Many foreign-trained medical doctors, who find it too difficult or expensive to obtain their physician’s license in the United States, opt to train as registered nurses instead.
Many physicians who come to the U.S. find it too expensive and the process too lengthy to obtain their licensing, and they are forced to take a job unrelated to health care in order to make ends meet. A new federally-funded program in California is working to change that, by offering these medical professionals a chance to stay in their chosen field.
Physicians and other internationally trained health care workers living in California can take advantage of a variety of options that will allow them to practice medicine in the United States through the Welcome Back Center. Since 2004, the Center has helped foreign-trained health care professionals with the education and licensing requirements needed to practice in America.
The Welcome Back Center works in conjunction with community colleges and state universities throughout California, assisting doctors, nurses, dentists and allied health care professionals with their transfer to the U.S. field of medicine. Since physicians have to go through the most difficult process to obtain their license, the center offers a special alternative program for international doctors to become nurses.
Laura Ann Fernea, MA, MPH, educational case manager for the Welcome Back Center, explained that foreign-trained doctors can use their extensive experience to become licensed as a nurse here in much less time then it would take for them to get re-licensed as a doctor.
“We assist internationally trained health care professionals to become licensed and available to work in the U.S. either in their own profession or a different one,” she explained. “We can help a doctor get licensed in an alternate profession, such as a nurse, using their previous educational experience in our doctors to-nurses program.”
The Welcome Back Center has a database of over 2,500 foreign health care professionals working in the state, and the doctors-to-nurses program has already graduated 100 students. The program is currently training their fourth class of foreign physicians to become nurses, with 31 students enrolled in the 14-month program.
There is an extensive interview and enrollment process for interested health care professionals, and Fernea estimates it takes the average student 12 to 18 months to get into the program.
Once enrolled, the doctors must complete a series of classes and requirements, including English proficiency tests, an introduction to the U.S. health care system and computer classes. These requirements are in addition to any other general education and nursing classes, Fernea said.
Before beginning the program, students must also provide all necessary transcripts, résumés and professional licensing tests they have taken to determine what educational course they need to take in order to become licensed. Once enrolled, they receive the full support of the staff including counseling, educational intervention, support groups and workshops.
The program also provides the graduates with the opportunity to secure a job while they are attending the course. They can rest assured that a job will be waiting for them upon completing their course and licensing requirements.
“During the coursework, they sign a contract with a hospital sponsor and then will work at that hospital once they are a licensed nurse,” Fernea said.
Utilizing the valuable skills of these un-tapped doctors is especially important during a time when the country faces a serious nursing shortage. The Welcome Back Center allows these doctors the opportunity to put their extensive knowledge and experience back to work again.
“We were able to get funding through the federal government for this program because of the shortage of nurses,” Fernea said. “We’re helping to provide more nurses to the community.”
Valentina Ruvalcaba, RN, and a licensed physician in Mexico, completed the doctor-to-nurse program last year. She heard about the Welcome Back Center from a friend, and couldn’t be happier with her decision to enroll in the program.
“The program is really good. You go for 14 months and then you are done; it’s a great program,” Ruvalcaba said.
As for making the transition from a doctor in one country to a nurse in the other, she said there was no difference for her.
“I didn’t mind at all,” she said. “As long as I am in the medical field, I am happy.”
Tuesday, November 1, 2011
Sunday, October 23, 2011
Difficulty of NCLEX increased today than it was in 2007
The first graduate nurses who take the National Council Licensure Examination for RNs starting on April 1 will encounter a test that is more difficult to pass than the one students took three years ago.
“Nursing practice is more difficult today than it was in 2007,” says Casey Marks, chief operating officer of the National Council of State Boards of Nursing, based in Chicago. “The bar has been raised, and, quite simply, the exam is harder. It’s projected that fewer students will pass on the first attempt.”
The NCSBN in December raised the passing standards for the national licensure examination after an analysis of the basic knowledge and skills new nurses need to practice safely. Since the last analysis in 2007, healthcare has become even more complex and sophisticated, requiring new nurses to have a greater baseline nursing knowledge and critical thinking skills.
