Nursing Education, Schools and Career Overview
People who are looking to make a difference with their careers are often drawn to nursing, and with good reason. Nurses often provide far more direct care than doctors do, and in many situations the nurse functions as the doctor's eyes, ears and hands. A nurse is the professional that manages the care to patients in their homes, and a nurse is the professional that an expectant mother sees more than anyone else. Nursing careers can be as simple as being the first aid staff in a large factory or public school, or as complex as being the extra hands of a vascular surgeon.
Becoming a nurse can open doors to opportunities in a wide variety of working environments. These professionals may work with many different population groups, often helping patients who have very different and/or highly specialized medical needs. It takes a lot of skill, knowledge and practice to become a nurse; let's examine some of the things you may want to know in order to embark on this compassionate career path.
Different Kinds of Nurses
There are many, many different kinds of nurses, some who work in a very broad area of healthcare and some who focus on a very narrow specialization. However, generally speaking, there are three different kinds of nurses, under which many of the specializations in the nursing field fall. These are as follows:
Licensed Practical Nurse (LPN)/ Licensed Vocational Nurse (LVN)
Licensed practical nurses, or LPNs, are the basic level of nursing professionals. (They are instead known as licensed vocational nurses, or LVNs, in California and Texas, but their responsibilities are otherwise identical.) They perform services such as taking blood pressure, administering medication, recording vital signs, and helping patients bathe and dress. The typical education requirement for LPN positions is an associate degree, and in some cases a certificate, diploma or endorsement may be sufficient as well.
Registered Nurse (RN)
Registered nurses, or RNs, are what you probably think of when you think of nurses. RNs are able to provide more types of care and perform more procedures than an LPN/LVN, and they do not need to work directly under the supervision of a more senior nurse. These professionals perform duties such as administering medications, conducting medical tests, and educating patients about their illnesses or injuries. RNs cannot prescribe medication, and diagnosing conditions or making complex assessments is deferred to an advanced practice nurse or a doctor. The typical education requirement for RN positions is a bachelor's degree or equivalent.
Nurse Practitioner (NP)
Nurse practitioners, or NPs, are also known as advanced practice nurses due to the high level of their position and responsibilities. NPs are allowed different levels of authorization to practice in different states, but their duties are often similar to those of a professional physician. They may examine and diagnose patients, then plan and prescribe their treatments. As these actions can be literally life-changing, NPs are usually required to earn a graduate degree and multiple years of on-the-job experience before they are permitted to practice.
Some aspiring nurses find themselves compelled to help people suffering from specific types of ailments, or find certain ailments or treatments to be especially interesting to them. While an environment like a doctor's office sees patients of many ages and types, other settings, such as specialized clinics, often draw more specific types of patients more exclusively. Clinical specialties are too many to list, but a few include:
- Cardiopulmonary (heart and lungs)
- Oncology (cancer)
- Orthopedics (deformities of bone or muscle)
- Gastroenterology (the digestive tract)
- Neurology (the brain)
- Pediatrics (working with infants and children)
- Gerontology (working with the elderly)
Advanced training and education are usually required in order to participate in these highly specialized nursing jobs. If an aspiring nurse finds a particular area of medicine, such as the ones listed above, particularly compelling, he or she should research the educational requirements for licensure in that area. This can be essential in order to make an informed decision about the training and education needed to attain a position in that particular aspect of the healthcare field.
How to Become a Nurse
Education is an integral – and often never-ending – part of a nurse's career. From the coursework required to become initially licensed, to the regular updating of changing clinical knowledge and medical procedures, a good nurse never stops learning.
Becoming a nurse is a very involved process. Let's summarize it here, then go through these steps in some more detail afterwards.
- Complete your high school education, or pass the GED. During this time, it can be wise to volunteer in a local medical center to observe first-hand what a nurse does. This can help you to decide if the career is a good fit for you.
- Decide what kind of nurse you would like to become, so you can assess how much education you may need. Do you want to become an LPN? An RN? An NP? Do you want to specialize in a particular illness? Do you want to work with a particular age group? All of these factors can contribute to understanding what education you may want to pursue.
- Research traditional and accelerated nursing programs available through your local junior colleges, universities, hospital-based learning programs, or online programs. Investigate whether or not there are prerequisite courses, or if passing an entrance examination is necessary.
- Complete the curriculum and associated practical experiences for your chosen program.
- Pass the national examination for your chosen level of nursing.
- Apply for the appropriate nursing license(s) through your state's Nursing Board.
