Nurses play an important role in the medical field. They care for patients and offer information and support about medical issues. They also do a lot of day-to-day medical tasks, collecting diagnostic information and administering some treatments.
What is nursing?
Nursing is a large field, and those who decide to pursue a career in nursing can take on one of many different roles, such as becoming a registered nurse, informatics nurse, nurse administrator, or nurse practitioner. A nurse might focus on general health care, or a specific area of nursing such as critical care, habilitation or pediatrics.
Nursing is just one way of working in the health care industry, but it is a rapidly growing field. As of 2019, there were more than 3,000,000 nursing jobs and the field is growing around 7% faster than the US average. For those who are looking for a patient-facing position in health care, becoming a nurse makes a lot of sense because these professionals are truly on the front-lines of patient care and nursing intervention can make a significant difference to a person’s life and health outcomes.
Nursing is a large field of practice, and there are several different types of nurse. Here, we provide a few nursing definitions to help you understand the different qualifications, areas of work, and options open to those considering a career in health care.
According to WHO, the field of nursing covers “autonomous and collaborative care of individuals,” and nurses “work on the front lines of disease prevention and the delivery of primary health care”. There are many different levels of qualification for nurses, and some nurses can diagnose and prescribe, while others work in a more limited role.
Registered Nurse (RN)
A Registered Nurse, or RN, is someone who has passed, at the minimum, a nursing diploma or an Associate Degree in Nursing and has passed the nursing exam that is administered by the National Council of State Boards of Nursing. There are several entry paths for RNs, allowing those who studied other related medical bachelor’s degrees the chance to still earn the qualification.
Advanced Practice Registered Nurse (APRN)
An APRN is sometimes referred to simply as an ‘Advanced Practice Nurse’. These nurses undergo extended training and study more nursing theory before starting practice. This means they can do some diagnosis and administer more treatments, often serving as a preliminary contact in a doctor’s practice, and passing on more complex issues to a medical doctor. APRNs can also order tests and prescribe medication.
Nursing practice describes the duties that a nurse performs. The scope of practice for a nurse, or other health care professionals, depends on their license and training. Someone who is an Advanced Practice Registered Nurse has more training and is able to perform a wider variety of tasks than a Registered Nurse. Nurses can practice in a health care facility or a private home.
Public Health Nursing
According to the American Public Health Association, public health nursing is the practice of promoting and protecting the health of populations. In contrast to advanced practice nursing, which involves treating individual patients, public health nurses communicate health information from scientists and doctors to broader population groups. Sometimes this is done on a one-to-one basis, but many public health nursing campaigns operate on a broader level through programs and advocacy.
Evidence Based Practice
Evidence based practice is something that guides the way all medical professionals work. Doctors and nurses use diagnostics and treatments that have been carefully evaluated based on the scientific method. All decisions made by nurses are based on the best available scientific evidence. This evidence may change over time, which is why it is so important for nurses to engage in continuous professional development.
Duties of a Nurse Practitioner
The duties of a nurse practitioner vary depending on the patients they work with, and where they work. Some nurses work with individual patients in their homes and will spend a lot of time with a specific person. Others work in doctor’s offices or busy hospitals and will therefore be exposed to a wide variety of medical issues and see many patients in a day.
A nurse practitioner will see patients passing through a health care facility and may take vitals, draw blood samples and in some cases write prescriptions for medications or offer advice and counseling on a limited number of medical issues. The duties of a nurse include.
Other nurses may focus on one specific area of care. Here are a few examples:
Neonatal nurses care for newborn babies, in particular those that were premature or who are born unwell. Neonatal care is complex and these nurses work as part of a multidisciplinary team depending on the health issues the newborn is facing.
This area of nursing focuses on anesthetics. These nurses are advanced practice registered nurses who have a high level of knowledge in their area of practice and as such have some autonomy. A nurse anesthetist may work alongside a surgeon, dentist or other specialist who uses anesthesia as a part of their work.
Agency nurses work alongside other care providers such as doctors or specialists in a hospital. They are registered nurses and their job is similar to the one done by nurses that are based at a specific health care facility. These nurses move around a lot depending on demand, which means they see a wide variety of cases.
Pediatric nurses work with children in a number of health care settings, assisting pediatricians and other specialists. Pediatric nurses are trained to work with children and monitor their symptoms, protect the privacy of the child and advocate for children in a health care setting. The way illnesses present themselves differs between children and adults, and children often struggle to communicate their symptoms. This makes the work of a pediatric nurse important.
Telemetry nurses are trained in the use and monitoring of the machines used in hospitals to monitor vital signs. Telemetry nurses help connect patients to the machines, monitor the patient’s vitals during their stay, and prepare patients for discharge. If a patient’s vital signs change, they provide the relevant care and call in expert aid as required.
Dialysis is the practice of filtering blood to remove toxins. This treatment is used for people who are suffering from kidney failure. Dialysis nurses specialize in delivering this treatment, connecting patients to the machine for their regular treatments and monitoring the patients so their care plans can be adjusted if required.
When a patient needs surgery they will work with perioperative nurses for a large part of their treatment. These nurses prepare the patient for surgery, work alongside the surgeon during the process and take care of the patient in the hours immediately after the surgery.
