Entry Level Nursing

Guide to Entry Level Nursing

Earning a nursing degree is without a doubt one of the best investments that you can make in your education. Nursing ranked 3rd among the best college majors for return on investment. It is a field that offers graduates opportunities for success, workplace satisfaction, generous income and an abundance of job opportunities. Nursing is an excellent profession to embark on for those who are entry-level or have no prior job experience.

Demand for health care services has been growing due to aging Baby Boomers and healthcare reforms. In order to avoid a nursing shortage, the U.S. will need to produce 1.1 million new registered nurses by the year 2022 to fill newly created jobs and replace retiring nurses. The American Nurses Association (ANA) President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN states “Demand for care is going to grow and nurses are going to retire in droves, so we have to prepare now to meet future needs.”

The strong demand for nursing professionals is a compelling sign that nursing will remain a strong career path for many years to come. Peter McMenamin, PhD, Senior Policy Fellow with the ANA reports “Nursing is a good job. Work satisfaction is high. If you look at the employment in U.S. hospitals for the last decade, month after month, there’s only a single month where employment went down. Hospitals have been continuing to hire during the recession.”

If you want a nursing career, you will need to familiarize yourself with the various educational pathways available. Your choice will depend on your career goals, salary considerations, time to complete the training and the type of nursing work you would like to do. Making a sound decision on your education path will set you up for career success.

This guide will explore the pathways available to you as well as how to get financing for your nursing education.

Types of Nursing Certificates and Licenses

Did you know that not all healthcare career paths require you to spend extensive time in school? If you want to enter the workforce sooner so you can start earning and build practical experience immediately, certificates and licenses are the best option for you. This pathway provides you enough education to get some nursing experience and gives you the option to return to school at a later time to earn your Bachelor’s or Master’s degree if you so choose.

Nursing Assistant

One of the easiest pathways to a direct-entry nursing career is as a nursing assistant. This position is alternately referred to as a certified nursing assistant (CNA), registered nursing assistant (RNA), nursing assistant (NA), or patient care assistant (PCA). Nursing assistant jobs are widely available and the training is minimal.

Nursing assistants help patients with healthcare needs while working under the supervision of a registered nurse or licensed practical nurse. Responsibilities include cleaning, bathing, dressing, and feeding patients; toileting assistance and catheter care; changing bed linens; turning and repositioning bedridden patients; assisting mobility-challenged patients; monitoring and assisting physical therapy and rehabilitation; taking vital signs; and monitoring patients for changes. Nursing assistants are employed by hospitals, nursing homes, assisted living facilities, adult day care centers, and homecare agencies.

Nursing assistants must complete a state-approved education program that includes education about basic nursing principles and completion of supervised clinical work. Many schools offer training within medical facilities as part of their curriculum. The length of training depends on the program and can take anywhere from a few weeks to a few months. Training programs are offered by vocational and technical schools, community colleges, online schools (available in certain states only) and through medical facilities. Some healthcare facilities will hire untrained and inexperienced workers and provide on-the-job training. To get into a program, you often need to have a high school diploma or GED.

Before becoming a qualified nursing assistant, you must take a competency exam that tests both your book knowledge and the practical skills that were taught during training. Additionally, you will often complete a brief period of on-the-job training to learn about your specific employer’s policies and procedures.

Licensed Practical or Licensed Vocational Nurse

Licensed practical nurses (LPNs), or licensed vocational nurses (LVNs) as they are known in California and Texas, provide hands-on care to patients under the supervision of registered nurses or physicians. LPN or LVN programs can be completed quickly, typically within a year, and generally cost less than registered nurse programs. This short time frame can be appealing because it allows you to quickly delve into the nursing profession.

The role of the LPN is to provide basic bedside care. Duties include administering medication; documenting in patient charts; collecting specimens; taking vital signs; changing wound dressings; insertion and care of urinary catheters; care of patients with ventilators and tracheostomy tubes; providing feedings through nasogastric or gastronomy tubes; administering CPR; monitoring patients and calling the physician as appropriate. Experienced LPNs may supervise nursing aides. They are employed in a variety of settings including doctor’s offices, outpatient care centers, school systems, correctional facilities, hospitals, and long-term care facilities.

Many community and technical colleges offer Board of Nursing (BON) approved LPN programs. Acceptance requirements may vary by state but all require a high school diploma or GED. Programs combine nursing courses with supervised clinical training. Certain courses may be available online, which allows busy students to complete classwork when it fits their schedule. LPN training focuses on the practical skills necessary to perform patient care as opposed to registered nurse (RN) training that also incorporates critical thinking skills.

