The health-care industry has continued to change dramatically over the past few years, transforming the roles and escalating opportunities for nurses. The current shortage of nurses is caused by an increased number of hospitalized patients who are older and more acutely ill, a growing elderly population with multiple chronic health problems, and expanded opportunities in HMOs, home care, occupational health, surgical centers, and other primary-care settings. Expanding technological advances prolonging life require more highly skilled personnel.

The increasing scope of nursing opportunities will grow immensely as nurses become the frontline providers of health care. They are assuming important roles in the provision of managed care, and they will be responsible for coordinating and continuing the care outside traditional health-care facilities. Nurses will play a big role in educating the public and addressing the social and economic causes of health issues.

Worldwide Standards

The nursing student of the future will be given much more information and, thus, knowledge of the technology used to manage that information will be essential to tracking and assessing care. In this area, nurses will be able to provide care over great distances. In some areas, care is being managed by the nurse via tele-home health over the Internet. Use of the Internet and other computer-oriented systems are now an integral part of the tools used by nurses. Nurses of the future, therefore, will have to become aware of worldwide standards of care. Yet despite this growth of technology, the essential function of the nurse's role will remain that of making sure that the right person is providing the right care for the patient at the right cost.

This will be accomplished as the industry turns away from the hospital as the center of the operation. Nurses will work in a broad array of locations, such as clinics, outpatient facilities, community centers, schools, and even places of business. Hospitals are now places only for the very sick, and the name itself may be changed to acute-care center.

Much of the emphasis in health care will be shifted toward preventive care and the promotion of health. The nurse will be asked to take on a broader and more diverse role in this system.

Unlimited Opportunities, Expanded Responsibilities

The four-year baccalaureate programs in today's nursing colleges provide the educational and experiential base not only for entry-level professional practice but also as the platform on which to build a career through graduate-level study for roles as advanced practice nurses, such as nurse practitioners, nurse midwives, clinical specialists, and nurse administrators and educators. Nurses at this level can be expected to specialize in oncology, pediatrics, neonatology, obstetrics and gynecology, critical care, infection control, psychiatry, women's health, community health, and neuroscience. The potential at this level is great, but so are the responsibilities. Increasingly, many families use the nurse practitioner for all their health-care needs. In almost all states, the nurse practitioner can prescribe medications and provide health care for the management of chronic non-acute illnesses and preventive care.

The health-care system is demanding more from nurses. The education of a nurse must transcend the traditional areas, such as chemistry and anatomy, to enable them to gain a deeper understanding of health promotion, disease prevention, screening, genetic counseling, and immunization. Nurses will have to understand how health problems may have a social cause, such as poverty and environmental contamination, as well as have insight into human psychology, behavior, cultural mores, and values.

The transformation of the health-care system offers unlimited opportunities for nurses at the baccalaureate and graduate levels as care in urban and rural settings becomes more accessible. According to the U.S. Bureau of Labor Statistics, employment of RNs will grow faster than the average for all occupations through 2012, due largely to growing demand in settings such as health maintenance organizations, community health centers, home care, and long-term care. Despite major changes in hospital structures, the ranks of registered nurses in hospitals increased nearly 5 percent between 1992 and 1996, according to figures from the Division of Nursing of the U.S. Department of Health and Human Services. While RN employment fell by 6 percent in hospital in-patient units, it grew by 25 percent in outpatient and labor and delivery departments and increased by more than 15 percent in emergency rooms. Between 1996 and 1997, however, total nurse employment grew by 8.2 percent in states with high managed-care penetration, with a significant portion of this growth in hospital settings. The increased complexity of health problems and increased management of health problems out of the hospitals require highly educated and well-prepared nurses at the baccalaureate and graduate levels. It is an exciting era in nursing, one that holds exceptional promise for nurses with a baccalaureate nursing degree.

