NURSING

Career opportunities in nursing are varied, abundant, and increasing as society moves into the twenty-first century. Begun in 1975, the Luther College department of Nursing has developed a baccalaureate program in nursing with a strong foundation in the liberal arts, including the natural and social sciences, humanities, and nursing. The third year of the program is spent in Rochester, MN, associated with the world renowned Mayo Foundation Hospitals.

The program is designed for both basic and RN students. It provides a solid basis for graduate study in advanced practice roles of nursing. It is also possible to complete a major in nursing and in another area, such as prephysical therapy, biology, psychology, music, or language. The nursing faculty are prepared to advise you about all possible options and the limitless settings where nurses work.

The program is accredited by the National League for Nursing and approved by the Iowa Board of Nursing. Graduates are qualified to write the national licensing examination for registered nurse licensure (NCLEX), and are sought out for employment across the nation.

Nature of the Work*

Registered nurses (R.N.'s) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress; collaborate with physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation. R.N.'s also develop and manage nursing care plans; instruct patients and their families in home care; and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks R.N.'s may perform, it is usually the work setting which determines their day-to-day job duties.

Hospital nurses form the largest group of nurses. Most are staff nurses who manage care of individual patients. They may also supervise licensed practical nurses and aides. Hospital nurses usually are assigned to one specialty area such as surgery, maternity, pediatrics, emergency room, intensive care, or treatment of cancer patients or may rotate among departments.

Home health nurses provide periodic services, prescribed by a physician, to patients at home. After assessing patients' home environments, they care for and instruct patients and their families. Home health nurses care for a broad range of patients, such as those recovering from illnesses and accidents, cancer, and child birth. They must be able to work independently and may supervise home health aides.

Public health nurses work in government and private agencies and clinics, schools, retirement communities and other community settings. They focus on health maintenance and promotion of populations, working with individuals, groups, and families to improve the overall health of communities. They also work as partners with communities to develop and implement programs. Public health nurses instruct individuals, families, and other groups in health education, disease prevention, nutrition, and child care. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community leaders, teachers, parents, and physicians in community health education.

Occupational health or industrial nurses provide nursing care at worksites to employees, customers, and others with minor injuries and illnesses. They provide emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, assist with health examinations and inoculations, and assess work environments to identify potential health or safety problems.

Nursing home nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease. Although they generally spend most of their time on administrative and supervisory tasks, R.N.'s also assess residents' medical condition, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform difficult procedures such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitation units for strokes and head-injuries.

Head nurses or nurse supervisors direct nursing activities. They plan work schedules and assign duties to nurses and aides, provide or arrange for training, and visit patients to observe nurses and to insure that care is proper. They may also insure that records are maintained and that equipment and supplies are ordered.

Office nurses work with physicians and other health care providers in private practice, clinics, surgicenters, emergency medical centers, and health maintenance organizations (HMO's). They prepare patients for and assist with examinations, administer injections and medications, dress wounds and incisions, assist with minor surgery, and maintain records. Some also perform routine laboratory and office work.

In advanced practice, nurse practitioners provide primary health care. They diagnose and treat common acute illnesses and injuries. Nurse practitioners can prescribe medications in most states. Other advanced practice nurses include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives. Advanced practice nurses have met higher educational and clinical practice requirements beyond the basic nursing education and licensing required of all R.N.'s.

Working Conditions*

Most nurses work in well-lighted, comfortable health care facilities. Home health and public health nurses travel to patients' homes and to schools, community centers, and other sites. Nurses may spend considerable time walking and standing. They need emotional stability to cope with human suffering, emergencies, and other stresses. Because patients in hospitals and nursing homes require 24-hour care, nurses in these institutions may work nights, weekends, and holidays. They may also be on-call. Office, occupational health, and public health nurses are more likely to work regular business hours although they may be on-call for nights and weekends. Almost 1 in 10 RN's held more than one job in 1998.

Nursing has its potential hazards, especially in hospitals, nursing homes, and clinics where nurses may care for individuals with infectious diseases such as hepatitis and AIDS. Nurses must observe guidelines to guard against these and other dangers such as radiation, chemicals used for sterilization of instruments, and anesthetics. In addition, they face physical stressors when moving patients, shocks from electrical equipment, and hazards posed by compressed gases. Safety procedures and guidelines are monitored in each facility by both internal and external agencies to ensure the safest environment possible.

