1 The Doors That Open With Your BSN: Opportunities for the BSN-Prepared Registered Nurse 

Jill Saxton

Learning Objectives

  • Discuss opportunities limited by the Associate Degree in Nursing (ADN) that are open to individuals with a Bachelor of Science in Nursing (BSN).

  • Distinguish the difference between a job and a career.

  • Understand the role of professional organizations in a nursing career.

  • Identify the advanced degrees that may be pursued after obtaining a BSN.

  • Examine the ways in which policy advocacy can ensure healthier communities.

  • Describe ways to lobby for legislation and regulations that affect a nurse’s ability to deliver safe care.

Opportunities for the BSN-Prepared Registered Nurse

Let us start with a video from someone in the same boat as you! Please watch as Wendy in Life As Wendy RN discusses the three reasons why she decided to obtain her BSN degree.

As an RN student with your ADN degree, you may wonder what the BSN degree offers you. Because you are already an effective bedside practitioner, what more do you need, strive for, deserve? This chapter will explore the many opportunities that come with obtaining your baccalaureate in nursing.

As far back as 1978, Alma Woolley, a nurse educator and historian, described the dichotomy of earning a BSN as “The change we are encouraging our RN students to make is not simply in the amount of knowledge and credits they can gain; instead, it is a whole behavioral [transformation] in their attitudes, roles, and  function” (Woolley, 1978, p. 103).

Now, that is exciting—new attitude, new role, new function! Let us look at your future opportunities with a BSN.

Job Roles and Titles Exclusive to BSNPrepared Nurses

One of the reasons you have returned to school may be to obtain an edge on jobs and career mobility. RNs who have clinical experience, but do not possess a BSN degree, may not apply for positions that require additional knowledge, skills, and competencies derived from baccalaureate education preparation (Parolisi, 2020). The roles and possibilities are endless. What role do you see yourself in?  We will discuss a few different roles within this section but you are encouraged to explore specialties, titles, and roles that peak your interest.

Do you see yourself as a nurse leader? Nurse managers, nursing directors, and all department-based leaders usually require a BSN degree. Do you wish to work in research, quality, or education? Clinical research nurses, quality assurance coordinators, and nurse educators all require the BSN. Is community health in your future? Public health nurses, health policy nurses, and case managers need their bachelor’s degree. In fact, most hospitals will likely require nurses to obtain their BSN degree, and having it will increase your hiring potential. To reach the “top end” of the career ladder, many organizations will also likely require the BSN. Career ladder advancement offers acknowledgment of nursing expertise, personal satisfaction, respect, and more money.

Healthcare has changed greatly over the last few decades, and nursing has grown into many new roles. Healthcare relies on technology, informatics, and medical data. Nursing informatics is an analytical science that allows nurse professionals to manage and communicate data. Nurse informatics upholds the integrity of electronic health records (EHRs) to help improve patient outcomes. A bachelor’s degree is needed to work as a nurse informaticist and to advance or take on a leadership role; earning a certification, a graduate degree, or both can be a big advantage. The average informatics nurse’s salary is $102,230 a year (Nursingprocess.org, 2022). This means that, on average, informatics nurses make $49.15 an hour and $8,520 a month. As a nurse informatics specialist, you can use your knowledge and expertise to improve healthcare technology.

Instead of dedicating their career exclusively to patient care, nurse educators are passionate about teaching and advocating for nurses. They work to instruct aspiring nurses and offer guidance, which may include training in both practical and educational settings. Nurse educators also support working registered nurses through experiential learning. They work in academic settings at nursing schools, community colleges, and technical schools along with healthcare settings. A BSN is needed to be a nurse educator for a healthcare organization, with a master’s or doctorate usually required to teach at institutions of higher education.

Forensic nurses work with law enforcement professionals to gather evidence from criminal investigations. These nurses help identify cause of death or inspect wounds and determine whether injuries are related to sexual assault, child abuse, spousal abuse, elder abuse, or another crime. In fact, there is a division of these nurses called Sexual Assault Nurse Examiners (SANE). A SANE nurse will conduct a forensic examination of the patient, cataloging evidence of physical or sexual abuse. Forensic nurses can serve as expert witnesses in trials. To qualify for the role, nurses are required to have a BSN and may wish to earn an MSN in forensic nursing.

