Nursing
It's a great time to be a nurse. According to the U.S. Bureau of Labor
Statistics, more than one million new nurses will be needed by 2012. It
even named registered nursing as the top occupation in terms of job growth
through the same year. There are a number of reasons for this, chief among
them the changing demographic makeup of the United States.
The Baby Boomers are aging, and needing more health care than ever as a
result. They are also retiring, leaving large numbers of open positions in
the nursing field. This translates to strong demand for new nurses,
especially in hospitals, long-term care facilities, and home health-care
settings. The forecast for specialty nursing is also excellent, especially
with increasingly sophisticated procedures that are moving out of the
hospitals and into doctor's offices and outpatient centers.
The gap between that demand and the supply of nursing job candidates is so
out of whack in some regions that nurses are making $65,000 and $70,000,
and nurse practitioners are making six figures. The downside (there's
always a downside, isn't there?) of the nursing shortage becomes clear
once you accept one of those high-paying jobs. Because of staffing
shortages, nurses are finding themselves saddled with increasing patient
loads. In some organizations today, nurses are under significant pressure
to work overtime.
Nurses work all over the country: in small-town hospitals, private clinics,
public schools and universities, government public-health agencies, the
military, and big-city hospitals. Nurses can work in specialty areas such
as critical care, the emergency room, maternity, the operating room,
pediatrics, or trauma. Others in nursing include nursing educators, nurse
epidemiologists, and quality assurance nurses, as well as nursing
professionals with master's degrees (and, typically, higher salaries)
such as certified nurse midwives, nurse anesthetists, and nurse
practitioners. Some in the field even go on to get their PhD in nursing.
What You'll Do
Wherever they are situated, nurses work within the health care industry and
promote the health of their patients. Nurses provide direct patient care in
hospitals (which account for two out of three nursing jobs), take care of
hospitals' daily regimen of recording patients' vital signs (such
as blood pressure), and ensure that medications (including intravenous
fluids and other treatments) are administered properly.
Nurses also observe and examine patients, sometimes recommending that a
physician investigate a particular problem. And although a large part of a
nurse's job is to follow physicians' orders, nurses also have
duties separate from those of a doctor.
Unlike doctors, who generally work to cure a specific ailment, nurses
concern themselves with a patient's entire well-being. They spend time
consulting with patients about their diet, hygiene, and the best way to
administer patients' medications. Nurses working outside of hospitals
don't necessarily deal with the same problems, but they still advise
patients, families, and communities on a variety of health care issues.
Who Does Well
Nurses need to be compassionate. They also need to understand complex
scientific principles relating to biology and physiology, and work with
increasingly complicated medical equipment. And they need to be able to
accept responsibility and follow directions precisely.
Types of Nursing
Education generally determines a nurse's salary, position, and job
location. Depending on a particular nurse's education and credentials,
he or she might find work as a nurses' aide, a licensed practical nurse
(LPN), a registered nurse (RN), or an advanced practice nurse such as a
nurse practitioner (NP) or a certified registered nurse anesthetist (CRNA).
On a continuum, nurses' aides, who have the least training, get paid
the least and have less responsibility than advanced practice nurses, who
must complete several years of postgraduate education and pass national
certification exams.
Whatever a nurse's job title, all nurses are blessed with being able to
work wherever they might live. In fact, nursing is one of the most flexible
careers, providing opportunities ranging from part-time work for someone
going back to school or raising a family, to full-time salaried positions
with great degrees of responsibility, and workloads to match. Simply put,
until people develop higher thresholds for pain, few nurses will find
themselves out of work.
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Fifty years ago, virtually all registered nurses working in hospitals were
graduates of hospital nursing programs. Such "diploma schools"
generally required 3 years of study. Then, in 1952, when the Korean War
precipitated a need for more nurses, associate degree programs were
introduced. Such programs, primarily administered by community and
technical colleges, require two years of study outside of the hospital
setting. In 1965, however, the American Association of Nurses called for
all nurses to get four-year degrees from universities.
All three routes to becoming a registered nurse have survived. Today,
however, hospital programs are greatly on the wane. Currently, about
two-thirds of all RNs come from associate programs and the other third from
four-year degree programs.
Once school's finished, you'll have to meet your state board's
requirements and pass the NCLEX-RN exam.
There's been some talk about splitting up the field of nursing into
"professional nurses," for those who have four-year degrees, and
"technical nurses," for those with associate degrees. North
Dakota even went so far as to require a four-year bachelor's degree,
and other states may follow suit. Currently, however, either route can lead
you to a job as a staff nurse at a hospital.
Why Get Extra Training?
Some jobs in nursing—such as a position as a public health nurse—require
the four-year degree. Plus, hospitals are more likely to promote a staff
nurse with a college degree to a supervisory (and higher paying) role. And
finally, to become an advanced practice nurse—such as a nurse practitioner
or certified nurse anesthetist, you have to have a bachelor's degree
first.
With a bachelor's degree out of the way, graduate school is open to
nurses who want to climb the career ladder and get an advanced practice
degree. Most degrees require an extra two to three years of postgraduate
study. Once that's done, you'll need to pass a national examination
to become certified.
To become a licensed practical nurse, you'll need to complete a
state-approved practical nursing program. Such programs are generally
offered at community and technical colleges and last one to two years. Then
you'll need to pass a state-administered licensing examination. Again,
each state has its own rules and regulations.
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The future looks bright in the nursing field. The outlook for new RNs is
exceptionally good; the number of new jobs for registered nurses is
expected to increase at a rate far greater than that of most other jobs in
coming years.
