REGISTERED NURSES AND NURSE PRACTITIONERS California Occupational Guide Number 29 Interest Area 13 1996
THE JOB
REGISTERED NURSES, abbreviated as RNs, comprise the largest group among all the health occupations. Most Registered Nurses work in acute care hospitals as Staff Nurses. They provide direct bedside care and assist physicians with examinations, chart the condition of patients, give medication, and administer treatment as ordered by the doctor. They may supervise auxiliary nursing personnel. Charge Nurses supervise a particular unit on one shift while Lead Nurses have 24 hour responsibility for a unit's staff, budget, planning, and long range goals.
Registered Nurses also work in convalescent hospitals providing long term care to the aged or chronically ill. They provide continuity of care, physical and mental rehabilitation, and give encouragement to patients and their families. RNs monitor all aspects of patient care, including diet and physical activity. One Registered Nurse serves as Director of Nursing, responsible for hiring the nursing staff and overseeing all nursing functions.
In addition to hospitals, other areas of RNs work for doctors and medical groups, public health agencies and home care services.
NURSE PRACTITIONERS are Registered Nurses with graduate level training in diagnostic and health assessment skills. They relieve physicians of many time consuming tasks. They interview patients, take medical histories, perform physical examinations, order laboratory tests, make tentative diagnoses, and prescribe appropriate treatments. Those who have a Drug Devise Furnishing (NFP) certificate can also prescribe medication and medical devices. Nurse Practitioners may refer patients to physicians for consultation or to specialized health resources for treatment. They always work under the direction of supervising physicians.
WORKING CONDITIONS
Nurses generally work in hospitals and clinics in a comfortable and well- lighted environment. Although most tasks are not strenuous, nurses need physical stamina to perform their duties. They also need emotional stability to cope with human suffering and frequent emergencies.
A few Registered Nurses work in dramatic environments as team members of emergency response teams. They may treat patients while en route by helicopter to hospitals or at triage centers at disaster sites, such as earthquakes.
Nurse-Midwives, licensed to provide care and treatment to pregnant women, often deliver babies in patients' homes.
EMPLOYMENT OUTLOOK
The following information is from the California Projections and Planning Information report published by the Labor Market Information Division.
Estimated number of workers in 1993 184,590 Estimated number of workers in 2005 230,520 Projected Growth 1993-2005 25% Estimated openings due to separations by 2005 38,630
(These figures do not include self-employment nor openings due to turnover.)
Registered Nurses and Nurse Practitioners rank among the top fifty largest growth occupations in California.
The State Board of Nursing reports that there are more than 280,000 RNs in California. Despite this large number, shortages still exist, due mainly to workers leaving and reentering this occupation many times throughout their careers. Hospital and clinics have ongoing, active recruitment programs, some offering unique benefits, to attract applicants.
Some Health Maintenance Organizations (HMOs) may employ Nurse Practitioners instead of physicians for certain medical duties. This trend, which has heightened the demand for Nurse Practitioners, should continue as HMOs become more common. Competition may be keen for the higher paying jobs in large cities.
ENTRANCE REQUIREMENTS AND TRAINING
RNs must by licensed to practice in California by the State Board of Registered Nursing. The licensing requirements are:
·-- Completion of a board approved nursing program. · -- Pass the examination given by the State board.
RNs with active licenses from other states may also be granted California licenses. RNs must renew their California licenses every two years and complete 30 hours of continuing nursing education during each two-year period.
Two types of Registered Nurse training programs are available in California: two year community college associate degree programs and four year bachelor's degree programs. Both programs include clinical experience in one or more hospitals and clinics in addition to classroom instruction. Most community colleges give Licensed Vocational Nurses (LVNs) credit for their basic nursing course work and experience. LVNs can complete the requirements for an associate degree in nursing in two years. At that point, a LVN can work or transfer to a four year college to obtain a bachelor's degree in nursing to be licensed as a RN. LVNs with associate degrees, or former military medical corps workers, may qualify for advanced placement in four year bachelor's degree nursing programs.
Nurse Practitioners must have a valid RN license and complete a program of study approved by the California Board of Registered Nurses to become licensed practitioners. This graduate level training is offered by hospitals and universities. It usually lasts one to two years and leads to a certificate or master's degree. A pharmacology course and six months of supervised experience with a physician and California Board of Registered Nurses certification prepares practitioners to prescribe medication and medical devices.
High school students should take chemistry, biology, anatomy, physiology, and other science and math courses to prepare for nursing school.
Prospective nurses should exhibit leadership, self confidence, and emotional stability. Other needed traits are a pleasant personality, patience, and an ability to deal with people of all cultures and social levels.
WAGES, HOURS, AND FRINGE BENEFITS
Wages for Registered Nurses with no experience range from $11.26 to $23.75 per hour. RNs with some experience earn between $12.25 to $27.75 per hour. RNs with more than three years with the same firm can earn from $14.00 to $31.00 hourly.
Wages for Nurse Practitioners start at an annual range of $28,000 to $50,000. With several years of experience, they earn between $48,000 and $57,000 or more annually.
A nurse's schedule varies. Nurses may work a morning shift one week and a night the next. Some emergency room staff work 24-hour shifts twice a week, while others work three 12-hour shifts weekly. Clinic staff usually work a five day, 40-hour week. Fringe benefits may vary among employers. Most employees receive paid vacation, sick leave, health and retirement benefits, dental, and vision insurance.
ADVANCEMENT
Experienced RNs may advance from bedside nursing to supervisory positions or clinical specialist positions, such as Critical Care Nurse. Those with bachelor's degrees may become nursing administrators, consultants, educators, or researchers. A growing number take special courses, often earning a master's degree, to become Nurse Practitioners.
Nurse Practitioners may advance into administration, but most view themselves as health care professionals trained to diagnose and treat patients for illnesses and injuries formerly treated only by doctors. Most of them stay in this occupation throughout their career life.
FINDING THE JOB
Nursing school graduate placement services link RNs and Nurse Practitioners with jobs. They should also apply directly to hospitals, clinics and physicians. Nursing Associations and newspaper ads also have job leads. State, county, city, and federal personnel administration offices provide announcements of jobs and requirements.
ADDITIONAL SOURCES OF INFORMATION
California Board of Registered Nurses P.O. Box 944210 Sacramento, CA 94244–2100 (916) 322–3350
California Nurses Association 1100 11th Street Sacramento, CA 95814 (916) 446-5019
American Nurses Association (ANA) 600 Maryland Ave SW, Suite 100 W Washington, D.C. 20024-2571 (202) 554-4444
RELATED OCCUPATIONAL GUIDES
Physical Therapists No. 117 Occupational Therapists No. 143 Respiratory Therapists No. 454
OCCUPATIONAL CODE REFERENCES
DOT (Dictionary of Occupational Titles , 4th ed., Rev. 1) Nurse Practitioner 075.264-010 Nurse Midwife 075.264-014 Nurse, General Duty 075.364-010
OES (Occupational Employment Statistics) System Registered Nurses 325020
Source: State of California, Employment Development Department,
Labor Market Information Division, Information Services Group,
(916) 262-2162.
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