Nursing Advancement Opportunities: Progressing Along the Career Ladder

August 29, 2023

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Four nurses walk through a hospital corridor. For anyone who is compassionate, capable, highly dedicated, and a good communicator, nursing can be an appealing and rewarding profession. Nurses play an essential role in diagnosing, treating, and educating patients at every level of the health care system, and they make a meaningful impact in private practices, community clinics, hospitals, long-term care facilities and other caring environments.

From nurse leadership to research to education, rich and varied nursing advancement opportunities are out there. For nurses who earn advanced degrees, in particular, the breadth of professional development opportunities is substantial. Those who are drawn to nursing, and desire to climb the career ladder, may benefit from exploring the many paths to becoming a nurse leader.

Pursuing Opportunities for Advancement in Nursing in Clinical Roles

Many nurses love interacting with patients each day and playing a direct role in care delivery. At the same time, they may look for greater responsibility and autonomy. Professionals who become advanced practice registered nurses (APRNs) can choose from many opportunities for advancement in nursing. APRNs possess higher levels of training and education, becoming certified to administer skilled patient care with more independence.

For those who become APRNs, a host of opportunities for advancement in nursing exist.

Nurse Practitioner

The most common type of APRN is nurse practitioner. Nurse practitioners often serve in a primary care role, but may also seek certifications in particular clinical specialties. Common types of nurse practitioner specializations include family nurse practitioner, psychiatric mental health nurse practitioner, and adult-gerontology acute care nurse practitioner.

While the specific duties of a nurse practitioner can vary by specialty and practice environment, some of the most common responsibilities of this role include:

Performing physical examinations and observing patients to arrive at accurate diagnoses
Ordering, performing, and interpreting diagnostic tests
Developing and implementing treatment plans
Administering medications or referring patients to specialists
Educating patients and their family members about disease prevention and wellness promotion

To become a nurse practitioner, start as a registered nurse (RN), obtain a master- or doctoral-level degree, then pass the nurse practitioner certification exam that is administered by the state nursing board. Nurse practitioner school can help you prepare for the exam.

Nurses who progress to the level of nurse practitioner can earn an annual median salary of roughly $120,700, according to November 2022 data from the U.S. Bureau of Labor Statistics (BLS).

Clinical Nurse Specialist

Another advancement opportunity for nurses who wish to pursue direct clinical care is to become a clinical nurse specialist. While this role is often confused with the nurse practitioner role, there are important distinctions. Both are APRN roles, but a nurse practitioner focuses mostly on patient care, while a clinical nurse specialist divides time between treating patients and performing research.

Clinical nurse specialists are committed to researching nursing trends and using research results to inform decisions about system-level improvements.

In November 2022, the annual median salary for a clinical nurse specialist was around $94,500, according to data from the compensation website Payscale.

Certified Nurse-Midwife

Other nursing advancement opportunities to consider include becoming a certified nurse-midwife. These APRNs provide direct care to women, focusing on reproductive health issues as well as childbirth. Gaining this position requires the completion of a graduate-level nursing program with an emphasis on midwife skills. A certified nurse-midwife must also complete a certification exam from the American Midwifery Certification Board.

Some of the duties most commonly associated with this position include:

Confirming and dating pregnancies
Providing prenatal and postpartum care
Monitoring mother and baby during and after labor
Providing new mothers with education and training on breastfeeding
Diagnosing and treating gynecological health issues
Guiding women through menopause

In November 2022, the annual median salary for a clinical nurse specialist was approximately $100,000, according to data obtained from Payscale.

Certified Registered Nurse Anesthetist

Certified registered nurse anesthetists are APRNs who administer anesthesia and deliver care and support before, during, and after surgical interventions. Duties include carefully screening patients for any allergies or illnesses that might adversely interact with the anesthesia, helping ensure patient safety.

Taking on this role involves completing RN certification, a graduate-level degree focused on anesthesia, and passing an exam administered by the National Board of Certification and Recertification for Nurse Anesthetists.

Data obtained from Payscale in November 2022 notes the annual median salary for this role was around $167,900.

