Most persons looking for employment in the health care industry have done so for two primary factors. These are Money and Job Availability. Nursing is no exception to these economic forces.

The 1988 entry level salaries for beginning Registered Nurses was $11.50 per hour. Today local entry level salaries are $13.50 to $17.50 with $3.00 and $4.00 per hour shift differentials. In urban areas such as Dallas/Fort Worth metroplex, salaries can start at $25.00 per hour. Agency Nurses can make $30.00 per hour on local assignments.

The nursing shortage in the 1980s brought new emphasis to meeting this critical need, and the number of licensed nurses in the United States increased dramatically. However, the nursing shortage continues today. This is due largely in part to the explosive growth in the health care industry which has increased employment by 17% from 1988 to 1992.

"Last year 29,000 new health care jobs were created each month ...
3 percentile points ahead of the rest of the nonfarm economy."
- Alexandria Town Talk

Projections on the effects of the health industry reforms under-way declare Nurses, Midwives, and Nurse Practitioners as among the winners. While hospital shortages of nurses in urban areas are less severe, the shifts to outpatient and home health care are increasing the need for nurses.

The shortfall of available nurses to meet these increasing nursing positions is also impacted by the usual losses from the workforce due to an aging population, burnout, and personal choices. However the educational requirements also have an impact.

In the years 1950 to 1970 most nurses in the United States received their education and training through hospital based Diploma Programs. Upon completion they were qualified to write the State Board Exam and receive licensure as a Registered Nurse. By 1980, the nursing shortage, along with the emphasis on education in a college setting saw an increase in the Baccalaureate Degree for BSN as a truly professional nurse. But the biggest growth was in the Associate Degree in Nursing. All three of these types of nurses are qualified to the license of Registered Nurse upon completion of the NCLEX exam. A 1988 poll demonstrated 37% BSN RN, 25% Diploma RN, 25% ADN RN and the remainder graduate degree MSN or PhD RN nurses in practice.

In Louisiana, about half of the graduating nurses taking RN NCLEX exam are ADN prepared. There are almost no Diploma Nurse Programs left in the United States today. The industry has responded with less or no differential pay for BSN RN nurses. The placement of Registered Nurses may depend on the experience and skill as much as educational levels. In the hospital where I am employed. the Director of Nurses is a Diploma Nurse who is working on her BSN. Nurses under her direction include those with Master's level education. My Unit Director is an ADN RN and she has two BSN RN nurses working under her direction.

The American Nurses Association recommends two levels of nursing by the year 2000. However, criteria for emtry level of practice for Registered Nurses is controlled by State Law. To date, only North Carolina requires a BSN degree to receive licensure as a Registered Nurse. The ANA plan would eliminate LPN and Diploma levels and create a Technical Nurse level and Professional Nurse level. These changes will only come into practice if they serve the needs and economics in the individual states. However, many LPN nurses as well as ADN and Diploma RNs are in the process of continuing their formal education to meet these requirements, some in anticipation of a future change in licensure. The literature indicates a "grandfathering" process for nurses currently holding licensure, should the changes go into effect.

Mandatory continuing education is a requirement of relicensure in a growing number of states and has become a requirement for relicensure for Registered Nurses in Louisiana this year.

The flux in criteria to achieve entry level also extends to the duties and responsibilities of Nursing Personnel. Specialization into various areas provide a wide variety of workplace environments as well as types of Nursing to choose from.

Nurses have two ways to achieve advancement.

VERTICAL MOBILITY: advancing upward in a hierarchy.

This would be the path of moving from staff nurse to head nurse in the area where one is employeed.

HORIZONTAL MOBILITY: advancing by changing practice setting.

This would be the path of moving from practicing nursing in a Nursing Home setting to a Community Health Agency for example.

There are also levels of advanced nursing practice to choose from. These entail more college preparation.

NURSE PRACTITIONER

Advanced education, usually Master's level.

• skilled at making nursing assessments
• performing physical assessments
• counseling and teaching
• treating (often in concert with a physician) minor, self-limiting illnesses or stable long-term illnesses.
• limited prescribing authority, dependent on state law

NURSE SPECIALIST

Education pre-requisite Master's Degree in Nursing to be eligible for certification.

• advanced knowledge and skills in a particular area of nursing

NURSE CLINICIAN

Bedside or direct care in a specialty area.

NURSE GENERALIST

Certification from ANA in 7 areas

• maternal child health
• child and adolescent
• high-risk perinatal
• medical-surgical
• psychiatric and mental health
• community health
• gerontologist

There are some things which do not change for each type of Nurse and these are called NURSING ROLES.

CAREGIVER/COMFORTER TEACHER CLIENT ADVOCATE LEADER RESEARCHER

COMMUNICATOR/HELPER COUNSELOR CHANGE AGENT MANAGER

Nursing Roles and the recognition of Nursing as a profession has broadened Nursing ... no longer a gender specific career, men are chosing Nursing in ever increasing numbers. 10% of my graduating class are male. Many of these are older men with wives and children to provide for and chose Nursing for a career change.

As Health Care continues to evolve and change in the United States, Nurses along with Health care Specialists will be required to broaden their skills and take on more responsibility to meet the emerging need for multiskilled health care providers and practitioners. Nursing has a history of being flexible to meet changing health care needs, thus ensuring an important place in future health care requirements.