Many nurses choose to pursue careers in one of a variety of advanced clinical practices. These programs generally require one or two years of advanced course work, accompanied by a suitable program of clinical experience. Nurse practitioners are able to provide primary health care to patients independently of a doctor's supervision, and may prescribe medications in most states. Nurse anesthetists support surgical teams independently, or under the supervision of an anesthesiologist. Others may become obstetric nurses, nurse-midwives or gerontology nurses, to name just a few possibilities.
Experienced nurses may wish to draw on their deep knowledge of the field to train the next generation of practicing professionals. Nurse educators are required to complete a program of classroom education in an accredited graduate degree program, followed by a certification process overseen by the National League for Nursing's Accrediting Commission. This requires applicants to complete a rigorous examination, and once earned, the certification must be maintained by a regular program of continuing education and professional development.
Some nurses are drawn to positions in management or administration. Health care is a large and important industry, and has an ongoing need for skilled administrators who understand the specific characteristics of the field. Nurses may qualify for management positions by various combinations of a master's degree in nursing, a doctorate in nursing, or a nursing degree paired with an MBA or other degree in business or management. Nurses with these degrees are eligible to advance to the highest administrative positions within a hospital or HMO, and may also find employment in government or as consultants.
The BLS notes in its 2010/2011 Occupational Outlook Handbook that nursing specialties are in exceptionally high demand, and almost invariably require a master's degree as the educational minimum. This additional education has a dramatic effect on a nurse's earning power. In the 2009 survey, the lowest 10 percent of respondents reported an average income of $43,970, compared to the median income of $63,750 for all registered nurses. At the top end of the scale, the highest 25 percent of earners reported incomes of $77,970, and the top 10 percent earned an average of $93,700. This makes a strong case for the value of higher education for nurses.