The compensation for new nurses is again starting to be more competitive compared with that of other industries. Entry-level nurses with baccalaureate degrees in nursing can expect a salary range from about $31,000 to $38,000 per year, depending on geographic location and experience. Five years into their careers, the national average for nurses with four-year degrees is over $50,000 per year, with many earning over $60,000. The current shortage has prompted sign-on bonuses and other incentives to attract and retain staff.

Applying to College

Meeting the school's general entrance requirements is the first step toward a university or college degree in nursing. Admission requirements may vary, but a high school diploma or equivalent is necessary. Most accredited colleges consider SAT I scores along with high school grade point average. A strong preparatory class load in science and mathematics is generally preferred among nursing schools. Specific admission information can be obtained by writing to the schools' nursing departments.

To apply to a nursing school, contact the admission offices of the colleges or universities you are interested in and request the appropriate application forms. With limited spaces in nursing schools, programs are more competitive, so early submission of the application is recommended.

Accreditation

Accreditation of the nursing program is very important, and it should be considered on two levels--the accreditation of the university or college and the accreditation of the nursing program. Accreditation is a voluntary process in which the school or the program asks for an external review of its programs, facilities, and faculty. For nursing programs, the review is performed by peers in nursing education to ensure program quality and integrity.

Baccalaureate nursing programs have two types of regular systematic reviews. First, the school must be approved by the state board of nursing. This approval is necessary to ensure that the graduates of the program have access to sit for the licensing examinations offered through the National Council of State Boards of Nursing, Inc. The second is accreditation administered by a nursing accreditation agency that is recognized by the U.S. Department of Education.

Though accreditation is a voluntary process, access to federal loans and scholarships requires accreditation of the program, and most graduate schools only accept students who have earned degrees from accredited schools. Further, accreditation ensures an ongoing process of quality improvement that is based on national standards. Canadian nursing school programs are accredited by the Canadian Association of University Schools of Nursing, and those Canadian programs listed in this book must hold this accreditation. There are two recognized accreditation agencies for baccalaureate nursing programs in the United States: the Commission on Collegiate Nursing Education (CCNE) and the National League for Nursing Accrediting Commission (NLNAC).

Focusing Your Education

Academic performance is not the sole basis of acceptance into the upper level of the nursing program. Admission officers also weigh such factors as student activities, employment, and references. Moreover, many require an interview and/or an essay in which the nursing candidate offers a "goal statement." This part of the admission process can be completed prior to a student's entrance into the college or university or prior to the student's entrance into the school of nursing itself, depending on the program.

In this interview or essay, students may list career preferences and reasons for their choices. This allows admission officers to assess the goals of students and gain insights into their values, integrity, and honesty. One would expect that a goal statement from a student who is just entering college would be more general than that of a student who has had two years of preprofessional nursing studies. The more experienced student would be likely to have a more focused idea of what is to be gained by an education in nursing; there would be more evidence of the student's values and the ways in which she or he relates them to the knowledge gained from preprofessional nursing classes.

Baccalaureate Curriculum

A standard basic or generic baccalaureate program in nursing is a four-year college or university education that incorporates a variety of liberal arts courses with professional education and training. It is designed for high school graduates with no previous nursing experience.

Currently, there are more than 674 baccalaureate programs in the United States. Of the 590 programs that responded to a fall 2004 survey conducted by the American Association of Colleges of Nursing, total enrollment in all nursing programs leading to a baccalaureate degree was 147,170. A report from the National Advisory Council on Nursing Education recommends that at least two thirds of the nursing workforce hold a baccalaureate degree or higher by 2010, compared to the current 40 percent.

The baccalaureate curriculum is designed to prepare students for work within the growing and changing health-care environment. With nurses taking more of an active role in all facets of health care, they are expected to develop critical-thinking and communication skills in addition to receiving standard nurse training in clinics and hospitals. In a university or college setting, the first two years include classes in the humanities, social sciences, basic sciences, business, psychology, technology, sociology, ethics, and nutrition.

