Nursing is a career filled with endless personal and professional rewards. If you choose nursing, you are choosing to spend your life helping others, using skills that blend scientific knowledge with compassion and caring. There are few professions that offer such a rewarding combination of high tech and high touch.
- Registered nurses constitute the largest health care occupation, with 2.5 million jobs.
- About 59 percent of jobs are in hospitals.
- Registered nurses are projected to generate about 587,000 new jobs over the 2006-16 period, one of the largest numbers among all occupations; overall job opportunities are expected to be excellent, but may vary by employment setting.
What is Nursing?
Nursing is a blend of science and technology with the art of caring and compassion. Nursing professionals provide preventative and restorative health care to patients in a variety of settings. Every day on the job nurses use the science they learned in nursing school, and when employed, they take continuing education courses on a regular basis to keep up with the latest in the medical and nursing sciences. Nurses work to promote health, prevent disease, and help patients cope with illnesses. Nursing is a science that requires in-depth knowledge, skills and understanding. Nursing deals not only with a person's biological needs, but their psychosocial and cultural needs as well. Nurses work closely with doctors and other health care professionals, and serve as the advocates for patients and families.
What Do Nurses Do?
Overall, nurses can assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. They also administer nursing care to ill, injured, convalescent, or disabled patients and may advise patients on health maintenance and disease prevention or provide case management.
Nurses care for patients in the following ways:
- Nurses help bring babies into the world, and they take care of new moms before and after childbirth.
- Nurses help sick and injured people get better, and they help healthy people stay healthy.
- Nurses perform physical examinations.
- Nurses give medications and treatments ordered by doctors.
- Nurses are concerned with the emotional, social, and spiritual conditions of their patients.
- Nurses teach and counsel patients, as well as family members, and explain what they can expect during the recovery process.
- Nurses provide health care teaching and counseling in the community.
- Nurses observe, assess, evaluate, and record patients' conditions and progress, and they communicate patient condition information to doctors and other members of the health care team.
- Nurses help patients and families determine the best mix of health and social services - hospice, home care, rehabilitation, physical therapy, and others.
- Nurses design and complete quality assurance activities to ensure appropriate nursing care.
- Nurses help terminally ill patients die with dignity, and they help family members deal with dying and death.
Nursing Opportunities in Hospitals
Where do nurses work in hospitals? Practically everywhere! They work in:
- Patient care units at the bedside
- Operating rooms, trauma centers, and emergency rooms
- Medical records or other hospital offices
- X-ray and other diagnostic units
- Intensive care units
- Surgical and recovery units
- Same-day surgery centers
- Pediatrics, caring for children
- Hospital nurseries or neonatal intensive care units, caring for newborns
- Obstetrics, helping new moms give birth
- Psychiatric and drug treatment centers
- Helicopters and ambulances, caring for patients in transport to hospitals
- And in many other places!
Will Nursing Be a Fit For Me?
- Maintain accurate, detailed reports and records.
- Monitor, record and report symptoms and changes in patients' conditions.
- Record patients' medical information and vital signs.
- Modify patient treatment plans as indicated by patients' responses and conditions.
- Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.
- Order, interpret, and evaluate diagnostic tests to identify and assess patient's condition.
- Monitor all aspects of patient care, including diet and physical activity.
- Direct and supervise less skilled nursing or health care personnel or supervise a particular unit.
- Prepare patients for, and assist with, examinations and treatments.
- Observe nurses and visit patients to ensure proper nursing care.
Tools and Technology
Tools used in this occupation:
- Acute care fetal or maternal monitoring units or accessories — Bilimeters; Fetal monitors; Fetal scalp electrodes
- Floor grade forceps or hemostats — Curved hemostats; Hemostats; Straight hemostats
- Medical oxygen masks or parts — Non-rebreather masks; Partial masks; Ventimasks
- Peripheral intravenous catheters for general use — Peripheral angiocaths; Peripheral butterflys; Single,double,triple lumen catheters
- Suction kits — Nasal suctioning equipment; Oral suctioning equipment; Tracheal suctioning equipment
Technology used in this occupation:
- Calendar and scheduling software — Per-Se Technologies ORSOS One-Call
- Medical software — Electronic medical record EMR software; Misys Healthcare Systems software; QuadraMed Affinity Healthcare Information System; Siemens SIENET Sky
- Office suite software — Microsoft Office
- Spreadsheet software — Microsoft Excel
- Time accounting software — Kronos Workforce Timekeeper
- Medicine and Dentistry — Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Psychology — Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
- Customer and Personal Service — Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Biology — Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
- Therapy and Counseling — Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
- Mathematics — Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
- Education and Training — Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
- Sociology and Anthropology — Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.
