Registered Nurses Overview
There are three common educational paths for registered nursing, which are a diploma, associate degree, or bachelors degree from an approved nursing program, though advanced practice nurses, such as nurses anesthetists, nurse practitioners, nurse-midwives and clinical nurse specialists are required to have a masters degree. There are 2.6 million jobs for registered nurses, making them the largest healthcare occupation. Close to 60 percent of registered nursing jobs are in hospitals. Job opportunities are expected to vary by employment and geographic setting, but overall job opportunities are expected to be excellent.
Nature of the Work for Registered Nurses
Registered nurses (RNs) work to treat and educate patients and the public about various medical conditions, as well as provide advice and emotional support to patients’ family members. They help perform diagnostic tests and analyze results, record patients’ medical histories and symptoms, administer treatment and medications, operate medical machinery and help out with patient follow-up and rehabilitation.
Registered nurses explain post-treatment home care needs, teach patients and their families how to manage their illnesses, conduct diet, nutrition and exercise programs and self administration of medication and physical therapy. Registered nurses might run general public health screenings, public seminars, blood drives or immunization clinics. Some work to promote general health by educating the public on symptoms of disease.
Registered nurses either establish a new care plan or contribute to existing plans, including starting, maintaining and discontinuing intravenous (IV) lines, administering therapies and treatments, careful checking of medication dosages, observing the patient and recording those observations, and consulting with physicians and other healthcare clinicians. In some cases, registered nurses will supervise nursing aides and licensed practical nurses regarding patient care. They may perform therapeutic and diagnostic procedures if they have advanced educational preparation and training.
Responsibilities of a registered nurse vary from with each position. Work title and duties are usually decided based on the patient population served or work setting. They may specialize in four ways: work in a particular type of treatment or setting, concentrate in certain health conditions, work with one or more organs or body system types, as well as focusing on a well-defined population. In some cases, registered nurses combine specialties.
A registered nurse who specializes in a work setting or type of treatment has many career options available to them. For example, ambulatory care nurses treat patients and administer preventative care to patients with a variety of illnesses and injuries in a clinic or physicians office. Emergency nurses are employed in hospital or stand-alone emergency departments to provide care and initial assessments to patients with life threatening conditions. Besides treating a patient’s physical health, holistic nurses treat patients mental and spiritual health through massage, acupuncture and aromatherapy. A home healthcare nurse works with patients who have recently been discharged from a hospital or long-term care, skilled nursing facility, or rehabilitation.
Registered nurses who specialize in a particular ailment, disease or other condition may be employed in basically all work settings. For example, intellectual and developmental disabilities nurses care for patients with mental, physical or behavioral disabilities. Genetics nurses provide counseling and treatment of patients with genetic disorders as well as administer early detection screenings. Oncology nurses work with cancer patients and may assist in providing chemotherapy and radiation treatments.
Typically, a registered nurse who focuses in a treatment of a particular organ or body system is employed in specialty clinics, critical care units and outpatient facilities. For example, dermatology nurses provide care to those with disorders of the skin. Cardiovascular nurses care for patients who had heart surgery or coronary heart disease. Gynecology nurses treat women with disorders of the reproductive system. Orthopedic nurses treat patients with skeletal or muscular problems.
RNs who specialize by population provide preventive and acute care in all healthcare 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 healthcare to patients outside of healthcare settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and throughout the world providing care to patients in areas with shortages of healthcare workers.
Registered nurses may choose to become advanced practice nurses who may provide primary care services in addition to working independently or in collaboration with physicians. They may also prescribe medication to patients in all States. For example, nurse anesthetists offer anesthesia and related care prior to and after surgical, diagnostic and therapeutic procedures. Nurse-midwives offer preliminary care services to women. A nurse practitioner works as a primary or specialty care provider in adult practices, family practices, pediatrics, women’s heath and geriatrics.
Many registered nurses are employed in comfortable, well-lit healthcare facilities. However, public and home health nurses travel to schools, patients’ homes, community centers, schools and other sites. Registered nurses who work in nursing care facilities or hospitals may work weekends, nights and holidays and also may be on call, while nurses who work in schools, offices or other settings that do not require 24-hour care usually work regular business hours.
Training, Other Qualifications and Advancement for Registered Nurses
A nurse may choose to obtain a bachelors of science degree in nursing (BSN), an associate degree in nursing (ADN) or a diploma. ADN programs usually take about two years to complete and are typically offered by junior or community colleges, while BSN programs last about four years and are offered at colleges and universities. A diploma program is provided by hospitals and typically last three years. Requirements for most entry-level staff nursing positions include a license and graduation from any of the three types of educational programs. There are many more ADN or BSN programs than there are diploma programs. Registered nurses who receive their BN, as opposed to a diploma or ADN, have better chances for advancement, so those considering a career in nursing should think carefully about the advantages and disadvantages of joining each program. BSN holders receive a greater amount of training in leadership, critical thinking and communication, which are all important aspects of the nursing practice. They also offer more clinical experience in settings outside of a hospital. ADN holders may choose to go back to school after they obtain an entry-level position in order to take advantage of tuition reimbursement. Most administrative, research, teaching and consulting positions require a bachelors degree or higher. An accelerated masters degree program usually takes three to four years to complete and grants students with both a BSN and MSN.
