How to Become a Nurse
Nurses are at the heart of health care.
Qualified nurses are in need not only for bedside care, but for leadership roles, education and research, marketing, technical writing, informatics, advocacy, and much more. A new era of nursing involves the role of preventative and functional medicine.
A person does not need to be sick to optimize their health.
What Is Nursing?
As a profession, nursing combines an in-depth knowledge of science and compassion. Nurses develop and implement care plans, collaborate with multidisciplinary groups and, most importantly, are patient advocates.
The nurse employs a holistic approach to the care of patients by utilizing the nursing process; i.e., nurses consider every aspect of a patient such as physical, psychological, social, and emotional wellbeing.
Skills and Qualities of a Nurse
Because nurses work directly with people, effective communication skills are crucial, i.e., active listening, clear and honest spoken communication, and nonverbal communication.
Other inherent qualities include:
- The ability to organize, plan, and prioritize work
- Critical thinking and Problem solving
- Attention to detail
- Understanding and a concern for others
- Conflict resolution
- Capacity to work independently
- Empathy and concern for others
- A willingness to take on responsibilities and challenges
- The ability to maintain composure and think quickly in stressful situations
Roles and Responsibilities of a Nurse
Roles and responsibilities of the nurse may include:
- Supervising others
- Perform physical exams and obtain a medical history
- Administer medications, wound care, and other interventions
- Monitor, record, interpret, and report significant findings and changes in the patient’s condition
- Prepare patients for, and assist with, examinations, treatments, or surgical interventions
- Implement and modify the patient’s care plan
- Consult and coordinate with other team members regarding the patient’s care plan
- Provide emotional and psychological support to patients and families
- Educate patients and families about disease management, medical conditions, and nutritional plans
- Patient advocate, the core values of which are preserving human dignity and patient autonomy with decision-making
- Participate in the shaping of health policy and researching improved practice and patient outcomes
Keep in mind that the level of education changes the role of the nurse in the above list.
Each state has a scope of practice. Here are examples of the scope of practice for different certifications (which are stepping stones to a nursing license) and degrees of nursing education:
- Medical Assistant (MA)
- Certified Nursing Assistant (CNA) or Home Health Aide (HHA)
- Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)
- Advanced Practice Registered Nurse (NP or APRN)
Types of Certificates, Degrees, and Licensing
Before deciding on a degree path, an individual must determine what works best to accomplish career goals.
Before choosing a program a prospective student must:
- Decide if and how a nursing school will fit into their life
- Determine if they have time to travel to a campus
- Take a close look at their financial situation or determine eligibility for financial aid
The following is a list of the most common certificates, career paths, and degrees for nurses:
Medical assistant – MAs are unlicensed individuals that perform non-invasive technical assistance under the supervision of a licensed healthcare provider, such as a physician, physician assistant (PA), nurse practitioner (NP or APRN), or nurse midwife in a clinic setting or medical office. The supervisor is to be on the premises for the MA to perform technical support duties.
Some states require the MA to credential with the department of health, while other states do not require an MA have certification. Many employers, however, will require a high school diploma or GED equivalent.
Certified Nursing Assistant or Home Health Aide – CNAs and HHAs help provide basic care for patients in medical settings and residents of long-term care facilities, such as nursing homes.
CNA/HHAs must complete a state-approved education program and must pass their state’s competency exam for certification. A high school diploma or GED equivalent is required.
Licensed Vocational Nurse/Licensed Practical Nurse Certificate Program – This is usually the quickest option for entering the nursing field (licensed) as these programs are fast-paced. Often, students can work as an MA or CNA a few hours a week while going to school.
Most LPN/LVN programs average 18 months to complete—enrolled full-time. Pre-requisites may be required before acceptance into the LPN/LVN program. Upon successful completion, the student is eligible to take the NCLEX-PN exam and earn an LPN/LVN license.