Employment*

As the largest health care occupation, registered nurses held about 2.1 million jobs in 1998. About 3 out of 5 jobs were in hospitals, in both inpatient and outpatient departments. Others were in offices and health care clinics, home health care agencies, nursing homes, temporary help agencies, schools, and government agencies. About 1 out of 4 R.N.'s worked part-time.

Training, Other Qualifications, and Advancement*

In all states, students must graduate from a nursing program and pass a national licensing examination to obtain a nursing license. Nurses may be licensed in more than one state, either by examination or endorsement of a license issued by another state. Licenses must be periodically renewed. Some states require continuing education for licensure renewal.

In 1998, there were over 2,200 entry level R.N. programs. There are three major educational paths to nursing: Associate degree (A.D.N.), diploma, and bachelor of science degree in nursing (B.S.N.). A.D.N. programs, offered by community and junior colleges, take about 2 years. About half of all R.N. graduates in 1998 were from A.D.N. programs. B.S.N. programs, offered by colleges and universities, take 4 or 5 years. About one-fourth of all programs in 1998 offered degrees at the bachelor’s level. Diploma programs, given in hospitals, last 2 to 3 years. Only a small number of graduates come from these programs. Generally, licensed graduates of any of the three program types qualify for entry level positions as staff nurses.

There have been attempts to raise the educational requirements for an R.N. license to a bachelor's degree and, possibly, create new job titles. These changes, should they occur, will probably be made state by state, through legislation or regulation. Changes in licensure requirements would not affect currently licensed R.N.'s, who would be "grandfathered" in, no matter what their educational preparation. However, individuals considering nursing should carefully weigh the pros and cons of enrolling in a B.S.N. program, since their advancement opportunities are broader. In fact, some career paths are open only to nurses with bachelor's or advanced degrees. A bachelor's degree is generally necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, teaching, or a clinical specialization.

Many A.D.N. and diploma-trained nurses enter bachelor's programs to prepare for a broader scope of nursing practice. They can often find a hospital position and then take advantage of tuition reimbursement programs to work toward a baccalaureate degree in their spare time.

Nursing education includes classroom instruction and supervised clinical experience in hospitals and other health facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes liberal arts classes.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing homes, public health departments, home health agencies, and ambulatory clinics.

Nurses need to be caring and sympathetic. They must be able to accept responsibility, direct or supervise others, follow orders precisely, and determine when consultation is required. Critical thinking skills are essential.

Experience and good performance can lead to promotion to more responsible positions. Nurses can advance, in management, to assistant head nurse or head nurse. From there, they can advance to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs preparing executive-level nurses usually last 1 to 2 years.

Within patient care specialties, nurses can advance to clinical nurse specialist, nurse practitioner, certified nurse-midwife, or certified registered nurse anesthetist. These positions require 1 or 2 years of graduate education, leading in most instances to a master's degree, or to a certificate.

Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home health, and chronic care services. Some are employed by health care corporations in health planning and development, marketing, and quality assurance. Some are also employed by government agencies in public health policy development.

Job Outlook*

Employment of registered nurses is expected to grow faster than the average for all occupations through the year 2008 and, because the occupation is large, many new jobs will result. As nursing school enrollments level off or decline, as they have on a cyclical basis in the past, the number of qualified applicants will fall, reducing reported competition for jobs. There will always be a need for traditional hospital nurses, but a large number of new nurses will be employed in home health, long-term, and ambulatory care.

Faster than average growth will be driven by technological advances in patient care, which permit a greater number of medical problems to be treated, and increasing emphasis on primary care. In addition, the number of older people, who are much more likely than younger people to need medical care, is projected to grow very rapidly. Many job openings also will result from the need to replace experienced nurses who leave the occupation, especially as the average age of the registered nurse population continues to rise.

Employment in hospitals, the largest sector, is expected to grow more slowly than in other health-care sectors. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain overnight) is not likely to increase much. Also, patients are being released earlier and more procedures are being done on an outpatient basis, both in and outside hospitals. Most rapid growth is expected in hospitals' outpatient facilities, such as same-day surgery, rehabilitation, and chemotherapy.

