U.S. Department of
Labor | Bureau of Labor Statistics | Bulletin 2540
Nature of the Work | Working
Conditions | Employment | Training,
Other Qualifications, and Advancement | Nursing
Job Outlook | Nursing Earnings
- Registered nurses constitute the largest healthcare occupation,
with 2.3 million jobs.
- More new jobs are expected to be created for registered nurses
than for any other occupation.
- Nursing job opportunities are expected to be very good.
- The three major educational paths to registered nursing are
a bachelor's degree, an associate degree, and a diploma.
Registered nurses (RNs) 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 in patients; assist physicians during surgeries,
treatments, and examinations; administer medications; and assist
in convalescence and rehabilitation. RNs 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 that RNs
may perform, it is usually the work setting that determines their
daily job duties.
Hospital nurses form the largest group of nurses. Most
are staff nurses, who provide bedside nursing care and carry out
medical regimens. They also may supervise licensed practical nurses
and nursing aides. Hospital nurses usually are assigned to one
department, such as surgery, maternity, pediatrics, the emergency
room, intensive care, or the treatment of cancer patients. Some
may rotate among departments.
Office nurses care for outpatients in physicians' offices,
clinics, ambulatory surgical centers, and emergency medical centers.
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.
Nursing care facility nurses manage care for residents
with conditions ranging from a fracture to Alzheimer's disease.
Although they often spend much of their time on administrative
and supervisory tasks, RNs also assess residents' health, develop
treatment plans, supervise licensed practical nurses and nursing
aides, and perform invasive procedures, such as starting intravenous
fluids. They also work in specialty-care departments, such as long-term
rehabilitation units for patients with strokes and head injuries.
Home health nurses provide nursing services to patients
at home. RNs assess patients' home environments and instruct patients
and their families. Home health nurses care for a broad range of
patients, such as those recovering from illnesses and accidents,
cancer, and childbirth. They must be able to work independently
and may supervise home health aides.
Public health nurses work in government and private agencies,
including clinics, schools, retirement communities, and other community
settings. They focus on populations, working with individuals,
groups, and families to improve the overall health of communities.
They also work with communities to help plan and implement programs.
Public health nurses instruct individuals, families, and other
groups regarding health issues such as preventive care, nutrition,
and childcare. 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
Occupational health nurses, also called industrial
nurses, provide nursing care at worksites to employees, customers,
and others with injuries and illnesses. They give emergency care,
prepare accident reports, and arrange for further care if necessary.
They also offer health counseling, conduct health examinations
and inoculations, and assess work environments to identify potential
or actual health problems.
Head nurses or nurse supervisors direct nursing
activities, primarily in hospitals. They plan work schedules and
assign duties to nurses and aides, provide or arrange for training,
and visit patients to observe nurses and to ensure that the patients
receive proper care. They also may ensure that records are maintained
and equipment and supplies are ordered.
At the advanced level, nurse practitioners provide basic,
primary healthcare. They diagnose and treat common acute illnesses
and injuries. Nurse practitioners also can prescribe medicationsbut
certification and licensing requirements vary by State. Other advanced
practice nurses include clinical nurse specialists, certified
registered nurse anesthetists, and certified nurse midwives.
Advanced practice nurses must meet educational and clinical practice
requirements beyond the basic nursing education and licensing required
of all RNs.
Most nurses work in well-lighted, comfortable healthcare facilities.
Home health and public health nurses travel to patients' homes,
schools, community centers, and other sites. Nurses may spend considerable
time walking and standing. Patients in hospitals and nursing care
facilities require 24-hour care; consequently, nurses in these
institutions may work nights, weekends, and holidays. RNs also
may be on callavailable to work on short notice. Office,
occupational health, and public health nurses are more likely to
work regular business hours. More than 1 in 5 RNs worked part time
in 2002 and nearly 1 in 10 held more than one job.
