Career Overview: Nursing

Posted by The Editors on December 3, 2012

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.


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.

Job Outlook

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.

Career Tracks

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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