Job Outlook for Registered Nurse

     Overall job opportunities for registered nurses 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. Employment of RNs is expected to grow much faster than the average and, because the occupation is very large, 581,500 new jobs will result, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation.
Employment change. Employment of registered nurses is expected to grow by 22 percent from 2008 to 2018, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health 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.
However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are:

Industry	Percent
Offices of physicians	48
Home health care services	33
Nursing care facilities	25
Employment services	24
Hospitals, public and private	17

Employment is expected to grow more slowly in hospitals—healthcare's largest industry—than in most other healthcare 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.
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 fast in these places as healthcare in general expands.
Employment in nursing care facilities is expected to grow because of increases in the number of older persons, many of whom require long-term care. Many elderly patients want to be treated at home or in residential care facilities, which will drive demand for RNs in those settings. The financial pressure on hospitals to discharge patients as soon as possible should produce more admissions to nursing and residential care facilities and referrals to home healthcare. 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 healthcare is expected to increase 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.
Job prospects. Overall job opportunities are expected to be excellent for registered nurses. Employers in some parts of the country and in certain employment settings report 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. Qualified applicants to nursing schools are being turned away because of a shortage of nursing faculty. The need for nursing faculty will only increase as many instructors near retirement. Despite the slower employment growth in hospitals, job opportunities should still be excellent because of the relatively high turnover of hospital nurses. To attract and retain qualified nurses, hospitals may offer signing bonuses, family-friendly work schedules, or subsidized training. Although faster employment growth is projected in physicians' offices and outpatient care centers, RNs may face greater competition for these positions because they generally offer regular working hours and more comfortable working environments. 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, nurse-midwives, and nurse 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.

Projections Data 

Projections data from the National Employment Matrix

Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Change, 2008-18		Detailed Statistics
				Number	Percent
Registered nurses	29-1111	2,618,700	3,200,200	581,500	22
NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter on Occupational Information Included in the Handbook.

Earnings 

Median annual wages of registered nurses were $62,450 in May 2008. The middle 50 percent earned between $51,640 and $76,570. The lowest 10 percent earned less than $43,410, and the highest 10 percent earned more than $92,240. Median annual wages in the industries employing the largest numbers of registered nurses in May 2008 were:

Employment services	$68,160
General medical and surgical hospitals	63,880
Offices of physicians	59,210
Home health care services	58,740
Nursing care facilities	57,060

Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.

Registered Nurses's nature of work

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 symptoms, help 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 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 healthcare clinicians. Some RNs provide direction to licensed practical nurses and nursing aides regarding patient care. (See the statements on licensed practical and licensed vocational nurses; nursing and psychiatric aides; and home health aides elsewhere in the Handbook). 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 perioperative 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 telehealth, providing care and advice through electronic communications media such as videoconferencing, 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 healthcare 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 healthcare 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 healthcare condition are employed in virtually all work settings, including physicians' offices, outpatient treatment facilities, home healthcare 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 healthcare 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 healthcare to patients outside of healthcare settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and throughout the world providing care to patients in areas with shortages of healthcare workers.
Most RNs work as staff nurses as members of a team providing critical healthcare. 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 healthcare 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 healthcare 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 healthcare providers. RNs also may work as healthcare 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 healthcare 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.

Registered nurses teach patients and their families how to manage their illness or injury.

Nursing Shortage in United States"Overview"

United States

According to the American National Council of State Boards of Nursing, the number of U.S. trained nurses has been increasing over the past decade: In 2000, 71,475 U.S. trained nurses became newly licensed. In 2005, 99,187 U.S. trained nurses became newly licensed. In 2009, 134,708 U.S. trained nurses became newly licensed. Therefore, a 9.8% annual increase of newly licensed U.S. nurses has been observed each year over the past 9 years. It is clear that, nursing enrollment in the U.S. has significantly increased over the past decade relative to the 1.19% annual U.S. population growth.
While the number of U.S. trained licensed nurses has increased each year, the projected nursing demand growth rate from 2008–2018, as reported by the U.S. Bureau of Labor Statistics is anticipated to be a 22%, or 2.12% annually. Therefore, the 9.8% annual growth of new R.N.'s exceeds the current new position growth rate by a net of 7.7% per year with the assumption of consistent growth figures over the next decade.
The US population is projected to grow at least 18% over two decades in the 21st century, while the population of those 65 and older is expected to increase three times that rate.The current shortfall of nurses is projected at over 1 million by the year 2020.

Professional and related occupations are expected to rapidly increase between years 2000–2012. The demand for healthcare practitioners and technical occupations will continue to increase. It is projected that there will be 1.7 million job openings between 2000 and 2012. The demand for registered nurses is even higher. Registered nurses are predicted to have a total of 1,101,000 openings due to growth during this 10 year period. In a 2001 American Hospital Association survey, 715 hospitals reported that 126,000 nursing positions were unfilled.

However, other research findings report a projection of opposite trend. Although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing personnel to substitute for nurses. With the decrease in employment, the earnings for nurses also decreased. Wage among nurses leveled off in correlation with inflation between 1990 and 1994.The recent economic crisis of 2009 has further decreased the demand for RN's.

