I Think I Want to Be a Nurse: Where Do I Start?

Since this a rather lengthy subject, I’ve decided to break it up into a series in order to give you a break to let it all sink in. Feel free to binge read if your brain can handle it!

Phase One: Decide What Level of Nursing You Want to Pursue First

Before deciding which type of nursing field you want to specialize in, you need to first and foremost decide which nursing program you want to complete first. I say first, because there are several levels to choose from, and most nurses go on to continue their education after obtaining an initial nursing license. I need to add that in order to apply for college and, specifically, a nursing program, you will need a high school transcript and a fairly recent ACT or SAT score, so if you’re serious about starting then make sure you get these if you don’t already have them. Now, let’s take a look at the different levels of nursing and how they differ in program length, payscale, and employment types. This is a very brief preview, but there is a wealth of information out there that covers each, once you decide which program interests you most. And, I sure hope you decide to join the field because we need you!! Seriously, I can promise you that there is-and will likely always be-a nursing shortage, which means lots and lots of opportunities for you to begin and continue to advance your nursing career. Okay, enough recruiting-for now. Let’s get started!

Levels of Nursing Programs, Pay, and Employment Areas

Level I: Licensed Practical Nurse (LPN)

We’ll start with the licensed practical nurse, or LPN. In some states, these are called Licensed Vocational Nurses, or LVNs. An LPN is basically an entry level nurse who practices under a registered nurse, or RN. That is, some of their skills and documentation require cosigning by an RN. Programs for LPNs range from 12 to 18 months in length. Upon completion, graduates will receive a certificate or diploma, and must sit for the NCLEX-PN to obtain licensure. These programs are offered in technical centers. community colleges, and some universities. Many schools have started offering STEM programs in partnership with local colleges which allow students to begin coursework in their senior of high school. Depending on the location and employment area, hourly pay ranges from $18-$23 an hour. Employment opportunities for LPNs may be found in hospitals, long-term care facilities, family and urgent care centers, physician offices, schools, and even some businesses, such as factories and manufacturing plants. This is a great first step if you want to get started with your nursing career ASAP because it has the shortest program length. In fact, at the local technical center where I first began my nurse educator career, our programs ran from the first week of August to the last week of June the following year-roughly 11 months. Not too shabby! However, if you plan to continue advancing your career and have the time and finances to stretch your education a little further, you may want to jump right into an a registered nursing (RN) program. From my experience as a nursing instructor, LPNs receive practically the same nursing education as RNs, but at a much faster pace so the content may be a little less in depth, but not much less, and the programs are very rigorous due to the shorter program length. And, as a staff nurse working alongside LPNs, I would suffice to say that they do nearly the same amount of work as RNs with the exception of a few limitations. So, you may decide that it’s worth the extra time to pursue an RN degree so that you can start out at a higher pay rate. It really depends on your personal circumstances and long-term goals.

Level II: Registered Nurse (RN) with Diploma/Associate Degree (ADN)

The next level of nursing is the registered nurse, or RN. RN programs include Diploma, Associate, Bachelor’s and Master’s degree programs. First off, we’ll discuss the Diploma/Associate Degree RN programs. Typically, RN programs are offered by hospitals or as bridge programs from LPN to RN. They may range from 13 months to two years long for full-time students, depending on any prior transfer credits you may have. Upon successful completion, graduates are eligible to sit for the NCLEX-RN exam, which s the required exam to obtain a nursing license. Associate Degree RN programs are similar to Diploma programs, but many are found in most community colleges and universities. Graduates receive an Associate Degree in Nursing, or ADN, and must sit for the NCLEX-RN to obtain licensure. Diploma and Associate level RNs are employed in many of the same areas as LPNs, but are more eligible to obtain charge nurse roles and management positions, especially in long-term care facilities. RNs may also teach in LPN or RN nursing education programs as full-time instructors or adjunct faculty. In fact, I first entered nursing education as a clinical instructor for an LPN program at a local technical center as extra income while still working full-time as an RN. More on that adventure in another post, perhaps 🙂 Entry level RN pay can range anywhere from $22-$40 per hour, depending on the location and specialty you choose. Again, there are many opportunities for advancement once you become an RN.

