Starting a Career in Nursing

Midlife career changes are nothing new. If you’re looking for a field with abundant opportunity and if you enjoy caring for others, nursing might be right for you. The job outlook is robust: The Bureau of Labor Statistics reports employment among registered nurses will grow faster than the average for all occupations through 2008. Some reports indicate that more than 1 million new and replacement nurses will be needed by 2012. A career in nursing is also lucrative: Typical salaries start in the $35K-$50K range and increase significantly for more specialized positions. Some hospitals are even offering signing bonuses upwards of $14K. So if you’ve spent some time off from work or are looking at a career switch, following are a few tips to help get you started in a nursing career:

Do your homework. There are numerous specialties to choose from—including oncology, pediatrics, recovery, and emergency care—and several settings in which you can work. Practices range from home care to private practice to clinics to hospitals. Determine your course by actively networking. Attend career fairs and educational sessions. Contact your state nursing board, the local nurses association, or the closest chapter of Sigma Theta Tau, the nursing honor society. The more informed you are, the better you can map out your direction.

Types of nurses include:

  • Advanced Practice Nursing (APN)
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)
  • Licensed Practical Nurse (LPN)
  • Licensed Vocational Nurse (LVN) in California and Texas
  • Nurse Practitioner (NP)
  • Registered Nurse (RN)
  • Certified Nursing Assistant (CNA)

For more specific information on the differences, visit The Nursing Degree Guide

Recognize the steps involved. According to the National Council of State Boards of Nursing, several steps must be taken before a nurse can enter the profession. This usually involves:

  • Graduating from a recognized nursing program
  • Meeting the specific requirements of the state board of nursing
  • Passing the National Council of State Boards of Nursing (NCSBN) NCLEX® examination for registered nurses (RNs) or licensed practical/vocational nurses (LPN/VNs).

 

The National Council of State Boards of Nursing Directory (list of nursing boards by state)

Carefully choose a school. There are over 1500 nursing programs in the country. The minimum education requirement to get into nursing programs is a high school diploma, but advanced degrees require higher education. Most require an entrance exam. There are three basic types of programs available:

  • For those with bachelor degrees, post-bachelor programs are available which build on your previous education and put you on an accelerated course. This allows you to finish in 12-18 months.
  • Bachelors of Science in Nursing (BSN degrees) are four-year programs at colleges and universities. They build a strong foundation, providing leadership and management skills.
  • Associate Degree in Nursing (ADN) are available at two-year programs found at many community and junior colleges. Pre-nursing courses are typically required.

The school you choose is vital. It will largely determine how prepared you are for the NCLEX. The schools you consider should be state board approved and accredited.

The National League for Nursing Accrediting Commission, Inc.
The Nursing Degree Guide
The College Network (online nursing degree options)
American Association of Colleges of Nursing

Research the financial commitment. Make sure you understand the financial commitment associated with nursing school. Tuition varies but can cost up upwards of $30,000 per year. Daunting, but the typical nurse’s salary should make it easier to swallow.

Financial Aid Resources:

Take The National Council Licensure Examination (NCLEX). Once you’ve made it through the craziness of school, you still have to pass the NCLEX. Regular study combined with the education you’ve acquired should prepare you.

Link to a Nursing NCLEX fact sheet.

Know your state’s licensing requirements. Get all the specifics on state licensure including the license period, fees, and continuing education requirements. Look into CEUs even if they’re not mandated. It’s always a good idea to stay current on knowledge and practices, and many CEUs are easily available online. SpeedyCEUs (www.speedyceus.com) offers several online continuing education courses. Make sure your state board accepts the CEUs you’re interested in.

The Nursing Center (list of state licensure information)

Go get your job! Finally, after researching, attending school, and passing your boards, it’s time to embark on your new career. Luckily, the job search should be the easy part. Your school’s placement program or an intent search should provide abundant opportunities. Enjoy the job shopping spree!