Comparing the data released by the Bureau of Health Professions, the projections of shortage within two years have increased.

Year	Supply	Demand	Shortage	Percent
2000	1,889,243	1,999,950	-110,707	-6%
2005	2,012,444	2,161,831	-149,387	-7%
2010	2,069,369	2,344,584	-275,215	-12%
2015	2,055,491	2,562,554	-507,063	-20%
2020	2,001,998	2,810,414	-808,416	-28.8%

US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions (2002)
However, emergency and acute care nurses are still in great demand, and this temporary reduction of the shortage is not expected to last as the economy improves. In 2009, it was reported that in places like Des Moines, Iowa that newly graduated nurses are having more difficulty finding jobs and older nurses are delaying retirement due to economic conditions. This hiring situation was mostly found in hospitals; whereas nursing homes continued to hire and recruit nurses in strong numbers.
Some states are have a surplus of nurses while other states face a shortage. This is due to factors such as the number of new graduates and the total demand for nurses in each area. Some states face a severe shortage (such as the Northwestern states, as well as Texas and OK), while other states actually have a surplus of registered nurses.

Year	Supply	Demand	Shortage	Percent
2000	1,890,700	2,001,500	-110,800	-6%
2005	1,942,500	2,161,300	-218,800	-10%
2010	1,941,200	2,347,000	-405,800	-17%
2015	1,886,100	2,569,800	-683,700	-27%
2020	1,808,000	2,824,900	-1,016,900	-36%

US: Supply versus Demand Projections for FTE Registered Nurses
Source: Data from the Bureau of Health Professions. (2004).

Patching up the shortage

Nursing shortages can be consistent or intermittent depending on the current number of patients needing medical attention. Retention and recruitment are important methods to achieve a long-term solution to the nursing shortage. Recruitment is promoted through ways of making nursing attractive as a profession, especially to younger workers to counteract the high average age of RNs and therefore future waves of retirement. Additionally, financial opportunities such as signing bonuses can attract more nurses.
To assist the health sector, Congress approved the Nurse Reinvestment Act passed in 2002 to provide funding to advance nursing education, scholarships, grants, diversity programs, loan repayment programs, nursing faculty programs, and comprehensive geriatric education.Currently, mandatory overtime for nurses is prohibited in nine states, hospital accountability to implement valid staffing plans in seven states, and only one state implement the minimum staffing ratio.
In order to respond to fluctuating needs in the short term, health care industries have utilized float pool nurses and agency nurses. Float pool nurses are nursing staffs employed by the hospital to work in any unit within the organization. Agency nurses are employed by an independent staffing organization and have the opportunity to work in any hospitals on a daily, weekly or contractual basis. Similar to other professionals, both types of nurses can only work within their licensed scope of practice, training, and certification.
Float pool nurses and agency nurses, as mentioned by First Consulting group, are currently used in response to the current shortage. Use of the said services increases the cost of healthcare, decreases specialty, and decreases the interest in long-term solutions to the shortage.
International recruitment is often used to fill the nursing gap but gives rise to concern of late now that the U.S. Homeland Security has stopped the issuance of the H-1C visa, which was deemed specifically for Nurses. "Obama Health Care Reform", which will result in every American being insured, it is estimated that there will be an even greater need for Nurses. U.S. trained nurses are concerned, however, that this recruitment initiative impedes on their ability to obtain positions in the field after completing their training. A nursing shortage does not translate to new nursing jobs. Any increase in demand will likely increase the nurse patient ratio and risk patient safety. It is predicted by the National Healthcare Organization, that the entire U.S. Healthcare system will come crumbling down because nurses are the core foundation of all healthcare. The issue is not in the supply of nurses, but the number of positions available in U.S. hospitals to cover the high nurse to patient ratios. Recruitment focus should geared toward under-served areas.
A growing response to the nursing shortage is the advent of travel nursing a specialized sub-set of the staffing agency industry that has evolved to serve the needs of hospitals affected by the increasing nursing shortage. According to the Professional Association of Nurse Travelers, there are an estimated 25,500 Registered Nurse Travelers working in the U.S. The number of LVN/LPN Nurse Travelers is not known.
There is a nursing recruitment initiative and nursing workforce development program for residents of the United States originally from foreign countries, who were professional nurses in their countries but are no longer in that profession in the United States. This initiative helps these nurses get back into the nursing profession, especially getting through credentialing and the nursing board exams.The original model was developed in 2001 at San Francisco State University in cooperation with City College of San Francisco ("The San Francisco Welcome Back Center") and there are centers in many cities, such as Los Angeles, San Diego, and Boston, Massachusetts, where it is called a "Boston Welcome Back Center for Internationally Educated Nurses". It is a program meant for residents of the United States only, not others who are overseas wishing to practice in the United States. The Boston Welcome Back Center was opened in October 2005 with a $50,000 seed grant from the Board of Higher Education’s Nursing Initiative.