Nursing has its hazards, especially in hospitals, nursing care
facilities, and clinics, in all three of which nurses may care
for individuals with infectious diseases. Nurses must observe rigid
standardized guidelines to guard against disease and other dangers,
such as those posed by radiation, accidental needle sticks, chemicals
used to sterilize instruments, and anesthetics. In addition, they
are vulnerable to back injury when moving patients, shocks from
electrical equipment, and hazards posed by compressed gases.
As the largest healthcare occupation, registered nurses held about
2.3 million jobs in 2002. Almost 3 out of 5 nursing jobs were in
hospitals, in inpatient and outpatient departments. Others worked
in offices of physicians, nursing care facilities, home healthcare
services, employment services, government agencies, and outpatient
care centers. The remainder worked mostly in social assistance
agencies and educational services, public and private. About 1
in 5 RNs worked part time.
Other Qualifications, and Advancement
In all States and the District of Columbia, students must graduate
from an approved nursing program and pass a national licensing
examination in order to obtain a nursing license. Nurses may be
licensed in more than one State, either by examination, by the
endorsement of a license issued by another State, or through a
multi-State licensing agreement. All States require periodic renewal
of licenses, which may involve continuing education.
There are three major educational paths to registered nursing:
a bachelor's of science degree in nursing (BSN), an associate degree
in Nursing (ADN), and a diploma. BSN programs, offered by colleges
and universities, take about 4 years to complete. In 2002, 678
nursing programs offered degrees at the bachelor's level. ADN programs,
offered by community and junior colleges, take about 2 to 3 years
to complete. About 700 RN programs in 2002 were at the ADN level.
Diploma programs, administered in hospitals, last about 3 years.
Only a small and declining number of programs offer diplomas. Generally,
licensed graduates of any of the three types of educational programs
qualify for entry-level positions as staff nurses.
Many ADN- and diploma-educated nurses later enter bachelor's
programs to prepare for a broader scope of nursing practice. Often,
they can find a staff nurse position and then take advantage of
tuition reimbursement benefits to work toward a BSN by completing
one of many RN-to-BSN programs.
Accelerated BSN programs also are available for individuals who
have a bachelor's or higher degree in another field and who are
interested in moving into nursing. In 2002, more than 110 of these
programs were available. Accelerated BSN programs last 12 to 18
months and provide the fastest route to a BSN for individuals who
already hold a degree. Accelerated master's degree programs in
nursing also are available and take about 3 years to complete.
Individuals considering nursing should carefully weigh the advantages
and disadvantages of enrolling in a BSN program, because, if they
do, their advancement opportunities usually are broader. In fact,
some career paths are open only to nurses with bachelor's or advanced
degrees. A bachelor's degree often is necessary for administrative
positions and is a prerequisite for admission to graduate nursing
programs in research, consulting, teaching, or a clinical specialization.
Nursing education includes classroom instruction and supervised
clinical experience in hospitals and other healthcare facilities.
Students take courses in anatomy, physiology, microbiology, chemistry,
nutrition, psychology and other behavioral sciences, and nursing.
Course work also includes the liberal arts.
Supervised clinical experience is provided in hospital departments
such as pediatrics, psychiatry, maternity, and surgery. A growing
number of programs include clinical experience in nursing care
facilities, public health departments, home health agencies, and
Nurses should be caring, sympathetic, responsible, and detail
oriented. They must be able to direct or supervise others, correctly
assess patients' conditions, and determine when consultation is
required. They need emotional stability to cope with human suffering,
emergencies, and other stresses.
Experience and good performance can lead to promotion to more
responsible positions. In management, nurses can advance to assistant
head nurse or head nurse and, from there, to assistant director,
director, and vice president. Increasingly, management-level nursing
positions require a graduate or an advanced degree in nursing or
health services administration. They also require leadership, negotiation
skills, and good judgment. Graduate programs preparing executive-level
nurses usually last about 2 years.