“Nursing is a dynamic, continually evolving discipline that employs critical thinking to integrate increasingly complex knowledge, skills, technologies and client care activities into evidence-based nursing practice,” according to the NCSBN 2010 NCLEX Test Plan.
Raising the Bar
In 1989, the NCSBN decided to evaluate the NCLEX passing standard every three years. Since then, the passing standard has only been increased and never made easier, a reflection of nursing practice itself.
“The NCSBN doesn’t drive practice,” says Marks. “We’re driven by practice; we reflect practice.”
Marks compares the new standards to a track-and-field runner jumping hurdles. A runner may successfully clear a hurdle 50% of the time. But if the hurdle is raised, the runner will not clear the bar as frequently.
But in a few years, the pass rate will rebound, as it has done in the past, she says. “We are looking at more capable candidates. We have no interest in seeing people fail.”
The practice analysis by the NCSBN included a nine-member expert panel and a survey that asked 12,000 newly licensed nurses about the frequency and importance of performing 15 nursing care activities, according to the 2010 NCLEX-RN Test plan. These activities were then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed.
For graduating nursing students, there is no magic formula for passing the national licensure examination, Marks says. Nursing students need to have mastered their school of nursing’s academic and clinical content, be well rounded, and understand how the NCLEX works, Marks says.
“There is no secret,” he says. “Trust yourself and your knowledge.”
Schools Follow Suit
The American Association of Colleges of Nursing, which represents the U.S.’s baccalaureate and higher-degree nursing education programs, typically notifies its members of the raising of the test standards and how they have changed, says Geraldine Bednash, RN, PhD, FAAN, chief executive officer and executive director. However, the announcement of the new standards was made too late for schools of nursing to revise their curricula, she says.
“We know that when passing standards are changed, there tends to be a temporary dip in the pass rates,” she says.
The declines are temporary as schools adjust their curricula, if necessary, and focus on the areas that the NCBSN has emphasized in its new standards. The temporary dip should not affect nursing schools’ accreditation, she adds.
The AACN encourages nursing students to take the NCLEX as soon as possible after graduating when the knowledge they gained in school is still fresh in their minds. “The sooner they take the exam, the more successful they will be,” she says.
Kaplan Nursing test preparation services reviews its test prep course every three years based on how the NCSBN decides to change the exam. “We review our questions to determine if the questions discriminate at a higher level and meet the needs of the revised NCLEX-RN test plan,” says Barbara Irwin, RN, BSN, director of nursing for Kaplan Nursing. The new standards will require students to be prepared to answer higher level questions that require more analysis. For example, a question might describe several patients and ask who the nurse should see first. The student might say all of them, which is not necessarily wrong, but the correct response would be that the most acute patient needs to be seen first, Irwin says.
Other changes that will take place on the NCLEX in April include increased emphasis on the management of care subcategory, Irwin says. The NCSBN defines management of care as providing and directing nursing care that enhances the care delivery setting to protect clients, family/significant others and healthcare personnel.
The test will reduce emphasis on the subcategory of reduction of risk potential, defined as reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures.
“Nursing practice is more difficult today than it was in 2007,” says Casey Marks, chief operating officer of the National Council of State Boards of Nursing, based in Chicago. “The bar has been raised, and, quite simply, the exam is harder. It’s projected that fewer students will pass on the first attempt.”
The NCSBN in December raised the passing standards for the national licensure examination after an analysis of the basic knowledge and skills new nurses need to practice safely. Since the last analysis in 2007, healthcare has become even more complex and sophisticated, requiring new nurses to have a greater baseline nursing knowledge and critical thinking skills.
“Nursing is a dynamic, continually evolving discipline that employs critical thinking to integrate increasingly complex knowledge, skills, technologies and client care activities into evidence-based nursing practice,” according to the NCSBN 2010 NCLEX Test Plan.
