As the largest health care occupation, registered nurses held about 2.4 million jobs in 2004. About 3 out of 5 jobs were in hospitals, in inpatient and outpatient departments.
Others worked in offices of physicians, nursing care facilities, home health care services, employment services, government agencies, and outpatient care centers. The remainder worked mostly in social assistance agencies and educational services, public and private. About 1 in 4 RNs worked part time.
So, the nursing job outlook for RNs in all specialties is expected to be excellent. Employment of registered nurses is expected to grow much faster than average for all occupations through 2014, and, because the occupation is very large, many new jobs will result.
In fact, registered nurses are projected to create the second largest number of new jobs among all occupations. Thousands of job openings also will result from the need to replace experienced nurses who leave the occupation, especially as the median age of the registered nurse population continues to rise.
Another reason for the positive nursing job outlook is that much faster-than-average growth will be driven by technological advances in patient care... which permit a greater number of medical problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.
Employers in some parts of the country and in certain employment settings are reporting difficulty in attracting and retaining an adequate number of RNs, primarily because of an aging RN workforce and a lack of younger workers to fill positions.
Enrollments in nursing programs at all levels have increased more rapidly in the past couple of years as students seek jobs with stable employment. However, many qualified applicants are being turned away because of a shortage of nursing faculty to teach classes.
Even though the nursing job outlook for all nursing specialties is expected to be excellent, it can vary by employment setting. For example, employment is expected to grow more slowly in hospitals—which comprise health care's largest industry—than in most other health care industries.
While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to grow by much.
Patients are being discharged earlier, and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy.
Despite the slower employment growth in hospitals, the nursing job outlook should still be excellent because of the relatively high turnover of hospital nurses. RNs working in hospitals frequently work overtime and night and weekend shifts and also treat seriously ill and injured patients, all of which can contribute to stress and burnout.
To attract and retain qualified nurses, hospitals may offer signing bonuses, family-friendly work schedules, or subsidized training. A growing number of hospitals also are experimenting with online bidding to fill open shifts, in which nurses can volunteer to fill open shifts at premium wages. This can decrease the amount of mandatory overtime that nurses are required to work.
Employment in nursing care facilities is expected to grow faster than average because of increases in the number of elderly, many of whom require long-term care.
In addition, the financial pressure on hospitals to discharge patients as soon as possible should produce more admissions to nursing care facilities.
Job growth also is expected in units that provide specialized long-term rehabilitation for stroke and head injury patients, as well as units that treat Alzheimer’s victims.
Employment in home health care is expected to increase rapidly in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.
Generally, RNs with at least a bachelor's degree will have better nursing career prospects than those without a bachelor's. In addition, all four advanced practice specialties—clinical nurse specialists, nurse practitioners, midwives, and anesthetists—will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Relative to physicians, these RNs increasingly serve as lower-cost primary care providers.