Accelerated BSN programs are reserved for aspiring nurses who have a bachelors degree in another field. They usually last 12 to 18 months. Accelerated MSN programs are reserved for those who have a bachelors degree or higher in another field.
Nursing students take a combination of academic classes in the sciences in combination with supervised clinical experience provided by hospital departments in psychiatry, maternity, pediatrics and surgery.
All States and US territories require that registered nursing students graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN) in order to obtain licensure. There may be other eligibility requirements varying by State. Continuing education is usually required to maintain licensure, as technological and medical advances are constantly occurring.
Registered nurses need to be able to supervise others, determine when consultation is required and be able to correctly assess patients’ conditions. Emotional stability, compassion, and caring attributes are also important, as they often have to deal with many stresses including emergencies and human suffering.
Registered nurses may choose to become credentialed in specialties such as informatics, gerontology, pediatrics, ambulatory care and many others. Although credentialing is voluntary, employers prefer it. Nurses may obtain credentials from the American Nursing Credentialing Center, the National league for Nursing, and other organizations.
As registered nurses gain experience as a staff nurse in hospitals, they are promoted to positions with more responsibilities. Management level positions usually require registered nurses with advanced degrees in nursing or health services administration.
Other registered nurses may move on to become advanced practice nurses who mainly work in primary care services independently or under supervision of physicians. There are four specializations for advanced practice nurses: nurse anesthetics, clinical nurse specialists, and nurse-midwives. At least a masters degree is required for all four types of advanced practice nurses. The authority for advanced practice nurses to prescribe medicine varies by State.
Another common advancement for registered nurses is to move into healthcare management because they have expertise that they can translate to managing acute, home-based, ambulatory or chronic care facilities. Registered nurses are needed for development and health planning, consulting, marketing, quality assurance, policy development. Some nurses become employed in a college, university or research facility.
Employment and Job Outlook for Registered Nurses
Registered nurses hold about 2.6 million jobs and make up the largest healthcare occupation. Most registered nurses, about 60 percent, are employed in hospitals. Offices of physicians employ close to 8 percent of jobs, home healthcare services employ 5 percent, another 5 percent in nursing care facilities and 3 percent in employment services. The rest worked in social assistance agencies, government agencies and educational services.
Registered nurses should expect an employment growth of 22 percent in the next decade, which is faster than average for all occupations. Technological advances in patient care and an increased importance places on preventative care will drive job growth for registered nurses. As the number of older people who will need nursing care continues to increase, so will the demand for registered nurses. Despite these projections, employment of registered nurses will grow at varying rates, depending on the industry.
In hospitals, employment growth is supposed to move slowly. Although the intensity of care is likely to increase, causing the need for more nurses per patient, the number of patients who stay in the hospital for more than 24 hours will stay similar. However, in hospital outpatient facilities should expect a rapid growth.
The number of sophisticated procedures that were only being performed in hospitals are now being performed in physician’s offices and emergency centers, causing employment growth as general healthcare expands.
Registered nurses in nursing care facilities should see an employment growth because of the large amount of baby boomers who are aging and will require long-term care. More admission to residential and nursing care facilities will also cause job growth. Registered nurses should also expect employment growth in specialized long-term rehabilitation centers such as for head injury and stroke patients.
Home healthcare employment is also expected to increase due to the growing number of older persons with functional disabilities, technological advances and the patient’s preference to live at home. Registered nurses who work in home healthcare will be required to perform complex procedures.
The number of qualified applicants is less than the number of job openings, and so employers are reporting having difficulty filling certain registered nursing positions. Also, there is a shortage of nursing teachers, which is expected to increase as older faculty begin to retire. Although employment growth is projected to be slower in hospitals, registered nurses should expect excellent job opportunities because of the high turnover rate of hospital nurses. In order to reverse this statistic, some hospitals offer family-friendly working schedules, signing bonuses or subsidized training. Registered nurses should expect greater competition for positions in physician’s offices and outpatient care centers because they offer a more comfortable working environment and regular working hours. Those who receive a bachelors degree or higher typically have better job prospects than those who have lower than a bachelors degree. Advanced practice nurses will all be in strong demand, especially in rural areas and inner cities. Sometimes registered nurses are employed as lower-cost primary care providers.
Earnings and Salary for Registered Nurses
Registered nurses have a median annual wage of $63,750. The highest 10 percent earn more than $93,700, while the lowest 10 percent earn less than $43,970. The middle 50 percent earn between $52,520 and $77,970. The median annual wages of top employing industries for registered nurses are:
Employment services: $68,160
General medical and surgical hospitals: $63,880
Offices of physicians: $59,210
Home healthcare services: $58,740
Nursing care facilities: $57,060
Approximately 21 percent of registered nurses are covered by a union contract or are union members. A registered nursing employer may offer child care, educational benefits, bonuses and flexible work schedules.