 Legislation

In September 2007, in the 110th Congress, Senator Richard Durbin of Illinois introduced S.2064: Nurse Training and Retention Act of 2007 on the floor of the Senate. It was a bill to fund comprehensive programs to ensure an adequate supply of nurses. It was referred to committee for study but was never reported on by the committee.
In April 2008, in the 110th Congress, H.R. 5924: Emergency Nursing Supply Relief Act was introduced as a bill to the House of Representatives by Robert Wexler of Florida. If it had passed, it would have amended the American Competitiveness in the Twenty-first Century Act of 2000 and would have given up to 20,000 visas per year to nurses and physical therapists until September 2011. Immediate family members of visa beneficiaries would not be counted against the 20,000 yearly cap. The bill was referred to committees for study in Congress but was never reported on by the committees.
On February 11, 2009, legislation was introduced by Representatives John Shadegg (R-AZ), Jeff Flake (R-AZ), and Ed Pastor (D-AZ) in the 111th Congress to the House of Representatives, HR 1001 ("The Nursing Relief Act of 2009" : To create a new non-immigrant visa category for registered nurses, and for other purposes) making a new non-immigrant "W" visa category for nurses to be able to work in the United States. This was to relieve the nursing shortage still considered to be a crisis despite the economic problems in the country. The proposed bill was referred to the Committee on the Judiciary but was never reported on by Committee.

 Immigration Process to U.S.

Nurses seeking to immigrate to the U.S. can either apply as direct hires or through a recruitment agency. For entry to the U.S. a foreign nurse must pass a Visa Screen which includes three parts of the process. First they must pass a creditable review, followed by a test of nursing knowledge called the Commission on Graduates of Foreign Nursing Schools examination (CGFNS), and finally a test of English-language proficiency.
Foreign nurses compete amongst themselves, with professionals, and other skilled workers for 140,000 employment-based viases (EB) every year. The Filipino nurses are only allocated 2,800 visas per year, thereby creating a backlog among applicants. For example, in September 2009, 56,896 Filipinos were waiting for EB-3 visa numbers. This number contrasts with the 95,000 nurses licensed in 2009, many of whom want to migrate to the U.S. Once a nurse obtains a visa number and is approved for a visa and authorized to work in the U.S., they must pass the National Council Licensure Examination to qualify for U.S. nursing standards.
Scholars point out that the use of foreign nurses prolongs the underlying issues of the nursing shortage. As a result, many of the problems with the U.S. health system will continue until addressed by a more long-term solution. For example, the unemployment rate in the Philippines was 7.5% in 2009 according to the CIA World Factbook; it was 10.6% in the US as of February 2009 according to the U.S. Bureau of Labor Statistics. Thousands of U.S. licensed newly trained nurses remain unemployed and are forced to leave the profession while thousands of seasoned nurses return to the profession to help their families make ends meet.

Immigration: More Foreign Nurses Needed?

The U.S. nurse shortage is getting worse, but are more visas the answer—or would improved training capacity, working conditions, and pay do the trick? 

 

For more than a decade, the U.S. has faced a shortage of nurses to staff hospitals and nursing homes. While the current recession has encouraged some who had left the profession to return, about 100,000 positions remain unfilled. Experts say that if more is not done to entice people to enter the field—and to expand the U.S.'s nurse-training capacity—that number could triple or quadruple by 2025. President Barack Obama's goal of expanding health coverage to millions of the uninsured could also face additional hurdles if the supply of nurses can't meet the demand.
Some lawmakers are looking to the immigration pipeline as one means to raise staffing levels. In May, Representative Robert Wexler (D-Fla.) introduced a bill that would allow 20,000 additional nurses to enter the U.S. each year for the next three years as a temporary measure to fill the gap. If the bill doesn't pass on its own, lawmakers may include it in a comprehensive immigration reform package. Obama is slated to meet with congressional leaders on June 25 to discuss reforming U.S. immigration laws.
Hospital administrators such as William R. Moore in El Centro, Calif., a sparsely populated town 100 miles east of San Diego, see the Wexler bill as a potential life raft. Moore is chief human resources director at El Centro Regional Medical Center, a 135-bed public hospital that typically has 30 open positions for registered nurses (RNs). While it's hard to lure nurses from nearby big cities (San Diego is 100 miles west), Moore says he could quickly recruit dozens of eager, qualified nurses from the Philippines if the government allocated more visas. "All we want is temporary relief," says Moore. "Let us get a group of experienced RN hires from the Philippines, and we won't ask for more."

Obama begs to differ

Wexler's bill is opposed by labor unions, whose leaders say it would undermine efforts to produce a steady domestic workforce while sapping other nations' nurses. Obama has also expressed skepticism about the idea that the U.S. needs to import nurses, in particular because the U.S. unemployment rate continues to rise. "The notion that we would have to import nurses makes absolutely no sense," Obama said at a health-care forum in March. "There are a lot of people [in the U.S.] who would love to be in that helping profession, and yet we just aren't providing the resources to get them trained—that's something we've got to fix." The $787 billion economic stimulus bill included $500 million to address shortages of health workers in the U.S., with about $100 million to promote nursing and increase capacity at U.S. nurse-training schools.
The nursing shortage has a number of causes, including an aging workforce, difficult working conditions coupled with stagnating pay, and a lack of capacity at U.S. nursing schools. Peter I. Buerhaus, professor of nursing at Vanderbilt University Medical Center, says the recession has eased the nurse shortage in some areas of the U.S. as more Americans seek out the field's relative job security. Some hospitals also see less need for staff as more Americans lose health insurance and fewer people spend money on elective surgery and doctor visits. But Buerhaus estimates that by 2025 the nurse deficit will be twice as severe as the last major staffing shortage in the mid-1960s, after Congress passed the Medicare and Medicaid programs.
As openings have become more difficult to fill domestically, more foreign-born nurses have entered the workforce, most commonly through green cards that allow for permanent residency.
In 1994, 9% of the total registered nurse workforce was composed of foreign-born RNs; by 2008 that percentage had risen to 16.3%, or about 400,000 RNs, according to Buerhaus' research. Of those 400,000 nurses, about 10% had immigrated to the U.S. within the previous five years. About one-third of the increase in RNs from 2001 to 2008 was composed of foreign-born RNs.