In terms of how the nursing profession is expected to change, nearly one
out of every eight Americans is older than 65—a number that's expected
to grow. In fact, according to the U.S. Census Bureau, the size of the
elderly population will almost double by the year 2050, meaning one out of
every five Americans will be a senior citizen.
At the same time as the population is aging, hospitals are downsizing. The
average duration of patients' stays at hospitals is down, and home
treatment is rising.
In other words, hospitals, which currently employ the most RNs, won't
be where the new opportunities develop. Instead, RNs will increasingly find
work outside hospitals in home-health and ambulatory care and in nursing
homes. Similarly, licensed practical nurses and nurses' aides should
expect to find more opportunities outside of hospitals. There will also be
an increasing number of jobs available in preventative care, due to
technological advances in medical problems and related treatments.
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While all nurses are concerned with improving the welfare of their
patients, the nature of an individual nurse's day-to-day work depends
heavily on his or her experience, education, certification, and employer.
Hospital Registered Nurses
Like all nurses, staff nurses in hospitals assess their patients'
conditions, administer medications, interpret and carry out physicians'
orders, and make sure their patients are comfortable and being taken care
of properly.
Yet registered nurses at hospitals don't all do the same job; the size
of the hospital has a major effect on the day-to-day work performed by a
registered nurse.
At larger hospitals (more often found in urban areas), nurses generally
have a higher level of specialization. At any given time, a nurse works in
a specific area of the hospital, such as the emergency room, the intensive
care unit (ICU), the operating room, or a specific floor of the hospital
that specializes in such areas as cardiology or oncology.
Each work environment has a specific set of skills that nurses need to
acquire to administer competent care. As one industry insider puts it,
"A scrub nurse who works in an operating room might never deal with
patients while they're awake. As you can imagine, their job is quite
different from the nurse who works in outpatient surgery and on a daily
basis is interacting with patients face-to-face to make sure they're
recovering and comfortable."
At smaller, rural hospitals, there are fewer areas of specialization.
Consequently, nurses at such facilities have to wear many more hats than
nurses at larger hospitals—generally, nurses at smaller hospitals work in
multiple areas. A single day might be taken up assisting doctors with minor
surgeries, taking care of newborn babies, and then finishing up the
paperwork for the day and scheduling appointments.
Non-Hospital Registered Nurses
One of the fastest-growing segments of nursing is home health nursing.
Often employed by private agencies or hospitals, home health nurses visit a
patient's home to assess his or her condition and carry out
instructions prescribed by the patient's physician.
Nursing homes are also employing registered nurses in increasing numbers,
due to a surging elderly population suffering from a disparate range of
illnesses associated with aging. In nursing homes, registered nurses
generally carry out supervisory tasks, administrative duties, assess
medical conditions, and develop treatment plans to make sure basic health
needs are being met.
Other employers of registered nurses include clinics, surgical centers,
emergency rooms, health maintenance organizations (HMOs); government and
private agencies where nurses instruct people on health education,
nutrition, child care, and disease prevention; and schools and companies
that require on-site nurses to care for students or employees.
Advanced Practice Nurses
Advanced practice nurses—registered nurses with special training—are taking
jobs that traditionally went to medical nurses. Certified registered nurse
anesthetists (CRNAs), for instance, deliver anesthetics to patients in a
variety of health care settings, such as operating rooms, ambulances, and
even dentists' offices. In fact, CRNAs deliver more than 65 percent of
all anesthetics nationwide. Nurse-midwives specialize in delivering babies
and in women's health issues associated with obstetrics.
Nurse practitioners (NPs) work in a wide range of settings, from large
hospitals to small clinics to individual practices, administering pediatric
care, generally to poorer patients. NPs perform many tasks previously
handled only by doctors, such as diagnosing patients. In most states, NPs
also have prescription-writing privileges.
Clinical nurse specialists (CNS), like NPs, can make diagnoses and, in most
states, can also write prescriptions. Most are trained in a specific area
of expertise, such as oncology, pediatrics, or obstetrics, and get
certified to work within that area.
Licensed Practical Nurses
In hospitals, licensed practical nurses (LPNs) (also known as licensed
vocational nurses) carry out basic bedside care such as taking
temperatures, preparing and giving injections, and collecting blood and
fluid samples. LPNs who work in clinics or doctors' offices may also be
hired to complete basic administrative tasks, such as making appointments
and keeping records.
LPNs work under the direct supervision of physicians or registered nurses
and generally make many less decisions than RNs. However, they generally
have more responsibilities than nurses' aides and in most states are
allowed to administer prescription medications.
Nurses' Aides
If you want to work with the sick but are wary of tackling the formal
rigors required to become a registered nurse, becoming a nurses' aide
will get you into the thick of patient care. Nurses' aides help staff
nurses in hospitals, nursing homes, home-care settings, and psychiatric
wards with such tasks as bathing and feeding patients and taking
temperatures. Training can easily be done in high school or college. For
those considering nursing as a career option, becoming a nurses' aide
is a great way to get an inside look at the industry.
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Following are average salary ranges for several nursing professions:
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Case manager RN: $65,000 to $165,000
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CCU nurse: $48,000 to $62,000
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Community health nurse: $35,000 to $56,000
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Emergency room nurse: $42,000 to $67,000
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Gerontology nurse: $38,000 to $92,000
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Licensed practical nurse: $35,000 to $41,000
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Nurse assistant: $21,000 to $27,000
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Nurse midwife: $47,000 to $86,000
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Nurse practitioner: $59,000 to $123,000
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Nurse supervisor: $53,000 to $81,000
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Registered nurse: $38,000 to $64,000
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School nurse: $19,000 to $40,000