The Hierarchy of Nursing

Filipino nurses should be proud of their achievements, whether as an RN or APRN/NP. I am very proud as an RN, an ANP and a Filipino. Tough as it is, knowledge is power and power will take you places and put food on your table..
In order to have power, let me take you to have a glimpse of what "real nurses" are:

Ground Zero - nursing assistants, lay man, anybody without a nursing background.
Some certified nursing assistants in the USA, are doctors or nurses or teachers in the Philippines. When I was new in NYC, one of my nursing assistants was a doctor in Cebu. He was working as a CNA because he did not pass the exam. I know of a very good friend, an adult Nurse Practitioner who worked as a CNA before she became what she is today, and she is not even a Pinoy.
These CNAs are not considered nurses per se. They do not go through rigorous studies or have responsibilities like a real nurse. Most,if not all, are in charge of cleaning up patients, ambulating them, or assisting them in ADLs of residents in the nursing home. In the hospital, they are utilized as helpers, taking vital signs, turning patients, transferring, and the like. In short, they are not nurses as they claim to be. Do not get fooled of titles.

1. LPN/LVN - this is the shortest route in becoming a nurse. The course is 18 mos to 24 months. Technical training and very little nursing knowledge. They are utilized to give medications and help out a little bit but not much of a responsibility. They work under an RN's license and cannot do physical assessment. Although they are considered nurses, they are not RNs. Their salary is only one half of an RN's.

2. Associate degree in nursing - the shortest and fastest route to become a registered nurse in the USA. It is 24 months only with rigorous training and clinical exposure. All graduates are able to sit in the RN exam. (NCLEX)

I was a professor in one of these courses in CUNY, teaching Fundamentals in nursing.
This degree is bound to be eliminated soon, so that all RNs will have a BSN.

3. BSN - 4 and 5 year curricula, with more extensive studies than the associate degree, however, only basic nursing courses.
I had my BSN from USC, Cebu City. WE were the last 5 year curriculum, but the trailblazers of College of Nursing in USC. Presently, BSN is just 4-year curriculum. All RNs can function in any specialty. This is just a general curriculum, and specialization can be acquired through experience. Most certifications require a BSN. All graduates are able to sit in the NCLEX exam to become an RN.

4. Masters degree in Nursing- It consists of clinical or educational track. The clinical track leads to specialization as a CNS or NP; educational track for research and teaching. This is also the entry level for advanced practice RNs.
I did my Masters degree in a CUNY which is mostly research and a few core courses.
MSN prepared nurses can be Director of nursing or hold higher management jobs, but some prefer just to be a bedside nurse or just a few letters after their names.

5. Post-Masters degree in Nursing - can lead to CRNA,adult, geriatric, family Nurse practitioner. I did mine in the College of Mount Saint Vincent, Riverdale, New York . Core subjects include: advanced pathophysiology, advanced pharmacology, advanced physical assessment I and II. I went straight to II as I have challenged the first one. Being an ER nurse saved me some good brownie points and money, even though, I was also a full-fledged scholar by my father in law.

Most advanced practice nurses have prescriptive privileges depending on the state they are in. I am in NY, and I have full prescriptive privileges since 1999.
Advanced practice nurses are forging the future. We hold high caliber jobs that are tantamount to MD functions and responsibilities. We cover for them when they are on vacation or when they are not available. A lot of clinics utilize NP's nowadays.

There was a study done about patient satisfaction and it revealed that patients are more satisfied with advanced practice RN/NP. The answer is very clear, our approach is holistic because we are nurses first.

Recent developments in nursing made this program disappear so the curriculum/ core subjects are included in the MSN program leading to the same clinical track as NPs or advanced practice registered nurse (APRN). This move actually saves time and money for a lot of RNs who want to pursue the advanced role.

6. Doctor of Nurse Practitioner - something new in the nursing arena, which is more clinical in nature. In 2013, the entry level of all advanced practice registered nurses will be a DNP. Maybe by then, we can sign death certificates. Salaries will be the same, I guess.

I do not need to continue, although I only need a few credits. I prefer to travel the world than go back to school. I think I have enough credentials under my belt and in my cap. Besides, it will not increase my salary any more.

Now that you have the knowledge of the hierarchy of nursing in terms of education, you are able to discern a real nurse from a 'faux' nurse. You can take your pick and conquer the world. Good luck to you all.

Always thank your nurse,
Sometimes the only one between you and a hearse.
~Carrie Latet

Nursing would be a dream job if there were no doctors. ~Gerhard Kocher

Marissa Torres Langseth
RN, MSN, Adult Nurse Practitioner
Board Certified