Nurses actually carry out a health-care plan for a patient. They usually do not prescribe drugs or therapies, but often take the initiative to provide practical comforts and care. While doctors may decide on a patient's course of treatments, the nurses actually carry out the routine parts of care. In the process, nurses usually perform most health-care services of a hospital or doctor's office.
Nursing has a discrete body of knowledge characterized by how patients and families are cared for to restore them to optimal health and functioning. Nurses work closely with all other members of the health care team (physicians, therapists, dietitians, etc.) to perform care and meet health needs.
Nurses come in distinct levels, distinguished by increasing responsibility, skills and income.
Nursing assistants and orderlies are trained on-the-job in specific skills. In acute-care hospitals, their duties are often limited to housekeeping. In convalescent hospitals, emergencies are less likely, and nursing assistants may also measure blood-pressure and temperature, or exercise, feed and turn patients. Most states prohibit nursing assistants from administering medicine, drawing blood, inserting catheters or intravenous fluids, or performing other medical procedures. Still, when they perform patient care they are real members of nursing staff, and deserve respect, supervision and training.
Most orderlies are trained to perform heavy patient-movement or other muscular tasks. Orderlies were originally the "police" of hospitals, to keep the patients "orderly." They retain this function in some mental hospitals. They also perform patient care, and often help male patients bathe or go to the bathroom.
Technicians and specialized therapists may wear white coats, but are not considered nurses, because they usually have no scope to affect a patient's comfort or degree of care. For example, certified injectionists are trained to perform injections. There are also blood collection technicians, and technicians trained to operate most kinds of advanced diagnostic and laboratory equipment. Respiratory and physical therapists perform only specific medical procedures. The incomes of technicians and therapists vary wildly depending on their skills.
Licensed vocational nurses (LVNx) exist in some states. These usually have two years of training, in anatomy, drug interactions and practical patient care. They can perform simple medical procedures and usually oeprate under the supervision of more highly trained registered nurses (RNs). They can administer medication, perform measurements (blood pressure, temperature, etc), record-keeping, patient-care planning, first-aid, CPR, sterile and isolation procedure and basic pychological care and house-keeping. In long term care facilities, they sometimes supervise nursing assistants and orderlies.
Registered Nurses (RNs) are yet more highly trained than LVNs, and besides LVN duties, can assist in surgery, recovery, or emergency care, and supervise other nurses. They often receive advanced training to run diagnostic equipment. They usually complete a three or four year program. They are the largest group of healthcare workers in the United States, with over 2.6 million RNs. It is estimated that an additional 750,000 RNs will be needed by 2005.
Advanced Practice Nurses perform routine health care, usually under the supervision of doctors. They can diagnose and prescribe, within limited specialties. APNs usually receive a Masters' Degree or higher in Nursing, and may sit for additional certification examinations. These exams allow an APN to practice at a more advanced (sometimes independent) level in a specialty. They may operate as a Certified Nurse Midwife (CNM), Nurse-Practitioner (NP), Clinical Nurse Specialist (CNS) or Certified Registered Nurse Anesthetist (CRNA).
All advanced practice certifications require continuing education and other requirements (such as periodic reexamination) to maintain the credential. Advanced practice nurses can expect to earn above-average salaries, especially as the population of the US ages and the demand for highly-skilled healthcare workers grows proportionally.
What do Nurses do?
According to the US Department of Labor's revised Occupational Outlook Handbook (2000), "Registered nurses (R.N.s) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, 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 their day-to-day job duties."
All US states and territories require RNs to graduate from an accredited nursing program which allows the candidate to sit for the NCLEX examination, a standardized examination administered through the National Council of State Boards of Nursing. Successful completeion of the NCLEX examination confers state licensure as an RN. 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. Some states require continuing education in order to renew licenses.
Nurses may receive their basic preparation for Registered Nursing through one of three avenues:
1. Graduation from an Associate-Degree nursing program (approximately 2 years of college level study with a strong emphasis on clinical knowledge and skills)earning the degree of ASN/AAS in Nursing (the most common means of entry into the profession as of this writing).
2. Graduation with a three-year (diploma) certificate from a hospital-based school of nursing (non-degree)
3. Graduation from a University with a Bachelor's Degree in Nursing (a 4 - 5 year program conferring the BSN/BN degree with enhanced emphasis on non-clinical topics as well as clinically-focused courses). All pathways into practice require that the candidate complete some clinical training in nursing, and graduates of all programs, once licensed, are generally eligible for employment as entry-level staff nurses.
It is common for RNs to seek additional education to prepare themselves to assume leadership or advanced practice roles within nursing. Management positions increasingly require candidates to hold an advanced degree in nursing. Many hospitals offer tuition remission or assistance to nurses who want to continue their education beyond their basic preparation.
Where do Nurses work?
Most RNs work in a hospital. A registered nurse has a very portable job skill. In many cities, RNs can enter their names in a "registry" and work a wide variety of temporary jobs. Beside hospitals, RNs work in schools, home health care, in office and occupational or industrial health settings, free-standing clinics and physician offices, long-term care facilities, camps, and as advisors and consultants to the healthcare and insurance industries. Some RNs even work with attorneys as Legal Nurse Consultants, reviewing patient records to assure that adequate care was provided.
There are many different nursing specialties, encompassing care throughout the human lifespan and based upon patient needs. Many nurses who choose a specialty become certified in that specialty, signifying that they are recognized as providing exceptional care within that specialty. There are over 200 nursing specialties and sub-specialties. Certified nurses usually earn a salary differential over their non-certified colleagues, and studies from the Institute of Medicine have demonstrated that specialty certified nurses have higher rates of patient satisfaction, as well as lower rates of work-related errors in patient care.