Pathways Forward

Curricula · Hands-On Healthcare · Tacoma & Pierce County

Nursing: the Tacoma Path

Nursing starts with a 138-hour course and climbs, one rung at a time, to graduate licenses that pay as much as a physician assistant’s. Each rung pays for the next. The same license opens dozens of specialties, from the intensive-care unit to the school nurse’s office, and nearly every kind of schedule.

Ed. 2026–27Builds on the Hands-On Healthcare core pathChecked 2026-09-26

Why this field is on the list · as of September 2026

$128,260Median registered-nurse pay, Seattle–Tacoma–Bellevue, May 2025
$113,575Pierce County living wage, one earner, three children

It passes the one-income test. At the metro median a registered nurse clears the living wage for one earner with three children. A new nurse near the 25th percentile ($104,540) clears the two-child bar. Nurse practitioners ($160,090 median) and certified nurse-midwives ($162,970) clear it with room to spare.

The work stays in human hands. Nursing is assessment, touch and judgment at the bedside. A nurse notices that a patient looks grayer than an hour ago, starts an IV in a collapsing vein and calms a family in the worst hour of their lives. AI now drafts chart notes and raises early-warning alerts. That helps, since documentation eats a large part of every shift, but no AI lifts a patient or sits with a dying man’s wife.

Watch for: some hospitals are testing “virtual nursing.” A nurse on video handles admission paperwork, discharge teaching and remote monitoring for several units. That moves some tasks off the floor, but the bedside still needs a nurse. Virtual nursing is also a nursing job itself, and it suits a nurse with a bad back or small children.

01 · The ladderFrom first course to graduate license

Each rung below is a real job with a real paycheck. A student can climb straight through, or stop and work at any rung. That makes nursing forgiving for a family that needs income along the way.

  1. Nursing assistant certified (NAC)

    The course is 138 hours of training, followed by state exams. Nursing assistants bathe, turn and feed patients and take vital signs: the physical core of patient care. Washington sets no minimum age, but each program sets its own, often 18. Bates Technical College, Tacoma Community College and Clover Park Technical College all offer the course, including CPTC’s program at the Pierce County Skills Center.

    Median $51,990 · stepping stone, not a family income

  2. Licensed practical nurse (LPN)

    Training takes about a year. LPNs give medications and treatments under an RN’s direction, mostly in clinics, long-term care and home health. Bates Technical College runs a part-time evening program, useful for someone already working as a NAC.

    Median $85,690 · just short of the one-child bar ($89,050)

  3. Registered nurse (RN)

    Two routes lead to the same license and the same national exam (NCLEX-RN):

    • Associate degree (ADN). About two years after prerequisites, at Tacoma Community College or Pierce College Puyallup. LPNs can bridge to the RN at Clover Park TC, Pierce College or TCC.
    • Bachelor’s degree (BSN). Four years at Pacific Lutheran University, which also has a BSN route for LPNs and veterans.

    Many hospitals prefer the BSN. An ADN nurse can finish one while working, through UW Tacoma’s RN-to-BSN program.

    Median $128,260 · 25th percentile $104,540 · clears the three-child bar at the median

  4. Specialty certification

    After a few years, nurses certify in the specialty they practice: emergency, hospice and palliative care, critical care, pediatrics and more. Certification is not required to work, but it is how a nurse shows depth. See the branches below.

  5. Advanced practice: nurse practitioner or nurse-midwife

    A graduate degree (MSN or doctorate) and a national board exam let a nurse diagnose and prescribe. Nurse practitioners run a patient panel. Certified nurse-midwives care for women through pregnancy, birth and after, as described below. PLU offers an MSN and UW Tacoma a master’s in nursing. Check each school’s current catalog for the nurse-practitioner specialties it offers. Most students keep working as RNs part-time while they study.

    Nurse practitioner: median $160,090, 25th percentile $130,680 · nurse-midwife: median $162,970, 25th percentile $153,590

02 · BranchesMany specialties from one license

An RN license can lead to many specialties. Four are described in full below: one fast-paced, one built on home visits, one that needs a graduate degree, and one worked from home. The list after them covers the rest.

Emergency nursing

The ER takes whoever comes through the door: the heart attack, the overdose, the toddler who swallowed a battery. Nurses sort patients by danger, stabilize them and keep six problems moving at once. It is the fastest way to build clinical judgment, and many nurses spend their early years there for that reason. Tacoma General and St. Joseph share the area’s Level II trauma care, so Tacoma ER nurses see serious injury.

Credential: Certified Emergency Nurse (CEN), from the Board of Certification for Emergency Nursing. The exam requires a current RN license. The board recommends two years of emergency experience but does not require it.

Schedule: Nights, weekends and holidays come with it, in 12-hour shifts. The pace is hard to keep up for a whole career.

Hospice & palliative nursing

Hospice nurses care for people in their last months, mostly in the patient’s own home or a care facility. They manage pain and breathlessness, teach families what is coming and what to do, and stay steady in the room when death comes. No machine is going to do this job. It rewards what acute-care years build: fast assessment, calm under pressure and plain talk with frightened families.

