Nursing in the United States
Nurses in the United States practice nursing in a wide variety of specialties.
Types of nurses
Licensed practical nurses (LPNs) are also known as licensed vocational nurses (LVNs) in California and Texas. These individuals usually have eighteen months to two years of training in anatomy and physiology, medications, and practical patient care. They must pass state or national boards and renew their license periodically.
LPNs perform simple as well as complex medical procedures but must operate under the supervision of a registered nurse or a physician. They can administer most medications (usually with the exception of IV push medications), perform measurements (for example, blood pressure, temperature), keep records, perform CPR, maintain sterile and isolation conditions, and administer basic care.
Registered nurses (RNs) are professional nurses who often supervise the tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and make decisions regarding the care for healthy, ill, and injured people. They have a diploma, associate degree, bachelor's degree, or master's degree in nursing at entry level, and after passing state board examinations, are granted the title registered nurse. Regardless of degree, RNs have many hours of clinical experience before graduating.
Advanced practice registered nurses (APRNs) are registered nurses with advanced education, knowledge, skills, and scope of practice. APRNs possess a master's or doctoral degree in nursing and may also sit for additional certification examinations. APRNs may function as a certified nurse midwife (CNM), nurse practitioner (NP), clinical nurse specialist (CNS) or certified registered nurse anesthetist (CRNA). They perform primary health care, provide mental health services, diagnose and prescribe, carry out research, and educate the public and other professionals.
All advanced practice credentials have requirements such as continuing education and periodic re-examination to maintain the credential.
Advanced practice registered nurses can expect to earn above-average salaries, especially as the population ages, and the demand for highly skilled healthcare workers grows proportionally.
Registered nurses generally receive their basic preparation through one of four basic avenues:
- Diploma in Nursing: Graduation with a three-year certificate from a hospital-based school of nursing. Few of these programs remain in the U.S. and the proportion of nurses practicing with a diploma is rapidly decreasing.
- Associate of Science in Nursing: Graduation from a degree-granting nursing program conferring the degree of ASN/AAS or ADN in nursing. This involves two to three years of college level study with a strong emphasis on clinical knowledge and skills.
- Bachelor of Science in Nursing: Graduation from a university, from a four- or five-year program conferring the BSN/BN degree with enhanced emphasis on leadership and research as well as clinically focused courses.
- Generic-entry Master of Science in Nursing: Graduation from a university, one to three year program conferring the MS/MSN degree with emphasis on leadership and research as well as clinically focused courses for students who hold a bachelor's degree or higher in an academic field other than nursing.
There are also special programs for "LPN to RN", for LPNs seeking an RN degree. There are also accelerated baccalaureate nursing programs that take 1.5 to 2 years for people who hold undergraduate degrees in other disciplines, such as respiratory therapists and paramedics/military medics. Graduates of all programs, once licensed, are eligible for employment as entry-level staff nurses.
Prerequisites for nursing school depend on the school, with baccalaureate programs requiring more courses, in general, than associate degree programs. Usual courses include 3 years of math, 3 years of science, including biology and chemistry, 4 years of English and 2 years of language. Additionally, human development, human anatomy with lab, human physiology with lab, microbiology with lab, nutritional science and English composition may be required. Applicants are usually expected to have a high grade point average, especially in the core prerequisites of anatomy, microbiology, chemistry and physiology.
A typical course of study at any level typically includes such topics as, anatomy and physiology, epidemiology, pharmacology and medication administration, psychology, ethics, nursing theory and legal issues in nursing.
All pathways into practice require that the candidate receive clinical training in nursing. Care is delivered by the student nurses under academic supervision in hospital and in other practice settings. Clinical courses typically include:
- Maternal-child nursing.
- Pediatric nursing.
- Adult medical-surgical nursing.
- Geriatric nursing.
- Psychiatric nursing.
While in clinical training, student nurses are identified by a special uniform to distinguish them from licensed professionals.
