Steps to Becoming a Nurse
When you learn how to become a nurse you’ll find the first step is getting a solid education, whether you hope to be an LPN, RN, or administrator. Every state and the District of Columbia require students to graduate from an accredited nursing program in order to become licensed.
Step 1: Choose a nursing path
Nursing can take you in many directions, from starting out as a certified nursing assistant (CNA) or staff nurse to working your way up to nurse administrator.
When choosing your career path, think about the type of work environment you prefer. For example, RNs can be found in hospitals, doctors’ offices,
Because there are so many facets to healthcare, nurses often specialize in certain areas, such as geriatrics or critical care. If you have a passion for a certain type of nursing, consider the type of schooling you’ll need to get there.
That brings us to the next step in becoming a nurse:
Step 2: Earn a degree
The career path you’re interested in pursuing will typically dictate the type of nursing degree you need. Nursing programs include classroom instruction as well as clinical experience. The latter will allow you to gain hands-on knowledge, ask questions in real-life scenarios, and connect with nurses. The experience will also give you the chance to observe how a medical facility runs.
Before choosing a program, determine how nursing school will fit into your busy life. Will you have time to get to campus? Many nursing bachelor’s and master’s degrees can be earned online (with clinical requirements completed in your local community).
An associate’s degree program takes less time to complete, allowing you to enter the workforce sooner. The downside? Employers may be more apt to hire a nurse with a bachelor’s degree because they received a more in-depth education. However, plenty of nurses with ADNs go on to earn higher degrees with the help of tuition reimbursement from their employer.
The following list details the types of nursing degrees available:
- Nursing diplomas are offered at community colleges and vocational schools.
- Associate’s degree in nursing (ADN) can be earned at community colleges.
- Bachelor’s degree in nursing (BSN) are available at colleges and universities.
- Master’s degree in nursing (MSN) are available at colleges and universities.
- Doctoral degrees (DNP, ND,
PhD, DNSc) are available at colleges and universities.
Step 3: Get licensed
Once you complete your education, you’ll need to take an exam to demonstrate your knowledge and nursing skills. Nurses need to be licensed in order to practice, and exams are the prerequisite to licensing. The NCLEX exams, other certification exams, and the topics covered, differ based on your chosen career path.
To become a licensed certified nursing assistant (CNA), you’ll need to pass a state competency exam.
Licensed practical nurses (LPNs) must pass the National Council Licensure Examination (NCLEX-PN).
Nurse practitioners must pass a national certification exam administered by a professional organization, such as the American Nurses Credentialing Center or the American Academy of Nurse Practitioners.
Upon completing their education, nurse midwives should pass the exam administered by the American Midwifery Certification Board (AMCB), while nurse anesthetists must pass the exam given by the National Board of Certification and Recertification for Nurse Anesthetists.
After you become a nurse…
- Continuing education: Nurses are required to complete continuing education courses, usually every two years. Check with your state nursing board for requirements.
- Get certified: If you decide to specialize in a certain area of nursing, consider earning professional certification. This cements your commitment to the field and demonstrates your skill set to employers.
- Earn an advanced degree: Earning a master’s degree will qualify you for a career as a nurse practitioner, clinical nurse specialist, certified nurse midwife, and certified nurse anesthetist.
For the Career Changer: Accelerated BSNs
You want to become a nurse, but your background is in finance. No problem. Not all RNs start out in nursing. Motivated by job dissatisfaction, salary, and other reasons, some RNs choose to head back to school and earn a bachelor’s degree in nursing, but who has the time and money to invest in another 4 years of school? Enter the accelerated BSN.
Accelerated BSNs are designed specifically for students who have already earned a bachelor’s degree in another field.
While you may have to complete certain science and math prerequisites, accelerated BSN students aren’t required to take general education courses again. Instead, the accelerated program (usually about 18 months) focuses solely on nursing skills. Students graduate with a BSN and should be prepared to take the NCLEX-RN.
Career changes within nursing
Nursing is infamously rewarding and challenging at the same time. After years of bedside care, some nurses look for a career switch within the field. Often, going back to school is the way to make a change.
- Specialize: Earning a master’s degree allows you to choose a specialty such as midwifery or informatics. If an MSN isn’t what you’re looking for, enroll in a certificate program, which takes less time to complete. You can choose from a variety of nursing specialties.
