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Registered /Practical Nurses Job Outlook
Significant Points
* Registered nurses constitute the largest health care
occupation, with 2.4 million jobs.
* About 3 out of 5 jobs are in hospitals.
* The three major educational paths to registered nursing
are a bachelor’s degree, an associate degree, and a diploma from an approved
nursing program.
* Registered nurses are projected to create the second
largest number of new jobs among all occupations; job opportunities in most
specialties and employment settings are expected to be excellent, with some
employers reporting difficulty in attracting and retaining enough RNs.
Nature of the Work
Registered nurses (RNs), regardless of specialty or work setting, perform
basic duties that include treating patients, educating patients and the public
about various medical conditions, and providing advice and emotional support
to patients’ family members. RNs record patients’ medical histories
and symptoms, help to perform diagnostic tests and analyze 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 illness or injury,
including post-treatment home care needs, diet and exercise programs, and self-administration
of medication and physical therapy. Some RNs also are trained to provide grief
counseling to family members of critically ill patients. RNs work to promote
general health by educating the public on various warning signs and symptoms
of disease and where to go for help. RNs also might run general health screening
or immunization clinics, blood drives, and public seminars on various conditions.
RNs can specialize in one or more patient care specialties. The most common
specialties can be divided into roughly four categories—by work setting
or type of treatment; disease, ailment, or condition; organ or body system
type; or population. RNs may combine specialties from more than one area—for
example, pediatric oncology or cardiac emergency—depending on personal
interest and employer needs.
RNs may specialize by work setting or by type of care provided. For example,
ambulatory care nurses treat patients with a variety of illnesses and injuries
on an outpatient basis, either in physicians’ offices or in clinics.
Some ambulatory care nurses are involved in telehealth, providing care and
advice through electronic communications media such as videoconferencing or
the Internet. Critical care nurses work in critical or intensive care hospital
units and provide care to patients with cardiovascular, respiratory, or pulmonary
failure. Emergency, or trauma, nurses work in hospital emergency departments
and treat patients with life-threatening conditions caused by accidents, heart
attacks, and strokes. Some emergency nurses are flight nurses, who provide
medical care to patients who must be flown by helicopter 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 care for patients who are recovering from surgery, accidents,
and childbirth. Hospice and palliative care nurses provide care for, and help
ease the pain of, terminally ill patients outside of hospitals. Infusion nurses
administer medications, fluids, and blood to patients through injections into
patients’ veins. Long- term care nurses provide medical services on a
recurring basis to patients with chronic physical or mental disorders. Medical-surgical
nurses provide basic medical care to a variety of patients in all health settings.
Occupational health nurses provide treatment for job-related injuries and illnesses
and help employers to detect workplace hazards and implement health and safety
standards. Perianesthesia nurses provide preoperative and postoperative care
to patients undergoing anesthesia during surgery. 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 nurses treat patients with personality and mood disorders.
Radiologic nurses provide care to patients undergoing diagnostic radiation
procedures such as ultrasounds and magnetic resonance imaging. 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 condition are employed
in virtually all work settings, including physicians’ offices, outpatient
treatment facilities, home health care agencies, and hospitals. For instance,
addictions nurses treat patients seeking help with alcohol, drug, and tobacco
addictions. Developmental disabilities nurses provide care for patients with
physical, mental, or behavioral disabilities; care may include help with feeding,
controlling bodily functions, and sitting or standing independently. 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 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 administer radiation
and chemotherapies. Finally, 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 specialty physicians’ offices or outpatient care facilities,
although some are employed in hospital specialty or critical care units. For
example, cardiac and vascular 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 specialize in endoscopic
procedures, 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.
Finally, RNs may specialize by providing preventive and acute care in all health
care settings to various segments of the population, including newborns (neonatology),
children and adolescents (pediatrics), adults, and the elderly (gerontology
or geriatrics). RNs also may provide basic health care to patients outside
of health care settings in such venues as including correctional facilities,
schools, summer camps, and the military. Some RNs travel around the United
States and abroad providing care to patients in areas with shortages of medical
professionals.
Most RNs work as staff nurses, providing critical health care services along
with physicians, surgeons, and other health care practitioners. However, some
RNs choose to become advanced practice nurses, who often are considered primary
health care practitioners and work independently or in collaboration with physicians.