Raising the Bar
In 1989, the NCSBN decided to evaluate the NCLEX passing standard every three years. Since then, the passing standard has only been increased and never made easier, a reflection of nursing practice itself.
“The NCSBN doesn’t drive practice,” says Marks. “We’re driven by practice; we reflect practice.”
Marks compares the new standards to a track-and-field runner jumping hurdles. A runner may successfully clear a hurdle 50% of the time. But if the hurdle is raised, the runner will not clear the bar as frequently.
But in a few years, the pass rate will rebound, as it has done in the past, she says. “We are looking at more capable candidates. We have no interest in seeing people fail.”
The practice analysis by the NCSBN included a nine-member expert panel and a survey that asked 12,000 newly licensed nurses about the frequency and importance of performing 15 nursing care activities, according to the 2010 NCLEX-RN Test plan. These activities were then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed.
For graduating nursing students, there is no magic formula for passing the national licensure examination, Marks says. Nursing students need to have mastered their school of nursing’s academic and clinical content, be well rounded, and understand how the NCLEX works, Marks says.
“There is no secret,” he says. “Trust yourself and your knowledge.”
Schools Follow Suit
The American Association of Colleges of Nursing, which represents the U.S.’s baccalaureate and higher-degree nursing education programs, typically notifies its members of the raising of the test standards and how they have changed, says Geraldine Bednash, RN, PhD, FAAN, chief executive officer and executive director. However, the announcement of the new standards was made too late for schools of nursing to revise their curricula, she says.
“We know that when passing standards are changed, there tends to be a temporary dip in the pass rates,” she says.
The declines are temporary as schools adjust their curricula, if necessary, and focus on the areas that the NCBSN has emphasized in its new standards. The temporary dip should not affect nursing schools’ accreditation, she adds.
The AACN encourages nursing students to take the NCLEX as soon as possible after graduating when the knowledge they gained in school is still fresh in their minds. “The sooner they take the exam, the more successful they will be,” she says.
Kaplan Nursing test preparation services reviews its test prep course every three years based on how the NCSBN decides to change the exam. “We review our questions to determine if the questions discriminate at a higher level and meet the needs of the revised NCLEX-RN test plan,” says Barbara Irwin, RN, BSN, director of nursing for Kaplan Nursing. The new standards will require students to be prepared to answer higher level questions that require more analysis. For example, a question might describe several patients and ask who the nurse should see first. The student might say all of them, which is not necessarily wrong, but the correct response would be that the most acute patient needs to be seen first, Irwin says.
Other changes that will take place on the NCLEX in April include increased emphasis on the management of care subcategory, Irwin says. The NCSBN defines management of care as providing and directing nursing care that enhances the care delivery setting to protect clients, family/significant others and healthcare personnel.
The test will reduce emphasis on the subcategory of reduction of risk potential, defined as reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures.
Friday, October 21, 2011
Nursing now a matter of degrees
New York poised to require bachelor's degrees for RNs
A century ago, nursing students learned their trade by trial and error while working in hospitals. Today, 45 percent of registered nurses have bachelor's degrees, and most have at least an associate degree.Nationally, there is a growing movement to require all RNs to earn a bachelor's degree, and the profession is looking to New York to be the first state to mandate it.
"New York is really a linchpin here in terms of what will happen in the rest of the country, and I believe if we can pass it there will be a cascading effect of other states following," said Barbara Zittel, the former executive secretary to the state Board for Nursing. Zittel retired so she could lobby for the mandate.
Last year, the Institute for Medicine published a report on the future of nursing that set a goal of increasing the number of baccalaureate nurses to 80 percent by 2020.
The push is on.
One New York hospital, North Shore LIJ, requires newly hired nurses to earn a bachelor's within five years.
Locally, hospitals havve almost completely stopped hiring licensed practical nurses, opting for registered nurses who have at least an associate's degree. Then hospitals urge associate-level RNs to go back to school for a bachelor's.
On Friday, Russell Sage College will announce it is slashing tuition for RNs who want to earn a bachelor's degree. "We asked what can we do as an institution to support the advancement of registered nurses," said Glenda Kelman, chair of nursing at Sage.