Successful completion of an LPN program makes you eligible for licensure after you pass the NCLEX-PN, an exam administered by individual State Boards of Nursing. After earning your LPN, you have the option of pursuing a bridge program where you can leverage your existing LPN training to earn the more advanced RN degree.

Types of Nursing Degrees

Although it is a longer path, you can enter the nursing profession as a registered nurse (RN) with a degree rather than a certification. Three basic programs will qualify you for an entry-level position as a staff nurse. Each will be addressed in this guide. Here we’ll explore the different nursing degrees available to you.

Diploma or Associate of Science in Nursing

These paths make the most sense if you don’t have a previous college degree and want to earn money as a RN sooner than the 4 years required to complete a bachelor’s degree. A nursing diploma takes 3 years to complete and is available through hospital-based schools of nursing. It was once the norm in nursing education but now these programs only educate 4 percent of new RNs.

An associate degree in nursing (ADN) is a great option for those of you who haven’t been working as an LPN and want to start your career as an RN. This type of program focuses more on technical skills than theory. An ADN degree typically takes 2 years to complete and is less expensive than pursuing a bachelor’s degree. It is offered by community colleges and hospital based schools of nursing. Most new RNs (53 percent) are educated through ADN programs.

RNs are employed in all healthcare settings. Some settings are expected such as hospitals, doctor’s offices, ambulatory care centers, community health centers, schools, correctional facilities, and long-term care facilities. Other locations may be surprising such as camps, sporting events, tourist destinations, and homeless shelters. In addition to performing the tasks of a LPN, their responsibilities include interpreting patient information and making critical decisions about needed actions; providing health promotion and education; performing health exams and obtaining health histories; and directing and supervising the care provided by nursing aides and LPNs.

Once you have completed a diploma or ADN program, you must pass the NCLEX-RN to be licensed to practice as a registered nurse. You will make significantly more money as an RN than you would as a CNA or LPN. The median hourly wage of a CNA is around $12 and around $20 for a LPN.  RNs earn a median hourly wage of over $32.

When making the decision about which option is right for you, is important to keep in mind the fact that nurses who hold a bachelor’s degree are eligible for more jobs than nurses who hold only a diploma or associate’s degree. Many hospitals and other healthcare providers are increasing the minimum qualifications required to fill RN positions. Employers recognize bachelor’s prepared nurses are better equipped with strong skills in critical thinking, health promotion, and case management. This degree does afford you the option of returning to school later to earn a bachelor’s degree through a bridge program.

Bachelor of Science in Nursing

A Bachelor of Science degree in nursing (BSN) is the preferred degree in today’s healthcare job market. With this degree, you will have access to more entry-level positions but, enrolling in a 4-year BSN program is a serious commitment. A considerable amount of time must be devoted to completing coursework and lab requirements. If you plan on pursuing advanced education, earning your BSN is likely the best option as it is a prerequisite for master’s programs.

Some programs offer an accelerated option that allows you to earn your degree in less time if you are an experienced RN with a diploma or associates degree or if you are a non-nurse who holds a bachelor’s degree in another field. Accelerated programs are rigorous but can be completed in as little as 18 months.

The BSN degree prepares graduates to participate in the full scope of professional nursing practice across all healthcare settings. The BSN combines classroom learning with clinical training. Some BSNs can be completed through a hybrid program where some of the classes are offered online while practical lessons are scheduled at a local hospital or on campus. Classes on nursing theory, research and leadership are provided in addition coursework on the practical skills of nursing.

To earn a BSN, you must be accepted at a college or university with an accredited nursing program. You can easily locate such programs by performing an online search or you can review those listed here. Programs will have their own specific admission criteria but generally you can expect to submit transcripts proving satisfactory completion of prerequisite science coursework.

Master of Science in Nursing

The final pathway you may select to enter the nursing profession is by obtaining a Master of Science in Nursing (MSN) degree. These programs are ideal if you are looking to specialize in a specific area such as advanced clinical training, education, or research. Investing in an MSN degree can help you get to the next level in your nursing career. You will earn a higher salary and gain advanced skills that will allow you to provide care to patients in a manner similar to a doctor.

You can enroll in an MSN program after working as a nurse, in which case it is not considered an entry-level degree, or you can enroll in a direct entry MSN program, which means you are a non-nurse who holds a bachelor’s degree in another field. Direct entry degrees are typically completed in 3 years. The first year is devoted to entry-level nursing coursework and the last two years focus on a more specialized track of master’s-level study. Most programs will require students to complete their education with a thesis or project. Graduates enter the nursing profession in advanced positions such as nurse managers, clinical research coordinators, nurse educators, or clinical nurse specialists in field such as child/adult mental health or gerontology.

