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The Definitive Nursing Guide (2014)

The Definitive Nursing Guide (2014)

Last Updated Aug 5, 2014

Overview, History, Education, Requirements, Responsibilities, Salaries, Advanced Practice Areas & Glossary

Introduction

The first image that comes to mind when the word Nurse is uttered is that of The Lady with the Lamp, Florence Nightingale. A crisp and clean pastel colored uniform, an equally imposing white apron, a friendly and winning smile, a neatly balanced cap and a practical no-nonsense attitude. This is one vocation that has not seen much of a change insofar as dress and attitude are concerned. Yes, starched cotton has given way to modern technical textiles, the color need not be white, the attitude may still be the same, but the aptitude and demands of both medical knowledge and hands-on capabilities have increased manifold. Nursing is a thankless job, wherein the nurse empathizes with her patient while remaining dispassionate in a holistic sense. Death can never be a friendly companion.

Some war has been raging in some part of the globe every single day since the beginning of the last millennium. It might have been equally so for the preceding millennium, but proper records for that period are not available. Millions of people must have died due to injuries sustained in wars which were not attended to in the manner seen today. Starting circa 1855, a few persons did conduct medical care in a uniform but the majority of the wounded were attended to by nuns and priests and in most military forces of today, nurses are addressed as ‘Sisters’. The role of the Christian churches has been documented, making it the pioneering organization in nursing. Most sanatoriums were run by Christian monasteries. Islam too has a role for nurses, except that male patients could be attended to only by male nurses, while female patients were taken care of by women. Pagans reportedly left the wounded to fend for themselves. Jesus Christ’s edicts gave weight to caring for the infirm, giving nurses the moral fibre to care for victims struck down by extremely hazardous diseases like smallpox. Outcasts like lepers were also attended to, in the prevailing but mistaken belief that Leprosy was contagious.

Definition of a Nurse

The perception of nursing varies from person to person, state to state and even country to country. Wikipedia provides a very broad-based opinion, “Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.” Perhaps the clearest definition is provided by the American Nurses Association, “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.” 

Brief History: The Rise of Nursing as a Career

Florence Nightingale, an upper class British lady turned nurse and born in Italy perhaps inspired many women to join her, though her nursing career spanned only three years. She brought in a Nursing Uniform for identification; nuns and priests had their habits and cassocks. The Catholic Church started to sponsor hospitals and introduced specific orders to care for the wounded, disabled and aged. The Protestants followed suit and, in 1836, titled their nurses Deaconesses. Since Martin Luther, the founder of the Protestant movement was German, most Deaconesses were initially German. Over time, The Little Sisters of the Poor (aged care), Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity managed to raise funds from the Prelate and well wishers and used this money to set up large hospitals and hospices internationally, shaping contemporary hospital and nursing systems of the today.

 

Florence Nightingale’s vociferous complaints about the appalling medical situation in the Crimean War galvanized the hierarchy to set up training centers for field doctors and nurses in 1860, and successful candidates took part in the many Boer Wars as well as WW I. WW II, however, changed the lives of the nursing sorority totally, particularly for those from the US. Apart from inspirational stories of heroism, the remuneration offered was munificent and educational qualifications required basic. This led to a rush from women from the relatively lower rungs of society. All nurses were women and officers, helped out by enlisted women (WACs) as hospital orderlies. In the case of the UK, nurses were given officer ranks, but weren’t commissioned. They were Class II gazetted officers. This situation changed as the war drew to a close, with Nursing Services Officers getting a Royal Commission.

Types of Nurses

The field of Medical Science has diversified greatly, leading to an incredible number of specializations. Three decades ago, you would have heard a common term like Ear, Nose and Throat (ENT) Specialist, your ‘go to’ man whenever your ear, nose or throat needed attention. Today, that ENT Specialist is called an Otolaryngologist. He still performs the tasks the ENT Specialist did, but to a somewhat limited degree. Often times, he will refer you to an Otologist/Neurotologist, Otoneurologist, Neurologist, Audiologist, Ophthalmologist, Neuro-ophthalmologist and more. If viewed in totality, a nurse trained in Otolaryngology should be able to adapt to any of the other fields mentioned. This is, however, not the case. A nurse assisting a Neuro-ophthalmologist would need to have specialized knowledge and experience in this field, as surgery might well be required. That said, the commonality factor in nursing in terms of pure patient care, which is the starting point of all healthcare training, is far greater than in the Medical Sciences field, making specialization a mite easier for them.

There are various types of nurses, depending entirely on their level of education in the health care field, their certification and licensing. If inclined towards nursing, it is possible for you to start with a specific role in mind and push through till the end. What is most likely is that along your path of education, subtle changes in role present themselves and, given the conditions obtaining, you might elect to modify your aim. Even as you reach the terminal phase, a range of types of nursing roles may become available to you as you finish with the process of your education and related certification.

Nursing roles are categorized somewhat disparately, without becoming mutually exclusive. The governing factor regulating the nursing career opted for by you is invariably the end product of a mix of the education and experience imbibed by you in the early days of your career. Consider education or certification. These two elements, i.e., education level and degree held by you, or your certification, can help in categorizing nursing roles. Other groupings could be related to the patient’s age or gender. If you who wish to look after people in their dotage, you could opt for geriatric care. At the other end of the age scale is the new-born baby and you could go in for pediatric care. If you wish to help only women, a vast panoply opens up.

Your choice could be location-dependent. If you live close to a school and have one or two of your own children studying there, you could opt to become a school nurse. Similar constraints could lead you into becoming a hospice nurse, or, for that matter, a normal nurse based in a hospital. Nothing stops you from focusing on your skillset in a specific medical specialty like surgery, oncology, gastroenterology or another medical specialty. As seen, a combination of your education, certifications, and experience will determine the career path you take within the field of nursing.

There are six types of nurses, starting at the lowest category in order of importance and income:

  • Certified Nursing Assistant (CNA)
  • Licensed Practical/Vocational Nurse (LPN / LVN)
  • Associate Degree Nurse (ADN)℗
  • Bachelor of Science in Nursing (BSN) ℗
  • Master of Science in Nursing (MSN)
  • Doctor of Nursing Practice (DNP)*

℗ ADN and BSN, 2 & 4 year courses respectively, grant you a Registered Nurse (RN) status and allow you to appear for your license to practice as an RN. RNs from the BSN course often get preference over those from the ADN course.

* Certain states ban the prefix of Doctor for DNPs, while some other states require them to clarify that they are not physicians.

There are 104 nursing specialties, each with its own set of categories, education levels and characteristics.

Role of Education in the Nursing Industry

A few years ago, field experience combined with an average education would give a nurse preference over another who was highly read, but had little hands-on experience. Things have changed totally. Today, education holds pride of place in the race to a flourishing career, both medical and financial, in the nursing industry. Theoretically, it is possible to envisage a scenario where job seekers with years of hands-on experience may be summarily eliminated from the interview list to make way for a candidate brandishing a degree, i.e., higher education, but with little experience.

