 |
||
|
|
 .
|
Job Report Registered Nurses
Nature of the Work
Registered nurses (R.N.'s) handle a variety of tasks related to both health and
illness. Typically concerned with the "whole person," registered nurses deal with patients'
mental and emotional functioning as well as their physical needs. 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. The work setting
determines the scope of the nurse's responsibilities.
Hospital nurses constitute by far the largest group of nurses. Most are staff nurses
who provide skilled 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 similar nursing care. For
instance, some nurses work with patients who have had surgery; others care for children,
the elderly, or the mentally ill.
Registered nurses working in nursing homes provide bedside nursing care to
patients convalescing from surgery or an illness, and to those suffering from chronic
illnesses and disabilities. They also supervise licensed practical nurses and nursing aides.
Private duty nurses give individual care to patients who need constant attention.
They may work in a home, a hospital, or a nursing home or rehabilitation center.
Community health nurses care for patients in clinics, schools, retirement and life care
communities, and other community settings. A growing number provide home health care.
They instruct patients and families in health care and give periodic care as prescribed by
a physician. They may 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 community health nurses work in schools.
Office nurses assist physicians, dental surgeons, and, occasionally, dentists in
private practice, clinic, and health maintenance organizations. Sometimes they perform
routine laboratory and office work in addition to their nursing duties.
Occupational health or industrial nurses provide nursing care to employees in
industry and government and, along with physicians, promote employee health. As
prescribed by a doctor, they treat minor injuries and illnesses at work, provide needed
nursing care, arrange for further medical care if necessary, and offer health counseling.
The also may assist with health examinations and inoculations.
Working Conditions
Nurses generally work indoors in well-lighted, comfortable buildings. Community
health nurses may be required to travel to patients in all types of weather. For those nurses
who care for the ill and infirm, the physical demands of patient care can be strenuous.
Nurses in general need physical stamina because they spend considerable time walking
and standing. When treating patients with infectious diseases such as hepatitis and AIDS,
nurses must rigidly adhere to guidelines regarding cleanliness and sterility. Emotional
stability is required to cope with human suffering and frequent emergencies. Because
patients in hospitals and nursing homes require care at all times, staff nurses in these
institutions may have to work nights, weekends, and holidays.
Employment
Registered nurses held about 1,610,000 jobs in 1990. As the following tabulation
shows, two out of three jobs were in hospitals:
Percent
Total................................... 100
Hospitals............................... 67
Offices of physicians (M.D.'s and D.O.'s).. 7
Government................................... 3
Nursing and personal care facilities......... 6
Educational services......................... 3
Personnel supply services.................... 4
Other........................................ 10
Between one-fourth and one-third of all nursing jobs are part time.
Training, Other Qualifications, and Advancement
To obtain the license to practice that is required by all States and the District of
Columbia, nurses 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. Some States
require continuing education for license renewal.
Nursing training programs vary in length from 2 to 5 years after graduation from high
school, depending on the nature of the program. Programs offered by community and
junior colleges take about 2 years and lead to an associate degree; hospital-based
programs last 3 years and lead to a diploma; college and university programs require 4 or
5 years and lead to a baccalaureate degree.
There is considerable controversy about the relative merits of the various training
programs. Some employers have specific preferences, but, with few exceptions, graduates
of all these programs qualify for entry level staff nurse positions after passing the licensing
examinations.
Individuals considering a career in nursing should bear in mind that the kind of
program they choose--associate, diploma, or bachelor's degree--will affect their future
opportunities. For supervisory or administrative positions, for jobs in public health agencies,
and for admission to graduate nursing programs, for example, a bachelor's degree in
nursing is necessary. Those considering research, consulting, teaching, or a clinical
specialization also should start their nursing education in a bachelor's program.
Some R.N.'s trained in diploma or associate degree programs subsequently enter
baccalaureate degree programs to prepare for a broader scope of nursing practice, but this
can be a costly and time-consuming way of securing baccalaureate level preparation.
All nurse training programs include classroom instruction and supervised nursing
practice in hospitals and other health facilities. Students take courses in anatomy,
physiology, microbiology, nutrition, psychology, and nursing. Increasingly, nursing students
learn the latest clinical and administrative uses of computers in medicine. In hospitals, for
example, nurses routinely use computers to enter or retrieve information about patients
such as X-rays, laboratory test results, or medication orders.
Nursing students also receive supervised clinical experience in various hospital
departments--pediatrics and surgery, for example. Students in bachelor's degree programs
as well as in some of the other programs are assigned to public health departments,
visiting nurse associations, and other community agencies to learn how to care for patients'
homes. Varying amounts of general education are combined with nursing education in all
three types of programs.
Persons who want to pursue a nursing career should have a sincere desire to serve
humanity and be sympathetic to the needs of others. Nurses must be able to accept
responsibility and direct or supervise the activity of others; they must have initiative, and in
appropriate situations be able to follow orders precisely or determine if additional
consultation is required; and they must use good judgement in emergencies.
From staff positions in hospitals, experienced nurses may be promoted to
increasingly responsible jobs, many of which can be obtained through experience and good
performance. For nurses who choose a career in management, advancement can include
the assistant head nurse or head nurse position. From there, assistant director, director,
and vice president positions ar possible. Increasingly, positions at the management level
require a graduate degree in nursing or health services administration, with emphasis on
finance. Executive level nursing positions require business judgement and strong
negotiation skills. Graduate programs are offered in colleges or universities and usually last
1-2 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 are
distinguished by the ability to exercise a high degree of independent judgment in assessing
nursing problems and determining priorities of care. Training is offered in hospitals and
universities, normally lasts 1-2 years, and leads to a certificate or master's degree.
