How to Become a Nurse

By Deborah Jeanne Sergeant

People who want to work as a nurse have many pathways to receive their credentials.

Unlike many careers, nursing does not have to cost a lot to enter.

Many people begin nursing in entry-level work, such as a certified nurse assistant (CNA) through a free tuition program with an employer such as a home health company or nursing home. These programs typically run four to 12 weeks.

Many organizations offer tuition in part or in full to become a licensed practical nurse (LPN), a credential that requires a year-long program and next, a registered nurse (RN), an associate degree program that requires passing a state exam before receiving licensure.

Since 2017, RNs are required to complete a bachelor’s degree (BSN) within 10 years, which is a four-year program (including the two years to complete the RN program). Again, most larger healthcare organizations assist with tuition so their employees can comply with this requirement.

The next level is the advanced practice registered nurse, or master of science in nursing (MSN). This could include a nurse practitioner (NP), clinical nurse leader (CNL), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA) or certified nurse midwife (CNM).

Beyond these levels are the non clinical specialties such as doctor of nurse practitioner (DNP), which enables professionals to serve as a nurse administrator, nursing informaticist, nurse educator or nurse researcher. With each level comes a higher level of responsibility, scope of practice and salary.

Lydia Rotondo

Lydia Rotondo, associate dean of education and student affairs with the University of Rochester School of Nursing, said their program will pay tuition in exchange for practicing three years at the hospital.

“This is a great way of attracting people to UR,” she said. “They have a tremendous career trajectory.”

Lisa Kitko, dean for the school of nursing at UR, added that seeking the bachelor’s degree is important—and not only for compliance—but investing time in seeking the education can challenge some students.

Lisa Kitko

“When we look at some of the evidence we have, it’s important that nurses should be prepared at the bachelor’s level,” Kitko said. “Many hospitals want a BSN in five years. At the University of Rochester and other places, we have an accelerated program for people to get a BSN in 12 months. That is a great way to help people in the workforce.”

Seeking more education can only help nurses in furthering their careers in the future, especially in management education or leadership roles.

“For these, you typically need a higher degree,” said. Yvette Conyers, who holds a doctorate in nursing and served as past president of the Rochester Black Nurses Association.   

At the master’s level, nurses can specialize in areas of interest so they can command higher wages and practice more independently. But Conyers said that the DNP is not recognized by many institutions. “It’s more an internal decision factor. That varies for everyone. For me, it was the desire to continue in academia teaching students to become advanced practice nurses. For those considering leadership roles, the DNP will allow you the education to do so.

Yvette Conyers

“What you learn in your DNP program allows you to oversee an organization in the C-suite with other leaders.”

It may seem that obtaining higher education in nursing requires many hours of hands-on nursing experience; however, Conyers said that is not necessarily so. While completing her DNP program, she had classmates who had never worked as a nurse practitioner. But a more hands-on future role would be better served by sufficient hands-on experience along with the education.

Kathy Mills, dean of the college of nursing at Finger Lakes Health College of Nursing & Health Sciences, said that her organization provides tuition support and “buy back,” for when students complete the program, and they pay back a portion of the student loan. The typical work obligation is about six to eight months.

“Right now, what I’m seeing is almost all the hospitals are paying,” Mills said. “I’m not seeing that yet from others, unless they fall under larger organizations.”

In addition to tuition help and offering educational stepping stones from CNA to RN, Finger Lakes Health offers options for mid-career workers to complete an RN program or BSN program through day or evening classes and online classes. This has proven so popular that only 10 to 12% of Finger Lakes’ students are directly from high school and the rest are second career adults.

“If you had bachelor’s from another college, you could transfer credits,” Mills said. “I tell my students, it’s usually cheaper to get the second degree at the same college.”

Transfer problems can cause students to have to retake courses sometimes. It’s important to check with schools before enrolling to avoid costly mistakes.

Key to Nursing? Training

How can nursing be more in touch with patient needs and public health needs? For Mary Dahl Maher, Nazareth College’s chairwoman of nursing and public health, the answer begins with training.

“The accreditation association is looking at the fact that nursing needs to be more population health based,” Maher said. “New standards are being passed that when we’re accredited by our national accreditors, we have to show how we’re addressing public health in those courses. The idea behind that is that new nurses have to understand how to keep people out of the hospital through good discharge planning. Nurses need to be exposed not only to acute care. We are responding to those recommendations. We’ve changed two courses in the fall required of students on population health and understanding what that involves. Senior nursing students will be taking a course in emergency preparedness and disaster response.”