Best & Worst States to Practice Nursing in 2014

To be certain, there’s plenty of misunderstanding about what exactly Nurses do, and who exactly Nurses are.

So, to clear the air, let’s set the record straight, and get a quick backgrounder before diving into the deep end.

In whatever state they choose to practice, all 50 states requires all Nurses to be licensed before they begin practice. Licensed Vocational Nurses (LNVs) are considered technicians, while Registered Nurses (RNs) are professionals.

The LPN (Licensed Practical Nurse), which in some states is called LVN (Licensed Vocational Nurse), most often has earned a certificate in less than a year, and has a significantly different educational track than a Registered Nurse (RN), even when the RN has an ADN (Associate Degree Nursing). The RN utilizes critical thinking skills, and the responsibilities the RN has are more complex, and therefore always supervisory in nature over the LVN/LPN. Because of the complexities and advances in healthcare, and patient care, LVNs are NOT permitted by license to do the same things as a RN. Pay, of course, comes along for the ride, and RNs are paid more.

Registered Nurses may begin practice by earning an Associate’s Degree Nursing (a two-year degree) typically at a Junior or Community College, or by earning a Bachelor of Science Nursing (BSN), a four-year degree most often earned from a University. Both the ADN & BSN must pass the NCLEX – the National Council Licensure Examination – before they can practice Registered Nursing.

Advanced Practice Nurses (APNs) are BSN-prepared RNs whom have obtained additional education and training, typically a Master of Science Nursing (MSN) in a specialty area of Nursing practice such as Gerontology (specialized care for the elderly), Family Nurse Practitioner (FNP), Acute Care Nurse Practitioner (ACNP), Pediatric Nurse Practitioner (PNP), Certified Registered Nurse Anesthetist (CRNA), etc. Frequently, following earning their MSNs, APNs have also obtained National Certification in their area of specialty, and many have prescriptive authority, depending upon the laws of the state in which they practice. Because they have more education, more experience, and more responsibility, they are also paid more. APNs may also continue education and training to the doctoral and post-doctoral levels.

In some states, APNs are allowed independent practice, and are not required by law to be supervised by a physician. Other states have laws that limit practice of APNs – even though they may be Board Certified – and require physicians to collaborate with them, or in some cases, to oversee their work. Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Maine, Montana, New Mexico, Nevada, New Hampshire, North Dakota, Rhode Island, Oregon, Vermont, Washington, Wyoming, and the District of Columbia all allow APNs to practice independently. Alabama is one such state which does not allow Board Certified Advanced Practice Nurses independent practice. According to the American Association of Colleges of Nursing, “in at least 45 states, advanced practice nurses can prescribe medications, while 16 states have granted APNs authority to practice independently without physician collaboration or supervision.”

There’s an entirely different can of worms when comparing the practice of APNs and physicians. One of the ways they differ, are that

MDs abandon Family Care, NPs step up to Care

A long-term trend in medicine in the United States has been that medical school students continue to abandon Family Care and Rural Practice.

The corollary trend among Advance Practice Nurses & Nurse Practitioners – many whom must also pass National Board Certifications in their area of practice – has been to fill the void formed in the delivery of healthcare by physician abandonment. Typically, the argument given for such abandonment is pecuniary. That is, by the time the medical student graduates from medical school & residency to assume full and independent practice, their debt load is not merely burdensome or impractical, but almost wholly impossible to repay.

More recently, however, medical schools and public health authorities have acknowledged the error of allowing that deterioration and abandonment to occur, and have begun to promote Primary & Family Care among medical schools and their students. Such strategies include not merely the promotion of community and the advantages of rural independent practice, but include full-ride scholarships while in medical school.

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Nurse practitioners look to fill gap with expected spike in demand for health services

By Sarah Kliff, Published: May 12

President Obama’s health-care law is expected to expand health insurance to 32 million Americans over the next decade. Health policy experts anticipate that