Determining Which Nursing Job to Take

The healthcare industry has been experiencing a shortage of qualified nurses for many years, and predictions indicate that the shortage will be more severe and more prolonged than had initially been anticipated. There are many reasons for this:

  • an aging nursing workforce (as women are now less limited in their career choices than they were in past generations)
  • low unemployment rates for nurses with all levels of experience
  • increased demand in every global market
  • changes in patient care that have resulted from the widespread implementation of managed care strategies

Because the length of hospital stays is very closely regulated, more and more patients are receiving acute care in ambulatory or home settings; this type of care requires a highly-skilled and experienced nurse. As a result of this serious shortage, good nurses have the opportunity to carefully research and evaluate potential jobs before picking the one that is best suited to their needs and expectations.

There are many things to consider before you should accept any nursing job or position. Make sure that you understand all of the roles and responsibilities of the job, as well as the associated benefits. The most important thing to remember is that you shouldn’t be afraid to ask questions if anything about the job isn’t clear to you. Ask your potential employer to put their proposed agreement or contract in writing so that you can review it, either by yourself or with the help of an attorney.

Potential employers recognize that there is a shortage of well-qualified nurses, so they won’t be offended if you are straightforward about the fact that you are considering a number of different job options. Because the world of nursing is relatively small and closely knit, it’s important to cultivate strong relationships with your past and potential employers because you never know when you might encounter them again. So, establish and maintain a strong reputation of honesty, good work, and professionalism. If you are working with a placement agency, be firm about your needs and your rates so that you are offered the types of assignments you enjoy.

When you are defining your expectations for a nursing position, think about the following things:

  • financial compensation
  • benefits
  • amount of personal or vacation time
  • the types of patients you will be caring for
  • location and reputation of the hospital or healthcare agency
  • travel nursing versus a permanent position
  • administrative responsibilities
  • liability and disability insurance

Naturally, financial compensation is an important consideration whenever you are offered a nursing position. The nursing shortage does offer you some degree of negotiating power, but be careful not to alienate employers or agencies by accepting a job offer and then reneging on it if a better assignment comes along. As you gain skills and experience, you will be able to command higher rates for your nursing assignments. Also ask about the benefits package that is being offered with the position – health insurance benefits and retirement plans may be an attractive alternative in situations where the salary is not ideal.

While compensation is important, an increasing number of nurses are looking for flexible jobs that offer more personal or vacation time, even if the salary rate is lower. If you want to have both an active personal life and a satisfying professional life, find the balance that works for you when you are determining which position is best.

In addition to the reputation and location of the hospital or healthcare agency you will potentially be working for, you should also consider the type of work you enjoy the most – perhaps you thrive in an intensive care setting or perhaps you would prefer to work in an ambulatory care setting.  Find out about the types of patients you will be responsible for taking care of – if your enjoy working in a particular medical specialty or with a specific population demographic (e.g., children, senior citizens, minorities, the underprivileged), find a nursing position that challenges you and suits your professional interests.

Some nurses enjoy working as travelers, while others prefer to take more permanent positions. If you want to see different parts of the country or the world, traveling may be a good choice for you. Travel nurses often like their positions because, as temporary employees, they are less affected by bureaucratic policies or have fewer administrative duties to detract from time spent on direct patient care. However, there are some disadvantages to travel nursing, including long hours on the road and learning curves for each new hospital or healthcare situation you join. Sometimes, travel nurses find it difficult to assimilate into new nursing environments because permanent employees do not always welcome travelers who will soon be moving on.

Liability and disability insurance is essential to consider, particularly for traveling nurses.

If you will be working as an independent contractor, you should clarify who will be responsible for the insurance premiums. It’s a good idea for nurses to have their own liability and disability coverage, even if the employer offers partial coverage. Find out what you are covered for and for how much, as well as the procedures regarding what happens if you make an error on the job or if there is litigation concerning one of the patients under your care. Also remember to ask about policies that protect you if you are injured at work.

