Nurses in the United States practice nursing in a wide variety of specialties and departments.
Nurses in the United States practice nursing in a wide variety of specialties and departments.
Nursing in the United States is provided by several levels of professional and paraprofessional staff.
| Level | Typical education requirement | Current practitioners | Median annual salary | Scope of practice |
|---|---|---|---|---|
| Certified Nursing Assistant (CNA) | 75-hour vocational course [1] | 1,389,900 [2] | $30,290 (2021) [2] | Certified Nursing Assistants are trained to perform a limited range of procedures in support of Registered Nurses, under whose supervision they are generally required to work. These include taking vital signs, dispensing prescribed medications, bathing patients, and moving patients in wheelchairs. [1] |
| Licensed Practical Nurse (LPN)/Licensed Vocational Nurse | one to two year vocational diploma program | 657,200 [3] | $48,070 (2021) [3] | In addition to the duties of a CNA, a Licensed Practical Nurse (LPN) is generally also qualified to administer injections, perform therapeutic massage, prepare patients for surgical procedures, maintain patient medical records, change bandages and dressings, and sometimes manage intravenous drips. LPNs are also responsible for communicating a patient's needs to medical staff. In some regions, the equivalent role is termed a Licensed Vocational Nurse (LVN). [3] [4] |
| Registered Nurse (RN) | Diploma in Nursing, Associate of Science (A.S.) in Nursing, Bachelor of Science (B.S.) in Nursing, or Master of Science (M.S.) in Nursing | 3,130,600 [5] | $77,600 (2021) [5] | In addition to the duties of CNAs and LPNs, RNs are qualified to make nursing diagnoses, and to supervise the work of CNAs and LPNs. |
| Advanced Practice Registered Nurse (APRN) | postgraduate education in specialized aspect of nursing and RN licensure | 300,000 [6] | $123,780 (2021) [6] | Advanced Registered Nurse Practitioners include nurse midwives, nurse practitioners, clinical nurse specialist and nurse anesthetist. |
Registered nurses generally receive their basic preparation through one of four basic avenues:
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 three years of math, three years of science, including biology and chemistry, four years of English and two 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,[ clarification needed ] especially in the core prerequisites of anatomy, microbiology, chemistry and physiology. [7]
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:
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 student's readiness for the NCLEX-RN or NCLEX-PN state board licensure exam. [8] 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.[ citation needed ]
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.[ citation needed ] Many hospitals offer tuition reimbursement or assistance to nurses who want to continue their education beyond their basic preparation.
Many nurses pursue voluntary specialty certification through professional organizations and certifying bodies in order to demonstrate advanced knowledge and skills in their area of expertise. [9]
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.
The individual states have authority over nursing practice. The scope of practice is defined by state laws and by regulations administered by State Nursing Boards.
Many states have adopted the Model Nursing Practice Act and Model Nursing Administrative Rules created by the National Council of State Nursing Boards (NCSNB). [10] 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.
The demand for nurses has been on the rise for several years,[ when? ] 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 [11] ). Candidates for nursing jobs that are in highest demand include registered nurses, licensed practical nurses, certified nurse assistants, and certified medical assistants.
As nurses endure long work hours, they face the struggles of being understaffed. These insufficient ratios of staff create a more stressful environment, discouraging some nurses to remain in their profession. [12] By either increasing the number of staff or the quality of the staff's training, there could be fewer barriers for aspiring nurses to surpass. [13]
The Department of Labor's estimated increase percentage per nurse employer type is:
A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.
Nurse education consists of the theoretical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to student nurses by experienced nurses and other medical professionals who have qualified or experienced for educational tasks, traditionally in a type of professional school known as a nursing school. Most countries offer nurse education courses that can be relevant to general nursing or to specialized areas including mental health nursing, pediatric nursing and post-operatory nursing. Courses leading to autonomous registration as a nurse typically last four years. Nurse education also provides post-qualification courses in specialist subjects within nursing.
A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.
A nurse practitioner (NP) is an advanced practice registered nurse (APRN) and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. One study found that although reasons for referrals to specialists are similar for both physicians and NPs, the quality of documentation in the referrals may be lower for NPs.
An advanced practice nurse (APN) is a nurse with post-graduate education and training in nursing. Nurses practicing at this level may work in either a specialist or generalist capacity. APNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing.