While education level may be subjective, the fact remains that an education certified on paper is mostly paramount to prospective success. Spending increasing amounts of time on studies indicates a motivated drive and dedication to first learn and then apply the acquired information, ideas, data, theories and concepts to acquire a higher range of goals. The two skills you cannot do without are those of communication and mathematics.

Communication skills: In the U.S., communication skills would imply an ability to converse freely in English, and, in the Hispanic Southwest, Spanish as well. Communication skills are a managerial ‘must have’ in every role – whether you’re talking to co-workers, doctors, subordinates or patients since you have to explain to the patient what has happened, what the remedy is, what the next step is and why, in a bedside manner different from that of the MDs.

Math skills: Math is a branch of science and a part of daily life. You need to know how to use your head in basic computations, like calculating dosages, totting up surgical supplies or tallying figures.

In the healthcare industry, salaries are based on educational qualifications, the final proof of the importance of education. A generalized scale is given below:

  • Medical jobs, no college degree: Pay $20,000-40,000 annually, on average
  • Allied Health Careers, two years of college: Pay from $40,000-60,000 annually.
  • Nursing Careers, Associate’s or Bachelor Degree: Pay $40,000-55,000 on average annually.
  • Advanced Nursing Careers, Master’s Degree required: Pay $60,000-90,000+ annually.

The trend is more than obvious. The more you study, the greater are your chances of finding employment as a nurse at a better than average salary. What has happened is that patients have been led to believe that once they place their lives in the hands of doctors, they can relax mentally in the mistaken notion that they have secured their longevity. If something untoward happens, they can sue the hospital for malpractice, a process that is on an upward slope. Nobody wants to see a patient denied the best treatment available under the prevailing circumstances. Barring isolated cases caused by paranoid or psychotic people, every individual in the field of healthcare gives off his/her best in the interest of the patient’s well being. Doctors and high profile nurses have rather long working hours. Good intentions notwithstanding, Damocles’ sword of malpractice looms over every practitioner’s head. The focus has therefore shifted to the knowledge level of the entire team, from the doctor handling the case and the nurse as she/he is in constant contact with the patient; the surgeon(s) if surgery is involved and the pre-op nurses who prepare the patient for surgery, the nurse(s) in theOperating Room (OR) assisting the surgeon; the doctor and nurse in the post-op recovery room and Intensive care unit, going back to the first pair of doctor/nurse for prescribed follow-up treatment prior to discharge.

The immediate fallout is that the applicant must be better educated than his/her competitor, now that the Internet is available to both applicant and patient and the latter asks many more pertinent questions before being satisfied. Even administrative assistants, who have little to do with patient care, need college degrees, something unheard of just a decade ago. Statistics show that in advanced nations, information scanned by just surfing the web is absorbed more easily by an uncluttered mind. A six-year  old gen next child has the same level of understanding of communication media as a 45-year old, even with their digital quotient scores equal at 100. A simplistic way of putting it is: The number of doors that will open when you knock is proportional to the number years you have studied.

In a field that has more aspirants than jobs, the fastest way of narrowing the field is by stipulating high educational requirements. Today, employers tend to select candidates who have a decidedly superior level of education. This phenomenon has always been prevalent in better occupations; it has inexorably filtered down to virtually every field requiring interpersonal relationships. Even as a barrier has been erected through educational requirements, the other end of this spectrum has also evolved to prepare for the anticipated barrier.

Schools and colleges have always imparted education; now they teach you how to apply the knowledge gleaned. They also focus on interpersonal skills, observing and then honing your interactive ability. They use this datum to enhance your skills at communication, concentrating on cogent articulation to persuade whoever is on the other end without rancor. Teamwork is improved by melding specific aptitudes to mesh perfectly, without stepping on anybody’s toes.

Management theories have been imported to understand time and job management, getting down to the basics of defining the ideal mean path, so crucial in program evaluation techniques; as well as internal and external analysis of strengths and weaknesses to learn how best to achieve deadlines by managing projects efficiently. These tools come in addition to what these institutions stand for−learning from others by using updated textbooks, understanding your instructor’s aims, admixing your own achievements and achieving formal educational degrees.

As just seen, education plays a great role in achieving your aim; while applicable to everyone, there is a greater bias towards education in the healthcare sector. This is simple to understand. The human body is the most researched subject in the world and some new finding crops up almost every day. If it was cloning the other day and stem cell research today, genome sequencing to avert inheritable diseases is on the anvil with artificial intelligence on the not too distant horizon. Proponents involved will require extremely high levels of academic knowledge, but as support staff in the Healthcare industry, you will also need to stay up to date with developments at your level. This will be possible only if your grounding in the medical sciences and technology is rock solid, not to forget the parallel flow of mathematics.

The bias comes in because human lives are at stake now, not laboratory-born mice and rabbits. Looking after the health and survival of contemporaries places a huge moral and ethical responsibility on you. They depend on you and you cannot let them down. In effect, signing on as a qualified nurse no longer means that you can throw your books away. Education has now become a regular process and you need to know how best to modify and apply it to every single person under your wing; it is highly possible that two different entities requiring two different treatment techniques come under each of your two wings or more. That’s a further addition to your medical knowledge requirements.

Small wonder that medical degrees and recognized certifications are mandatory before you can be permitted to set foot in regular practice. Put together, they will get you that much needed license to don your jacket and stethoscope. You will need to be associate degree qualified, at the very least, for various healthcare roles; to become a Registered Nurse, you will need an associate or bachelor’s degree and if you are thinking of advanced practice in nursing, you will need a lot of experience in post-grad training before you can apply for a Master’s, perhaps a Doctorate.

Nursing Student Loans and Financial Aid

Advanced studies are always expensive and the nursing field is no exception. You need to know or find how many grants, loans, scholarships, work-study and loan forgiveness programs are available to you and where to find them. Grants are “free” money—you do not need to pay grants back. There are well over a thousand Govt grants in the US totaling $400 billion, and managing a student grant will you save you thousands of dollars. Some schools consider you for grants at their own initiative when you complete a Free Application for Federal Student Aid (FAFSA) and submit an application to join that school. Do visit the resources listed below for more info.

Nursing scholarships are competitive, but a popular resource as they, like federal grants, are not repaid.

Some loans have to be repaid, or have conditions / limitations and it would be prudent for you to visit their websites. Surf through the u/m sites for better and comprehensive knowledge:

Loan Forgiveness Programs

Federal or state loans are provided under what is called a loan forgiveness program, where the recipient does not repay the loan in cash, but through services rendered in remote or unpopular areas or areas critically short of nurses. The following websites are well worth a visit:

The University of Missouri has a many financial aid programs, including Grants, Scholarships, Loans, etc. Some of the better known Grants are the Federal Pell Grant and the War Veteran Grant. The maximum amount is $5,550. Each Grant or packet of financial aid is subject to a number of conditions, like residence status, prior qualifications, etc.

