Careers in Nursing: An Overview

A registered nurse (RN) is a nurse who has graduated from a nursing program at a university or college and has passed the National Council Licensing Examination (NCLEX). An RN helps individuals, families, and groups achieve health and prevent disease through advice, education, and support. Regardless of the specialty or work setting, an RN’s scope of practice is determined by each state’s Nurse Practice Act (NPA). Each state outlines legal practices for RNs and what tasks they may or may not perform.

Areas of Concentration for RNs

Specific work responsibilities will vary from one RN to the next, depending on work setting or patient population. RNs can specialize in one or more areas of patient care. RNs may work mostly with patients that have the same diagnosis, or with a certain demographic, such as women or children. Nurse practitioners have more choice about the patients they work with, but RNs can choose to work in specific roles or facilities that fit their interests and qualifications as well. Some of the roles an RN can fill are:

  • 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.
  • 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.
  • 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 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.

Settings for RNs to Work In

The type of facility an RN works in determines the nature of their work to a great extent. Working in an urban hospital’s emergency room is a totally different experience from working in a rural family practice. The specialty care provided by RNs may differ drastically in different facilities. Some of the types of care that nurses can provide, depending on where they work, are as follows.

  • Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics.
  • Critical care nurses often work in critical or intensive care hospital units to provide care to patients with serious, complex, and acute illnesses or injuries.
  • Emergency, or trauma, nurses work in hospital or stand-alone emergency departments. Some emergency nurses may become qualified to serve as transport or flight 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 therapy, aromatherapy, 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 nursing facility.
  • Hospice and palliative care nurses focus on maintaining quality of life for terminally ill patients, often in a home or hospice atmosphere.
  • 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 nursing facilities.
  • Medical-surgical nurses provide health promotion and basic medical care to patients with various 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. School nurses are considered occupational nurses.
  • Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedures.
  • 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.

Settings also can include the military, as each branch of military service contains medical services. Military nurses can include men and women, and the military offers benefits and advancement just as any other career. For more information on military nursing, look to each service branch, such as Army, Navy, and Marines. The graph below displays the top five industries employing RNs, and the number of RNs employed in those settings, according to The Bureau of Labor Statistics.

How Education Determines Responsibilities

RN responsibilities are often determined by type and level of education. The three typical educational paths to registered nursing are a bachelor’s degree, an associate’s degree, or a diploma from an approved nursing program. Advanced practice nurses need a master’s degree, and RNs with a master’s degree can pursue the following career paths.

  • 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. Nurse practitioners can also choose a variety of other specialties, including neonatology and mental health. Advanced practice nurses can prescribe medications in all states and in the District of Columbia.

Some nurses move up into management or supervisory roles, and those who choose to get a master’s degree and become a nurse practitioner can even open their own practices and provide primary care. Hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others, also 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.

Advancement for RNs

Although most RNs begin their careers as staff nurses in medical facilities, experience and performance can open doors to more responsibilities. RNs who move into management positions can advance their careers with more education. Senior-level administrative roles include assistant director, director, vice president or chief of nursing. 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. RNs have educational opportunities open to them to advance from associate’s degrees to doctoral degrees. Education and experience both can determine job responsibilities and opportunities in a field that is growing in demand for RNs.

Job Prospects for RNs

The future is bright for RNs, as employers in some parts of the county and in certain settings report difficulty in attracting and retaining RNs. Part of the reason for this shortage is the aging of the RN workforce and a lack of younger workers to fill positions. Also, the need for nursing faculty is expanding for the same reason, and more teachers are needed to educate new nurses.

Hospitals, which currently are the highest employers for RNs, may offer signing bonuses, family-friendly work schedules, or subsidized training to attract and retain nurses. 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.

Getting Ahead

Job responsibilities and career opportunities for RNs vary, depending upon education, experience, and settings. It is an exciting time to become an RN, as job prospects are growing, and the field has expanded into numerous specialties. With the ability to acquire more education, a student RN can advance his or her career and open doors to possibilities such as opening a business or securing a senior-level position in administration. In rural or urban areas and across the world, the RN has vast choices in educating people on preventive care and helping those in distress.

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