Ways to Become a Nurse
© 2018 by Kathy Quan RN BSN PHN All Rights Reserved (updated ©2020)
While job prospects diminished in many fields during the Great Recession of 2008, but healthcare has continued to grow and today it's once again healthy.
The nursing shortage was predicted to get worse as the economy strengthened, and many Baby Boom nurses were finally able to retire. However, most of the Baby Boom (over age 50) nurses who comprise 900,000 of the 3 million nurses in the workforce today are still working.
Unfortunately, along with the shortage of practicing nurses comes a Catch 22 shortage of nursing educators. Therefore, nursing programs have been difficult to get into, and many still have waiting lists. The wait is worth it. Wages will continue to increase, and experienced nurses will be in high demand for years to come. There are a number of excellent schools without waiting lists. As Baby Boom nurses do retire over the next 2 decades, the job outlook will continue to grow.
Begin with a CNA
You may want to begin your career as a nursing assistant or aide. Also known as a CNA This requires a short course of study, and is usually available from your local adult education department or community college system. In some instances, it may give you an advantage in getting into a nursing program as well. (Indeed, for some nursing programs it is required.) It also provides you with a source of employment while you pursue your nursing career, as well as practical experience and direct insight into the world of nursing.
Surgical Technician
There are other programs such as becoming a Surgical Tech which don’t require you to become a nurse first, but can lead into a path towards nursing. Often these programs are available through technical schools or adult education programs.
Licensed Practical or Vocational Nurse
Moving on up the career ladder, you may choose to become an LPN/LVN (Licensed Practical or Vocational Nurse). This is generally a one-year to eighteen-month course of study typically from a vocational school or community college.
Upon completion, the LPN/LVN graduate takes nursing boards through the NCLEX (National Council Licensure Examination) program and upon passing is granted a license through the state where the board exam is taken. The LPN/LVN works under the direct supervision of a physician or an RN.
The LP/VN role has been known for many years as "the practical or bedside nurse," but it has been expanding in recent years. Once theses nurses provided bed baths, back rubs, and performed procedures such as dressing changes and enemas. Medication administration once required extra courses as did phlebotomy. Now they are part of the education and IV's are being added to the list as well.
Since 2000 however, many hospitals have eliminated the LP/VN position and strictly use RNs and either CNAs or unlicensed patient care assistants. This was done with a push towards requiring RNs to have bachelor degrees and to therefore elevate the level of nursing education across the board in hospitals. However, with the shortage of RNs, some facilities have had to re-hire LP/VNs to fill vacancies. LP/VNs have been limited to other employers such as skilled nursing facilities, assisted living facilities, clinics and physician's offices.
Many LP/VNs enjoy their roles as the more task-oriented nurse and choose to provide direct patient care without the added responsibilities of an RN. However, it is not uncommon for students to choose to become an LP/VN as a means of support as they pursue their RN (Registered Nurse). Some RN schools offer course credit to LPNs or allow you to challenge some courses through exams. It certainly adds to the value of a nursing student for admission criteria. This practice of giving course credit is not as common as it once was, however, with the shortage of nurses reaching crisis levels in some locations, we may see more of this again.
Registered Nurses
For RNs there are more choices to be made in regards to levels of education. Historically, hospitals offered three-year diploma courses where students lived and worked in the hospital while they earned a nursing diploma, and then sat for their boards to become RNs. As nursing roles expanded far beyond the realm of hospital nursing, these programs began to close. Today, very few remain, and most of those are affiliated with 2-year (Associate’s Degree) programs.
ADN vs BSN
The two most popular RN programs are the ADN (Associate Degree Nurse) and the BSN (Bachelor of Science Nurse). The ADN course is typically a two-year degree program from a community college, and the BSN a four-year program from a college or university. The BSN can also be obtained as an add-on to a community college ADN course as opposed to a straight 4-year college program.
The ADN program is often focused more on practical applications of nursing where as the BSN program expands into the theoretical realms of patient care including nursing theories, best-practices, concept maps, critical thinking and leadership. Most institutions pay on a scale based on level of education as well as experience.
Mandated BSN
For a long time the ANA has been campaigning for a mandatory BSN. In recent years there has been a big push to mandate the BSN as the minimum requirement to be a professional nurse. New York state recently (2017) passed the first "BSN in 10" law. Nursing is a profession and not a vocation. Requiring a BSN helps ensure that.
With continuing evidence proving improved patient outcomes and lowered mortality rates when patients are cared for in units with a higher percentage of BSN prepared nurses, the push has sparked much discussion in state legislatures.
Many hospitals in particular magnet facilities and those working towards achieving magnet status, new employees must have a BSN or be enrolled in school to obtain their BSN within a set minimum number of years. Many specialities such as oncology and rehab require a BSN now.
By the end of 2020 it is expected that 80% of new nurses will have a BSN as a minimum as predicted by the Institute of Medicine. ADN nurses are beginning to feel the crunch and are having difficulty finding and even keeping jobs without their BSN. And some have been digging in their heels and refusing to move forward with a BSN. One of the biggest arguments against the BSN is that a BSN is only for those who want to become managers and administrators. Bedside nurses don't need a BSN.
The nursing shortage continues to play a big role in the practicality of this, but the profession is pushing forward. Nursing schools continue to struggle to be able to produce enough BSN prepared nurses to fill the need faster than over the next decade. But enrollment is up and even nurses who have reached retirement age continue to work because of economic factors.
