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INTRODUCTION
Despite our efforts to prevent and relieve it, there is still a terrible
amount of suffering in the world. While the rates of illness and death from
infectious disease and malnutrition have gone down in developed countries, the
same rates from cancer and circulatory disease have risen. Genetic defects,
accidents, and violence take their toll; population density makes the impact of
natural disasters worse than it once was. Although medical science has helped us
to achieve longer life spans, we often require medical assistance to live through
those extra years. As much as we need doctors, there is also a need for nurses to work with patients and translate doctors recommendations into real
health improvements or pain relief.
Nursing schools can not only prepare you for a great and financially rewarding career,
they can also give you the knowledge and skills you need to make a difference in
peoples' lives. This can take place in a hospital, hospice, doctor's office, school,
camp, nursing home, or patient's residence. "I want to make the world a better
place" might be a cliche, but there are few better ways to do it than by
studying and practicing nursing.
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NURSING IN HISTORY
From the dawn of human societies, people have attempted to heal one another
and care for the sick and wounded. In Western cultures, doctors eventually
replaced shamans and medicine men; semi-professional nurses came on the scene to
assist family care givers; and in cities, the focus of major health care moved
from the home to specialized medical districts. While some people identify the
theater of Hippocrates (he of "Hippocratic Oath" fame) on the Greek island of
Kos as the world's first hospital, it's more probable that first hospital we
would recognize as such was founded in Jerusalem by the Knights Hospitalers of
St. John in the 11th century AD.
The first "nursing school" is said to have been founded in India in about 250
BC; according to the document known as The Charaka, it trained only men "of good
behavior, distinguished for purity, possessed of cleverness and skill, imbued
with kindness, skilled in every service a patient may require, competent to cook
food, skilled in bathing and washing the patient, rubbing and massaging the
limbs, lifting and assisting him to walk about, well skilled in making and
cleansing of beds, readying the patient and skillful in waiting upon one that is
ailing and never unwilling to do anything that may be ordered." For the next
2000 years, men and women received training in caring for the sick and wounded
in many different ways: from healers and physicians, from hospitals and
hospices, and from military organizations. But one war, and one woman, would
change nursing and nursing education forever.
In 1853, war broke out between Russia and the Ottoman Empire (now Turkey),
and England and France soon entered the war on the side of the Ottomans. In
1854, English and French forces attempted to invade the peninsula called the
Crimea, in what is now The Ukraine, expecting to surprise the Russians and meet
little resistance. The "Crimean War" turned into a fiasco; strong Russian
defenses and horrible strategic decisions caused massive allied casualties.
Because of poor logistical support, malnutrition, and little or no sanitation
and hygiene at the main allied barracks hospital, appalling numbers of wounded
British soldiers died from disease. The British government allowed a woman named
Florence Nightingale to try to set things right. Nightingale was trained in nursing
despite her wealthy family's strong objections. She led a team of nurses to the
barracks hospital and virtually singlehandedly overhauled the treatment of the
soldiers there. The result was a dramatic reduction in the hospital's rates of disease and death.
She went on to revolutionize nursing, health care, and hospital design
throughout Europe and in India, founded the Visiting Nurse Association,
contributed to the founding of the British Army Medical School, and gave her
name to the Nightingale Training School for Nurses at St. Thomas' Hospital in
London. The "Florence Nightingale Pledge," written for the graduates of
Detroit's Farrand Training School for Nurses, is to nurses what the Hippocratic
Oath is to doctors.
Less fortunately, the medical establishment also adopted Nightingale's
Victorian conception of nursing as a nurturing, maternalistic female-only
profession. While famous poet Walt Whitman was one of many male
nurses who would assist the Union and Confederate armies during the American
Civil War, the number of men working in nursing in North America and Europe
greatly declined and remained very low for over a century. Women would be
responsible for most of nursing's early milestones. The first "trained nurse"
(by modern standards) in the US, Linda Richards, received her diploma from the
New England Hospital for Women and Children in 1873. Nursing superintendent
Clara Barton helped found the American branch of the Red Cross in 1881 and
steered the whole organization into peacetime disaster relief work. Ethel
Bedford-Fenwick founded both the British Nursing Association and the first
professional nursing publication (the British Journal of Nursing), then
became the world's first mandatorily registered nurse in 1919.
