Health care as a whole is one of the fastest growing career opportunities worldwide. Combined with the growing shortage of personnel, nurses are in high demand and will remain so for at least the next ten years. Part of the reason for the shortage is the ever-expanding opportunity and accompanying need for nurses. Nurses no longer work primarily in hospitals, nursing homes, doctor's offices, and clinics. These will continue to be major employers for nurses, but as many new opportunities arise as a result of constant changes in the workplace, nurses are leaving these sites. New nurses are also exploring the opportunities that have grown out of advances in technology and medicine.

Most of these new opportunities require an R.N.; and often a B.S.N., but some areas do offer opportunities for LVNs as well. Sometimes these are limited roles such as in home health care, hospice, and private duty where the LPN can perform certain tasks such as Foley care, venipuncture for lab specimens, wound care, ventilator care, and basic bedside nursing.

The only truly expanded role for LVNs is IV care. IV certification at present is an additional optional course of study in most states. Each state's Nurse Practice Act for LPNs spells out the level of care of IVs that this certification covers. In most instances, dressing changes and hanging new bags and possibly adjusting the rate of flow, is about all that is allowed. New laws are being legislated to allow LVNs to flush central lines and perform central-line care.

Be sure that you have a clear understanding of the policies of your employer as well as the law in the state in which you practice. Never rely on the culture of what is acceptable in your facility as the final rule. You are responsible for knowing the law and abiding by it. If some administrator has bent the law for the convenience of the facility, you can be held liable.

Advance Practice Nurses (APNs) are nurses who hold advanced degrees and/or certifications in specialties that include certified registered nurse anesthetists (CRNA), certified nurse-midwives (CNM), certified diabetic educators (CDE), clinical nurse specialists (CNS), and nurse practitioners (NP) in such areas as palliative care, pediatrics, geriatrics, family practice, women's health, and mental health. There are many more areas of specialization and more to come in the future. Nurse practitioners work under the supervision of a physician. In some states, they can prescribe medications. They assess patients and can perform many procedures that are normally performed only by physicians such as pap smears.

Pending legislation at the state and national levels may pave the way for even more changes in the range of opportunities for advance practice nurses. If Medicare and/or Medicaid reimbursement to nurse practitioners becomes possible, the APRN role may be expanding further especially in rural areas where access to physician care is limited. NPs could serve to supplement the care. In particular, case management of patients with palliative care and mental health issues could once again be reimbursed if this legislation is passed.

Nurses can be childbirth educators and lactation consultants, flight nurses and legal nurse consultants. They can specialize in managed care, infection control, IV infusion, nutrition support, oncology, cardiology, and heart catheterization and in case management of catastrophic illness and workmen's compensation cases.

In some instances, nurses holding a B.S.N. can now become instructors in vocational and A.D.N. programs. Generally, nurse educators must hold a master's or Ph.D. in nursing, or education. In fact even in vocational and A.D.N. programs, the minimum requirement has been for a master's prepared nurse educator. However, with the shortage of nurses and the need to increase enrollment in nursing programs, the B.S.N. prepared nurse now has more opportunities to teach.