Nursing Certifications for Aspiring Nurses

Written by Sasha Blakeley

What Are Nursing Certifications?

Nursing certifications are credentials that prove that nurses are properly trained to handle the responsibilities of their jobs. In most cases, nurses obtain their certifications by passing exams or submitting applications to independent certification organizations. All nurses must be properly certified before they can start work, although specific certifications that an individual needs will depend on their level of education, the type of nursing that they want to do, and the national and state requirements for any given nursing specialization they might pursue. Nurse practitioner board certification verification usually happens at the end of an individual's nursing education but before the start of a healthcare career. All nurses must obtain a base level of certification that enables them to work; they can then pursue more specialized certifications if desired.

Nursing Board Certification: Types of Nurses

When most people think of a nurse, they are usually thinking of a registered nurse (RN), but some people may choose a different career path to become a certified nursing assistant (CNA) or a licensed practical nurse (LPN). Each of these careers comes with distinct education and certification requirements. For the most part, specialized nursing certifications are only available to registered nurses, as becoming an RN has relatively strict educational requirements. There may be exceptions depending on an individual's experience, a hospital or region's needs, and the specialization in question.

Certified Nursing Assistant (CNA)

A certified nursing assistant is a type of healthcare worker. Unlike registered nurses, whose basic credentials are tracked at the national level, individual states regulate CNAs. What education a certified nurse needs to receive will, therefore, vary, but becoming a CNA is traditionally the shortest pathway to entering the nursing field. Certified nursing assistants do not need to get a college degree to be able to work; a high school diploma or GED is sufficient, and the next step is to take part in nurse assistant training. Usually, community colleges or other post-secondary institutions provide this training. CNA programs are non-degree programs, so they offer graduates a diploma or a certificate that takes a few weeks to a few months to complete.

Any program must be certified by the National League for Nursing Accredited Commission to be equipped to provide a high-quality nursing assistant education. Programs culminate with an exam students must pass to become certified nursing assistants. The details of these exams will vary by state, but those who pass can seek employment as CNAs.

CNAs work in a wide range of healthcare environments. Some find employment in nursing homes, hospitals, or clinics. Others provide in-home care for patients. Some CNA duties overlap with the work other nurses do, but the scope of CNA responsibilities tends to be more limited. CNAs often monitor patients' vital signs and other health metrics before reporting their findings to nurses and doctors. They are in charge of feeding and bathing patients, dressing wounds, and talking with patients about their care, their physical and emotional well-being, and more.

According to the US Bureau of Labor Statistics (BLS), the median annual wage for certified nursing assistants is $38,130. Alaska, the District of Columbia, and California have some of the highest wages for CNAs.

Licensed Practical Nurse (LPN)

A licensed practical nurse shares some of the responsibilities of a CNA, but the position requires somewhat more specialized expertise. Like CNAs, LPNs do not need a degree to do their jobs. They do need to complete a diploma program from an accredited college or university. Some colleges and employers prefer to hire LPNs who have previous experience as CNAs, but this is not a universal prerequisite. Diploma programs for CNAs usually take a year to complete.

At the end of their education, aspiring LPNs will need to take an exam to obtain their license. Unlike CNA exams, LPN exams are standardized across the country. All LPNs must take and pass the NCLEX-PN (National Council Licensure Examination - Practical Nurses). This examination is currently undergoing some changes; as of 2023, the Next Generation NCLEX (NGN) is the new examination standard for LPNs and RNs. Some LPNs use their training as a jumping-off point to become RNs, while others treat licensed practical nursing as the end point of their careers.

LPNs work in many of the same healthcare environments as CNAs or RNs. When interacting with patients, LPNs will also check vitals and care for patients' daily needs. However, they are empowered to perform more complex tasks than CNAs, including administering vaccinations, collecting blood and urine samples, inserting catheters, and more. In some healthcare settings, CNAs work under the supervision of LPNs, though it is common for members of both professions to take on similar roles in patient care. The BLS reports that the median annual wage for licensed practical nurses and licensed vocational nurses is $60,790, a significant step up from the average CNA salary. The top 10% of LPNs earn $77,870 according to the same data. States like Washington, California, Rhode Island, Alaska, and Massachusetts pay LPNs comparatively high salaries.