In the US, many professions began opening to women starting in the 1960s and
70s; conversely, nursing began opening to men. Males now make up over 6% of
nursing professionals, which seems like a small percentage but is still higher
than it's been in the past hundred years. Simultaneously, community colleges and
other vocational training institutions began to offer nursing education in areas
where it hadn't previously been available, and to people who wouldn't previously
have been able to get it. But the supply of nurses still hasn't risen as fast as
the demand for them. This first decade of the 2000s has become a time of
opportunity for those who want to study nursing: nursing programs are widespread
and affordable, and employment for skilled and motivated graduates is almost
assured.
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LEVELS OF LICENSED NURSING PRACTICE
In the US, there are four "levels" of licensed nursing personnel. In general,
the higher the level you are, the more procedures you are allowed to do and the
more money you can earn (but the more responsibility you have as well).
- It takes relatively little training to become a certified nursing
assistant (CNA), but compared to other healthcare personnel, CNAs
aren't allowed to do very sophisticated tasks either. CNAs -- once known as
"orderlies," now more often referred to as "nurse's aides," "home health
aides," or "patient care technicians" -- aren't actually nurses themselves,
but perform tasks as directed by nurses. Exactly what they're expected to do
and not do will vary depending on where they're working, but the tasks usually
involve basic day-to-day non-invasive patient care: assisting them with
dressing, bathing, feeding, walking, and going to the bathroom; taking their
vital signs; turning them in bed; making their beds; helping them into and out
of wheelchairs; etc. CNAs can get their certification after as little as a few
weeks in the classroom and a month or two of on-the-job training. For more
information on working as a CNA, see this site.
- Licensed practical nurses (LPNs) and licensed vocational nurses
(LVNs) are "basic" nurses on the front lines of health care. What
they're permitted to do varies from state to state, but in addition to the
basic patient care that CNAs can perform, LPNs/LVNs can usually do some
combination of tasks like these: help develop care plans for patients and
assess patients progress; communicate with patients about their health
(teaching them about new medications they've been prescribed or new procedures
or exercises they've been asked to do, for example); dress wounds; apply
compresses; give alcohol rubs and massages; administer some medications; give
some injections; start IVs; insert catheters; take samples for testing and
perform some simple lab tests; help in delivery rooms; feed and bathe
newborns; and perform CPR as necessary. However, LPNs/LVNs can't fill doctors
orders directly; they can only take direction from higher level nurses.
LPNs/LVNs can get their license after as little as a year of diploma
education. Although many hospitals have a policy of not employing LPNs/LVNs,
this is changing in the face of the current nursing shortage. Nursing homes
continue to employ many LPNs/LVNs.
- Registered nurses (RNs) are "full-spectrum" nurses who
can do a wide variety of medical procedures as directed by doctors. Besides
all of the tasks that LPNs and LVNs can do, RNs can operate monitors and other
medical equipment; give almost all medications and injections; administer IVs
on an ongoing basis; assist in surgery; administer care plans; supervise other
nursing personnel and sign off on their work; and much more, depending on
their work environment. RNs can get their license after a minimum of two years
of diploma or associate degree study, although many hospitals prefer RNs to
have a four year bachelor's degree.
- Some types of complex, specialized nursing care are reserved for
advanced practice registered nurses (APRNs). You need an
additional specialty license to become any of these APRNs: Certified
Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), Certified
Nurse Specialist (CNS), Certified Nurse Specialist for Psychiatric/Mental
Health (CNS-PSYCH), or Nurse Practitioner (NP). Most APRN licenses require at
least four years of study, a bachelor's degree, and some postgraduate study;
some require a master's degree or more.