Level III: RN with Bachelor’s Degree (BSN)

A step above the Associate Degree in nursing is the Bachelor’s Degree in nursing or BSN, which typically takes around four years for entry-level full-time students or two years for students who already have an Associate Degree. BSN programs are offered in most four-year universities. Graduates will receive a Bachelor’s Degree in nursing. Those who do not already have an RN license will have to sit for the NCLEX-RN. However, currently licensed RNs do not need to retake the exam (Yippee!) Many hospitals and long-term care facilities offer incentives, including pay increases and tuition assistance for obtaining a BSN degree. BSN prepared nurses work in hospitals, long-term care facilities, and other healthcare clinics. They are qualified for many leadership positions, such as nurse managers and nurse administrators. Many teach in community and technical colleges as full-time faculty and may also be employed as adjunct faculty in larger universities. Pay is typically around $2-$3 per hour higher for a BSN prepared staff nurse, but due to eligibility for leadership positions, there is significant potential to make considerably more with a Bachelor’s Degree. Many BSN prepared nurses will go on to obtain their Master’s degree in nursing (MSN) for greater advancement and even higher pay.

Level IV: RN with Master’s Degree (MSN)

Many MSN prepared nurses already hold at least an ADN or BSN degree. Entrance into MSN programs is more selective so it is important to maintain a fairly high GPA, preferably 3.5 or above in undergraduate nursing programs, especially in nursing specific courses. I have to add that because I’ve heard the phrase “C=RN” so many times that it isn’t funny anymore, and honestly, it’s very misleading for those who may want to advance their nursing education. To be clear, grades do matter! Okay, off my soap box. Where were we? Oh, yes, well MSN Programs last two to four years, depending on the previous degree held and prior completed coursework. A specialty track typically needs to be selected when applying for a Master’s nursing program. Popular specialty areas include Nurse Practitioner (may be family, adult-gerontological, pediatric, psychiatric, women’s health, certified midwife), nursing administration, and nursing education. Upon completion of the MSN program, you will receive a certificate in the specialty track that you choose, and will likely be required to take further certification exams before being able to practice. The pay for MSN prepared nurses varies vastly due to the many branches of employment at this level. To offer an idea, though, MSN prepared nurse educators and nurse administrators average roughly $65,000-$100,000 per year, while APRNs start out at around $85,000 to $100,000 per year, or around $50 per hour. Again, this varies according to location and specialty so be sure to do more research once you decide you which area appeals most to you. MSN prepared nurses can make a substantial income without any further education. However, some employers, especially larger universities, prefer that their nurses go on to obtain a Doctorate Degree of nursing practice, or DNP, which is our final category of discussion. Fortunately, many employers are happy to pay part or all tuition costs in return for a few years of commitment.

Level V: RN with Doctorate of Nursing Practice (DNP) Degree

The final level of nursing is the Doctorate of Nursing Practice, or DNP, which is considered a terminal degree in nursing. MSN to DNP programs take around two to three years of full-time study to complete, possibly a little less where summer courses are offered. Again, depending on the chosen specialty, graduates may be required to obtain further certification in order to practice. DNP prepared nurses are basically doctors of nursing. That is, they’ve built a solid foundation of nursing knowledge that equips them to not just practice nursing, but to change and advance the field (not to say that lower level nurses can’t). They may practice as APRNs, advanced nurse educators in hospitals and universities, or other nursing leaders, such as chief nursing officers. They’re often involved in nursing research and evidence-based practice and contribute largely to improvement of nursing skills and patient-centered care. As with MSN salaries , DNP practitioner salaries vary according to position and specialty, but according to a few online sites, the average is about $95,000 to $130,000 a year, and potentially much higher for advanced leadership roles.

Final Thoughts

As you can see, there are multiple starting and ending points within the nursing field. The truth is, it really depends on many factors, including: (1) how fast you want to get to work, (2) how much time and money you are able and willing to spend on your education, (3) how much money you want to make, (4) what area you want to specialize in, and (5) how far you want to advance in your career. I can tell you that I had lots of obstacles when I started college, including a bitter divorce, single parenting, a low-paying job, and bankruptcy. But, by the grace of God and a supportive family, I have managed to work my way up little by little, beginning with my ADN, then BSN, and lastly my MSN. As of this post, I’m currently enrolled in the Family Nurse Practitioner Post Master’s Certificate program and plan to start in the Fall of 2020. Call me ambitious or crazy, both are probably fitting here! Whatever the case, I just don’t feel like I’ve reached the end of my nursing journey just yet. We shall see what the future holds. Best of luck as you embark on your career, whatever it may be. Stay tuned for Phase Two of the series, in which we’ll discuss the application process.