, one out of every five people will be a senior, and for the first time ever, older people will outnumber children.”
Because of prescient demographic forecasting the healthcare field has been preparing for the shortage of doctors for decades to ensure that basic demands are met. Advanced practice registered nurses (APRNs or APNs) are on the front lines of this strategy.
APRNs get advanced levels of training at the master’s or doctoral level of education so they can step in to medical scenarios that were strictly a physician’s territory in decades past. Today this is commonly in the form of a master’s of science in nursing (MSN), a post-master’s certificate, or a doctor of nursing practice (DNP). Because APRNs represent the long-term future of nursing, many educational programs today offer MSN and DNP entry options for nurses with ADNs and BSNs. An MSN is the minimum education requirement to become an APRN.
APRN education is highly specialized and requires passing exams sponsored by national organizations. And those national certification organizations only recognize education programs from schools accredited by specific organizations.
The following are the four main categories of APRNs. Their roles and scopes of practice are set by each state’s Board of Nursing:
- Nurse practitioner (NP)
- Clinical nurse specialist (CNS)
- Nurse midwife
- Nurse anesthetist
APRN national certification exams are sponsored by different national organizations. When you apply for licensure in your state as an APRN, your state’s Board of Nursing will want to see that you’ve earned the appropriate national certification.
Of all APRNs, nurse practitioners can specialize in the widest varieties of fields:
- Family nurse practitioner (ANCC, AANPCP)
- Women’s health nurse practitioner (NCC)
- Adult-gerontology acute care nurse practitioner (ANCC, AACN)
- Adult-gerontology primary care nurse practitioner (ANCC, AANPCP)
- Psychiatric mental health nurse practitioner (ANCC)
- Pediatric primary care nurse practitioner (ANCC, PNCB)
- Pediatric acute care nurse practitioner (PNCB)
- Neonatal nurse practitioner (NCC)
There are five national certification boards that certify for the different NP specializations by examination. These are cross-listed above on the NP list to show which boards certify for which NP role:
The licensure and certification process is similar for clinical nurse specialists. CNS roles include:
- Adult-gerontology clinical nurse specialist (ANCC)
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- Adult gerontology acute care clinical nurse specialist (AACN)
- Pediatric acute care clinical nurse specialist (AACN)
- Neonatal acute care clinical nurse specialist (AACN)
Once you’ve earned APRN status you’ll be geared to reach the top of your professional capabilities. The US Department of Labor reports the following as the average national salary in 2019:
- Nurse midwives – $108,810
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- Adult gerontology acute care clinical nurse specialist (AACN)
- Nurse practitioners – $111,840
- Nurse anesthetists – $181,040
Together these three APRN roles are projected to experience a 26% growth rate over the decade leading up to 2028, a rate that’s much faster than the average for all other occupations, according to the US Department of Labor.
Annually that translates to about 16,900 openings for NPs, 3,200 for nurse anesthetists, and 500 for nurse midwives.
Ultimately earning an MSN or DNP requires thousands of hours of investment in work experience and nearly a decade in higher education. As with any rewarding career, it’s the journey that counts. And the journey through a career in nursing is unique.
Advancing through this field allows you to incrementally stack your progressive levels of education on top of each other. As you discover its most interesting niches you’re free to alter the path of your career’s trajectory with advanced education that’s reinforced by your foundation. All the while you’ll find a refreshing feeling of freedom thanks to a field that’s high in demand, that offers a high salary, and that provides plenty of flexibility to boot.