For example, clinical nurse specialists provide direct patient care and expert
consultations in one of many of the nursing specialties listed above. Nurse
anesthetists administer anesthesia, monitor patient’s vital signs during
surgery, and provide post-anesthesia care. 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 provide
basic preventive health care to patients, and increasingly serve as primary
and specialty care providers in mainly medically underserved areas. The most
common areas of specialty for nurse practitioners are family practice, adult
practice, women’s health, pediatrics, acute care, and gerontology; however,
there are many other specialties. In most States, advanced practice nurses
can prescribe medications.
Some nurses have jobs that require little or no direct patient contact. Most
of these positions still require an active RN license. Case managers ensure
that all of the medical needs of patients with severe injuries and illnesses
are met, including the type, location, and duration of treatment. Forensics
nurses combine nursing with law enforcement by treating and investigating victims
of sexual assault, child abuse, or accidental death. Infection control nurses
identify, track, and control infectious outbreaks in health care facilities;
develop methods of outbreak prevention and biological terrorism responses;
and staff immunization clinics. Legal nurse consultants assist lawyers in medical
cases by interviewing patients and witnesses, organizing medical records, determining
damages and costs, locating evidence, and educating lawyers about medical issues.
Nurse administrators supervise nursing staff, establish work schedules and
budgets, and maintain medical supply inventories. Nurse educators teach student
nurses and also provide continuing education for RNs. Nurse informaticists
collect, store, and analyze nursing data in order to improve efficiency, reduce
risk, and improve patient care. RNs also may work as health care consultants,
public policy advisors, pharmaceutical and medical supply researchers and salespersons,
and medical writers and editors.
Working Conditions
Most RNs work in well-lighted, 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 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
office settings are more likely to work regular business hours. About 23 percent
of RNs worked part time in 2004, and 7 percent held more than one job.
Nursing has its hazards, especially in hospitals, nursing care facilities,
and clinics, where nurses may care for individuals with infectious diseases.
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, shocks from electrical
equipment, and hazards posed by compressed gases. RNs who work with critically
ill patients also may suffer emotional strain from observing patient suffering
and from close personal contact with patients’ families.
Training, Other Qualifications, and Advancement
In all States and the District of Columbia, students must graduate from an
approved nursing program and pass a national licensing examination, known as
the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed
in more than one State, either by examination or by the endorsement of a license
issued by another State. Currently 18 States participate in the Nurse Licensure
Compact Agreement, which allows nurses to practice in member States without
recertifying. All States require periodic renewal of licenses, which may involve
continuing education.
There are three major educational paths to registered nursing: A bachelor’s
of science degree in nursing (BSN), an associate degree in nursing (ADN), and
a diploma. BSN programs, offered by colleges and universities, take about 4
years to complete. In 2004, 674 nursing programs offered degrees at the bachelor’s
level. ADN programs, offered by community and junior colleges, take about 2
to 3 years to complete. About 846 RN programs in 2004 granted associate degrees.
Diploma programs, administered in hospitals, last about 3 years. Only 69 programs
offered diplomas in 2004. Generally, licensed graduates of any of the three
types of educational programs qualify for entry-level positions as staff nurses.
Many RNs with an ADN or diploma later enter bachelor’s programs to prepare
for a broader scope of nursing practice. Often, they can find a staff nurse
position and then take advantage of tuition reimbursement benefits to work
toward a BSN by completing an RN-to-BSN program. In 2004, there were 600 RN-to-BSN
programs in the United States. Accelerated master’s degree programs in
nursing also are available. These programs combine 1 year of an accelerated
BSN program with 2 years of graduate study. In 2004, there were 137 RN-to-MSN
programs.
Accelerated BSN programs also are available for individuals who have a bachelor’s
or higher degree in another field and who are interested in moving into nursing.
In 2004, more than 165 of these programs were available. Accelerated BSN programs
last 12 to 18 months and provide the fastest route to a BSN for individuals
who already hold a degree.