Becoming a Nurse: Education, Requirements, Responsibilities, Salaries

Surprisingly, the first country to register nurses on a national scale was New Zealand, in 1901. Since the term Nurse is recognized globally as a person who provides practical human health care, their controlling bodies in Government tend to have a common aim, that of care for one and all. While the richer nations ensure quality, poor countries have to depend on the largesse of well-off countries for a modicum of quality. Though each nation has its own educational path to a career in nursing, one factor remains common: the study of accepted core theories of nursing and its practical application, including a lengthy period of supervised hands-on training to acquire the requisite clinical skills. Moreover, since each patient is an individual entity with unique personal needs, the final part of training includes both arts and sciences, like psychology, sociology, technology and, in some cases, particularly in the oriental nations, an insight into spirituality. This training program is invariably followed by external comprehensive tests. In the US, all aspirants-like you- have to appear for and pass the National Council Licensure Examination (NCLEX) in order to get a license for practicing at the entry level.

The NCLEX is devised and conducted by the National Council of State Boards of Nursing, Inc. (NCSBN) in all 50 states, the District of Columbia, and the four territories of American Samoa; Guam; and the Northern Mariana & the Virgin Islands. There are two types of the exam, one for practical nurses, the NCLEX-PN, and the other for registered nurses, the NCLEX-RN, to be revalidated every two years.

LPN training is generally done at hospitals over three years, with the first month at a college to study the basics in anatomy, diet, physiology and chemistry. You then return to the hospital and after a total of three years, are granted a Diploma. You can look for a job on passing the licensing exam. Many prospective nurses opt for the low-paid jobs when they do not have the money for a college course, build up their bank balance and / or obtain Govt. aid where possible and move upwards. LPNs go in for a two-year college course to get the Associate Degree in Nursing tab, one step up the ladder. The lowest level of trained nurses fall in the Certified Nursing Assistant (CNA) category and command the smallest salaries, as seen earlier. At times, they are paid by the hour.

Certified Nursing Assistant (CNA)

Certified Nursing Assistants (CNAs) need not have college degrees. Training is focused on getting a post-secondary non-degree certificate or diploma. An educated CNA may be called upon to wear different hats at different times. (This post used to be called Nursing Orderly earlier). A CNA’s major role is that of providing basic care to inpatients, besides assisting them in routine daily activities which they have difficulty with by themselves, like bathing. The type of job tends to be personal; CNAs should be patient, compassionate, have good communication skills and take pleasure in helping others in need. As may be envisaged, in daily nursing or in long-term adult care facilities, CNAs become a patient’s de facto main caregiver. In today’s cyberworld, CNAs may be asked to operate medical technology services, like billing or general medical information and records software. In some institutions, CNAs are permitted to give medicines to patients, but this will obviously depend on the CNAs aptitude and experience, apart from state regulations. CNAs rarely operate independently. They are delegated tasks by RNs and LPNs, and they provide them the required feedback.

A CNA’s job has downsides too. It could require physically demands, coupled with unpleasant responsibilities; an incontinent patient can be annoying but then, that is the very reason he’s there. He could turn things around and build lasting and gainful relationships with his patients. While CNAs may work in hospitals, most of them prefer nursing and home-care facilities, where they interact with their patients more frequently and can even get acquainted personally. If you wish to join this booming field, a CNA could be a good starting point. Once in, you can work your way around to become an LPN and keep moving up the value chain. To succeed, you’ll need to meet the criteria listed below.

 

You are…

   You should have…
Compassionate Strong decision-making skills
An excellent listener Excellent attention to detail
Supportive Good communication skills
Dependable Problem-solving skills
Physically fit Good ethical standards
Good-natured Ability to maintain interpersonal relationships

Responsibilities:

  • Help patients bathe, dress, get out of bed and other daily activities
  • Turn or reposition bedridden patients
  • Take patients’ temperature, blood pressure and other vital signs
  • Answer patients’ calls
  • Document patients’ health issues and report to nurses
  • Feed patients, measure and record food and liquid intake
  • Clean rooms and bed linen
  • Help with medical procedures and dress wounds

Salaries:

According to the US Bureau of Labor Statistics (BLS) Occupational Outlook Handbook 2014-15, the median expected annual salary for certified nursing assistant is $24,420. Actual salaries may vary greatly based on specialization within the field, location, years of experience and a host of other factors.

Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

Licensed Practical Nurse

If you have some problem with entering college yet want your foot put into the door for nursing quickly, get yourself a certificate titling you a licensed practical nurse (LPN) [licensed vocational nurse (LVN)in California and Texas]. To get your LPN/LVN certificate, you’ll have to undergo a lengthy training schedule at a technical or trade school or a community college. Bear in mind that you are studying at one level below an Associate Degree in Nursing (ADN). This drawback is countered by the fact that if you’re an LPN/LVN, you can enroll in an LPN-to-RN program, where credits earned during your LPN/LVN training are put toward your Registered Nurse (RN) coursework.

LPN training is generally done at hospitals over three years, with the first month at a college to study the basics of anatomy, emergency care, physiology, medical-surgical nursing, nutrition and chemistry. You will then return to the hospital and after a total of three years, get a Diploma. You can look for a job on passing the licensing exam. Many prospective nurses opt for the low-paid jobs when they do not have the money for a college course, build up their bank balance and / or obtain Govt. aid where possible and move upwards. LPNs often go in for a two-year college course to get the Associate Degree in Nursing tab, one step up the ladder.

Licensed Practical /Vocational Nurses provide basic nursing care. Their duties vary depending on the work setting, but they typically do the following:

  • Monitor patients’ health – such as checking their blood pressure
  • Administer basic nursing care, including changing bandages and inserting catheters
  • Provide for the basic comfort of patients, such as helping them bathe or dress
  • Discuss health care with patients and listen to their concerns
  • Report patients’ status to registered nurses and doctors
  • Keep records on patients’ health
  • Experienced licensed practical and licensed vocational nurses oversee and direct other LVNs and unlicensed medical staff.

LPNs have to undergo a specific accredited program where subjects taught in class, like nursing itself, biology, and pharmaceutical products are coalesced with clinical experience under local supervision. After getting their certificates in practical nursing, the LPNs/LVNs-to-be take the NCLEX-PN exam. A license is obtained on passing to work in that capacity across all states.

LPNs can progress to becoming an RN using a bridging course at any appropriate college, to become an Associate of Applied Science in Registered Nursing (ASN), though the preferred course is a four-year bridging course at college to become a Bachelor of Science in Nursing (BSN). Then they can sit for the NCLEX-RN exam to gain nomination as a Registered Nurse, going through the procedure for licensing.