After graduation from any of these courses of study, nurses all sit for their boards to become Registered Nurses. This exam is known as the NCLEX-RN.
Advanced Degree RN
There are also many advanced degree options including Nurse Practitioner (NP) programs, as well as Masters and Doctoral degree programs with various areas of focus, specialization and practice. Most management and educational positions require advanced degrees.
Make Sure it's Accredited!
Before choosing ANY nursing program it is important to make sure it is accredited by the appropriate accrediting bodies. (ACEN and CCNE) This ensures that you will be able to sit for your boards. Not all schools are accredited, and can delay the licensing process.
Then, be sure to check with your Board of Nursing to be sure this program is accredited and accepted by your state. If not, you won't be able to practice nursing in that state.
There's nothing more heartbreaking than spending time and money to obtain a nursing education and then to find out you can't take the NCLEX and practice as a nurse because the school wasn't appropriately accredited.
This is important if you ever want to continue your education! Make sure…. The school you attended might have been accredited, but by a different agency. This was OK and you got to take the NCLEX and be licensed, however… The school was a pass/fail system and therefore no GPA was recorded.
If you want to go to grad school, you need a GPA and actual grades for undergrad work in order to be accepted into the program. Sorry, but you're going to have issues there. Perhaps that same school offers and advanced degree program?
In addition, there ARE schools that lack accreditation or are just getting their accreditation, but didn't tell you up front. Yes, there are unscrupulous folks out there. If it sounds too good, it's probably not accredited.
And some states may accredit a program while others will not. This can be especially true of online nursing programs.
Check it all out carefully before you spend money to apply, and definitely before you go to that school!!!
For RNs there are more choices to be made in regards to levels of education. Historically, hospitals offered three-year diploma courses where students lived and worked in the hospital while they earned a nursing diploma, and then sat for their boards to become RNs. As nursing roles expanded far beyond the realm of hospital nursing, these programs began to close. Today, very few remain, and most of those are affiliated with 2-year (Associate’s Degree) programs.
ADN vs BSN
The two most popular RN programs are the ADN (Associate Degree Nurse) and the BSN (Bachelor of Science Nurse). The ADN course is typically a two-year degree program from a community college, and the BSN a four-year program from a college or university. The BSN can also be obtained as an add-on to a community college ADN course as opposed to a straight 4-year college program.
The ADN program is often focused more on practical applications of nursing where as the BSN program expands into the theoretical realms of patient care including nursing theories, best-practices, concept maps, critical thinking and leadership. Most institutions pay on a scale based on level of education as well as experience.
Mandated BSN
For a long time the ANA has been campaigning for a mandatory BSN. In recent years there has been a big push to mandate the BSN as the minimum requirement to be a professional nurse. New York state recently (2017) passed the first "BSN in 10" law. Nursing is a profession and not a vocation. Requiring a BSN helps ensure that.
With continuing evidence proving improved patient outcomes and lowered mortality rates when patients are cared for in units with a higher percentage of BSN prepared nurses, the push has sparked much discussion in state legislatures.
Many hospitals in particular magnet facilities and those working towards achieving magnet status, new employees must have a BSN or be enrolled in school to obtain their BSN within a set minimum number of years. Many specialities such as oncology and rehab require a BSN now.
By the end of 2020 it is expected that 80% of new nurses will have a BSN as a minimum as predicted by the Institute of Medicine. ADN nurses are beginning to feel the crunch and are having difficulty finding and even keeping jobs without their BSN. And some have been digging in their heels and refusing to move forward with a BSN. One of the biggest arguments against the BSN is that a BSN is only for those who want to become managers and administrators. Bedside nurses don't need a BSN.
The nursing shortage continues to play a big role in the practicality of this, but the profession is pushing forward. Nursing schools continue to struggle to be able to produce enough BSN prepared nurses to fill the need faster than over the next decade. But enrollment is up and even nurses who have reached retirement age continue to work because of economic factors.
After graduation from any of these courses of study, nurses all sit for their boards to become Registered Nurses. This exam is known as the NCLEX-RN.
Advanced Degree RN
There are also many advanced degree options including Nurse Practitioner (NP) programs, as well as Masters and Doctoral degree programs with various areas of focus, specialization and practice. Most management and educational positions require advanced degrees.
Make Sure it's Accredited!
Before choosing ANY nursing program it is important to make sure it is accredited by the appropriate accrediting bodies. (ACEN and CCNE) This ensures that you will be able to sit for your boards. Not all schools are accredited, and can delay the licensing process.
Then, be sure to check with your Board of Nursing to be sure this program is accredited and accepted by your state. If not, you won't be able to practice nursing in that state.
There's nothing more heartbreaking than spending time and money to obtain a nursing education and then to find out you can't take the NCLEX and practice as a nurse because the school wasn't appropriately accredited.
This is important if you ever want to continue your education! Make sure…. The school you attended might have been accredited, but by a different agency. This was OK and you got to take the NCLEX and be licensed, however… The school was a pass/fail system and therefore no GPA was recorded.
If you want to go to grad school, you need a GPA and actual grades for undergrad work in order to be accepted into the program. Sorry, but you're going to have issues there. Perhaps that same school offers and advanced degree program?
In addition, there ARE schools that lack accreditation or are just getting their accreditation, but didn't tell you up front. Yes, there are unscrupulous folks out there. If it sounds too good, it's probably not accredited.
And some states may accredit a program while others will not. This can be especially true of online nursing programs.
Check it all out carefully before you spend money to apply, and definitely before you go to that school!!!
