Nursing Career Paths/Ladders

[Natpark1]

Hello,

I would like to preface this message by saying that I am not a nurse, however I am currently working on a research project for school that is meant to deal with the current/upcoming health care shortage and is focused primarily on nursing. I've been watching this board for about four months and have found it extremely useful.

The questions that I would like to pose are.

1) What kind of career path or ladder exists for someone entering nursing? What position do you enter at, and where can you hope to go from there? I realize that there people enter the nursing field with different background and at different positions, so a varied response would be helpful.

2) What kind of professional development is currently available once you enter the workforce? Does your employer encourage/help with this training, or is it left up to the individual?

3) (This is the one that I haven't been able to really find any information on at all. I think that this is a really interesting question but don't really know how to find the information.) What is the cost to an organization when one nurse leaves? (cost lost on developing that nurse, developing a new one, added stress to other employees etc..) Does this one person leaving lead to an increased chance of others leaving due to the added workload cause by losing a colleague?

Any information that you could give me would be extremely useful, whether it is based on first hand experience or if it is merely pointing me to another source of information.

Thank you,

Brett

[RHinesRN]

Hi I am an ER Nurse, been in nursing for approx. 7 years and am currently doing staffing and management in a hospital in VA. I have my Bachelors of Science in Nursing and am licensed as a RN (Registered Nurse) ... now on to your questions.

1. The paths to becoming a RN come from many different directions with the ending point of passing the NCLEX exam (Nursing Licensure Boards) and getting the title Registered Nurse (RN). It is a national test, with the results going to whatever state(s) you will be licensed in. In the simplest terms there are 3 basic ways to be eligible to sit for this exam: 1) Completing a Diploma School of Nursing - approx. 3 years, there are few of these type of programs left in the US, most of the time they are hospital affiliated and run. 2) Completing Associates of Science in Nursing Degree (AD) from a college - these are 2-year programs found across the US and it is said turn out more of a technical prepared RN. 3) Completing a Bachelors of Science in Nursing (BSN) from a college - these are 4 year programs also found across the US and it is said graduates from these programs are less technical and more theory based RN's (don't go there). Now here is where it gets confusing. Many colleges offer programs to go from a RN (AD or Diploma) to a BSN, some are correspondence courses and some are called bridge programs. These enable working RN's to get their Bachelors with out completing a normal 4-year college program. There are also programs for people with other degrees (usually some other science degree) to get their Nursing degrees; these are some times called an accelerated track. The bottom line is we are all Registered Nurses (RNs) in any number of specialties (ER, ICU, L&D, OR, School Nursing, etc). Now if you want to get an advanced degree (a masters) you can ... it's usually 2 more years of school and you get your Master of Science in Nursing (MSN) in all kinds of specialties (i.e. education or administration) or your Advanced Practitioner Degree: (i.e. a Midwife, a Nurse Practitioner, or a Nurse Anesthetist). OK ... on to #2

2. Hopefully all employers promote and support professional development. I'm sure it runs the spectrum, from none at all to multiple classes and opportunities. Here at my hospital we have a tuition re-imbursement program that is pretty good (like if your working on your masters) but the professional development side is way behind. I consider professional development things like classes, conferences, seminars that makes you a better nurse (not necessarily advances your degree). Here is the problem, the hospital gives full time employees 3K a year to get a degree, but hardly gives any money for professional development (PD). To get to the point I think that a nurse should be able to use their money for PD as easy as they can use it to go to college. Getting the hospital to change is a long process. My hospital requires approx. 10 hrs of PD per year, and now many states are requiring specific hours in PD to re-new your license. There are multiple opportunities for PD from nursing organizations, specialties, and other educational sources it can just get very expensive going to all of these sessions.

3. I can't give you hard numbers (I should know) but here goes. A new RN (no ER experience) starting in our ER will be precepted for approx. 6 months. So for six months we are paying 2 nurses for 1 position. The teaching nurse has an increase in stress from not only taking care of patients but also from teaching and watching over the new RN. After approx. 6 months (if everything goes great) the new nurse will be on their own, but most of the time will be surrounded by other senior nurses (for the first year she is still being closely supervised). During the first six months to 1 year they are sent to critical care classes, advanced life support classes, etc. This is an additional financial burden on the department/hospital. So for the first year it is an expensive endeavor to bring on a "new" nurse. As for when a nurse leaves ... I have never had nurses leave because someone else has left and the workload increased. I think most places try to replace that nurse as quickly as possible. We have lost some nurses to agencies where the money is better, but they always seem to come back. It hurts the hospital pocketbook because we have to advertise, hire, and go through the whole training process again. And now with the shortage of experienced RNs the hospital might have to hire temp help and that is very expensive, so the best thing to do is retain all the nurses you can.

Hope this long winded response helps.

Ryan, RN