The bottom line is – think carefully about your potential job offers before you make the decision to accept a position. There is a lot of opportunity for nurses, so weigh all of your options and make the smartest choice for you.

Current Nursing Job Market

Nursing is a field where shortages are being seen as demand for skilled nurses greatly exceeds the supply of trained nurses.  Many organizations are desperately trying to hire nurses and resorting to high signing bonuses and other practices in order to recruit much needed help.  There are two types of nursing professionals – Licensed Professional Nurses (LPNs) and Registered Nurses (RNs).

Licensed Practical Nurses

As of 2004, there were over 700,000 people employed as LPNs in the United States. 

  • Work Settings – LPNs currently can be found working in hospitals, nursing care facilities, offices of physicians, as well as home health care, employment services, community facilities, and government agencies.  LPNs are found working in both city and rural settings.
  • Annual Salary – the median hourly salary for an LPN is just under $16.00 ($33,000 annually) with about 50% of LPNs making somewhere in the range of $13.00 to $19.00 per hour ($27,000 to $40,000 annually).
  • Advancement Opportunities – LPNs often gain salary increases as they gain experience in the field.  Some may also be given new responsibilities by the registered nurse or physician that oversees their work, while others choose to gain additional education and become registered nurses themselves or move into administration.
  • Future Outlook – the growth of hospital and nursing home LPNs is expected to grow at average proportions over the next ten years.  It is expected that hiring at hospitals may become more competitive for LPNs and decline over time as tasks currently performed by LPNs become automated with the use of equipment and computers. 

However, the employment of LPNs in the home health industry is expected to grow much faster than average due to the number of patients needing long-term care services and assistance in their homes, and the number of nurses that will be retiring in coming years.

LPNs in rural areas are expected to continue to be in great need as it is often more difficult for those areas to recruit nurses and compete with amenities available in the larger cities.

Registered Nurses

As of 2004, there were over 2.4 million registered nurses working in the United States.

  • Work Settings – About 60% of the current RNs work in hospitals, but other settings include offices of physicians, nursing homes and care facilities, home health agencies, employment services and government agencies.
  • Annual Salary – the median hourly salary for a RN is just around $24.50 ($50,000 annually) with about 50% of LPNs making somewhere in the range of $20.00 to $29.00 per hour ($41,000 to $60,000 annually).
  • Advancement Opportunities – RNs have a variety of options available including positions such as assistant head nurse, head nurse, and management roles.  With a Bachelor’s degree, the career options are even more plentiful.  RNs can also choose to gain additional education and then specialize in areas such as nurse-midwife, nurse practitioner and nurse anesthetist.  Other options include teaching at colleges.
  • Future Outlook – the job outlook for RNs over the next ten years is expected to be excellent and to grow faster than average for all areas of RN work due to the aging population and need to replace retiring nurses.  Some areas, such as hospital employment, might become more competitive, but with turnover and retirement of current RNs, the opportunities are still expected to be plentiful.

Bonuses, flexible hours, and other recruitment strategies are expected to continue for RNs as demand will continue to be greater than the supply of available RNs.

As you can see from these statistics and outlook information, nursing, whether as an LPN or RN, will continue to be a great choice for those looking for a growing industry with plentiful employment and advancement opportunities.

More On How to Choose Between Nursing Jobs

One good thing about the global shortage of nurses is that it gives nurses a lot of freedom when it comes to employment. There are jobs out there—lots of them—more jobs than there are nurses to fill them. It’s a seller’s market. This means that whether you are just graduating from nursing school or have many years of experience, there is a facility that is anxious to add you to its staff.

That’s good news for you because they’ll pay top dollar for you and have to compete with each other to see who can offer the best pay and benefits. They know you have choices when it comes to your employment. Although these conditions work to your benefit, they can also present challenges. How do you choose between jobs that appear practically equal by most measurements? You can’t tell the future to see which job would work out the best, but you can apply sound principles as you evaluate your offers. This article is for nurses who are getting ready for their first job or who are thinking of changing jobs. We hope it will help you land the job that is personally and professionally rewarding.

