A nurse is sitting down with a doctor discussing patient care.

A nursing career opens the door to a world of limitless possibilities and enriching experiences in the healthcare industry. Beyond the bedside care and compassion that defines the core of nursing, countless advanced avenues await those who dare to venture further into this dynamic field.

When it comes to climbing the nursing career ladder, everyone's path is different—and that's okay because no matter where you're at in your journey, there's always room for growth and advancement. Heck, if you Google nursing specialization, you'll probably feel overwhelmed by all the routes you can take.

Navigating Nursing Career Advancement

Some folks know exactly what they want, so they press on the gas and advance their nursing career at warped speeds. Then there are those who aren't quite sure what path to take, so they take their time, get their feet wet, and see where the path leads. And sometimes life just happens, delaying our long-term career aspirations—but the key is to embrace the detour and not let unexpected events throw you entirely off course.

For example, nursing school is highly competitive, with learning institutions inundated with qualified applicants. So, while we might be amid a nursing shortage, these institutions turn many of these applicants away because they don't have the space or staff to accommodate them. But instead of giving up, applicants whom nursing schools have turned away can become CNAs to build a solid nursing foundation and stand out when re-applying to nursing school.

But as you're about to see, navigating the world of nursing involves ascending through a dynamic spectrum of expertise and responsibility captured by the five levels of nursing.

The Five Levels of Nursing

These five tiers represent a ladder of nursing education and certification. However, it’s crucial to recognize the nuanced nature of nursing, where state-specific regulations and distinctive titles add layers of diversity to the tapestry of these roles. For example, while most states use the title licensed practical nurse (LPN), California and Texas use licensed vocational nurse (LVN) even though it's the same job.

An illustration that showcases and describes the five levels of nursing: CNA, LPN, RN, APRN and DNP.

1. Certified Nursing Assistant (CNA)

CNAs provide patient care under the supervision of licensed practical nurses (LPNs) or registered nurses (RNs). They assist with activities of daily living, such as bathing, feeding, and mobility. To become a CNA, you must complete a state-approved education program, which takes approximately eight weeks. You must then pass your state's CNA certification examination to practice the profession.

ShifMed, in partnership with the National Association of Healthcare Assistants (NAHCA), offers a free CNA training and certification program. Accessible via the National Institute of CNA Excellence (NICE) training platform, the program blends online coursework with hands-on experience.

CNA Specializations

Once you have your CNA license, you can advance your career by earning a CNA specialty certification in a specific practice area. Having one or more specialty certifications benefits you personally and professionally by providing you with more job opportunities and a salary increase. Among the highest-paying CNA specialties are critical care, surgical, pediatrics, and geriatrics.

Right now, ShiftMed is looking for CNAs with adult specialties that include:

  • Acute Care

  • Behavioral Health

  • Emergency Room

  • Intensive/Critical Care

  • Labor & Delivery

  • Mother-Baby

CNA Career Advancement

CNAs looking to take a giant leap in advancing their nursing career can become LPNs or RNs. Should you become an LPN or RN? It depends on your end goal and current circumstances.

The differences between the two roles lie in their educational requirements, licenses, and scope of practice. An LPN education is shorter, so it takes less time to earn your license. The nursing education and certification requirements to become an RN are more involved and time-consuming. But in the end, RNs have more independence in the workplace and enjoy a broader scope of practice.

Helpful Hint: If you're a CNA working towards becoming an LPN or RN, you can earn good money without taking away from your education. By downloading the ShiftMed app and completing the onboarding process, you can work local CNA shifts when, where, and how often you want!

2. Licensed Practical Nurse (LPN)

LPNs provide nursing care, administer medications, and monitor patients under the supervision of RNs or physicians. You must complete an accredited practical nursing certificate program, which usually takes about 12 months, and pass the NCLEX-PN to become an LPN.

LPN Specializations

Once you have your LPN license, you can advance your role by pursuing specialized LPN certification, from IV therapy to tracheostomy care to wound care. Surgical LPNs tend to earn the highest salaries due to the knowledge and skills required for working in a fast-paced, high-pressure environment.

Right now, ShiftMed is looking for LPNs with these nursing specializations:

  • Acute Care

  • Behavioral Health

  • Emergency Room

  • Labor & Delivery

  • Medical/Surgical

  • Mother-Baby

  • Telemetry

  • Stepdown

  • Nursery

  • Pediatric

  • Pediatric Behavioral Health

  • Pediatric Emergency

LPN Career Advancement

If you're an LPN, moving to the RN level is the next major step for your career advancement. These are the three education paths that lead to the RN profession:

  • Bachelor of Science in Nursing Degree (typically takes four years to earn)

  • Associate Degree in Nursing (can take up to three years to earn)

  • Nursing Diploma (can take up to two years to earn)

However, as an LPN, you can complete a bridge program (LPN-to-ADN or LPN-to-BSN) to expedite your path to registered nursing. These programs build on your existing knowledge, training, and experience.

So, how do you know which route to take? At this point in the game, you must determine your end goal and how much time, money, and energy you have to put towards your nursing career progression.

In years past, it was common for individuals to start their registered nursing career by earning an ADN—which makes sense because it was a faster, more affordable option. These days, however, most healthcare employers prefer to hire baccalaureate-prepared nurses. Furthermore, many hospitals pursuing Magnet status now require their ADN nursing staff to go back to school to earn a BSN.

So, while an ADN may sound more enticing at the moment, it might not be your best option over the long term if you want to continue advancing your career. Furthermore, nurses with a BSN typically earn more money and have more career advancement opportunities than someone with an ADN or nursing diploma.