Individuals considering nursing should carefully weigh the advantages and disadvantages
of enrolling in a BSN program, because, if they do, their advancement opportunities
usually are broader. In fact, some career paths are open only to nurses with
a bachelor’s or master’s degree. A bachelor’s degree often
is necessary for administrative positions and is a prerequisite for admission
to graduate nursing programs in research, consulting, and teaching, and all
four advanced practice nursing specialties—clinical nurse specialists,
nurse anesthetists, nurse midwives, and nurse practitioners. Individuals who
complete a bachelor’s receive more training in areas such as communication,
leadership, and critical thinking, all of which are becoming more important
as nursing care becomes more complex. Additionally, bachelor’s degree
programs offer more clinical experience in nonhospital settings. In 2004, 417
nursing schools offered master’s degrees, 93 offered doctoral degrees,
and 46 offered accelerated BSN-to-doctoral programs.
All four advanced practice nursing specialties require at least a master’s
degree. Most programs last about 2 years and require a BSN degree and some
programs require at least 1 to 2 years of clinical experience as an RN for
admission. In 2004, there were 329 master’s and post-master’s programs
offered for nurse practitioners, 218 master’s and post-master’s
programs for clinical nurse specialists, 92 programs for nurse anesthetists,
and 45 programs for nurse midwives. Upon completion of a program, most advanced
practice nurses become nationally certified in their area of specialty. In
some States, certification in a specialty is required in order to practice
that specialty.
All nursing education programs include classroom instruction and supervised
clinical experience in hospitals and other health care facilities. Students
take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology
and other behavioral sciences, and nursing. Coursework also includes the liberal
arts for ADN and BSN students.
Supervised clinical experience is provided in hospital departments such as
pediatrics, psychiatry, maternity, and surgery. A growing number of programs
include clinical experience in nursing care facilities, public health departments,
home health agencies, and ambulatory clinics.
Nurses should be caring, sympathetic, responsible, and detail oriented. They
must be able to direct or supervise others, correctly assess patients’ conditions,
and determine when consultation is required. They need emotional stability
to cope with human suffering, emergencies, and other stresses.
Some RNs start their careers as licensed practical nurses or nursing aides,
and then go back to school to receive their RN degree. Most RNs begin as staff
nurses, and with experience and good performance often are promoted to more
responsible positions. In management, nurses can advance to assistant head
nurse or head nurse and, from there, to assistant director, director, and vice
president. Increasingly, management-level nursing positions require a graduate
or an advanced degree in nursing or health services administration. They also
require leadership, negotiation skills, and good judgment.
Some nurses move into the business side of health care. Their nursing expertise
and experience on a health care team equip them to manage ambulatory, acute,
home-based, and chronic care. Employers—including hospitals, insurance
companies, pharmaceutical manufacturers, and managed care organizations, among
others—need RNs for health planning and development, marketing, consulting,
policy development, and quality assurance. Other nurses work as college and
university faculty or conduct research.
Foreign-educated nurses wishing to work in the United States must obtain a
work visa. Applicants are required to undergo a review of their education and
licensing credentials and pass a nursing certification and English proficiency
exam, both conducted by the Commission on Graduates of Foreign Nursing Schools.
(The commission is an immigration-neutral, nonprofit organization that is recognized
internationally as an authority on credentials evaluation in the health care
field.) Applicants from Australia, Canada (except Quebec), Ireland, New Zealand,
and the United Kingdom are exempt from the language proficiency exam. In addition
to these national requirements, most States have their own requirements.
Employment
As the largest health care occupation, registered nurses held about 2.4 million
jobs in 2004. About 3 out of 5 jobs were in hospitals, in inpatient and outpatient
departments. Others worked in offices of physicians, nursing care facilities,
home health care services, employment services, government agencies, and outpatient
care centers. The remainder worked mostly in social assistance agencies and
educational services, public and private. About 1 in 4 RNs worked part time.
Job Outlook
Job opportunities for RNs in all specialties are expected to be excellent.
Employment of registered nurses is expected to grow much faster than average
for all occupations through 2014, and, because the occupation is very large,
many new jobs will result. In fact, registered nurses are projected to create
the second largest number of new jobs among all occupations. Thousands of job
openings also will result from the need to replace experienced nurses who leave
the occupation, especially as the median age of the registered nurse population
continues to rise.
