How to Navigate Your Nursing Career: Paths, Progression, and Opportunities

You've decided that a career in nursing is in your future, but how do you get started, and what kind of professional path should you follow? Today's Osmosis blog offers helpful guidance on how to become a nurse, different types of nursing career paths, and how to pursue them.

Congratulations on embarking on your journey to explore career paths in nursing! The field of nursing is incredibly diverse, presenting a multitude of avenues to become a nurse and an abundance of opportunities for professional growth. 

Becoming a nurse

Let's start by describing some of the most common ways to become a nurse.  

First, you should decide whether you want to be a Licensed Practical Nurse (LPN) or a Registered Nurse (RN). While the titles are similar, LPNs and RNs have key differences, including education, licensure, and scope of practice. 

Licensed Practical Nursing (LPN) 

LPNs work in nearly every healthcare setting, including hospitals, nursing homes, home care, and clinics. They work under the supervision of RNs and other members of the healthcare team.  

LPN programs require a high school diploma or equivalent; however, a few vocational programs allow you to simultaneously obtain your high school diploma and your LPN. Another avenue is to go through an LPN program. Students typically complete a practical nursing program in 1 year to 18 months.   

After graduation, you must pass the LPN licensure examination, called the NCLEX-PN, and you can begin your career with an average income of around $27 per hour or $56,000 per year.  

Registered Nursing (RN) 

Like LPNs, RNs are vital healthcare team members and work in about every setting where patients require care. RNs manage patient care, participate in health promotion for their patients, and advocate for individuals and communities. 

There are several options to become an RN. 

The first is completing a diploma program, which is typically 2-3 years long, associated with a hospital, and includes lots of clinical experience.  

Next is an Associate Degree in Nursing, or ADN, program. These typically last around two years and can be associated with community or junior colleges.   

Then there's the Bachelor of Science in Nursing (BSN). These programs take about four years to complete. 

After you graduate from any of these RN programs, you must pass the RN licensure examination, called the NCLEX-RN. You can begin your career with an average income of nearly $43 per hour or $89,000 per year.  

Regardless of your initial path into nursing, there are local, state, and national initiatives to allow for more seamless academic progression to further levels of nursing education. For example, there are programs for students with an associate degree in nursing who want to get their BSN. Those programs are called BSN completion programs or RN to BSN programs, as well as programs for students who have a degree in a field other than nursing, called second-degree programs or accelerated BSN (ABSN) programs; and programs where you become a nurse while pursuing a master's degree called Master of Science in Nursing Entry programs.  

Starting your career 

Once you've passed the NCLEX and received your State Board of Nursing license, you are ready to begin your nursing career! 

A common piece of advice used to be that all new graduates should start working on a medical-surgical (med-surg) floor to gain experience caring for patients with a variety of conditions. While med-surg is a great place to start, you may decide that working in a setting you feel passionate about, like oncology, pediatrics, geriatrics, ICU, or community health, is the right decision for you. 

While exploring your career options and interviewing for positions, be sure to ask about the facility's orientation process. Some hospitals have a new graduate residency program that provides new graduate nurses training, guidance, and mentorship. Some residency programs also allow new nurses to work on multiple units within the first year to see where they fit best.  

It's normal to feel nervous or overwhelmed, especially in the first few months following graduation. Finding someone to talk to about your experiences can be helpful, like your nurse preceptor, the facility's nurse educator, another new nurse, or a former classmate.  

Advancing your career 

As time passes, you'll gain confidence, and you may even decide that it is time to take your career to the next level through certification or even formal education. 

Certifications in Nursing 

Nursing certifications help demonstrate your knowledge and expertise to your patients, colleagues, and employers. Obtaining a certification can help you stand out from the crowd on job applications, climb the clinical ladder, and receive promotions. Certifications are typically tied to a specialty in nursing, like wound care, nephrology, education, lactation, oncology, dialysis, and diabetes education, as well as many others. Typically, there's an examination you must pass to receive your initial certification. Oftentimes there are review books and study courses to help you prepare for the exam. Once you're certified, you must demonstrate that you have maintained your expertise every few years by submitting proof of continuing education or retaking the certification exam.  

Master's in Nursing 

Another way to advance your career is through more formalized education by obtaining a Master's or Doctoral degree. 

There are several options when it comes to furthering your education in nursing, like becoming a Nurse Practitioner (NP), a Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Clinical Nurse Leader (CNL), or a Certified Nurse Midwife (CNM). 

• Nurse Practitioners (NPs): NPs are advanced practice nurses who provide primary and specialty care. NPs specialize in a population and must be certified in their population to practice in most states. They can diagnose, treat, and prescribe medications. Salary ranges for NPs vary depending on the specialty and location, but the median annual wage is approximately $111,680-$165,000, depending on the specialty.  
• Certified Registered Nurse Anesthetists (CRNAs): CRNAs are advanced practice nurses who administer anesthesia and monitor patients during surgical procedures. They play a critical role in the operating room. CRNAs have a high earning potential, with a median annual wage of approximately $183,580. 
• Certified Nurse Midwives (CNMs): CNMs provide care to women throughout their lifespan, including prenatal, delivery, and postpartum care. They also offer family planning services. The median annual wage for CNMs is around $111,130-$130,000, depending on the setting. 
• Clinical Nurse Specialists (CNSs): CNSs are advanced practice nurses who specialize in a particular patient population, clinical setting, or medical subspecialty. They provide expert care, education, and research within their specialized area. The median annual wage for CNSs is approximately $117,670-$135,000, depending on the settings. 

