Registered nurse career path

The nursing ladder has four main rungs. Each one adds education and a wider scope of practice. Licensed practical nurses (LPNs, called LVNs in some states) complete a practical nursing program that commonly runs about 12 months. According to the US Bureau of Labor Statistics (BLS), the LPN median wage is $64,400 per year. LPNs who plan to move up can compare the LPN and RN roles and look for LPN-to-RN bridge programs.

Registered nurses enter through an ADN, which commonly takes about two years, or a BSN, which takes about four. The RN median is $97,550 per year, or $46.90 per hour, according to BLS. The lowest-paid 10 percent of RNs earn less than $68,940. The highest-paid 10 percent earn more than $137,470. Many RNs who start with an ADN later complete a BSN to prepare for graduate study.

Nurse practitioners need a master's or doctoral degree. These programs commonly take 2 to 4 years beyond the BSN. The NP median is $132,300, which is $34,750 more than the RN median. Nurse anesthetists need a doctoral degree and ICU experience. Their median is $236,590, which is $139,040 more than the RN median. The ladder below shows each rung with its requirement and pay.

Advanced practice registered nurses (APRNs) are RNs with graduate education in one of four roles. The roles are nurse anesthetist, nurse practitioner, clinical nurse specialist and nurse-midwife. Each role has its own national certification. State law sets what each role may do, so the scope of practice varies by state.

Certified registered nurse anesthetists (CRNAs) give anesthesia and watch patients before, during and after surgery and other procedures. They work in hospitals, surgery centers and other places where patients receive anesthesia. To enter the role, an RN gains ICU experience and then completes a doctoral program in nurse anesthesia. Graduates must pass the certification exam given by the NBCRNA. The steps from RN to nurse anesthetist follow that order in detail.

Nurse practitioners (NPs) examine patients, diagnose conditions and prescribe treatment. Many work in primary care, and others focus on one patient group. NPs complete an MSN or DNP program and pass a national board exam, such as one offered by the American Nurses Credentialing Center (ANCC). The route from RN to nurse practitioner lists each step. Like CRNAs and NPs, clinical nurse specialists and nurse-midwives enter their roles through a graduate nursing program. Clinical nurse specialists work to improve care for one type of patient across a unit. Nurse-midwives care for patients through pregnancy, birth and recovery.

Among nursing roles, nurse anesthetists have the highest median pay, and nurse practitioners are next. Both medians appear on the ladder above. Each of these roles requires a graduate degree, so the highest nursing wages depend on further schooling.

For nurses who stay at the RN level, the work setting and the state move pay the most. According to BLS, RNs in specialty hospitals earn a median of $102,840 per year. RNs in elementary and secondary schools earn a median of $69,340. General medical and surgical hospitals employ 1,902,960 RNs at a median of $100,210. Home health care services pay a median of $84,930.

State has a similar effect, as the California and Alabama comparison above shows. For this reason, RNs who want higher pay without a new degree often compare employers by setting and state. Nurses weighing offers can review RN pay by state and setting. Some RNs also take short-term travel contracts in other states.

Many RNs change their daily work by moving to a new unit or earning a specialty certification. These moves do not require a new degree. The American Association of Critical-Care Nurses (AACN) offers the CCRN certification for nurses who care for critically ill patients. ANCC offers board certification in several areas, such as medical-surgical and pediatric nursing. Certifying bodies generally require an active RN license and a set amount of practice in the specialty before the exam.

Lead roles, such as charge nurse, usually require bedside experience first. At the Medical University of South Carolina (MUSC), for example, some lead roles ask for at least one year of RN experience. ICU experience is also required for nurse anesthesia programs. For this reason, RNs who plan to become CRNAs often move into critical care early. The nursing specialties open to RNs include units such as emergency, pediatrics, labor and delivery, and the operating room.

Some RNs move into roles away from the bedside. These roles still use clinical knowledge, but the daily work is different.

Informatics nurses work with health records and other computer systems. They help clinical staff use these tools safely. Nurse educators teach in nursing schools or train staff in hospitals. Teaching in a nursing program generally requires a graduate degree. Case managers plan care for patients across visits and settings. They also work with insurers and families to set up services after a hospital stay.

Physician assistant (PA) and paramedic roles are separate careers. Each has its own training program and its own license or certification. An RN who wants either role completes that training as a new program.

RNs who want an advanced practice role have several graduate routes. RN-to-MSN programs let nurses with an ADN earn a master's degree. These programs usually include bachelor's-level courses before the graduate coursework begins. BSN-to-DNP programs take nurses with a bachelor's degree directly to a doctorate.

Average tuition and fees are about $12,480 per year for an MSN and about $61,080 per year for a DNP. These figures do not include room and board. Costs vary widely by school. If you are comparing programs, ask each one for its full cost, its length and its clinical hour requirements.