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Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.
Registered nurses typically do the following:
Registered nurses’ duties and titles often depend on where they work and the patients they work with. For example, an oncology nurse may work with cancer patients or a geriatric nurse may work with elderly patients. Some registered nurses combine one or more areas of practice. For example, a pediatric oncology nurse works with children and teens who have cancer.
Many possibilities for working with specific patient groups exist. The following list includes just a few examples:
Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.
Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.
Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.
Genetics nurses provide screening, counseling, and treatment for patients with genetic disorders, such as cystic fibrosis.
Neonatology nurses take care of newborn babies.
Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.
Rehabilitation nurses care for patients with temporary or permanent disabilities.
Registered nurses may work to promote public health, by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs. Other nurses staff the health clinics in schools.
Some nurses do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, public policy advisors, researchers, hospital administrators, salespeople for pharmaceutical and medical supply companies, or as medical writers and editors.
Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working with other nurses and various other staff to improve the quality of care that patients receive. They often serve in leadership roles and may educate and advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.
Registered nurses held about 2.8 million jobs in 2014. The industries that employed the most registered nurses were as follows:
|Hospitals; state, local, and private||61%|
|Nursing and residential care facilities||7|
|Offices of physicians||7|
|Home healthcare services||6|
Registered nurses are the largest healthcare occupation. They work in hospitals, physicians’ offices, home healthcare services, and nursing care facilities. Others work in schools or outpatient clinics, or serve in the military. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites.
Some nurses move frequently, traveling in the United States and throughout the world to help care for patients in places where there are not enough healthcare workers.
Registered nurses may spend a lot of time walking, bending, stretching, and standing. They are vulnerable to back injuries, because they often must lift and move patients.
In addition, the work of registered nurses may put them in close contact with people who have infectious diseases, and they frequently come in contact with potentially harmful and hazardous drugs and other substances. Therefore, registered nurses must follow strict, standardized guidelines to guard against diseases and other dangers, such as radiation, accidental needle sticks, or the chemicals used to create a sterile and clean environment.
Because patients in hospitals and nursing care facilities need round-the-clock care, nurses in these settings usually work in shifts, covering all 24 hours. They may work nights, weekends, and holidays. They also may be on call.
Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.
In 2014, about 1 out of 6 registered nurses worked part time.
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Registered nurses usually take one of three education paths: a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses also must be licensed.
In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. All programs include supervised clinical experience.
Bachelor’s degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching.
Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.
Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.
Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.
In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).
Other requirements for licensing vary by state. Each state’s board of nursing can give details. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.
Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it.
CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.
Critical-thinking skills. Registered nurses must be able to assess changes in the health status of patients, including determining when to take corrective action and when to make referrals.
Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to explain instructions, such as how to take medication, clearly. They must be able to work in teams with other health professionals and communicate the patients’ needs.
Compassion. Registered nurses should be caring and empathetic when caring for patients.
Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.
Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses.
Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care.
Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift.
Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.
In management, nurses can advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions are requiring a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.
Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.
Some RNs choose to become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs may provide primary and specialty care, and in many states they may prescribe medications.
Other nurses work as postsecondary teachers in colleges and universities.
The median annual wage for registered nurses was $67,490 in May 2015. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $46,360, and the highest 10 percent earned more than $101,630.
In May 2015, the median annual wages for registered nurses in the top industries in which they worked were as follows:
|Hospitals; state, local, and private||69,510|
|Home healthcare services||63,840|
|Offices of physicians||60,820|
|Nursing and residential care facilities||60,370|
Employers may offer flexible work schedules, childcare, educational benefits, and bonuses.
Because patients in hospitals and nursing care facilities need round-the-clock care, nurses in these settings usually work in shifts, covering all 24 hours. They may work nights, weekends, and holidays. They may be on call, which means that they are on duty and must be available to work on short notice. Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.
In 2014, about 1 out of 6 registered nurses worked part time.
Employment of registered nurses is projected to grow 16 percent from 2014 to 2024, much faster than the average for all occupations. Growth will occur for a number of reasons.
Demand for healthcare services will increase because of the aging population, given that older people typically have more medical problems than younger people. Nurses also will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity.
In addition, the number of individuals who have access to health insurance is expected to continue to increase because of federal health insurance reform. People who previously were uninsured or found treatment to be cost prohibitive will obtain health insurance and have access to primary and preventive care services. More nurses will be needed to care for these patients in offices of physicians, clinics, and other ambulatory care settings.
The financial pressure on hospitals to discharge patients as soon as possible may result in more people being admitted to long-term care facilities and outpatient care centers, and greater need for healthcare at home. Job growth is expected in facilities that provide long-term rehabilitation for stroke and head injury patients, and in facilities that treat people with Alzheimer’s disease. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings.
Growth also is expected to be faster than average in outpatient care centers, where patients do not stay overnight, such as those which provide same-day chemotherapy, rehabilitation, and surgery. In addition, an increased number of procedures, as well as more sophisticated procedures previously done only in hospitals, are being performed in ambulatory care settings and physicians’ offices.
Overall, job opportunities for registered nurses are expected to be good. However, the supply of new nurses entering the labor market has increased in recent years. This increase has resulted in competition for jobs in some areas of the country. Generally, registered nurses with a Bachelor of Science degree in nursing (BSN) will have better job prospects than those without one. Employers also may prefer candidates who have some related work experience.
Job opportunities should be good because of the need to replace workers who retire over the coming decade and because of the growing number of people with access to healthcare services.
|Occupational Title||Employment, 2014||Projected Employment, 2024||Change, 2014-24|