Technically, "Registered Nurse" is the highest designation available for nurses. However, as the RN continues his or her education, additional credentials may be obtained. A Doctor of Nursing Practice (DNP) who works as a nurse practitioner, but they are still a registered nurse. When signing their name, instead of using the credential "RN", they would use the credential "RN, DNP" In this article, we will discuss the different levels of education and opportunities for Registered Nurses.
The basic and lowest level of education to become an RN is an Associate Degree, or ADN. This is a two year program after some prerequisites are completed, and prepares the RN for work in Hospital, Long Term Care, Home Health, Emergency Department, Clinics and any other settings where direct care is provided to patients. The RN has more advanced training in assessment compared to the LPN, and can supervise LPNs and CNAs. They must also pass the National Council Licensure Exam (NCLEX-RN) in order to use the title RN and work as such. The same exam is given whether the student comes from an Associate or Bachelor's Degree program. Some nurses may choose to go through the entire three to four year Bachelor's Degree program before entering the profession, while others may obtain an Associate's Degree and either stay there or go back for their BSN (many online programs are available for this) at a later time.
In the clinical setting as an RN, typical duties include supervision of CNAs and LPNs, performing assessment of patient condition and communicating with the physician or practitioner as needed. RNs must do initial assessments of incoming patients in some states because of their more advanced training. RNs can also do all the duties an LPN can do, such as change wound dressings, give medications, insert catheters and providing basic nursing care, including those functions normally delegated to the CNA.
We have already discussed that the Bachelor's Degree (BSN) is the next step, and it opens new doors to the RN. In addition to having an easier time obtaining work in a hospital as described above, most facilities require supervisors or Directors of Nursing to have a Bachelor's Degree. The same is true for nurses aspiring to work in public health.
If an RN wants to take their education further still, a Master's Degree is the next option. There are many online options to obtain this degree, to allow students to continue to work as an RN while continuing their education. At this point, the RN usually chooses to specialize. With a master's degree, the RN may become a Certified Nurse Educator, opening the door to teach in Bachelor's Degree programs or lower. Nurse Educators are also employed by hospitals to provide patient and family teaching. The RN may also choose to become a Certified Clinical Specialist in their field, such as pediatrics or emergency room care. This option gives the nurse some prescriptive authority in some states, and further opens the door for supervisory positions. A nurse aspiring to go into management may choose a nurse leadership specialty, and nursing informatics is a specialty becoming more popular as facilities are now required to use computerized charting. A nurse with an informatics specialty not only assists other staff with using the system and troubleshooting, but analyzes data. Nurse Anesthetists, who administer anesthesia in the hospital setting, and Nurse Midwives are additional options Some states also allow nurses to enter the field as a Nurse Practitioner at this level. A Nurse Practitioner works under the supervision of a doctor and can diagnose conditions and prescribe medications. Increasingly, states are beginning to require new Nurse Practitioners to enter at the doctorate level.
The final, top step of the nursing career ladder is the doctorate degree. Generally, nurses in clinical practice will choose the Doctor of Nursing Practice degree, while those in education pursue a PhD in Nursing. Again, this opens more opportunities for the RN, such as becoming a Nurse Practitioner, or teaching in advanced degree nursing programs.
Like the job of a CNA and LPN, it is important for the prospective nurse to know that the job, regardless of setting, can be physically and emotionally stressful. Lifting and turning of patients is required, in some settings, which is physically taxing, and can result in injury if proper body mechanics are not used. Nurses and CNAs are often called on to care for patients at the end of life, and may be present during or just after the death of a patient. Dealing with this situation, and consoling the family, is a very emotional experience for many nurses. Nurses often work 12 hour shifts, and may spend much of that time on their feet. Working overtime, while discouraged by some employers, may be necessary in the case of staff shortages or emergencies. While the rewards of caring for others are great, these conditions cause some nurses to leave the field entirely.
Even advanced practice nurses, such as nurse educators, will encounter situations that are stressful, such as supervising a group of students in the clinical settings, and long hours preparing lessons and grading assignments. A nurse practitioner may spend much of the day going from one patient to another without the opportunity for a break many days. Regardless of educational level, nursing can be physically, mentally, and emotionally challenging. However, many nurses develop a great passion for their profession, which makes the demands placed on them entirely worth it.
RN Career Outlook
Because of the considerable differences in education and employment settings for RNs, statistics vary as to the percentage of job growth expected. But, according to the U.S. Bureau of Labor Statistics most recent data (2014), what all settings and levels of education have in common is that the demand will increase. Because the "Baby Boomer" generation is aging and the increase in conditions such as obesity and diabetes, it is forecast that many more RNs will be needed to help care for the additional patients requiring care. More nurse practitioners to administer primary care, and educators to send out new nurses to replace those retiring will be crucial. In fact, nursing at all levels is one of the top career fields in terms of projected job growth. Whichever path a nurse chooses to take in terms of education or specialization, Bureau of Labor Statistics data forecast an increase in demand for the position.
Again, because the levels of education and specializations vary so much, salaries do as well. According to the most recent U.S. Bureau of Labor Statistics data from 2014, the median salary for RN's working in the clinical setting is $66,640 per year, or about $32.04 per hour. This can vary greatly depending on the clinical setting, whether the nurse has an ADN or BSN, and how many years of experience the nurse has. For nurse educators, those who teach nursing students, the salary is often in this range or sometimes even less. At the other end of the spectrum are nurse anesthetists, midwives and nurse practitioners. U.S. Bureau of Labor Statistics data for this group is an annual salary of $102,670 per year, or about $49.36 per hour.
By mean annual wage, the 10 highest-paying states are:
Below are the mean annual salaries for registered nurses in the US by state:
|State||Mean Annual Salary|
|District of Columbia||$77,550|