Another role nurses with a BSN might consider is becoming a nurse health coach, also known as an RN wellness coach. Nurse health coaches consult with patients one on one, guiding them to make healthy lifestyle choices. They advocate for patients, negotiating patient insurance claims and speaking with doctors on their patients’ behalf. Nurse health coaches help people establish long-term goals for health and wellness that relate not only to medicine but also to their education and careers.

The BSN degree opens many doors to new and exciting job roles and titles. What new role will you pursue?

Roxanne likes her role at the facility and admires the role of the Director of Nursing (DON) in guiding practice and policy that affects her and the residents. Roxanne understands that many formal leadership roles require at least a BSN.

She is also aware that networking with nurses in the leadership role would be beneficial to learn more about different opportunities that come with a BSN education. Roxanne has a great interest in leadership and management. She is looking forward to putting what she learned in her 447X Leadership and Management course into practice!

She has already led a quality improvement initiative and would like to learn more about leadership and perhaps become a manager of her own unit eventually. Roxanne  ask the DON, if she could shadow in order to gain greater insight into the position and learn more about the responsibilities of overseeing the nursing operations of their healthcare facility. She also plans to ask her manager to become a mentor for her and has joined the American Nurses Association (ANA) and will enter their mentoring program. The ANA Mentor program will match her with a virtual mentor to help her network online and give her another tool in career development.

Job Versus Profession

Or perhaps you are not considering a position that requires your BSN, but rather want to excel further in your current career or apply for your “dream job”? Having your BSN gives you critical thinking skills. You gain greater understanding of the big picture of the interconnectedness between healthcare systems, quality, evidence, healthcare policy, nursing practice, and patient care outcomes. All of this knowledge will improve your abilities and give you a competitive edge over other applicants in a job interview for your “dream job”!

The education you gain in earning your BSN helps change your focus from task-oriented to critical thinking. You are no longer just working a job; you are a member of a profession. Our profession is accountable to the ANA Nursing Scope and Standards of Practice, which contains professional nursing practice and performance standards, and the  ANA Code of Ethics for Nurses With Interpretive Statements (American Nurses Association, 2021). We must hold true to the scope of practice that describes the services that as registered nurses, we are deemed competent to perform and permitted to undertake in keeping with the terms of our professional license. Also, we must follow the ANA Code of Ethics, which lists the nursing profession’s ethical standards of practice and nursing’s contract with society.

Your career is something you plan for and work at. It constantly evolves and expands whether you work in one place or move around during your professional life. The Gallup Poll has consistently found the nursing profession to be ranked as the number one trusted profession in its annual polls of Americans (Reinhart, 2020). For the 18th year in a row, Americans rate the honesty and ethics of nurses highest among a list of professions that Gallup asks U.S. adults to assess annually. Currently, 85% of Americans say nurses’ honesty and ethical standards are “very high” or “high” (Reinhart, 2020). This ranks nurses above pharmacists, medical doctors, and members of the clergy. Nurses’ commitment to people and families, advocating for others and protecting the health, safety, and rights of people, makes nursing more than a job; it is a true profession.

Having your BSN will expand your career. You will find your work to be more than a job but a profession that brings profound meaning to yourself and others. Nurses that have a high sense of professional values have high job satisfaction and quality of care (Wei et al., 2021). The education you earn in obtaining your BSN shows you have the ability to handle increasingly complex nursing responsibilities. Being a professional nurse means the patients in your care will trust you; it means you will stay up to date with best practices; it means treating your patients and colleagues with dignity, kindness, respect, and compassion. Working as a professional nurse brings you challenges, rewards, and means for self-actualization and fulfillment.

Roxanne feels she has learned a great deal within the BSN program, and she has reflected on how this has affected her practice.

She has noticed a shift from being task-oriented to being able to recognize the bigger picture (such as improving outcomes at the facility). She has also reflected on the fact that she has been able to apply various components of the Leadership and Management course immediately in practice. She feels more confident in the ability to navigate the complexities of the healthcare environment and utilize evidence to improve patient safety and outcomes. She plans to use the free resources from the Institute of Healthcare Improvement (IHI) to assist her in this plan.

