What exactly is a registered nurse? What do they do, and how does one become a nurse? If you are one of the many people who are considering becoming a nurse, these are questions that you will want answered. Nursing is one of the most highly respected and trusted professions in the world, and, for you, it will include both personal and professional rewards throughout the natural course of your career. As a profession, nursing combines an in-depth knowledge of science and compassion in a variety of health care settings by helping patients cope with illness and disease, assisting with disease prevention and promoting a healthy lifestyle. Every day a nurse will utilize the scientific knowledge they have learned and implement it according to the ever-changing needs and dynamics of each patient within the healthcare system.
Registered nurses provide direct care to their patients in many different healthcare settings such as hospitals, retirement homes, helicopters and ambulances, psychiatric and drug treatment centers, private practices, patient homes, community centers, and more. As a whole, RNs perform assessments of patient health problems and needs and administer care to those who are ill, injured, disabled, or convalescent. They also develop and implement nursing care plans, collaborate with multidisciplinary groups and, most importantly, are patient advocates. They are constantly in direct contact with patients; in fact, a nurse is often the first person a patient meets when he/she goes to a healthcare facility, and it does not end there. The patient will spend more time with a nurse than any other healthcare professional. Due to the prolonged contact between nurses and patients, nurses contribute immensely to the overall care of the patient and family. The RN employs a holistic approach in the care of patients by utilizing the nursing process; i.e. they consider every aspect of a patient such as physical, psychological, social, and emotional aspects in regards to the patient’s plan of care.
To become a RN, it is important to understand what the roles and responsibilities are, what skills and qualities are needed, what kind of training is necessary, and what types of nursing programs and degrees are available. You may also begin to consider what nursing specialty you might be interested in. The information provided within this article will help you to gain a better understanding of what will be expected of you and assist you with making your decision. Listed below are a few links that provide in-depth information about the registered nurse to help you understand this unique profession.
What is Nursing?
Nursing is a profession that requires certain types of qualities, skills and understanding in order to be successful. Because you will be working with the public, effective communication skills are vitally important. Active listening, oral and written comprehension, speaking, and social perceptiveness are just some of the crucial communication skills that are needed. You will spend much of your time giving your full attention to doctors, patients and families by answering and asking questions, giving and receiving updates, performing patient and family teaching, and being involved in conflict resolution. In addition, you will frequently communicate with other health care professionals directly involved in patient care such as respiratory therapists, physical therapists, certified nursing assistants, dieticians, case managers, and social workers.
The ability to critically think is also a vital skill you will use on a daily basis within the nursing profession. This usually involves using inductive reasoning, deductive reasoning, and the sciences you will learn in nursing school and applying it to real-world situations. Nursing is a hands-on career that often involves activities that require an extensive amount of thinking, ideas and problem solving. You will frequently find yourself needing to think quickly on your feet as, in some cases, it can mean the difference between life and death.
Other important skills and qualities needed are:
Overall, nurses should be responsible, caring and sympathetic, and have the emotional stability to cope with stresses, emergencies and human suffering on a regular basis.
As a registered nurse you will frequently find yourself in the position of directing and supervising others, assessing patient conditions, and utilizing critical thinking and problem solving skills in stressful situations.
Other main roles and responsibilities of the nurse are:
While this is not an exhaustive listing of the roles and responsibilities of the nurse, these are common for most nursing positions and facilities. You may have different and/or additional responsibilities depending on where you work and your specialty.
Before you decide on a school, you will need to determine what program and/or degree will work best for you depending on your career goals. Making an informed decision will assist you with setting up a successful nursing career. There are several career paths available to students who are looking to enter the nursing profession. The following is a listing of information regarding the most common career paths, certificates and degrees for nurses:
LPN Degree/Certificate Program - This is usually the quickest option for entering the nursing field as these programs are fast-paced. Most LPN programs average 18 months to completion. These are typically completed at a vocational college or as part of a hospital program and are a convenient option for those students who have outside obligations such as family and work. Once the program is successfully completed the student will be eligible to take the NCLEX-PN exam and earn a LPN/LVN license.
There are very few available administrative and management positions for LPNs in the nursing industry, and as such many LPNs often choose to further their education and go on to earn an associate’s or bachelor’s degree and become an RN. If an LPN chooses to further their education, they can take advantage of a bridge program. Many colleges offer bridge programs where an LPN will not have to take the traditional 2-4 year route to obtain their desired degree. Details and rules about the bridge program will vary by institution. In addition, many employers offer tuition reimbursement for LPNs who are interested in becoming an RN.
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 RN licensure sooner than a 4-year BSN program. Liberal arts and general studies are required and add a bit of time and complexity to the program. Associate’s degrees can be earned at either a community college or 4-year institution. Successful completion of this degree program will qualify you to take the NCLEX-RN exam and earn RN licensure.
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 seek to earn a higher degree at a later date as most general education requirements and nursing courses will have already been completed.
