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Registered Nurses: Caring For The Sick And Helping Them Stay Well

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Registered Nurses work to uphold health, avertillness and support patients cope with illness. They are promoters and health mentors for patients their families and the communities where they work.

Nature of the Work

Registered nurses (R.N.'s) care for the sick and help people stay well. Typically concerned with the whole person, registered nurses provide for the physical, mental, and emotional needs of their patients. They observe, assess, and record symptoms, reactions, and progress; administer medications; assist in convalescence and rehabilitation; instruct patients and their families in proper care; and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks R.N.'s are allowed to perform, it is usually the work setting, together with the nurse's educational preparation and experience that determines day-to-day job duties.



Hospital nurses constitute the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out the medical regimen prescribed by physicians. They may also supervise licensed practical nurses, aides, and orderlies. Hospital nurses usually work with groups of patients who require the same type of care, for instance, those recovering from surgery, acutely ill children, trauma victims, or cancer patients.

Nursing home nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease. Although they generally spend most of their time on administrative and supervisory tasks, R.N.'s also assess residents' needs, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform complex treatments such as starting intravenous fluids.

Public health nurses care for patients in clinics, schools, retirement and life care communities and other community settings. They instruct community groups in proper nutrition and exercise and arrange for immunizations, blood pressure testing, and other health screening measures. These nurses work with community leaders, teachers, parents, and physicians in community health education. Some public health nurses work in schools. A growing number provide, oversee, or manage home health care, where they instruct patients and families in the home and provide periodic services prescribed by a physician.

Private duty nurses provide nursing services to patients needing constant attention. They either work directly for a family on a contract basis or for a nursing or temporary help agency which assigns them to patients. They may alternate between work in a home, hospital, nursing home, or rehabilitation center.

Office nurses assist physicians in private practice, clinics, and health maintenance organizations. Some perform routine laboratory and office work in addition to nursing duties.

Occupational health or industrial nurses provide nursing care to employees in industry and government. They treat minor injuries and illnesses at work, provide emergency care, arrange for further care if necessary, and offer health counseling. They also may assist with health examinations and inoculations.

Working Conditions:

Nurses generally work indoors in well-lighted, comfortable buildings. Public health nurses travel to patients in all types of weather. Nurses in general need physical stamina because they spend considerable time walking and standing. Emotional stability is also required to cope with human suffering, frequent emergencies, and other stresses. Nurses work closely with but subordinate to physicians. Because patients in hospitals and nursing homes require care at all times, staff nurses in these institutions may work nights, weekends, and holidays.

Nursing has its hazards, especially in hospital work where nurses may care for individuals with infectious diseases such as hepatitis and AIDS. Nurses must observe rigid guidelines to guard against these and other dangers such as radiation, chemicals used for sterilization of instruments, and gases used for anesthesia. In addition, nurses must take precautions to avoid back injury, shocks from electrical equipment, and hazards posed by compressed gases.

Employment:

A majority of the nurses, more than two-thirds, worked in hospitals, whilstothers found employment inPhysicians' offices, Nursing homes, Temporary help agencies, Schools and some for the federal governments.

Training, Other Qualifications, and Advancement:

In order to obtain the license needed to practice as a registered nurse, a person must graduate from an approved school of nursing and pass a national examination administered by each State. Nurses may be licensed in more than one State, either by examination or endorsement of a license issued by another State. Licenses must be periodically renewed, and, in some States, continuing education is a requirement for renewal.

For those interested in nursing, there are three major educational paths: Associate degree (A.D.N.), diploma, and Bachelor of Science degree in nursing (B.S.N.). A.D.N, programs are offered by community and junior colleges and take about 2 years; diploma programs are given in hospitals and last 2 to 3 years; B.S.N, programs are offered by colleges and universities and require 4 or 5 years. With relatively few exceptions, graduates of any of the three program types qualify for entry level positions as staff nurses once they are licensed.

Prospective nursing students should be aware of recent attempts to raise the educational requirements for R.N. licensure to the baccalaureate level. However, proposals to upgrade entry requirements and, possibly, create new job titles for registered nurses have been around for years. It remains to be seen just how quickly this will occur. The process is likely to be slow since it necessitates legislative or regulatory action in each State and the District of Columbia.

Changes in licensure requirements would not affect currently licensed R.N.'s, who would be grandfathered in, no matter what their educational preparation. However, individuals considering a future in nursing should carefully weigh the pros and cons of enrolling in a B.S.N, program since advancement opportunities arc broader for those who have B.S.N, degrees than for those who do not. In fact, some career paths are open only to nurses with bachelor's or advanced degrees.

While nursing home nurses may advance to the position of director of nursing on the basis of A.D.N, or diploma preparation, baccalaureate preparation is generally necessary for supervisory or administrative positions in hospitals, and for positions in community nursing and home health care. Moreover, the B.S.N. is a prerequisite for admission to graduate nursing programs. Since most research, consulting, teaching, administrative, and clinical specializations in nursing require graduate degrees, individuals considering these areas should consider starting out in a B.S.N. program since it is the quickest path to graduate school.

A growing number of R.N.'s trained in diploma or associate degree programs subsequently enter baccalaureate programs to prepare for a broader scope of nursing practice. And, since many hospitals now have tuition reimbursement programs, individuals with limited resources can get a 2-year degree, find a hospital position, and let the employer finance a B.S.N, degree.

