Nursing in the United States

Nurses in the United States can practice nursing in a wide variety of specialties.

Education[edit | edit source]

Registered nurses generally receive their basic preparation through one of three basic avenues:

Associate of Science in Nursing: Graduation from a degree-granting nursing program confering 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.
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.
Bachelor of Science in Nursing: Graduation from a university, from a four - five year program conferring the BSN/BN degree with enhanced emphasis on leadership and research as well as clinically-focused courses.

There are also special programs for "LPN to RN", for people who hold undergraduate degrees in other disciplines, and for paramedics or military medics. Graduates of all programs, once licensed, are eligible for employment as entry-level staff nurses.

A typical course of study at any level typically includes such topics as, anatomy and physiology, 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 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.

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.

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.

Legal regulation[edit | edit source]

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).^[1] 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.

Types of nurses[edit | edit source]

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.

LPNs are often found working under the supervision of physicians in clinics. In long term care facilities, they sometimes supervise nursing assistants and orderlies.

The Bureau of Labor Statistics estimates that there are about 700,000(1) persons employed as licensed practical nurses and licensed vocational nurses in the U.S.

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, or bachelors 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.

RNs are the largest healthcare occupation in the U.S. The Bureau of Labor Statistics estimates that there are about 2.3 million (1) persons employed as registered nurses in the U.S.

Advanced practice nurses (APNs) are registered nurses with advanced education, knowledge, skills, and scope of practice. APNs possess a master's or doctoral degree in nursing and may also sit for additional certification examinations. APNs 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 nurses can expect to earn above-average salaries, especially as the population ages, and the demand for highly-skilled healthcare workers grows proportionally.