Many U.S. nurses choosing not to work

The trend worries leaders of nurses' unions, who say importing workers can lower incentives to improve working conditions. Understaffing, mandatory overtime, and physically demanding work, such as lifting and bathing patients, take their toll. And while pay has risen in some regions to attract more nurses, in recent years it has flattened at the national level. That's why up to 500,000 registered nurses are choosing not to practice their profession—fully one-fifth of the current RN workforce of 2.5 million. Union leaders say the down economy is a chance to bring these nurses back into the field. "If unemployment is spiking, why do we need to bring in nurses from another country?" asks Ann Converso, president of United American Nurses, which represents 50,000 RNs. "We believe thousands and thousands of RNs would rejoin the profession if conditions improved." Converso says she doesn't oppose all overseas recruitment, but that lawmakers' focus should be on improving staffing ratios in hospitals to improve working conditions. "We have to again allow nurses to do what they do best: care for human beings," she says.
Mick Whitley, managing director of London-based global health-care staffing firm HCL International, says there's no need for alarm about foreign nurses. He points out that since 2006 it has become increasingly difficult for foreign-born nurses to obtain green cards to work in the U.S.; an applicant backlog has built up as annual quotas have been reached. "While patients in U.S. hospitals wait and suffer from a lack of sufficient care, experienced and caring internationally trained nurses who want to come here to help are also waiting [for a green card] for as long as seven years," says Whitley, a former nurse in the U.K. and Australia. "It's great that President Obama has committed more money to expanding health care, but the nurses that will be necessary to staff such expansions are nowhere to be found—at least not here, not yet."
Moore of El Centro Regional Medical Center says his hospital has been waiting for two years for 20 Philippine nurses he recruited to obtain visas. He says in the meantime he's unable to find talent in the area. "We're in the poorest and least literate county in California, right in the middle of the desert," says Moore. "We're not a destination for [American] nurses." Moore has had success hiring Philippine nurses, many of whom choose to stay and settle in El Centro. To them the U.S. "is the land of milk and honey, and the streets are paved in gold," says Moore. "They're not so particular."
Moore denies he wants to hire foreign-born talent to hold down wages. "We pay [a nurse] fresh out of school $28 an hour and $35-$40 with experience," he says.
One point everyone seems to agree on is that the U.S. needs more capacity to train nurses. Since 2002, enrollments at nursing schools have increased so much that up to 50,000 qualified applicants are turned away each year from training programs. The main problem is a lack of teaching staff at these schools. Dan Stultz, president of the Texas Hospital Assn., which represents more than 500 Texas hospitals, helped form the Texas Nursing Workforce Shortage Coalition to push for funding from the state legislature to boost capacity at Texas nursing schools. Stultz says the state has about 22,000 nurse vacancies now, and that the number could rise to 70,000 by 2020. Meanwhile, for the last five years, 8,000 to 12,000 nursing-student applicants have been denied places at training programs for lack of space. "We have qualified people that get accepted and can't attend," says Stultz. "We don't need more immigration; we need to increase capacity and grow our own workforce."

Best Careers 2011: Registered Nurse

As one of the 50 Best Careers of 2011, this should have strong growth over the next decade

The rundown:
From the squeal of a newborn facing the world for the first time to the final heartbeat tolling the end of a life—and all the flu shots, broken bones, mammograms, weigh-ins, and check-ups in between—nurses play a central role in the milestones and minutiae of most Americans' lives. As one of more than 2.6 million registered nurses, it may be your job to explain a prescription to a patient, start an intravenous drip, check and record vital signs, or provide care to a patient being transported by helicopter (as a transport nurse). Or you might treat patients with mood disorders as a mental health nurse. There are plenty of specialties. You could focus on the care of transplant patients and living donors as a transplant nurse, or even provide alternative health preparations and preventive care as a holistic nurse.

The outlook:
Nursing has flourished throughout the recession, compared with most other occupations. Job growth is expected to be much faster than average—the country is expected to add 582,000 new R.N. jobs by 2018, a growth rate of more than 22 percent, the Labor Department projects. The greatest growth within the profession will be in physicians' offices.

Money:
The median salary in 2009 was $63,750. The lowest-paid 10 percent earned less than $44,000, while the highest-paid 10 percent earned more than $93,000.

Upward mobility:
As you gain experience, you may ascend the ladder into management roles such as unit manager or head nurse, and up into director or chief nurse positions. Many nurses choose to pursue master's degrees in advanced practice nursing specialties, such as a nurse practitioner or nurse anesthetist.

