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Registered Nurses

(D.O.T.  075.124-010 and -014, .127-014, -026, -030 and -034,
.137-010 and -014, .167-010 and -014, .264-010 and -014, .364-010,
.371-010, .374-014, -018, and -022)

Nature of the Work

Registered nurses (R.N.'s) care for the sick and injured and help
people stay well.  They are typically concerned with the whole
person, providing for the physical, mental, and emotional needs of
their patients.  They observe, assess, and record symptoms,
reactions, and progress; assist physicians during treatments and
examinations; administer medications; and assist in convalescence
and rehabilitation.  R.N.'s also develop and manage nursing care
plans; instruct patients and their families in proper care; and help
individuals and groups take steps to improve or maintain their
health.  While State laws govern the tasks R.N.'s may perform, it is
usually the work setting which determines day-to-day job duties.

   Hospital nurses form the largest group of nurses.  Most are staff
nurses, who provide bedside nursing care and carry out the medical
regimen prescribed by physicians.  They may also supervise licensed
practical nurses and aides.  Hospital nurses usually are assigned to
one area such as surgery, maternity, pediatrics, emergency room,
intensive care, or treatment of cancer patients or may rotate among
departments.

   Nursing home nurses manage nursing care for residents with
conditions ranging from a fracture to Alzheimer's disease.  Although
they generally spend most of their time on administrative and
supervisory tasks, R.N.'s also assess residents' medical condition,
develop treatment plans, supervise licensed practical nurses and
nursing aides, and perform difficult procedures such as starting
intravenous fluids.  They also work in specialty-care departments,
such as long-term rehabilitaion for stroke and head-injury patients.

   Public health nurses work in government and private agencies and
clinics, schools, retirement communities and other community
settings.  They instruct individuals and families and other groups
in health education, disease prevention, nutrition, child care, and
home care of the sick or disabled.  They arrange for immunizations,
blood pressure testing, and other health screening.  These nurses
also work with community leaders, teachers, parents, and physicians
in community health education.  Some work in home health care,
providing periodic services prescribed by a physician and
instructing patients and families.

   Private duty nurses care for patients needing constant attention.
They work directly for families on a contract basis or for a nursing
or temporary help agency which assigns them to patients.  They
provide services in homes, hospitals, nursing homes, and
rehabilitation centers.

   Office nurses assist physicians in private practice, clinics,
surgicenters, emergency medical centers, and health maintenance
organizations (HMO's).  They prepare patients for and assist with
examinations, administer injections and medications, dress wounds
and incisions, assist with minor surgery, and maintain records.
Some also perform routine laboratory and office work.

   Occupational health or industrial nurses provide nursing care at
worksites, to employees, customers, and others with minor injuries
and illnesses.  They provide emergency care, prepare accident
reports, and arrange for further care if necessary.  They also offer
health counseling, assist with health examinations and inoculations,
and work on accident prevention programs.

   Head nurses or nurse supervisors direct nursing activities.  They
plan work schedules and assign duties to nurses and aides, provide
or arrange for training, and visit patients to observe nurses and to
insure that care is proper.  They may also insure that records are
maintained and that equipment and supplies are ordered.

   Advancement opportunities are broader for nurses with a B.S.N.

Working Conditions

Most nurses work in well-lighted, comfortable medical facilities.
Public health nurses travel to patients' homes and to schools,
community centers, and other sites.  Nurses may spend considerable
time walking and standing.  They need emotional stability to cope
with human suffering, emergencies, and other stresses.  Because
patients in hospitals and nursing homes require 24-hour care, nurses
in these institutions may work nights, weekends, and holidays.
Office, occupational health, and public health nurses are more
likely to work regular business hours.

   Nursing has its hazards, especially in hospitals and clinics where
nurses may care for individuals with infectious diseases such as
hepatitis and AIDS.  Nurses must observe rigid guidelines to guard
against these and other dangers such as radiation, chemicals used
for sterilization of instruments, and anesthetics.  In addition,
nurses face back injury when moving patients, shocks from electrical
equipment, and hazards posed by compressed gases.