This is the school's answer: Instead of $40,000, the program will now cost $24,000.
Sage will also offer on-site courses at St. Peter's Hospital and Glens Falls Hospital.
Glens Falls Hospital and Albany Medical Center have also partnered with Excelsior College in Albany, an online school, to provide courses at a reduced rate -- between $9,000 and $24,000 depending on the student's experience level.
Research has shown that patients fare better when cared for by nurses with higher education levels. According to a 2003 study, for each 10 percent increase in the number of hospital nurses with bachelor's degrees, death rates decrease 5 percent.
In New York, more than half of RNs have bachelor's degrees, slightly higher than the national average.
New York licenses about 8,000 new RNs each year, and 5,000 of them are prepared at the associate-degree level. On average, about 20 percent of associate-degree nurses go on to earn a bachelor's, Zittel said.
Legislation was introduced in the state in 2005 that would have required new nurses to earn a bachelor's degree within 10 years of receiving their nursing license. It would take that long to earn a bachelor's degree if a student took one course a semester. During those 10 years, nurses can practice as RNs.
Currently licensed nurses would not be subject to the law, and even students on the waiting list of nursing schools would be grandfathered.
The Legislature has never voted on the bill, but nursing leaders plan to renew their lobbying efforts. The bill now has the backing of community college leaders, who initially resisted it, Zittel said. Unions still oppose it because they are concerned grandfathered nurses will demand financial assistance for a bachelor's education even though they are allowed to practice without one.
Zittel believes that won't happen based on the experience in pharmacy and physical therapy, which now require doctorates to practice. Most grandfathered practitioners continued to practice at their original education level, she said.
New York has been chosen as a pilot site to implement the recommendations in the IOM report. On Thursday, nursing leaders will gather at the Foundation of New York State Nurses in Guilderland at a conference convened by the NYS Action Coalition. The coalition is funded by a grant from the Robert Wood Johnson Foundation and AARP.
Susan Reinhard, a nurse and senior vice president of policy at AARP, will be a keynote speaker. Reinhard said nurses are taking more responsibility as health care is focusing on preventing illness and reducing hospitalizations.
"Nurses need to be better prepared to do the teaching and the care coordination that is required to help people manage their chronic conditions, rather than getting into a situation where they need to go back into the hospital," Reinhard said. "It's a different skill set that many nurses have been taught or been practicing."
Reach Cathleen F. Crowley at 454-5348 or ccrowley@timesunion.com.
Improving nursing
The Institute of Medicine's "Future of Nursing" had eight recommendations:
1. Allow nurses to practice to the full extent of their training and remove restrictions like collaborative agreements between nurse practitioners and physicians
2. Expand opportunities for nurses to lead quality improvement efforts
3. Implement nurse residency programs
4. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020
5. Double the number of nurses with a doctorate by 2020
6. Ensure that nurses engage in lifelong learning
7. Prepare and enable nurses to be leaders
8. Build an infrastructure for the collection and analysis of inter-professional health care workforce data
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Education levels of New York registered nurses:
52 percent have bachelor's degree or higher
44 percent have an associate's degree
4 percent have a diploma from a hospital-based program
Source: NYS Board for Nursing
Steps for International Nurses to Practice in the U.S.
Are you preparing for nursing practice in the United States? NCSBN can help guide you through everything required to make this important step into your future.
NCSBN Learning Extension offers a course geared toward international nurses who are preparing to practice in the U.S. The Acclimation of International Nurses into U.S. Nursing Practice online course will help with orientating both professionally on a U.S. health care team and personally into U.S. culture.
Note that international testing does not change the requirements of states or remove any of the other steps needed to practice in the U.S. You will still need to apply to a U.S. board of nursing to receive clearance to take your examination.
For help locating international testing centers and more about applying for the NCLEX, see the NCLEX Candidate Bulletin and NCLEX International Candidates FAQs.