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TYPES OF NURSING EDUCATION
Nursing education is available almost anywhere in the world that has modern
medical care; you can search the directory on our main page and the information in
our international
page to find a nursing program near you. Several types of nursing programs
are available:
- Hospital based diploma programs: At one time, all
"nursing schools" were affiliated with hospitals; although many fewer health
facilities offer nursing education now, some still do. Some examples: Bridgeport Hospital School of Nursing in
Bridgeport, CT; Christ Hospital
School of Nursing in Cincinnati, OH; and The Royal
Marsden Hospital School of Cancer Nursing and Rehabilitation in Chelsea
and Sutton, UK. Students usually study at the facility under people who
actually work there, graduating in two to three years with a diploma. Dan
Cook, staff nurse at Mercy Hospital in
Pittsburgh, PA (which also operates a nursing
school), graduated from the Ohio Valley General Hospital
School of Nursing in Kennedy Township, PA; he recommends that students
strongly consider going to a hospital based school. "They're much less
expensive, for one thing. Plus, in a hospital program, you start getting
clinical experience from day one. In a four year college program, you get more
book learning, but you might not get actual experience with patients until
your junior or senior year. Suppose a student finds out, when they actually
start working with patients, that they're not cut out to be a nurse? If you've
gone to a four year school, that's a lot of time and money spent on training
you might never use."
- Degree and diploma programs at community colleges: Large
numbers of American community colleges offer nursing diplomas and Associate
Degree in Nursing (ADN) programs. Examples include Compton Community
College in Compton, CA; Hudson Valley Community
College in Troy, NY; and Bishop State Community
College in Montgomery, AL. ADN students typically graduate in two to two
and a half years. Some community colleges offer "accelerated" Bachelor of
Science in Nursing (BSN) programs that can be completed in as little as three
years.
- Undergraduate programs at traditional colleges and
universities: Many colleges and universities offer Bachelor of
Science in Nursing (BSN) programs as well as RN-to-BSN programs for registered
nurses who only have diplomas or associate degrees. Undergraduate nursing
programs are offered by such schools as Curry College in
Milton, MA; Goshen College in
Goshen, IN; New Mexico State
University in Las Cruces, NM; Ryerson University in
Toronto, ON; and Saint Louis
College in Bangkok, Thailand. Students who study for a BSN "from scratch"
can graduate with one in three to four years. RN-to-BSN students can graduate
in a year to two years if they can go to school full time, but will probably
take much longer if they have to attend classes around their work schedule.
That's the main reason that Sandra Gray, a registered staff nurse with the
Visiting Nurse Association of Western PA, recommends that prospective nurses
go for their BSN right away: "Go for a degree program if you want the maximum
possible opportunity when you graduate -- if you want to be a school nurse or
a teaching nurse, for example. If you get a diploma or associate degree,
you'll have to take additional courses while you work at some other job, a few
credits at a time for several years, until you have what you need for
something better."
- Graduate programs at colleges, universities, and
hospitals: Quite a few colleges and universities, and some hospitals,
offer Master of Science in Nursing (MSN) programs, RN-to-MSN programs,
graduate specialty diplomas, or even PhD doctorates for students that want to
pursue advanced nursing work or research. Institutions that offer graduate
studies in nursing include Lewis University in
Romeoville, IL; Excelsior
College in Albany, NY; the University of Leeds in Leeds, UK;
Chonnam University in Kwang
Ju, South Korea; and The
Queen Elizabeth Hospital in Woodville, Australia. If you start with a BSN,
graduate diplomas can be earned in a year or two; an MSN will require two
years; a PhD will require four years and a dissertation.
- It is increasingly possible to replace classroom based courses (but not
clinical experience) with online education. If you want to
take classes online, be careful to take them from a reputable, accredited
school whose credits will be transferable elsewhere and will be recognized as
legitimate by other schools and employers. Among others, the University of Phoenix and Jacksonville University both
offer online nursing course work.
For another list of nursing schools in the US, see this page; for a
list of nursing schools in Canada, try here.
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NURSING CAREERS
Many people's conception of nursing is limited to "caring for frail or sick
old people in a home or hospital ward." It's true that more nurses than ever are
needed to provide that type of care. But many nursing specialties and careers
can take you beyond "Good morning, Mrs. Hoskins, are you feeling any better
today?". Here are a few of them:
Nurse-midwives deliver
babies and help women to stay healthy and avoid complications during and after
pregnancy.
Perinatal (also known
as neonatal or obstetric)
nurses monitor and care for women before, while, and after they
deliver their babies.
