Nursing is a diverse field. Some people enter into nursing by taking a one-year diploma and becoming a Licensed Vocational Nurse (LVN) or a Licensed Practical Nurse (LPN). Others pursue an associate degree and become a Registered Nurse (RN), later upgrading to a bachelor’s or even higher level qualification.
Whatever route into nursing you choose, your education is not over once you’ve earned your license. There are many options for specialization and progression for nurses, allowing them to enjoy a broader scope of practice, work with different patient demographics or specialize in other areas of care.
When you go to nursing school, you’ll be taught about lots of different aspects of nursing. You’ll be exposed to pediatric care, what goes on in the emergency room, the job of a palliative nurse, what goes into making public health decisions and how to manage a ward. After earning your nursing degree you can decide what you want to focus on throughout your career.
The next step after becoming a registered nurse could be to train as a Nurse Practitioner, become an ICU nurse, informatics nurse, or choose a different nursing specialty. There are many possibilities to choose from, and that’s one of the things that makes nursing such an appealing and rewarding field.
Types of nursing certifications
To become a Registered Nurse, you will be expected to pass the NCLEX-RN. After earning this qualification, you’ll be able to work in a variety of roles in a hospital, clinic, or other health care setting. Most registered nurses spend a year or two getting some exposure to different aspects of health care so they can decide where they would like to spend most of their time.
Once a nurse has some clinical experience, they’ll have the opportunity to train for a nursing certification. Some certifications are open to newly-qualified registered nurses, while others require users to study for a master’s degree and have a significant amount of clinical experience before they take the test.
To qualify for a role as an advanced practice nurse, you’ll need to have a master’s degree or a doctorate. This takes an additional two to four years of study after earning a bachelor’s degree. Some universities offer an RN to MSN course for people who earned their nursing license via the associate’s degree route.
There are several foundational courses on the MSN that all nurses will study, but the main purpose of the MSN is to train the nurse in the area they’ve chosen to specialize in.
What are the different types of nursing certifications?
The American Nurses Credentialing Center (ANCC) offers many certifications for nurses at different stages of their careers. some of the certifications open to newly-qualified nurses include:
- Ambulatory Care Nursing Certification (AMB-BC)
- Nursing Professional Development Certification (NPD-BC)
- Pediatric Nursing Certification (PED-BC)
- Psychiatric-Mental Health Nursing Certification (PMH-BC)
- National Healthcare Disaster Certification (NHDP-BC)
- Cardiac Vascular Nursing Certification (CV-BC)
- Care Coordination and Transition Management Certification (CCCTM)
- Pain Management Nursing Certification (PMGT-BC)
- Gerontological Nursing Certification (GERO-BC)
- Informatics Nursing Certification (RN-BC)
- Medical-Surgical Nursing Certification (MEDSURG-BC)
- Nurse Executive Certification (NE-BC)
- Nursing Case Management Certification (CMGT-BC)
As of February 2020, these certifications cost $395. Discounts are available for ANA members.
These certifications do not open up new job titles, but will give a nurse the entry-level skills they require to work under supervision in the fields that they cover, allowing them to gain the clinical experience required to pursue an Advanced Practice Registered Nurse certification once they have their master’s degree.
Later in their career, a nurse can apply for a more specialist qualification such as:
- Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP-BC)
- Adult-Gerontology Primary Care Nurse Practitioner Certification (AGPCNP-BC)
- Family Nurse Practitioner Certification (FNP-BC)
- Adult-Gerontology Clinical Nurse Specialist Certification (AGCNS-BC)
- Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC)
There are many other certifications available from other bodies, such as the Advanced Oncology Certified Clinical Nurse Specialist award from the ONCC, or the Certified Aesthetic Nurse Specialist qualification from the PSNCB. The certifications listed above are some of the most common and ones that are in the highest demand.
How do you choose a nursing specialty?
Choosing a nursing specialty can be difficult. There are so many factors to take into account, including where you want to work, your interests, and even whether you like dealing with people or not. Consider the following:
- If you enjoy rapidly changing situations and facing new challenges every day, the trauma room or emergency department might be a good choice for your specialization.
- If you like to work with a smaller group of patients over a long period of time, consider psychiatric-mental health, or pediatrics in a family practice.