Median salary for LPNs was around $41,500 per year, whereas median salary for RNs was around $65,500 per year in 2012 and has increased since then. These figures should not be taken for granted as there is plenty of small print to read and quite a few hurdles to cross before you can reach your posted starting salary, particularly if you apply for a job through an agency.

Associate’s Degree in Nursing (ADN)

The requirement for Registered Nurses (RN) is expected to grow at 19% between today and 2022. The requirement for CNAs is slated to rise at 22%. The requirement for ADNs, sandwiched in between will be close to 20%. The ADN post is the most popular entry level post in nursing, closely followed by the RNs. The rationale is simple. It provides you a rock solid career base in the field of healthcare. ADNs have historically mixed well with RNs, with work content not too different as entry-level nursing posts. 36% of RNs have come up as ADNs, so the empathy factor is palpable.

An ADN can be earned over a course of two years and the curriculum will include not only nursing, but also liberal arts. After you earn your ADN, you’ll need to pass a national licensing examination, NCLEX-RN, in order to begin working as a registered nurse.

The principal benefit in obtaining your ADN is that you can complete it in just two years, making this program a good option for those interested in health care, but under external compulsion to get to working at the earliest, generally a finance driven obligation. The ADN program prepares you with a lucid understanding of the how, why and wheretofores of the nursing arena and the duties expected of you. As always, the course syllabus will include a host of topics, most important of which is the preparation to obtain your nursing license.

The salary is generous and theoretically equal to that of an RN who has come up through four years of college. Real life situations are different. If salary is your only criterion, you can drop anchor here. If you wish to progress further, as you must, you will need to take up the additional two years in college to earn the right to append a BSN degree to your name and look ahead. General education prerequisites are covered so you will not need to repeat them in a subsequent bachelor’s degree program. This will entail concurrent working and studying, so you need to anticipate the stress vs time factor in meeting work deadlines and organize your short-term future accordingly. Always remember that thousands of people have done it before you so you can and will hack it. You also have the option of the increasingly popular online courses if you do not wish to go for the on-campus program.

The popularity of an online nursing program stems from the flexibility it offers, allowing students to decide optimal schedules. Online nursing programs are best suited to

  • Single parents: Coordinating on-campus schedules with the vicissitudes of single parents can be a real nightmare. Online courses, done when your child has left for school or is asleep, offer flexible alternatives.
  • Students from remote areas: Excessive distance between college/hospital and home or frequent relocation can render an on-campus program impossible. The answer: online programs. Moreover, most online programs refrain from charging out-of-state tuition fees.
  • Professionals wishing to change careers: If you wish to switch over to nursing as a career, the best way of achieving your aim is via online programs that let you continue working so that tuition costs are covered while you attend school whenever you get free time.
  • Freedom in Timeframe. You can work at your own speed. Some online programs offer you the facility of faster programs, allowing you to achieve your aim quickly.

ADN programs are available at quite a few community colleges, and included as a two-year course in some institutions that run four-year courses. Such a program will combine field training with classroom studies. The basic or foundation courses you will have to undergo will be no different from those required of LPN/LVNs, except for their depth of detail.

A typical set of duties are:

  • Observe patients and report on their wellbeing
  • Keep a thorough record of patients’ medical histories and symptoms
  • Perform diagnostic tests on patient samples and analyze the results
  • Operate medical equipment
  • Administer medicines and treatments to patients
  • Come up with treatment plans for patients’ care
  • Teach patients how to manage their illnesses or injuries at home

Registered Nurse (RN)

The principal aim for most candidates joining the nursing industry is to become a licensed Registered Nurse. You can become a Registered Nurse by obtaining a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an accredited nursing program. Thereafter you need to pass the NCLEX –RN exam to get your License. This license is valid only for the state you appeared in, but is easily transferable if you move. You’ve already seen that the BSN will take you four years to finish while the ADN and diploma will take you two to three years.

In all nursing education programs without exception, you will take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other social and behavioral sciences, as well as in liberal arts. Moreover, all programs include clinical experience under supervision.

In the two additional years for a BSN, you will undergo further education in physical as well as social sciences, communication, leadership, and critical thinking. This training gives you more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching. The American Nursing Association prefers your taking the four-year BSN program route as the entry level for nursing practice, which also makes getting a job easier than an RN from an ADN. Some hospitals show a preference for BSNs; some states like California impose specific restrictions on certain posts, like mandating a BSN for workers in public health. In most cases, supervisory positions are reserved for BSNs, who obviously are paid more. Home healthcare agencies tend to select BSNs.

BSNs are at an advantage if the hospital they work in intends to get a certification from the American Nurses Credentialing Center (ANCC). Two types of certifications are possible, The Pathway to Excellence Program® and the Magnet Recognition Program®. Both certifications recognize health care organizations and long term care institutions for positive practice environments where nurses excel. Both programs have listed parameters that will be checked by ANCC representatives, and deal mainly with the quality of staff care, both medical and medico-administrative. RNs who have come to that hospital through a BSN Program tend to get better reviews, increasing their chances of accreditation in any one or both programs. Obviously, a hospital with twin accreditation will be rated higher than those with just the one. The Magnet Recognition Program® has found takers overseas, in countries like Saudi Arabia, Singapore, Australia, etc., and is therefore rated higher than The Pathway to Excellence Program®. One of the main questions asked of nurses in a confidential survey is about their satisfaction level. Nurses rate salary, recognition, work environment and job satisfaction as the prime ingredients controlling their satisfaction level, which is one reason such hospitals prefer BSNs.

Multiple qualifications can make a career in the healthcare sector very lucrative. For instance, a person with a business degree can take up nursing and, once qualified and licensed, move into the healthcare administration field. The Medical Course will generally take two years as the supplementary information gained in acquiring the previous degree counts towards total time required to obtain a BSN. The avenues for employment open to a healthcare administrator are multifold, like health insurance companies, healthcare associations, hospitals, nursing homes, physician practices and clinics. Salaries in this vast field will vary for each industry, although the median pay for a medical and health services manager in 2010 was a lavish $82,470.  As a matter of fact, a healthcare/nursing degree is currently rated the highest paying College degree.

The US Bureau of healthcare statistics has rated certain parameters as vital for RNs, but a more comprehensive and detailed chapter on their attributes lists the following:

  • Empathy. By definition, the epicenter of nursing is caring and empathy.
  • Detail Oriented. Nursing is a zero error syndrome job as you are dealing with a person’s life.
  • Communication. The ability to quietly interact with all kind of patients can work wonders.
  • Intuition. The ability to notice minutiae and subtle nuances can help chart a patient’s treatment.
  • Emotional Stability. Nurses cannot afford to lose focus in gruesome cases or when relatives / acquaintances are the patients involved.
  • Critical Thinking. The ability to react immediately and correctly is a crucial factor.
  • Coordination of Services. The nurse is the focal point around whom everybody in that patient’s medical team revolves.
  • Patience. The ability to stay calm under all circumstances reassures the patient involved.
  • Dedication. The ability to provide the best possible care under any circumstances, irrespective of any personal discomfort.
  • Physical Endurance. The need to often work 12 hours nonstop causes extreme fatigue, but it should not exact its toll in the form of medical errors. Nurses must learn how to stay fit. Fatigue was cited as the main reason for the fairly high rate of turnover in the nursing field.