3. Registered Nurse (RN)

RNs perform various nursing duties, including administering medication, educating patients, and coordinating care. You must complete an accredited nursing diploma program, Associate Degree in Nursing (ADN) program, or Bachelor of Science In Nursing (BSN) program. You must also pass the NCLEX-RN to become an officially licensed RN.

RN Specializations

Once you have your RN license, you can advance your role by pursuing a specialized RN certification. With nearly 100 nursing specializations available, the sky is the limit.

Right now, ShiftMed is looking for RNs with these specializations:

  • Behavioral Health

  • Emergency Room

  • Intensive Care Unit

  • Pediatric Intensive Care Unit

  • Neonatal Intensive Care Unit

  • Medical/Surgical

  • Mother-Baby

  • Operation Room/Surgical

  • Pediatric Care

  • Perioperative

  • Telemetry

  • Stepdown

RN Career Advancement

Suppose you eventually plan to become an advanced practice registered nurse (APRN) or a doctor of nursing practice. In that case, you must have a BSN because you'll need this level of education to pursue a Master of Science in Nursing (MSN) degree.

ShiftMed RNs with an Associate of Science in Nursing (ASN) receive a 10% discount when they enroll in this 12-month RN-to-BSN program.

4. Advanced Practice Registered Nurse (APRN)

While an RN skillfully executes a patient's care plan, the APRN takes the helm, passionately guiding and orchestrating the entire care journey. Furthermore, APRNs have a higher level of autonomy and can provide a wide range of advanced healthcare services, including diagnosing and treating illness.

To become an APRN, you must have a Master of Science in Nursing (MSN), an active RN license, and at least one year of experience working as an RN.

ShiftMed RNs with a BSN receive a 10% discount when they enroll in this online MSN program

APRN Specializations

As an APRN, you can pursue advanced certification to become a nurse practitioner, nurse anesthetist, nurse midwife, or clinical specialist. Requirements to practice as a licensed professional in one of these areas vary. For example, becoming a nurse anesthetist can take as many as 10 years.

5. Doctor of Nursing Practice (DNP)

Technically speaking, the Doctor of Nursing Practice is not a role but a degree. With this level of education, these nurses have the expertise to teach and inspire the next generation of nursing leaders. Simultaneously, they stand at the forefront of cutting-edge research and unravel the intricacies of optimal patient care.

To earn a DNP degree, you must first have a BSN degree and up to six years of doctoral research at an accredited university. Additionally, you'll have to have worked as an RN or APRN for at least one year and synchronously present original research that offers something new and practical to the nursing field.

Nursing Success Stories

These stories prove that if you're committed and willing to put in the effort, you can advance your nursing career any way you want.

From Custodian to Nurse Practitioner

In 2010, Jaines Andrades worked for Baystate Medical Center, cleaning operating rooms after surgeries. Ten years later, she was a trauma nurse practitioner tending to patients in those operating rooms. How did she achieve this goal? By having a vision, a career path, and determination. She got her BSN while still working as a custodian, was hired as a nurse, gained experience, and then returned to graduate school to become an NP. 

From Pregnant Teen to Nursing Director

The skillful and supportive nursing care that Rita Aguilar received when she delivered her first child by cesarian section at 17 years old was the driving factor to her becoming a nurse and, ultimately, a senior nursing director. Her experience inspired her to look up nursing programs in the Yellow Pages—before the Internet—and apply to nursing school. Thirteen years after becoming a nurse, she returned to school to get her BSN—with three small boys at home. She didn't stop learning there but continued to earn her doctorate and is now the Senior Nursing Director at the University of Utah Health.

From Pediatrics to Critical Care

I was working in a pediatric nursing unit when we received an unconscious child in diabetic ketoacidosis (DKA) with a potential hydrogen (pH) of less than 7. I knew enough to be scared and decided I wanted more training because I never wanted to be in that situation again.

I applied for a job in the ICU and took the required courses and training. I loved the adrenaline rush of being on the code team, mixing and titrating potent drugs, monitoring critical patients, and being part of a team. By becoming specialized, I increased my confidence and set my sights on even higher aspirations. I went on to get my MSN and then took a job in administration.

Strategies for Nursing Career Advancement

When I started nursing, I never thought about the future of my career—or how nurses got the upper-echelon jobs I wanted. Since then, I've learned many strategies for advancement, which I will share with you here:

  • Set career goals and review them yearly to ensure you continue moving forward. 

  • Find a nurse mentor on your unit to gain from their expertise and advice.

  • Hire a nursing coach to help you strategize a career path to reach your goals.

  • Look for nursing network opportunities that match your aspirations.

  • Join a nursing association to get guidance and support.

  • Attend nursing conferences to stay current and network to find new opportunities.

In Conclusion

A nursing career is a thrilling 'choose-your-own-adventure' within the vast realm of healthcare. Whether it's donning the scrubs of a critical care nurse, charting the course of policy as a healthcare administrator, or delving into groundbreaking research, the possibilities are as boundless as the compassionate hearts that embark on this extraordinary journey. After all, a nursing career isn't just a job; it's an invitation to script your narrative and leave an indelible mark on those in your care.

Alice Blackmore, MN, RN, Content Writer

Alice is a registered nurse and healthcare writer. She has more than 20 years of nursing experience, which ranges from labor and delivery to long-term care, with pediatrics, community nursing, and critical care sandwiched in the middle.

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