When caring for patients, RNs establish a care plan or contribute to an existing plan. Plans may include numerous activities, such as administering medication, including careful checking of dosages and avoiding interactions; starting, maintaining and discontinuing intravenous (IV) lines for fluid, medication, blood and blood products; administering therapies and treatments; observing the patient and recording those observations; and consulting with physicians and other healthcare clinicians. Some RNs provide direction to licensed practical nurses and nursing aides regarding patient care. RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority.
Specific work responsibilities will vary from one RN to the next. An RN’s duties and title are often determined by their work setting or patient population served. RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs may work a particular setting or type of treatment, such as perioperative nurses, who work in operating rooms and assist surgeons. RNs may specialize in specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs may also specialize with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer. The opportunities for specialization in registered nursing are extensive and are often determined on the job.
There are many options for RNs who specialize in a work setting or type of treatment. Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians' offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing, the Internet or by telephone. Critical care nurses provide care to patients with serious, complex and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units. Emergency or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy and biofeedback, which are meant to treat patients' mental and spiritual health in addition to their physical health. Home healthcare nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients. Infusion nurses administer medications, fluids and blood to patients through injections into patients' veins. Long- term care nurses provide healthcare services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities. Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses. Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services and help employers implement health and safety standards. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery. Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging and radiation therapy for oncology diagnoses. Rehabilitation nurses care for patients with temporary and permanent disabilities. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.
RNs specializing in a particular disease, ailment or healthcare condition are employed in virtually all work settings, including physicians' offices, outpatient treatment facilities, home healthcare agencies and hospitals. Addictions nurses care for patients seeking help with alcohol, drug, tobacco and other addictions. Intellectual and developmental disabilities nurses provide care for patients with physical, mental or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently and speaking or other communication. Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections. Genetics nurses provide early detection screenings, counseling and treatment of patients with genetic disorders, including cystic fibrosis and Huntington's disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring. Wound, ostomy and continence nurses treat patients with wounds caused by traumatic injury, ulcers or arterial disease; provide postoperative care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence.
RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics and outpatient care facilities. Cardiovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer and sexually transmitted diseases. Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures. Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma and to patients undergoing eye surgery. Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures and muscular dystrophy. Otorhinolaryngology nurses care for patients with ear, nose and throat disorders, such as cleft palates, allergies and sinus disorders. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis and cystic fibrosis. Urology nurses care for patients with disorders of the kidneys, urinary tract and male reproductive organs, including infections, kidney and bladder stones and cancers.
RNs who specialize by population provide preventive and acute care in all healthcare settings to the segment of the population in which they specialize, including newborns (neonatology), children and adolescents (pediatrics), adults and the elderly (gerontology or geriatrics). RNs also may provide basic healthcare to patients outside of healthcare settings in such venues as including correctional facilities, schools, summer camps and the military. Some RNs travel around the United States and throughout the world providing care to patients in areas with shortages of healthcare workers.
Most RNs work as staff nurses as members of a team providing critical healthcare. However, some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians and may focus on the provision of primary care services. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery and neonatal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and healthcare services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women's health, pediatrics, acute care and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.
Some nurses have jobs that require little or no direct patient care, but still require an active RN license. Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity and traumatic accident. Infection control nurses identify, track and control infectious outbreaks in healthcare facilities and develop programs for outbreak prevention and response to biological terrorism. Nurse educators plan, develop, implement and evaluate educational programs and curricula for the professional development of student nurses and RNs. Nurse informaticists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses and other healthcare providers. RNs also may work as healthcare consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons and medical writers and editors.
For more information on the nursing work environment, training and employment, please view Bureau of Labor Statistics-Registered Nurses
Registered nurses (RNs), regardless of specialty or work setting, treat patients, educate patients and the public about various medical conditions and provide advice and emotional support to patients' family members. RNs record patients' medical histories and symptoms, help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications and help with patient follow-up and rehabilitation.
RNs teach patients and their families how to manage their illnesses or injuries, explaining post-treatment home care needs; diet, nutrition and exercise programs; and self-administration of medication and physical therapy. Some RNs may work to promote general health by educating the public on warning signs and symptoms of disease. RNs also might run general health screening or immunization clinics, blood drives and public seminars on various conditions.