HEARO'S RoadMap To Nursing Careers
- kyraashelton
- Nov 21, 2024
- 11 min read
TABLE OF CONTENTS
Introduction
Different Nursing Degrees - What Are All These Acronyms?
Common Nursing Pathways
ADN - Associates Degree in Nursing
BSN - Bachelor's Degree in Nursing
The NCLEX-RN
What are Clinicals?
Nurse Residency - Training and Mentorship In Your First Year of Practice.
Alternative Nursing Pathways (To RN)
Graduate Schooling in Nursing
HEARO Nursing Interviews + Career Video Series
HEARO Program Nursing Contacts
Applying to Nursing School
Introduction
There are MANY ways to become a nurse and many ways to be a nurse or be involved in caregiving in general. In this guide, we’ll outline several different pathways to being an RN, to receiving a BSN, being an ARNP, etc., in addition to testimonies from both new grad RNs, seasoned RNs, and those in ARNPs and beyond. There will also be a section with recommendations for mentors in guiding an individual interested in becoming a nurse.
Nurses are responsible for a wide variety of care tasks. Nurses work in hospitals, in clinics, teaching others nurses, managing others nurses and even, in people's homes providing care! They do everything including administering medication, managing critical illness, helping patients with activities of daily living, providing emotional support, and much more. Nurses can have a wide variety of licenses and qualifications which allow them to do a wide variety of care tasks throughout the healthcare system.
Different Degrees - What Are All Of These Acronyms??
RN: Stands for registered nurses. An RN does NOT need a BSN but at least needs an associates degree, passage of the NCLEX (the state licensing test for nursing, covered in AA), and experience in the medical field.
BSN: Stands for bachelors of science in nursing. A four year undergraduate program that prepares students for practice in the medical field and passage of the NCLEX.
LPN: Licensed practical nurse - nurses that perform basic patient care tasks under the supervision of registered nurses (RNs). Required to pass the NCLEX-PN.
NP: Nurse practitioners - skilled healthcare professionals with a doctoral degree in nursing practice. They are authorized to provide specialty care to a wide variety of patients across many different specialties. They have more authority than RNs in the healthcare setting, as they can prescribe medications and treatments, as well as confirm patient diagnosis.
CNM: Certified Nurse Midwife - assists in the delivery of babies and the care of mothers leading up to, during, and after delivery.
CRNA: Certified Registered Nurse Anesthetist - responsible for providing anesthetics to patients under certain conditions.
MSN: Masters of Science in Nursing.
DNP: Doctorate of Nursing Practice.
Common Nursing Pathways + Degrees
ADN - Associates Degree in Nursing
One pathway to becoming a nurse is by acquiring an associates degree in nursing (ADN). An ADN is a two year program that can be pursued at most community colleges, technical colleges, colleges, and universities. After completing an ADN, it is possible to go straight to being an RN, going on to complete a BSN or going onto graduate school for nursing.
Often composed of many different prerequisite courses including those from humanities, social sciences, natural sciences, and problem solving - microbiology, biology, mathematics, chemistry, etc.
Core ADN courses include foundations in nursing, nursing care of adults, behavioral health, pharmacology, etc.
Often requires application to the program for the second year of the program that contains core ADN courses!
After this coursework is completed, if the individual choses, they do not have to move on to pursuing a BSN or graduate degree. If they feel ready, they may take the NCLEX and if they pass, can become a practicing RN.
Note: it is not typically recommended to decide for ADN if you do not have an extensive background in a nursing adjacent field. The NCLEX requires intensive study that is undergone during the course of a BSN and MANY hospitals and facilities are hesitant to hire someone without a BSN.
BSN - Bachelors of Science in Nursing
A BSN is a two year program that can be pursued at some community colleges, colleges, and universities. Typically, this degree is pursued after completion of an associate's degree. This can either be an ADN or general associate's degree, as long as you’ve met the requirements to begin the BSN program. After completing a BSN, the individual will take, and hopefully pass the NCLEX.
Year 1 - Year 2: associates degree general coursework, see above. Near the middle of year 2, you should be applying to BSN programs. You can apply to the BSN program at your institution if it exists. It is also recommended to apply to BSN programs at other institutions if possible.
Year 3 -Year 4: core nursing program courses + clinical rotations.
Graduation & Taking the NCLEX-RN!
Wait... What's the NCLEX?
The NCLEX is the licensure test that nurses must take in order to practice. There is an NCLEX for RNs and an NCLEX for LPNs. You can read more extensively about the NCLEX on Kaplan's Test Prep website. There are many different ways to study for the NCLEX - oftentimes, your BSN program will guide you along and will provide study materials and support. It is possible to study WITHOUT a prep course but if you feel this would be useful for you and you can afford it, it never hurts!
The NCLEX assess whether you are able to practice safely as an RN and is a precursor to employment. You MUST complete and pass this exam before being recognized as an RN. It assess your ability to critically think, apply nursing knowledge, and promote patient safety.
