Nurses are highly skilled professionals who care for the sick, help to educate the population on health care issues, and promote wellness. Licensed practical nurses (L.P.N.s) or licensed vocational nurses (L.V.N.s), depending on the state, perform most of the bedside care. In hospitals they may have more opportunities for expanded care, which they learn on the job. However, L.P.N.s are being phased out in most areas of the country. Those who were grandfathered in still work in hospitals, but new L.P.N.s find work primarily in skilled-nursing facilities (nursing homes) or doctors' offices. Registered nurses (R.N.s) perform many expanded roles and have multiple avenues for specialization and advanced education.

Duties, Activities, and Scope of Practice

Nurses were once thought to be handmaidens of physicians, but today that couldn't be further from the truth. Nursing is a profession, and the nurse's role complements the physician's role on the health care team.

R.N.s assess patients, educate and counsel patients, and carry out treatments and procedures as directed by physicians. They apprise physicians of significant changes. There are many roles for nurses, from positions in hospitals and clinics to working in schools and business organizations.

Nurse practitioners are advanced-practice nurses with a master's degree and specialized training in diagnosing and prescribing. (In forty-eight states they can prescribe medications.) They specialize in an area, such as family practice, pediatrics, women's health, mental health, or geriatrics, and they work under a physician. They conduct physical exams, order tests, diagnose and treat minor illnesses and injuries, and refer to the physician as needed.

There are many advanced-practice roles for nurses, such as in clinical settings, midwifery, anesthesia, and education. These require additional training and education such as master's and doctoral degrees.

Education and Training

All nursing programs require a high school diploma. Math and sciences are included in all nursing curriculums to varying degrees. Algebra is required. Chemistry, biology, anatomy and physiology, and microbiology are also required.

Most nursing programs require applicants to have a C.N.A. (certified nursing assistant) and some level of experience in the health care field. Many schools also require the NET (Nursing Entrance Test). See Appendix B for more information.

R.N. programs begin at three levels. There are still a few diploma nursing schools in existence, but most R.N.s attend either a community college and earn an associate's degree, or a four-year college or university and obtain a B.S.N. (Bachelor of Science in Nursing). Advanced degrees of Masters of Science in Nursing or a doctoral in nursing are also available, as well as several other master's and doctoral degrees in health care, health care administration, nursing education, etc.

All nursing programs consist of classroom education as well as supervised practical/clinical rotations in hospitals and other facilities. These clinical rotations include medical, surgical, orthopedics, pediatrics, labor and delivery, and mental health. Some include other areas such as public health and home health.

Associate's and bachelor's degree programs have general-education requirements, as well as math, sciences, and nursing courses. General-education courses are typically taken in the first year for the A.D.N. program and the first two years in the B.S.N. program. Nursing courses, both classroom and clinical, usually make up the latter year(s) of the program.

Licensure/Certification

Upon graduation from an accredited school of nursing, L.P.N.s and R.N.s are required by all states to pass the NCLEX (National Council Licensure Examination) for licensure. This test is administered by the National Council of State Boards of Nursing. It is given via computers at testing centers across the country at various times. It tests both scientific and math knowledge, as well as nursing situations. Reciprocity is available in most states. Renewal is done on a periodic basis of every one to three years. Most states require continuing education in order to renew. If a license lapses, the nurse must retake the NCLEX in order to practice again.

Work Settings and Salaries

Nursing is one of the most physically and emotionally demanding careers. Nurses cover shifts and patient needs in hospitals and home health care 24 hours per day, 365 days per year. Many situations require nurses to be on call and available on short notice. Nurses spend a considerable amount of time standing and walking.

Nursing constitutes the largest health care occupation. According to the U.S. Department of Labor, nurses accounted for 2.4 million jobs in 2004. One out of every four nurses worked part-time in 2004, and nearly 7 percent held more than one job. Almost 60 percent of the jobs were in hospitals, in inpatient and outpatient departments. The other 40 percent of jobs were primarily in nursing homes, home health, physicians' offices, clinics and outpatient facilities, schools, insurance and managed care companies, pharmaceutical companies, industry, and government agencies.

Salaries for nurses can vary greatly, especially for those working more than one job. However, the U.S. Department of Labor reports that for 2004, the median salary for an R.N. was $45,330, and for an L.P.N. it was $33,970. Advanced-practice R.N.s typically earn between $50,000 and $85,000 annually.

Career Potential and Additional Information

In recent history there have been cycles of nursing shortages followed by a surplus and another shortage and another surplus. Changes in health care management have greatly reduced the number of R.N. jobs available, as hospitals have needed to cut down on nursing staff in order to deal with reduced reimbursement issues. Nonetheless, the nursing shortage has increased over the past few years, as women have taken advantage of other health care opportunities. Critical shortages of nurses over the past two decades have led to increased salaries and improved working conditions.

The average age of nurses today is forty-five and older, and nurses entering the field are older as well. As the population ages and the baby boomers retire, the number of nurses will continue to fall.

Nursing will be the fastest-growing occupation from now until 2014. This will be due to advances in technology and the need for health education. The need for nurses in hospitals may shrink, but the need for nurses in outpatient settings, day surgeries, home health, and ambulatory care settings will rapidly increase. Advanced training and education will be needed for nurses in many of these areas. There is a significant shortage at the present time of nurse educators, which is severely limiting the number of new nurses who can be trained. Most nursing schools have waiting lists.

For more information about nursing as a career contact the American Nurses Association. Their Web site is www.nursingworld.org. Their address is 8515 Georgian Avenue, Suite 400, Silver Spring, MD 20910.

For information about accredited nursing programs contact the National League for Nursing. Their Web site is www.nln.org. Their address is 61 Broadway, 33rd Floor, New York, NY 10006.