Registered nurses (RNs) help individuals, families, and groups to improve and maintain health and to prevent disease. They care for the sick and injured in hospitals and other health care facilities, physicians’ offices, private homes, public health agencies, schools, camps, and industry. Some registered nurses are employed in private practice. RNs hold about 2.4 million jobs in the United States.
History of Registered Nurse Career
Modern ideas about hospitals and nursing as a profession did not develop until the 19th century. The life and work of Florence Nightingale were a strong influence on the profession’s development. Nightingale, who came from a wealthy, upper-class British family, dedicated her life to improving conditions in hospitals, beginning in an army hospital during the Crimean War. In the United States, many of Nightingale’s ideas were put into practice for the care of the wounded during the Civil War. The care, however, was provided by concerned individuals who nursed, rather than by professionally trained nurses. They had not received the kind of training that is required for nurses today.
The first school of nursing in the United States was founded in Boston in 1873. In 1938, New York State passed the first state law requiring that practical nurses be licensed. Even though the first school for the training of practical nurses was started almost 74 years ago, and the establishment of other schools followed, the training programs then lacked uniformity.
After the 1938 law was passed, a movement emerged to have organized training programs that would assure new standards in the field. The role and training of nurses have undergone radical changes since the first schools opened.
Education standards for nurses have been improving constantly since that time. Today’s nurse is a highly educated, licensed health care professional. Extended programs of training are offered throughout the country, and all states have enacted laws to assure training standards are maintained and to assure qualification for licensure. Nurses are a vital part of the health care system.
The Job of Registered Nurses
Registered nurses work under the direct supervision of nursing departments and in collaboration with physicians. Two-thirds of all nurses work in hospitals, where they may be assigned to general, operating room, or maternity room duty. They may also care for sick children or be assigned to other hospital units, such as emergency rooms, intensive care units, or outpatient clinics. There are many different kinds of RNs. (Advanced Practice Nurses, Clinical Nurse Specialists, Community Health Nurses, Critical Care Nurses, Emergency Nurses, Home Health Care and Hospice Nurses, Home Health Care and Hospice Nurses, Geriatric Nurses, Legal Nurse Consultants, Licensed Practical Nurses, Neonatal Nurses, Nurse Managers, Nurse- Midwives, Nursing Instructors, Occupational Health Nurses, Oncological Nurses, Psychiatric Nurses, and School Nurses.)
General duty nurses work together with other members of the health care team to assess the patient’s condition and to develop and implement a plan of health care. These nurses may perform such tasks as taking patients’ vital signs, administering medication and injections, recording the symptoms and progress of patients, changing dressings, assisting patients with personal care, conferring with members of the medical staff, helping prepare a patient for surgery, and completing any number of duties that require skill and understanding of patients’ needs.
Surgical nurses oversee the preparation of the operating room and the sterilization of instruments. They assist surgeons during operations and coordinate the flow of patient cases in operating rooms.
Maternity nurses, or neonatal nurses, help in the delivery room, take care of newborns in the nursery, and teach mothers how to feed and care for their babies.
The activities of staff nurses are directed and coordinated by head nurses and charge nurses. Heading up the entire nursing program in the hospital is the nursing service director, who administers the nursing program to maintain standards of patient care. The nursing service director advises the medical staff, department heads, and the hospital administrator in matters relating to nursing services and helps prepare the department budget.
Private duty nurses may work in hospitals or in a patient’s home. They are employed by the patient they are caring for or by the patient’s family. Their service is designed for the individual care of one person and is carried out in cooperation with the patient’s physician.
Office nurses usually work in the office of a dentist, physician, or health maintenance organization (HMO). An office nurse may be one of several nurses on the staff or the only staff nurse. If a nurse is the only staff member, this person may have to combine some clerical duties with those of nursing, such as serving as receptionist, making appointments for the doctor, helping maintain patient records, sending out monthly statements, and attending to routine correspondence. If the physician’s staff is a large one that includes secretaries and clerks, the office nurse will concentrate on screening patients, assisting with examinations, supervising the examining rooms, sterilizing equipment, providing patient education, and performing other nursing duties.
Occupational health nurses, or industrial nurses, are an important part of many large firms. They maintain a clinic at a plant or factory and are usually occupied in rendering preventive, remedial, and educational nursing services. They work under the direction of an industrial physician, nursing director, or nursing supervisor. They may advise on accident prevention, visit employees on the job to check the conditions under which they work, and advise management about the safety of such conditions. At the plant, they render treatment in emergencies.
School nurses may work in one school or in several, visiting each for a part of the day or week. They may supervise the student clinic, treat minor cuts or injuries, or give advice on good health practices. They may examine students to detect conditions of the eyes or teeth that require attention. They also assist the school physician.