Professional Organizations

Another characteristic that makes nursing a profession is in its formation of professional organizations. The purposes of nursing professional organizations include unity in advocacy, informing nurses, dissemination of professional knowledge, and professional development. Organizations and their members educate the public, policymakers, healthcare administrators, and professionals on specific issues (Matthews, 2012). A professional culture is sustained by formal professional associations. Being a member of a professional nursing organization provides you with an opportunity to stay current with issues related to nursing public policy. The financial contribution you make to your professional membership supports the work the organization can do in influencing public policy. The organization also provides you and other nurses with the avenue to amplify the voice of the nursing profession with policymakers on key issues that impact nursing practice and patient care. Some of the advantages of joining a professional nursing organization include education, conventions, networking, resources, and career assistance. Professional organizations also offer specialty certifications, mentoring, leadership development, policy advocacy, and scholarship opportunities. As science and technology change rapidly, organizations can help you keep up with the changes that affect healthcare. They facilitate making professional contacts, meeting other nurses in your specialty, and mentoring opportunities to advance your leadership skills. You will have networking opportunities to connect with other healthcare professionals at national, state, or local levels. Healthcare organizations may require specialty certification in addition to your BSN for career advancement. Professional organizations are here to support nurses who pursue specialty certification, and gaining certification in your specialty demonstrates your commitment to excellence in your practice. When you join a professional organization, you may get discounts to obtain online continuing education credits, newsletters, certification review materials, and more. Stay in touch with the latest trends in your specialty by looking to your association’s career center for openings, advice, and opportunities. These benefits allow nurses to grow in their careers and increase lifetime learning potential.

 

Some examples of professional organizations include:
  • ANA: The American Nurses Association represents the interests of the nation’s 4 million registered nurses (RNs) through joint membership with their constituent and state nurses’ associations, direct membership in ANA, and through their partnerships with specialty nursing and affiliate organizations. Joining ANA gives you access to educational opportunities, curated news, and mentorships. American Nurses Association (ANA)
  • ANA is also a highly regarded certification provider through the American Nurses Credentialing Center (ANCC) Certification Program: American Nurses Credentialing Center (ANCC) Certification Program 
  • AAMN: The American Association for Men in Nursing is a group to help shape the practice, education, research, and leadership for men in nursing and advance men’s health. The American Association for Men in Nursing
  • AACN: The American Association of Critical-Care Nurses is a non-profit community of acute and critical care nurses. The organization supports its members professionally and personally and works to pursue the best possible patient care. American Association of Critical-Care Nurses (AACN)
  • GLMA: Health Professionals Advancing LGBTQ Equality (previously known as the Gay & Lesbian Medical Association) is a professional association founded to promote the interests of gay and lesbian nurses and their patients in the United States. Its mission is to improve the health and healthcare of all LGBTQ individuals and families. Health Professionals Advancing LGBTQ Equality (GLMA)
  • Link to many more national, state, and international nursing organizations: List of nursing organizations
Roxanne would like to meet other nurses who share similarities such as culture and nursing practice; she begins reading the ANA’s Nursing Innovation Blog to learn more and connect with nurses across the country.

Additionally, her coworker shares that there is a professional nursing organization called the National Association of Hispanic Nurses (NAHN) that may be of interest. Roxanne is curious about what NAHN has to offer and begins to explore the website.  National Association of Hispanic Nurses (NAHN) She discovers a conference she could attend with her coworker. The conference will help them explore several key aspects of the current experience in Latinx healthcare, including understanding the effects and values of advances in technology; addressing inequities in healthcare and disparities in patient outcomes; and self-care for nurses in stressful and traumatic environments (mind, body, and spirit).