Registered Nurse (RN)

Registered nurses must complete a degree program to receive their certification. It is possible to become a registered nurse with an associate degree in nursing (ASN) or a bachelor's degree in nursing (BSN). Most people take around two years to complete an ASN and four years to complete a BSN, though the timeline can be variable. Only accredited colleges and universities can provide students with these degrees. Some hospitals and clinics are more likely to hire nurses with a BSN rather than an ASN — the salary for those who hold a bachelor's degree may also be higher.

For RNs who started with an ASN, there are ASN-to-BSN college programs that can help individuals earn a more advanced degree. What makes a registered nurse board certified is passing the NCLEX-RN, which is a similar exam to the LPN equivalent. It is common for nursing students to spend months studying for the NCLEX-RN, as the exam covers a great deal of content and is known to be challenging.

RNs are empowered to make more complex healthcare decisions than LPNs or CNAs. They can administer medication, provide patients with instructions on their ongoing care, and liaise directly with doctors on diagnosis and treatment plans. RNs usually get more face-to-face contact with individual patients than doctors do. They may be in charge of LPNs and CNAs as part of a broader healthcare team. As of 2023, registered nurses make a median salary of $94,480. A degree, specialization, and increased experience will likely lead to higher pay over time. California, Hawaii, and Oregon have the highest salaries for registered nurses; the mean wage across those three states is over $110,000 annually.

Specialty Nursing: National Certifications

In addition to basic certification, nurses may choose to specialize in a particular medical field. Specialization can be a way for nurses to explore areas of interest, meet healthcare needs in a given region or hospital, and improve job outlook and salary potential. Not all nurses choose to specialize, and those who do can pursue specialization at any point in their careers. Usually, nursing specializations require further education and testing. Specific certification requirements can vary significantly. Some are federally regulated, while others differ from state to state. In nursing, national certifications tend to open up more career opportunities, as all states will accept them. Some state certifications are transferable, while others are not. There are hundreds of nursing certifications for different specializations, each with unique requirements. The following are some of the most common options.

Pediatric Nursing Certification Board

The Pediatric Nursing Certification Board (PNCB) is one of the major nursing certification organizations in the country. Pediatric nurses specialize in working with children in a healthcare environment. PNCB certifications are open to those who have already obtained RN certification. Registered nurses who want to pursue one of the certifications that the PNCB offers can verify their eligibility and then take an exam, either at a testing facility or from home. Like all nursing certifications, the pediatric nurse certification can be challenging. The certifications that the PNCB currently offers include:

• Certified pediatric nurse (CPN)
• Pediatric Primary Care Mental Health Specialist (PMHS)
• Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC)
• Primary Care Certified Pediatric Nurse Practitioner (CPNP-PC)

The latter two options are only open to nurses who have already received CPN certification. Applicants for CPNP-AC and CPNP-PC must also have an advanced degree: either a master's, a doctorate, or a post-doctorate degree. While the PNCB is the largest pediatric certification board, it does not provide all of the possible pediatric nursing certifications in the country. Other pediatric specializations include:

• Neonatal pediatric transport nursing
• Hospice and palliative pediatric nursing
• Pediatric hematology oncology nursing

Before RNs can obtain any pediatric nursing certifications, they will need to spend many hours working with children in a healthcare environment. The PNCB requires at least 1,800 hours of recent experience, for instance. Nurses interested in pursuing these specializations often start by seeking opportunities to work with younger patients and learn more about pediatric nursing before applying.

