Registered nurses (R.N.'s) care for the sick and injured and help people stay well. They are typically concerned with the whole person, providing for the physical, mental, and emotional needs of their patients. They observe, assess, and record symptoms, reactions, and progress; assist physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation. R.N.'s also develop and manage nursing care plans; instruct patients and their families in proper care; and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks R.N.'s may perform, it is usually the work setting which determines day-to-day job duties.
Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out the medical regimen prescribed by physicians. They may also supervise licensed practical nurses and aides. Hospital nurses usually are assigned to one area such as surgery, maternity, pediatrics, emergency room, intensive care, or treatment of cancer patients or may rotate among departments.
Nursing home nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease. Although they generally spend most of their time on administrative and supervisory tasks, R.N.'s also assess residents' medical condition, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform difficult procedures such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitaion for stroke and head-injury patients.
Public health nurses work in government and private agencies and clinics, schools, retirement communities and other community settings. They instruct individuals and families and other groups in health education, disease prevention, nutrition, child care, and home care of the sick or disabled. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community leaders, teachers, parents, and physicians in community health education. Some work in home health care, providing periodic services prescribed by a physician and instructing patients and families.
Private duty nurses care for patients needing constant attention. They work directly for families on a contract basis or for a nursing or temporary help agency which assigns them to patients. They provide services in homes, hospitals, nursing homes, and rehabilitation centers.
Office nurses assist physicians in private practice, clinics, surgicenters, emergency medical centers, and health maintenance organizations (HMO's). They prepare patients for and assist with examinations, administer injections and medications, dress wounds and incisions, assist with minor surgery, and maintain records. Some also perform routine laboratory and office work.
Occupational health or industrial nurses provide nursing care at worksites, to employees, customers, and others with minor injuries and illnesses. They provide emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, assist with health examinations and inoculations, and work on accident prevention programs.
Head nurses or nurse supervisors direct nursing activities. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to insure that care is proper. They may also insure that records are maintained and that equipment and supplies are ordered.
Advancement opportunities are broader for nurses with a B.S.N.
Most nurses work in well-lighted, comfortable medical facilities. Public health nurses travel to patients' homes and to schools, community centers, and other sites. Nurses may spend considerable time walking and standing. They need emotional stability to cope with human suffering, emergencies, and other stresses. Because patients in hospitals and nursing homes require 24-hour care, nurses in these institutions may work nights, weekends, and holidays. Office, occupational health, and public health nurses are more likely to work regular business hours.
Nursing has its hazards, especially in hospitals and clinics where nurses may care for individuals with infectious diseases such as hepatitis and AIDS. Nurses must observe rigid guidelines to guard against these and other dangers such as radiation, chemicals used for sterilization of instruments, and anesthetics. In addition, nurses face back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases.
Registered nurses held about 1,835,000 jobs in 1992. About 2 out of 3 jobs were in hospitals. Others were in offices and clinics of physicians, nursing homes, home health care agencies, temporary help agencies, schools, and government agencies. About one-fourth of all R.N.'s worked part time.
To obtain a nursing license, all States require graduation from an accredited nursing school and passing a national licensing examination. Nurses may be licensed in more than one State, either by examination or endorsement of a license issued by another State. Licenses must be periodically renewed, and continuing education is a requirement for renewal in some States.
In 1991, there were 1,470 entry level R.N. programs. There are three major educational paths to nursing: Associate degree (A.D.N.), diploma, and bachelor of science degree in nursing (B.S.N.). A.D.N. programs, offered by community and junior colleges, take about 2 years. More than 60 percent of graduates in 1991 were from A.D.N. programs. B.S.N. programs, offered by colleges and universities, take 4 or 5 years. More than 30 percent of graduates in 1991 were from these programs. Diploma programs, given in hospitals, last 2 to 3 years. A small and declining number of graduates come from these programs. Generally, licensed graduates of any of the three program types qualify for entry level positions as staff nurses.
There have been attempts to raise the educational requirements for an R.N. license to a bachelor's degree and, possibly, create new job titles. However, such proposals have been around for years. These changes, should they occur, will be made State by State, through legislation or regulation. Changes in licensure requirements would not affect currently licensed R.N.'s, who would be grandfathered in, no matter what their educational preparation. However, individuals considering nursing should carefully weigh the pros and cons of enrolling in a B.S.N. program, since advancement opportunities are broader for those with a B.S.N. In fact, some career paths are open only to nurses with bachelor's or advanced degrees.