Credential: Certified Hospice and Palliative Nurse (CHPN), from the Hospice and Palliative Credentialing Center. It requires a current RN license and hospice or palliative practice of 500 hours in the last 12 months, or 1,000 hours in the last 24.

Schedule: Home-visit work is mostly daytime and planned, with on-call rotations. It is one of the nursing jobs that fits best around a family.

Nurse-midwifery

Certified nurse-midwives care for women through pregnancy, birth and after, and many also provide routine gynecologic care. They deliver babies in hospitals, birth centers and homes, and they call in a physician when a birth turns surgical.

Credential: Certified Nurse-Midwife (CNM). The route is an RN license, a graduate program accredited by the Accreditation Commission for Midwifery Education (ACME), and the national exam from the American Midwifery Certification Board. The nearest program is Seattle University’s nurse-midwifery doctorate (DNP), accredited through 2031, about 35 miles north of Tacoma. Labor-and-delivery nursing experience first makes a much stronger applicant.

Income: it clears the one-income bar easily, with a median of $162,970 and a 25th percentile of $153,590. But the field is small: about 70 nurse-midwives work in the whole metro. Expect fewer openings than for a nurse practitioner.

Schedule: Births keep no schedule, but the work can still fit around a family. In a group practice, midwives share call: a few 24-hour call shifts a month, and ordinary clinic days the rest of the time. Some midwives work clinic-only (prenatal visits, postpartum and gynecologic care) and never take call. Others work part-time or per-diem call shifts. For a mother at home, a small part-time share of a group practice can bring in a strong income on limited, predictable hours.

Remote and virtual nursing

Some RNs now work from a screen. A virtual nurse watches hospital patients by camera and handles admissions, discharge teaching and paperwork for the bedside team. Others answer a telephone triage line, watch remote-monitoring data sent from patients’ homes, or do case management and utilization review. Nearly every employer asks for two to five years at the bedside first, often in medical-surgical nursing. Pay averages about $38.50 an hour, or roughly $75,000 to $100,000 a year full-time, and most earn about $28 to $43 an hour. That is well below Tacoma bedside pay (metro median $128,260).

Some employers limit which states a remote nurse may live in. Providence’s home-based virtual RN postings listed Washington, with Oregon, Alaska, Montana, California, New Mexico and Texas, and Providence Swedish has hired RN care managers for virtual primary care from the Puget Sound area. Read each posting’s residency rule before applying. Washington joined the Nurse Licensure Compact, and so did Idaho. A Washington multistate license lets a nurse care for patients in every compact state without a second license, which helps a great deal in remote work.

Schedule: Often part-time (0.6 or 0.9 of full-time) at set hours. The job needs a quiet room, reliable internet, and hours when no one else needs the nurse’s attention.

Other nursing specialties

Why only the nurse-midwife route. Washington also licenses midwives who are not nurses (“licensed midwives,” who mostly attend home and birth-center births). Federal wage data does not count them separately, and their income depends on running a private practice. They are left off this page until the route can be shown to meet the one-income bar. The nurse-midwife route clears the bar, and it leaves the RN license to fall back on.

A career that bends with the family. The license stays the same while the setting changes. A nurse can spend her first years in a hospital unit building judgment. While her children are small and schooling at home, she can cut back to two weekend shifts or per-diem work. As they grow, she can move to a clinic, a school, home health or hospice, or back to full-time hospital work. Few careers let a mother change her hours this much without starting over.

03 · For a parent at homeKeeping the license alive on fewer hours

04 · The home-school yearsWhat to add to the core path

Grades 9–10

  • Everything in the shared core, with extra weight on chemistry and dosage math
  • CPR and first aid, kept current
  • Regular time with the elderly: a grandparent, a neighbor, a church shut-in

Grades 11–12

  • Running Start: anatomy & physiology I and II, microbiology, English, psychology, statistics. Nursing programs screen applicants on these prerequisites, so aim for strong grades.
  • A NAC course at the first age a program accepts, then paid or volunteer hours as a NAC
  • Shadow a nurse for a day, in a hospital and, if possible, in a clinic or home-health setting

After high school

  • Work as a NAC while applying to programs. Hands-on hours strengthen an application.
  • ADN (about 2 years) or BSN (4 years), then the NCLEX-RN
  • A year or two in acute care (medical-surgical, ER, ICU, or labor and delivery for a future midwife) before specializing

Tie to the Verification Track

Nurses are the last check before a drug reaches a patient: right patient, right drug, right dose, right route, right time. The chart is a claim and the patient is the evidence. Suppose an AI-drafted note says “resting comfortably” while the patient is sweating and confused. The nurse believes the patient. Remote monitoring is this same work in its purest form. Is this alarm real, or did a sensor slip? Is this trend in the vital signs real? Does the medication list match what the patient actually takes? The Verification Track builds this habit early.

05 · SourcesWhere these facts come from

Checked 2026-09-26