- Once you've made it through all these steps and become a full-fledged nurse, pat yourself on the back: you did it!
The most important part of choosing any career is deciding whether that career is really right for you. Often, volunteering and internship opportunities can be a good way to get a closer look at how a career works, which can help you make that decision. If you're in high school or already in school to earn your GED, your school may have advisors or resources that can help you find good opportunities in this field. If you're a career-changer who is not in school, you might consider contacting local hospitals or doctor's offices to see if they have any kind of volunteer opportunities you could fill.
Once the interest in nursing has been explored, take some time and learn about various types of nursing and the different places a nurse works, and then decide what types of patients, diagnoses and work settings are most appealing to you. Consider how much independence you want, and how long you want to take getting your education completed. If you want to work very independently and are ready to invest a few years in your education, then a master's level credential may be right for you. However, if you want to enter the workforce quickly, perhaps starting as an LPN is the best choice.
Remember that your decisions at this stage are not set in stone. Some people choose to pursue their LPN license, and then continue to advance their educations while they are working. Others start out intending to become a general kind of nurse, such as an RN, but then find an unexpected passion for a particular nursing specialization during their studies and change course to focus on that part of the field. Try to stay flexible, and never be afraid to change your plans if you realize your needs or priorities have changed.
How do I select a nursing school?
Nursing programs can be found in many different types of institutions, from junior colleges or four-year universities, to private colleges, to hospital-based training centers. It is important to make sure that the state's board of nursing approves any nursing school that a student may be considering; all fifty states have this requirement. Because nursing is a licensed profession, states must approve a nursing program in order for candidates to be eligible for the national exam (the National Clinical License Examination, or NCLEX), and to ultimately be eligible for state licensure. Always check your State Board of Nursing's list of approved learning institutions before enrolling.
In addition, there are two national organizations that accredit nursing schools: the National League for Nursing Accreditation Commission (NLNAC) and the Commission for Collegiate Nursing Education (CCNE). Being accredited by one of these organizations and being approved by a state's nursing board are not the same thing, and a program may be approved by the state without being accredited.
What courses can I expect from nursing school?
Nursing coursework usually includes foundational courses in anatomy, physiology, pharmacology, nutrition, psychology and microbiology. These provide a basic structure for understanding how the body and mind work, which can then built upon by more specific nursing courses.
Lower-division nursing courses often have broad titles like "Nursing Care Management" or "Foundations in Nursing Practice." These courses teach the basics of assessing health, analyzing vital signs, delivering medications, administering treatments, reporting findings, differentiating normal from abnormal, and making quality assessments.
Some programs may include courses in computers, health information handling, or communication skills. This may seem strange at first, but it's not so strange if you think about it. These supplemental courses can help teach students new technologies or improve their listening and teaching skills, leading to more capable, well-rounded healthcare providers.
In advanced nursing degree programs, courses build on the basic curriculum. More advanced anatomy and physiology may be studied for certain systems, deeper understandings of pharmacology may be necessary, and more complex and more specialized treatments and procedures are likely to be explored.
Courses in a graduate-level curriculum often include instruction in nursing management and leadership, research methods, health policy, community nursing and public health. These courses are designed to create a more independent practitioner and allow a nurse to understand the implications of disease process and health management.
Nursing Degree Programs
There's no two ways about it: nursing school is challenging for many. Regardless of the degree level they're pursuing, nursing students engage in exacting courses of study that cover the principles of care delivery and treatment. But what does that mean at different levels of nursing education? Let's look at the different nursing degree levels in a bit more depth.
- Associate Degree in Nursing (ADN)
Associate degree programs in nursing such as the Associate of Applied Science (AAS), the Associate of Science in Nursing (ASN) or the Associate Degree in Nursing (ADN) are undergraduate-level degree programs that tend to focus on teaching students the basics of nursing. This may include skills such as patient care and clinical decision making.
This degree level is most often associated with licensed practical nurses (LPNs) and licensed vocational nurses (LVNs).
- Bachelor of Science in Nursing (BSN)
Bachelor's degree programs in nursing can come in many different forms, but as a general rule, they have the same purpose: to cover a range of general education requirements in order to broaden a student's knowledge and understanding, while also establishing core nursing skills and practices. Many different topics can be covered in BSN programs, including ways to use technology for patient care; how to communicate with patients and their family members; and methods for staying calm and reacting properly during an emergency.
Earning a bachelor's degree in nursing is most often used as part of becoming a registered nurse (RN).