Don't worry - as a new nurse (or 'new grad' as new nurses are often referred to as), you aren't thrown COMPLETELY in the deep end. A nurse residency program is a training program for recent nursing graduates that helps them gain the knowledge and experience they need to provide high-quality patient care. Nurse residency programs can help new nurses develop confidence, improve their skills, and build support systems. You can choose to apply for nursing positions that DO NOT include residency but most individuals recommend engaging with a residency during your first year to gain more experience in kickstarting your career.
When searching for applications for your first nursing job, it is recommended to use words like 'new grad' or 'residency' when applying. Individual jobs can be investigated using the hospital career websites (search the name of the hospital you are interested in working at + nursing careers and typically, this will lead you to the career application portal that details open positions).
What are clinicals?
Clinical rotations involve nursing students interacting with patients under the supervision of clinical faculty or preceptors in local healthcare facilities. Often working across specialty areas, nursing students put into practice everything they’ve learned in their nursing theory courses and nursing skills and simulation labs in terms of how to interact with and care for patients in a real-world healthcare setting (Marian University, 2020).
Depending on your institution, you will experience a wide variety of specialties and settings!
This is a great medium through which to explore nursing specialties you may be interested in!
What Can You Do With A BSN?
Nurses with a BSN or even, simply an RN licensure, can work in a wide variety of settings. Here are some examples.
Medical surgical nursing
Outpatient: Refers to nursing care that occurs outside of a hospital setting - for example, in a clinic. Patients come in for appointments with routine health concerns. Nurses in these settings prepare the patient to see the primary provider, take vitals, take medical histories, and reconcile medication history. This can be in a variety of areas including pediatrics (children), geriatrics (older adults), etc.
Inpatient: Refers to nursing care that occurs in a hospital setting. Nurses that work in inpatient medical-surgical settings care for patients with a wide variety of illnesses requiring hospital care including complications from diabetes, heart disease, post-surgery care, etc. Nurses in these settings administer medications, monitor the patient, provide emotional support and nourishment, etc.
Nurses can work in a variety of specialties including pediatrics, maternal-fetal, oncology (cancer care), geriatrics (older adults), or general medical care.
Emergency room nursing: Nurses in the ER are responsible for helping manage individuals who come to the hospital with acute, life threatening concerns. In this setting, nurses are responsible for quickly identifying medical issues, determining severity, and providing immediate support. They may also be tasked with managing triage, ensuring the most critically affected patients receive care first and drawing labs.
Intensive Care nursing (ICU): Nurses in the intensive care unit or ICU manage patients who are in the hospital in critical condition, meaning their life is significantly threatened by their current condition or they are medically unstable. They monitor patients very closely, record changes in patient condition, ensure integrity of lines and airways, provide medication, and ensure patient comfort.
Hospice nursing: In this setting, nurses are caring for individuals at the end of their lives. They are responsible for providing medication, comfort, and support to the individual as they pass away.
Inpatient Hospice nursing: Sometimes, individuals on hospice stay in the hospital. Some hospitals have special units for this purpose.
Home Hospice nursing: Oftentimes, individuals wish to be in the comfort of their own home or bed as they pass away. Nurses in home hospice visit their patients daily and ensure their care is managed, administer medications, provide support, etc. Sometimes nurses remain in the household for an entire day or shift and sometimes, they simply visit and defer everyday care to home health aides, individuals certified to provide some facets of nursing care.
Home health nursing: Sometimes, nurses visit people in their homes to provide medical care. This can be anything from wound care, assistance with activities, providing IV fluids or medications, etc. Oftentimes, these nurses visit several patients in a day and are compensated for their travel. The schedule can be highly flexible.
Research nursing: Some nurses work in the setting of research studies. Most typically, they administer medications for clinical trials, monitor patients as they receive study drugs and perform follow-up care and blood collection.
Alternative Nursing Pathways
LPN - Licensed Practical Nurse
Typically under the supervision of an RN, LPNs perform many crucial healthcare tasks such as administering medications/vaccinations, collecting samples (blood, urine, etc), wound care, catheter insertion, tube feedings, vital signs, and assisting with patient care (dressing, bathing, toileting). LPNs typically undergo a training program that takes around 12 months. These programs are typically offered at many community and technical colleges.
Coursework covers a variety of topics: legal, ethical, and cultural aspects of nursing, anatomy and physiology, assessment, documentation, growth and development, patient safety, medication administration, and patient care.
Most programs also have clinicals
After completion of the LPN program, LPNs must take the NCLEX-PN, the specific NCLEX for those who are pursuing a license to practice as an LPN.
CNA - Certified Nursing Assistant
A certified nursing assistant (CNA) is an individual who works under the direction of a registered nurse (RN) to enhance patient care and safety. They fulfill many duties, including turning/moving patients, gathering medical supplies, bathing, toileting, feeding, answering call lights and many other tasks based on what the RN needs. CNA courses are typically 4-8 weeks long and are provided at private agencies, community colleges, and technical colleges.
After taking a CNA course, the individual is able to take the required licensure examination. This examination varies by state and your CNA education program will give you direction on how to sign up for the exam.
