One of the fastest growing sectors of the medical industry is that of home health.

Registered nurses (RNs) 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 in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and rehabilitation. RNs also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it is usually the work setting that determines their daily job duties.

Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They also may supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one department, such as surgery, maternity, pediatrics, the emergency room, intensive care, or the treatment of cancer patients. Some may rotate among departments.

Office nurses care for outpatients in physicians’ offices, clinics, ambulatory surgical centers, and emergency medical centers. 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.

Nursing care facility nurses manage care for residents with conditions ranging from a fracture to Alzheimer’s disease. Although they often spend much of their time on administrative and supervisory tasks, RNs also assess residents’ health, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform invasive procedures, such as starting intravenous fluids. They also work in specialty-care departments, such as long-term rehabilitation units for patients with strokes and head injuries.

Home health nurses provide nursing services to patients at home. RNs assess patients’ home environments 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 childbirth. They must be able to work independently and may supervise home health aides.

Public health nurses work in government and private agencies, including clinics, schools, retirement communities, and other community settings. They focus on populations, working with individuals, groups, and families to improve the overall health of communities. They also work with communities to help plan and implement programs. Public health nurses instruct individuals, families, and other groups regarding health issues such as preventive care, nutrition, and childcare. 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 nurses, also called industrial nurses, provide nursing care at worksites to employees, customers, and others with injuries and illnesses. They give emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, conduct health examinations and inoculations, and assess work environments to identify potential or actual health problems.

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

At the advanced level, nurse practitioners provide basic, primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse practitioners also can prescribe medications—but certification and licensing requirements vary by State. Other advanced practice nurses include clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. Advanced practice nurses must meet educational and clinical practice requirements beyond the basic nursing education and licensing required of all RNs.

Working Conditions - Most nurses work in well-lighted, comfortable healthcare facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. Nurses may spend considerable time walking and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Office, occupational health, and public health nurses are more likely to work regular business hours. More than 1 in 5 RNs worked part time in 2002 and nearly 1 in 10 held more than one job.

Nursing has its hazards, especially in hospitals, nursing care facilities, and clinics, in all three of which nurses may care for individuals with infectious diseases. Nurses must observe rigid standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases.

Employment - As the largest healthcare occupation, registered nurses held about 2.3 million jobs in 2002. Almost 3 out of 5 jobs were in hospitals, in inpatient and outpatient departments. Others worked in offices of physicians, nursing care facilities, home healthcare services, employment services, government agencies, and outpatient care centers. The remainder worked mostly in social assistance agencies and educational services, public and private. About 1 in 5 RNs worked part time.