Nurses must be able to accept responsibility, direct or supervise others, follow orders precisely, and determine when consultation is necessary. As nurses are advocates for patients, families and communities, they should be caring and sympathetic.
- Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Reading Comprehension — Understanding written sentences and paragraphs in work related documents.
- Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Instructing — Teaching others how to do something.
- Speaking — Talking to others to convey information effectively.
- Time Management — Managing one's own time and the time of others.
- Service Orientation — Actively looking for ways to help people.
- Monitoring — Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
- Social Perceptiveness — Being aware of others' reactions and understanding why they react as they do.
- Writing — Communicating effectively in writing as appropriate for the needs of the audience.
- Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
- Oral Expression — The ability to communicate information and ideas in speaking so others will understand.
- Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
- Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences.
- Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense.
- Speech Clarity — The ability to speak clearly so others can understand you.
- Speech Recognition — The ability to identify and understand the speech of another person.
- Written Expression — The ability to communicate information and ideas in writing so others will understand.
- Written Comprehension — The ability to read and understand information and ideas presented in writing.
- Near Vision — The ability to see details at close range (within a few feet of the observer).
Interest code: SI
Social — Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Investigative — Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Realistic — Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
- Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations.
- Integrity — Job requires being honest and ethical.
- Self Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
- Concern for Others — Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
- Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
- Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace.
- Attention to Detail — Job requires being careful about detail and thorough in completing work tasks.
- Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high stress situations.
- Initiative — Job requires a willingness to take on responsibilities and challenges.
- Independence — Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
- Achievement — Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
- Relationships — Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
Specific Work Activities
- Assisting and Caring for Others — Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.
- Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
- Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
- Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
- Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
- Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
- Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
- Performing for or Working Directly with the Public — Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.
- Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
Wage and Employment Trends
Median annual earnings of registered nurses were ,280 in May 2006. The middle 50 percent earned between ,710 and ,850. The lowest 10 percent earned less than ,250, and the highest 10 percent earned more than ,440. Median annual earnings in the industries employing the largest numbers of registered nurses in May 2006 were:Employment services ,260 General medical and surgical hospitals ,550 Home health care services ,190 Offices of physicians ,800 Nursing care facilities ,490
Many employers offer flexible work schedules, child care, educational benefits, and bonuses.
National estimates for this occupation
Employment estimate and mean wage estimates for this occupation:2,417,150 0.5 % .71 ,730 0.2 %
Percentile wage estimates for this occupation:Hourly Wage .35 .94 .54 .58 .11 Annual Wage ,250 ,710 ,280 ,850 ,440
Employment of registered nurses is expected to grow faster than average
Areas of Specialty
There are many areas open to nursing graduates, including the traditional hospital nurse who may work in pediatrics, maternity, the operating room, medical/surgical units, critical care, trauma, or the ER. Also found in hospitals are nursing educators, quality assurance nurses, nurse managers, nurse epidemiologists, and nursing supervisors. At the masters degree level the various specialties available to graduates include: nursing administration, certified nurse-midwifery, clinical specialist, nurse anesthetist, and nurse practitioner (most of the clinicians in our Women's Health Clinic in Student Health Services are nurse practitioners). Nurses holding doctoral degrees often take positions in research or academic settings.
RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs can choose a particular work setting or type of treatment, such as perioperative nurses, who work in operating rooms and assist surgeons. RNs also may choose to specialize in specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs also can choose to work with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer.
There are many options for RNs who specialize in a work setting or type of treatment:
- Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing, the Internet, or by telephone. Critical care nurses provide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units.
- Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions.
- Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility.
- Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients’ mental and spiritual health in addition to their physical health.
- Home health care nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing facility.
- Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins.
- Long- term care nurses provide health care services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities.
- Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses.
- Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety standards.
- Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure.
- Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery.
- Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses.
- Rehabilitation nurses care for patients with temporary and permanent disabilities. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.
RNs specializing in a particular disease, ailment, or health care condition are employed in virtually all work settings, including physicians’ offices, outpatient treatment facilities, home health care agencies, and hospitals:
- Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions.
- Intellectual and developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speaking or other communication.
- Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections.
- Genetics nurses provide early detection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington’s disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS.
- Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring.
- Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence.
RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics, and outpatient care facilities:
- Cardiovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis.
- Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue.
- Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer, and sexually transmitted diseases.
- Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or substance abuse.
- Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures.
- Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery.
- Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy.
- Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders.
- Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis.
- Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers.
RNs who specialize by population provide preventive and acute care in all health care settings to the segment of the population in which they specialize, including newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). RNs also may provide basic health care to patients outside of health care settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and abroad providing care to patients in areas with shortages of health care workers.
Most RNs work as staff nurses as members of a team providing critical health care. However, some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on the provision of primary care services:
- Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health.
- Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management.
- Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care.
- Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and health care services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.
- Some nurses have jobs that require little or no direct patient care, but still require an active RN license.
- Case managers ensure that all of the medical needs of patients with severe injuries and severe or chronic illnesses are met.
- Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident.
- Infection control nurses identify, track, and control infectious outbreaks in health care facilities and develop programs for outbreak prevention and response to biological terrorism.
- Legal nurse consultants assist lawyers in medical cases by interviewing patients and witnesses, organizing medical records, determining damages and costs, locating evidence, and educating lawyers about medical issues.
- Nurse administrators supervise nursing staff, establish work schedules and budgets, maintain medical supply inventories, and manage resources to ensure high-quality care.
- Nurse educators plan, develop, implement, and evaluate educational programs and curricula for the professional development of student nurses and RNs.
- Nurse informaticists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses, and other health care providers. RNs also may work as health care consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors.
Licensure and Certification
In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination or by the endorsement of a license issued by another State. The Nurse Licensure Compact Agreement allows a nurse who is licensed and permanently resides in one of the member States to practice in the other member States without obtaining additional licensure. In 2006, 20 states were members of the Compact, while 2 more were pending membership. All States require periodic renewal of licenses, which may require continuing education.
Certification is common, and sometimes required, for the four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Upon completion of their educational programs, most advanced practice nurses become nationally certified in their area of specialty. Certification also is available in specialty areas for all nurses. In some States, certification in a specialty is required in order to practice that specialty.
Foreign-educated and foreign-born nurses wishing to work in the United States must obtain a work visa. To obtain the visa, nurses must undergo a federal screening program to ensure that their education and licensure are comparable to that of a U.S. educated nurse, that they have proficiency in written and spoken English, and that they have passed either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination or the NCLEX-RN. CGFNS administers the VisaScreen Program. (The Commission is an immigration-neutral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Nurses educated in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom, or foreign-born nurses who were educated in the United States, are exempt from the language proficiency testing. In addition to these national requirements, foreign-born nurses must obtain state licensure in order to practice in the United States. Each State has its own requirements for licensure.
Degree Options and Compensation
There are several levels of career choices including: the Licensed Vocational Nurse (L.V.N.), Registered Nurse (R.N.), and advance practice nurses who generally have a masters degree and/or a doctoral degree in nursing. The demand for nurses is overwhelming and the salaries are increasing accordingly. A bachelors degree in nursing (B.S.N.) is strongly recommended over the two year nursing program (L.V.N.). While both may lead to licensure as an R.N., a B.S.N. affords the opportunity to continue the nurse's education to the masters, Ph.D., or D.N.Sc (Doctor of Nursing Science) levels, whereas the L.V.N. is a terminal degree. Salaries for nurses with bachelors’ degrees range from around ,500 to ,000, varying greatly with geographical region. In administration, salaries range from ,000 to ,000. Generally, the more education a nurse has the greater pay and the greater number of options s/he will have.
Changes in health care trends, as well as an aging RN workforce—the average age is 44—are increasing the demand for more nurses in the workforce than ever before. These changes in health care trends are also making it even more important for nurses to be educated at the minimum level of baccalaureate degree. An article published by the American Association of Colleges of Nursing in February 1998 addresses this importance with their statement, "Unlike associate-degree and diploma graduates who are prepared primarily for hospital and nursing home practice, BSN nurses have broad education in the physical and behavioral sciences, management concepts, and community health and have the flexibility to practice across a range of settings...critical thinking and leadership skills give BSN nurses an edge..."
Workers in other health care fields with responsibilities related to those of nursing include occupational therapists, emergency medical technicians, physical therapists, physician assistants, and respiratory therapists.
Sources of Additional Information
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