Community health nurses, also called public health nurses, require specialized training for their duties. Their job usually requires them to spend part of the time traveling from one assignment to another. Their duties may differ greatly from one case to another. For instance, in one day they may have to instruct a class of expectant mothers, visit new parents to help them plan proper care for the baby, visit an aged patient requiring special care, and conduct a class in nutrition. They usually possess many varied nursing skills and often are called upon to resolve unexpected or unusual situations.
Administrators in the community health field include nursing directors, educational directors, and nursing supervisors. Some nurses go into nursing education and work with nursing students to instruct them on theories and skills they will need to enter the profession. Nursing instructors may give classroom instruction and demonstrations or supervise nursing students on hospital units. Some instructors eventually become nursing school directors, university faculty, or deans of a university degree program. Nurses also have the opportunity to direct staff development and continuing education programs for nursing personnel in hospitals.
Advanced practice nurses are nurses with training beyond that required to have the RN designation. There are four primary categories of nurses included in this category: nurse-midwives, clinical nurse specialists, nurse anesthetists, and nurse practitioners.
Some nurses are consultants to hospitals, nursing schools, industrial organizations, and public health agencies. They advise clients on such administrative matters as staff organization, nursing techniques, curricula, and education programs. Other administrative specialists include educational directors for the state board of nursing, who are concerned with maintaining well-defined educational standards, and executive directors of professional nurses’ associations, who administer programs developed by the board of directors and the members of the association.
Some nurses choose to enter the armed forces. All types of nurses, except private duty nurses, are represented in the military services. They provide skilled nursing care to active-duty and retired members of the armed forces and their families. In addition to basic nursing skills, military nurses are trained to provide care in various environments, including field hospitals, on-air evacuation flights, and onboard ships. Military nurses actively influence the development of health care through nursing research. Advances influenced by military nurses include the development of the artificial kidney (dialysis unit) and the concept of the intensive care unit.
Registered Nurse Career Requirements
If you are interested in becoming a registered nurse, you should take high school mathematics and science courses, including biology, chemistry, and physics. Health courses will also be helpful. English and speech courses should not be neglected because you must be able to communicate well with patients.
There are three basic kinds of training programs that you may choose from to become a registered nurse: associate’s degree, diploma, and bachelor’s degree. The choice of which of the three training programs to pursue depends on your career goals. A bachelor’s degree in nursing is required for most supervisory or administrative positions, for jobs in public health agencies, and for admission to graduate nursing programs. A master’s degree is usually necessary to prepare for a nursing specialty or to teach. For some specialties, such as nursing research, a Ph.D. is essential.
There are approximately 674 bachelor’s degree programs in nursing in the United States. It requires four (in some cases, five) years to complete. The graduate of this program receives a bachelor of science in nursing (B.S.N.) degree. The associate degree in nursing (A.D.N.) is awarded after completion of a two-year study program that is usually offered in a junior or community college. There are approximately 846 A.D.N. programs in the United States. You receive hospital training at cooperating hospitals in the general vicinity of the community college. The diploma program, which usually lasts three years, is conducted by hospitals and independent schools, although the number of these programs is declining. At the conclusion of each of these programs, you become a graduate nurse, but not, however, a registered nurse. To obtain the RN designation you must pass a licensing examination required in all states.
Nurses can pursue postgraduate training that allows them to specialize in certain areas, such as emergency room, operating room, premature nursery, or psychiatric nursing. This training is sometimes offered through hospital on-the-job training programs.
Certification or Licensing
All states and the District of Columbia require a license to practice nursing. To obtain a license, graduates of approved nursing schools must pass a national examination. Nurses may be licensed by more than one state. In some states, continuing education is a condition for license renewal. Different titles require different education and training levels.
You should enjoy working with people, especially those who may experience fear or anger because of an illness. Patience, compassion, and calmness are qualities needed by anyone working in this career. In addition, you must be able to give directions as well as follow instructions and work as part of a health care team. Anyone interested in becoming a registered nurse should also have a strong desire to continue learning, because new tests, procedures, and technologies are constantly being developed within medicine.
Exploring Registered Nurse Career
You can explore your interest in nursing in a number of ways. Read books on careers in nursing and talk with high school guidance counselors, school nurses, and local public health nurses. Visit hospitals to observe the work and talk with hospital personnel to learn more about the daily activities of nursing staff.
Some hospitals now have extensive volunteer service programs in which high school students may work after school, on weekends, or during vacations in order both to render a valuable service and to explore their interests in nursing. There are other volunteer work experiences available with the Red Cross or community health services. Camp counseling jobs sometimes offer related experiences. Some schools offer participation in Future Nurses programs.
The Internet is full of resources about nursing. Check out Nursing Net (http://www.nursingnet.org/), and the American Nursing Association’s Nursing World (http://www.nursingworld.org/).
