Maybe being a nurse has been your dream for as long as you can remember. Or you might be like I was, an adult holding a job with a dismal future that paid little. I was trying to support and a wife and two children. I considered the nursing profession only after talking to a career counselor. Knowing why you are considering a nursing career is important. You also need to answer three key questions before you can choose your educational path.
Do you want to be an LPN or RN?
What are your time and financial budgets?
What is your end goal?
In the first question, you need to decide between two basic options: LPN/LVN or RN? Different regions of the U.S. use licensed practical nurse or licensed vocational nurse to describe the same role. I use the term LPN exclusively. This first decision is the key to all following questions.
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The Difference Between LPN and RN
A nurse's complete job description and allowable actions are the “scope of duty”. That is set through administrative law by each state's board of nursing. Since each state defines the scope of duties, I cannot give state-by-state examples, but here are common characteristics.
An LPN cares for many types of people, and may work in hospitals, long-term care facilities, and clinics. In all cases, the LPN gathers data, gives medications and performs simple treatments like dressing changes. The LPN’s assigned tasks are caring for convalescent, sub-acute or chronically ill and injured patients. All LPNs work under the supervision of an RN who is accountable for the actions and performance of the LPN.
The RN also works in the same sorts of facilities. However, an RN does more than gather data. The RN assesses and evaluates that data, and then makes any necessary changes to the current care plan. The RN still gives the patient care in some settings but has greater involvement in managing the patient’s entire health process. An RN is commonly a supervisor over a team that includes one or more LPNs and certified nursing assistants (CNAs). In a common hospital-based situation, an RN may have overall responsibility of 8-12 patients. However, the registered nurse may only give the direct care to those who are most ill or injured. The nurse delegates the remainder of the assignment to the LPNs on the team. In a long-term care facility, one RN may have responsibility for all residents within the facility. The RN would guide and supervise the many LPNs and CNAs who provide the cares.
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Your Time Budget
To rephrase the first question, is your goal to become a caregiver or a care manager? Do you want to care for people who are incapable of caring for themselves? If so, then you might want to consider the LPN role. Do you want to be in charge of a team while providing care to more acutely ill and injured people? An RN would fit better where a patient's condition may rapidly deteriorate.
The LPN program is usually a one-year commitment and results in a technical diploma. An RN program has more options. The two most common educational routes for an RN is a two-year associate’s degree (ADN) or a four-year bachelor’s degree. A three-year diploma is the oldest type of nursing education but is unusual now.  These time frames may not include any prerequisite education. If the student attends any of these programs on a part-time basis, the duration will be further extended.
Your Financial Budget
You already saw how you can choose different educational pathways based upon the time available. Financially, the options are similar to the time constraints. A shorter path to the desired degree will usually have a lesser total cost. Compare the per-credit cost at Wisconsin two-year technical colleges with four-year public universities. The difference is dramatic at $128.40 and $337.13 respectively. An Associate’s Degree in Applied Science-Nursing (ADN) is 64 credits. A Bachelor of Science in Nursing (BSN) is 120 credits. The extended costs for each are $8217.60 and $40,455.60. Those are only the per-credit costs and do not include books, fees, or room and board.
A two-year degree will be fastest and least expensive. Many times, a technical college student spends less total time in lectures and more time working in clinical settings, learning via the hands-on approach. (Disclaimer: I am an educator in a two-year technical college, teaching both a lecture course and two different clinical courses.)
Regardless of which program you choose, you will take the same NCLEX-RN and have the same title: registered nurse. Most “bedside” nurses start at very close to the same wage, regardless of education. Obviously, saving $32,238.00 is a major decision point, but before you immediately choose the local technical college, you need to ask yourself the last question.
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What is Your End Goal?
If you only want to be an RN working in a hospital and giving high-quality care, you can choose any of the educational paths. However, if your end goal is to move beyond the bedside and into a supervisory role, you should earn a BSN. There are many BSN completion programs available for those RNs with an ADN. They are usually more expensive per credit than the traditional BSN programs. Often an employer will offer some educational reimbursement because more BSNs on staff are important to hospitals.
Hospitals that focus on quality patient care, nursing excellence and innovations in professional nursing practice can earn designation as Magnet Hospitals. One of the requirements of Magnet status is that at least 50% of nurses must have their BSN or higher. Even as an instructor in an ADN program, I continually urge my students to continue their education after graduation. Earning a BSN will help secure their future employment opportunities.
If the idea of becoming a nursing instructor is a consideration for your future, you will need additional education. A Master’s of Science of Nursing (MSN), preferably with a Nurse Educator focus, is the minimum requirement. Any MSN can also unlock the doors to higher levels of nursing management, such as a hospital's Chief Nursing Officer (CNO). It can also allow you to become a clinical nurse specialist or a nurse researcher. You can also earn other advanced degrees. To become a nurse practitioner, you will need a Doctor of Nursing Practice. If you want to enter the highest levels of education and research, you need a Ph.D. in Nursing.
A person has many options to become a nurse. Once qualified as an RN, the employment opportunities are nearly limitless. Pick a school, work hard, and find that dream job caring for people.