You can easily locate direct-entry MSN programs by performing an online search or you can review those listed here. Each program will have specific admission criteria including prerequisite, GPA, and GRE requirements. Applicants must possess a bachelor’s degree and often will have worked in another field for a few years.

Job Outlook

Nurses are the heart of healthcare and will always play a vital role in the industry. Employment of registered nurses is expected to grow faster than the average for all other occupations. The U.S. Bureau of Labor and Statistics projects a 16% increase in growth from 2014 to 2024. Job prospects for nursing assistants are also expected to be good, particularly in-home healthcare and community-based care settings. These positions are easy to come by due to a high turnover rate related to lower wages, heavy workloads, and immense emotional and physical demands. This creates opportunities for jobseekers, particularly those looking to get a foothold in the healthcare industry.

Your job prospects will vary depending on the degree you obtained. The current trend in nursing is advanced education. Registered nurses with a bachelor’s degree or higher will have better job prospects than those who hold an associate’s degree. A 2013 survey conducted by the American Association of American Colleges of Nursing (AACN) found 43.7% of hospitals and other healthcare settings required new hires to have a bachelor’s degree in nursing (up 4.6 percentage points since 2012), while 78.6% of employers expressed a strong preference for graduates of bachelor programs.

The American Nurses Association (ANA) noted the presence of mixed signals in the nurse employment market with shortages in some areas and surpluses in others. The increased supply of new nurses entering the labor market has generally resulted in more competition for jobs. Healthcare employers have instituted hiring freezes or ordered layoffs and many nurses have delayed retirement due to the recession. Despite these mixed signals, opportunities abound for registered nurses. The fastest growth for employment is projected in the West and Mountain states with the slowest growth anticipated in the Northeast and Midwest. In every state, annual growth is projected at 11% through 2022.

According to Suzanne Prevost, PhD, RN, dean and professor at the Capstone College of Nursing at the University of Alabama and an alumna of the RWJF Executive Nurse Fellows program (2009-2012), “Nursing is always a marketable degree. During my 34 years in the profession, I have seen several cycles of shortage and oversupply. Even during the years of oversupply, plenty of options remain for nurses who demonstrate competence, a commitment to lifelong learning, and responsiveness to the needs of patients, families, and our health care system.” Nursing is, and will continue to be, a dynamic profession full of opportunity for those who seek it.

Financial Aid for Nursing Education

There is an abundance of financial aid opportunities for all nursing degree types. The first step is to fill out a Free Application for Federal Student Aid (FAFSA). Each year, Federal Student Aid offers college students more than $150 billion in federal grants (money that does not need to be repaid), loans (money that is borrowed and therefore must be repaid along with interest), and work-study funds (students earn money by working to help pay for school).

Second, you should familiarize themselves with the various grant and scholarship programs available to defray some of the costs of attending nursing school. Some grants and scholarships are open to application from any nursing student while others are open only to specific groups based on gender, race or ethnicity, geographic location, or interest in a specialty area.

Past, present and future members of the United States Armed Forces can apply for grants to study nursing or further their nursing education. For veterans, a quick online search will aid you in discovering the numerous colleges offering the Veteran’s Bachelor of Science Degree in Nursing (VBSN) Program, which provides grants to schools to expedite the path to a nursing degree for military personnel. Institutions participating in the VBSN program provide academic credit for military training and experience. The Health Professions Scholarship Program (HPSP) offered through the U.S. Army, Navy and Air Force are two- and three-year scholarships for nurse corps specialties. HPSP scholarships cover all tuition and fees as well as provide a monthly allowance for living expenses. The Army ROTCNavy ROTC or Air Force ROTC are excellent paths to develop critical-thinking and leadership skills while receiving financial assistance for nursing education.

Some states and hospital systems with dire nursing needs offer incentives and grants for nursing students. Two such programs will be here. The National Health Service Corps (NHSC) awards scholarships and loan repayment to nurses and nursing students who, in exchange, work at a facility with a critical shortage of nurses upon graduation. The Scholarship Program provides funding for tuition and other educational costs, while providing a monthly living stipend. Competitive pay and benefits from your employer are also provided. The Loan Repayment Program enables RNs to pay off 60% of their nursing education debt with a 2-year commitment of service and up to 85% with a 3-year commitment. The Department of Veterans Affairs, a leader in U.S. Healthcare, offers several incentive programs aimed at attracting nursing professionals including the Tuition Reimbursement Program, The Education Debt Reduction Program, the Employee Incentive Scholarship Program and the National Nursing Education Initiative.

There are many things to consideration as you set out on career in nursing. We hope that this guide has helped you pursue your aspirations the wonderful field of nursing.