- Teach: If you enjoy guiding new nurses in the workplace, you might be a good fit as a nurse educator. Colleges and universities hire nurses who hold a master’s or doctorate to teach nursing courses.
- Research: A Doctor of Nursing Philosophy (
PhD) or Doctor of Nursing Science(DNSc) qualifies you to work in medical research. Your work could help make advances in the nursing profession.
Levels of Nursing
There are few career paths that offer the same opportunities for advancement and career diversity as nursing. A complex healthcare system creates a wide range of options for nurses. And, as more patients look for specialized approaches, nurses can fill this demand by gaining more education, which often equates to a higher salary.
Entry-level nursing offers several career paths. Which one suits your goals?
|Job duties:||CNAs help patients with daily tasks, such as bathing and feeding. They also answer patient calls, clean rooms, and are responsible for recording information and reporting issues to a nurse.|
|Degree needed:||Post-secondary certificate or diploma (4–12 weeks)|
|Median annual salary*:||$28,530|
|Become a CNA if:||You want to join the nursing field quickly and gain valuable on-the-job experience.|
|Job duties:||Under the supervision and instruction of an RN, LPNs—also called licensed vocational nurses in California and Texas—provide patients with basic care, including dressing, changing bandages, and bathing. Some LPNs are permitted to administer medication but this depends on state regulations.|
|Degree needed:||Certificate or diploma (1 year)|
|Median annual salary:||$46,240|
|Become an LPN if:||You want to work in nursing sooner rather than later, but hope to become an RN one day. Many RN degree programs give credit for LPN experience.|
|Job duties:||RNs coordinate patient care, administer medication, assist doctors with exams and surgeries, educate patients, promote wellness, and manage other nurses and LPNs.|
|Degree needed:||Associate’s (2 years) or bachelor’s (4 years)|
|Median annual salary:||$71,730|
|Become an RN if:||You’re interested in a diverse work experience, potential career growth, and further educational opportunities.|
Advanced nursing programs require students to hold a bachelor’s degree before enrolling. Many students earn their BSN from one school and attend a different school for their MSN. However, bridge programs allow students to earn 2 degrees at the same time
|Job duties:||Nurse anesthetists work with patients before, during, and after medical procedures to ensure they’re free of pain. They determine the amount and type of anesthesia needed—general, local, or regional—as well as the method for administering anesthesia.|
|Degree needed:||Master’s degree (2 years)|
|Median annual salary:||$167,950|
|Become a nurse anesthetist if:||You want to work as part of a team under the supervision of doctors, or independently, depending on the laws of your state.|
|Job duties:||Nurse midwives provide prenatal, postpartum, and newborn care. You’ll guide and support women throughout their pregnancy. Nurse midwives also educate women and families about health and wellness. If major complications arise, you’ll refer women to a physician.|
|Degree needed:||Master’s degree (2 years)|
|Median annual salary:||$103,770|
|Become a nurse midwife if:||You want to specialize in healthcare for women and infants.|
|Job duties:||NPs serve as primary care providers to patients of all backgrounds. Nurse practitioners can diagnose illnesses and prescribe medication, but part of the job of an NP is to educate patients about preventative care as well.|
|Degree needed:||Master’s degree (2 years)|
|Median annual salary:||$107,030|
|Become a nurse practitioner if:||You’re interested in providing more comprehensive care to patients.|
|Job duties:||Training other nurses on new technology is just one part of a nursing informatics job. You’ll also spend time on system development, quality control, and finding new ways to use data. Patient confidentiality is key as is efficiency in the workplace.|
|Degree needed:||Bachelor’s (4 years) or master’s (2 years)|
|Median annual salary:||$88,270 for clinical informatics coordinators, as part of the larger group of computer systems analysts|
|Become a nurse informatics specialist if:||You want to combine your tech-savviness with an advanced nursing career.|
|Job duties:||From creating work schedules to managing finances, nurse administrators juggle many responsibilities. You’ll manage the nursing staff, but also analyze service, look for ways to cut costs, and monitor the use of resources.|
|Degree needed:||Bachelor’s (4 years) or master’s (2 years)|
|Median annual salary:||$99,730 for medical and health services managers|
|Become a nurse administrator if:||You want to be instrumental in improving patient care while managing the business side of a medical facility.|
Job Outlook for Nurses
According to the American Nurses Association (ANA), there are more than 4 million registered nurses in the United States. Yet, there’s still room for more.
