Nurse
Nature of the work
Registered nurses (RNs), regardless of specialty or work setting, treat
patients, educate patients and the public about various medical conditions,
and provide advice and emotional support to patients’ family members. RNs
record patients’ medical histories and symptoms, help perform diagnostic tests
and analyze results, operate medical machinery, administer treatment and
medications, and help with patient follow-up and rehabilitation.
RNs teach patients and their families how to manage their illness or
injury, explaining post-treatment home care needs; diet, nutrition, and
exercise programs; and self-administration of medication and physical therapy.
Some RNs work to promote general health by educating the public on warning
signs and symptoms of disease. RNs also might run general health screening or
immunization clinics, blood drives, and public seminars on various conditions.
Work Environment
Most RNs work in well-lighted, comfortable health care facilities. Home
health and public health nurses travel to patients’ homes, schools, community
centers, and other sites. RNs may spend considerable time walking, bending,
stretching, and standing. Patients in hospitals and nursing care facilities
require 24-hour care; consequently, nurses in these institutions may work
nights, weekends, and holidays. RNs also may be on call—available to work on
short notice. Nurses who work in offices, schools, and other settings that do
not provide 24-hour care are more likely to work regular business hours. About
21 percent of RNs worked part time in 2006, and 7 percent held more than one
job.
Nursing h
as its hazards, especially in hospitals, nursing care facilities,
and clinics, where
nurses may be in close contact with individuals who have infectious diseases
and with toxic, harmful, or potentially hazardous compounds, solutions, and
medications. RNs must observe rigid, standardized guidelines to guard against
disease and other dangers, such as those posed by radiation, accidental needle
sticks, chemicals used to sterilize instruments, and anesthetics. In addition,
they are vulnerable to back injury when moving patients, shocks from
electrical equipment, and hazards posed by compressed gases. RNs also may
suffer emotional strain from caring for patients suffering unrelieved intense
pain, close personal contact with patients’ families, the need to make
critical decisions, and ethical dilemmas and concerns.
Training, Other Qualifications, and Advancement
The three major educational paths to registered nursing are a bachelor’s
degree, an associate degree, and a diploma from an approved nursing program.
Nurses most commonly enter the occupation by completing an associate degree or
bachelor’s degree program. Individuals then must complete a national licensing
examination in order to obtain a nursing license. Further training or
education can qualify nurses to work in specialty areas, and may help improve
advancement opportunities
Education and training
There are three major educational paths to registered nursing—a bachelor’s
of science degree in nursing (BSN), an associate degree in nursing (ADN), and
a diploma. BSN programs, offered by colleges and universities, take about 4
years to complete. In 2006, 709 nursing programs offered degrees at the
bachelor’s level. ADN programs, offered by community and junior colleges, take
about 2 to 3 years to complete. About 850 RN programs granted associate
degrees. Diploma programs, administered in hospitals, last about 3 years. Only
about 70 programs offered diplomas. Generally, licensed graduates of any of
the three types of educational programs qualify for entry-level positions.
Many RNs with an ADN or diploma later enter bachelor’s programs to prepare
for a broader scope of nursing practice. Often, they can find an entry-level
position and then take advantage of tuition reimbursement benefits to work
toward a BSN by completing an RN-to-BSN program. In 2006, there were 629
RN-to-BSN programs in the United States. Accelerated master’s degree in
nursing (MSN) programs also are available by combining 1 year of an
accelerated BSN program with 2 years of graduate study. In 2006, there were
149 RN-to-MSN programs.
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.
Other qualifications
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.
Advancement
Some RNs start their careers as licensed practical nurses or nursing aides,
and then go back to school to receive their RN degree. Most RNs begin as staff
nurses in hospitals, and with experience and good performance often move to
other settings or are promoted to more responsible positions. In management,
nurses can advance from assistant unit manger or head nurse to more
senior-level administrative roles of assistant director, director, vice
president, or chief nurse. Increasingly, management-level nursing positions
require a graduate or an advanced degree in nursing or health services
administration. Administrative positions require leadership, communication and
negotiation skills, and good judgment.
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-based, and chronic care. Employers—including
hospitals, insurance companies, pharmaceutical manufacturers, and managed care
organizations, among others—need RNs for health planning and development,
marketing, consulting, policy development, and quality assurance. Other nurses
work as college and university faculty or conduct research.
Employment
As the largest health care occupation, registered nurses held about 2.5
million jobs in 2006. Hospitals employed the majority of RNs, with 59 percent
of jobs. Other industries also employed large shares of workers. About 8
percent of jobs were in offices of physicians, 5 percent in home health care
services, 5 percent in nursing care facilities, 4 percent in employment
services, and 3 percent in outpatient care centers. The remainder worked
mostly in government agencies, social assistance agencies, and educational
services. About 21 percent of RNs worked part time.
Job Outlook
Overal
l
job opportunities for registered nurses are expected to be excellent, but may
vary by employment and geographic setting. Employment of RNs is expected to
grow much faster than the average for all occupations through 2016 and,
because the occupation is very large, many new jobs will result. In fact,
registered nurses are projected to generate 587,000 new jobs, among the
largest number of new jobs for any occupation. Additionally, hundreds of
thousands of job openings will result from the need to replace experienced
nurses who leave the occupation.
Employment change
Employment of registered nurses is expected to grow 23 percent from 2006 to
2016, much faster than the average for all occupations. Growth will be driven
by technological advances in patient care, which permit a greater number of
health problems to be treated, and by an increasing emphasis on preventive
care. In addition, the number of older people, who are much more likely than
younger people to need nursing care, is projected to grow rapidly.
However, employment of RNs will not grow at the same rate in every
industry. The projected growth rates for RNs in the industries with the
highest employment of these workers are:
Offices of physicians
39%
Home health care services
39%
Outpatient care centers
34%
Employment services
27%
General medical and surgical hospitals 22%
Nursing care facilities
20%
Job prospects
Overall job opportunities are expected to be
excellent for registered
nurses. Employers in some parts of the country and in certain employment
settings report difficulty in attracting and retaining an adequate number of
RNs, primarily because of an aging RN workforce and a lack of younger workers
to fill positions. Enrollments in nursing programs at all levels have
increased more rapidly in the past few years as students seek jobs with stable
employment. However, many qualified applicants are being turned away because
of a shortage of nursing faculty. The need for nursing faculty will only
increase as many instructors near retirement. Many employers also are relying
on foreign-educated nurses to fill vacant positions.
Even though overall employment opportunities for all nursing specialties
are expected to be excellent, they can vary by employment setting. Despite the
slower employment growth in hospitals, job opportunities should still be
excellent because of the relatively high turnover of hospital nurses. RNs
working in hospitals frequently work overtime and night and weekend shifts and
also treat seriously ill and injured patients, all of which can contribute to
stress and burnout. Hospital departments in which these working conditions
occur most frequently—critical care units, emergency departments, and
operating rooms—generally will have more job openings than other departments.
To attract and retain qualified nurses, hospitals may offer signing bonuses,
family-friendly work schedules, or subsidized training. A growing number of
hospitals also are experimenting with online bidding to fill open shifts, in
which nurses can volunteer to fill open shifts at premium wages. This can
decrease the amount of mandatory overtime that nurses are required to work.
Projections Data
