In all States and the District of Columbia, students must graduate from an approved nursing program and pass a national licensing examination in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination, by the endorsement of a license issued by another State, or through a multi-State licensing agreement. All States require periodic renewal of licenses, which may involve continuing education.
There are three major educational paths to registered nursing: a bachelor’s of science degree in nursing (BSN), an associate degree in Nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2002, 678 nursing programs offered degrees at the bachelor’s level.
ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 700 RN programs in 2002 were at the ADN level. Diploma programs, administered in hospitals, last about 3 years. Only a small and declining number of programs offer diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as staff nurses.
Many ADN- and diploma-educated nurses later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find a staff nurse position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing one of many RN-to-BSN programs.
Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2002, more than 110 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. Accelerated master’s degree programs in nursing also are available and take about 3 years to complete.
Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN program, because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with bachelor’s or advanced degrees. A bachelor’s degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, teaching, or a clinical specialization.
Nursing education includes classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Course work also includes the liberal arts.
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
Experience and good performance can lead to promotion to more responsible positions. In management, nurses can advance to assistant head nurse or head nurse and, from there, to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs preparing executive-level nurses usually last about 2 years.
Within patient care, nurses can move into a nursing specialty such as clinical nurse specialist, nurse practitioner, certified nurse midwife, or certified registered nurse anesthetist. These positions require about 2 years of graduate education leading to a master’s degree.
Some nurses move into the business side of health care. Their nursing expertise and experience on a healthcare team equip them with the ability to manage ambulatory, acute, home health, and chronic care services. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.