Activity level:
Variable but generally pretty high. You're likely to spend much of your time on your feet, caring for patients and assisting in operating rooms.

Stress level:
Sometimes high. Schedules can include a lot of graveyard shifts, weekends, and holidays. Caring for patients and their families and friends can be emotionally draining. Also prepare for the occasional ethical dilemma over treatment.

Education and preparation:
The most common path to an entry-level nursing job is a bachelor of science degree in nursing or an associate's degree. The two-year associate's degree is a quicker and more economical route, but many graduates of associate's programs eventually aim to complete a bachelor's degree for a more comprehensive nursing education. For people who have already earned a bachelor's degree in a different field, accelerated B.S.N. degree programs can last from 12 to 18 months.

Real advice from real people about landing a job as a registered nurse:
While clinical and technical nursing skills are a must-have, the skills that set the successful RN apart from the rest are not the ones learned in a textbook; they are human skills like the ability to work in a team, strong customer/patient service skills, and a demonstrated passion for your work. "Your managers want to know that you can be a positive contributor and a leader on the job with specific examples to demonstrate those skills, even if transferable from outside the industry," says Tamryn Hennessy, national director of career services at Rasmussen College, which operates nursing schools in five states and online. "Another tip for job-seeking registered nurses is to present a resume tailored for the healthcare industry that includes professional information such as continuing education, professional memberships, and clinical competencies like CPR and ACLS. Your future employer will appreciate it, and you will be a stand-out contender."

 

Trendsetters: Specialty Nursing Preview 2011

Top nurses are not only tuned into their patients’ vital signs, but they also have their fingers on the pulse of the profession. To get a feel for some of the up-and-coming trends in nursing, Nurse.com spoke with five nursing specialty organization presidents about what the future holds for RNs.

(Pediatrics) School Offers Tools

Pediatric nurses are embracing the importance of education and weaving it into all areas of their nursing practice, says Debbie Arnow, RN, MSN, NE-BC, president of the Society of Pediatric Nurses.

SPN has created guidelines for nurses who care for children and families during disasters. “We think it’s important to give guidance to our members and other healthcare professionals on how to help families deal with some of those issues,” Arnow says.

Promoting quality pediatric nursing education in the nation’s nursing schools is another way pediatric nurses are championing the importance of education to their nursing faculty colleagues. “There’s a lot of things that are important in the curriculum in schools, like public policy or research,” Arnow says, “but we want to make sure that schools continue to include [pediatric nursing] in their curriculum so that when these nurses graduate from nursing school and they are working in a community hospital and a pediatric patient comes in they have some basis to provide the right care to that patient.”

The need for education doesn’t stop after students have passed the NCLEX and are sporting RN credentials. “We’d like to see more [pediatric nurses] become prepared with their bachelor’s degree, master’s degree and doctoral preparation,” Arnow says. To help RNs attain this goal, SPN will launch a scholarship program this year.

(Oncology) Side Effects May Vary

When patients receive a cancer diagnosis and learn they’ll undergo chemotherapy, they often assume they’ll lose their hair and experience extreme fatigue and nausea as a result of the treatments. Depending on their courses of treatment they could be right, but, with the advent of new types of chemotherapy agents, they might just bypass those side effects altogether, says Oncology Nursing Society President Carlton Brown, RN, PhD, AOCN.

“The idea that everyone will get chemotherapy or radiation in liquid form is not always the case,” Brown says. “A trend for us right now is more oral chemotherapy administration. Over the last couple of years, we’ve had some really good chemotherapy agents that patients take orally.”

But with new medications and new delivery methods come new side effects. “For instance, epidermal growth factor receptor inhibitors, these drugs are not like the chemotherapy drugs that you thought about in the past that were IV,” Brown says. “They’re really inhibitors, so patients are taking these at home, but they also have their own strange types of side effects.” Nail and skin issues such as rashes are common side effects that indicate the EGFR inhibitors are working.

“Now we’ve got to educate nurses about new and different side effects,” Brown says. “No longer are we having side effects that are nausea and hair loss, so now we have to change the way we’re educating nurses and patients.”
 
(Medical/Surgical) What’s Old Is New

The trials and tribulations of caring for high-acuity patients with multiple comorbidities and fewer staff isn’t new to med/surg nurses, but according to Academy of Medical-Surgical Nurses President Sandra Fights, RN, MS, CNE, CMSRN, these are still the major issues facing med/surg nurses today.

“The patients are so complex and have so many comorbidities going on that it makes it difficult to spend the amount of time that you need to spend with a patient because you’re short-staffed,” says Fights, who also is the freshman division coordinator at St. Elizabeth School of Nursing in Lafayette, Ind.

The aging nurse workforce compounds the difficulties faced by med/surg nurses. “As a nurse, continuing to be able have the energy you need to have to care for the patients who are sicker and require more effort, time and energy to take care of — that’s becoming a bigger issue for us,” Fights says.

While these challenges might sound daunting, Fights actually finds them invigorating. “The med/surg nurse really has the challenge of keeping all the different disciplines working together for the benefit of the patient,” Fights says.

