- Registered nurses (RNs) constitute the largest health care occupation, with 2.6 million jobs.
- About 62 percent of RN jobs are in hospitals.
- The three typical educational paths to registered nursing are a bachelor's degree, an associate degree, and a diploma from an approved nursing program; advanced practice nurses—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners—need a master’s degree.
- Overall job opportunities are expected to be excellent, but may vary by employment and geographic setting; some employers report difficulty in attracting and retaining an adequate number of RNs.
Nature of the Work
Registered nurses teach patients and their families how to manage their illness or injury.
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 medical symptoms, help perform tests and analyze testing 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 illnesses or injuries, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy. Some RNs may 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.
When caring for patients, RNs establish a care plan or contribute to an existing plan. Plans may include numerous activities, such as administering medication, including careful checking of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treatments; observing the patient and recording those observations; and consulting with physicians and other health care clinicians. Some RNs provide direction to licensed practical nurses and nursing aides regarding patient care. RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority.
Specific work responsibilities will vary from one RN to the next. An RN’s duties and title are often determined by their work setting or patient population served. RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs may work a particular setting or type of treatment, such as preoperative nurses, who work in operating rooms and assist surgeons. RNs may specialize in specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs may also specialize with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer. The opportunities for specialization in registered nursing are extensive and are often determined on the job.
There are many options for RNs who specialize in a work setting or type of treatment.
Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians' offices or in clinics. Some ambulatory care nurses are involved in tele-health, providing care and advice through electronic communications media such as video conferencing, the Internet, or by telephone.
Critical care nurses provide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units.
Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility.
Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients' mental and spiritual health in addition to their physical health. Home health care nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients.
Infusion nurses administer medications, fluids, and blood to patients through injections into patients' veins.
Long- term care nurses provide health care services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities.
Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses.
Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety standards.
Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure.
Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery.
Psychiatric-mental health nurses treat patients with personality and mood disorders.
Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses.
Rehabilitation nurses care for patients with temporary and permanent disabilities.
Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.
RNs specializing in a particular disease, ailment, or health care condition are employed in virtually all work settings, including physicians' offices, outpatient treatment facilities, home health care agencies, and hospitals.
Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions.
Intellectual and developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speaking or other communication.
Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections.
Genetics nurses provide early detection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington's disease.
HIV/AIDS nurses care for patients diagnosed with HIV and AIDS.
Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring.
Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence.
RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics, and outpatient care facilities.
Cardiovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation.
Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis.
Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue.
Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer, and sexually transmitted diseases.
Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or substance abuse.
Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures.
Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery.
Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy.
Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders.
Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis.
Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers.
RNs who specialize by population provide preventive and acute care in all health care settings to the segment of the population in which they specialize, including newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). RNs also may provide basic health care treatment to patients outside of health care settings in such venues as including correctional facilities, schools, summer camps, and the military. Some LPNs & RPNs travel around the USA and the world providing health-care to patients in areas with shortage of health-care workers.
Most RNs work as staff nurses as members of a team providing critical health care. However, some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on the provision of primary care services.
Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health.
Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management.
Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care.
Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and health care. services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women's health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.
Some nurses have jobs that require little or no direct patient care, but still require an active RN license.
Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident.
Infection control nurses identify, track, and control infectious outbreaks in health care. facilities and develop programs for outbreak prevention and response to biological terrorism.
Nurse educators plan, develop, implement, and evaluate educational programs and curricula for the professional development of student nurses and RNs.
Nurse informaticists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses, and other health care. providers. RNs also may work as health care. consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors.
Work environment. Most RNs work in well-lit, 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 20 percent of RNs worked part time in 2008.
RNs may be in close contact with individuals who have infectious diseases and with toxic, harmful, or potentially hazardous compounds, solutions, and medications. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients.