Registered nurses (RNs) 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.

Duties

Registered nurses typically do the following:

  • Record patients' medical histories and symptoms
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute to existing plans
  • Observe patients and record observations
  • Consult with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

Most registered nurses work as part of a team with physicians and other healthcare specialists. Some registered nurses oversee licensed practical nurses, nursing assistants, and home health aides.

Registered nurses' duties and titles often depend on where they work and the patients they work with. They can focus in the following areas:

  • A specific health condition, such as a diabetes management nurse who helps patients with diabetes or an oncology nurse who helps cancer patients
  • A specific part of the body, such as a dermatology nurse working with patients who have skin problems
  • A specific group of people, such as a geriatric nurse who works with the elderly or a pediatric nurse who works with children and teens
  • A specific workplace, such as an emergency or trauma nurse who works in a hospital or stand-alone emergency department or a school nurse working in an elementary, middle, or high school

Some registered nurses combine one or more of these specific areas. For example, a pediatric oncology nurse works with children and teens who have cancer.

Many possibilities for working with specific patient groups exist. The following list includes just a few other examples:

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, tobacco, and other substances.

Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.

Critical care nurses work in intensive care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.

Genetics nurses provide screening, counseling, and treatment of patients with genetic disorders, such as cystic fibrosis.

Neonatology nurses take care of newborn babies.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Rehabilitation nurses care for patients with temporary or permanent disabilities.

Some nurses have jobs in which they do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, public policy advisors, researchers, hospital administrators, salespeople for pharmaceutical and medical supply companies, or as medical writers and editors.

Registered nurses may work to promote general health, by educating the public on warning signs and symptoms of disease. They may also run general health screenings or immunization clinics, blood drives, or other outreach programs.

Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working with other nurses and various other staff to improve the quality of care that patients receive. They often serve in leadership roles and may advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.

Work Environment

As the largest healthcare occupation, registered nurses held about 2.7 million jobs in 2012. The industries that employed the most registered nurses in 2012 were as follows:

Hospitals; state, local, and private 61%
Nursing and residential care facilities 7
Offices of physicians 7
Home health care services 6
Government 6

Registered nurses work in hospitals, physicians' offices, home healthcare services, and nursing care facilities. Others work in correctional facilities, schools, clinics, or serve in the military.

Most registered nurses work in well-lit, comfortable healthcare facilities. Home health and public health nurses travel to patients' homes, schools, community centers, and other sites.

Some nurses move frequently, traveling in the United States and throughout the world to help care for patients in places where there are not enough healthcare workers.

Injuries and Illnesses

Registered nurses may spend a lot of time walking, bending, stretching, and standing. They are vulnerable to back injuries, because they must often lift and move patients.

In addition, the work of registered nurses may put them in close contact with people who have infectious diseases, and they often come in contact with potentially harmful and hazardous drugs and other substances. Therefore, registered nurses must follow strict, standardized guidelines to guard against diseases and other dangers, such as radiation, accidental needle sticks, or the chemicals used to create a sterile and clean environment.

Work Schedules

Because patients in hospitals and nursing care facilities need round-the-clock care, nurses in these settings usually work in rotating shifts, covering all 24 hours. They may work nights, weekends, and holidays. They may also be on call.

Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.

In 2012, about 1 out of 5 registered nurses worked part time.

Education and Training

Registered nurses usually take one of three education paths: a bachelor's of science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses also must be licensed.

Education

In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. All programs also include supervised clinical experience.

Bachelor's degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor's degree or higher is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor's, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, some employers may require a bachelor’s degree.

Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and programs for those who wish to enter the nursing profession but hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Certified nurse specialists (CNSs) must earn a master’s degree in nursing. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license.

To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination, or NCLEX-RN.

Other requirements for licensing vary by state. Each state's board of nursing can give details. For more on the NCLEX-RN examination and a list of state boards of nursing visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers may require it.

CNSs must satisfy additional state licensing requirements. They may choose to earn certification in a specialty.

Important Qualities

Critical-thinking skills. Registered nurses must be able to assess changes in the health state of patients, including when to take corrective action and when to make referrals.

Compassion. Registered nurses should be caring and sympathetic, characteristics that are valuable when caring for patients.

Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional stability to cope with human suffering, emergencies, and other stresses.

Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given proper care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as helping to lift and to move patients. They may be on their feet for most of their shift.

Speaking skills. Registered nurses must be able to talk effectively with patients to assess their health conditions. Nurses need to explain how to take medication or to give other instructions. They must be able to work in teams with other health professionals and communicate the patients’ needs.

Advancement

Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses can advance from assistant unit manager or head nurse to more senior-level administrative roles, such as assistant director, director, vice president, and chief of nursing. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses.

Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs choose to become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with certified nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs may provide primary and specialty care, and, in most states, they may prescribe medicines. For example, clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health.

Other nurses work as postsecondary teachers in colleges and universities.

Pay

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.

In May 2012, the median annual wages for registered nurses in the top five industries in which they worked were as follows:

Government $68,540
Hospitals; state, local, and private 67,210
Home health care services 62,090
Nursing and residential care facilities 58,830
Offices of physicians 58,420

Many employers offer flexible work schedules, childcare, educational benefits, and bonuses.

Because patients in hospitals and nursing care facilities need round-the-clock care, nurses in these settings usually work in rotating shifts, covering all 24 hours. They may work nights, weekends, and holidays. They may be on call, which means they are on duty and must be available to work on short notice.

Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.

In 2012, about 1 out of 5 registered nurses worked part time.

Job Outlook

Employment of registered nurses is projected to grow 19 percent from 2012 to 2022, faster than the average for all occupations. Growth will occur for a number of reasons.

Demand for healthcare services will increase because of the aging population, since older people typically have more medical problems than younger people. Nurses also will be needed to educate and to care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. In addition, the number of individuals who have access to healthcare services will increase, as a result of federal health insurance reform. More nurses will be needed to care for these patients.

The financial pressure on hospitals to discharge patients as soon as possible may result in more people admitted to long-term care facilities, outpatient care centers, and greater need for home healthcare. Job growth is expected in facilities that provide long-term rehabilitation for stroke and head injury patients, as well as facilities that treat people with Alzheimer's disease. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings.

Growth is also expected to be faster than average in outpatient care centers where patients do not stay overnight, such as those that provide same-day chemotherapy, rehabilitation, and surgery. In addition, an increased number of procedures, as well as more sophisticated procedures previously done only in hospitals, are performed in ambulatory care settings and physicians' offices.

Job Prospects

Overall, job opportunities for registered nurses are expected to be good. Generally, registered nurses with at least a bachelor’s degree in nursing (BSN) will have better job prospects than those without one. Employers may prefer candidates who have some related work experience.

Job opportunities should be good because of the need to replace workers who retire over the coming decade and because of the growing number of people with access to healthcare services.

For More Information

For more information about registered nurses, including credentialing, visit

American Nurses Association

For more information about nursing education and being a registered nurse, visit

National League for Nursing

For information about undergraduate and graduate nursing education, nursing career options, and financial aid, visit

American Association of Colleges of Nursing

For information about the National Council Licensure Examination (NCLEX-RN) and a list of individual state boards of nursing, visit

National Council of State Boards of Nursing

For information about clinical nurse specialists, including a list of accredited programs, visit

National Association of Clinical Nurse Specialists

Source: Bureau of Labor Statistics, U.S. Department of Labor, 2014–2015 Occupational Outlook Handbook, http://www.bls.gov/ooh.