A study on the age of RNs showed that the average age of RNs, both male and female, was 41.5 years with about 16 years of experience as an RN; most RNs upgraded their status by the age of 48; only 13 percent of the 829 nurses interviewed were below the age of 30, which age group also had the highest turnover. Approximately 30 percent had come through a diploma program, 13 percent were ADNs, 53 percent were BSNs, and 4 percent had earned graduate degrees in nursing.

Job Profile

Registered nurses provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members. They work as part of a team with physicians and other healthcare specialists. Specialized RNs work within their specialty, e.g., as an oncology nurse, you would be in a cancer ward; as a surgical nurse, you would be in a surgical ward, etc. Some RNs, usually BSNs supervise LPNs and CNAs. Essentially, the basic tasks RNs perform are:

  • Record patients’ medical histories and symptoms and give them their medicines and treatment.
  • Observe patients and record observations; discuss these with the doctor assigned.
  • Operate and monitor medical equipment and help perform diagnostic tests.
  • Teach patients and their families what to do once discharged from hospital.

According to the Bureau of Labor Resources, RNs held close to 2.7 million jobs in 2012 as the largest healthcare occupation. The top five industries that employed the most registered nurses in 2012 were as shown in Chart 1 below:

employment 2012Chart 1

median 2012Chart 2

Salary:

Again, according to the Bureau of Labor Resources, the median annual wage for registered nurses was $65,470 in May 2012. The median wage is the wage at which half of the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than  $45,040 and the top 10 percent earned more than $94,720. It must be noted that different employers offer different perks, like flexible work schedules, childcare, educational benefits, and bonuses. A chart (Chart 2) depicting median annual wages for RNs is placed supra.

Nurse Administrator

The role of a Nurse Administrator is to manage and oversee all work done by nurses, with an eye towards the improvement of quality and efficacy of patient care. The Administrator is also involved in budgeting, expenditure control, selecting and inducting new staff and the general coordination of training and creating work schedules. Since most of their job is cost control related vis-à-vis quality of patient care, the administrators should have a flair for thinking out of the box and being innovative.

A bachelor’s degree is adequate for a Nurse Administrator’s job. The trend, however, is to acquire a master’s degree in healthcare management, which has a surfeit of the higher degree programs. The content of these programs is focused on advanced nursing practices, networked with ethics and system policy, i.e., the syllabus will be heavily biased to the role of a nurse administrator with its concomitant challenges. The contents of the syllabus will include:

  • Organizational management
  • Leadership
  • Human and Fiscal Resource Management

On passing a written exam, the American Nurses Credentialing Center will certify you as a nurse administrator on the capacity of Nurse Executive or Advanced Nurse Executive, which has to be renewed every lustrum. You will require an active RN license, a BSN or higher in nursing and a specific administrative background for at least two years in the past five years. As an MSN without any administrative background, you will require 30 hours of continuous training in this field in the past three years. The only difference in the Advanced Certification is the experience factor. It is necessary to have held some admin post at an executive level for nurses OR been on the faculty in a full-time post teaching nursing administration at the executive level for two years (or equivalent) in the preceding five years. According to The US Bureau of Labor Statistics (BLS) Occupational Outlook Handbook 2014-15, the median expected annual salary for healthcare administrators is $88,580, subject to many variables and imponderables. It is one of the better jobs for people with administrative skills.

comparison
Chart 3

 

Nurse Informatics Specialist

The job of a Specialist in Nurse Informatics is fairly new, in that hospitals are becoming fully computerized and computer specialists are required in every department, fully networked to provide the patient enhanced care. The one difference from geeks is that this specialist must be an RN, that too through a BSN degree. Some institutions manage with RNs, irrespective of how they achieved that distinction. If properly integrated, there will be fewer medical errors, improved patient security as well as confidentiality, on a need to know basis. Since technology is involved, an additional test of your knowledge of modern computer technology will be taken. On earning your degree, the American Nurses Credentialing Center (ANCC) will certify your credentials. Tyros (< 5 years experience) will need to pass the Certified Associate in Healthcare Information Management Systems (CAHIMS) exam.

According to a survey by the Healthcare Information and Management Systems Society (HIMSS), “57 percent or respondents said their main responsibility was providing systems preparation, training and continued support to users, while 53 percent spent most of their time on systems development, where they customize or update systems or create a new homegrown system.” Additionally, certification is available from HIMSS based on years of service in healthcare infosystems.

As technology evolves, salary levels will rise alongside. Currently, a Social Science Research Assistant is paid a median salary of $37,140, rising to $54,638 for a Clinical Research Coordinator and $79,680 for a Computer Systems Analyst. Salary.com has pegged the median expected annual salary for Clinical Informatics Coordinators at $76,503, no mean sum. This is one area where you can get a good job as this is a relatively new career opening in nursing, where most nurses in the field are not sufficiently trained in IT, leaving the door for candidates looking to plug the gap between clinical care and technology open.

salariesChart 4

 

 

Master of Science in Nursing (MSN)

As is the case with all Master’s, a commitment to acquire a Master’s in Nursing (MSN) takes dedication and hard work, impacting your success in the field of nursing. The Master’s degree in nursing is often the ultimate goal of nurses. Apart from the connotation it carries, it opens the door to a large number of vocations, fresh vistas and opportunities, one of which may be ideally suited to you. Higher pay and greater responsibilities are related adjuncts. You could even shatter the glass ceiling.

A master’s degree provides you with the ability and higher levels of hands-on training you will require to provide top grade nursing care in specialized roles, e.g., nurse practitioner. In real life, your MSN lets you deliver healthcare services similar to those provided by physicians. Physicians tend to be overbooked or beyond the means of some patients, thereby advancing your position.

Advanced Practice Areas

The advanced practice areas for you are quite diverse in content and could be:

  • Nurse Practitioner (NP)
  • Certified Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)
  • Certified Nurse Midwife (CNM)
  • Nurse Educator (NE)

On completion and accredition, you would fall into the Advanced Practice Registered Nurses (APRN) category. The CRNA, though an APRN, would categorize you as a Doctor of Nurse Anesthesia Practice (DNAP). All these degrees, especially NPs, can have sub-specialties, each in the APRN category. Moreover, these degrees are terminal degrees.