There are very few available administrative and management positions for LPN/LVNs in the nursing industry, and as such, many LPN/LVNs often choose to further their education and go on to earn an associate’s or bachelor’s degree and become an RN.
Many colleges offer bridge programs where an LPN/LVN will not have to take the traditional 2–4-year route to obtain their desired degree.
Associate of Science in Nursing (ADN) – An associate degree in nursing is a 2–3-year nursing program that blends hands-on training with nursing theory and is ideal for those who are looking to obtain an RN license sooner than a 4-year program.
Associate’s degrees are available via either a community college or 4-year institution. Successful completion of this degree program will qualify the student to take the NCLEX-RN exam and earn an RN license.
Earning an ADN is ideal for those seeking to enter the nursing field as an RN in a shorter amount of time. It is also helpful for those who may endeavor to earn a higher degree at a later date.
Bachelor of Science in Nursing (BSN) – This is a 4-year degree that will provide some of the best opportunities for professional nurses in the job market.
The BSN program is rigorous and requires an extensive time commitment due to the amount of mandatory theoretical coursework and clinical practice. As a result of the nursing shortage, nurses with a bachelor’s degree are in high demand and work in administrative and supervisory roles.
Nurses in these positions will earn a higher salary. Similar to other levels of education, upon successful completion of this nursing program, the student is eligible to take the NCLEX-RN exam.
Earning a bachelor’s degree is advantageous for those who may eventually seek to obtain a master’s degree or doctorate and become an APRN.
Those who have already earned a bachelor’s degree in another non-nursing career field may qualify to enter the nursing program in an accelerated program.
Master of Science in Nursing (MSN) – A master’s degree in nursing will take roughly 2–3 years to complete after earning a BSN. If entering this program as an RN, there are bridge programs available at some colleges to assist in the transition to earning a higher degree.
The MSN degree path is ideal for those who are looking to obtain more advanced or specialized training and education. Those who pursue this path often major in becoming a Certified Nurse Midwife (CNM), Certified Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP).
Some nurses will also earn a degree in tandem with their MSN to propel their career further into leadership, policy making, and business management.
Also, there are direct entry programs for other non-nursing students, depending on previous education.
Doctor of Nursing Practice (DNP) – This is a newer terminal degree in nursing that takes an average of 4–6 years of full-time studies to complete. The program is incredibly challenging and only a choice few earn their DNP each year.
A DNP is the favored degree among nursing executives as the curriculum will have an emphasis on expanding analytical and critical thinking processes and research skills.
In addition, a DNP is favored for those who want a career in clinical studies, systems management, education, or as an analyst. It is expected that nurses who have earned a DNP will be in an increasingly higher demand over the next decade.
The Basics of Nursing Education
Before – Prior to admission into the nursing program, some colleges will require the HESI Admission Assessment (A2) Exam. Institutions often use this test for evaluating and ranking candidates for admission into their program.
- During – Every nursing program will involve both classroom and clinical settings.
- Classroom studies include science and health-related subjects, such as biology, health sciences, pharmacology, medical-surgical, pediatric and OB nursing, psychology, anatomy and physiology, leadership and management, and much more.
- Practical skills nursing students will learn during classroom simulation, include inserting an IV, inserting a foley catheter, medication administration, wound care, respiratory care, sterile technique, and more.
- Clinicals involve taking care of real patients within different healthcare settings with an assigned instructor.
- Graduation – During the last semester of nursing school, students are required to take and pass the HESI Exit Exam before graduation. This exam is used by schools to evaluate a student’s readiness to take the NCLEX.
NCLEX Testing Information
After graduation a standardized exam is taken to demonstrate competency. The standardized exam and the topics differ based on the career path that was chosen.
To prepare themselves, some nursing graduates choose to go through NCLEX review programs before testing.
Below are generalized steps to apply and register for the NCLEX.
