“I’m a registered nurse.”
Today, about 2.5 million people in the United States can make that claim. But being a nurse in 2008 is vastly different than it was 20 years ago. Perhaps more than in any previous decade, this is an extremely exciting and challenging time to be a nurse.
The nursing profession continues to stand for caring, respect for the individual, and health and wellness promotion. But recent changes in health care, along with societal and demographic trends, have led to new career possibilities for nurses.

The strong draw of nursing
Nursing is a more attractive profession than ever due to growing diversification of nursing roles, greater demand for nurses, and higher compensation. In May 2006, RNs earned a median of $57,280 annually, compared to $49,840 in 2002. While nearly 60% of nursing positions are in hospitals, other settings (such as home health) are expected to see the greatest growth in the next 5 to 10 years.

Our changing healthcare environment
In the past two decades, nursing responsibilities have been altered by rapid implementation of new technology, changing reimbursement trends, the Joint Commission’s National Patient Safety Standards, and the Health Insurance Portability and Accountability Act. Scientific and technological advances have redefined many aspects of health care. Today’s highly complex care requires practitioners—even nurses working in basic care settings—to have greater knowledge and skills.
Changes in healthcare business models also have opened up new nursing niches. With the emphasis shifting from managing resource use to promoting good patient outcomes, and with increasing focus on pay for performance, nurses have moved into new roles and settings. Today, they can work as analysts of clinical data or as nurse practitioners (NPs) who implement evidence-based practice protocols. They can manage outcomes with specific patient populations in specific settings, such as community clinics or corporations. New areas of nursing responsibility and practice, including geriatric and oncology nursing, also have arisen to address the challenges of Americans’ increasing life span and greater awareness of diseases and treatments.
National awareness of the nursing profession appears to be at an all-time high, as the public has begun to understand the implications of the nursing shortage and wonders whether they’ll have access to safe and efficient health care in the future. These circumstances are likely to expand nurses’ professional opportunities even further.

The specialist nurse
More nurses now specialize in and serve specific patient populations. Parish nurses serve church members, advising the elderly on polypharmacy issues, counseling newlyweds about starting families, and educating middle-aged persons about healthy aging. Community nurses have become better versed in electronic assessment techniques in the home, such as telemedicine, which allows them to assess, document, and transmit data for confirmation of diagnoses and treatment plans.

More advanced practice roles
Advanced practice nurse (APN) roles are increasing. APNs can choose to work as NPs, certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs), or certified nurse-midwives (CNMs).
NPs are educated well beyond what’s required for RN licensure. They must have master’s degree–level training in a specific area. State regulations define the NP’s scope of practice. In all 50 states, NPs can prescribe drugs, although some states restrict their authority to prescribe controlled substances. In many states, they also can order and interpret diagnostic tests. NPs’ estimated median annual salary is about $80,000.
CRNAs provide anesthesia services similar to those of anesthesiologists. After completing extensive education and training, CRNAs must obtain national certification. Working with surgeons, dentists, podiatrists, and anesthesiologists, they provide a patient’s anesthesia needs before, during, and after surgery or newborn delivery. Annual CRNA salaries range from about $130,000 to $150,000.
The CNS specializes in a specific patient population (such as pediatric or geriatric patients), a specific disease or medical subspecialty (such as oncology), a specific type of care (such as rehabilitation or psychiatry), or a specific problem (such as wounds or pain). Besides caring for patients, CNSs assist healthcare systems in implementing improvements in care delivery. Research shows CNSs have improved many aspects of patient-care outcomes and resource use. On average, they earn from $65,000 to more than $110,000 annually, depending on the geographic area and practice specialty.
A CNM must have a bachelor’s degree and complete a training program accredited by the American College of Nurse-Midwives Division of Accreditation. CNM salaries typically range from $54,000 to $66,000 annually.

Other nursing roles
Legal nurse consultant, nurse informaticist, and Clinical Nurse Leader (CNL) are additional roles that have opened up recently.
RNs who add marketable legal skills to their nursing backgrounds can work for law firms or set up their own practices as legal nurse consultants. They review, organize, and analyze medical records; perform medical and legal research; locate and interview expert witnesses; and assist attorneys with pretrial and trial activities. In most states, RNs who become certified as legal nurse consultants can earn $125 to $150 per hour.
The nurse informaticist specialty integrates nursing science, computer science, and information. Nurse informaticists manage and communicate data, information, and knowledge in nursing practice to support patients, nurses, and other healthcare providers in decision making in all roles and settings. They must complete specific course work, have specific experience, and be certified by the American Nurses Credentialing Center. In 2007, the average salary for a nurse informaticist was $83,675.
The CNL role was established in 2005 by the American Association of Colleges of Nursing to address issues surrounding the quality of care. CNLs are generalist clinicians with master’s degree–level education who bring a high level of clinical knowledge and competence to the point of care and serve as resources for the nursing team. It’s too soon to accurately define salary ranges and opportunities for the CNL role.

Specific growth areas in nursing
Regional market needs influence the availability of many APN and other nursing opportunities. Some states have a more severe nursing shortage or a higher demand for particular types of nurses, and even offer incentives to fill vacancies.
Nonetheless, several exceptionally strong areas for growth exist, including occupational health, nursing faculty, and nursing administration. Occupational health nurses have varying degrees of academic preparation ranging from entry level to PhD. Depending on their experience and preparation, they may work as clinical nurses, clinical nurse managers, nurse managers, corporate nurses, nurse researchers, nurse educators, or nurse consultants. Typically, they’re responsible for employee health related to workplace hazards, including safety and hygiene associated with engineering and equipment. They’re expected to be knowledgeable about toxicology and epidemiology related to the work site and its employees.

Getting the education you need to move up
If you’re thinking of taking a step forward in your career, first step back and examine your career goals. What do you want to accomplish and experience throughout your professional life?
Nearly all current and future nursing opportunities require education beyond an associate degree in nursing. Many of the highest-paying and most flexible positions require a master’s degree.
Depending on your current educational level, this may mean you have to go back to school. That’s a major commitment, but one that will net a substantial return on your investment. Be aware that the nursing shortage has made available many grants, scholarships, and other forms of financial support for nurses seeking to continue their education.
Also know that educational options are greater than ever, thanks to high-quality online degree programs that remove geographic barriers. Such programs offer the flexibility to continue your education so you can enter new or advanced areas of nursing practice while keeping up with your family and work responsibilities.
As a nurse, you change lives. In this era of greater opportunity, you can change your professional life, too.

Sheila Burke is the Acting Dean for the School of Nursing at Kaplan University, which provides online post-secondary educational courses. Previously, she spent more than 20 years as a healthcare administrator for several large organizations; served as vice president for hospice care agencies in Illinois, California, and Texas; and worked as a nursing director, field supervisor, and surgical nurse.