- Someone detail-oriented who likes precise, methodical work might enjoy working in research or as an OR nurse or nurse anesthetist.
The working environment is an important consideration, too. If you love working with people then a patient-facing role in a clinic or a busy ward could be incredibly enjoyable and satisfying. Some people head into healthcare because they’re passionate about the science side, but find dealing with people on a day-to-day basis rather draining. Fortunately, there are nursing roles that suit people who don’t always enjoy dealing with the public, such as:
- Informatics nurse
- Nurse researcher
- Legal nurse consultant
- Public health nurse
- Nurse administrator
There are some jobs that require a lot of bedside care, but even in those jobs the level of care and the demographic you deal with can vary significantly. For example, a family nurse practitioner will work in a clinic, seeing people who have made an appointment. A family nurse practitioner’s day-to-day work will usually involve ordering tests, writing prescriptions, and giving health advice.
This working environment is vastly different from that of a critical care or emergency nurse, who will be delivering hands-on care in a hospital ward.
Other options for specialization include geriatrics or pediatrics. An advanced practice nurse with a certification in geriatrics might work in a long-term care facility, caring for older adults. This job could be stressful at times, especially if the adults are living with dementia and are sometimes erratic or confused. Some nurses find this kind of work rewarding, but others may find this type of patient difficult to communicate with.
A nurse who enjoys working with children could qualify as a pediatric nurse and spend most of their time advocating for children, giving health advice, and supporting families with children who have chronic conditions. Again, some nurses are naturally good at communicating with children and building a rapport, but others struggle with this.
Finding nursing positions in your area
One thing many nurses forget when they’re looking into areas for specialty certification is whether they’ll be able to get a job in their area. Someone who lives in a big city and is working towards APRN recognition may be able to pick absolutely any of the dozens of certification options and feel confident they’ll be able to find employment in that city.
The same is not true in rural areas. If you live in an area with a very small hospital with limited facilities, where patients with more unusual health conditions are usually transferred to another hospital out-of-town, you’ll need to take that into account when you choose a specialization.
Are you willing to commute or even move to pursue your dream specialization, or do you want to stay where you are? Some qualifications, such as pediatric nurse practitioner, family nurse practitioner, and clinical nurse specialist are useful in most hospitals, giving you far more flexibility when it comes to seeking employment.
Reasons to pursue a nursing certification
Once you have a license as an LPN or an RN, you’re entitled to call yourself a nurse. However, the scope of practice of an LPN is limited compared to that of an RN, and even as a newly-qualified RN the roles you can fill in a hospital are limited. If you want to specialize in a specific area of patient care, work with a particular age group or have the autonomy to diagnose, prescribe and work independently then you’ll need to continue your education and become an Advanced Practice Registered Nurse.
It’s clear that nurses with a higher level of education offer a higher standard of care, resulting in better patient outcomes. For example, BSN-prepared nurses provide better care than ADN-prepared nurses, resulting in lower mortality rates, greater patient safety, and even shorter hospital stays. Earning a certification in a specific care area allows a nurse to work more effectively with that patient group.
Whether you choose to pursue qualifications for your own personal curiosity, to increase your earning potential, or because the certification will unlock new career options, you can be confident that the investment you make in your education will pay off.
Why would you want to earn a nursing certification?
Those who are serious about the nursing profession and planning on staying in the field of health care for many years will most likely wish to advance their career, working in a specific department, managing a ward, or taking on a specific role such as nurse-midwife or nurse anesthetist.
These roles require the nurse to complete further academic study and a certification program. Undergraduate study is designed to give a nurse a broad understanding of the field of health care, so they can provide basic services to patients and communicate effectively with doctors and specialists.
The field of health care is so broad that it’s not possible for a nurse to learn everything, which is why a pediatric nurse practitioner and a psychiatric-mental health nurse would have to study rather different modules for their master’s degree. Both of these advanced practice registered nurses would have started with the same foundation knowledge from the BSN, but as they continue their education their studies will diverge.
There are some core competencies that all advanced practice nurses are expected to understand. Those competencies are:
- Expert coaching and guidance
- Research skills
- Clinical and professional leadership
- Ethical decision-making skills
These skills highlight the differences in the job roles between LPN/LVNs, RNs, and APRNs. At the LPN/LVN level, the nurses do a lot of practical work, measuring vitals, administering injections, inserting catheters, and performing other prescriptive procedures.
