Job Report Registered Nurses

Job Report Registered Nurses

Published 1996

Mascor Publishing Co.

P.O. Box 8308

Silver Spring, MD 20907

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.