Registered Nurse Health Article

Work settings

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.