Registered nurses, or RNs, are health care professionals who work as part of health care teams to promote health and prevent and treat disease. They are patient advocates and health care educators working to teach not only patients but also families and the community.
With about 2.1 million positions in the field, RNs make up the largest health care occupation. More than half of all health professions students are nursing students, and there are four times as many RNs in the United States as physicians. Most nurses as of 2001 are women; only 5-7% of all nurses are men.
Nurses work collaboratively with physicians and other health care providers, although the nursing profession
In the area of direct patient care, RNs have many responsibilities:
- They observe, assess, and record patients' symptoms, responses to treatment, and progress.
- They provide assistance to physicians and other health care providers during examinations and treatments.
- They administer medications and take vital signs.
- They help patients to rehabilitate and heal.
- They educate patients and families about appropriate care after treatment, as well as long-term health.
- They develop and manage plans for nursing care.
In hospitals, RNs often work as staff nurses, providing care at the bedside and managing patients' medical needs. In some cases, RNs in hospitals supervise licensed practical nurses and aides.
RNs who work in office settings, for physicians or in clinics, assist administratively in the office and help the medical staff with patient preparation and examination. They administer medications, perform some lab tests and injections, as well as dress wounds and incisions. RNs also assist with minor surgery techniques and record-taking.
Nurses in the nursing home setting provide a variety of care to elderly or sickly patients who cannot care for themselves because of age or illness. RNs in nursing home settings spend a good deal of their time developing treatment plans and performing other administrative duties, including supervising LPNs and nursing aides. They also provide direct patient care, assessing residents' medical conditions, monitoring treatment, and performing more advanced tasks, such as starting intravenous fluids. Nurses in this setting might concentrate on an area of specialization, such as long-term rehabilitation, in which they would care for stroke and head injury patients.
Home health nurses are often RNs who provide periodic at-ome care for patients who might be recovering from illness or suffering from a chronic condition. While home health nurses work independently during their time in the home, the care they provide is prescribed by a physician or nurse practitioner.
RNs in public health nursing work in a variety of government and community organizations, including as school nurses and in public health clinics. The focus in this area of nursing is to make health care accessible to populations, including the underserved and those in rural areas. The goal is to improve overall health care in a community. Public health nurses work with community members to plan and implement programs to enhance community health care and educate groups about good health practices, such as disease prevention, child care and nutrition. They work in partnership with families, schools and other public organizations to help educate members about health. And these RNs make arrangements for such health screenings as immunizations and blood pressure and cholesterol testing.
Occupational health or industrial nurses provide health care services on-site in different environments. These nurses might work at a company's headquarters providing nursing care to employees or at a resort providing nursing care to tourists. RNs in this environment provide emergency care, prepare accident reports and make arrangements for any necessary additional care. Especially in the employee environment, they might coordinate health screenings, health counseling and assess work environments for safety.
In 1998, RNs' median annual income was $40,690. The median income that year of RNs working in hospitals was $39,900; home health care services $39,200; offices and clinics run by MDs $36,500; and nursing and personal care facilities $36,3000.
The job market has been changing for RNs, making them more in demand. Much of this growth in opportunity is due to changing demographics. As more people become elderly, more will need nursing care and many more will need long-term care. The expansion of managed care has led to an increased emphasis on primary care. Another factor in the growth of the need for RNs is advancing technology, which requires the knowledge of RN or higher-level nurses. Essentially, the world is open to RNs because of opportunity and need now and in the future.
The largest group of nurses work in hospitals, where they usually focus on a particular area of care, such as emergency room, intensive care, critical care, maternity, oncology, or pediatrics; or rotate throughout the hospital.
Nurses also work caring for patients on an outpatient basis in doctors' offices, clinics, surgery centers and emergency medical clinics. Some also work in nursing homes; public health facilities, such as government or private agencies and schools; on-site work environments in the occupational health or industrial nursing field; or in administrative positions within a corporate or organizational setting overseeing other nurses.
Nurses who work in hospitals generally work in fast-paced, pressure-filled environments. Many hospitals today are short-staffed due to budget cuts and the nursing shortage. Nurses in these and other environments spend considerable time standing and perform tasks that are hard on the body, such as lifting patients. Nurses often work all types of shifts, including daytime, weekend, and night shifts. Many nurses see the flexibility in scheduling as a positive factor—especially if they juggle childcare responsibilities. Nursing can be a dangerous occupation. They often care for people with infectious diseases, such as hepatitis, and are near radiation, chemicals used for instrument sterilization, and anesthetics. To avoid possible hazards, nurses must adhere to rigid safety guidelines. There is also an emotional toll involved with the job, as nurses often have close daily contact with patients who are severely ill or dying.