Each school and/or program has its own set of admission requirements, but they generally include: 

1. Baccalaureate degree in nursing 
2. GPA of 3.0-4.0 
3. RN license 
4. Letters of recommendation (can be academic, professional, and clinical) 
5. Current resume 
6. Interview 
7. Application fee 

In most cases, taking the Graduate Record Examination (GRE) is not required. Some programs, particularly NP, CRNA, and CNS, also require a certain amount of relevant clinical nursing experience (e.g., 1-2 years as a nurse in the ICU). 

These programs take 2-4 years to complete, and there are options for both in-person and remote classes, which means you can choose a program even if it's far from where you live. Once you've graduated, you will also need to take a certification examination and apply for a practice license. One other factor to keep in mind is that some professional organizations are advocating that all entry-level NP education moves to the Doctor of Nursing Practice (DNP) level by 2025. 

Doctoral degrees 

There are three primary doctoral degrees, also called terminal degrees, that nurses can achieve. Doctorally prepared nurses can work in a variety of settings and can follow many different career paths. Therefore, the median salary for a nurse with a doctoral degree will depend on the career chosen by that nurse.  

The first is the Doctor of Nursing Practice (DNP). DNP programs have a clinical, or practice, focus, and graduates of DNP programs serve as leaders in nursing. A DNP program typically takes 1-2 years to complete and culminates in a DNP capstone project where you implement and report on a complex project in a healthcare delivery system.  

The next is the Doctor of Education (EdD). An EdD program takes around 2-4 years to complete and prepares graduates to serve as innovators and leaders of nursing and health professions education. EdD programs include a dissertation, where the student must conduct and then report on original educational research. 

Lastly is the Doctor of Philosophy (PhD), which focuses on nursing science, theory, and research. PhD graduates often go on to conduct research in their preferred field to expand and share knowledge as well as teach future nurses and nursing scholars. Usually, a PhD program takes 2-4 years to complete, and, like an EdD, a dissertation is the last step of the process.  

Outside of nursing 

There are also career options that aren't specific to nursing but allow you to advance your nursing career in other ways. These can include business training (e.g., becoming a nursing entrepreneur or executive), architecture (designing spaces where nurses care for people), and informatics (creating the technology that nurses use).  

What to consider

Various personal and professional factors should be considered when choosing a nursing path that's right for you. These factors include time commitment, program format (e.g., online or in-person), and career prospects following graduation.  

When it comes to paying for school, there are many options for financial assistance. Since there's a national shortage of nurses, there are also a variety of nursing-specific scholarships and grant opportunities to help increase and advance the nursing workforce, with awards that range from $100 to $18,000. Many healthcare facilities offer tuition assistance to their employees, meaning you can enter the workforce as an LPN or RN and receive money from your employer while working to go to school. 

We're excited to help get you on the path to your nursing career! Nursing offers a variety of paths and opportunities for growth. Make sure to keep personal factors and financial assistance options in mind. And make sure to take time to enjoy the journey! 

About the Author

Liz Lucas has been an RN since 2008 and has an Ed.D. with Emphasis in Nursing and Health Professions Education. Liz’s clinical background is in oncology, and she later transitioned into nursing academia where she taught in a pre-licensure nursing program for several years. Liz feels passionate about building a strong nursing workforce through increasing education accessibility and believes in the role of technology in that pursuit. At Osmosis, Liz manages the nursing assessment and scripting teams. Liz currently lives near Baltimore, MD with her husband, two sons, and dog.

References & Resources 

• https://www.ncsbn.org/publications/2023-nclex-pn-test-plan 
• https://www.bls.gov/oes/current/oes292061.htm 
• https://www.nclex.com/files/2023_RN_Test%20Plan_English_FINAL.pdf 
• https://www.bls.gov/oes/current/oes291141.htm 
• https://oadn.org/resource/statement%E2%80%84of%E2%80%84ana%E2%80%84and%E2%80%84oadn%E2%80%84joint%E2%80%84position-academic-progression-to-meet-the-needs-of-the-registered-nurse-the-health-care-consumer-and-the-u-s-health/ 
• https://nurse.org/articles/nursing-certifications-credentials-list/ 
• https://university.osmosis.org/courses 
• https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-6 
• https://www.bls.gov/oes/current/oes291151.htm 
• https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-6 
• https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/dnp/04_12_23_reaffirming_the_dnp.pdf 
• https://www.osmosis.org/blog/2022/05/16/alternative-careers-in-nursing 
• https://www.osmosis.org/blog/2021/08/09/a-list-of-usbased-nursing-school-scholarships