RNs are expected to exercise more judgment in their day-to-day work and are permitted to perform a wider variety of duties, but they are usually supervised by doctors or more experienced medical personnel. Advanced practice nurses use evidence-based practice and are responsible for making more decisions during their work.
Because advanced practice nurses have more freedom, they are required to have more critical thinking skills and their education focuses on concepts and understanding rather than rote learning and practice of individual skills. This shift in education becomes apparent at the BSN level. ADN-prepared nurses spend two years learning the core skills of nursing, and the extra time BSN-prepared nurses spend in education gives them a deeper understanding of evidence-based practice, interdisciplinary communication, and decision-making skills.
How does earning a nursing certification increase your earning power?
The median salary of a BSN-prepared Registered Nurse is $73,300 per year. A registered nurse with an ADN would most likely earn less than this. Nurses who stay at the RN level but earn basic nursing certifications may have the opportunity to move departments or choose a specialization that offers a higher-than-average salary.
Those who choose to become an Advanced Practice Registered Nurse can command much greater salaries, however. Nurses with a postgraduate qualification who complete a certification program allowing them to become a nurse anesthetist, nurse-midwife, or a certified critical care nurse earn an average of $115,800 per year.
The exact salary earned by a nurse qualified to the advanced practice level will vary depending on the state, and even city, the nurse is working in as well as their job title. Nurses who work in a field where they are on call, face irregular hours or high-stress situations are likely to command a higher salary than those who work in clinics and have a lower patient workload.
In the long term, earning a nursing certification can open up other opportunities for career progression, too. A nurse who is trained as a pediatric nurse practitioner or a psychiatric-mental health nurse practitioner is not forced to stay in that field forever. There are opportunities to move into research, education, and even public health later on in your career.
After earning an MSN and a license to work as a nurse practitioner or a clinical specialist, many nurses op to become a Doctor of Nursing Practice. The DNP is an academic qualification, not a job title. At the moment, there is no requirement for someone to hold a DNP, even if they are hoping to pursue a career as a nurse practitioner. This may change in the next few years, however, as the AANC endorses the idea of requiring Advanced Practice nurses to be educated to doctorate-level.
How to determine the right nursing certification for you
There are some clear qualification pathways for nurses. When you decide which area of nursing you’d like to specialize in, you can talk to the nurse educator at your hospital or health care facility to get advice about the qualifications you’ll need in order to move into that role.
Alternatively, you can look up the qualifications on the AACN, ONCC, or other awarding body’s website. Each nursing specialization has its own set of qualifications, awarding bodies and memberships. In some cases, the bodies that are recognized will vary from state to state, so it’s best to speak to a nurse that is already qualified in your chosen area of practice to learn more about the best pathway into that field.
What should you consider before choosing a nursing certification?
Before you apply for a specific certification, make sure you’ll qualify for it and that it covers the area of practice you’re interested in. There are no shortcuts to becoming a certified nurse in a given field. Each area of practice requires academic study and clinical experience.
Typically, when you apply to become a clinical nurse specialist you’ll have to study a master’s degree with a focus on that area of nursing, and also build up a certain number of hours of nursing practice applicable to that field within a clearly defined period of time. Once you meet those requirements, you can take the certification exam.
The exact number of clinical practice hours required for a certification varies depending on the level of the certification and who the awarding body is. As a general example, a nurse hoping to qualify as an Oncology Certified Nurse (OCN) would need 2,000 hours of adult oncology nursing practice, earned within a four-year period.
For some of the most advanced qualifications, it’s possible to have practice hours counted twice. So, if you earned a master’s degree and a nursing certification, then studied for a DNP, and wanted to become a nurse practitioner, the hours that were counted towards your master’s qualification may be counted for the nurse practitioner award as long as they were earned within the last four years. This isn’t always the case, however, so it’s best to confirm the policy for clinical practice hours with the awarding body you are using for your certification.
Do you have to re-take nursing certifications every year?
Most certifications in nursing have a validity period of five years, but some do expire more quickly than that. Once you have earned a certification, you will have to follow a program of continuing education in order to keep the certification valid.
