In all States and the District of Columbia, students must graduate from an approved nursing program and pass a national licensing examination, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination or by the endorsement of a license issued by another State. Currently 18 States participate in the Nurse Licensure Compact Agreement, which allows nurses to practice in member States without recertifying. All States require periodic renewal of licenses, which may involve continuing education.
There are three major educational paths to registered nursing: A bachelorís of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2004, 674 nursing programs offered degrees at the bachelorís level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 846 RN programs in 2004 granted associate degrees. Diploma programs, administered in hospitals, last about 3 years. Only 69 programs offered diplomas in 2004. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as staff nurses.
Many RNs with an ADN or diploma later enter bachelorís programs to prepare for a broader scope of nursing practice. Often, they can find a staff nurse position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2004, there were 600 RN-to-BSN programs in the United States. Accelerated masterís degree programs in nursing also are available. These programs combine 1 year of an accelerated BSN program with 2 years of graduate study. In 2004, there were 137 RN-to-MSN programs.
Accelerated BSN programs also are available for individuals who have a bachelorís or higher degree in another field and who are interested in moving into nursing. In 2004, more than 165 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree.
Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN program, because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with a bachelorís or masterís degree. A bachelorís degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, and teaching, and all four advanced practice nursing specialtiesclinical nurse specialists, nurse anesthetists, nurse midwives, and nurse practitioners. Individuals who complete a bachelorís receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing care becomes more complex. Additionally, bachelorís degree programs offer more clinical experience in nonhospital settings. In 2004, 417 nursing schools offered masterís degrees, 93 offered doctoral degrees, and 46 offered accelerated BSN-to-doctoral programs.
All four advanced practice nursing specialties require at least a masterís degree. Most programs last about 2 years and require a BSN degree and some programs require at least 1 to 2 years of clinical experience as an RN for admission. In 2004, there were 329 masterís and post-masterís programs offered for nurse practitioners, 218 masterís and post-masterís programs for clinical nurse specialists, 92 programs for nurse anesthetists, and 45 programs for nurse midwives. Upon completion of a program, most advanced practice nurses become nationally certified in their area of specialty. In some States, certification in a specialty is required in order to practice that specialty.
All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other health care facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patientsí conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
Some RNs start their careers as licensed practical nurses or nursing aides, and then go back to school to receive their RN degree. Most RNs begin as staff nurses, and with experience and good performance often are promoted to more responsible positions. In management, nurses can advance to assistant head nurse or head nurse and, from there, to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment.
Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employersincluding hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among othersneed RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.
Foreign-educated nurses wishing to work in the United States must obtain a work visa. Applicants are required to undergo a review of their education and licensing credentials and pass a nursing certification and English proficiency exam, both conducted by the Commission on Graduates of Foreign Nursing Schools. (The commission is an immigration-neutral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Applicants from Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom are exempt from the language proficiency exam. In addition to these national requirements, most States have their own requirements.