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 are often found in administrative and supervisory roles. Nurses in these positions will generally earn a higher salary. Similar to other degrees, upon successful completion of this nursing program you will be eligible to take the NCLEX-RN exam.
Earning a bachelor’s degree is advantageous for those who may eventually seek to earn a master’s degree or doctorate and become an advanced practice nurse. In addition, 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. In this program they will receive credit for general studies and liberal arts courses and will only have to complete the required theoretical nursing courses and clinical practice. Details and information regarding this type of program will vary by institution.
Master of Science in Nursing (MSN) - A master’s degree in nursing can be completed in roughly 2-3 years after earning a BSN. If you enter this program as an RN, there are bridge programs available at some colleges to assist you in your transition to earn a higher degree. In addition, there are also direct entry programs for other non-nursing students, depending on previous education. Bridge program and direct entry program information and curriculum will vary by institution.
The MSN degree path is ideal for nurses 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. The degrees most likely to be simultaneously earned with a MSN are a Master of Health Administration, a Master of Public Health, or a Master of Business Administration.
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 your analytical and critical thinking processes and research skills. In addition, a DNP is also favored for those who want a career in clinical research, 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.
Choosing an area of nursing specialty can be a daunting task for some and yet an easy decision for others. You will need to ask yourself what you are most passionate about and search for those areas where you feel you would be a great fit. New graduates from RN nursing programs 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. RNs can specialize in a particular disease, health condition, ailment, organ, or body system, surgical setting, or preventative care setting. If you become an advanced practice nurse, you can work independently or in collaboration with a physician and focus on a primary area of interest and care services for a public or private practice.
Below is a compiled listing of the most common nursing specialties for RNs along with certifications that are helpful for the corresponding field of interest.
Emergency or Trauma - Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Trauma Certification (TNCC or TNS). You 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.
Cardiovascular - BLS and ACLS. Once you have practiced the equivalent of 2 years as an RN you could be eligible to test and earn a Cardiac-Vascular Nursing Certificate, a Cardiovascular Nursing Board Certification Level 1, or CVRN-BC Board Certification.
Neurology - BLS and ACLS. As an option, you can choose to obtain a Neuroscience Nursing Certification.
Orthopedic - BLS. An Orthopedic Nursing Certification is optional but is seen as valuable to employers as it shows your commitment to this specialty.
ICU/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.
Medical-Surgical - BLS and ACLS. A Certified Medical-Surgical Registered Nurse (CMSRN) credential is optional, though it is helpful to show your employer that you are knowledgeable and committed.
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 your 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. You can earn a Certified Wound Care Nurse (CWCN) or Certified Wound, Ostomy and Continence certification (CWOCN) through the organization of your choice.
Gynecology/Obstetrical - 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. You can earn a Certified Gastroenterology Registered Nurse credential after working the equivalent of 2 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. There are some institutions that may require this certification.
Case Management - BLS. Most, though not all, case managers are required to 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 your expertise in accordance with 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.
Psychiatric/Mental Health - BLS and ACLS. An option for this field 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 30 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. There are two credentials that are normally required for this field: Certified Post Anesthesia Nurse (CPAN) and Certified Ambulatory Perianesthesia Nurse (CAPN).
Home Health - BLS, ACLS and PALS, if the agency you are working for includes pediatric patients.
One of the biggest decisions you will make when becoming a registered nurse is deciding which nursing school you will attend. You will want to enroll in an accredited nursing program at a university or college that best fits your budget and academic goals. Most nursing programs are full-time with a 2-4 year duration after which you will graduate with an associate’s or bachelor’s degree. Many online accelerated programs are available for students with other health-related or nursing certificates such as licensed practical nurses. These online accelerated programs are often shorter in duration than the regular on-site programs.
Prior to admission into the nursing program at the university or college of your choice, you will likely be required to take the HESI A2 Admission Assessment Exam. This test is often used by institutions for evaluating and ranking candidates for admission into their program. Because nursing schools are heavily regulated by strict accreditation criteria, they will usually only accept students who have shown a higher propensity for success in the nursing program. Each institution has their own requirements for which HESI subtests are taken and what scores they will accept.
Every nursing program will involve both classroom and clinical settings. You will learn 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. In addition to academic work, students will complete many hours of hands-on clinical experience before graduating. Clinicals involve taking care of real patients within different healthcare settings! For each clinical rotation you will be assigned to an instructor who will help you develop your classroom knowledge and show you how to utilize it within a healthcare setting. You will also learn practical nursing skills through simulation in the classroom. Some practical skills you will learn include inserting an IV, inserting a foley catheter, medication administration, wound care, respiratory care, sterile technique, basic life support, and more. Once you have shown proficiency in classroom simulations you will be allowed to perform these skills on real patients while under direct supervision from your instructor. Time management, stress management, and attention to detail are also skills you will either learn to develop or improve upon while in nursing school. These three skills will be vital to your success in a nursing program and in your career as a nurse.