- Contact the state board to apply for licensure to the state board of nursing. The nursing school will likely provide all the information to succeed in the application. After licensure, nurses may be eligible to apply for a multi-state license.
- Register for the NCLEX through Pearson Vue via their online or telephone registration system. Registration fees apply.
- Once eligible, students receive an authorization to test (ATT). Then, they must call and schedule the test within the validity dates.
- An acceptable form of non-expired government-issued photo ID is required. The first and last name must exactly match what is on the ATT email.
- Acceptable IDs include drivers license, passport, military identification card, permanent resident card, or state identification card.
- Before testing, all personal items are stored in a locker. An exception is made for medical aides or devices.
- Students should arrive at the testing center at least 30 minutes early to allow enough time to provide biometric information and receive testing materials.
- Keep in mind that the score is not available or released at the testing center.
- The state board of nursing sends the results. For a fee, some states allow access to results after 48 business hours through a quick results service.
- If the student fails the exam, they will receive a Candidate Performance Report (CPR).
- This report provides information about how the Computerized Adaptive Testing (CAT) works along with how many items were answered.
- The second portion of the CPR provides information regarding performance within the content areas of the exam. The exam can be retaken up to eight times a year, but no more than once every 45 days.
After Becoming a Nurse
- Continuing education – Nurses are required to complete continuing education courses, usually every two years. Check with the state nursing board for requirements.
- Requirements – Healthcare facilities will require nurses to maintain active Basic Life Support (BLS) training and some may mandate nurses have Advanced Cardiac Life Support training (ACLS).
- Certification – Consider earning a professional certification—this proves commitment to the field of interest and demonstrates a strong skill set to employers.
New graduates from a nursing program are considered generalists because they have the skills and knowledge to practice on all people with any illness and in any setting. There are many areas of patient care open to nursing graduates. Nurses can specialize in a particular disease, organ or body system, or preventative care setting, for example.
Below is a list of common specialties along with certifications for the corresponding field of interest. To see other nursing specialties visit the American Nurses Credentialing Center.
- Emergency or Trauma – BLS, ACLS, Pediatric Advanced Life Support (PALS), and Trauma Certification (TNCC or TNS). Nurses can also become a Certified Emergency Nurse (CEN). While a CEN is not usually required, it can be helpful in securing a job, and most hospitals will pay more per hour for nurses who have gone the extra mile to obtain this certification.
- Critical Care – BLS, ACLS, and PALS. A Critical Care Nurse (CCRN) certification is not required, but many RNs in this environment choose to gain this credential and training to enhance their nursing practice.
- Cardiovascular – BLS and ACLS. Once the nurse has practiced the equivalent of two years as an RN, they may be eligible to test and earn a Cardiac-Vascular Nursing Certificate, a Cardiovascular Nursing Board Certification Level 1, or CVRN-BC Board Certification. A Monitor Tech certification, which is an online ECG/Telemetry Certification Course for nursing assistants, LVNs, and RNs.
- Neurology – BLS and ACLS. As an option, nurses can choose to obtain a Neuroscience Nursing Certification.
- Medical-Surgical – BLS and ACLS (not required in all facilities, however it is highly recommended). A Certified Medical-Surgical Registered Nurse (CMSRN) credential is optional, though it is helpful to show an employer commitment to the field.
- Orthopedic - BLS and ACLS (not required in all facilities, however it is highly recommended). An Orthopedic Nursing Certification is optional but is seen as valuable to employers as it shows commitment to this specialty.
- Surgery – BLS, ACLS, and PALS. A CNOR credential is not usually required, but it is very helpful for this specialty.
- Oncology – BLS, ACLS, and PALS. There are several oncological certifications that can improve a nurses career in this field: Oncology Certified Nurse (OCN), Certified Pediatric Hematology Oncology Nurse (CPHON), Certified Breast Care Nurse (CBCN), Blood and Marrow Transplant Certified Nurse (BMTCN), Certified Pediatric Oncology Nurse (CPON), Advanced Oncology Certified Nurse (AOCN), Advanced Oncology Certified Clinical Nurse Specialist (AOCNS), and Advanced Oncology Certified Nurse Practitioner (AOCNP).
