Becoming a Nurse


Bachelor of Science in Nursing

Graduates with an associate degree or a hospital diploma can begin practice as a registered nurse (RN) if they successfully pass the state-licensing exam (NCLEX-RN). The bachelor of science in nursing degree (BSN), however, is essential for nurses seeking to move up the career ladder and provide higher levels of care.

Typically during their first two years in college, BSN students take general education courses. In their last two years of college, they focus on nursing courses.

A variety of programs are available that enable licensed practical nurses (LPNs) and registered nurses (RNs) to complete their BSN degree. (See the
All Nursing Schools and the BestNursingDegree websites.)

For descriptions of a few the programs that recruit/support American Indian and Alaska Native students, see

Master of Science in Nursing

Master’s degree programs are 18 to 24 months in length and enable graduates to specialize in areas such as advanced clinical training or research. Most master’s degree candidates already have their BSN, but there are programs that help people move directly from the RN to the BSN to the MSN.

A master’s degree in nursing is needed by advanced practice nurses (APNs). There are joint-degree programs, such as a master's in nursing combined with a master’s degree in business administration or public health, or hospital administration. Master's degrees in nursing administration or nursing education are also available. (See the
All Nursing Schools and the BestNursingDegree websites.)

Nurse Practitioners

Nurse practitioners (NPs) are Advance Practice Nurses who provide a range of services. They assess their patients’ needs by talking with them, examining them and ordering and interpreting various studies and tests. They work collaboratively with patients in preventing illness, promoting health, treating common acute illnesses and injuries, and managing chronic problems. They focus both on caring and curing.

NPs work in a wide range of settings and numerous fields, such pediatrics, family health, women's health, and other specialties. Some NPs have private practices. NPs can prescribe medications in all states. In 25 states NPs can practice independently without physician collaboration or supervision.

Family nurse practitioners are in great demand in the Indian Health Service (IHS). They provide basic primary care in collaboration with the nursing, medical, and dental staff as well as staff in the laboratories and pharmacies.

(For more information about nurse practitioners, see the
American Academy of Nurse Practitioners and the American College of Nurse Practitioners.)

Clinical Nurse Specialists

Clinical nurse specialists (CNSs) are Advanced Practice Nurses who have earned a master’s or a doctoral degree in a specialized area of nursing practice, such as pediatrics, geriatrics, women’s health, oncology, diabetes, rehabilitation and mental health. CNSs practice in a wide variety of health care settings assessing and treating disease injury and disability. They also help patients prevent and resolve illness. (For more information see the website of the National Association of Clinical Nurse Specialists.)

Certified Nurse-Midwives

Working with physicians or on their own, certified nurse-midwives (CNMs), who are Advanced Practice Nurses, provide comprehensive care to healthy pregnant women. They deliver babies in hospitals, birthing centers, and homes and then follow-up with postpartum care. They help patients with family planning and provide such gynecological services as physical and breast exams and preventive health screening. In most states, CNMs can prescribe medications. CNMs in the IHS deliver babies and engage in all aspects of perinatal care, including care for newborns. Most births take place in IHS hospitals, often with family members and friends in attendance. For more information see the website of the
American College of Nurse-Midwives.

Certified Registered Nurse Anesthetists

Certified registered nurse anesthetists (CRNAs) administer more than 65 percent of anesthetics given to patients each year in the U.S. In almost two-thirds of all rural hospitals, CRNAs are the only providers of anesthesia.

CRNAs administer anesthesia for all types of surgery in settings ranging from operating rooms and dental offices to outpatient surgical centers. Because most IHS hospitals do not have anesthesiologists, CRNAs within IHS work independently or under the supervision of a surgeon or a physician. (See the
American Association of Nurse Anesthetists website for more information.)

Doctoral Programs

Doctoral programs prepare nurses for careers in advanced clinical practice, clinical research, nursing education, and health administration. The doctorate-level degrees in nursing include: Doctor of Nursing Practice (DNP or DrNP); Doctor of Nursing Science (DNSc, DNS or DSN); and Doctor of Philosophy (PhD) in Nursing. Typically the PhD and DNS degrees are considered reach-oriented degrees, while the DNP is a practice-oriented or clinical doctorate. Programs typically take 4 to 6 years to complete. (See the All Nursing Schools and the BestNursingDegree websites.)

See the
American Association of Colleges of Nursing for more information on nursing education programs, including undergraduate programs, programs for RNs, Master’s Degree Programs, Doctoral Programs, and Accelerated Programs.
This article was originally published in the Summer 2007 issue of Winds of Change. This page was updated 2010. (The cover artist is Bunky Echo-Hawk, Yakama/Pawnee.)