While A.D.N. or diploma preparation is enough for a nursing home nurse to advance to director of nursing, a bachelor's degree is generally necessary for administrative positions in hospitals and for positions in community nursing. Moreover, the B.S.N. is a prerequisite for admission to graduate nursing programs. So individuals considering positions requiring graduate training, such as research, consulting, teaching, or clinical specializations should enroll in a B.S.N. program.
A growing number of A.D.N. and diploma-trained nurses are entering bachelor's programs to prepare for a broader scope of nursing practice. They can often find a hospital position and then take advantage of tuition reimbursement programs to get a B.S.N.
Nursing education includes classroom instruction and supervised training in hospitals and other health facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing.
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include courses in gerontological nursing and clinical practice in nursing homes. Some provide clinical training in public health departments and home health agencies.
Nurses should be caring and sympathetic. They must be able to accept responsibility, direct or supervise others, follow orders precisely, and determine when consultation is required.
Experience and good performance can lead to promotion to increasingly more responsible positions. Nurses can advance, in management, to assistant head nurse or head nurse. From there, they can advance to assistant director, director, and vice president positions. Increasingly, management level nursing positions require a graduate degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs preparing executive level nurses usually last 1 to 2 years.
Within patient care, nurses can advance to clinical nurse specialist, nurse practitioner, nurse midwife, or nurse anesthetist. These positions require 1 or 2 years of graduate education, leading to a certificate or master's degree.
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 health, and chronic care services. Some are employed by health care corporations in health planning and development, marketing, and quality assurance.
Job prospects in nursing are good. Although employers in some parts of the country reported shortages of R.N.'s in the past, large wage increases have attracted more people to nursing and dampened demand. However, R.N. recruitment has long been a problem in rural areas, in some big city hospitals, and in specialty areas including intensive care, rehabilitation, geriatrics, and long-term care.
Employment of registered nurses is expected to grow much faster than the average for all occupations through the year 2005. Driving this growth will be technological advances in patient care, which permit a greater number of medical problems to be treated, and increasing emphasis on primary care. The number of older people, who are much more likely than younger people to need medical care, is projected to grow very rapidly. Many job openings also will result from the need to replace experienced nurses who leave the occupation, especially as the average age of the registered nurse population continues to rise.
Employment in hospitals, the largest sector, is expected to grow more slowly than in other health-care sectors. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain overnight) is not likely to increase much. Also, patients are being released earlier and more procedures are being done on an outpatient basis, both in and outside hospitals. Most rapid growth is expected in hospitals' outpatient facilities.
Employment in physicians' offices and clinics, including HMO's, ambulatory surgicenters, and emergency medical centers is expected to grow very rapidly as health care in general expands. In addition, an increasing proportion of sophisticated procedures, which once were performed only in hospitals, are being performed here, thanks largely to advances in technology.
Employment in home health care is also expected to grow very rapidly. This is in response to a growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances which make it possible to bring increasingly complex treatments into the home.
Employment in nursing homes is expected to grow very fast due to increases in the number of people in their eighties and nineties, many of whom will require long-term care. In addition, the financial pressure on hospitals to release patients as soon as possible should produce more nursing home admissions. Growth in units to provide specialized long-term rehabilitation for stroke and head injury patients or to treat Alzheimer's victims will also increase employment.
Median annual earnings of full-time salaried registered nurses were $34,424 in 1992. The middle 50 percent earned between $27,820 and $41,600. The lowest 10 percent earned less than $21,944; the top 10 percent, more than $50,960.
According to a University of Texas Medical Branch survey of hospitals and medical centers, the median annual salary of staff nurses, based on a 40 hour week and excluding shift or area differentials, was $33,278 in October 1992. The average minimum salary was $27,476 and the average maximum was $41,563. For head nurses, the median was $47,335; clinical nurse specialists, $44,845; professional nurse practitioners, $43,680; and nurse anesthetists, $66,622.
According to the Buck Survey conducted by the American Health Care Association, staff R.N.'s in chain nursing homes had median annual earnings of approximately $30,200 in January, 1993. The middle 50 percent earned between $27,200 and $33,400 a year.
Many employers are offering flexible work schedules, child care, educational benefits, bonuses, and other incentives.
Workers in other occupations with responsibilities and duties related to those of registered nurses are occupational therapists, paramedics, physical therapists, physician assistants, and respiratory therapists.
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Reprinted with Permission of U. S. Department of Labor