Careers in
Nursing
Nursing
Shortage
The need for
nursing is at an all time high. The critical nursing
shortage impacts not only American Indian and Alaska Native
people, but also the entire population of the United
States. The American Hospital Association (AHA) reports
that approximately 118,000 registered nurses (RNs) are
needed to fill vacant positions. Many thousands of nurses
are needed in settings outside of hospitals.
Since nurses provide most of the hospital and long-term
care in the U.S., the consequences of the nursing shortage
are enormous. Emergency rooms are shutting down. Surgeries
are delayed. Many patients are not getting the care that
they need, resulting in higher rates of poor patient
outcomes.
Unless there are some major changes, the shortage will
worsen rapidly. The Health Resources and Services
Administration (HRSA) projects that the nursing shortage
will grow to 213,500 in 2010 and to more than one million
by 2020.
Why the Shortage?
Multiple
factors are contributing to the nursing shortage. More
nurses than ever before 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. The
U.S. Bureau of Labor Statistics projects that through the
year 2014 employment for registered nurses will grow faster
than most other occupations. 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.
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 IHS 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.
Salaries
Nurses with
bachelor’s degrees are eligible for some of the highest
starting salaries in any field. In 2004, the average annual
earning of RNs employed as nurses was $57,784. Nurses with
more advanced degrees can earn over $100,000 a year.
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. (The cover
artist is Bunky Echo-Hawk, Yakama/Pawnee.)