Applicants must be R.N.'s and many programs require 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 level training in diagnostic and health assessment skills that enables 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 through completion of a master's degree program.
A growing number of nurses are moving into the business side of health care. Their
nursing expertise and training to work as members of a team prepare 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, perhaps through the
year 2000. Hospitals in many parts of the country are currently reporting shortages of
R.N.'s. In addition, RN 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.
The rapidly growing demand for registered nurses is in part a function of their
training, which permits them to work effectively in a wide variety of roles and employment
settings. Over the years, staffing patterns for hospital nursing personnel have shifted in the
direction of greater reliance on registered nurses and less use of licensed practical nurses
and nursing aides. The growth of intensive care, coronary care, and other special units for
seriously ill patients has spurred demand for clinically specialized nursing personnel. Such
nurses are equipped to handle the highly sophisticated equipment used in hospitals.
The trend toward greater reliance on registered nurses is expected to accelerate
because of prospective payment, Medicare's new system of paying for hospital care.
Substitution of registered nurses and "multicompetent" technicians for allied health workers
is likely to occur in some hospitals. In addition, registered nurses will be sought for
technically demanding but "generalists" responsibilities in the rapidly growing outpatient
care sector. They may be preferred over more specialized personnel for jobs in health
maintenance organizations, ambulatory surgery centers, group medical practices, and other
outpatient settings.
The home is an increasingly important practice site, not only because of changes in
the way treatment is provided in hospitals, but because of the prevalence of functional
disabilities among older persons and consumer preference for care in home or community-
based settings. The home health field is expected to experience spectacular growth by the
mid-1990's, and should provide excellent opportunities for R.N.'s.
The nursing home sector--a major employer of registered nurses--is also expected
to expand due to the projected increase in the number of elderly people requiring this level
of care. In addition, cost containment pressures on hospitals to release patients as soon
as possible will require nursing home care for those recovering from surgery, stroke, or
other major episodes. Patients such as these will stay in nursing homes for a relatively brief
time, but they will require intensive services--intravenous therapy, feeding tubes, and
respirator support--that necessitate advanced nursing skills. Job opportunities for R.N.'s
in nursing homes should be excellent, especially in view of the chronic shortage of nurses
experienced by many facilities.
The supply of registered nurses is roughly in balance with demand at present,
although there are shortages in certain areas--in rural communities, big city hospitals, and
such specialties as geriatrics. At the same time, competition is expected to persist for the
more desirable, higher paying jobs, especially in areas considered highly attractive because
of climate or recreational or cultural facilities, and in areas where training programs abound.
Nurses with a bachelor's degree should have the best prospects in these areas.
Overall, job opportunities for nurses during the coming decade will reflect the
interplay of demand and supply, and a highly favorable job market seems likely. Recent
graduates of nursing school are a major source of supply for the profession. The number
of new graduates is expected to decline by the mid-1990's, although demand is projected
to burgeon. In settings or communities that experience a shortage of nurses, employers
are likely to respond with higher pay and other incentives designed to attract licensed R.N.'s
not currently active in the field. Some are at home caring for families; others have
transferred to other kinds of jobs. Supply might also be augmented by R.N.'s who reinstate
their licenses in order to return to work, and by part-time workers who switch to full time.
Earnings
Starting salaries of staff nurses employed in hospitals averaged about $24,500 a
year in 1990, according to a national survey conducted by the University of Texas Medical
Branch. Experienced staff RN's averaged about $34,025, while experienced head nurses
averaged $43,250. Beginning nurse anesthetists averaged $37,630, those with experience
$55,850.
RN staff nurses in nursing homes had median annual salaries of approximately
$22,575 in 1990, according to a survey by the Hospital Compensation Service.
Registered nurses in home health agencies had average salaries of about $33,075
a year in 1990.
Most hospital and nursing home nurses receive extra pay for work on evening or
night shifts. Nearly all receive from 5 to 13 paid holidays a year, at least 2 weeks of paid
vacation after 1 year of employment, and health and retirement benefits.
Related Occupations
Other Occupations with responsibilities and duties similar to those of registered
nurses include: Occupational therapists, paramedics, physical therapists, physician
assistants, and respiratory therapists.
Sources of Additional Information
The National League for Nursing (NLN) publishes a variety of materials about
nursing and nursing education, including a list of approved schools of nursing and
information on student financial aid. One Brochure describes master's degree programs
to prepare nurse practitioners, clinical specialists, and nurse educations. For a complete
list of NLN publications, write for a career information brochure. Send your request to:
Communications Department, National League for Nursing, 10 Columbus
Circle, New York, N.Y. 10019.
Information on career opportunities as a registered nurse is available from:
American Nurses' Association, 2420 Pershing Rd., Kansas City, Mo. 64108.
Information about employment opportunities in Veterans Administration medical
centers is available form local Veterans Administration medical centers and also from:
Recruitment and Placement Service, Veterans Administration, 810 Vermont
Ave. NW,, Washington, D.C. 20420.
For information on nursing careers in hospitals, contact:
American Hospital Association, Division of Nursing, 840 North Lake Shore
Dr., Chicago, Ill. 60611.
For a copy of Health Careers in Long-Term Care, write:
American Health Care Association, 1200 15th St., NW., Washington, D.C.
20005.
work at home - work at home jobs
Copyright 2002 Work-at-Home.org
|