By 2028, it’s expected the RN workforce will see an increase of 371,000 jobs, according to the U.S. Bureau of Labor Statistics (BLS). When you factor in the number of nurses who will leave the field during this time, there could be more than 1 million job openings by then.
It’s common to hear about America’s nursing shortage, but also be warned the job market is tight. If you’re interested in becoming a nurse, which story should you believe?
The answer isn’t black and white. Here’s a look at the factors that make both scenarios true.
|Positive Factors||Negative Factors|
|More Jobs: Nursing shortages exist in some areas of the country||Less Jobs: Nursing surpluses exist in some parts of the country|
|Spurred by the Affordable Care Act, more patients enter the healthcare system||Employers implement hiring freezes or layoffs due to recession|
|Baby boomers are living longer, in need of care||Nurses delay retirement|
|Specialized nursing is growing||Interview process is rigorous and competitive|
Where should you look for growth? In an ANA 2016 survey, respondents said they see increased opportunities in primary care, public health, nurse education, and advanced practice as drivers of future change in nursing.
Want to make yourself more marketable? Here are a few tips:
- Learn another language: Many hospitals seek out nurses who speak more than English, with Spanish being in the highest demand.
- Get certified: If you have expertise in a specialized area, secure professional certification.
- Be flexible: Be open to working for different employers, even if you have your heart set on one in particular. The experience you gain will be priceless.
How to Find Jobs as a Nurse
You’ve graduated from school. Now, you need to know how to find jobs as a nurse. While you can take the traditional route of sending resumes to employers and hope for a call, there are savvier options that could help you land a nursing job. It’s important to note that new nurses sometimes have difficulty since employers often look for more experienced staff.
In most careers, including nursing, it’s about who you know. Start by joining your local chapter of the American Nurses Association. By attending events held by the chapter, you’ll have an opportunity to meet nurses in your area. Make contacts with others and if there’s a job opening at their workplace, they might think of you first.
Specialized nursing associations, such as the Emergency Nurses Association or the National Association of School Nurses, also have chapters.
Another networking option? Join a registered nurse meetup in your area.
Some states are hit harder by the nursing shorter than others. If you’re not tied to your current location, moving to a state that needs nurses could potentially open doors to job opportunities.
Research shows that certain states will see a shortage in the coming years, while only 2 states are projected to experience a surplus (Massachusetts and South Dakota).
Looking at the shortage by region, the West and the South will be hardest hit.
The military is another avenue nurses can take as they build their career. A few possible job opportunities within the military include critical care nursing, OBGYN nursing, family nurse practitioner, and public health nursing.
As a military nurse on active duty, you may work overseas, on a ship, or on a base. You can also choose to enlist in the reserves. This allows you to continue working at home and only serve when you’re needed.
Concerned about how you’ll pay off your nursing school loans? As a nurse in the military, you may qualify for loan repayment.
Volunteering is another networking opportunity. Giving your time to a healthcare facility not only gives you experience working with patients in a medical environment, but you’ll meet other healthcare professionals.
If you plan to choose a nursing specialty, look for volunteer opportunities in that area. While you won’t be paid for your time, treat the experience as you would a job. Making a good impression could mean a career connection in the future.
When it’s time for you to complete clinical rounds during school, you’ll likely be assigned to a hospital where you’ll shadow a nurse (preceptor). During this period, be an attentive learner and showcase a positive attitude. Make connections with your preceptor and even their managers. If a position opens up, they may be more willing to recommend you for the job.
Once your clinical ends, stay in touch with your preceptors as they may be a good resource for job opportunities.
10 Growing Nursing Specialties
1. Nursing informatics specialist
Nursing informatics gets more attention in today’s technology-obsessed world, but the discipline has been around for several decades. In the 1980s, nurse informatics specialists dreamed of big things:
“We envisioned such things as minimal time spent in documentation, working together with patients to document past history and care received, a lifetime healthcare record, and the use of aggregated data to improve nursing practice.”
