The notion that registered nurses (RNs) have achieved the pinnacle of their profession and earning power is untrue. Today’s nursing landscape offers a variety of advanced specializations, some of which offer the status of primary care provider. With doctors in increasingly short supply, advanced nursing specialists are becoming an important purveyor of health care.

These high-paying options appear in reverse order using their highest annual salaries from 2012. The top 5 paying nursing positions are:

5. Clinical Nurse Specialist ($54,000 to $104,000)

If you’re an RN who likes research and management,this is a great field. You’ll take a step back from day-to-day responsibilities, investigate the state of the art in nursing practice, and carry out key improvements where you work. Earning an MS degree in nursing (MSN) will give you more opportunities for advancement and earnings. Earning an MBA helps as well.

Regardless of what degrees you earn, your education can never end if you wish to succeed as a Clinical Nurse Specialist. Setting and reaching continuing education goals will be key to your success.

4. Perioperative Registered Nurse ($61,000 to $108,000)

A perioperative RN, supports surgeons and patients. Locations include traditional operating rooms, outpatient clinics, and practices such as plastic surgery and ophthalmology. You’ll prepare patients for surgery, support the surgical team during operations, and check post-operative recovery.

Roles you may play in the operating room include scrub nurse, who prepares and delivers the surgical instruments and supplies that the operation requires, and circulating nurse, who manages the perioperative staff and maintains a positive work atmosphere.

3. Adult Geriatric Nurse Practitioner ($73,000 to $123,000)

Consider this specialty if you’re an RN with a bachelors’ degree who wants to help people handle the aging process. Take the first step towards your new career by earning an online degree for nurse practitioners that emphasizes caring for adults who are coping with the effects of aging on their quality of life.

Completing this MSN should prepare you’ll for the American Nurses Credentialing Center (ANCC)’s Adult-Gerontology Acute Care Nurse Practitioner (ACNPC-AG®) Certification Exam  Then you’ll be able to help adults of all ages make smooth transitions from one phase of life to the next by helping with preventive care, chronic  condition management, and early problem detection. It’s a specialty that brings one-on-one attention to populations who may not have regular access to doctors.

2. Certified Orthopaedic Nurse ($76,000 to $129,000)

Combine your interest in the muscular and skeletal systems with your love of individualized care as a Certified Orthopaedic Nurse. Only RNs or the equivalent with two years’ experience that includes 1,000 hours in orthopaedics can take the Orthopaedic Nurse Certification (ONC) exam. Upon completing certification, you’ll continue to help patients regain or keep up their mobility while counseling their families and loved ones. Possible workplaces include nursing homes, hospitals, private practices, patient homes, and clinics. Your MSN degree can qualify you to enter private practice as a Nurse Practitioner in Orthopedic Nursing or assume supervisory responsibilities as an Orthopedic Head Nurse.

1. Certified Registered Nurse Anesthetist ($105,000 to $131,000)

If you’re an RN with a year of experience in critical care, make your next career move to this high-paying job with hands-on responsibility for administering anesthesia. You’ll work in a variety of surgical settings including hospitals, dental practices, and many outpatient offices. Surgeons and anesthesiologists will work with you to make sure that you administer the best anesthetic for the patient’s needs.

This is an Advanced Practice Registered Nurse (APRN) role that requires a two-year MSN program with anesthesia training and Certified Registered Nurse Anesthetist (CRNA) certification. If you like to manage, schedule, and train your fellow CRNAs, you can earn another $10,000 to $20,000 a year as a Chief Nurse Anesthetist.

Other high-paying career options are available if these don’t appeal to you. For example, if you enjoy comforting women in labor, consider a career as a midwife. Neonatal nurses help premature and sickly newborns survive the first critical days of life. If you prefer a more general practice that offers autonomy, become a licensed nurse practitioner. The important thing is to combine the earning power and job satisfaction that makes going to work worthwhile.