Evaluation of Potential Nursing Jobs

Put yourself in the sturdy yet comfortable shoes of Tina, an LPN with fifteen years of experience in obstetrics, ICU, and oncology. She has just moved from the west coast to the Midwest due to her husband’s job transfer, and has sent resumes to three hospitals and half a dozen small to midsize clinics. Her resumes have generated a lot of interest and she has already had six telephone interviews and five in-person follow-up interviews. She has evaluated the locations and the facilities, has talked to people on and off the record at each site, and knows how long a commute to each location will take. One fateful day, four job offers arrive in her email from the facilities she thinks she would most like to work for.

Now she has a decision to make; the offers are all comparable in terms of salary, benefits, and location. The decision is not the no brainer she had hoped it would be.  What else should Tina consider before accepting an offer?

Overlooked Nursing Job Elements

While Tina’s situation is a bit fanciful (your offers probably won’t arrive on the same day!), it’s not unheard of. You want to make the best possible decision—and you’re doing your potential employers a favor by thinking long and hard about which job to take. So here are some not-so-obvious tips to help you evaluate the important—but less visible—aspects of nursing jobs that are sometimes overlooked by candidates. (In other words, we assume you’ve already thought about the big and obvious things like salary, benefits, location, hours, and atmosphere.)

Read the benefits fine print. Especially the insurance policy. If you’ve spent any time in the workforce, you know that all insurances are not created equal. Deductibles and co pays can vary widely, even between providers at the same employer. Your health insurance policy may not cover your whole family, or may have special restrictions based on spouse coverage, if applicable. Some policies require a three-months waiting period before benefits start; some require six.

Think about your first months on the job. When considering job offers, job seekers tend to imagine themselves in the job as a settled and adjusted employee, and make a decision from that sometimes rose-colored view. But you have to survive the transition period, and that can be very different from site to site depending on the employer’s policies. How does your potential employer help the newcomer adjust? How are newcomers treated—do they have a voice and means for airing grievances? What kind of orientation is offered for new nurses? Is there a mentoring program so the new hire can get the help and advice of a veteran?

Consider the stress factor of the facility. Does it handle mostly acute cases, such as in large urban hospitals, or does it run at a slower pace, allowing you to develop more substantial relationships with patients? How many patients pass through the doors, and how much average time does a nurse spend with a patient? While you may be able to perform very well in a facility that does not match your personality in this regard, you will likely not thrive and be as happy at work as you could be with a better fit.

Look at the facility’s reputation. You’ve toured the location and have a good feel for the overall quality of the facility and its departments. Now do some research about its reputation in the wider community and in the healthcare industry. Look at its accreditations and see if accreditation review records are available. Has the facility been recognized with awards or merit-based grants? US News and World Report publishes annual rankings of US healthcare facilities. How does your potential employer stack up?

Evaluate the working conditions. In addition to your observations during the workplace tour, ask specific questions about working conditions. What is the nurse-patient ratio? What kind of security measures are in place to protect you and your patients (and in some cases, from your patients)? You should ask to meet your supervisor; he or she can dramatically impact your daily work experience based on his or her background and personality. Is your supervisor a nurse or a non-medical administrator? How does he/she handle workplace conflict? Can you get along with this person with whom you may have to spend eight hours (or more) per day?  

Think about the “pecking order.� Every organization has one—they even need them. But some are more tolerable than others. You should think about your career goals and personality and evaluate whether they are compatible with the decision-making process of your potential employer. Are nursing staff involved in policy decisions that affect them, or are such decisions merely handed down from on high? Being at the mercy of others’ decisions without the ability to give input or affect the outcome is a large source of stress and dissatisfaction on the job.

Finding the ideal job is a big job in itself. But it can have big rewards for a long time to come. Everyone looks at the obvious things, but lots of nurses overlook these less obvious but equally important aspects of the job that can have a very real daily impact on happiness. So do your homework and ask the hard questions; you’ll be glad you did

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