Employment

Registered nurses held about 1,835,000 jobs in 1992.  About 2 out of
3 jobs were in hospitals.  Others were in offices and clinics of
physicians, nursing homes, home health care agencies, temporary help
agencies, schools, and government agencies.  About one-fourth of all
R.N.'s worked part time.

Training, Other Qualifications, and Advancement

To obtain a nursing license, all States require graduation from an
accredited nursing school and passing a national licensing
examination.  Nurses may be licensed in more than one State, either
by examination or endorsement of a license issued by another State.
Licenses must be periodically renewed, and continuing education is a
requirement for renewal in some States.

   In 1991, there were 1,470 entry level R.N.  programs.  There are
three major educational paths to nursing: Associate degree (A.D.N.),
diploma, and bachelor of science degree in nursing (B.S.N.).  A.D.N.
programs, offered by community and junior colleges, take about 2
years.  More than 60 percent of graduates in 1991 were from A.D.N.
programs.  B.S.N.  programs, offered by colleges and universities,
take 4 or 5 years.  More than 30 percent of graduates in 1991 were
from these programs.  Diploma programs, given in hospitals, last 2
to 3 years.  A small and declining number of graduates come from
these programs.  Generally, licensed graduates of any of the three
program types qualify for entry level positions as staff nurses.

   There have been attempts to raise the educational requirements for
an R.N.  license to a bachelor's degree and, possibly, create new
job titles.  However, such proposals have been around for years.
These changes, should they occur, will be made State by State,
through legislation or regulation.  Changes in licensure
requirements would not affect currently licensed R.N.'s, who would
be grandfathered in, no matter what their educational preparation.
However, individuals considering nursing should carefully weigh the
pros and cons of enrolling in a B.S.N.  program, since advancement
opportunities are broader for those with a B.S.N.  In fact, some
career paths are open only to nurses with bachelor's or advanced
degrees.

   While A.D.N.  or diploma preparation is enough for a nursing home
nurse to advance to director of nursing, a bachelor's degree is
generally necessary for administrative positions in hospitals and
for positions in community nursing.  Moreover, the B.S.N.  is a
prerequisite for admission to graduate nursing programs.  So
individuals considering positions requiring graduate training, such
as research, consulting, teaching, or clinical specializations
should enroll in a B.S.N.  program.

   A growing number of A.D.N.  and diploma-trained nurses are entering
bachelor's programs to prepare for a broader scope of nursing
practice.  They can often find a hospital position and then take
advantage of tuition reimbursement programs to get a B.S.N.

   Nursing education includes classroom instruction and supervised
training in hospitals and other health facilities.  Students take
courses in anatomy, physiology, microbiology, chemistry, nutrition,
psychology and other behavioral sciences, and nursing.

   Supervised clinical experience is provided in hospital departments
such as pediatrics, psychiatry, maternity, and surgery.  A growing
number of programs include courses in gerontological nursing and
clinical practice in nursing homes.  Some provide clinical training
in public health departments and home health agencies.

   Nurses should be caring and sympathetic.  They must be able to
accept responsibility, direct or supervise others, follow orders
precisely, and determine when consultation is required.

   Experience and good performance can lead to promotion to
increasingly more responsible positions.  Nurses can advance, in
management, to assistant head nurse or head nurse.  From there, they
can advance to assistant director, director, and vice president
positions.  Increasingly, management level nursing positions require
a graduate degree in nursing or health services administration.
They also require leadership, negotiation skills, and good judgment.
Graduate programs preparing executive level nurses usually last 1 to
2 years.

   Within patient care, nurses can advance to clinical nurse
specialist, nurse practitioner, nurse midwife, or nurse anesthetist.
These positions require 1 or 2 years of graduate education, leading
to a certificate or master's degree.

   Some nurses move into the business side of health care.  Their
nursing expertise and experience on a health care team equip them to
manage ambulatory, acute, home health, and chronic care services.
Some are employed by health care corporations in health planning and
development, marketing, and quality assurance.