“Informatics, we believed, would free nurses and other healthcare professionals to spend more time with patients and minimize the pain of documentation.”
Linda Thede, PhD, RN-BC.
While informatics has certainly changed the nursing landscape, experts say there is more work to be done. As electronic health records and mobile technology become the norm, nurse informatics is a field full of possibilities.
2. Virtual nurse
Nurses have plenty of stories to share about patients treating a health problem based on information they found on the internet. As a virtual nurse, you can provide valid, accurate guidance and care online or over the telephone. While the job mostly deals with basic care, virtual nurses may also specialize in a certain area.
Virtual nurses need at least an ADN or BSN and should be good communicators.
3. Nurse midwife
Nurse midwives go beyond delivering babies; they also work as primary care providers for women and newborns. Because of their versatility, more nurse midwives are needed. The BLS expects 21% job growth through 2026, which is 3 times faster than average.
According to the National Library of Medicine, nurse midwives have been instrumental in improving primary health care services for women in inner-city and rural areas of the country. There’s even more good news: The National Institute of Medicine recommends that
4. Travel nursing
Travel nursing was created as a solution to the nursing shortage and remains a popular option for adventurous types. While some nurses are placed in beautiful locales, you may also be placed in an emergency situation or disaster zone. During a strike, a travel nurse may be called to fill the role of a regular employee. RNs work with an agency who match them with a short-term assignment in another city or country. Flexibility and the ability to adapt to new surroundings easily are necessary criteria.
Travel nursing tends to offer higher-than-average pay and housing may be provided.
To find travel nursing jobs, go online. You’ll find different agencies, such as TravelNursing.org, who match nurses with job opportunities.
Foreign nurses who would like to work in the U.S. also have opportunities, though there are criteria that must be met before they can become qualified.
5. Nurse educator
Share your experience and knowledge with aspiring nurses by educating them. According to the American Association of Colleges of Nursing (AACN), more than 75,000 qualified nursing school applicants were turned away in 2018 partly due to faculty shortages.
AACN says the next decade will see a significant number of faculty retirements, creating vacancies at campuses across the country. Also contributing to the shortage is too few job candidates with a master’s or doctoral degree.
Want to educate others and join a growing area of nursing? Consider earning an advanced degree.
6. Nurse advocate
The healthcare system can be a complicated maze to navigate for patients, which is why nurse advocacy careers are surging. Health educators and community health workers, such as nurse advocates, are expected to see job growth of 11% through 2028.
As a nurse advocate, you’ll represent a patient, help them understand their diagnosis, assist with insurance, and be the liaison between the patient and doctor. There may be instances where a patient’s beliefs won’t allow for a certain treatment. A nurse advocate will work with the doctor to find a solution.
7. Home-care nurse
Hospital stays may have gotten shorter, but patients still need care once they’re discharged. This is why home-care nursing is experiencing a boost in employment. Another factor? Advances in technology allow patients to receive more elaborate treatments at home.
As a home-care nurse, your patients will have a variety of backgrounds; you may treat older people, new moms, patients recovering from an accident, and those with chronic illnesses.
If you prefer to work outside a hospital and build relationships with a regular set of patients, a home-care nurse career could be a good fit.
8. Case management nurse
The number of older people in the U.S. is increasing which has created opportunity for case management nurses. As people live longer, it’s more likely they’ll cope with chronic or long-term illnesses that require expert advice and guidance.
Case management nurses organize the type of care a patient will receive, monitor costs and resources, and ensure patients and families are supported.
As a case management nurse, you’ll have the unique opportunity of providing patient care while also serving as an important decision-maker.
9. Geriatric nurse
The National Council on Aging estimates about 80% of older adults
While many tasks of a staff RN will be the same for a geriatric nurse, you’ll also focus on treating conditions more prevalent in old age, such as cancer, Alzheimer’s disease,
10. Critical care nurse
Agility and good decision-making skills are crucial as a critical care nurse. Many work in a hospital’s Intensive Care Unit, or ICU, treating patients suffering from burns, serious cardiac problems, and other grave conditions.
As more hospitals expand their ICUs and nursing homes care for very sick patients, critical care nursing has become a growing specialty. Critical care nurses should be comfortable with advanced technology and working at a fast pace.