Ready to get started? Let these resources to guide you through the process of establishing your new nursing career in the United States:
First…find your Board of Nursing
Each state in the U.S. is responsible for the licensure of nurses within their state. Variations exist among the states. So you’ll want to determine the requirements of the state in which you hope to practice. The best place to start is to visit that state’s board of nursing website for information regarding state requirements.Second…study NCSBN Resources for International Nurses
Now you’re ready to explore all the logistics of establishing a nursing career in the United States. NCSBN has developed a free online manual that covers everything from having your credentials evaluated to making it through immigration, from getting certified for English Proficiency to obtaining a social security number.NCSBN Learning Extension offers a course geared toward international nurses who are preparing to practice in the U.S. The Acclimation of International Nurses into U.S. Nursing Practice online course will help with orientating both professionally on a U.S. health care team and personally into U.S. culture.
Third…think about your NCLEX
You may want to consider taking the NCLEX before you immigrate to the United States. Once you’ve arrived, that will be one less thing to think about. The NCLEX now is administered by Pearson VUE at over 220 Pearson Professional Centers located in the U.S., and in 18 international locations.Note that international testing does not change the requirements of states or remove any of the other steps needed to practice in the U.S. You will still need to apply to a U.S. board of nursing to receive clearance to take your examination.
For help locating international testing centers and more about applying for the NCLEX, see the NCLEX Candidate Bulletin and NCLEX International Candidates FAQs.
Ready to get started? Let these resources to guide you through the process of establishing your new nursing career in the United States:
Wednesday, October 19, 2011
What is NCLEX -RN?
Everyone in America hoping to be certified as a Registered Nurse and find nursing jobs must first pass the National Council Licensure Examination-Registered Nurse (NCLEX RN) test. This NCLEX RN test is a comprehensive computer based test designed to measure your skills and knowledge in relation to the demands of the job. You should allow up to six hours to take the test, although it may not necessarily take that long.
The NCLEX RN test is given in computer adaptive format, which means that the next question you receive will depend on the answer you gave before. Correct answers will mean questions at a higher skill level, while wrong answers will mean going back to a lower level. Those doing well right off the bat will have to answer fewer question, as they've demonstrated by their answers a mastery of the basics. The software will keep providing new questions until satisfactory competency, or the lack of it, is demonstrated. So test takers will answer between 75 and 265 questions.
The subject matter is centered around nursing, and not general academic skills like math and literature. Subjects covered include Safe Effective Care Environment-coordinated care and safety and infection control; Health Promotion and Maintenance; Psychosocial Integrity; and Physiological Integrity-basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation. The results of your NCLEX RN test are only reported as either pass or fail. It's a difficult and challenging test, but if you've obtained an RN degree, there's no reason that with solid preparation you can't pass the NCLEX RN exam.
Sunday, October 16, 2011
Nursing is the Most Ethical and Honest Profession
Nurses work at the forefront of providing direct patient care. As such, nurses are confronted with many issues and tribulations. Despite this, nurses still work paramount to provide safe and quality care while observing ethical and legal aspects of practice. With utmost dedication, nurses are regarded the most ethical and honest professionals. Who wouldn’t be proud to be a nurse? Gallup Inc., 2010 polls reveal that nurses top honesty and ethics list for the 11th consecutive year.
It was in 1999 when Gallup first asked its respondents to rate nurses in terms of honesty and ethical standards of profession. Since then, the nursing profession has maintained its number one spot. The survey which was based on telephone interviews with a random sample of 1,037 adults, selected using random-digit-dial sampling revealed that 81% of Americans believe that nurses are the most honest and ethical professionals. Although there is a decline in the percentage garnered, nurses are still topping the list followed by military officers, pharmacists, grade school teachers, medical doctors, police officers, clergy, judges, day care providers, and auto mechanics comprising the top ten.