Job Outlook

Job prospects in nursing are good.  Although employers in some parts
of the country reported shortages of R.N.'s in the past, large wage
increases have attracted more people to nursing and dampened demand.
However, R.N.  recruitment has long been a problem in rural areas,
in some big city hospitals, and in specialty areas including
intensive care, rehabilitation, geriatrics, and long-term care.

   Employment of registered nurses is expected to grow much faster than
the average for all occupations through the year 2005.  Driving this
growth will be technological advances in patient care, which permit
a greater number of medical problems to be treated, and increasing
emphasis on primary care.  The number of older people, who are much
more likely than younger people to need medical care, is projected
to grow very rapidly.  Many job openings also will result from the
need to replace experienced nurses who leave the occupation,
especially as the average age of the registered nurse population
continues to rise.

   Employment in hospitals, the largest sector, is expected to grow
more slowly than in other health-care sectors.  While the intensity
of nursing care is likely to increase, requiring more nurses per
patient, the number of inpatients (those who remain overnight) is
not likely to increase much.  Also, patients are being released
earlier and more procedures are being done on an outpatient basis,
both in and outside hospitals.  Most rapid growth is expected in
hospitals' outpatient facilities.

   Employment in physicians' offices and clinics, including HMO's,
ambulatory surgicenters, and emergency medical centers is expected
to grow very rapidly as health care in general expands.  In
addition, an increasing proportion of sophisticated procedures,
which once were performed only in hospitals, are being performed
here, thanks largely to advances in technology.

   Employment in home health care is also expected to grow very
rapidly.  This is in response to a growing number of older persons
with functional disabilities, consumer preference for care in the
home, and technological advances which make it possible to bring
increasingly complex treatments into the home.

   Employment in nursing homes is expected to grow very fast due to
increases in the number of people in their eighties and nineties,
many of whom will require long-term care.  In addition, the
financial pressure on hospitals to release patients as soon as
possible should produce more nursing home admissions.  Growth in
units to provide specialized long-term rehabilitation for stroke and
head injury patients or to treat Alzheimer's victims will also
increase employment.

Earnings

Median annual earnings of full-time salaried registered nurses were
$34,424 in 1992.  The middle 50 percent earned between $27,820 and
$41,600.  The lowest 10 percent earned less than $21,944; the top 10
percent, more than $50,960.

   According to a University of Texas Medical Branch survey of
hospitals and medical centers, the median annual salary of staff
nurses, based on a 40 hour week and excluding shift or area
differentials, was $33,278 in October 1992.  The average minimum
salary was $27,476 and the average maximum was $41,563.  For head
nurses, the median was $47,335; clinical nurse specialists, $44,845;
professional nurse practitioners, $43,680; and nurse anesthetists,
$66,622.

   According to the Buck Survey conducted by the American Health Care
Association, staff R.N.'s in chain nursing homes had median annual
earnings of approximately $30,200 in January, 1993.  The middle 50
percent earned between $27,200 and $33,400 a year.

   Many employers are offering flexible work schedules, child care,
educational benefits, bonuses, and other incentives.

Related Occupations

Workers in other occupations with responsibilities and duties
related to those of registered nurses are occupational therapists,
paramedics, physical therapists, physician assistants, and
respiratory therapists.

Sources of Additional Information

   The National League for Nursing (NLN) publishes a variety of nursing
and nursing education materials, including a list of nursing schools
and information on student financial aid.  For a complete list of
NLN publications, write for a career information brochure.  Send
your request to:

   Communications Department, National League for Nursing, 350 Hudson
St., New York, NY 10014.

   For a list of B.S.N.  and graduate programs, write to:

   American Association of Colleges of Nursing, 1 Dupont Circle, Suite
530, Washington, DC 20036.

   Information on career opportunities as a registered nurse is
available from:

   American Nurses' Association, 600 Maryland Ave.  SW., Washington, DC
20024-2571.

   Information about employment opportunities in Department of Veterans
Affairs medical centers is available from local VA medical centers
and also from:

   Title 38 Employment Division (054D), Department of Veterans Affairs,
810 Vermont Ave.  NW., Washington, DC 20420.

   For information on nursing careers in long-term care, write to:

   American Health Care Association, 1201 L St.  NW., Washington, DC
20005-4014.