During your last semester of nursing school you will be required to take and pass the HESI Exit Exams prior to graduation. These exams are used by schools to evaluate a student’s readiness to take the NCLEX-RN. The materials covered in these exams are thorough and are the same as those covered on the NCLEX. Most schools feel that a score of 850 on the HESI exam is an indicator of potential success on the NCLEX.
To assist you with your search for the right school and nursing program, here is a list of scholarship and grant information in addition to accredited schools that offer nursing education programs.
Once you have successfully graduated from an accredited nursing program you must obtain a license to practice from a regulatory body in your area. With a nursing degree you will be eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and earn your nursing license. The NCLEX is an entry-level standardized test that every state board of nursing utilizes in order to determine whether or not the nursing candidate is prepared for practice. By giving you a license, the regulatory body is telling the general public that you are safe and can be trusted. They are also in charge of making sure that you are not a threat to the public throughout your nursing career. You will be expected to renew your license after a certain period of time, usually two years for most states. There are also different regulatory requirements in each state for license renewal such as evidence of continuing education (the number of CE hours will vary by state), practice hours, quality assurance and evaluation.
Below is a list of steps on how to apply and register and what to expect during testing for the NCLEX.
Submit an application for licensure to the state board of nursing where you wish to be registered. You will need to contact your state board of nursing to determine eligibility, and also if you have any additional questions regarding your application. Application fees vary by state.
Register for the NCLEX-RN through Pearson Vue via their online or telephone registration system. Registration fees apply.
Once you are determined to be eligible, you will be sent an Authorization to Test (ATT) email. You must call and schedule a testing date within the validity dates given in your ATT. First time test takers will be offered dates within 30 days of their request.
On your exam day you will need to bring an acceptable form of non-expired government-issued photo ID. The first and last name must exactly match what is on your ATT email. Acceptable IDs are: drivers license, passport books and cards, military idenfication card, permanent resident card, or state identification card.
Before testing, all personal items will be stored in a locker. If you bring any electronic items they will be placed in a Pearson Vue plastic bag and secured. An exception is made for medical aides or devices. It is suggested that you not bring these items to the testing center as you will not be allowed to test if you refuse to store your belongings.
You should arrive at the testing center at least 30 minutes early to allow enough time to provide biometric information and receive testing materials. You will have up to six hours to take the RN exam which includes two optional breaks. Once you have completed the test you will wait for the testing assistant to dismiss you.
Keep in mind that your score will not be available or released at the testing center. Your state board of nursing will mail you the results within six weeks of taking the exam. For a fee, there are some states that will allow you to access your results after 48 business hours through a quick results service.
If you fail your test you will receive a two-page Candidate Performance Report (CPR). This report will give you information about how the Computerized Adaptive Testing (CAT) works along with how many items you answered. The second portion of the CPR will provide you with information regarding your performance within the content areas of the exam. You will see these content areas grouped together along with your performance in these areas stated as “Above”, “Near” or “Below” the passing standard. This will give you an indication of where your strengths and weaknesses lie and in what areas you should study before reattempting the test. If you choose to retake the exam you will need to start the test registration process over again through Pearson Vue and submit the associated fees. Nursing candidates who have applied with a participating state board are allowed to retake the test up to eight times a year, but no more than once every 45 days.
To prepare themselves, some nursing graduates choose to go through NCLEX review programs prior to testing. A popular review program that includes practice tests for nursing graduates is the Hurst Review. There are many organizations that offer similar programs, and it will be up to you to decide which one is best for you.
After you have graduated, or even before you have graduated, you will be searching for the right job that fits your needs and interests. Since this field can be competitive and job hunting can be a daunting task for some, here are some tips to help you along with your job search.
There are several nursing associations and communities available to offer support, advice and information to aspiring nurses, newly graduated nurses, and experienced nurses all throughout their nursing career. While training to be an RN 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. Professional nursing organizations are critical to the dedication of raising the standards of the profession’s education and practice. There are over 100 national nursing associations in addition to many more international organizations. Many of these organizations are specialty-based, such as setting-specific nursing, age specific nursing (pediatric, geriatric, neonates), ethnic and cultural, as well as advanced practice nursing.
The American Nurses Association is just one of the groups that offer free career advice and information on ethics, policies, and health and safety information relevant to nursing practice. Continuing education opportunities are readily available for you to stay updated with the latest developments in nursing. Many organizations offer certifications that can demonstrate your commitment to excellence in a nursing specialty or field. Other perks offered after becoming a member of an organization include discounts for online continuing education and auto, life and professional liability insurance. Links to job opportunities are found on association websites along with career advancement tips to help you remain relevant in your practice.
Written by Michelle Owen and last updated Jun 28, 2017
Last reviewed by Michelle Owen on Aug 31, 2016