Licensed Vocational Nurse
Licensed vocational nurses fill a broad role, offering supportive medical care for other health professionals. They may be the first person a patient sees, and perform tasks such as asking the patient about symptoms, recording their medical history and taking vital signs. Licensed vocational nurses can administer medication and perform a limited number of treatments, but are overseen by doctors and specialists for more complex tasks.
Critical Care Nurse
Critical care nurses work with the most vulnerable patients. They are highly trained nurses who make important decisions in a high-pressure environment. These nurses operate life-support equipment, administer medication and are responsible for the day-to-day care of patients in critical care wards.
We have already discussed some of the jobs done by nurses with a particular specialization, and touched on the question of “what types of nurses are there?” The nursing profession is diverse, and these health care professionals fill an important role in the sector. When someone decides to become a nurse they are choosing to care for the most vulnerable and provide support, advocacy and health education to those in need.
Before someone can choose to specialize in something like pediatric nursing or critical care, they must first have an overall base of nursing knowledge. This typically means studying for an associate’s degree or earning a bachelor’s in a related area, then gaining practical experience via a nursing school before they can call themselves a licensed practical nurse or a registered nurse.
What non-patient facing careers are associated with nursing?
From there, a nurse has a number of options for their career path. For example, someone who cares a lot about health care but finds dealing with patients on the front lines constantly to be stressful may fill a valuable role as a nurse administrator. This job involves coordinating nursing activities, prioritizing certain types of care, scheduling the work of registered nurses, hiring and training new nurses, and documenting the care provided.
The nurse administrator may work with a nurse leader to manage a floor, department, or hospital. This role helps keep health care facilities moving smoothly and ensures that patients receive a high standard of care even when the facility is very busy.
Another potential option for those looking for a career in nursing that is less patient-facing is that of the informatics nurse. This is a field that is growing in importance as the United States is facing a nursing labor shortage, with the US Bureau of Labor Statistics saying that up to 11 million additional nurses may be required by 2026. An informatics nurse looks for ways to streamline health care and make nursing more efficient through the use of technology.
Clinical experience is usually expected of an informatics nurse specialist so that the nurse knows what data each nurse needs, and how that data can be used and communicated to better support patients, nurses, and doctors. The role of an informatics nurse is particularly important in areas where there are multiple health care networks, and for patients who see people from more than one specialism, because communicating critical information between care providers is challenging.
Nursing informatics is an emerging field, which means there’s a lot of opportunities for someone who has the qualifications and expertise to get in early.
Types of Nurses
We have already discussed some of the different types of nurse and what each specialism does. To recap, there are many different types of nursing job, including:
Some other nursing specialties include a nurse-midwife, oncology nurse, and ER nurse. An individual can choose their nursing specialty after they have completed their initial training. Some nurses may qualify for more than one type of practice over the course of their career. Someone who likes rapidly changing situations may find the challenge of ER satisfying. Another individual may prefer a nursing job at a general practitioner’s office where they see a steady flow of patients with less urgent issues.
Nurse Educators – Training the future
Another option for nurses is to move into the role of nurse educator. This job sits between clinical practice and education, and there are employment options on both sides, allowing a qualified nurse to work in the environment that suits them best.
A nurse educator provides training and education for both would-be nurses and those who are already qualified. The health care sector is constantly evolving as new treatments, diagnostic options, and best-practices are found. It can be hard for nurses who are constantly busy in the field to keep up with the latest evidence-based practices and new technologies.
There are two kinds of nurse educator, those who work in an academic setting, and clinical nurse educators who work in health care settings and focus on the professional development of nurses who are currently practicing. A nurse educator encourages nurses to keep their training and skills up to date and also helps them plan their next move, choosing a specialism or improving the skills they already have.
Another part of this field is helping to onboard new nurses. Recently qualified nurses may need some assistance to adapt to the real-world demands of working in a clinical setting, and even an experienced nurse might require some help to settle in if they’re moving from one nursing job to another because of the differences in procedures at each hospital.
A nurse educator can work with the nurse leaders and nurse administrators to help streamline the process of bringing in new hires, and also help established nurses maintain their skills and move forward with their careers.
Choosing a Nursing Specialty
As a part of their training, nurses are exposed to many different specialties. Some people may find it easy to choose where they want to work. For example, an individual who was inspired to go into nursing because of a relative with kidney failure may opt to specialize in dialysis. One who was personally helped by a nurse as a child may wish to go into pediatrics.
Not all nurses have such a clear pathway. Often, a nurse earns their RN title, moves into day-to-day practice, and takes a few years to discover their nursing specialty. There are a few considerations that may help an early-career nurse find the right path for them:
What Part of Nursing is Most Enjoyable for You?
Each nursing specialty presents its own challenges and has a completely different feel when it comes to day-to-day work. An ER nurse or an ICU nurse will be faced with challenges that someone working at a community wellness center would rarely see.
Someone who prefers fast-paced days and unpredictable situations might thrive in the ER. That same nurse may find pediatric nursing a challenge if they struggle to relate to children and put them at ease.
