Registered nurses (RNs), regardless of specialty or work setting, perform basic duties that include treating patients, educating patients and the public about various medical conditions, and providing advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help to 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 illness or injury, including post-treatment home care needs, diet and exercise programs, and self-administration of medication and physical therapy. Some RNs also are trained to provide grief counseling to family members of critically ill patients. RNs work to promote general health by educating the public on various warning signs and symptoms of disease and where to go for help. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions.
RNs can specialize in one or more patient care specialties. The most common specialties can be divided into roughly four categoriesby work setting or type of treatment; disease, ailment, or condition; organ or body system type; or population. RNs may combine specialties from more than one areafor example, pediatric oncology or cardiac emergencydepending on personal interest and employer needs.
RNs may specialize by work setting or by type of care provided. For example, ambulatory care nurses treat patients with a variety of illnesses and injuries on an outpatient basis, either 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 or the Internet. Critical care nurses work in critical or intensive care hospital units and provide care to patients with cardiovascular, respiratory, or pulmonary failure. Emergency, or trauma, nurses work in hospital emergency departments and treat patients with life-threatening conditions caused by accidents, heart attacks, and strokes. Some emergency nurses are flight nurses, who provide medical care to patients who must be flown by helicopter 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 health care nurses provide at-home care for patients who are recovering from surgery, accidents, and childbirth. Hospice and palliative care nurses provide care for, and help ease the pain of, terminally ill patients outside of hospitals. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long- term care nurses provide medical services on a recurring basis to patients with chronic physical or mental disorders. Medical-surgical nurses provide basic medical care to a variety of patients in all health settings. Occupational health nurses provide treatment for job-related injuries and illnesses and help employers to detect workplace hazards and implement health and safety standards. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery. 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 nurses treat patients with personality and mood disorders. Radiologic nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds and magnetic resonance imaging. 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 condition are employed in virtually all work settings, including physicians’ offices, outpatient treatment facilities, home health care agencies, and hospitals. For instance, addictions nurses treat patients seeking help with alcohol, drug, and tobacco addictions. Developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, and sitting or standing independently. 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 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 administer radiation and chemotherapies. Finally, 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 specialty physicians’ offices or outpatient care facilities, although some are employed in hospital specialty or critical care units. For example, cardiac and vascular 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 specialize in endoscopic procedures, 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.
Finally, RNs may specialize by providing preventive and acute care in all health care settings to various segments of the population, including newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). RNs also may provide basic health care to patients outside of health care settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and abroad providing care to patients in areas with shortages of medical professionals.
Most RNs work as staff nurses, providing critical health care services along with physicians, surgeons, and other health care practitioners. However, some RNs choose to become advanced practice nurses, who often are considered primary health care practitioners and work independently or in collaboration with physicians. For example, clinical nurse specialists provide direct patient care and expert consultations in one of many of the nursing specialties listed above. Nurse anesthetists administer anesthesia, monitor patient’s vital signs during surgery, and provide post-anesthesia care. 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 provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers in mainly medically underserved areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most States, advanced practice nurses can prescribe medications.
Some nurses have jobs that require little or no direct patient contact. Most of these positions still require an active RN license. Case managers ensure that all of the medical needs of patients with severe injuries and illnesses are met, including the type, location, and duration of treatment. Forensics nurses combine nursing with law enforcement by treating and investigating victims of sexual assault, child abuse, or accidental death. Infection control nurses identify, track, and control infectious outbreaks in health care facilities; develop methods of outbreak prevention and biological terrorism responses; and staff immunization clinics. Legal nurse consultants assist lawyers in medical cases by interviewing patients and witnesses, organizing medical records, determining damages and costs, locating evidence, and educating
lawyers about medical issues. Nurse administrators supervise nursing staff, establish work schedules and budgets, and maintain medical supply inventories. Nurse educators teach student nurses and also provide continuing education for RNs. Nurse informaticists collect, store, and analyze nursing data in order to improve efficiency, reduce risk, and improve patient care. RNs also may work as health care consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors.