Nursing Career Paths and Advancement Guide

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A DNP-prepared nurse educator sitting and talking with two nurses.

The roles that registered nurses (RNs) play in keeping communities healthy and safe have never been more vital than today. According to May 2020 data from the U.S. Bureau of Labor Statistics (BLS), the U.S. had nearly 3 million RNs, with an estimated 179,500 new job openings for RNs expected between 2019 and 2029. Nursing is the largest healthcare profession and one of the largest professions in all industries. For 19 years in a row, the Gallup Poll has named nursing the most honest and ethical profession.

However, there continues to be a serious shortage of nursing representation on the boards of hospitals and health systems and in leading community health efforts, as Assanatu Savage, director of the American Academy of Ambulatory Care Nursing (AAACN), points out in an interview in Minority Nurse. The nursing profession needs leaders in all areas of healthcare, from the bedside at the clinical level to the boardroom at the administrative level. Nurse leaders are also present in research, technical and academic healthcare settings. They play important roles in serving as liaisons with business, government and community organizations.

Numerous nursing career paths allow qualified nurse leaders to play key roles in a range of important areas of healthcare:

  • They help mitigate the effects of the nursing shortage.
  • They address gaps in the quality of healthcare that patients receive, especially patients living in underserved areas.
  • They investigate ways to automate healthcare processes to improve their accuracy and efficiency.

Nursing Goals for Career Advancement

A nurse’s career journey begins by imagining their perfect job and then identifying the skills and experience they’ll need to qualify for that job. However, as the person advances through their career, their nursing goals will change in light of new circumstances and professional challenges. Few careers are straight lines, so nurses need to be prepared to say yes when an unexpected opportunity arises in a direction they hadn’t anticipated.

Nurses will find themselves redefining success as their careers progress and situations change. They’ll also commit to continually learning about their profession and picking up useful new skills. These are the giant steps on their journey to realizing their nursing goals.

Earning an Advanced Nursing Degree

Nursing education programs include one-year training programs for becoming a licensed practical nurse (LPN) or licensed vocational nurse (LVN), two-year associate degree programs, three-year diploma in nursing programs, and four-year bachelor’s degree programs for becoming an RN.

Beyond the bachelor’s degree in nursing are two types of postgraduate nursing career paths:

  • Advanced practice nurse: The APN category includes nurse practitioner (NP), nurse educator, nurse anesthetist, nurse-midwife and nurse administrator.
  • Researcher: Nurse researchers have typically earned a doctorate in nursing to qualify for their positions.

Obtaining an Advanced Nursing Certification  

Various professional and certification bodies issue dozens of nursing and medical certifications, but the two largest organizations offering advanced nursing certifications are the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP).

  • ANCC certifications include Family Nurse Practitioner-Board Certified (FNP-BC), Adult-Gerontology Primary Care Nurse Practitioner-Board Certified (AGPCNP-BC) and Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC).
  • AANP certifications include Family Nurse Practitioner (FNP), Adult-Gerontology Nurse Practitioner (AGNP) and Emergency Nurse Practitioner (ENP).

In addition, the American Association of Critical-Care Nurses (AACN) issues certification for acute care nurse practitioners (adult-gerontology), and the Oncology Nursing Certification Corporation offers the Advanced Oncology Certified Nurse Practitioner (AOCNP) certification.

Pursuing Leadership Roles in Nursing

Two of the most important aspects of nurses’ progress toward their nursing goals are their role in mentoring and educating new nurses and their input and influence in shaping local and national health policy. Preparing to apply for a nurse leadership position starts by determining the qualifications for the job and understanding all the responsibilities and duties of the position.

  • Nurse leaders must be able to anticipate and prevent conflict when possible and know techniques for mitigating conflicts when they arise.
  • Nurse leaders need first-rate writing and speaking skills and should be adept at presenting medical information clearly, concisely and completely.
  • Nurse leaders must commit to their own long-term success in terms of keeping abreast of developments in their field and learning useful new skills.
  • Nurse leaders must be committed to the short- and long-term success of their employees, departments and organizations.

The SMART Goal Nursing Model

SMART is a goal-setting technique that can help nurse leaders set specific, measurable goals that they can attain in a realistic, timely manner. Nurses should write their goals in their own words, and the goals should reflect the ideals and achievements they prize. They should structure the goals so that they can measure their progress toward achieving them.

  • Specific: State the goal clearly, such as “I want to qualify for a nurse manager position.”
  • Measurable: Set identifiable mileposts on the path to achieving the goal, such as gaining experience managing a team or project.
  • Attainable: Find an achievement that’s within reach, such as qualifying for a nursing position with budget responsibilities, rather than setting a goal of becoming a hospital CEO.
  • Relevant: Set a goal that resonates with one’s values and the reasons for pursuing a career as a nurse leader.
  • Time-bound: Set a deadline for achieving the goal, and place the interim steps to the end result on a timeline to monitor progress toward the goal.

What Are the Different Types of Nursing Degrees?

Each type of nursing degree qualifies nurses for specific roles and duties. Each degree can also serve as a steppingstone on a nursing career path that culminates in a leadership position in a healthcare setting, whether a hospital or clinic; a public health role; or a management or top administrative position with a healthcare provider or other organization.

The professional degree that most RN employers require is a Bachelor of Science in Nursing (BSN), although RNs may also hold an Associate Degree in Nursing (ADN), an Associate of Science in Nursing (ASN) or a diploma from an approved nursing program. The BLS notes that far more BSN, ADN and ASN degree programs exist than diploma programs.

All the undergraduate programs include supervised clinical experience as well as courses in anatomy, physiology, microbiology, and various social and behavioral sciences. Their goal is to prepare students to pass their states’ licensing examination for RNs as well as to teach the skills and experience to thrive in their nursing careers.

Bachelor of Science in Nursing

In addition to the science topics listed above, the curriculum of BSN degree programs includes courses in physical and social sciences, communication, critical thinking, and leadership. In the past, a bachelor’s degree in nursing was considered the minimum education requirement to qualify for nurse administrator positions as well as for work as a nursing researcher, consultant or teacher. However, a growing number of employers now consider a master’s degree in nursing to be a prerequisite to qualify for nurse manager roles.

To receive a state-issued nursing license, RNs must graduate from an approved nursing program and pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN).

Many hospitals and other healthcare providers now require that candidates for entry-level RN positions have a bachelor’s degree. RN-to-BSN programs allow RNs with an associate degree or diploma to earn their bachelor’s degree. Holding a BSN degree qualifies RNs for work in specialties such as genetics and public health. RNs are also able to take on more responsibilities for treating and diagnosing patients in clinical settings.

Master of Science in Nursing

A Master of Science in Nursing (MSN) degree is the minimum education requirement for clinical nurse specialists (CNS), most of whom also have at least one year of experience working as RNs. For nurses aspiring to leadership roles in their profession, most employers now consider an MSN degree or higher to be a prerequisite to qualify for nurse manager and administrator positions. These include assistant clinical nurse manager, charge nurse or head nurse at the lowest level of management, as well as senior-level positions, such as assistant director or director of nursing, vice president of nursing and chief nursing officer (CNO).

The curriculum of an MSN degree program expands on the science and clinical subjects that undergraduate nursing programs cover and includes health services administration, leadership skills, negotiation, health planning and development, marketing, consulting, policy development, and quality assurance. Master’s degrees are the minimum education requirement for advanced practice RNs (APRNs) trained in specific areas of primary and specialty care, although a doctoral degree may qualify them for a wider range of nurse leadership positions.

Doctor of Nursing Practice

The BLS points out that many APRNs choose to earn a Doctor of Nursing Practice (DNP) to boost their training and experience in preparation for leadership roles in healthcare settings. The DNP curriculum typically includes advanced health assessments, pathophysiology, pharmacology and other courses related to each NP specialty.

The following are among the other nursing leadership positions that nurses with a DNP degree may qualify for:

  • Nurse educator: In addition to preparing new nurses for the profession, nurse educators promote innovation in clinical practice. They combine their clinical experience and nursing expertise with strong communication skills and cultural competency.
  • Nurse administrator: Nurse administrators manage and lead work groups, departments and facilities that provide clinical services. They influence and execute health policy, tapping their knowledge of and experience with nursing administrative procedures.
  • Director of nursing: Nursing directors are charged with managing the day-to-day functions of nursing departments and entire healthcare facilities in collaboration with other health professionals. They serve as liaisons between medical teams and other departments within the organization, and they represent nursing departments with parties outside the healthcare setting.

DNP vs. Ph.D.

Nurses who wish to pursue a doctorate in nursing must choose between earning a DNP or a Ph.D. DNP vs. Ph.D. differences can be categorized in five areas, according to the American Association of Colleges of Nursing (AACN):

  • Program of study: The DNP degree prepares nurse leaders for applying the results of research in areas of nursing practice.A Ph.D. in nursing emphasizes research at the highest level of nursing science.
  • Students: DNP graduates focus on improving patient care outcomes and population health. Ph.D. holders develop new nursing knowledge that furthers nursing science.
  • Program faculty: DNP faculty members have expertise in practice areas and working with patient populations. Faculty members in Ph.D. programs have expertise in research and experience with research funding and related areas.
  • Resources: DNP graduates rely on mentors and the opportunity to gain firsthand experience in a range of clinical settings. Ph.D. holders also rely on mentors as well as access to medical information, research technology and dissertation support.
  • Program assessment and evaluation: The goal of DNPs is to contribute directly to healthcare practice and policy. Ph.D.s develop new knowledge that improves the provision of healthcare generally.

Focus of Ph.D. in Nursing Degree

Nurses who earn a Ph.D. lead through their nursing research into healthcare innovations and novel approaches to improving the provision of healthcare on an individual and population basis. The AACN points out that the number of nurses with a Ph.D. has remained constant despite the increase in nursing doctorate programs being offered. This has led to a shortage of qualified nurse educators at a time of growing need for research on the treatment of chronic illnesses.

The research topics that Ph.D. candidates investigate have expanded in recent years from clinical areas, such as diabetes, cancer and mental health, to technologies and techniques for improving the treatment of chronic illnesses. In many cases, the research seeks to improve patients’ quality of life by minimizing the negative effects of treatments.

To be accepted to a nursing Ph.D. program, candidates must have an RN license and a suitable GRE score. They typically submit their college transcripts along with a letter of recommendation and an essay. Most nursing Ph.D. programs are the equivalent of three to five years of full-time study.

Focus of DNP Degree

Nurses who wish to pursue various leadership roles in the profession will gain a broad range of skills and experience by graduating from a DNP program. The curriculum of a DNP program prepares nurse leaders for roles and duties that are beyond those for which RNs usually train.

  • Investigate the impact of modern health issues on health policy
  • Assess and report on program outcomes in healthcare settings
  • Study the distribution of diseases in communities and populations
  • Examine the legal, social, ethical, financial and technological aspects of modern evidence-based nursing practice

The AACN explains that the DNP degree is becoming the standard education requirement to qualify for many specialty APRN positions. The majority of nursing schools that offer APRN programs now have post-master’s DNP programs. Areas, where DNP degree holders may pursue careers, include forensics, case management, military nursing, nursing administration, nursing informatics and genetics. They also work as entrepreneurs, public health policy makers, consultants and nursing department directors.

The requirements for pursuing a DNP degree may also include letters of recommendation, an in-person or a remote interview, a 3.0 GPA, a declaration of professional goals, and a minimum score on the GRE. Along with course requirements, the programs entail at least 500 clinical hours. Degree tracks cover clinical and executive preparation and usually require from two to six years to complete for students who don’t already have an MSN degree.

Advancement Opportunities for Nurses with a DNP Degree

The growing demand for NPs and other APRNs creates diverse nursing career paths for nurses looking to qualify for leadership roles in healthcare. The BLS forecasts that the number of jobs for NPs, nurse anesthetists and nurse-midwives will increase by 45% between 2019 and 2029, which is much faster than the projected average job growth for all occupations.

Several factors contribute to the growing demand for DNP degree holders:

  • Greater emphasis on preventive care
  • The healthcare demands of an aging population
  • Medical advances that convert formerly deadly diseases into manageable chronic conditions
  • Changes in state laws that allow APRNs to perform a wider range of medical procedures and other healthcare services

Consider four advancement opportunities for nurses with a DNP degree.

Health Policy Analyst

Health policy analysts research topics related to the impact of existing and prospective government policy on healthcare providers and the healthcare industry. Government agencies, nonprofit organizations and community groups employ health policy analysts.

  • Typical duties: Health policy analysts gather data related to healthcare policy or supervise the collection of the data by others. They apply advanced data analytics techniques to convert the data into actionable intelligence that policymakers can use to inform their decisions related to healthcare.
  • Essential skills: The position typically requires a graduate degree in public health, public policy or a similar field. Analysts must have strong research and communication skills for preparing reports and making presentations to executives, administrators and the public.
  • Median annual salary: PayScale estimates that the median annual salary of health policy analysts is about $64,000 as of May 2021. Starting salaries for the position are around $53,000 annually, and analysts with more than 20 years of experience earn about $81,000 annually.

Nurse Educator

Nurse educators are charged with preparing the next generation of nurses and nurse leaders. They contribute to the design of nursing curricula and analyze the effectiveness of nursing education programs. Nurse educators work in classrooms and a range of clinical settings, including clinics, hospitals and nursing homes.