It’s also worth considering the tasks that a nurse will perform on a day-to-day basis. A perianesthesia nurse, for example, will work with patients who are currently undergoing anesthesia, and those who are recovering from it. This is a highly specialized job, and someone who enjoys that aspect of nursing may find it a suitable specialism. However, over time there’s the risk of the job feeling repetitive. Lapses of judgment or mistakes in this area of nursing could be serious so it’s important for any nurse considering the field to have good attention to detail.
What environment do you like working in?
In addition to considering the nature of the job, it’s worth considering the environment that you work in. A nurse in a doctor’s office will deal with a steady flow of patients with general complaints and will do a lot of documenting case histories and taking vitals.
An oncology nurse will work in a hospital providing advice and care for cancer patients. They’ll be shielded from the bustle of ER, and will work with more specialists and complex cases than n LPN or a Registered Nurse, but their focus is on their department only. The same could be said for a nurse midwife who will see the same patients for a few months at a time.
A public health nurse could do community outreach, so may find themselves talking to patients at community centers, visiting schools, or even dealing with patients in their own home. There’s a lot of flexibility in this field, and that means newly qualified nurses can build the career that suits them.
Would you be willing to relocate?
Those who are considering becoming a clinical nurse specialist may find that there are more opportunities at hospitals outside of their local area. For example, a pediatric nurse practitioner may have the dream of working at the best hospital in their state for pediatrics.
Someone who lives in a rural area might find that there’s a lot of demand for general nurses who will work quite closely with their community, but that there’s little demand for specialists because the rural hospitals are limited in the procedures they perform. When someone is diagnosed with a condition that those hospitals can’t handle, the case is sent to a bigger city. This means nurses will have to decide whether they wish to pursue a specialism based on their own interests, or look to fill roles that are in demand in the area they already live and work.
There’s a lot of upward mobility in nursing as a career for those who are willing to move to big cities, and the medical sector overall has high demand and good job stability. When you’re considering a move into nursing as a career, or planning your next course of CPD, think about whether there are job openings in an area you would be happy to live.
The Nursing Process
The nursing process is a procedure that nurses are trained to follow when they are providing day-to-day care. The process is client-centered and consists of five key steps. Nurses use these to develop a care plan that works for their patients.
The nursing process involves:
Assessment is required before any nursing intervention can happen. The assessment process is where the nurse uses their critical thinking skills and their training to collect data from the patient or the patient’s caregiver, measure vital signs, and determine the current status of the patient.
The nurse must employ critical thinking to decide whether the patient’s needs are urgent and whether there are any issues outside of what the patient is bringing up. This heavy reliance on critical thinking is why there are calls for an emphasis on concepts in nursing curriculums, rather than simply relying on tick-boxes and memorizing facts.
Diagnosis in nursing care is different from the diagnosis that a doctor would do. Nurses use Maslow’s Hierarchy of Needs to develop patient-centered care plans. This means in the short term they will focus on basic physiological needs and ensuring the safety of the patient. Nursing diagnoses prioritize acute issues, and from there the nurse may work with other professionals depending on the client’s health status.
This stage of nursing intervention involves developing a nursing care plan that is specific, measurable, attainable, realistic, and timely. Care plans are tailored to the patient and should take into account not just the specific condition the client presented for, but also any comorbid conditions or issues that may limit the client’s ability to follow certain treatments.
Care plans should be revisited and revised regularly and implemented in cooperation with other health care professionals.
Depending on the care setting, a nurse may be responsible for monitoring vital signs, administering medication, carrying out various treatments and overseeing day-to-day care. In some cases, nurses simply provide a plan of care for the patient to follow and then ask the patient to return periodically for check-ups.
The evaluation process is the final step, but it should not be overlooked. It is one that is still core to ensuring that the patient’s outcome is as good as it can be. Some patients simply see a nurse once, receive treatment and recover. Others require ongoing assessment and may need medication doses altered, treatments to be monitored in the long term, or referral to a specialist.
Evaluations and monitoring are central to the idea of evidence-based practice and are something nurses take seriously.
Roles of Nurses Alongside Other Health Professionals
The job that a nurse does is an important one, and nurses have a lot of respect from doctors, dentists and specialists. Nurses handle many of the time-consuming tasks that are required to empower doctors to do their jobs, and also handle highly specialized areas such as anesthesia, allowing surgeons to focus on their own narrow areas.
The health care field is huge and it is not possible for one person to know it all or to stay current with the ever-changing ideas and best practices within it. Nurses fill a valuable role and when they collaborate with other health professionals they can advocate for patients and help patients get the best possible health outcomes.
Deciding to become a nurse is a big decision. The training, especially for someone who wishes to become an Advanced Nurse Practitioner or take up a clinical specialization, takes a long time and requires diligence and attention to detail. The field can be challenging and stressful but it can also be rewarding and have good job security.
Nurses operate within a narrow scope of practice and are required to undergo extensive training in each area that they would like to operate. This makes the field one that is full of opportunities for those who are willing to embrace ongoing study and learning to constantly challenge themselves and explore new areas of medicine while making a difference to the lives of those they treat.