Moving into Management and Leadership Positions

Other career trajectories allow nurses to leverage their experience and expertise to assume health care management or leadership positions. These roles tend to be less focused on seeing patients, but they allow nurses to make a positive impact on policies and procedures, specifically at the team-, department-, or system-level. Significantly, some nurses who move into management roles choose to continue working the occasional clinical shift.

Some common nurse management and leadership positions include the following.

Director of Nursing

A director of nursing demonstrates leadership to a team of nurses or a nursing unit. This position is ultimately accountable for all nursing services received by residents or patients. The director of nursing will often report directly to the chief nursing officer.

Duties and responsibilities associated with the director of nursing position include:

Implementing new policies and procedures that impact the nursing staff
Recruiting, hiring, retaining, terminating, and training nurses
Developing and managing a budget for the nursing unit

Preparation for taking on the director of the nursing role typically begins with clinical practice, followed by earning either a master-level nursing degree or a Master of Business Administration (MBA) with a focus on health care leadership.

In November 2022, the annual median salary for this role was $93,900, according to data from Payscale.

Chief Nursing Officer (CNO)

Chief nursing officer (CNO) is an executive-level position. In most health systems, it represents the terminal position for nurses. One way to think about it: A chief nursing officer may oversee nursing operations at multiple sites or in multiple departments, each of which might have its own director of nursing. The chief nursing officer serves as a liaison between the nursing team and the rest of the C-suite.

Becoming a chief nursing officer usually entails possessing years of experience in clinical work, an advanced degree (in nursing or health care administration), and some experience in a lower-level managerial position, such as director of nursing.

Payscale data obtained in November 2022 notes the annual median salary for a chief nursing officer was roughly $135,400.

Hospital Chief Executive Officer

In some cases, nurses climb all the way up the corporate ladder to become the chief executive officer of a hospital or even an entire health system. These high-level administrators make important strategic decisions about the hospital as a whole, including critical choices regarding budgeting priorities, marketing, and community outreach, policy formation, legal compliance, and more. Hospital CEOs also interface with other executives, including the CNO.

Additional duties of the CEO include:

Hiring and retaining staff
Delivering strong financial performance
Implementing clinical policies and procedures
Ensuring regulatory compliance at federal and state levels

Becoming a chief executive officer typically requires earning an advanced degree in health care administration or finance, as well as years of experience in leadership-level roles.

According to Payscale data from November 2022, the annual median salary for a hospital’s chief executive was roughly $153,600.

Educating the Next Generation of Nurses

Nurses can find numerous nursing advancement opportunities in education, including nurse educator positions in an academic setting as well as a clinical setting. The need to train and develop the next generation of nursing professionals is ever present, making nurse educator positions invaluable.

Academic Nurse Educator

Another way to influence the future of nursing is to become an academic nurse educator. These experienced nurses work at nursing schools, imparting their clinical acumen and medical knowledge to students in a classroom setting. Duties associated with this role include presenting educational content to students, assessing and evaluating student performance, and engaging in ongoing scholarship.

Academic nurse educators typically combine clinical experience with advanced nursing degrees, often completing BSN to DNP programs.

The annual median salary for a nurse educator was around $78,900, according to Payscale data from November 2022.

Clinical Nurse Educator

Another exciting career path in nursing education is a clinical nurse educator. These respected clinicians impart their skills to the next generation of nurses, typically working in actual clinical care facilities as opposed to classrooms. They equip their students with skills to deliver high-quality, compassionate, comprehensive patient care.

Clinical nurse educators usually have a high level of clinical experience combined with an advanced degree, often through to the DNP level.

Payscale data from November 2022 notes the annual median salary for a nurse educator was around $78,900.

Pursuing Research to Advance Health Care

Nurses may decide that they’d rather apply their nursing expertise in a research setting. Nurse researchers help implement clinical trials with the aim of developing new medications or treatment procedures.

Types of Nurse Researchers

Nurse researchers typically work alongside physicians, research scientists, fellow nurses, and other clinicians. Their duties include assisting in the development of clinical trials, as well as simply monitoring and caring for the individuals who are participating in those trials.

Studies in which nurse researchers may work include the following areas.