The more ambitious nurses could consider even more rewarding jobs in terms of degrees and salary. These are the twin-qualification programs of:

  • MSN/MPH: Where you combine your MSN with a master’s in public health.
  • MSN/MBA: Where you combine your MSN with a master’s in business administration.
  • MSN/MHA: Where you combine your MSN with a master’s in health administration.

Part of the MSN syllabus is training in the business aspect of nursing. The topics covered will include down to earth programs like leadership, man and resource management, health policies and the financial aspect of advanced training. An MSN program generally takes two years. Most MSN programs include work experience as mandatory and generally stipulate the following add-ons:

  • A BSN
  • An RN license
  • Minimum GPA and GRE scores, which depend on the program in mind
  • Clinical experience, once again dependent on the program in mind

A non-medical graduate could also qualify to become an MSN. These tend to be three-year programs, with the first year dedicated to entry-level nursing and the next two dedicated to MSN- related courses. At the end of it all, the NCLEX-RN has to be cleared. You can attend college or university for your MSN, but the trend is to study online, providing that you meet laid down criteria similar to, or the same as discussed earlier.

Nurse Practitioner

Nurse Practitioners (NP) originally worked in the children’s health department. Today, that role has changed and become more broad-based, as NPs are allowed to home in on a specialty such as adult care, family care or women’s healthcare. An NP is a high-demand high-pay job with a current shortage in staff. They have been clamoring for equal footing with MDs, stating that APRNs offer services beyond traditional office hours, serving patients and families that might not otherwise be able to secure primary care services.

NPs focus on overall preventative healthcare with customized treatment for each patient. There are many types of NPs:

  • Women’s Health Nurse Practitioner
  • Advanced Registered Nurse Practitioner
  • Family Nurse Practitioner
  • Acute Care Nurse Practitioner
  • Adult Nurse Practitioner
  • Neonatal Nurse Practitioner
  • Perinatal Nurse Practitioner
  • Rural Nurse Practitioner

In a landmark decision, nurse practitioners in New York will soon be able to operate more independently of doctors. The Nurse Practitioners Modernization Act 2014 removes the requirement of a written practice agreement between an experienced nurse practitioner and a doctor as a condition of practice. The law will take effect Jan. 1, 2015.  The Medical Society of the State of New York (MSSNY) strongly opposed the decision.  MSSNY referred to studies that showed that increasing the use of NPs does not lower costs as the patients of NPs tended to have higher rates of medical service utilization. However, NPs and CNSs will be paid less for an identical service rendered by an MD.

Certified Registered Nurse Anesthetists (CRNAs)

The life span of most Americans has increased considerably, partly due to increased awareness about health, assessing their own health and involvement in their own medical care. The need for healthcare professionals, including CRNAs, is projected to grow at a better-than-average rate. Today, CRNA opportunities have gone beyond a traditional OR setting, as there is, and will remain a need for nurse anesthetists in hospital delivery rooms, and as primary providers of anesthesia in field military clinics.

Salary: CRNAs are the highest paid category of healthcare specialists. The median pay is $1,70,000. Starting salary is in the $120,000 range, while highly experienced CRNA professionals take home over $220,000 a year. Per hour rates are over $100!

Clinical Nurse Specialist (CNS)

Clinical Nurse Specialists are APRNs with a master’s or doctoral degree in a specialized area of nursing practice.  The area of specialization may be in:

  • population (e.g., pediatrics, geriatrics, women’s health)
  • a setting (e.g., critical care, emergency room)
  • a disease or medical subspecialty (e.g., diabetes, oncology)
  • type of care (e.g., psychiatric, rehabilitation)
  • type of health problem (e.g., pain, wounds, stress)

Apart from traditional nursing responsibilities to help patients prevent or resolve illness, CNS’ scope of practice includes diagnosis and treatment of diseases, injuries and disabilities within their field of expertise. They provide direct patient care, act as expert consultants for nursing staff and are proactive in improving healthcare systems.

Certified Nurse-Midwives

Certified Nurse-Midwives (CNMs) are APRNs who counsel and provide gynec care during pre-conception, pregnancy, childbirth and the postpartum period. CNMs, along with certified midwives (CMs) also provide family-oriented primary healthcare to women throughout their reproductive lives. Skilled midwifery reduces high-tech intervention for most women in labor, but CNMs also are trained in using up to date scientific procedures to assist in normal deliveries.  CNM-attended births account for 10% of all spontaneous vaginal births in the US, and 7% of all US births in total.  Of these deliveries, 97% occur in hospitals, 1.8% in freestanding birth centers and 1% at home.

Many people harbor the wrong impression that midwives only assist with births. While attending births is the integral part of their job, it is only a fraction of what midwives actually do. On average, CNMs/CMs spend 10% of their time taking direct care of women giving birth and newborn children.

Comparativechart 5

 

Comparative Salaries of MSNs

Nurse Educator (NE)

Nurse educators are registered nurses with advanced education who also teach. Most work as nurses for some time before dedicating their careers (part or full-time) to educating future nurses. They serve as faculty members in nursing schools and teaching hospitals, imparting their knowledge and skills to the next generation of nurses for efficient practice. Most of them have extensive clinical experience, and continue patient care even after becoming educators. Nurse educators need to stay current with evolving nursing methodology and technologies, to stay abreast of advancing clinical practices.

Nurse Educators are in high demand, because the US is facing a serious shortage of nurses. One key reason given is the paucity of nurse educators to teach and train future nurses. Campaigns have been launched to encourage the younger generation to opt for a career in nurse education. One example is the Nurses for a Healthier Tomorrow Coalition, launched in 2004.

The campaign was launched by a coalition of 43 leading nursing and healthcare organizations to address the nursing shortage, and is touting their cause with a slogan, “Nursing education … pass it on.” The aim is to increase the number of nurse educators, the shortage of whom is forcing nursing schools

to turn away prospective students.

According to the American Association of Colleges of Nursing (AACN), a member of Nurses for a Healthier Tomorrow, nursing schools in the United States turned away more than 11,000 qualified applicants in 2003. Almost 65 percent of the reporting nursing schools cited faculty shortages as the reason for not accepting all qualified applicants into entry-level baccalaureate programs.

The comparative salaries of MSNs vs that of a Registered Nurse is listed in Chart 5.

Doctor of Nursing Practice

The Doctor of Nursing Practice (DNP) is a professional degree that prepares graduates to provide the most advanced level of nursing care for recipients. This includes direct care of individual patients, management of care for individuals and populations, administration of health care and nursing systems, and the development and implementation of health policy. If you have completed the Doctor of Nursing Practice program, you should be able to:

  • Assume organizational and system leadership in the analysis, delivery, and management of nursing care, within system limits.
  • Implement the highest level of advanced nursing care to produce high quality, cost-effective outcomes for widely divergent groups of patients.
  • Use theories, concepts, and analytic methodologies learned to design, implement, and evaluate practice by applying your mind to improve extant nursing systems.
  • Contribute to the knowledge of best-practices and dissemination of outcomes through professional papers with or without a mentor, discourses and presentations.
  • Develop practice standards based on the integration of ethics, sociology and evidenced-based nursing care.