- Master of Science in Nursing (MSN)
The Master of Science in Nursing degree program is often used to help registered nurses take the next step in their careers. By taking your nursing career to this level, you will be prepared to assess the health care needs of patients, analyze their laboratory findings, and develop the most effective plan of patient care.
Some of the advanced practice nursing careers associated with the MSN degree are:
- Nurse Practitioner
- Acute Care Nurse Practitioner
- Family Nurse Practitioner
- Certified Nurse Midwife
- Neonatal or Pediatric Nurse Practitioner
- Women's Health Practitioner
- Adult/ Gerontological Nurse Practitioner
- Certified Nurse Anesthetist
- Doctor of Nursing Practice (DNP)
A doctoral program in nursing, whether it is a Doctor of Nursing Practice (DNP) or a Doctor of Philosophy in nursing (PhD), is the highest level of attainable education in the United States. These programs focus on understanding how to research and present nursing topics and data, as well as how to deliver the highest level of patient care.
Most nursing careers do not require nurses to earn a doctoral degree. However, in some instances, it might be required for those intending to become nursing instructors or nursing managers.
- Accelerated Nursing Programs (Bridge Programs)
For individuals who have already earned some level of degree or certificate in nursing -- or sometimes in another area of study, particularly other healthcare-related areas -- and are looking to enhance their education with a higher-level nursing degree, an accelerated nursing degree program may be the perfect solution.
Also known as "bridge programs," these programs use the degree a student has already earned to assess what education requirements in the more advanced degree program have already been completed. In other words, bridge programs exist so nursing students don't have to repeat coursework they've already completed. These programs can allow a BSN (Bachelor of Science in Nursing) to be completed in 12-18 months instead of four years, and an MSN (Master of Science in Nursing) to be completed in three years instead of five to six.
These programs may sound extremely appealing, but the schedules are challenging. The programs are typically scheduled year-round, and the same amount of information and clinical experience hours that a student would learn in a traditional program is scheduled into a much more concentrated time frame. Admission criteria are often strict, with GPA requirements and thorough background screenings. Candidates are often discouraged from working during these programs due to the intensity of the instruction. Programs may also have prerequisites in the areas of biology, anatomy and physiology that must be completed before a student can be admitted.
Hands-On Nursing Training
Labs and clinical experience are an important part of a nursing program. Labs are hands-on, group courses that typically accompany a lecture class. For example, human biology may have a lab associated with it. The class is the lecture, where a textbook is used and a teacher gives instruction. The lab is an environment where microscope work and dissection is done. Many nursing education programs have lab components.
Clinical rotations, practical experiences and/or practicums are also part of the nursing curriculum. A practicum is a hands-on, real-world training experience where a nursing student is paired with a licensed nurse to learn the dynamics and treatment demands of various work environments. In a practicum, nursing students are tasked with putting their own hands and brains to work with the information they've been learning from their classes and labs. These practical experiences are typically broken into several classes' worth of activity and take place in multiple clinical settings.
Online Nursing Education
You may be wondering: if hands-on training is so important, how can nursing students participate in an online nursing degree program, where a student might live thousands of miles away from the school they are attending? In fact, there is a simple and elegant solution to this problem. Online nursing degree programs provide most of the lecture portion of their instruction through online courses and web-based homework programs, and then coordinate labs and practical work from facilities within the student's home community.
With approval from their online program, students can identify local colleges, medical centers or other useful facilities that can offer the opportunity to complete the clinical training components of a nursing degree program. Once the arrangements have been made between the online school and the local facilities, students can use the internet to engage with lectures, participate in forum discussions, complete assignments and take exams, while participating in required labs, practicums or hands-on activities locally.
These are some examples of the types of nursing courses that might be delivered online:
- Introduction to nursing practices
- Nursing theory
- Health and disease management
- Research methods
- Clinical integration
- Health behavior
- Developmental and normal adult psychology
- Introduction to pharmacology
- Health policy
Many graduate-level MSN programs are including elements of distance learning in their curriculum to help students who live considerable distances from the campus or who are working while they're completing an advanced course of nursing studies. Furthermore, many nursing bridge programs are available online. This makes online programs a convenient way to complete a nursing degree program for individuals who do not live close enough to make a campus-based program practical.
Without exception, practicing nurses in the United States are required to be certified. The Licensed Practical Nurse and Registered Nurse designations are certifications that are granted after a student has completed a course of study at a Board-approved program and passed the National Clinical License Examination (NCLEX). The designation Nurse Practitioner is also a certification given after completing an education, fulfilling practical requirements, and passing a national examination. With some nursing jobs, specifically in advanced practice areas such as nurse midwife or nurse anesthetist, a certification is necessary even to perform the job.