The presented facts and figures are not meant to boast the profession but to further boost it. Nursing has long been depicted as a noble profession and the findings of the Gallup study is one of the many that characterize nurses. Findings such as that of Gallup uplifts the spirit of nurses inspite of disparity. In addition, it is also worthwhile to recount statements made by very notable and highly regarded individuals for nurses and their practice of nursing. The presence of nurses with their care, warmth, and interaction with patients, Her Royal Highness, the Princess Royal of England once said “…technological improvements do not do away with the importance of having that link with an individual, that response from another human being, which is what nursing perhaps defines most clearly.” Moreover, former President of the United States Bill Clinton also shared that “in a variety of settings, from hospitals to homes to long-term care facilities, nurses serve patients and their families with skill, earning their trust and lasting gratitude.” And just like the situation in Libya where nurses stayed to care for their patients despite the increasing tension, this is a truth to the statement of Dr. Gro Harlem Bruntland, Director General, WHO, “I know that nurses will continue to be there when it is needed – when people suffer and the vulnerable need care and assistance.”
And as a testament that nurses works and efforts are not in vain, The Reverend Dr. John Sentamu, Bishop at Westminster Abby highlighted that “…nurses are the unsung heroes of the health profession.”
It was in 1999 when Gallup first asked its respondents to rate nurses in terms of honesty and ethical standards of profession. Since then, the nursing profession has maintained its number one spot. The survey which was based on telephone interviews with a random sample of 1,037 adults, selected using random-digit-dial sampling revealed that 81% of Americans believe that nurses are the most honest and ethical professionals. Although there is a decline in the percentage garnered, nurses are still topping the list followed by military officers, pharmacists, grade school teachers, medical doctors, police officers, clergy, judges, day care providers, and auto mechanics comprising the top ten.
The presented facts and figures are not meant to boast the profession but to further boost it. Nursing has long been depicted as a noble profession and the findings of the Gallup study is one of the many that characterize nurses. Findings such as that of Gallup uplifts the spirit of nurses inspite of disparity. In addition, it is also worthwhile to recount statements made by very notable and highly regarded individuals for nurses and their practice of nursing. The presence of nurses with their care, warmth, and interaction with patients, Her Royal Highness, the Princess Royal of England once said “…technological improvements do not do away with the importance of having that link with an individual, that response from another human being, which is what nursing perhaps defines most clearly.” Moreover, former President of the United States Bill Clinton also shared that “in a variety of settings, from hospitals to homes to long-term care facilities, nurses serve patients and their families with skill, earning their trust and lasting gratitude.” And just like the situation in Libya where nurses stayed to care for their patients despite the increasing tension, this is a truth to the statement of Dr. Gro Harlem Bruntland, Director General, WHO, “I know that nurses will continue to be there when it is needed – when people suffer and the vulnerable need care and assistance.”
And as a testament that nurses works and efforts are not in vain, The Reverend Dr. John Sentamu, Bishop at Westminster Abby highlighted that “…nurses are the unsung heroes of the health profession.”
Friday, October 14, 2011
Trainings, Education, employment and Advancement of Career in Nursing
The three typical educational paths to registered nursing are a bachelor's degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor's degree program. Individuals then must complete a national licensing examination in order to obtain a nursing license. Advanced practice nurses—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners—need a master’s degree.
Education and training. There are three typical educational paths to registered nursing—a bachelor's of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. Diploma programs, administered in hospitals, last about 3 years. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as a staff nurse. There are hundreds of registered nursing programs that result in an ADN or BSN; however, there are relatively few diploma programs.
Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher. Individuals who complete a bachelor's degree receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing practice becomes more complex. Additionally, bachelor's degree programs offer more clinical experience in nonhospital settings. A bachelor's or higher degree is often necessary for administrative positions, research, consulting, and teaching
Many RNs with an ADN or diploma later enter bachelor's degree programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. Accelerated master's degree in nursing (MSN) programs also are available. They typically take 3-4 years to complete full time and result in the award of both the BSN and MSN.
There are education programs available for people interested in switching to a career in nursing as well. Individuals who already hold a bachelor’s degree in another field may enroll in an accelerated BSN program. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor's or higher degree in another field; master’s degree programs usually last 2 years.