In many nursing programs in the United States, a computerized exam is given before, during, and upon completion to evaluate the student and nursing program outcomes. This exam, upon completion of the nursing program, measures a students readiness for the NCLEX-RN or NCLEX-PN state board licensure exam. The exam identifies strengths and weaknesses and areas for remediation prior to taking the state board exam. This is not a requirement of all nursing programs in the United States, but has increased its usage in the past three to four years.
It is common for RNs to seek additional education to earn a Master of Science in Nursing or Doctor of Nursing Science to prepare for leadership or advanced practice roles within nursing. Management and teaching positions increasingly require candidates to hold an advanced degree in nursing. Many hospitals offer tuition reimbursement or assistance to nurses who want to continue their education beyond their basic preparation.
Most U.S. states and territories require RNs to graduate from an accredited nursing program which allows the candidate to sit for the NCLEX-RN, a standardized examination administered through the National Council of State Nursing Boards. Successful completion of the NCLEX-RN is required for state licensure as an RN.
Nurses from other countries are required to be proficient in English and have their educational credentials evaluated by an association known as the Commission on Graduates of Foreign Nursing Schools prior to being permitted to take the U.S. licensing exam.
Government regulates the profession of nursing to protect the public.
Many states have adopted the Model Nursing Practice Act and Model Nursing Administrative Rules created by the National Council of State Nursing Boards (NCSNB). In addition, many state nursing boards model their licensure requirements on the Uniform Core Licensure Requirements which set forth competency development and competency assessment principles.
Nurses may be licensed in more than one state, either by examination or endorsement of a license issued by another state. In addition, the states which have adopted the Nurse Licensure Compact allow nurses licensed in one of the states to practice in all of them through mutual recognition of licensure.
Licenses must be periodically renewed. Some states require continuing education in order to renew licenses.
In April 2013, Health Resources and Services Administration, Bureau of Health Professions, and National Center for Health Workforce Analysis jointly released a report, the. "U.S. Nursing Workforce: Trends in Supply and Education", showing the growth in full-time nurse salaries. In May 2012, the estimated average annual income for registered nurses in the U.S. was $65,470 and the average hourly wage was $32.66. Salary ranges are lower for Licensed Practical Nurses and higher for Advanced Practice Nurses, though this varies widely with geography and specialty. According to the report, a full-time (works 36 or more hours a week) registered nurse's annual income was $43,906.16 in 2000 and $63,944.22 in 2010 which has increased by about $20,000. A full-time licensed practical nurse's annual income was $27,809.77 in 2000 and $39,360.64 in 2010 which has increased by about $11,500.
The high demand for nurses in the US
The demand for nurses has been on the rise for several years, spurred by various economic and demographic factors. Demand for nurses is projected to increase for the foreseeable future (an increase of 23% between 2006 and 2016, according to the US Department of Labor). Candidates for nursing jobs that are in highest demand include registered nurses, licensed practical nurses, certified nurse assistants, and certified medical assistants.
The Department of Labor's estimated increase percentage per nurse employer type is:
25% - Offices of physicians
23% - Home health care services
34% - Outpatient care centers, except mental health and substance abuse
33% - Employment services
23% - General medical and surgical hospitals, public and private
23% - Nursing care facilities
- "Occupational Employment and Wages, May 2012". bls.gov. Retrieved 27 February 2014.
- Pre-Nursing Society[dead link]
- RN (July 21, 2011), Becoming a Registered Nurse, Registered Nurses, retrieved February 27, 2014
- "Nurses for a Healthier Tomorrow". Retrieved 27 February 2014.
- "State Board of Nursing". NurseUniverse.com and Vertical Alliance Group Inc. Retrieved 27 February 2014.
- "The U.S. Nursing Workforce: Trends in Supply and Education" (PDF). Health Resources and Services Administration Bureau of Health Professions National Center for Health Workforce Analysis. Retrieved 25 Jan 2014.
-  US Department of Labor, Bureau of Labor Statistics, Health Care.]