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Most RNs begin as staff nurses in hospitals, and with experience and good performance often move to other settings or are promoted to more responsible positions. In management, nurses can advance from assistant unit manger or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief nurse. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.

Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employers-including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others-need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.


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