Pediatric (children's) nurses care for children and
adolescents: monitoring their growth and development, treating and trying to
prevent their illnesses, helping them with asthma and other chronic problems,
and working with them to overcome any disabilities they might have.
School nurses help kids
in away-from-home schools. They make sure children are immunized, give eye and
ear tests to make sure that any problems with those faculties are detected and
corrected, treat injuries and illnesses that occur at school, teach and counsel
kids about their health, and sometimes provide daily assistance to
"mainstreamed" children with severe medical challenges.
College nurses assist older young people and adults at
colleges and universities. They too treat illnesses and injuries, but they
typically do more counseling and education to try to prevent psychological
problems, alcohol and drug abuse, unintended pregnancy, sexually transmitted
disease, and other health concerns that occur more often at college
campuses.
Nutritionists make sure that patients get food and drink
that will best meet their various health needs.
Peri operative (operating room)
nurses assist before, during, and after surgery. Among
peri operative nurses, RN first assistants provide direct nursing care to the
patient being operated on; scrub nurses pass supplies and instruments to and
from surgeons inside the sterile area surrounding the patient
("scalpel...forceps...retractor..."); and circulating nurses handle the nursing
tasks outside the sterile area.
Nurse anesthetists help
prepare patients for surgery, give them anesthesia during surgery or childbirth,
and assist them through recovery.
Critical care
(emergency room or acute/intensive care)
nurses are called on to watch over patients with the most
critical health needs: either acute situations requiring an emergency room visit
or chronic situations requiring intensive, cardiac, or highly complex care.
In seeking to improve the health of their patients and the work environment
of their staff, nursing administrators and managers don't only
give care, they design it; they not only follow policy, they make it; they don't
just make do with the resources they have, they help to allocate the
resources.
Hospice nurses make the
process of dying easier for terminal patients and their families. They provide
emotional support and whatever physical care is required to minimize patients
pain and symptoms while maximizing their dignity.
Public health nurses
attempt to keep entire communities as healthy as possible by preventing and
containing the spread of disease and the incidence of environment related health
problems, as well as by educating people how to maintain their wellness. They
are employed by community organizations ranging in size from camps and schools
to city health departments and HMOs.
Psychiatric and mental health
nurses assess and respond to people's mental health needs, whether
it be in a counselor's office, a hospital psych ward, or in an evacuation center
during a natural disaster.
Occupational nurses are
concerned with the health and safety of employees in the workplace. In normal
situations they try to help workers stay well and productive and prevent the
types of ergonomic problems that lead to stress injuries. When accidents occur,
they make sure that employees get the medical attention they need and that
worker's compensation, if necessary, is dealt with correctly.
Sports nurses try to keep athletes and sports enthusiasts in
optimum physical shape, advising them how to stay well and treating injuries if
they occur.
Military nurses care for soldiers: treating their injuries
and illnesses, giving psychological and moral support, and helping them to be as
physically prepared as possible to do their duty.
Forensic nurses
treat victims of crimes, particularly sexual assaults, with a view toward not
only healing the patient but also solving the crime.
Nursing researchers/scientists research and evaluate all
aspects of the nursing practice, including the effectiveness of nursing tools,
methods, and procedures.
For a more complete list of nursing specialties and careers, see this page.
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ARE NURSING SCHOOL AND A NURSING CAREER FOR
YOU?
So are you the kind of person who makes a good nursing student and then a
good nurse? Dan Cook points out some things you need to consider: "Being able to
help people with their health needs is a wonderful thing, and it's terrific if
you want to learn how and do that. But there are a lot of things you'll need to
be able to do: Spend long hours on your legs. Be multi tracked enough to care
for six to ten patients at the same time. Put aside what you might feel
about patients and prioritize your care by the sickest patients first. Maintain
patients privacy and the confidentiality of their information. In some nursing
jobs, you might be called on to care for prisoners. And because some facilities
can't afford not to hire qualified nurses even if they're unpleasant or lazy
people, you might need to be able to shrug off personal conflicts and pick up
slack for others." Sandra Gray adds that prospective visiting nurses should have
"well rounded experience," so that they can deal with many different health
concerns (and other issues that patients might have) on their own, outside a
hospital environment; they should also have the patience and communication
skills to both listen to homebound patients -- many of whom are elderly -- and
to respond to their questions and teach them what they need to do to maintain
their health.