Advanced Degrees 

Once you have your BSN, in addition to the many opportunities it will bring you, you will have the possibility to pursue more education to lead you toward a full array of high-paying, high-demand nursing jobs. Some careers may require educational preparation first and then additional licensing or certification. There are several options in nursing to move your career forward with an advanced degree. See the chart below for several examples (the list of advanced degrees is constantly evolving, so the table below may not reflect what’s current):

Degree Program Description What Is Required to Start the Program? Job Examples
Master of Science in Nursing (MSN) This program teaches students to combine the latest in nursing theory, research, and evidence-based practice to improve patient care. Specializations allow students to focus on care coordination, informatics, nurse education, or leadership and administration. BSN degree from an accredited program

Or may enter an RN-to-MSN bridge program

Current verified RN licensure

A Clinical Nurse Leader (CNL) is an advanced clinician outcomes-based practice and quality improvement strategies.

A Nurse Educator (NE) instructs aspiring nurses and/or practicing nurses furthering their education.

Master of Business Administration (MBA)

Or

Dual:

MSN/MBA or DNP/MBA

The MBA teaches students administrative skills to oversee finances, accounting, marketing, and the general management of an organization.

The dual MSN/MBA degree blends a nurse’s healthcare background with business skills and expertise.

Bachelor's degree

Dual program requires BSN degree from an accredited program and

Current verified RN licensure

Chief Nursing Officer, Chief Nurse Executive, and Director of Nursing (DON) roles are responsible for leading and supervising nurses and other healthcare workers.
Master of Public Health (MPH) Public health focuses on empowering communities to improve the health of their community members. This program teaches collaborative leadership across disciplines to develop solutions to public health issues, create healthy communities and environments, and establish strategies in disease prevention and healthcare access for diverse populations.

A desire to become a civic or community leader is a must.

Bachelor's degree in a science field Public Health Nurses have both a BSN and an MPH. Public health nurses work in

prevention, education, advocacy, activism, assessment, and evaluation of public health. Other roles include

Researcher, Health Scientist, and Occupational Health and Safety Specialist.

Master of Science in Human Services (MS) Learn to manage the coordination of departments and individuals in public safety, healthcare, and administration to positively address challenges such as job stability, housing, and health benefits for clients. Bachelor's degree Marriage and Family Therapist

Human Services Educator

Higher Education Counselor

Drug and Alcohol Counselor

Director of Human Services Agency

Master of Public Administration (MPA) Learn about current policies and practices of being an administrator of various public services. Study ethical standards, advanced communication skills, and how to develop solutions to public policy issues. Bachelor's degree in a science field This career focuses on correcting issues that may exist within health services, such as poor budgeting. Nurses can step away from client care and become leaders to address shortcomings in healthcare settings and/or policies.
Master of Health Administration (MHA) Students learn to be leaders within a healthcare organization, developing skills to assist them in managing clinical and non-clinical staff, system redesign (in response to the changing healthcare environment), and focused efforts around delivering high-quality, cost-effective care for their consumers and within their communities. Bachelor's degree in a science field Healthcare Administrator

The MHA provides a broader look at administration that will be less clinical focused than the MSN degree and more business focused.

Advanced Practice Registered Nurses (APRNs):
There are four licensed Advanced Practice Registered Nurses (APRNs). APRNs include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives. All APRNs have graduate preparation (master’s [MSN] or doctorate [DNP]) in nursing and are trained in advanced physiology, pharmacology, and physical assessment in their specialty area. APRNs are required to take examinations for licensing and certification in their specialty area.
Nurse Practitioner (NP) Nurse practitioners are becoming increasingly integral to medical teams as more hospitals and healthcare facilities utilize their clinical expertise. NPs practice in primary, acute care, and specialty services to integrate clinical expertise with diagnosing, treating, managing, and preventing health conditions.

Currently, you can pursue this specialty by enrolling in an accredited MSN or DNP program in either the MSN-NP track or the DNP track.

BSN degree from an accredited program, or may enter an RN-to-NP accelerated program

Post-master’s certificate options available

Active, unencumbered current verified RN licensure

Nurse Practitioner practice settings include rural, urban, and suburban communities in clinics, hospitals, emergency rooms, urgent care sites, private physician or NP practices, nursing homes, schools, colleges, and public health departments (American Association of Nurse Practitioners, 2022).