- Wound Care – BLS. Most wound care nurses are required to be certified in this field. Nurses can earn a Certified Wound Care Nurse (CWCN) or Certified Wound, Ostomy and Continence certification (CWOCN) through the organization of their choice.
- Gynecology and Obstetrics – BLS, ACLS, and Neonatal Advanced Life Support (NALS). Added certificates such as Electronic Fetal Monitoring, Maternal Newborn Nurse, Ambulatory Women’s Health Care Nurse, and Reproductive Endocrinology/Infertility Nurse certificates would be helpful, but they are not required.
- Gastroenterology – BLS and ACLS. Nurses can earn a Certified Gastroenterology Registered Nurse credential after working the equivalent of two years as an RN. This certification is optional.
- Pediatrics – BLS, ACLS, PALS, and NALS. An RN can pursue a Certified Pediatric Nurse (CPN) credential at any point after becoming a pediatric nurse. Some institutions may require this certification.
- Case Management – BLS. Most, though not all, case managers must have a certification in this field, specifically the Certified Case Manager credential (CCM).
- Infection Control – BLS. Earning a Certification in Infection Prevention and Control (CIC) is not necessary, but it is highly recommended to demonstrate expertise by professional standards formed by the Association for Professionals in Infection Control (APIC).
- Rehabilitation – BLS and ACLS. An option for this field is a Certified Rehabilitation Registered Nurse (CRRN) credential.
- Mental Health – BLS and ACLS. An option for this area is the Psychiatric-Mental Health Nursing Certification credential. This certification is available for those who have worked the equivalent of two years as an RN and have completed at least thirty hours of continuing education in psychiatry in the last three years.
- Hospice and Palliative Care – BLS. There are several optional credentials for this field: Certified Hospice and Palliative Licensed Nurse (CHPLN), Certified Hospice and Palliative Nurse (CHPN), Advanced Certified Hospice and Palliative Nurse (ACHPN), and Certified Hospice and Palliative Pediatric Nurse (CHPPN).
- Long-term Care – BLS and ACLS. An optional credential for nurses working in this field is the CRNL - Certified Registered Nurse, Long-Term Care.
- Perianesthesia – BLS, ACLS, PALS, and NALS. Two credentials are typically required for this field: Certified Post Anesthesia Nurse (CPAN) and Certified Ambulatory Perianesthesia Nurse (CAPN).
- Home Health – BLS and ACLS. PALS is required if the agency the nurse is working for includes pediatric patients.
Searching for Job Opportunities
Since the nursing field is competitive and job hunting can be a daunting task for some, here are some tips to help with the job search.
- Create a nursing resume to highlight the skills related to the prospective position. Often, resumes need an adjustment with each submission.
- Fill out online applications and send in resumes with cover letters to several healthcare facilities.
- Networking is a fantastic tool to find and score a job. LinkedIn is a great online networking tool for many people. Face-to-face networking is even better. Attending nursing conventions, conferences, and career fairs will help to stay more visible and maintain connections.
- Make simple business cards that includes all contact information.
- Send a thank-you note to the prospective employer after the interview.
- Volunteer to gain relevant working experience.
- Take the time to learn about the facility before going to the interview.
Ask questions during the interview.
- Connect with nursing associations and communities.
- They offer support, advice, and information to aspiring nurses, newly graduated nurses, and experienced nurses. It is comforting to have an entire society of nurses available to answer questions and even offer advice on choosing one of the many nursing specialties out there.
- Links to job opportunities are found on association websites along with career advancement tips.
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Written by Sarah Gehrke, MSN, RN and last updated Apr 16, 2018
Last reviewed by Amanda Spier, RN, BSN on Mar 14, 2018