Employment in home health care is expected to grow the fastest. This is in response to a growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances which make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.

Employment in nursing homes is expected to grow much faster than average due to increases in the number of people in their eighties and nineties, many of whom will require long-term care. In addition, the financial pressure on hospitals to release patients as soon as possible should produce more nursing home admissions. Growth in units to provide specialized long-term rehabilitation for stroke and head-injury patients or to treat Alzheimer's victims will also increase employment.

An increasing proportion of sophisticated procedures, which once were performed only in hospitals, are being performed in physicians' offices and clinics, including HMO's, ambulatory surgicenters, and emergency medical centers. Accordingly, employment is expected to grow faster than average in these places as health care in general expands.

In evolving integrated health care networks, nurses may rotate among employment settings. Since jobs in traditional hospital nursing positions are no longer the only option, R.N.'s will need to be flexible. Opportunities will be best for nurses with advanced education and training, such as nurse practitioners.

Earnings*

Median annual earnings of registered nurses were $40,690 in 1998. The middle 50 percent earned between $34,430 and $49,070 a year. The lowest 10 percent earned less than $29,480 and the highest 10 percent earned more than $69,300 a year. Median annual earnings in the industries employing the largest numbers of registered nurses in 1997 were as follows:

Personnel supply services	$43,000
Hospitals	39,900
Home health care services	39,200
Offices and clinics of medical doctors	36,500
Nursing and personal care facilities	36,300

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

Sources of Additional Information*

The National League for Nursing (NLN) publishes a variety of nursing and nursing education materials, including a list of nursing programs and information on student financial aid. For a complete list of NLN publications, write for a career information brochure. Send your request to:

• National League for Nursing, 61 Broadway, New York, NY 10006.

For a list of B.S.N. and graduate programs, write to:

• American Association of Colleges of Nursing, 1 Dupont Circle NW., Suite 530, Washington, DC 20036. FAX: (202) 785-8320.

Information on registered nurses is also available from:

• American Nurses Association, 600 Maryland Ave. SW., Washington, DC 20024-2571.

Sample Luther Curriculum

The following sample curriculum is intended to provide advice to students regarding a possible course of study for this program.  This is only a sample--the specific course of study may be altered in consultation with your faculty adviser.

First Year - Fall Semester

• PAIDEIA I
• General Chemistry
• Introduction to Psychology
• Elective or general requirement

First Year - January Term

• Elective

First Year - Spring Semester

• PAIDEIA I
• Introduction to Nursing and Health Care
• Developmental Psychology
• Functional Mammalian Anatomy
• Elective or general requirement

Sophomore Year - Fall Semester

• Nursing, the Individual, and the Health Continuum I
• Microbiology
• Introduction to Sociology or Anthropology
• Elective or general requirement

Sophomore Year - January Term

• Elective or general requirement

Sophomore Year - Spring Semester

• Nursing, the Individual, and the Health Continuum II
• Human Physiology
• Nutrition
• Elective or general requirement

Junior Year - Fall Semester

• Psychosocial Concepts in Nursing or Nursing of Children: A Family-centered Approach
• Pharmacology
• Pathophysiology I
• Interruptions of the Health Continuum I
• Religion

Junior Year - January Term

• Elective or general requirement

Junior Year - Spring Semester

• Psychosocial Concepts in Nursing or Nursing of Children: A Family-centered Approach
• Pathophysiology II
• Interruptions of the Health Continuum II
• Research Methods in Nursing
• Trends and Issues in Nursing

Senior Year - Fall Semester

• Maternity Nursing: A Family-centered Approach or Community-centered Care
• Health Care Management
• Synthesis of Nursing Practice or Senior Paper
• Elective or general requirement

Senior Year - January Term

• Elective or general requirement

Senior Year - Spring Semester

• Maternity Nursing: A Family-centered Approach or Community-centered Care
• Synthesis of Nursing Practice or Senior Paper
• Elective or general requirement

Campus Contact(s)

Donna Kubesh, Associate Professor of Nursing

* U.S. Bureau of Labor Statistics, 1998-99 Occupational Outlook Handbook.