Nurse Practitioner Certifications include:

Family Nurse Practitioner, Adult-Gerontology NP, Neonatal Nurse Practitioner, Pediatric Nurse Practitioner, Psychiatric Mental Health NP

Clinical Nurse Specialists (CNSs) Clinical Nurse Specialists influence healthcare delivery by providing diagnosis, treatment, and ongoing management of patients; providing expertise and support to nurses caring for patients at the bedside; helping to drive practice changes throughout the organization; and ensuring use of best practice and evidence-based care to achieve best possible patient outcomes (National Association of Clinical Nurse Specialists [NACNS], 2022). CNSs work within the healthcare system and nursing discipline to bring evidence-based practices to the forefront of patient care. Currently, you can pursue this specialty by enrolling in an accredited MSN or DNP program. BSN degree from an accredited program, or

Post-master’s certificate options available

Active, unencumbered RN license

Clinical Nurse Specialists work in a wide variety of healthcare settings, based on advanced education and training in a specialized area of nursing. Specialty work areas are defined by:

Population (such as pediatrics, geriatrics, women’s health)

Setting (such as critical care or emergency room)

Disease or medical subspecialty (such as diabetes or oncology)

Type of care (such as psychiatric or rehabilitation)

Type of problem (such as pain, wounds, or stress) (NACNS, 2022)

Clinical Nurse Specialist Certification specialty areas include adult-gerontology, pediatrics, and neonatal.

Certified Nurse- Midwives (CNMs) Certified Nurse-Midwives provide a wide range of primary healthcare services for women of all ages including primary care; gynecologic and family planning; and prenatal, pregnancy, childbirth, and postpartum care (American College of Nurse-Midwives, 2012). Currently, you can pursue this specialty by enrolling in an accredited MSN or DNP program. BSN degree from an accredited program

Active, unencumbered RN licensure

Current verified RN licensure

Most programs require at least 1-2 years of clinical experience before admission

Certified Nurse-Midwives (CNMs)
Certified Registered Nurse Anesthetists (CRNAs) Certified Registered Nurse Anesthetists safely provide and administer anesthesia and anesthesia-related care in every setting where anesthesia is delivered, such as in operating rooms, obstetrical delivery rooms, ambulatory surgery centers, and pain management clinics (American Association of Nurse Anesthesiology [AANA], 2022). Currently, you can pursue this specialty by enrolling in an accredited MSN or DNP program. BSN degree from an BSN degree from an accredited program

Active, unencumbered RN licensure

Current verified RN licensure

Most programs require at least 1-2 years of critical care nursing experience managing complex, critically ill patients.

Critical care specialty certification recommended

Certified Registered Nurse Anesthetists (CRNAs)
PhD in Nursing A PhD is a doctoral degree that prepares nurses for work in academic or research settings. The focus is on creating new knowledge and education rather than leadership roles in clinical practice. BSN degree from an accredited program

Current verified RN licensure

Nurse Researcher Professor at a healthcare organization or university
Doctor Nursing Practice (DNP) If your ultimate goal is to earn a practice-doctorate, then consider the BSN-to-Doctor of Nursing Practice (DNP) program.

DNP is a doctoral degree that prepares nurses for work in healthcare or academic settings. The focus is on nursing practice, leadership, and bringing evidence into practice. DNP programs are available in many specialty areas, such as APRN specialty, leadership, nurse executive, administration, population health, and nursing informatics.

BSN degree from an accredited program

Current verified RN licensure

Post-master's program options also available

Doctor of Nursing Practice (DNP)

Earning this degree positions you to lead system-wide healthcare improvements, advocate for healthcare policy, and change operational nursing procedures.

MSN or DNP may also be the required educational preparation for any of the APRNs mentioned above.

Roxanne has also been intrigued by the nursing students who have come into her facility for clinical experience and considers pursuing an advanced degree that would allow her to teach nursing in addition to obtaining a job in management.

She believes getting her MSN will be a great next step for her career plans.  Roxane is aware that she can pursue an MSN Generalist path, which opens the doors to several other nursing positions. She may consider a CNL degree to focus on care coordination, management of outcomes, risk assessment, and quality improvement within her unit, or a CNS to focus on her specialty area and identify gaps in healthcare delivery to help drive practice and process changes within her organization. She knows with an MSN degree she can also teach nursing. Roxane may even choose a Master of Science in Nursing Education. As she finds teaching engaging, Roxanne/Roxane may have found the right degree for herself. She could use her expertise to improve care, work in healthcare management, and teach at a nursing school.