Approximately 2.4 million registered nurses are employed in the United States. Inpatient and outpatient hospital departments account for about three out of five jobs for registered nurses. Nurses are employed by hospitals, managed-care facilities, long-term care facilities, clinics, industry, private homes, schools, camps, and government agencies. One out of five nurses works part time.
The only way to become a registered nurse is through completion of one of the three kinds of educational programs, plus passing the licensing examination. Registered nurses may apply for employment directly to hospitals, nursing homes, home care agencies, temporary nursing agencies, companies, and government agencies that hire nurses. Jobs can also be obtained through school placement offices, by signing up with employment agencies specializing in placement of nursing personnel, or through the state employment office. Other sources of jobs include nurses’ associations, professional journals, and newspaper want ads.
Increasingly, administrative and supervisory positions in the nursing field go to nurses who have earned at least the bachelor of science degree in nursing. Nurses with many years of experience who are graduates of a diploma program may achieve supervisory positions, but requirements for such promotions have become more difficult in recent years and in many cases require at least the B.S.N. degree.
Nurses with bachelor’s degrees are usually those who are hired as public health nurses. Nurses with master’s degrees are often employed as clinical nurse specialists, faculty, instructors, supervisors, or administrators. RNs can pursue further education to become advanced practice nurses, who have greater responsibilities and command higher salaries.
According to the U.S. Department of Labor, registered nurses had median annual earnings of $52,330 in 2004. Salaries ranged from less than $37,300 to more than $74,760. Earnings of RNs vary according to employer. According to the Occupational Outlook Handbook, those who worked at hospitals earned $53,450; those working in home health care services earned $48,990; and RNs who worked at nursing and personal care facilities earned $48,220.
Salary is determined by several factors: setting, education, and work experience. Most full-time nurses are given flexible work schedules as well as health and life insurance; some are offered education reimbursement and year-end bonuses. A staff nurse’s salary is often limited only by the amount of work he or she is willing to take on. Many nurses take advantage of overtime work and shift differentials. About 10 percent of all nurses hold more than one job.
Most nurses work in facilities that are clean and well lighted and where the temperature is controlled, although some work in rundown inner-city hospitals in less-than-ideal conditions. Usually, nurses work eight-hour shifts. Those in hospitals generally work any of three shifts: 7:00 a.m. to 3:00 p.m.; 3:00 p.m. to 11:00 p.m.; or 11:00 p.m. to 7:00 a.m.
Nurses spend much of the day on their feet, either walking or standing. Handling patients who are ill or infirm can also be very exhausting. Nurses who come in contact with patients with infectious diseases must be especially careful about cleanliness and sterility. Although many nursing duties are routine, many responsibilities are unpredictable. Sick persons are often very demanding, or they may be depressed or irritable. Despite this, nurses must maintain their composure and should be cheerful to help the patient achieve emotional balance.
Community health nurses may be required to visit homes that are in poor condition or very dirty. They may also come in contact with social problems, such as family violence. The nurse is an important health care provider and in many communities the sole provider.
Both the office nurse and the industrial nurse work regular business hours and are seldom required to work overtime. In some jobs, such as where nurses are on duty in private homes, they may frequently travel from home to home and work with various cases.
Registered Nurse Career Outlook
The nursing field is the largest of all health care occupations, and employment prospects for nurses are excellent. The U.S. Department of Labor projects that registered nurses will have the second largest number of new jobs for all professions through 2014.
There has been a serious shortage of nurses in recent years. A national survey prepared by the Federation of Nurses and Health Professionals in 2001 found that one in five nurses plans to leave the profession within five years because of unsatisfactory working conditions, including low pay, severe understaffing, high stress, physical demands, mandatory overtime, and irregular hours. The shortage will also be exacerbated by the increasing numbers of baby-boomer aged nurses who are expected to retire, creating more open positions than there are graduates of nursing programs.
The much faster than average job growth in this field is also a result of improving medical technology that will allow for treatments of many more diseases and health conditions. Nurses will be in strong demand to work with the rapidly growing population of senior citizens in the United States.
Approximately 60 percent of all nursing jobs are found in hospitals. However, because of administrative cost cutting, increased nurse’s workload, and rapid growth of outpatient services, hospital nursing jobs will experience slower than average growth within the nursing profession. Employment in home care and nursing homes is expected to grow rapidly. Though more people are living well into their 80s and 90s, many need the kind of long-term care available at a nursing home. Also, because of financial reasons, patients are being released from hospitals sooner and admitted into nursing homes. Many nursing homes have facilities and staff capable of caring for long-term rehabilitation patients, as well as those afflicted with Alzheimer’s. Many nurses will also be needed to help staff the growing number of outpatient facilities, such as HMOs, group medical practices, and ambulatory surgery centers.
Nursing specialties will be in great demand. There are, in addition, many part-time employment possibilities, with about one in four RNs working part time.