Health Information Systems & Nursing
Emerging technology is changing the landscape of nursing and the use of health information systems (HIS) is a regular discussion among healthcare providers. For many nurses, their first introduction to HIS is with an electronic health record (EHR), or a digital version of a patient’s paper chart. It can include information from multiple providers, hospitals, and specialists, and can be accessed at any time of day. EHRs are designed to be confidential and secure.
EHRs have been a long-time coming. More than 15 years ago, President George Bush outlined a plan where most Americans would have an EHR by 2014. During President Barack Obama’s presidency, $30 billion was allotted as stimulus funds to help hospitals implement EHRs.
A robust health information system offers several benefits:
- EHRs can be viewed by patients and providers in different locations.
- Reminders can be set for follow-up tests which lessen the chance for error.
- Information from medical devices can be automatically transferred to EHRs instead of by hand.
- Medical prescriptions are clearer to read and understand.
- Electronic health records can be used to analyze data about certain conditions, medications, and outcomes. This can lead to changes in health care.
Many healthcare facilities are also using mobile devices to collect information and communicate with patients.
In the 2017 HIMSS Mobile Technology Survey, 70.6% of respondents said at least some of the information on a mobile device is uploaded to EHRs.
As with any new technology, there is a learning curve. While today’s nursing programs teach students about technology, you may find you’ll need additional on-the-job training once you become a nurse. During your clinical time, learn as much as you can about emerging technology.
Other Technologies Affecting Nursing
Medicine and technology are moving fast and nurses will be required to keep up. As you embark on a nursing career, you’ll need to be prepared for some of the latest innovations in the field.
Genetics | Gene mutations can predict whether a patient is at risk of developing a disease. The use of genetics and genomes can also help identify whether a parent will pass along a mutation to their child. Since nurses often have the most communication with patients, it’s their job to gather as much information about family history and provide guidance to patients based on test results.
Biometrics | Proper healthcare can’t exist without confidentiality and security, which is why biometrics is so important in today’s fast-paced health care environment. Biometrics is the scientific method used to identify people using fingerprints, voice, or other physical qualities. In today’s world, many medical facilities use fingerprints to identify a healthcare provider. As a nurse, you will be given access to the necessary patient information that allows you to do your job. Flipping through a patient’s folder to find what you need? Those days are numbered.
Social Media | The use of social media in nursing has benefits and drawbacks. It can provide networking opportunities and an easier way to communicate with fellow students or colleagues. A quick scan of Facebook and Pinterest will also show you that nurses use social media for support and levity.
There can be a dark side to social media, however. Nurses must be careful not to post disparaging remarks or information that violates a patient’s privacy. The American Nurses Association recognized social media’s role in nursing in 2011 with its Principles for Social Networking and the Nurse: Guidance for the Registered Nurse.
Nurses and nursing students are encouraged to use this resource to equip themselves with the do’s and don’ts of social media.
Highlights in Nursing History
Here are a few moments in history that helped shaped the nursing profession.
|1900 › The first issue of the American Journal of Nursing was distributed.|
1902 › Linda L. Rogers becomes the first school nurse.
1913 › The War Department accepts the Red Cross enrollment as a reserve for the Army Nurse Corps and Navy Nurse Corps.
1921 › The first class (512 student nurses) graduates from the Army School of Nursing.
1934 › The National Association of Colored Graduate Nurses establishes its New York City headquarters.
1940 › American Nurses Association forms a section for male nurses.
1945 › ANA collects uniforms and clothing for nurses in war-torn countries.
1952 › ANA dues increase from $3 to $5.
1967 › It’s estimated there are 640,000 practicing RNs.
1973 › The number of RNs jumps to 815,000.
1987 › AIDS treatment and testing programs and community-based health services are recommended by ANA.
1995 › 25,000 nurses from across the country protest nurse cutbacks and improper use of unlicensed personnel.
2001 › Nurses play an instrumental role at hospitals in the wake of September 11. Many volunteer to help with rescue efforts.
2014 › “Nurses Leading the Way” is the theme of National Nurses Week.
Sources: http://www.medscape.com/viewarticle/813263_2; http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Informatics-Where-Is-It.html;
*Salary information from the U.S. Bureau of Labor Statistics Occupational Outlook Handbook.