Pharmaceutical innovations
New medical devices
New techniques or surgical interventions
Vaccine development

Nurse Researcher Duties and Responsibilities

While the job duties of research nurses may vary, their core duties include:

Creating and implementing new studies or research trials
Screening participants to ensure their eligibility for safe participation in the trial
Preparing the correct dosages of medication to administer to each participant
Collecting patient data, including vital signs and blood samples
Writing reports to document findings, and presenting them to colleagues or supervisors
Ensuring patient safety before, during, and after the trial

Becoming a Nurse Researcher

To become a nurse researcher, complete an undergraduate nursing degree, then obtain an RN license. Most nurse researchers choose an area of focus (e.g., allergies, cardiac health, or reproductive health), then obtain an advanced degree. Nurse researchers can gain clinical research experience at teaching hospitals, universities, pharmaceutical companies, and government agencies.

Nurse Researcher Salary

The median annual salary for a nurse researcher was around $82,000, according to Payscale information from November 2022.

Pivoting to a Role in Informatics and Technology

Nursing advancement opportunities abound in the realm of information and technology. Nurses who are drawn to data, analytics, and technological innovation may wish to become nurse informaticists, where they can use tech to contribute to the nursing field.

What Is a Nurse Informaticist?

Nurse informaticists work closely with clinical data, carefully collecting, managing, reviewing, and interpreting patient analytics to make recommendations for improving care delivery. These nurses may present data-driven, evidence-supported insights that help nursing teams or entire health systems avoid infection, reduce patient readmissions, or promote patient safety.

Nurse Informaticist Job Description

The duties and responsibilities of a nurse informaticist typically include the following.

Capturing and managing data from patients
Ensuring that data collection conforms to cybersecurity and privacy standards
Coordinating care for patients
Assisting in the implementation of electronic health records (EHRs)
Making recommendations to nursing leadership or IT teams

Becoming a Nurse Informaticist

Aspiring nurse informaticists need to take certain steps to prepare for this unique career path. Earning an undergraduate nursing degree, along with an RN license, is critical. A master’s degree with a focus on informatics is advisable, especially for those who seek senior informatics roles. Clinical experience is also important.

Nurse Informaticist Salary

The annual median salary for a nurse informatics professional was approximately $84,800, according to figures obtained from Payscale in November 2022.

Putting Nursing Expertise to Use in Consulting

Another key field for nursing advancement opportunities is legal consulting. Nurses may choose to become independent consultants, working on a contract basis. They may also seek employment with nurse consultant agencies, where their legal expertise may be leveraged on behalf of hospitals, practices, or health systems throughout the region or even nationwide.

Consultants provide insight into legal matters, drawing from their clinical background to advise on situations that could involve liability for medical-related issues.

What Do Nurse Consultants Do?

A legal nurse consultant may offer private companies or government agencies insight into any legal case that involves health care. Specifically, legal nurse consultants can help lawyers, business leaders, and politicians understand the complexities of medical care and the experiences of doctors and patients. Additionally, nurse consultants may provide insight to health organizations that are looking to improve quality, safety, or care delivery.

Becoming a Nurse Consultant

To pursue nursing advancement opportunities as a nurse consultant, earn an undergraduate degree, become an RN, then cultivate clinical experience as an RN. An advanced education, along with certification to participate in legal work, is also necessary. (Becoming a certified legal nurse consultant, or CLNC, is usually preferred.)

Nurse Consultant Salary

The salary range for a nurse consultant can vary quite a bit, but Payscale data from November 2022 noted an annual median salary of around $85,800. Individuals with an advanced degree or ample legal experience will typically command higher compensation.

Moving Forward on the Nursing Career Path

Nurses with advanced education can take advantage of many rewarding career trajectories. They can deliver direct patient care in a spectrum of roles and assume a range of responsibilities, depending on what career path they choose. In sum, the nursing field’s broad scope makes the profession a fascinating one for any type of aspiring nurse.

All nurses need the education to advance toward their goals. Hawai‘i Pacific University’s online Bachelor of Science in Nursing to Doctor of Nursing Practice program is an excellent way to earn advanced nursing know-how and to hone the skills for growth in any type of nursing role.