All nursing education programs include classroom instruction and supervised training in hospitals and other health facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Increasingly, nursing students learn how to use computers to enter or retrieve test results and medication orders, and to develop work schedules.

Nursing students receive supervised clinical experience in various hospital departments such as pediatrics and surgery. An increasing number of programs include clinical practice in nursing homes and courses in gerontological nursing. Students in bachelor's degree and some other programs are assigned to public health departments, visiting nurse associations, and other community agencies to learn how to care for patients in clinics and in patients' homes.

Persons wanting to pursue a nursing career should have a strong desire to assist people and be sympathetic to their needs. Nurses must be able to accept responsibility and direct or super-vise others; they must have initiative and, in appropriate situations, be able to follow orders precisely or determine whether additional consultation is required. Good judgment is essential.

From staff positions in hospitals and nursing homes, promotion to increasingly responsible jobs is possible through experience and good performance. Nurses who choose a career in management can advance to a position as assistant head nurse or head nurse. From there, advancement to assistant director, director, and vice president positions is possible. Increasingly, management level nursing positions require a graduate degree in nursing or health services administration and require good business judgment and strong negotiation skills. Graduate programs preparing executive level nurses usually last 1 to 2 years. Applicants must be R.N.'s, preferably with some experience in beginning management.

For nurses who prefer close contact with patients, career advancement may mean becoming a clinical nurse specialist, nurse practitioner, nurse clinician, or nurse anesthetist. Graduate level preparation is necessary to reach these positions, all of which require the ability to exercise a high degree of independent judgment in assessing problems and determining priorities. Therequired education, which is offered in hospitals and universities, normally lasts 1 to 2 years, and leads to a certificate or master's degree. Applicants must be R.N.'s, and may need up to 2 years of nursing experience in a relevant specialty.

Nurse anesthetists complete a certificate program allowing them to administer anesthesia under the direction of a physician. Nurse practitioners and nurse midwives have graduate training in how to diagnose and assess patients, enabling them to perform certain duties normally performed by a physician. Clinical nurse specialists and nurse clinicians have expertise in a clinical area such as pediatrics or gerontology/geriatrics which usually is obtained in a master's degree program.

Agrowing number of nurses are moving into the business side of health care. Their nursing expertise and preparation for work as members of a health care team equip them for management positions in fields such as ambulatory, acute, and chronic care services. Some are employed by large health care corporations in areas like health planning and development, marketing, and quality assurance. Others run their own businesses, such as home health care agencies.

Job Outlook

Job prospects in nursing should be excellent for some time with Hospitals in many parts of the country reporting shortages of R.N.'s. In addition, R.N. recruitment has long been a problem in rural areas, in some big city hospitals, and in specialty areas including intensive care, medical-surgical nursing, rehabilitation, geriatrics, and long-term care.

Whether the current shortage of nurses will persist is difficult to say. Despite a need for more new nurses, enrollments in nursing schools may not rise much, if at all. Reasons for this include the decline in the college-age population, shifts in young women's career aspirations, and expanding opportunities for women in traditionally male-dominated occupations, and the profession's inability to attract more men. However, efforts by employers to fill vacancies by raising salaries and improving working conditions, could attract more people to nursing and eventually create a balance between job-seekers and openings.

Employment of registered nurses is expected to grow much faster than the average for all occupations. Driving this growth will be technological advances in patient care, which involve a greater number of increasingly complex services, coupled with a growing and aging population.

A large and growing proportion of patients being admitted into hospitals are very sick and in need of constant monitoring and highly skilled care. Partly because minor procedures are now performed on an outpatient basis, and partly because of incentives in the reimbursement system, only the gravely ill or those needing major surgery are admitted into the hospital. Furthermore, many patients are hospitalized only for the most acute portion of their illness, the period when high-technology procedures are performed and sophisticated equipment is used. It takes not one, but several, highly skilled nurses to provide the care such patients require.

Thanks largely to advances in technology; the number of sophisticated procedures performed in physicians' offices and clinics is expected to grow. An example is outpatient treatment of cataracts. Very rapid expansion is foreseen in the outpatient or ambulatory care sector, which comprises physicians' offices, medical group practices, walk-in clinics, surgicenters, diagnostic imaging centers, cardiac rehabilitation clinics, and health maintenance organizations (HMO's). Such facilities bear little resemblance to the conventional doctor's office and offer a wide range of sophisticated health care services that provide new career opportunities for registered nurses. HMO's, medical group practices, and other outpatient settings are expected to offer very attractive employment prospects for R.N.'s.

Home health care is also becoming an increasingly important source of employment.This is in response to the prevalence of functional disabilities among older persons, consumer preference for care in the home, and technological advances which make it possible to bring increasingly complex treatments into the home.

Employment in nursing homes is expected to grow very fast due to the projected increase in the number of people in their eighties and nineties, many of whom will require long-term care. In addition, the financial pressure on hospitals to release patients as soon as possible should produce more nursing home admissions for post hospital care. People recovering from surgery, stroke, or other major episodes will stay in nursing homes for a relatively brief time but will continue to require the services of an R.N. to provide such intensive services as intravenous therapy and respirator support.

Hospitals and other employers faced with a shortage of nurses are responding with flexible work schedules, child care, educational benefits, bonuses, higher pay, shared decision making, and other incentives designed to retain existing staff and to attract licensed nurses who are currently inactive.

Related Occupations:

Workers in other occupations with responsibilities and duties related to those of registered nurses include occupational therapists, paramedics, physical therapists, physician assistants, and respiratory therapists.
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