Before delving into occupational specifics, let’s start with a general definition of a registered nurse.
A registered nurse (RN) is a nurse who holds a nursing diploma or Associate Degree in Nursing (ADN), has passed the NCLEX-RN exam administered by the National Council of State Boards of Nursing (NCSBN) and has met all the other licensing requirements mandated by their state’s board of nursing.
Though a nursing diploma or ADN meets minimum education requirements, a growing number of educators, health care agencies, employers, professional associations, and medical community members encourage RNs to pursue a Bachelor of Science in Nursing (BSN), either as a path to initial licensure or as a way to expand their expertise after becoming licensed.
Luckily, colleges and universities are working to develop more creative, nontraditional degree pathways for students and nurses alike to earn a BSN:
- RN to BSN post-licensure programs help RNs that already hold an ADN or diploma earn a BSN in just one to two years.
- Accelerated BSN pre-licensure programs help career changers with college degrees in other fields become RNs by fast-racking them toward the completion of a BSN in just 12 to 18 months.
Let’s talk numbers. According to the Henry J. Kaiser Family Foundation, the number of professionally active RNs in the United States reached nearly 3.2 million in September 2016. During that same period there were just 926,000 active physicians.
So, what are these numbers telling us?
The fact that there are more than three times more RNs than doctors staffing hospitals and clinics provides a reminder of just how much the healthcare system relies on registered nurses and how badly patients need RNs to provide care. Think of RNs as the backbone of the healthcare system in American; without them the entire structure would collapse.
Registered Nurse Scope of Practice
Although a textbook definition of a registered nurse may be helpful, it does little to describe any occupational function. The truly defining nature of a registered nurse lies in the scope of practice …
- The term “scope of practice” is an expression used to indicate a set group of services and procedures an RN is qualified to perform or not perform
- Every state has its own board of nursing (BON) which is the authoritative body that governs the standards and scope of practice for RN’s and their licensing requirements
- Since each BON determines its own scope of practice, the scope differs slightly depending on which state an RN is licensed in.
Still, the RN scope of practice is pretty consistent from state to state …
- Every RN, regardless of their state of residency, must pass the NCLEX-RN exam.
- This across-the-board requirement means that the NCLEX-RN exam is the best assessment available to properly gauge a RN’s ability to perform a generally agreed upon scope of practice.
According to the National Council of State Boards of Nursing (NCSBN), an RN’s scope of practice includes:
- Management of Care
- Safety and Infection Control
- Health Promotion and Maintenance
- Psychosocial Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaption
Typical RN Duties Within the Scope of Practice
Of course, not all RNs perform the same duties because their responsibilities often depend on several factors such as work setting, training, education, experience, and specialty. However, there are many tasks that fall under an RN’s basic scope of practice and that are universal for all RNs:
- Preparing patients for exams or treatments and making assessments, including helping to perform diagnostic tests and analyzing results
- Recording patients’ medical histories and symptoms, including observations, health promotion recommendations, and methods of disease prevention
- Administering medicine and treatments to patients
- Helping to establish plans of care for patients
- Operating and monitoring medical equipment
- Teaching patients and their families how to manage medical conditions and post-treatment care
- Conferring and collaborating with supervising physicians and additional healthcare professionals
The Nursing Process
At the core of all registered nursing practice is the delivery of holistic, patient-focused care, according to the American Nurses Association. Delivering this care is a five-step process:
- Assessing the needs of a patient, not only physically but also based on psychological, sociocultural, spiritual, economic, and lifestyle factors
- Using clinical judgment to diagnose the needs of the patient
- Establishing a care plan for the patient by setting measurable and achievable short- and long-term goals for the patient based on the assessment and diagnosis
- Implementing nursing care according to the care plan
- Evaluating the patient’s status and the effectiveness of the nursing care
The nurse also carefully documents all these steps so that other health care providers have access to the information.
Let’s Talk Specializations
Many RNs become interested in gaining expertise in a specific aspect of nursing, called a specialization. There are literally dozens of specializations available to RNs that specify concentrated knowledge in a workplace setting, body system, patient population, administrative role, medical condition or research.
In general, RN specializations are reflected in their job title. For example:
- Rehabilitation Nurse
- HIV/AIDS Care Nurse
- Psychiatric Nurse
- Pediatric Oncology Nurse
- Ambulatory Care Nurse
- Neonatal Intensive Care Nurse
- Geriatric Nurse
- Critical Care Nurse
- Hospice Nurse
- Pulmonary Care Nurse
- Infection Control Nurse
- Ophthalmic Nurse
To be clear: many RNs are generalists and are not required to choose a specialization. To gain recognition as a specialized nurse professional, RNs typically need to undergo further experience, clinical practice, and education in their specialized field.
In fact, employers may require RNs to prove their specialized competency by becoming certified in their specialty area through a nationally recognized certifying body. For instance, many cardiac nurses gain certification through formal examination by the American Board of Cardiovascular Medicine.
What is an APRN?
An advanced practice registered nurse (APRN) is an RN with the ambition to complete a graduate degree in a specific, specialized nursing role along with a corresponding certification in that role, and most often in a particular patient population focus. There are four defined APRN roles:
- Certified Registered Nurse Anesthetist (CRNA)
- Certified Nurse Midwife (CNM)
- Clinical Nurse Specialist (CNS)
- Certified Nurse Practitioner (CNP)
One of the biggest differences between RNs and APRNs is level of education:
- All RNs must hold a nursing diploma or associate’s degree (ADN) at minimum, with some electing to enter the field of nursing with a bachelor’s degree (BSN) or going on to earn one later in their career.
- All APRNs must earn a master’s (MSN) at minimum, with some electing to earn a practice focused doctoral degree (DNP).
Another major difference is in the APRN’s ability to exercise greater professional autonomy, which extends their scope of practice. The National Association of Clinical Nurse Specialists (NACNS) defines this autonomy as the freedom to act as primary or acute care provider without the supervision of a physician. In many states, this even includes the authority write prescriptions.
This distinction means an ARPN’s scope of practice stretches beyond the RN role to include:
- Conducting advanced assessments
- Requesting and interpreting diagnostic procedures
- Forming primary and differential diagnosis
- Prescribing, ordering, administering, supplying, and delivering therapeutic methods
- Authorizing and delegating therapeutic methods to assisting personnel
- Conferring with outside disciplines and offering referrals to health care agencies, health care providers, and community resources
Understanding the Unique Role of RNs in Comparison to Other Types of Nurses
With several different nursing classifications, it can be helpful to understand what an RN is by clarifying which nursing professions are not RNs:
Licensed practical nurses (LPN) and licensed vocational nurses (LVN) are not registered nurses.
- LPNs and LVNs often work under the supervision of RNs, as well as physicians and APRNs. They are qualified through LVN/LPH certificate programs and by passing the NCLEX-PN exam. Only a handful of states offer LPN and LVN licenses, and though the scope of practice varies from state to state, it is always far more restrictive that the scope of practice for RNs.
Certified nurse assistants/aides are not registered nurses.
- CNAs work under the supervision of RNs and LPNs/LVNs. CNAs typically hold a high school diploma, complete a CNA certificate program, and pass a state competency exam. The scope of practice for CNAs is typically limited to providing patients with basic care needs, transportation, and daily exercise routines.