Moving Up the Nursing Ladder

Many people might look at nursing education as a single-shot go-to-school-and-you’re-done kind of activity.

In reality, many nurses begin their careers not as registered nurses or even licensed practical/vocational nurses, but several rungs lower.

They may not have the money for nursing education, or may want to get their feet wet in the field without committing to long-term education. Whatever the reason, becoming a nurse is often more of a journey than a destination.

Whatever the reason, becoming a nurse is often more of a journey than a destination.




Getting a Start


Entry level nursing occupations include those of the certified nurses aide, medical assistant or home health aide, as well as other allied health occupations like those of phlebotomist, physical or occupational therapy aide.

What all of these have in common is that they take only a few months of education, usually at the community college level, which is relatively inexpensive.

For some, like the medical assistant and phlebotomist, you may even be able to learn on the job. Salaries vary, but in comparison to something like working as a waitress or in fast food service, it’s a reasonable wage.

No matter where you start on the nursing ladder, there’s nearly always another step.

They are also relatively portable occupations, so if you plan to go elsewhere for your nursing education, you can take them with you to the new location.

Licensed Practical Nurses

The next step up on the rung is that of the licensed practical nurse (they’re called licensed vocational nurses in California and Texas).

LPNs provide basic nursing care under the supervision of a registered nurse or doctor. In some states, they can also perform more complex tasks like intravenous therapy or dialysis.

Some states allow LPNs to supervise other LPNs and unlicensed health care staff like nurse aides, orderlies or medical assistants.

Although some LPNs work in hospitals, they are more likely to be found in nursing and residential care facilities, physicians’ offices and home care.

An LPN training program usually lasts 12 to 18 months, and the graduate receives a certificate of completion rather than a degree.

LPN programs are found in community colleges, technical/vocational schools and some universities. After graduation, the LPN must pass the NCLEX-PN national licensing exam.

Becoming a Registered Nurse

Registered nurses make up the largest worker group of all nursing occupations.

Although they all have the same license, a registered nurse might begin her professional education in an associate program, a hospital-based school of nursing (diploma program) or with a bachelor’s degree.

Once you have your RN, you have the option to go on for additional school, work and go to school part-time or simply work as an RN and remain in that career path until retirement.

Even within those boundaries, however, RNs have many opportunities to specialize, whether in terms of a location like critical care or the neonatal intensive care unit, or in a specialty like orthopedics, neurology or mental health.

An RN can also become certified in a specialty (certification is not an option for an LPN). RNs also have many more options when it comes to work settings, although about 61 percent still worked in hospitals in 2014, according to the US Bureau of Labor Statistics.

The Master’s Degree

Even after achieving the RN, nurses who want to go on can still climb more rungs on the ladder.

In some cases, this means going on for a BSN degree after attaining an ADN or nursing diploma.

In others it means setting your sights on a master’s degree.


An RN can practice without a master’s degree, but certain positions required more advanced credentials.

For example, in nursing management, a master’s degree is usually required for anything beyond the level of head nurse or nurse manager (a nurse responsible for a single unit or department).

Nursing instructors in ADN and BSN programs need a master’s degree in most states to work full-time in that capacity.

And a master’s degree is the basic requirement for advanced practice nursing.

Advanced Practice

Advanced practice nurses, in many respects, stand at the top rung of the nursing career ladder.

Although they remain nurses, their scope of practice takes them into the realm of medicine, and they can perform many tasks once reserved for physicians, such as prescribing medications or ordering diagnostic tests.

APRNs include nurse practitioners, certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists.

Nurse practitioners provide primary care, either in family practice or specialties like pediatrics, geriatrics or mental health.

Certified nurse midwives offer obstetrical and gynecological care (except for C-sections) and may provide home births.

CRNAs specialize in the provision of anesthesia and pain management, and according to the American Association of Nurse Anesthetists, are the sole anesthesia providers in the majority of rural US hospitals.

Clinical nurse specialists may focus on direct bedside care, health care system improvement or nursing education.

The Nursing Doctorate

There’s still one more step for some nurses — the nursing doctorate. This is still a very small group; as of 2011, an editorial in Nursing Economics noted about one percent of all RNs in the US had a doctoral degree.

Most doctorally-prepared RNs opt for nursing education, nursing research or government jobs.

A few are APRNs, and there’s a strong push to require a doctorate for all APRNS, but especially for CRNAs. This step is not for the faint of heart; it means you must complete a BSN, master’s degree and a doctorate — approximately 10 years of education.

Nor does that education come cheap.

However, one advantage of being a member of a small group is that you may have more job opportunities, especially in nursing education, which is facing critical shortages of qualified faculty as current faculty members approach retirement age.


No matter where you start on the nursing ladder, there’s nearly always another step.

At each step, you can build on previous education and experience to achieve new goals. Few professions offer such a variety of opportunities for growth.
Written by 3rd independent party

2016-30287  Exp. 10/17