Dan Cook also identifies a lot of benefits that go along with a nursing
career. "Once you've been working there awhile, some places let you pick the
schedule you want to work. Full time nurses usually get good benefits, and good
medical care if they get sick. Many nurses have access to credit unions for
better savings returns and less expensive loans. You'll have a 401(k) or pension
plan. You can help people get better and feel better, of course, which is
satisfying. Hopefully you're learning new medical procedures all the time. If
you work at a teaching hospital, you'll be able to get help from interns and
residents." Sandra Gray likes the independence of being a visiting nurse, and
she also likes the freedom of arranging her hours: "You can schedule visits
around your own appointments, although you have to do more work at home than a
non-visiting nurse would."
We'll talk more about landing a nursing job later in this article, but if you
think you want to get a nursing education, there are things you can do to
prepare for a career before you even start school. Esther Atwood, Nurse
Preceptor Educator at Armstrong County Memorial Hospital (ACMH) in Kittanning,
PA, suggests that you try doing volunteer work in a medical setting, perhaps
with an ambulance service, in a hospital auxiliary, or as a CNA. This will not
only give you valuable experience, but it will also help you to figure out
whether a nursing career is right for you. She goes on to point out that you can
make valuable contacts with potential employers at high school career days and
job fairs, and that many hospitals, including ACMH, are also willing to employ
student nurses as CNAs while they go to school and then as full nurses after
they graduate and earn their license. You might want to talk to human resource
personnel at hospitals near you about this possibility before you even apply to
a program.
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CHOOSING A PROGRAM
Location
One of the basic concerns you'll have about any type of school you want to
attend is the location of its campus, if it has one. If you'll be commuting from
home to school, you'll want a campus with either good public transportation or
good parking. If you'll be living on the campus away from home while attending
school, you'll want a campus with plenty of services (stores, restaurants,
Laundromats, etc.). Keep in mind that attending a nursing school outside the
U.S. is not necessarily an impediment to getting a good nursing job in the U.S.;
refer to the Commission on Graduates of Foreign
Nursing Schools Web site for more information.
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Facilities
It's a good idea to visit the physical facilities of any school you might
want to attend. (Even an online nursing school will be affiliated with various
hospitals or other medical educational settings where you can get your practical
experience.) Are the buildings clean? Are they equipped to train you on the
latest medical technology and procedures? If you'll be attending the school as
part of a "train here and get a job here when you graduate" program, is it a
place you'll feel comfortable both learning and working?
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Cost vs. Length and Type of Program
In the "Levels of Licensed Nursing Practice" and "Types of Nursing Education"
sections above, we discussed different varieties of nursing work and education
and the venues in which you'd pursue a nursing education. Generally speaking,
while it's possible to finish CNA or LPN training in less than two years, which
gets you through school at low cost and into the job market quickly, the
positions you'll qualify for aren't liable to be either challenging or
lucrative, nor is there liable to be much chance for advancement. Two to two and
a half years will get you a diploma or ADN leading to an RN; three or more, a
BSN. Though the extra time costs more, the career possibilities are much
greater. With loan forgiveness for nursing students as prevalent as it is, the
higher cost is less of a problem anyway.
That being said, if you're thinking about enrolling in a high priced program,
you'll still want to make sure it's really worth the extra investment. A large,
heavily attended four year school might have better equipment and a more
decorated nursing faculty, and its "core curriculum" of basic English, math,
science, and other courses will stand you in good stead for life in general. But
is its RN or BSN program really going to be more useful to you than one offered
by a hospital or a community college? Dan Cook cautions, "How much do you want
to pay for the same nursing degree -- $18,000 or less to a hospital based
program or $40,000 or more to a big university?"
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Accreditation
You will probably want to choose an "accredited" nursing program. There are
two types of accreditation: one for schools and one for individual educational
programs.
For a school to be accredited, its finances, facilities, faculty,
and procedures have to have been investigated by an educational standards
organization and found to meet those standards. In the USA, colleges and
universities are accredited by one of the regional accreditation
organizations recognized by the U.S. Dept. of Education and the Council for
Higher Education Accreditation.