Fights says the struggles are not without their benefits. “The reward comes from being with the patient and knowing that you’ve made all the connections with the patient and the family but you’ve also connected all the dots with the other disciplines,” she says.

(Perioperative) Be Blunt About It

With its embrace of minimally invasive procedures and robotic surgery, perioperative nursing is known as a leader in adopting new technology in the clinical arena. But according to Association of periOperative Registered Nurses President Charlotte Guglielmi, RN, BSN, MA, CNOR, there is one area where perioperative nursing has lagged behind the rest of the profession — sharps safety.

“Since President Clinton signed the sharps safety legislation [in 2000], non-surgical injury rates around sharps have decreased by 31.6%,” Guglielmi says. However, “in the surgical suite, they increased by 6.5%.” (These statistics were reported in the April 2010 issue of the Journal of the American College of Surgeons.)

Early blunt needles were not acceptable to surgeons, who reported they were difficult to use, she says. Technology has caught up and new blunt sharps move through tissue more effectively, comparable to traditional sharps. Beth Israel Deaconess Medical Center in Boston, where Guglielmi works as a perioperative nurse specialist, launched its transition to blunt-needle sutures in November.

AORN is making a marked effort to put together more tools and strategies to promote sharps safety, such as the Sharps Safety Took Kit, which wil be ready for the AORN Congress in March. It will be available free to members and for a fee to non-members. “As we move forward into 2011, we’re going to be working with partners to help to reverse this trend,” Guglielmi says. “My dream would be in 10 more years that the problem would be eradicated.”

(Emergency) Safe and Sound

As goes emergency nursing, so goes the nation — of nurses that is. At least that’s how Emergency Nurses Association President AnnMarie Papa, RN, DNP, CEN, NE-BC, FAEN, describes the significance of trends occurring in emergency nursing. “The ED is the microcosm of the community,” Papa says. “So you see something first in the ED before it makes its way up to the floor.”

One unfortunate phenomenon creeping out of the trauma bay and onto acute care units is violence against staff. “In the ED, we see patients on what they often describe as the worst day of their life,” Papa says. “You have a lot of people in a small space, in high-crisis mode, and this causes a lot of stress and anxiety for patients.”

Often, this leads patients or family members to take out their fear and frustration on the nursing staff. In September, the ENA reported that more than half of 3,211 ED nurses surveyed experienced physical or verbal abuse at work during the previous seven-day time frame.

Although some might think dealing with violence is just part of a high-intensity job, Papa sees it differently. “[In the past] we were very accepting of the fact that someone lashed out and hit us because we recognized it’s a tough place and people are upset,” she says. “It’s there, but that doesn’t mean that we shouldn’t have things in place to mitigate it.”

Papa says EDs should take a page from the emergency medical services field when it comes to dealing with workplace violence. “Years ago, the EMS community got it right because whenever they go to a scene, the first thing they say is, ‘We have to ensure that the scene is safe because if we’re not safe, we’re not doing anybody any good,’” Papa says. “We need to start looking at violence through those lenses in the emergency nursing world.”

Papa stresses that while every step needs to be taken to prevent violence against staff, when it does happen, an RN needs support recovering so he or she can feel safe returning to work.

(Critical Care) Beyond the ICU

Gone will be the days when critically ill patients are exclusively relegated to care in critical care units. “It’s impossible to deny that hospitals have become critical care facilities regardless of how units are named,” says Kristine Peterson, RN, MS, CCRN, CCNS, president of the American Association of Critical-Care Nurses. ”Hospital nursing and critical care nursing will become one and the same as the specifics of healthcare reform play out. Hospital care represents one of the most expensive forms of healthcare. When one moves as much care delivery as possible to other locations, critical care is what will remain in the hospital.”

With an increase in critically ill patients, new modes to deliver high-quality care will become a necessity. Peterson cites eICUs, centralized groups of critical care nurses who can monitor patients from remote locations. “Tele-ICUs will make it easier for the knowledge and skills of an interdisciplinary team outside a clinical unit to match a patient’s needs by using state-of-the-art clinical monitoring, audiovisual and electronic record links,” Peterson says.

For example, there can be an eICU hub at one hospital in Chicago monitoring patients in other facilities and even other states. “Tele-health refers to health professionals monitoring from a central location patients in other locations, such as hospital units or even home,” she says.

These new care delivery methods will allow critical care nurses to take their expertise outside the ICU and share it with other RNs, not just in their own hospital but those miles away.

Nepali scholar makes breakthrough in TB,,Gets Rs 117m research grant from US govt

Gyanu Lamichhane, a 35-year-old Nepali researcher at John Hopkins University School of Medicine, has drawn the world several steps closer in finding a better, faster and reliable cure for tuberculosis (TB), which kills over two million people across the globe each year.

His latest findings have paved the way for a much faster approach of weakening the TB causing bacterium, Mycobacterium Tuberculosis, which could potentially shorten TB treatment that now takes at least six months.

In recognition of his achievement, the US government’s National Institute of Health honoured Lamichhane with the coveted New Innovator Award-2011 on September 19 along with a direct funding of $ 1.5 million (Rs 117 million) for his research to be carried out at the university within five years. A statement issued by the Institute on September 19 stated that the award was conferred on Lamichhane and 48 other young scientists for various promising researches in health sciences.