Recertification requirements vary between issuing bodies. Some certification providers allow nurses to re-certify by submitting proof of practice and continuing education. In some cases, you may be able to recertify once using this method, then have to re-take the certification exam to extend the certification a second time.
The body of knowledge that nurses need to know is constantly changing and expanding, and that’s why certification requirements are so strict. Nurses must show they are committed to staying up-to-date with the latest best-practices, and that they are making an effort to keep their skills current.
Academic qualifications such as the MSN and DNP confer titles that do not expire, but titles such as LPN, RP, or APRN require continuing education and practice.
Top schools with nursing certification programs
There are many schools that offer nursing programs accredited by the CCNE. This accreditation is important because you’ll need to have an accredited degree in order to sit the certification exams. If you’re looking to start a career in nursing or upgrade your qualifications to try a new specialization, you have the option of studying at a traditional university or completing your program of study online.
Which schools offer the best nursing certification programs?
Some of the best schools to study an online nursing degree at include:
- Walden University
- Grand Canyon University
If you’re looking to study at a traditional institution, you’ll have several choices. Some of the most respected universities offering nursing programs include:
- Duke University School of Nursing (Accelerated BSN)
- Georgetown University
- Johns Hopkins University
Duke University offers both traditional and online nursing certification programs. Undergraduate nurses can take the accelerated BSN, which boasts an NCLEX-RN pass rate of more than 98%. Tuition fees at Duke University are quite high compared to some of the online-only universities, at about $60,000 per year. However, Duke is one of the most respected research universities and it offers a variety of scholarship options for students at the undergraduate and postgraduate levels.
Scholarships are available for people from many different backgrounds, so even if you don’t think you’d be eligible for one, it’s worth looking at the list. Funding is limited, however, so be sure to apply early if you’re interested in any of the scholarships on offer.
Georgetown University is another respected university offering a variety of nursing programs, including a direct entry BSN degree, an MSN program leading to the nurse-midwife specialization, and a program that leads directly from the BSN to a DNP, allowing those aiming for nurse practitioner status the option of skipping the master’s degree and studying only the most relevant modules on the way to their doctoral-level qualification.
Georgetown University has links with many health care facilities across Washington, D.C., and as a part of the BSN program nurses will earn around 850 hours of clinical experience, giving them a head start on their next nursing certification. The university claims a 100% pass-rate for the NCLEX-RN. Online study is available.
Johns Hopkins University (Postgraduate Study)
Johns Hopkins University is a highly respected research institution. It doesn’t currently offer an undergraduate program, but it does offer Master’s degrees, including a pre-licensure MSN for people who hold a non-nursing related bachelor’s degree. This offers people who are following a non-traditional career path a chance to move into nursing without having to spend the extra time in undergraduate study.
The university claims a pass-rate of over 92% for the NCLEX-RN, which is an impressive rate considering the intensive study required for this non-traditional program.
How can you decide which nursing qualification program is best for you?
In an ideal world, we’d be able to choose a nursing program based purely on academic credentials or the pass-rate for the certification you’re aiming for. Sadly, this isn’t always practical. There are many things that may influence your decision for which institution to study with, including:
- Entry requirements
- The cost of the program
- Available scholarships and bursaries
- Whether online study is available
- Part-time or full-time offerings
- Which licensing boards they work with
- How much clinical time they offer
- Whether bridge programs are available
Because nursing is such a diverse field, there are many different entry routes. It’s possible to succeed as a nurse even if you come from a non-traditional academic background. Many people start with a diploma and qualify as an LPN, then upgrade their qualifications at a later date.
Those who followed that route, or who took a pre-licensure MSN such as the one offered at Johns Hopkins, may find their options later on in their career are limited by their previous GPAs or the courses they studied. For example, a person who struggled at the BSN level and has a lower GPA may need to take some additional courses in the sciences at the postgraduate level before enrolling in a doctoral program.
If you come from a less traditional academic background and your first choice of university doesn’t accept you for a postgraduate program, don’t give up. There are many universities that are willing to consider applicants on a case-by-case basis and who might look at your transcript and references and offer a place on their program. Some institutions offer conditional entry, giving you a chance to prove yourself once you have a place on the program.