For a program to be accredited, its faculty and curriculum have to
have been investigated by a professional organization in that field and found to
meet its standards for preparing practitioners of the field. In the US, general
nursing education programs are accredited by three different organizations. In
the USA, the National League of Nursing
Accrediting Commission (NLNAC) accredits programs of all types, from diploma
up through master's degrees; in this interview,
NLNAC's Dr. Barbara Grumet explains the process in more detail. Programs that
offer only bachelors and masters degrees, such as those at four year colleges,
can be accredited by the Commission on Collegiate Nursing
Education (CCNE). Continuing-education programs for nurses are accredited by
the American Nurses
Association (ANA). In Canada, nursing schools are accredited by the Canadian
Association of Schools of Nursing (Association).
Several other organizations accredit educational programs for advance
practice specialties, including the Council on Accreditation of Nurse
Anesthesia Educational Programs/Schools (COA) of the American Association of
Nurse Anesthetists (AANA) for nurse anesthesia and the American College of Nurse-Midwives
(ACNM) Division of Accreditation for nurse midwifery.
Accreditations last for specific time periods, often five or ten years; they
are then reviewed by the accrediting organization. It is very rare for
accreditations not to be renewed, but to be on the safe side, you might want to
check with any school you're thinking of attending or the relevant accrediting
bodies to find out for how long the school and its programs are currently
accredited.
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Reputation
How do you determine the relative reputations of the nursing schools you're
interested in? Making sure they have the relevant accreditations is a good
start. You can also investigate where the school's faculty have worked, what
procedures they've done., and what advancements they've attained. Beyond that,
Esther Atwood suggests that you ask about the schools' requirements for admission
and graduation, as well as their "pass boards" rate (the percentage of their
alumni who have passed their state board licensure exams). And if the school
tracks where their alumni are currently working, that can also be revealing.
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GETTING INTO A SCHOOL
Decided on a couple of programs you like the looks of? Then apply to them.
Most schools will have application forms and directions for submitting them on
their Web sites. Schools will want you to provide proof that you graduated from
high school or have a GED. Any four year nursing program with limited,
competitive admissions will also want a copy of your ACT or SAT scores, several
references, (probably) your high school transcripts, and (very probably) an
essay in which you tell them why you want to study nursing there and why you'll
make a good student. As mentioned earlier, any medical or personal care work or
volunteer experience you can cite, no matter how limited or marginal, will be a
plus.
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PAYING FOR SCHOOL
In addition to standard college level student grants and loans (such as the
Stafford and PLUS loans in the US), a wide variety of scholarships and other
aids are available for nursing students; refer to our financial aid page. Dan
Cook points out that if you attend a hospital based school, the hospital will
often forgive your tuition if you agree to work for the hospital for a few years
after you graduate. He adds that it's often possible for a student at a
hospital based school to get a low interest loan through the hospital's credit
union, if necessary. Even if you didn't get your education from them, many
hospitals and other employers offer loan forgiveness to recent graduates who
come to work there; according to Esther Atwood, even ACMH (which is not a
particularly large hospital) will currently pay off up to $12,000 of loans.
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COURSE SUBJECTS
Here are some of the subjects you might learn if you choose to study
nursing:
- Some programs will start you out with biology (the
science of life) and/or chemistry (the science of matter),
perhaps leading to biochemistry (the science of how living
things use matter, including the chemicals and chemical reactions occurring in
the human body).
- Anatomy will teach you the body's components (bones,
muscles, organs, etc.) and physiology will teach you how they
function under normal conditions; pathophysiology will teach
you how they function (and malfunction) in response to illness or injury.
- Microbiology is the study of the microorganisms that live
around, on, and inside us, including both the "good bugs" that are necessary
for our health and the "bad bugs" -- bacteria, viruses, parasites, and other
pathogens -- that can cause infectious disease.
- Learn nutrition and you'll understand how our diets can
help or hinder our health. You'll also get an idea of the special dietary
needs of people with various medical conditions.
- In psychology you'll learn about the mind and in
sociology you'll learn about societies, including how
people's mental states and social environments can contribute to their
wellness or illness.
