Careers in Nursing

Nursing Shortage

The United States is in the midst of a nursing shortage that is likely to intensify. More nurses are needed to care for the growing population, particularly elderly people and acutely-ill, hospitalized patients. Nurses are needed in every aspect of health care from high-tech operating rooms to community healthcare centers to home care. Physicians have less time with patients, so nurses are needed even more for direct care. With the spiraling cost of care, nurses and other health professionals are doing tasks that were once almost exclusively in the physicians’ domain. The high cost of care has resulted in shorter hospital stays for patients, so nurse specialists are needed to oversee patients’ ongoing care in their home or a lower level facility, such as a nursing home.

Unfortunately, at this time of great need for nurses, significant numbers of nurses and nursing educators are retiring. The shortage of nursing educators, in turn, means that schools can’t enroll enough nurses to meet the projected demand for nurses.

Job Opportunities

Not surprisingly, the job market for nurses is excellent. According to the U.S. Bureau of Labor Statistics, registered nursing is among the Top Ten Occupations with the largest job growth. The bureau projects that through the year 2018, employment for registered nurses (RNs) will grow faster than most other occupations.

However, since a growing number of nursing tasks require a high level of responsibility and a wide area of skills, many employers are seeking nurses who have at least a bachelor’s degree in nursing (BSN). In fact, nationally there is a movement to require all nurses to hold a BSN rather than the three-year RN degree. Graduate level nurses (e.g., advance practice nurses, nurses practitioners, and PhDs) are also needed.

Indigenous Wisdom Needed

Of the more than 2.9 million registered nurses in the United States, only 0.5% are American Indian or Alaska Native. Karine Crow, Cherokee, PhD, RN, says, “Educated, culturally re-enforcing indigenous nurses are particularly needed for programs that serve the American Indian and Alaska Native people. Inclusion of the Elders and the medicine people within the plan of care promotes a more culturally appropriate and holistic approach.”

Like many other indigenous nursing educators, Crow feels that the goal of high-quality care for indigenous people requires nurses with high-level educational and clinical skills. “Because of the nursing shortage some new nurses advance quickly. The added value of a bachelor’s degree provides them with leadership, research, and critical thinking skills as well as a public health background on which Indian Health Service is founded. American Indian and Alaska Native nurses with master’s and doctoral level degrees are also needed. Currently there are less than 20 of us with doctoral level degrees in nursing.”

The perspectives and wisdom of indigenous people are also needed nationwide to help create a high-quality healthcare system that is more holistic and humane as well as available and accessible to all people.

Nursing Roles and Opportunities

Nurses typically work as part of a team, but they do not simply assist physicians and other health care provides. They work within their own scope of practice that includes health promotion and disease prevention, direct patient care, supervising the care provided by others, case management, developing and monitoring quality assurance procedures, and directing complex systems of care

Advance practice nurses (also called APNs) are independent practitioners with the authority to diagnose, prescribe medications, and manage their own practices. APNs include nurse practitioners, nurse midwives, nurse anesthetists, and nurse specialists.

Some nurses with masters and doctoral level degrees work in administration, management, research, and in the education of future nurses and other health professionals.

Work Settings

More than half of all employed RNs work in hospitals, but nurses at all levels of education work in a variety of settings, including hospitals, private practices, clinics, public health agencies, outpatient surgicenters, health maintenance organizations (HMOs), mental health agencies, home health care, community health centers, nursing homes, hospices, rehabilitation centers, businesses, schools and universities, the military and even churches.
This article was originally published in the Summer 2007 issue of Winds of Change. This information was updated in 2010. (The cover artist is Bunky Echo-Hawk, Yakama/Pawnee.)