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Registered nurses work under the direct supervision of nursing departments and in collaboration with physicians. Approximately 59 percent of all nurses work in hospitals, where they may be assigned to general, operating room, or maternity room duty. They may also care for sick children or be assigned to other hospital units, such as emergency rooms, intensive care units, or outpatient clinics. There are many different kinds of RNs.
General duty nurses work together with other members of the health care team to assess the patient's condition and to develop and implement a plan of health care. These nurses may perform such tasks as taking patients' vital signs, administering medication and injections, recording the symptoms and progress of patients, changing dressings, assisting patients with personal care, conferring with members of the medical staff, helping prepare a patient for surgery, and completing any number of duties that require skill and understanding of patients' needs.
Surgical nurses oversee the preparation of the operating room and the sterilization of instruments. They assist surgeons during operations and coordinate the flow of patient cases in operating rooms.
Maternity nurses, or neonatal nurses, help in the delivery room, take care of newborns in the nursery, and teach mothers how to feed and care for their babies.
The activities of staff nurses are directed and coordinated by head nurses and charge nurses. Heading up the entire nursing program in the hospital is the nursing service director, who administers the nursing program to maintain standards of patient care. The nursing service director advises the medical staff, department heads, and the hospital administrator in matters relating to nursing services and helps prepare the department budget.
Private duty nurses may work in hospitals or in a patient's home. They are employed by the patient they are caring for or by the patient's family. Their service is designed for the individual care of one person and is carried out in cooperation with the patient's physician.
Office nurses usually work in the office of a dentist, physician, or health maintenance organization (HMO). An office nurse may be one of several nurses on the staff or the only staff nurse. If a nurse is the only staff member, this person may have to combine some clerical duties with those of nursing, such as serving as receptionist, making appointments for the doctor, helping maintain patient records, sending out monthly statements, and attending to routine correspondence. If the physician's staff is a large one that includes secretaries and clerks, the office nurse will concentrate on screening patients, assisting with examinations, supervising the examining rooms, sterilizing equipment, providing patient education, and performing other nursing duties.
Occupational health nurses, or industrial nurses, are an important part of many large firms. They maintain a clinic at a plant or factory and are usually occupied in rendering preventive, remedial, and educational nursing services. They work under the direction of an industrial physician, nursing director, or nursing supervisor. They may advise on accident prevention, visit employees on the job to check the conditions under which they work, and advise management about the safety of such conditions. At the plant, they render treatment in emergencies.
School nurses may work in one school or in several, visiting each for a part of the day or week. They may supervise the student clinic, treat minor cuts or injuries, or give advice on good health practices. They may examine students to detect conditions of the eyes or teeth that require attention. They also assist the school physician.
Community health nurses, also called public health nurses, require specialized training for their duties. Their job usually requires them to spend part of the time traveling from one assignment to another. Their duties may differ greatly from one case to another. For instance, in one day they may have to instruct a class of expectant mothers, visit new parents to help them plan proper care for the baby, visit an aged patient requiring special care, and conduct a class in nutrition. They usually possess many varied nursing skills and are often called upon to resolve unexpected or unusual situations.
Administrators in the community health field include nursing directors, educational directors, and nursing supervisors. Some nurses go into nursing education and work with nursing students to instruct them on theories and skills they will need to enter the profession. Nursing instructors may give classroom instruction and demonstrations or supervise nursing students on hospital units. Some instructors eventually become nursing school directors, university faculty, or deans of a university degree program. Nurses also have the opportunity to direct staff development and continuing education programs for nursing personnel in hospitals.
Advanced practice nurses are nurses with training beyond that required to have the RN designation. There are four primary categories of nurses included in this category: nurse-midwives, clinical nurse specialists, nurse anesthetists, and nurse practitioners.
Some nurses are consultants to hospitals, nursing schools, industrial organizations, and public health agencies. They advise clients on such administrative matters as staff organization, nursing techniques, curricula, and education programs. Other administrative specialists include educational directors for the state board of nursing, who are concerned with maintaining well-defined educational standards, and executive directors of professional nurses' associations, who administer programs developed by the board of directors and the members of the association.
Some nurses choose to enter the armed forces. All types of nurses, except private duty nurses, are represented in the military services. They provide skilled nursing care to active-duty and retired members of the armed forces and their families. In addition to basic nursing skills, military nurses are trained to provide care in various environments, including field hospitals, on-air evacuation flights, and onboard ships. Military nurses actively influence the development of health care through nursing research. Advances influenced by military nurses include the development of the artificial kidney (dialysis unit) and the concept of the intensive care unit.