Registered 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.
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.
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.
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
Overall 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, except mental health and substance abuse 34
Employment services 27
General medical and surgical hospitals, public and private 22
Nursing care facilities 20
Employment is expected to grow more slowly in hospitals—health care’s
largest industry—than in most other health care industries. While the
intensity of nursing care is likely to increase, requiring more nurses per
patient, the number of inpatients (those who remain in the hospital for more
than 24 hours) is not likely to grow by much. Patients are being discharged
earlier, and more procedures are being done on an outpatient basis, both
inside and outside hospitals. Rapid growth is expected in hospital outpatient
facilities, such as those providing same-day surgery, rehabilitation, and
chemotherapy.
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.
Earnings
Median annual earnings of registered nurses were $57,280 in May 2006. The
middle 50 percent earned between $47,710 and $69,850. The lowest 10 percent
earned less than $40,250, and the highest 10 percent earned more than $83,440.
Median annual earnings in the industries employing the largest numbers of
registered nurses in May 2006 were:
Employment services $64,260
General medical and surgical hospitals 58,550
Home health care services 54,190
Offices of physicians 53,800
Nursing care facilities 52,490
Many employers offer flexible work schedules, child care, educational
benefits, and bonuses.
Related Occupations
Because of the number of specialties for registered nurses, and the variety
of responsibilities and duties, many other health care occupations are similar
in some aspect of the job. Other occupations that deal directly with patients
when providing care include licensed practical and licensed vocational nurses,
physicians and surgeons, athletic trainers, respiratory therapists, massage
therapists,
dietitians and nutritionists, occupational therapists, physical therapists,
and emergency medical technicians and paramedics. Other occupations that use
advanced medical equipment to treat patients include cardiovascular
technologists and technicians, diagnostic medical sonographers, radiologic
technologists and technicians, radiation therapists, and surgical
technologists. Workers who also assist other health care professionals in
providing care include nursing, psychiatric, and home health aides; physician
assistants; and dental hygienists. Some nurses take on a management role,
similar to medical and health services managers."
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook
Handbook, 2008-09 Edition, Registered Nurses, on the Internet at http://www.bls.gov/oco/ocos083.htm
(visited March 31, 2008).