During his research at Johns Hopkins Centre for Tuberculosis Research, Lamichhane, the assistant professor at the university, discovered what exactly the cell wall of TB causing bacteria is made of. He revealed that the protective cell wall of Mycobacterium Tuberculosis is held together by an enzyme named L,D-transpeptidase. The revelation is said to have come as a breakthrough in the effort to develop medicine that could break the protective wall of the bacterium and thus weaken it and cure the disease altogether.

His research has a key finding that if L,D-transpeptidase is unable to function, Mycobacterium Tuberculosis will have its cell wall weakened and the remaining chemical linkages in the bacterial wall will be an easy target for drugs used in the treatment of TB. Lamichhane now intends to pursue his research on what effect antibiotics will have on L,D-transpeptidase and the possible cure for tuberculosis as well as other bacterial infections.

“My primary interest is the study of genes essential to the growth of mycrobacteria. In future I intend to study the cell division and regulation of cell cycle in mycrobacteria,” Lamichhane told the John Hopkins University publication after receiving the award. He had harboured the dream of finding a cure for TB since 1993, when he was a high school student in Chitwan. In an interview with the Post in 2009, he had stated that his grandfather's death from TB pushed him to find a cure for it.

"My team was doing research with the aim to identify how mycobacterium tuberculosis grows. We found that an unusual enzyme is required for the bacteria to grow properly and cause disease," he told the Post over telephone from the US on Sunday.

“We have demonstrated what needs to be done to make new drugs. Now the challenge is to work on making drugs and testing them,” he added.

About one third of the world’s population is believed to be infected with M Tuberculosis with 10 million new cases each year.

Tuberculosis is a leading cause of death among those who are infected with both HIV virus and M Tuberculosis, causing for the death of nearly 500,000 people with infections of both.

The complete treatment of tuberculosis requires at least six months for a “short” course treatment. Lamichhane hopes that the findings will help shorten the treatment duration to mere two weeks.

Lamichhane, who himself suffered from latent tuberculosis, had received a grant worth $ 100,000 from the Bill & Melinda Gates foundation in 2009 for the research on tuberculosis. He was also featured as one of the 36 best and brightest in America by Esquire magazine in 2007.

Key findings

•Lamichhane found what exactly the cell wall of TB causing bacteria is made of

•He discovered that the protective cell wall of Mycobacterium Tuberculosis is held together by an enzyme named L,D-transpeptidase

•Findings to shorten TB treatment duration considerably

Acetamenophen

Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers).It reduces fever through its action on the heat-regulating center of the brain.
It also helps to relieves symptoms of pain, sinus congestion, runny nose, sneezing, and cough due to colds, upper respiratory infections, and allergies


Common dosages:  325, 500 and 650 mg.
 Taking more can damage your liver. Ask a doctor before taking acetaminophen if you drink more than 3 alcoholic beverages per day, and never take more than 2 grams (2000 mg) of acetaminophen per day.


Stop using acetaminophen and call your doctor if:

• you still have a fever after 3 days of use;
• you still have pain after 7 days of use (or 5 days if treating a child);
• you have a skin rash, ongoing headache, or any redness or swelling; or
• if your symptoms get worse, or if you have any new symptoms.

Urine glucose tests may produce false results while you are taking acetaminophen. Talk to your doctor if you are diabetic and you notice changes in your glucose levels during treatment.

Store acetaminophen at room temperature away from heat and moisture. The rectal suppositories can be stored at room temperature or in the refrigerator.

