Becoming an RN in Massachusetts: Nursing Careers Paths

Massachusetts nurses practice in a wide range of settings. In a field with so much breadth – and depth – one can have new challenges across a lifetime. Those new challenges are often accompanied by salary increases as well.

RN Licensing and Scope of Practice

RNs must complete qualifying professional nursing programs (RN Programs in Massachusetts) and then pass a licensing examination. They have more nursing education than LPNs. The level of their academic degree, though, varies. RNs do not receive a new state-issued credential – or take any more qualifying tests — unless they complete one of several very specific graduate tracks and become advanced practice registered nurses. This doesn’t mean that all RNs below the advanced practice level have the same career options. Data collected by the Department of Public Health shows clear distinctions in practice settings for nurses with different academic preparation.

On the national scene, organizations have come out in support of higher degrees; these can be particularly important for critical hospital-based positions. The level of education one has when they start their nursing career is not the one they will have at a later stage. There have been efforts at the state level to support academic progression in nursing.

The scope of practice for different levels of nursing is dependent in part on what’s explicitly written into state code and in part on whether the nurse is adequately prepared to carry out the act.

Nurses typically receive additional training once they are hired into a particular unit; this is termed orientation. They develop expertise over time and may transition into higher level positions on their unit (or a similar one. Sometimes they choose to demonstrate expertise through specialty-specific third party certifications).

Some nurses of course do switch units and work settings. High levels of aptitude have a way of transferring!

Massachusetts RN Work Settings and Roles

The Massachusetts Department of Public Health published a workforce study in 2016, based largely on data collected during the 2014 license renewal cycle.

Hospitals are the single biggest employer of RNs nationwide. Massachusetts has provided a more nuanced picture of hospital employment than some states, taking into account both the organizational affiliation and where the nurse was employed within that organization. The following is a list of all settings reported by at least 2% of respondents:

  • Inpatient units of community hospitals: 20.5%
  • Inpatient units of academic medical centers: 17.5%
  • Chronic care and rehabilitation hospitals: 2.5%
  • Hospital-based ambulatory care centers: 11.8%
  • Non-hospital ambulatory care centers: 2.2%
  • Physician’s offices: 4.7%
  • Home health: 7.1%
  • Skilled nursing or extended care: 6.2%
  • Community nursing centers: 2.3%
  • School nursing: 4.2%

Massachusetts, unlike some states, has included Advanced Practice Registered Nurses in the data. Nationwide, they are more likely to be employed in settings that provide non-acute family care. Indeed, they are often providers, carrying out duties similar to those of a family doctor.

The 2014 report indicated that employment setting was influenced by academic degree. BSNs tend to be hospital nurses. In fact, the top three practice settings for nurses with education at the bachelor’s level were inpatient units of academic medical centers (23.2%), inpatient units of community hospitals (21%), and hospital-based ambulatory care (12.6%).

Those with associate’s degrees were often hospital-based, but there were some key differences. The top settings for this subset were community hospital (24.5%), skilled nursing or extended care (10.7%), and home health (10.2%).

Slightly over 50% of the nurses surveyed reported their role as being best described as staff nurse. Only a minority of nurses with graduate degrees had this role. 58% of those with education at the bachelor’s level or lower, though, described their role as such.

The percentage who routinely provide direct patient care was far greater than the percentage who described themselves as staff nurses: fully 83%. Here there was only a small difference between associate’s degree and bachelor’s degree nurses: 85.8% vs 84.9%.

The second most common role, after staff nurse, was case manager; this role was reported by 7.7%. The following were other common roles:

  • Nurse practitioner: 7%
  • Manager or director: 6.6%
  • Charge nurse: 6.0%
  • School nurse: 4.0%

This list is not all inclusive. The Dana Farber Cancer Center, for example, recruits nurses for various roles, including Clinical Research Nurse. Nurses in this role provide treatment and education to patients (http://www.dana-farber.org/about-us/careers-at-dana-farber/career-opportunities/research-nursing-jobs/). Their patients, unlike many others, are receiving investigational treatment. Clinical Research Nurses also participate in protocol development and review.

Nurses who practice in the same setting (e.g. academic medical center) can have any of many specialties. The following represent the most common ones reported by Massachusetts registered nurses:

  • Acute care: 18.6%
  • Critical care: 7.2%
  • Home health: 6.4%
  • Primary care: 6.2%
  • Anesthesia/perioperative: 5.3%

RNs in Nursing Home Settings

Nursing homes employ many staff with training below the RN level, but RN presence is vital. They have had more nursing preparation; that can help them assess patient condition and provide appropriate clinical care. The Cape Cod Times notes that there is a correlation between RN staffing hours –not just general staffing hours — and nursing home quality (http://www.capecodtimes.com/news/20171216/new-means-to-assess-nursing-home-quality).

Average Salary

Massachusetts registered nurses earned an average of $42.82 an hour (or $89,060 a year) in 2016, according to data reported by the Bureau of Labor Statistics; this is well above the national average. These figures do not include nurse practitioners whose more advanced skills allow them to command higher incomes.

One does see a wide range of salaries, with RNs at the 10th percentile in Massachusetts making $26.63 and those at the 90th percentile making $64.57.

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