All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the National Council Licensure Examination, or NCLEX-RN, in order to obtain a nursing license. Other eligibility requirements for licensure vary by State. Contact your State’s board of nursing for details.
Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients' conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
RNs should enjoy learning because continuing education credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for RNs.
Some nurses may become credentialed in specialties such as ambulatory care, gerontology, informatics, pediatrics, and many others. Credentialing for RNs is available from the American Nursing Credentialing Center, the National League for Nursing, and many others. Although credentialing is usually voluntary, it demonstrates adherence to a higher standard and some employers may require it.
Advancement. Most RNs begin as staff nurses in hospitals and, with experience and good performance, often move to other settings or are promoted to positions with more responsibility. In management, nurses can advance from assistant unit manager or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief of nursing. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.
Some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on providing primary care services. There are four types of advanced practice nurses: clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. 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.
All four types of advanced practice nurses require at least a master's degree. In addition, all States specifically define requirements for registered nurses in advanced practice roles. Advanced practice nurses may prescribe medicine, but the authority to prescribe varies by State. Contact your State’s board of nursing for specific regulations regarding advanced practice nurses.
Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.
Education and training. There are three typical educational paths to registered nursing—a bachelor's of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. Diploma programs, administered in hospitals, last about 3 years. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as a staff nurse. There are hundreds of registered nursing programs that result in an ADN or BSN; however, there are relatively few diploma programs.
Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher. Individuals who complete a bachelor's degree receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing practice becomes more complex. Additionally, bachelor's degree programs offer more clinical experience in nonhospital settings. A bachelor's or higher degree is often necessary for administrative positions, research, consulting, and teaching
Many RNs with an ADN or diploma later enter bachelor's degree programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. Accelerated master's degree in nursing (MSN) programs also are available. They typically take 3-4 years to complete full time and result in the award of both the BSN and MSN.
There are education programs available for people interested in switching to a career in nursing as well. Individuals who already hold a bachelor’s degree in another field may enroll in an accelerated BSN program. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor's or higher degree in another field; master’s degree programs usually last 2 years.
All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the National Council Licensure Examination, or NCLEX-RN, in order to obtain a nursing license. Other eligibility requirements for licensure vary by State. Contact your State’s board of nursing for details.
Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients' conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
RNs should enjoy learning because continuing education credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for RNs.
Some nurses may become credentialed in specialties such as ambulatory care, gerontology, informatics, pediatrics, and many others. Credentialing for RNs is available from the American Nursing Credentialing Center, the National League for Nursing, and many others. Although credentialing is usually voluntary, it demonstrates adherence to a higher standard and some employers may require it.
Advancement. Most RNs begin as staff nurses in hospitals and, with experience and good performance, often move to other settings or are promoted to positions with more responsibility. In management, nurses can advance from assistant unit manager or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief of nursing. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.
Some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on providing primary care services. There are four types of advanced practice nurses: clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. 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.
All four types of advanced practice nurses require at least a master's degree. In addition, all States specifically define requirements for registered nurses in advanced practice roles. Advanced practice nurses may prescribe medicine, but the authority to prescribe varies by State. Contact your State’s board of nursing for specific regulations regarding advanced practice nurses.
Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.
Employment
As the largest healthcare occupation, registered nurses held about 2.6 million jobs in 2008. Hospitals employed the majority of RNs, with 60 percent of such jobs. About 8 percent of jobs were in offices of physicians, 5 percent in home healthcare services, 5 percent in nursing care facilities, and 3 percent in employment services. The remainder worked mostly in government agencies, social assistance agencies, and educational services.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:
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.
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.
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 |
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
Occupational Title | SOC Code | Employment, 2008 | Projected Employment, 2018 | Change, 2008-18 | Detailed Statistics | ||
|---|---|---|---|---|---|---|---|
Number | Percent | ||||||
Registered nurses | |||||||
| 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 |
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.
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.
Thursday, October 13, 2011
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% |
Source: Data from the Bureau of Health Professions (2002)
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% |
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.
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