- To work in acute or critical care or in any position that involves
evaluation or investigation, it's important to master health
assessment, the skill of determining how well or badly a patient is
doing and what should be done about it.
- Health care requires careful and assured teamwork; role
development assures that you know what role you can perform in a
medical team, including which procedures the various licenses legally allow
you to do, which tasks RNs can delegate to LPNs or nurses of any kind can
delegate to CNAs, etc.
- Some programs will have courses that focus on the different procedures,
methods, and strategies involved in care of individuals,
care of families, care of community,
mental health care, end-of-life care, and so
on.
- As in any field with so much potential to impact people's lives for better
or worse, ethics is vital in nursing. When you deal with your
patients, your coworkers, and the medical system in general, you can't simply
do whatever you want, or whatever other people want, or whatever you
think they want. Doing the ethically right thing is important for you
personally, your patients, and your profession.
- Nursing management highlights how to supervise and manage
nursing teams, including how to meet business goals such as improving
productivity and reducing costs without sacrificing the quality of patient
care.
- If you're an LPN studying to be an RN, an undergraduate RN studying for a
BSN, or someone working toward a similar "skill upgrade," many programs
suggest or require a course that prepares you for the challenges of that
transition.
In addition to these, Sandra Gray recommends that if you're thinking of
becoming a school nurse or teaching nurse later in your career, you take the
courses you'll need for these specialties during your initial nursing education,
before you start a nursing job. If you wait until after you graduate and start
working to take these kinds of courses, she warns that "it can be up to four
more years, taking a class here and there when you can, to get the credits you
need."
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AFTER YOU GRADUATE
Getting Your Nursing License
To be licensed to practice nursing in the United States, you need to pass one
of the license exams administered by the National Council of State Boards of Nursing
(NCSBN). To become an RN, you must pass the National Council Licensure
Examination for Registered Nurses (NCLEX-RN®); to become an LPN or LVN, you must
pass the National Council Licensure Examination for Practical Nurses
(NCLEX-PN®). As mentioned earlier in this article, you'll also need to pass a
separate licensing exam to work in many advanced practice nursing fields. You'll
need to renew your license(s) periodically; currently RNs in Pennsylvania, for
example, have to renew their license once every three years.
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Getting a Job
Given the current job market for nurses, it probably won't be hard for you to
find a position once you graduate and get your license (assuming you don't
already have one lined up and waiting for you). However, there are still some
things you should have, and can do, to improve your chances.
(Two things you must not have are a criminal record or a drug habit.
Esther Atwood mentions that ACMH's pre-employment screening for nurses includes
both a physical and a drug test; Dan Cook points out that most nursing positions
will also require a background check.)
Work up a good resumé that includes any prior paid or volunteer medical work;
positions in some specialties require previous experience. Line up some
references. Check the newspaper classifieds and the employment-related Web sites
-- not just general sites such as monster.com and hotjobs.yahoo.com, but also
nursing specific sites such as rn.com,
nursezone.com, allnurses.com,
nurse-recruiter.com, and nurses123.com. Put the word out among your
friends and family that you're looking for work (which is actually a more
effective way to find a job than all the others combined).
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CONCLUSION
Nursing is a curious profession; it has the Golden Rule (loosely, "treat
others the way you'd want them to treat you") built in. Yes, nursing can be
emotionally and possibly monetarily rewarding in the short term, but it also
carries the promise of long-term reciprocity: While you're well,as a nurse you
can and should do your best for those who are frail or unwell, because someday,
if you should become frail or unwell, you have to hope that others will do the
same for you. Though a similar circle of "instant karma" also holds between
doctors and patients, the relationship isn't as day-to-day or intimate.
Of all the common relationships between professions and the people they serve,
perhaps only teachers and students share the same kind of close and inevitable
interchangeability that nurses and their patients have. So, if you choose, be a
good student and then a good nurse; if God or fortune smiles, when your time
comes to be a teacher or a patient, you won't be disappointed by those who
follow in your footsteps.
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W. Randy Hoffman is not a nurse, but his
91-year-old grandfather Charles tries to get him dates with visiting nurses all
the time. It's not easy to appreciate these misguided attempts at matchmaking,
but he tries.
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