Much faster-than-average growth will be driven by technological advances in
patient care, which permit a greater number of medical problems to be treated,
and by an increasing emphasis on preventive care. In addition, the number of
older people, who are much more likely than younger people to need nursing
care, is projected to grow rapidly.
Employers in some parts of the country and in certain employment settings are
reporting difficulty in attracting and retaining an adequate number of RNs,
primarily because of an aging RN workforce and a lack of younger workers to
fill positions. Enrollments in nursing programs at all levels have increased
more rapidly in the past couple of years as students seek jobs with stable
employment. However, many qualified applicants are being turned away because
of a shortage of nursing faculty to teach classes. The need for nursing faculty
will only increase as a large number of instructors nears retirement. Many
employers also are relying on foreign-educated nurses to fill open positions.
Even though employment opportunities for all nursing specialties are expected
to be excellent, they can vary by employment setting. For example, employment
is expected to grow more slowly in hospitals—which comprise health care’s
largest industry—than in most other health care industries. While the
intensity of nursing care is likely to increase, requiring more nurses per
patient, the number of inpatients (those who remain in the hospital for more
than 24 hours) is not likely to grow by much. Patients are being discharged
earlier, and more procedures are being done on an outpatient basis, both inside
and outside hospitals. Rapid growth is expected in hospital outpatient facilities,
such as those providing same-day surgery, rehabilitation, and chemotherapy.
Despite the slower employment growth in hospitals, job opportunities should
still be excellent because of the relatively high turnover of hospital nurses.
RNs working in hospitals frequently work overtime and night and weekend shifts
and also treat seriously ill and injured patients, all of which can contribute
to stress and burnout. Hospital departments in which these working conditions
occur most frequently—critical care units, emergency departments, and
operating rooms—generally will have more job openings than other departments.
To attract and retain qualified nurses, hospitals may offer signing bonuses,
family-friendly work schedules, or subsidized training. A growing number of
hospitals also are experimenting with online bidding to fill open shifts, in
which nurses can volunteer to fill open shifts at premium wages. This can decrease
the amount of mandatory overtime that nurses are required to work.
More and more sophisticated procedures, once performed only in hospitals, are
being performed in physicians’ offices and in outpatient care centers,
such as freestanding ambulatory surgical and emergency centers. Accordingly,
employment is expected to grow much faster than average in these places as
health care in general expands. However, RNs may face greater competition for
these positions because they generally offer regular working hours and more
comfortable working environments.
Employment in nursing care facilities is expected to grow faster than average
because of increases in the number of elderly, many of whom require long-term
care. In addition, the financial pressure on hospitals to discharge patients
as soon as possible should produce more admissions to nursing care facilities.
Job growth also is expected in units that provide specialized long-term rehabilitation
for stroke and head injury patients, as well as units that treat Alzheimer’s
victims.
Employment in home health care is expected to increase rapidly in response
to the growing number of older persons with functional disabilities, consumer
preference for care in the home, and technological advances that make it possible
to bring increasingly complex treatments into the home. The type of care demanded
will require nurses who are able to perform complex procedures.
Generally, RNs with at least a bachelor’s degree will have better job
prospects than those without a bachelor’s. In addition, all four advanced
practice specialties—clinical nurse specialists, nurse practitioners,
midwives, and anesthetists—will be in high demand, particularly in medically
underserved areas such as inner cities and rural areas. Relative to physicians,
these RNs increasingly serve as lower-cost primary care providers.
Earnings
Median annual earnings of registered nurses were $52,330 in May 2004. The
middle 50 percent earned between $43,370 and $63,360. The lowest 10 percent
earned less than $37,300, and the highest 10 percent earned more than $74,760.
Median annual earnings in the industries employing the largest numbers of registered
nurses in May 2004 were as follows:
Employment services $63,170
General medical and surgical hospitals $53,450
Home health care services $48,990
Offices of physicians $48,250
Nursing care facilities $48,220
Suggested citation: Bureau of Labor Statistics, U.S. Department of Labor,
Occupational Outlook Handbook, 2006-07 Edition, Registered Nurses, on the Internet
at http://www.bls.gov/oco/ocos080.htm (visited September 08, 2006).
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