The exam typically has a skills component and a written component.
This is an excellent stepping stone career - if you have the time and the means, this is a recommended job to engage with before nursing school, or before many other healthcare careers.
HCA - Home Health Aide
A home health aide (HCA) is an individual who is certified to provide care in people's homes, either under the direction of a home health nurse or independently. They may fulfill many duties including helping patients with physical therapy, medications, activities of daily living (cooking, laundry, etc.), and helping patients attend medical appointments. HCA courses typically require 74 hours of training (typically provided via private agencies, community and technical colleges), and the passage of a state licensure test. The test, similar to the CNA test, has a written portion and skills component.
Graduate Schooling in Nursing
Master of Science - MSN
Typically, these programs range anywhere from 18 to 24 months. There is a wide variety of MSNs that exist, as there are a variety of different specializations.
Nurse practitioner: There are several different specialties - family nurse, pediatrics, neonatal, adult/gerontological, psychiatric, etc.
Clinical nurse specialist: An advanced practice nurse who has the ability to assess, diagnose, and manage patient problems based on extensive training in that specialty - this can be in a variety specialties such as pediatrics, cardiovascular, public health, etc.
Certified registered nurse anesthetist (CRNA): CRNAs provide anesthetics to patients of all ages for surgeries and procedures.
Certified nurse midwives: Nurse midwives undergo advanced midwifery training. Certified and licensed to deliver babies, assisting in family planning, prenatal care and gynecological checkups.
Nursing education: Trained to instruct graduate-level, undergraduate level nursing students as well as clinical skills demonstrations for nursing staff.
Nursing leadership and administration: The degree that equips RNs to become nurse managers, take on positions in finance, and healthcare administration.
Nursing informatics: Computer science and information systems related to patient care and health information.
Forensic nursing: RNs who work with patients with a history of trauma or violence, as well as experience with criminal proceedings. Often work in specific clinics or centers that are dedicated to the applicable patients.
Public health nursing: Trains nurses to work in preventative healthcare, typically work in clinic settings and address various public health issues afflicting the public at any given time (for instance, public health nursing these days focuses a lot on harm reduction and care for drug users, particularly educating drug users on the dangers of fentanyl lacing and potency).
Doctoral Degrees in Nursing
There are several doctoral degrees in nursing that allow RNs to expand their career and capacity.
Research-focused doctorate: Focused on becoming a nurse scientist. Nurse scientists conduct research in fields relevant to nursing care (an example is a study being conducted by nurse scientists within the University of Washington School of Nursing on prevention of pressure induced injuries and hospital acquired infections (HAI).
Doctorate of education with nursing education specialization: Includes research expectations and training in being a nurse educator
Doctorate of nursing practice (DNP): DNPs can work in a variety of settings including nurse management, and direct patient care. In addition, with direct patient care, there are several roles that people with DNPs can take on.
Nurse midwife: Certified to deliver and care for babies, reproductive healthcare. Similar to a master's degree in nurse midwifery.
Nurse anesthetist (CRNAs): Responsible for administering anesthesia to patients during any type of procedure or surgery. They enjoy a high degree of autonomy and opportunity for career expansion. This is similar to a master's degree to become a CRNA.
Nurse practitioners (NPs): A nurse that is authorized to prescribe medications, treat patients, and diagnose patients, without the direct supervision and permission from an MD or DO. They can enjoy a wide variety of specialties, career expansion, and autonomy.
Advice From Our Career in Nursing Panel
Name: Maggie Jackson
Degree: Bachelor's in Nursing (BSN)
School: University of Montana
Specialty: Medical-Surgical & Oncology Nursing, previous float nurse
Why Nursing?: "I love the variety in med-surg - the baby fever sets in real hard when I am working on pediatric and mother-baby units, but I love that I also get to work with older adults. My passion at the moment is in hospice and palliative nursing. The goal for me is to move towards inpatient hospice, as I did my senior clinicals in this unit and enjoyed it immensely. I'm content with my BSN because it allows me to engage with these jobs but if I ever want to practice overseas, I may consider an advanced degree!"
What Challenges Have You Faced?: "I think initially the challenge felt like it was my age. I am significantly younger than most of the nurses I work with and it was harder to find people to talk to and make friends. Residency did help a lot as I had a mentor sticking with me in my first year of practicing. The challenges have mostly been emotional. I am generally a go-getter and am always open to asking for help and questions but I struggled at first to balance a life and career and the people I'm caring for. You see people in pain, you feel responsible for things out of your control. You work your way through it and you talk to and lean on your people."
What is the best part of your job? The worst?: "The best part is the patients. I am an absolute people person, always have been. I love sitting and talking with my patients during the day. I get to introduce myself as their nurse every morning and a jump happens in my heart - I put in work to be able to say that. There are bits and pieces throughout the day of people saying you touched their lives, took the time to see them as a person and not just a patient. That fuels me. I love my job and I wouldn't give this career up for anything! Worst? I don't think there is a worst! I once had a patient throw soup at me, but that's all that comes to mind!"
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