Additionally, all states require that nurses be licensed through their state's nursing board. Fees are collected, and fingerprints may be required for the state's database. This is in order to check several criteria about candidates, i.e.:
- Does the nursing education the candidate received meet the state's standards?
- Has the candidate taken and passed the national exam?
- Have all other state criteria, including background checks, high school education requirements, etc, been met?
Once certifications are received, and licenses have been issued, nurses can accept employment and operate in their full capacity.
In additional to the certifications that define the professional qualifications of a nurse, there are many additional certifications that can be acquired to demonstrate additional training, education or expertise in various clinical or administrative areas. In some cases a certification communicates expertise in certain clinical areas, and in some cases it may expand the nurse's scope of practice. For instance, in many states, an LPN license does not include the ability to insert an IV. But in some of those states, an LPN can take supplemental courses, complete a clinical experience and pass an examination and be certified to site IVs.
Some of the areas where clinical specialty certification is available include:
- Cardiac management (nursing practice or rehabilitation)
- Community Health/Public Health
- Home Health
- Pain Management
- Pre/PeriNatal Nursing
- Psychiatric Nursing (child/teen/adult)
Certifications are issued by many different organizations, and the organization typically sets the requirements for earning the certification. Some require attending specific classes or completing an established clinical experience; some require taking tests. Some specialty certifications require renewal; others last for as long as the nurse maintains his or her license. Some certifications can even be completed online, usually through colleges and universities that offer online nursing degree programs.
Continuing Education for Nurses
Once someone has become a nurse, learning and instruction remains a fundamental part of life in the field. Over half of America's 50 states require continuing education as part of the licensure process. In these states, renewing the license to practice (which typically happens every two years, although this may vary from one year to four) requires the completion of courses designed to maintain and advance clinical knowledge. These classes are offered in a wide variety of locations and cover a broad array of clinical topics. While many nurses elect to take classes in their field of practice, some take classes in new or previously unexplored areas as a way to learn about alternative career paths or consider new work settings.
Many nursing schools that offer continuing education courses make these courses available online. When taking online courses, however, it is important to research whether the state's continuing education requirements can be met with an online course. States typically place limits on the amount of continuing education units that can be taken as self-study, and some states may consider an online class to be self-study. Check with your state to see how many online courses you may be permitted to take to satisfy these requirements.
Nursing Skills and Qualities
While LPN's and RN's have specific supervision and oversight requirements, clinical nurse specialists and nurse practitioners have more ability to make independent decisions and direct patient care. In many settings, nurse practitioners are supplementing the gap in physicians. A nurse practitioner can prescribe medications and order tests, as well as make a medical diagnosis. Nurse practitioners work in conjunction with physicians, but can often step into the role of primary care provider in doctors' offices, clinics, ambulatory centers and skilled nursing facilities.
Career Outlook and Salary Information for Nurses
People often think of nurses as the people they meet in the doctor's office, but there are countless work environments in which nurses can perform their role, both in and out of the clinical setting. A nurse might work in a hospital, a doctor's office, an ambulatory care center, a specialized treatment clinic, a skilled nursing facility or an occupational health center, to name only a few.
After establishing a nursing career, advancement into management positions is possible, usually dependent upon advanced degrees and additional training. Case managers, unit managers, nursing managers and administrators, as well as nurse educators, are all positions that a nurse who wants continued growth in his or her career can pursue.
There are a number of factors that influence the actual salary a registered nurse (RN) can expect. Different professional levels of nursing have different income brackets. Additional factors, such as time on the job, experience and specific credentials, also determine where in each income bracket a particular nurse will land. As a result, pay can vary significantly.
Professional and Academic Resources for Nursing
- The American Nurses Foundation (ANA)
- The Emergency Nurses Association (ENA)
- The International Council of Nurses (ICN)
- May 2014 National Occupational Employment and Wage Estimates United States, U.S. Bureau of Labor Statistics, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes_nat.htm
- Nurse Practitioners, Bureau of Labor Statistics, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes291171.htm
- Registered Nurses, Bureau of Labor Statistics, Occupational Outlook Handbook, Jan. 8 2014. http://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6
- Registered Nurses, Bureau of Labor Statistics, Occupational Employment Statistics, May 2014. http://www.bls.gov/oes/current/oes291141.htm