Now that you have learned of a few different ways to optimize your BSN degree, consider starting to put a plan together for your future professional and personal growth in nursing. 

Policy Advocacy

BSN education adds leadership to the clinical skills you learned in obtaining your ADN. One of the important aspects of the baccalaureate essentials is policy advocacy. In the BSN program, you will prepare for leadership positions in the areas of advocacy and policy development, allowing you to develop a vision for how nurses contribute to creating healthy communities along with the profession of nursing. Nurses can advocate for the right social policies to promote justice, fairness, and health equity and adequately address social determinants of health (Matthews, 2012). They need to be active in the development of health policies to be better able to control their practice (Nsiah et al., 2019). Nurses, on the frontlines of healthcare, are uniquely positioned to assess social determinants of health and positively impact health equity and their own work conditions.

Community and public health nursing courses that are part of the BSN program help better prepare nurses for practice in and outside of the acute care environment and teach ways to reduce health inequity in the United States (Thornton & Persaud, 2018). Policies that are subject to different interpretations will, over a period of time, result in several possible outcomes, whereas an effective policy is relevant, timely, current, action-oriented, and based on research. Evidence-based, effective policies can ensure healthier communities. Policies can be made to address the lack of access to social and material resources that form the root of health inequities. Nurses’ influence in health policies protects patient safety, increases quality of care, and facilitates patient access to required resources and promotes quality healthcare (Gandelman, & Moran, 2021). The BSN nurse is educated to help with developing policies, lobbying for legislation and regulations that protect and serve users of nursing services, and advocating for patients and issues that affect a nurse’s ability to deliver safe care.

You may wonder what are some specific steps that can be taken to get involved in political advocacy and lobbying. As discussed above, involvement with a professional organization is a good place to start the journey to political advocacy. ANA and state nurses’ associations provide nurses with the tools they need to become leaders in the community, including reaching out to elected officials, organizing local support, and educating themselves on critical issues facing nurses today (Schaeffer & Haebler, 2019). Nurse advocates have many platforms from which to speak. Nurses may advocate to decision-makers in their organizations and utilize forums like social media or professional conferences to publicize issues and gain support. Also, never underestimate the power of your vote. Nurses can have a powerful impact on individual patients, the nursing profession, and public policy by raising their voices and sharing their experiences. Everyone stands to benefit when nurses are willing to talk openly about their concerns and needs on the job.

Roxanne has strong feelings about the current challenges in the nursing profession and how she can help improve it.

She would like to advocate for the removal of barriers that hold nurses back from working to the full extent of their education and training and help find ways to make the profession of nursing safer and more rewarding.

She would also like to advocate in Latinx healthcare. She is concerned about the fact that many Latinx lack access to healthcare and have poorer health outcomes. Roxanne would like to work with her elected officials and organizations to improve these issues, but she doesn’t know where to start or possess the skills to advocate in a professional manner. 

She decides to talk with her mentor about how to get started. Her mentor suggests she start by checking out the ANA health policy websites, ANA’s blog on health policy called Capitol Beat, and in her home state with the Wisconsin Nurses Association’s current legislative priorities.

In her research, Roxane finds another website where she learns about how she can become a health advocate to speak up on behalf of other nurses. Becoming a Nurse Advocate To learn about improving the disparities in healthcare for Latinx, she begins to listen to a podcast called Salud Talks on her commute to work.  Salud Talks focuses on Latino health outcomes and leads her to find several proposed health policies she can get involved with to help improve healthcare for Latinx. 

Policies she feels strongly about include: 

Wow, Roxane has found many ways to get started on improving health policy!  She knows she cannot do everything in a day, but with this information, she can get started on being an advocate for nursing and her Latinx community.

End of Chapter Activities

References

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Opening Doors to Your Future: A Handbook for RN-BSN Students Copyright © 2022 by Nicole Simonson; Jessica Hertig; Jill Saxton; and Amy Driscoll. All Rights Reserved.

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