In some programs, the nursing classes start in the sophomore year, whereas others have students wait until they are juniors. Many schools require satisfactory grade point averages before students advance into professional nursing classes. On a 4.0 scale, admission into the last two years of the nursing program may require a minimum GPA of 2.5 to 3.0 in preprofessional nursing classes. The national average is about 2.8, but the cutoff level varies with each program.

In the junior and senior years, the curriculum focuses on the nursing sciences and emphasis moves from the classroom to health facilities. This is where students are exposed to clinical skills, nursing theory, and the varied roles nurses play in the health-care system. Courses include nurse leadership, health promotion, family planning, mental health, environmental and occupational health, adult and pediatric care, medical and surgical care, psychiatric care, community health, management, and home health care.

This level of education comes in a variety of settings: community hospitals, clinics, social service agencies, schools, and health maintenance organizations. Training in diverse settings is the best preparation for becoming a vital player in the growing health-care field.

Reentry Programs

Practicing nurses who are returning to school to earn a baccalaureate degree will have to meet requirements that may include possession of a valid RN license and an associate degree or hospital diploma from an accredited institution. Again, it is best to check with the school's admissions department to determine specifics.

Nurses returning to school will have to consider the rapid rate of change in health care and in science in general. A nurse who passed an undergraduate-level chemistry class ten years ago would probably not receive credit for that class today, due to the growth of knowledge in that and all other scientific fields. The need to reeducate applies not only to practicing nurses returning to school but also to all nurses throughout their careers.

In the same vein, nurses with diplomas from hospital programs who want to work toward a baccalaureate degree would find themselves in need of meeting the common requirements for more clinical practice as well as developing a deeper understanding of community-based nursing practices, such as health prevention and promotion.

There are colleges and universities available to the RN in search of a baccalaureate that give credit for previous nurse training. These programs are designed to accommodate the needs and career goals of the practicing nurse by providing flexible course schedules and credit for previous experience and education. Some programs lead to a master's-level degree, a process that can take up to three years. Licensed practical nurses (LPNs) can also continue their education through baccalaureate programs.

Nurses thinking of reentering school may also consider other specialized programs. For example, there are programs aimed at enabling a nurse with an ADN or an LPN/LVN degree to earn a BSN Also, accelerated BSN. programs are available, as are accelerated BSN programs for nurses with degrees in other fields.

Choosing a Program

With approximately 674 baccalaureate programs in the United States, some research will reveal which programs match your needs and career objectives.

If you have no health-care experience, it might be best to gain some insight into the field by volunteering or working part-time in a care facility, such as a hospital or an outpatient clinic. Talking to nurse professionals about their work will also lend insight into how your best attributes may apply to the nursing field.

When considering a nursing education, consider your personal needs. Is it best for you to work in a heavily structured environment or one that offers more flexibility in terms of, say, integrating a part-time work schedule into studies? Do you need to stay close to home? Do you prefer to work in a large health-care system, such as a health maintenance organization or a medical center, or do you prefer smaller, community-based operations?

As for nursing programs, it's best to ask the following: How involved is the faculty in developing students for today's health-care industry? How strong is the school's affiliation with clinics and hospitals? Is there any assurance that a student will gain an up-to-date educational experience for the current job market? Are a variety of care settings available? How much time in clinics will be needed for graduation? What are the program's resources in terms of computer and science laboratories? Does the school work with hospitals and community-based centers to provide health care? How available is the faculty to oversee a student's curriculum? What kind of student support is available in terms of study groups and audiovisual aids? Moreover, what kind of counseling from faculty members and administrators is available to help students develop well-rounded, effective progress through the program?

Visiting a school and talking to the program's guidance counselors will give you a better understanding of how a particular program or school will fit your needs. You can get a closer look at the faculty, its members' credentials, and the focus of the program. It's also not too early to consider what each program can offer in terms of job placement.