Ten tips for healthy eating

1. Eat a variety of nutrient-rich foods. You need more than 40 different nutrients for good health, and no single food supplies them all. Your daily food selection should include bread and other whole-grain products; fruits; vegetables; dairy products; and meat, poultry, fish and other protein foods. How much you should eat depends on your calorie needs. Use the Food Guide Pyramid and the Nutrition Facts panel on food labels as handy references.
2. Enjoy plenty of whole grains, fruits and vegetables. Surveys show most Americans don't eat enough of these foods. Do you eat 6-11 servings from the bread, rice, cereal and pasta group, 3 of which should be whole grains? Do you eat 2-4 servings of fruit and 3-5 servings of vegetables? If you don't enjoy some of these at first, give them another chance. Look through cookbooks for tasty ways to prepare unfamiliar foods.
3. Maintain a healthy weight. The weight that's right for you depends on many factors including your sex, height, age and heredity. Excess body fat increases your chances for high blood pressure, heart disease, stroke, diabetes, some types of cancer and other illnesses. But being too thin can increase your risk for osteoporosis, menstrual irregularities and other health problems. If you're constantly losing and regaining weight, a registered dietitian can help you develop sensible eating habits for successful weight management. Regular exercise is also important to maintaining a healthy weight.
4. Eat moderate portions. If you keep portion sizes reasonable, it's easier to eat the foods you want and stay healthy. Did you know the recommended serving of cooked meat is 3 ounces, similar in size to a deck of playing cards? A medium piece of fruit is 1 serving and a cup of pasta equals 2 servings. A pint of ice cream contains 4 servings. Refer to the Food Guide Pyramid for information on recommended serving sizes.
5. Eat regular meals. Skipping meals can lead to out-of-control hunger, often resulting in overeating. When you're very hungry, it's also tempting to forget about good nutrition. Snacking between meals can help curb hunger, but don't eat so much that your snack becomes an entire meal.
6. Reduce, don't eliminate certain foods. Most people eat for pleasure as well as nutrition. If your favorite foods are high in fat, salt or sugar, the key is moderating how much of these foods you eat and how often you eat them.
   Identify major sources of these ingredients in your diet and make changes, if necessary. Adults who eat high-fat meats or whole-milk dairy products at every meal are probably eating too much fat. Use the Nutrition Facts panel on the food label to help balance your choices.
   Choosing skim or low-fat dairy products and lean cuts of meat such as flank steak and beef round can reduce fat intake significantly.
   If you love fried chicken, however, you don't have to give it up. Just eat it less often. When dining out, share it with a friend, ask for a take-home bag or a smaller portion.
7. Balance your food choices over time. Not every food has to be "perfect." When eating a food high in fat, salt or sugar, select other foods that are low in these ingredients. If you miss out on any food group one day, make up for it the next. Your food choices over several days should fit together into a healthy pattern.
8. Know your diet pitfalls. To improve your eating habits, you first have to know what's wrong with them. Write down everything you eat for three days. Then check your list according to the rest of these tips. Do you add a lot of butter, creamy sauces or salad dressings? Rather than eliminating these foods, just cut back your portions. Are you getting enough fruits and vegetables? If not, you may be missing out on vital nutrients.
9. Make changes gradually. Just as there are no "superfoods" or easy answers to a healthy diet, don't expect to totally revamp your eating habits overnight. Changing too much, too fast can get in the way of success. Begin to remedy excesses or deficiencies with modest changes that can add up to positive, lifelong eating habits. For instance, if you don't like the taste of skim milk, try low-fat. Eventually you may find you like skim, too.
10. Remember, foods are not good or bad. Select foods based on your total eating patterns, not whether any individual food is "good" or "bad." Don't feel guilty if you love foods such as apple pie, potato chips, candy bars or ice cream. Eat them in moderation, and choose other foods to provide the balance and variety that are vital to good health.

Kidney Disorder

Kidney disorder occurs when kidney do not function normally. Kidneys are a bean shaped in structure located on either side of the spine just above the waist,performing several life sustaining roles. It helps to regulate blood pressure by balancing fluid.

Causes
The commonest causes of Kidney disorder are: Diabetes, Hypertention, Glumerulonephritis, Polycystic kidney disease,High Cholesterol, Use of analgeics like acetamenophen and ibuprofen for long duaration, clogging and hardening of artey ( atherosclerosis), Obstruction of urine flow by stones, Enlarged prostate, Stricture, cancer , Sickle cell disease, HIV infection, Herion abuse etc.

Symptoms
The kidneys are remarkable in their ability to compensate for problems in their function. That is why kidney disorder may progress without symptoms for a long time until only very minimal kidney function is left. Many people never realize they have a kidney problem until a symptom such as back pain or blood in the urine appears.The symptoms of Kidney disorder are:-1. Pain and tenderness inthe back and abdomen. 2. Need to urinate frequently especially at night (nocturia). 3. Loss of appetite, headache, nausea and vomitting. 4. Burning micturition abdominal pain associated with urinaray tract infection.5.Blood in the urine 6.Odema of the leg and puffiness of eyes 7. Flank and abdominal masses in infant. 8. Shortness of breath from fluid accumulation in the lungs. 9. Itching, easy bruising, and pale skin. 10. Decreased sexual interest or erectile dysfunction.

Treatment:
Medication cannot reverse the kidney disorder but it helps to treat the symptoms and complication to prevent further damage and slow the  progress of the disorder.           
1. Antihypertensive medication to keep blood pressure at safe range below 130/80.eg, ACE Inhibitors, diuretics,vasodilators, angiotensin II receptor blocker,beta blocker, calcium channel blocker,direct renin inhibitor. 2. medication to lower the cholesterol level 3. Erythropoietin to induce production of more red blood cells and reduce anaemia. This may help relieve the fatigue and weakness that's associated with anemia. 4. Diuretics to balance fluid volume in the body. 5. Dialysis 6. kidney transplantation
              Calcium and vitamin D suplements, iron supplements, low protein diet inorder to minimize waste product in the body,Phosphorus-lowering medications(calcium carbonate, calcitirol),Minimize use of salt,milk, cheese, nuts, and cola drinks.

Prevention
Checking  blood pressure regularly,control and keep blood sugar at normal level, saty at healthy weight which can prevent diabetes and blood pressurse,maintain cholesterol level,donot smoke,avoid using non prescription drug like acetamenophen, aspirin, ibiprofen.do regular exercise, manage any medical condition with doctors help.

Potential treatment and Research
1.Drug rapamycin could be a potential treatment for kidney disease, according to a study at UC Santa Barbara.
2.Oral Tolvaptan Tablets Regiments in Adult Subjects With Autosomal Dominant Polycystic Kidney Disease,Susan Spiegel, Development & Public Affairs
3.LCP-Tacro™, which may be used in the future to improve the care of transplant patients.