Within patient care, nurses can move into a nursing specialty
such as clinical nurse specialist, nurse practitioner, certified
nurse midwife, or certified registered nurse anesthetist. These
positions require about 2 years of graduate education leading to
a master's degree.
Some nurses move into the business side of health care. Their
nursing expertise and experience on a healthcare team equip them
with the ability to manage ambulatory, acute, home health, and
chronic care services. Employersincluding hospitals, insurance
companies, pharmaceutical manufacturers, and managed care organizations,
among othersneed RNs for health planning and development,
marketing, consulting, policy development, and quality assurance.
Other nurses work as college and university faculty or conduct
Job opportunities for RNs are expected to be very good. Employment
of registered nurses is expected to grow
faster than the average for all occupations through 2012, and
because the occupation is very large, many new jobs will result.
In fact, more new jobs are expected be created for RNs than for
any other occupation. Thousands of job openings also will result
from the need to replace experienced nurses who leave the occupation,
especially as the median age of the registered nurse population
continues to rise.
Faster-than-average growth will be driven by technological advances
in patient care, which permit a greater number of medical problems
to be treated, and an increasing emphasis on preventive care. In
addition, the number of older people, who are much more likely
than younger people to need nursing care, is projected to grow
Employers in some parts of the country are reporting difficulty
in attracting and retaining an adequate number of RNs, due primarily
to an aging RN workforce and insufficient nursing school enrollments.
Imbalances between the supply of, and demand for, qualified workers
should spur efforts to attract and retain qualified RNs. For example,
employers may restructure workloads, improve compensation and working
conditions, and subsidize training or continuing education.
Employment in hospitals, the largest sector, is expected to grow
more slowly than in most other healthcare sectors. While the intensity
of nursing care is likely to increase, requiring more nurses per
patient, the number of inpatients (those who remain in the hospital
for more than 24 hours) is not likely to increase much. Patients
are being discharged earlier and more procedures are being done
on an outpatient basis, both inside and outside hospitals. Rapid
growth is expected in hospital outpatient facilities, such as those
providing same-day surgery, rehabilitation, and chemotherapy.
An increasing proportion of sophisticated procedures, which once
were performed only in hospitals, are being performed in physicians'
offices and in outpatient care centers, such as freestanding ambulatory
surgical and emergency centers. Accordingly, employment is expected
to grow faster than average in these places as healthcare in general
Employment in nursing care facilities is expected to grow faster
than average due to increases in the number of elderly, many of
whom require long-term care. In addition, the financial pressure
on hospitals to discharge patients as soon as possible should produce
more admissions to nursing care facilities. Job growth also is
expected in units that provide specialized long-term rehabilitation
for stroke and head injury patients, as well as units that treat
Employment in home healthcare is expected to increase rapidly
in response to the growing number of older persons with functional
disabilities, consumer preference for care in the home, and technological
advances that make it possible to bring increasingly complex treatments
into the home. The type of care demanded will require nurses who
are able to perform complex procedures.
In evolving integrated healthcare networks, nurses may rotate
among various employment settings. Because jobs in traditional
hospital nursing positions are no longer the only option, RNs will
need to be flexible. Opportunities should be excellent, particularly
for nurses with advanced education and training.
Median annual earnings of registered nurses were $48,090 in 2002.
The middle 50 percent earned between $40,140 and $57,490. The lowest
10 percent earned less than $33,970, and the highest 10 percent
earned more than $69,670. Median annual earnings in the industries
employing the largest numbers of registered nurses in 2002 were
|General medical and surgical hospitals
|Home health care services
|Offices of physicians
|Nursing care facilities
Many employers offer flexible work schedules, childcare, educational
benefits, and bonuses.
Information From: Bureau of Labor Statistics, U.S. Department
of Labor, Occupational Outlook Handbook , 2004-05 Edition , Registered
Nurses , on the Internet at http://www.bls.gov/oco/