Nurses may be doctors' assistants, but they provide much more than just support to their MD counterparts. Registered nurses (RNs) not only care for their patients' physical condition, but they are also often the sole source of comfort to people in times of trauma, such as after an accident or just before going under the knife. Nurses spend more time with patients than doctors; sometimes they even spend more time with patients than the patients' families. Because of this close relationship with patients, there is immense physical and emotional strain associated with being a nurse, as well as many rewards.
With over two million jobs, nursing is the largest occupation in the field of health care, and the demand is growing. As the current crop of registered nurses advances towards retirement, not enough younger workers are entering the field to replace them. This shortage may result in greater perks in order to attract and retain qualified nurses. Generally speaking, registered nurses promote health, prevent disease, and help patients cope with illness. In more specific terms, this entails assisting physicians during treatments and examinations, administering medications and assisting in rehabilitation. RNs also provide instruction in health care and manage nursing care plans.
Nurses generally fall into several main groups, depending on where they work: in hospitals, in private practice, in private homes, etc. Hospital nurses, the largest group, are staff nurses who provide bedside nursing care and carry out the medical regimen prescribed by physicians. They also supervise licensed practical nurses and aides. Hospital nurses are typically assigned to one area such as surgery, maternity, pediatrics, emergency, ICU or oncology, but they sometimes rotate among departments.
As opposed to hospital nurses, office nurses work in private practice, clinics, surgicenters, emergency medical centers and HMOs, serving as right hands to doctors in these medical facilities. Home health nurses provide periodic services, prescribed by a physician, to patients at home. They also provide support to patients and their families, and at times work independently.
Nurses who work in nursing homes manage care for elderly residents. They spend most of their time on administrative tasks, but also assess the medical condition of residents and work in rehabilitation units, assisting patients recovering from strokes and injuries.
Public health nurses work for government and private agencies in clinics, schools, and retirement communities. They are professionals in disease prevention, proper nutrition and prenatal care. Occupational health or industrial nurses provide care at work sites to employees, either in the case of injury or for general wellness. Nurse practitioners are the most advanced nurses, with the power to write prescriptions and independently diagnose and treat patients.
It is common for hospital nurses to maintain long, irregular hours, often working double shifts or staying on call 24 hours a day. Occupational health and office nurses work more conventional 40-hour weeks. Nursing can also be a dangerous occupation, as nurses are sometimes exposed to highly infectious diseases and handle sharp objects, needles and blood.
After graduating from an accredited nursing school and passing a state licensing examination, an entry-level registered nurse will have graduated from one of three programs: the associate degree of nursing (ADN) program, the bachelor of science in nursing (BSN) program, or a two-year nursing program from a community or junior college. An enrolled student in one of these programs can expect courses in such subjects as anatomy, microbiology and nutrition, as well as nursing. In addition, students receive supervised clinical experience in hospitals, ambulances or nursing homes. A bachelor's degree is generally necessary for administrative positions in hospitals and for positions in community nursing or teaching.
Experience and a good performance record bring a promotion to management, assistant head nurse or head nurse. The next advancement level is assistant director of nursing, then director, then vice president. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. Graduate programs that prepare nurses for executive positions are one to two years long. If nurses want to advance within patient care positions, a one- to two-year graduate education is also needed to become a nurse practitioner, clinical nurse specialist or a certified nurse anesthetist. Another career option is to become a consultant for health care corporations in health planning and development, marketing and quality assurance.
Nursing educational requirements vary depending on the level of certification. Licensed practical nurses (LPs) require the least amount. For one, this was a "high school diploma, an approved 12-month nursing course, then certification through state boards"--though a colleague of hers said that her "LPN program was 18 months [and] very intense."
The next level, registered nurse (RN), requires a bachelor's or "an associate degree in nursing," says one RN. Another asserts that "the nursing classes are intense and require a lot of time; you take the same board exam whether you graduate with an associate's or a bachelor's degree." A clinical nurse specialist (CNS) says that her "position requires a master's degree in nursing with a clinical specialist track at a university level." Her colleague agrees: aspiring CSNs "need a master of science in nursing, preferably in the area [one wishes to] specialize in."
Nursing can be difficult to advance in, as one practitioner points out: "More experienced nurses are not always supportive of new nurses and sometimes try to take advantage of them. A new nurse will typically have to work the night shift for several years." Nurses must also keep up with the latest advances in medical science. Says one RN, "Nursing is a field that requires a lot of continuing education. I take classes in person and online to keep my skills up to date."
"The great thing about nursing is the possibilities and opportunities are almost endless," says an RN from Missouri. Pay varies by location, experience and education. "You should enter for the desire to do the work and not for the money," advises one nurse who works in the ER. On the other hand, not all nurses feel underpaid. "The salary is pretty good, the insurance benefits are fair, the bonuses are really good," notes one LP nurse. A nurse from New York says, "The pay is decent but it comes with a lot of stress." Her colleague, an RN, adds, "I have good benefits, including health insurance." One seasoned professional says, "We are in a nursing shortage; the older us Baby Boomers get, the more we need you younger nurses." "The job outlook is excellent for nursing as the population ages and has increasing health care needs," adds another nurse from the Empire State.
Not your daily grind
"You have to have a good heart and strong stomach," says a LP nurse from Trenton. Adds an Arkansas-based nurse, "This is a very rewarding career, [but] make sure your heart is in it. And don't over-do it. Burnout is very common in nursing." While the career may be rewarding, it's not always easy. An RN says, "Some patients and family are not appreciative of the care we provide. Some are even abusive. Sometimes even with a well-planned schedule, staff emergencies arise and our workload increases due to shortage." "Not all of our patients get better and it can be very hard when patients die," adds his colleague. "When you're a nurse," another says, "you often grab the obituary section of the newspaper first."
One nurse feels that the "worst part of [her] job is too little time to do everything that needs to be done. A nurse could never spend enough time with her patients." Her colleague adds, "It's hard to leave work [when] at home. The work is physically exhausting. I don't know any nurses without back pain!" The profession does offer rewards for all of the hard work that nurses put in, though. "It is not an easy job, but if you love what you do it is very rewarding," says one RN. "When it comes down to it, I wouldn't trade my nursing license for anything!" adds another. A third registered nurse says, "My job is not a job but a calling. I cannot imagine myself doing anything else as a profession other than nursing. Whether the patient gets better or not, knowing that I made a difference regardless of the outcome--it is fulfilling to me."
Wide variety of career options; Satisfaction from helping people
Long hours; Erratic schedule
Efficient; Sympathetic; Caring
Lazy; Easily tired; Squeamish
Average about 55 per week
Median salary for RNs: $57,280; Licensed practical or vocational nurses: $36,546
Degree from an accredited nursing school; ADN, BSN, MS Nursing; Nursing license