Board of Certification for Emergency Nursing

The Board of Certification for Emergency Nursing (BCEN) is another major organization that works to train and certify nurses. Their certifications confirm that nurses have the experience, knowledge, and skills to do great work in an emergency room setting. Patients visit emergency rooms when they require urgent healthcare assistance. That means that emergency room nurses must be highly responsive, calm in a crisis, and able to handle various medical emergencies. Like the PNCB's certifications, the BCEN only provides specialization training and certification to people who are already registered nurses.

The process for becoming a Certified Emergency Nurse (CEN) involves submitting an application and completing an examination. Applicants are encouraged to spend at least two years focusing on their area of specialization before applying to become a CEN, but this is a recommendation, not a requirement. The BCEN also provides other certifications, including:

• Certified Pediatric Emergency Nurse
• Trauma Certified Registered Nurse
• Certified Flight Registered Nurse
• Certified Transport Registered Nurse

All of these nurses can and do work alongside non-specialized RNs. Because of their advanced training, CENs and other BCEN-certified nurses often take on leadership roles in emergency rooms, ambulances, and other urgent healthcare environments. As with other specialty certifications, CENs may make more money than other emergency room nurses.

Other Nurse Specializations

Nursing is a broad career; two nurses might have minimal overlap between their daily duties and experiences, even if they work in the same hospital. This is particularly true for nurses with more niche specializations. In most cases, nurse certifications require experience, an application, and an exam. Some advanced certifications require a master's degree or higher, or require applicants to have already begun their specialization journey with another certification. Some of the major nursing specializations include:

This list is just a sample of the possibilities when it comes to nursing specializations. Just because a nurse is specialized in a given area does not mean that they cannot also perform more general nursing tasks if desired or needed.

Becoming a Nurse: Nursing Exams

All nurses, regardless of specialization, must complete some form of examination as part of the certification process. For CNAs, that examination is often largely practical and hands-on, ensuring applicants can perform all required tasks competently and confidently. For LPNs and RNs, the examination process is more involved. To begin with, aspiring registered nurses will need to take an entrance exam to get into nursing school. There are two widely recognized entrance exams for this purpose: the Health Education Systems Incorporated (HESI) exam and the Test of Essential Academic Skills (TEAS) exam. Before starting work, both LPNs and RNs will need to complete a version of the NCLEX test.

HESI and TEAS

The HESI test focuses on verifying students' basic knowledge of science, reading and writing, and mathematics. There is another version of the HESI that some students have to pass near the end of nursing school; it is known as the HESI exit exam. Students who pass the HESI exit exam are more likely to be able to pass their later licensure exams, which is why the test has become so common across the country. Nursing schools often provide their students with HESI practice tests, and such resources are also available online. The TEAS test looks at students' skills in similar subject areas to the HESI exam. Aspiring nurses should ensure that they study using TEAS practice tests before attempting the exam, as some individuals who are otherwise qualified to become registered nurses may not be able to attend nursing school because of their TEAS exam scores.

NCLEX-RN and NCLEX-PN

The NCLEX exam is the standard nursing exam for LPNs and RNs across the country. The test is somewhat different for members of these two professions, though there is a great deal of overlapping content. Because RNs take on more of a leadership role in a hospital setting, the NCLEX-RN focuses more prominently on supervision and decision-making than the NCLEX-PN. In comparison, the latter concentrates more on working as part of a team and taking instructions. Otherwise, the exams are the same length and structure. Official and unofficial NCLEX practice tests are available online and through nursing programs to help aspiring healthcare providers prepare for their careers.

The Next Generation NCLEX puts a greater emphasis on making accurate decisions under pressure. Nursing can be a highly stressful profession, as nurses need to make quick decisions about how best to care for patients. If nurses make a mistake, it can be dangerous or even deadly for patients. The NGN aims to reduce the frequency of these errors. NCLEX exams are taken on a computer and are dynamic in structure. That means that two people who take the same exam will encounter different questions. The test responds and changes based on the test taker's answers to verify competency in all important areas. If an individual gets too many answers wrong, the test will end early. The exam is meant to cover all of the major areas and subjects that aspiring nurses need to be comfortable with.