Education and training
RNs must graduate from a nursing program and pass a national examination to become licensed. They must periodically renew their licenses and, depending on which state they work, must also take continued education courses for license renewal.
There were more than 2,200 entry-level RN programs in the United States in 1998. RNs can pursue one of three educational options. They can complete an associate degree in nursing, which is usually offered at community and junior colleges and is about two years long; a bachelor of science degree in nursing, taken at colleges and universities and usually taking from four to five years; or a diploma program, which is given in hospitals and lasts about two to three years. Licensed graduates at any of these levels usually qualify to start work at the staff nurse level. Most RNs graduate with either an associate's or bachelor's degree. Today an increasing number of nurse executives are saying that they want a majority of their hospital staff nurses to have bachelor's degrees because of the more complex demands of patient care. In 1996, 27% of RNs reported have a diploma, 31% had a bachelor's degree and 32 percent held an associate's degree. There have been discussions in some states of requiring an RN to obtain a bachelor's degree or higher; however, this trend would not affect current associate degree RNs and would probably take place on a state-by-state basis. Most agree that there are more opportunities for advancement for RNs with bachelor's degrees in nursing. A bachelor's degree is often necessary for administrative positions and is required for admission to graduate nursing programs of all types, including research, consulting, teaching and clinical specialization.
Students in nursing programs take courses in anatomy, physiology, microbiology, nutrition, psychology, chemistry, nursing, and other behavioral sciences. In addition to classroom instruction, nursing students receive supervised clinical experience in hospitals and other health care facilities. Nursing students receive a variety of clinical experience in settings such as hospital maternity, psychiatric, pediatric and surgical wards. They also gain experience in public health departments, home health agencies, and ambulatory clinics.
Advanced education and training
RNs can go on to become advanced practice nurses, which include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives. Advanced practice nurses generally have master's degrees or certificates. Nurse practitioners deliver front-line primary and acute care. They can prescribe medications, and diagnose and treat common acute illnesses and injuries. Nurse practitioners provide immunizations, conduct physical exams, and provide care to manage chronic diseases, such as diabetes. Certified nurse-midwives are trained to provide prenatal and gynecological care to healthy women. They also deliver babies in all types of settings, including the patient's home, and provide postpartum care. Clinical nurse specialists specialize in such areas as cardiology, oncology and pediatrics. Certified registered nurse anesthetists administer anesthetics to patients in in-patient, outpatient and in-office settings. They are often the sole providers of anesthesia.
RNs can also go on to careers in teaching, research, or administration. These areas require master's degrees in nursing or PhD or doctorate-level degrees. Doctorallyprepared RNs tend to go into education or research.
Registered nursing is projected to among the 10 top occupations in the United States to have the largest number of new jobs. Many areas of the country are suffering from severe nursing shortages and the problem is expected to get worse as baby boomers age. It is estimated that if current trends continue, demand for nurses will out-weigh their supply by the year 2010. It is projected that by 2015, some 114,000 jobs for full-time equivalent RNs will go unfilled in the United States. In sum, nurses will be able to pick and choose the paths of their careers. It is expected that job growth in nursing will be faster than average, largely because of technical advances in patient care. These advances will diagnose disease earlier and improve upon current treatments. With the median age of nurses over 40, many nurses will be retiring. Many of the
While hospitals will continue to need a tremendous number of nurses, hospitals are expected to grow more slowly than other health care environments. This is because the number of inpatients is expected to remain somewhat steady; patients are being released earlier and more procedures are being done outside hospitals. Nurses will find more opportunity in the hospital's specialty areas, including outpatients services, such as chemotherapy and rehabilitation. Home health employment for nursing will probably grow rapidly. A growing number of elderly who need nursing care but do not want to leave their homes will stimulate the expansion of this area of nursing. Nurses who are able to perform complex procedures in the home will be at the forefront of those able to take advantage of the home health opportunity. Nurses who want to work in nursing homes will find much faster than average growth in opportunities due to the growing number of people who are too old to live on their own.
American Association of Colleges of Nursing. 202-463-6980. <http://www.aacn.nche.edu>.
American Nurses Association. 600 Maryland Avenue, SW, Suite 100 West. Washington, DC 20024. 202-651-7000. <http://www.nursingworld.org>.
Occupational Outlook Handbook. U.S. Department of Labor, Bureau of Labor Statistics. Division of Information Services. 2 Massachusetts Ave., NE., Room 2860. Washington, D.C. 20212. (202) 691-5200.<http://stats.bls.gov>.