The National Council Licensure Examination (NCLEX) is a nationwide examination for the licensing of nurses in the United States, Canada, and Australia since 1982, 2015, and 2020, respectively. There are two types: the NCLEX-RN and the NCLEX-PN. After graduating from a school of nursing, one takes the NCLEX exam to receive a nursing license. A nursing license gives an individual the permission to practice nursing, granted by the state where they met the requirements.
A Diploma in Nursing or Nursing Diploma is an entry-level tertiary education nursing credential.
An Associate of Science in Nursing (ASN) is a tertiary education nursing degree which typically takes 2–3 years to complete. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some four-year colleges also offer this degree. Students awarded an Associate of Science in Nursing are qualified to sit for the NCLEX-RN and apply for licensure as a Registered Nurse.
Nursing credentials and certifications are the various credentials and certifications that a person must have to practice nursing legally. Nurses' postnominal letters reflect their credentials—that is, their achievements in nursing education, licensure, certification, and fellowship. The letters usually appear in the following order:
In the United States, a psychiatric-mental health nurse practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. They are licensed to provide emergency psychiatric services, psychosocial and physical assessment of their patients, treatment plans, and manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, and on medication treatment for psychiatric disorders.
A family nurse practitioner (FNP) provides continuing and comprehensive healthcare for the individual and family across all ages, genders, diseases, and body systems. Primary care emphasizes the holistic nature of health and it is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion.
Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses in Canada practise in a wide variety of settings, with various levels of training and experience. They provide evidence-based care and educate their patients about health and disease.
Health professional requisites refer to the regulations used by countries to control the quality of health workers practicing in their jurisdictions and to control the size of the health labour market. They include licensure, certification and proof of minimum training for regulated health professions.
Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.
Nurse licensure is the process by which various regulatory bodies, usually a Board of Nursing, regulate the practice of nursing within its jurisdiction. The primary purpose of nurse licensure is to grant permission to practice as a nurse after verifying the applicant has met minimal competencies to safely perform nursing activities within nursing's scope of practice. Licensure is necessary when the regulated activities are complex, require specialized knowledge and skill and independent decision making.
Midwives in the United States assist childbearing women during pregnancy, labor and birth, and the postpartum period. Some midwives also provide primary care for women including well-woman exams, health promotion, and disease prevention, family planning options, and care for common gynecological concerns. Before the turn of the 20th century, traditional midwives were informally trained and helped deliver almost all births. Today, midwives are professionals who must undergo formal training. Midwives in the United States formed the Midwifery Education, Regulation, and Association task force to establish a framework for midwifery.
Advanced practice registered nurses (APRNs) are registered nurses with graduate degrees in nursing. APRN roles include: certified nurse midwife, clinical nurse specialist, certified registered nurse anesthetist, and nurse practitioner. APRNs assess, diagnose, manage patient medical problems, order diagnostic tests, and prescribe medications. Rules, regulations, and credentialing for APRNs vary by state. This page outlines the regulatory processes for nurse practitioners in Wisconsin, including education, certification, licensing, and credentialing. Regulatory and credentialing processes are continuously changing, and the information contained on this page is current as of November 2015.
Nursing is the largest healthcare profession in the United States, with more than 3.1 million registered nurses. Between 2012 and 2022, employment for nurses is projected to grow by 19 percent, which is more than any other profession. Nurses make up the largest component of staff in hospitals but are also able to provide care in clinic settings, patient's homes, schools, nursing homes, public health agencies, and mental health centers. In addition, nurses can be found in the military, in industry, nursing education, and do health care research. Nurses in these various roles and settings can provide direct patient care and case management, but also develop and establish nursing practice and quality standards within complex healthcare systems. As each degree can provide a different level of care for patients and function in vastly different roles, it is important to differentiate between them. The levels of nursing degrees have different educational requirements, licensure, and credentialing that can vary state to state.
The graduate nurse (GN) is a nurse who has completed their academic studies but not completed the requirements to become a registered nurse (RN). Depending on the country, state, province or similar licensing body, the graduate nurse may be granted provisional nursing licensure. A graduate nurse has not yet passed the National Council Licensure Examination (NCLEX-RN) to become a registered nurse (RN).