Within the nursing spectrum, you have four types of nursing doctorate degrees to choose from. Each degree stipulates specific path to follow.

  • Doctor of Nursing Practice (DNP): This degree stresses clinical practice-oriented leadership training.
  • Doctor of Nursing (ND): This degree looks at further development of exhibited advanced specialist skills.
  • Doctor of Nursing Science (DNSc): This degree relates to investigative and research skills.
  • Doctor of Nursing Philosophy (PhD): This degree is inclined towards scholarly research and inquiry.

Note 1: A DNP is a degree for practice in a clinical set up, whereas a PhD is geared towards research.

Note 2: The DNP degree is set to become the degree for entry to advanced practice nursing by 2015.

There are two other options, which are joint programs.

  • MSN/PhD: A master’s degree holder gets a doctorate in an accelerated program.
  • BSN-PhD: A program generally limited to BSN-holders who hold out plans to become researchers or nursing instructors.

A Doctorate is the ultimate in the nursing field. You cannot sit back on your laurels, because the Doctorate brings with it expectations of the highest levels of efficiency in every aspect related to nursing. You will become the father figure and need to set an example worthy of emulating. All responsibility will fall on your shoulders, though you would delegate both responsibility and authority to your senior staff members. Ultimately, your reputation is at stake.

A doctorate in nursing takes, on the average, four to six years to attain. This gives you adequate time to prepare. You can accelerate matters a bit, depending on your confidence level. Your pay packet also increases a fair bit. The doctor of nursing practice degree is set to become the degree for entry to advanced practice nursing by 2015, to the dismay of nurse practitioners. The salary difference is of the order of $8,000. But then, these DNPs degrees (67%) were obtained by NPs with 6 to 15 years’ experience. The median salary of DNPs with 0-2 years of experience in that post was $102,500. These would naturally increase as incremental pay linked to years of practice.

THE NURSING PARADOX: America’s Health Worker Mismatch

The recession saw high unemployment in almost all sectors, but jobs in the healthcare industry increased by more than 1.2 million, with high salaries of over $60,000. The need for these very workers will keep increasing. The Affordable Care Act, or Obamacare is a complete overhaul of the US healthcare system and is projected to add 32 million people to insurance coverage over the years to come. The aging of the US, as death rates are dropping with each passing year, will fuel the need for healthcare as geriatric numbers and concomitant diseases must also increase.

US healthcare workers should be rejoicing, but that is hardly the case. The Bureau of Labor Statistics’ Employment Projections 2012-2022 released in December 2013 listed Registered Nursing (RN) among the top occupations in terms of job growth through 2022. The RN strength in 2012 was 2.71 million and forecast to grow to 3.24 million in 2022, increase numbers by 526,800 or 19%. The Bureau also listed replacements in the industry at 525,000 raising the overall job openings for nurses due to retirements to 1.05 million by 2022.

Despite so many vacancies, medical professional schools are rejecting applications from almost eighty thousand qualified US citizens and plugging the gap by recruiting foreign workers in tens of thousands. Today, about 33,000 healthcare workers are foreign-born and trained, including 25 percent of all physicians. The primary reason is the deplorable state of healthcare schools, which, for some unknown reason, is disregarding the demand/supply curve. The cost of higher education has increased over the past twenty-five years and the cost of educating graduates has shot up rapidly. Over the same time frame, public medical school tuitions have gone up by a mindboggling 312 percent, compounding the problem. The shortage of nursing staff is projected to increase to 260,000 by 2025.

Only 60 percent of the nurses work in hospitals. The remaining 40 percent work in schools, correctional facilities, private companies, home health, nursing homes, government agencies, social assistance agencies and research labs. One out of every four RNs works part time. At the same time, the rising number of patients suffering from complex diseases has called for more complex and specialized skill sets. In-demand specialties include traveling nurses, nurse informatics specialists, acute nurse practitioners, geriatric nurses, hospice nurses, and home care nurses. The greatest need is for Nurse Educators.

The Govt Institute of Medicine, in its report on The Future of Nursing, called for increasing the number of baccalaureate-prepared nurses in the workforce to 80 percent and doubling the population of nurses with doctoral degrees. The current nursing workforce falls far short of these recommendations with only 55 percent of registered nurses prepared at the baccalaureate or graduate degree level.

The number of professionals that can be trained in healthcare in the US is limited by an archaic law requiring US students to be educated only in teaching hospitals, even when their stated destination is a clinic or community hospital. This automatically places a limit on numbers. A waiting list is created, increasing the training period and virtually barring students from indigent communities.

Credential creep sets in. Audiology, physical therapy and optometry now require doctorate  licensees for therapists who had earlier required a master’s degree. The cascading effect is more schooling, higher attrition rates, higher debt, higher wage demands and fewer workers from underserved and low-income areas. This licensing system favors foreign-trained health workers, who do not have to meet the self-imposed qualifications.

In numbers, 30,000 additional nurses should be graduated annually to meet the nation’s healthcare needs, an expansion of 30 percent over the current number of annual nurse graduates. This solution, though numerically viable, cannot be put into practice straightaway. The greatest worry is that a significant segment of the nursing workforce is nearing retirement age. 55 percent of the RN workforce is aged 50 or older. They will retire in next to no time.

One solution suggests increasing the retirement age. This will create a hierarchy logjam, in that senior vacancies will remain blocked to younger nurses, who will then shift to private nursing homes and similar posts. According to a May 2001 report on the US impending health care crisis released by University of Illinois College of Nursing, “The ratio of potential caregivers to the people most likely to need care, the elderly population, will decrease by 40% between 2010 and 2030. Demographic changes may limit access to health care unless the number of nurses and other caregivers grows in proportion to the rising elderly population.”

Changing demographics signal a need for more nurses to care for our aging population. The future demand for nurses will increase dramatically as the baby boomers reach their 60s and more. Insufficient staffing will raise the stress level of nurses, impact job satisfaction, and force many nurses to leave the profession or go elsewhere. In a 2005 survey printed in the Nursing Economic$ journal, “Almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).” One parallel conclusion was that failure to retain nurses contributed to avoidable patient deaths.

This problem is not limited to the US alone. Most advanced countries tend to outsource jobs in the healthcare industry, whether at below the RN level or above. There is a need to get local people to learn to look after others, but today’s Gen Next thinks that Medical Studies is far too time consuming and not adequately rewarded. As long as this attitude persists, the problem will not go away.

