career advice

llg, PhD, RN · Mar 22, 2007

Yes, nursing is like other careers in that there is a hierarchy of jobs (and salaries) based on scope of responsibility, education required, market factors, etc. While there are a few exceptions, nursing positions that involve taking more responsibility, require more education, and involve doing less pleasant and/or less popular work pay more than positions that are popular, involve working a popular schedule, require less education, and involve a more limited scope of practice (i.e. being responsible for the care of only a few patients vs being responsible for managing or teaching those who who take care of many patients).

What many people who switch careers in nursing fail to appreciate ahead of time is the time and effort required to move up the ladder. An advanced education alone is usually not enough. As a practice discipline, most higher level (and better paying) positions are given to people who have both a strong educational foundation and also sufficient clinical experience to develop expertise.

Here's an extreme example to illustrate the point: A person who wants to be the Director of Nursing for a large organization can't just get a Master's Degree in Nursing Administration and get the job as a new grad. She would need to first get a nursing degree and practice as a nurse for a while to establish her basic competence as a nurse. Then she would be eligible for promotion to a lower-level or mid-level management position. After working at that level of management for a couple of years, she would be eligible for promotion further up the ladder. She would need to earn her MSN somewhere along the way (though there are some entry-level MSN programs). It would take a period of several years of both education and work experience to qualify for such a high-level job.

While each specific career path is different, the general principles usually hold true. One moves up the career ladder by getting the needed education and/or certifications and also establishing expertise through practice at lower levels of the career ladder.

Salaries vary greatly based on the region of the country, cost of living, etc. But generally, the upper levels of nurse administrators, educators, and advanced clinical practice nurses make about 1.5 to 2.0 times what the starting salary is for new RN's in entry level positions. A few people at the very top make a little more.

jjjoy, LPN · Mar 22, 2007

If you are a bedside nurse, there's not very far to go unless you go back to school and get a job that's not at the bedside. Some hospitals do have clear "clinical ladders" where qualified nurses get a promotion in their title (eg RN I, RN II) and move into a higher pay bracket. I don't think the actual job description changes all that much, though. These days, in some areas, though, nursing pays pretty well to begin with, especially if you throw in differentials for working nights, weekends and overtime.

It's my understanding that floor nurse managers don't necessarily make more money as they don't get overtime. One benefit usually is more regular hours. A major drawback is that they are often responsible for implementing unpopular policies and may have little influence over the development of those policies.

You might pursue advanced practice nursing where you work in a more medical capacity generally collaborating with physicians or become a clinical nurse specialist and perhaps function as an expert to consult on specific types of cases.

Or you might pursue higher hospital management, where you'd certainly need more education, perhaps in administration and your work wouldn't be clinical in nature - although as a "nurse adminstrator" you'd be expected to have substantial clinical experience behind you.

This is just my limited understanding that may be incorrect to varying degrees in different areas of the country and in different facilities. Anyone please feel free to correct me where I'm off.