  • Typical duties: Among the subjects that nurse educators teach are administering medication and changing dressings. They serve as coaches and mentors for nursing students throughout their education, and they instruct working nurses and other healthcare workers in training sessions. Nurse educators may conduct research and participate in professional nursing organizations.
  • Essential skills: Nurse educators must possess strong communication and interpersonal skills when working with groups of students and in one-on-one teaching situations. They bring their practical nursing experience to bear as they instruct students in hands-on nursing skills.
  • Median annual salary: According to May 2021 data from PayScale, the median annual salary of nurse educators is about $77,000. Starting salaries are approximately $72,000 annually, and nurse educators with more than 20 years of experience earn a median annual salary of about $86,000.

Advanced Clinical Educator

Advanced clinical educators share practical knowledge about nursing in clinical settings with nursing professionals who work in specialized fields. They work in classrooms and healthcare settings and interact with nurses, clinicians in training, public healthcare workers and patients.

  • Typical duties: Advanced clinical educators need to be good communicators in group settings and one-on-one teaching situations. They differ from nurse educators in having a sharper focus on specialized instruction for working nurses and other healthcare professionals, as well as those in training.
  • Essential skills: Advanced clinical educators must be licensed healthcare professionals who possess specialized clinical knowledge about their areas of instruction. They often work with seasoned professionals who are keeping their skills and knowledge up to date.
  • Median annual salary: PayScale estimates that the median annual salary of clinical educators is around $77,000 as of May 2021. Starting salaries for the position are about $64,000 annually, and clinical educators with 20 or more years of experience earn a median of approximately $87,000 annually.

Chief Nursing Officer

CNOs are responsible for the operation of all nursing activities in a healthcare institution. They ensure that the organization’s nursing care complies with all standards and regulations and that patients receive quality care. CNOs work with healthcare professionals, officials in business and government, community groups, and the public.

  • Typical duties: A primary duty of CNOs is ensuring sufficient staffing of nursing units across shifts and workdays. They participate in developing contingency plans for a range of emergencies and are also responsible for the organization’s nursing budget, including purchasing supplies and equipment.
  • Essential skills: Serving as a CNO requires practical nursing skills; management and administrative skills; and political skills for dealing with policymakers, community groups and patients.
  • Median annual salary: PayScale estimates that the median annual salary of CNOss is about $134,000 as of May 2021. Their starting salaries are about $116,000 annually, and those with 20 or more years of experience earn approximately $149,000 annually.

A Satisfying Career in Healthcare

Few professions are more vital to their communities than nurses. Effective nursing requires skilled, trained, dedicated nurse leaders who ensure positive patient outcomes and quality patient care while promoting the careers of their nursing colleagues. Nursing programs such as Duquesne University’s online Doctor of Nursing Practice program teach nurse leaders the skills and expertise to qualify for leadership positions and chart a successful nursing career path.

Learn more about how the online DNP program can help nurses pursue their professional goals.

Recommended Readings

Nurse Practitioner vs. Doctor: Examining the Key Differences

Strategies for Managing Nurse Stress in the Workplace: The Ultimate Guide

DNP vs. NP: Comparing Career Paths in Nursing

Sources:

American Academy of Nurse Practitioners Certification Board, Testing Domains

American Association of Colleges of Nursing, DNP Education

American Association of Colleges of Nursing, Nursing Fact Sheet

American Association of Colleges of Nursing, PhD Education

American Association of Critical-Care Nurses, Board Certification

American Nurse Journal, “Should You Pursue Leadership? 10 Questions to Help You Decide”

Gallup, “U.S. Ethics Ratings Rise for Medical Workers and Teachers”

Houston Chronicle, “What Are the Duties of a Nurse Educator?”

Incredible Health, A Guide to Pursuing the RN to DNP Degree Path

Minority Nurse, “Why Leadership Matters for Nurses”

National Committee for Quality Assurance, Goals to Care: How to Keep the Person in Person-Centered

Oncology Nursing Certification Corporation, Certifications

PayScale, Average Chief Nursing Officer (CNO) Salary

PayScale, Average Clinical Educator Salary

PayScale, Average Health Policy Analyst Salary

PayScale, Average Nurse Educator Salary

The Balance Careers, “Nursing Major Career Paths”

U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics

U.S. Bureau of Labor Statistics. Registered Nurses

ZipRecruiter, What Is a RN BSN and How to Become One