GLOSSARY OF TYPES OF NURSING

Agency – Agency Nursing is essentially where a nurse registers or signs up with an agency or similar group to tell them what hours they are available to work. The nurses are then contacted and offered work on a shift to shift basis. Agency Nurses are now in high demand, particularly, in the case of nurses with specialized training or experience.

Ambulatory Care – Ambulatory Care Nurses care for patients whose stay in the hospital or other facility will be less than 24 hours. Such nursing covers a broad range of specialties in the out-patient setting.

Anesthesia – Nurse Anesthetists work with surgeons, dentists, podiatrists, anesthesiologists, and other doctors to provide anesthesia to patients before, during, and after surgery or child birth.

Cardiac Care – The Cardiac Care Nurse works with other members of the medical staff in assessing, intervening, and implementing nursing care for cardiac patients. The American Board of Cardiovascular Medicine is a sub-specialty cardiology organization that provides cardiology professionals with primary and secondary education in their specific area of need, and professional certification awards to validate their role within the cardiology service line.

Case Management – Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.

Critical Care – Critical Care nurses provide care for patients and families who are experiencing actual or potential life-threatening illness. More specific fields that fit into the critical care category include cardiac care, intensive care, and neurological and cardiac surgical intensive care.

Emergency – Emergency Nurses assess patients, provide interventions and evaluate care in a time limited and sometimes hectic environment. Emergency Nurses work independently and interdependently with various health professionals in an attempt to support patients and their families as they experience illness, injury or crisis.

Forensics – Forensic Nurses provide medical care to victims of crime, collect evidence after crimes occur, and provide medical care to patients within the prison system. Their affiliation needs be international as most major crimes tend to be cross-border incidents. Their controlling agency is the International Association of Forensic Nurses

Gastroenterology – Gastroenterology (GI) Nurses provide care to patients with known or suspected gastrointestinal problems who are undergoing diagnostic or therapeutic treatment and/or procedures. GI Nurses practice in physician offices, inpatient and outpatient endoscopy departments, ambulatory endoscopy centers and inpatient hospital units.

Geriatrics – Geriatric Nurses care for elderly patients in a number of settings which include the patients home, nursing homes, and hospitals. Geriatric Nurses face constant challenges because their patients are often very ill, very complex, and very dependent on the nurses’ skills.

Holistic – Holistic Nurses provide medical care for patients while honoring the individual’s subjective opinions about health, health beliefs, and values. Holistic nursing requires nurses to integrate self-care, self-responsibility, spirituality, and reflection into their daily nursing care.

HIV/AIDS – HIV/AIDS Nurses provide healthcare for patients who are HIV or AIDS positive. These nurses usually have specialized training in HIV/AIDS.

Informatics – Nursing Informatics is a broad field which combines nursing knowledge with the use of computers. Jobs in this field could range from the implementation of a new computer network within a hospital to the sales of computer systems to hospitals by an outside computer company.

Legal Nursing – Legal Nursing combines the use of the legal system with a thorough knowledge of the nursing field. Legal Nurses are usually seasoned veterans of the nursing field who work with attorneys to review medical documents and determine if medical negligence occurred. The regulatory agency in the U.S. is the American Association of Legal Nurse Consultants

Midwifery – Midwives are nurses that are specially trained to deal with childbirth and providing prenatal and postpartum care. The midwives are qualified to deliver babies by themselves unless there are extenuating circumstances which require the midwife to consult with a physician.

Military – Military Nurses work in a variety of settings, ranging from family practice at a local military base to providing emergency care for the wounded during war times.

Neonatal – Neonatal Nurses provide care for newborns by assessing the patient to ensure good health, providing preventative care to prevent illness, and caring for the babies which are sick. The neonatal nurse is responsible for anticipating, preventing, diagnosing and minimizing illness of newborns.

Neuroscience – Neuroscience Nurses care for patients using new therapies and innovative technologies to treat diseases of the nervous system.

Nurse Practitioner – Nurse Practitioners are advanced practice nurses who have obtained their masters degree and are qualified to prescribe medication, and interpret diagnostic and laboratory tests. They fall under the fiefdom of either the American Academy of Nurse Practitioners or the American College of Nurse Practitioners in the U.S.

Occupational Health – the Occupational Health Nursing is responsible for improving, protecting, maintaining and restoring the health of employees. By providing this care for employees, the occupational health nurse is able to influence the health of the organization.

Oncology – Oncology Nurses provide health care for cancer patients at all stages of treatment and remission.

Pediatric – Pediatric Nurses care for children in all aspects of health care. Pediatric nurses practice in a

variety of settings which include hospitals, clinics, schools, and in the home. The controlling agencies in the U.S. are the Association of Pediatric Oncology Nurses or the National Association of Pediatric Nurse Associates and Practitioners.

Perioperative (OR) – Perioperative Nurses work in operating rooms in tertiary care hospitals, community and rural hospitals, day care surgery units and specialized clinics. They often provide post-anesthetic care in rural hospitals or specialized units where nurses provide total patient care.

Psychiatric – Psychiatric Nurses provide care for patients and families with psychiatric and mental illnesses. These nurses practice in a variety of settings which include hospitals, and institutions. Since this is an underdeveloped field, affiliation is to an international agency, the International Society of Psychiatric – Mental Health Nurses

Research – Research Nurses perform clinical and basic research to establish a scientific basis for the care of individuals across the life span-from management of patients during illness and recovery to the reduction of risks for disease and disability, the promotion of healthy lifestyles, promoting quality of life in those with chronic illness, and care for individuals at the end of life.

School Nursing – School Nurses work with students and faculty of schools providing medical care and other support in an in-school environment. Since parents can be very demanding in the U.S., they are affiliated to the National Association of School Nurses.

Transplant – Transplant Nurses work in a variety of settings and function in various aspects of transplant procedures. They assist in the transplantation of various body parts which include, but are not limited to: liver, kidney, pancreas, small bowel, heart, and lungs. Their regulatory agency is the International Transplant Nurses Society.

Trauma – Trauma Nurses care for patients in an emergency or critical care setting. These nurses generally care for patients who have suffered severe trauma such as a car accident, gunshot wound, stabbing, assault, or other traumatic injury.

Travel Nursing – Travel Nurses work for an agency that provides nurses to hospitals and other health care facilities across the country. Travel nurses usually get to choose which locations they are willing to travel to and are typically given assignments which last for 13 weeks or more. Travel nurses usually make a very good salary, receive paid housing accommodations, sign-on bonuses, and other excellent benefits.

Urology – Urology Nurses care for patients in such specialties as oncology, male infertility, male sexual dysfunction, kidney stones, incontinence, and pediatrics. Urology nurses may also participate in such urological surgeries as surgery for cancer, general urology, plastic, infertility, brachytherapy, lithotrispy, and pediatric surgery.

Women’s Health – Women’s Health Nurses participate in fields such as OB/GYN, mammography, reproductive health, and general women’s health. These nurses practice in a variety of settings.

References:

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