Although nursing is the nation's largest health care field, with 2.5 million registered nurses nationwide, misinformation from news stories and other media at times has fueled public misperceptions about the profession. As you plan or consider a career as a registered nurse, you should know these facts:

• The U.S. Bureau of Labor Statistics projects that employment for registered nurses will grow faster than the average for all occupations through 2008.
• Nursing students comprise more than half of all health professions students.
• Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. 
• Most health care services involve some form of care by nurses. Although 60 percent of all employed RNs work in hospitals, many are employed in a wide range of other settings, including private practices, public health agencies, primary care clinics, home health care, outpatient surgicenters, health maintenance organizations, nursing-school-operated nursing centers, insurance and managed care companies, nursing homes, schools, mental health agencies, hospices, the military, and industry. Other nurses work in careers as college and university educators preparing future nurses or as scientists developing advances in many areas of health care and health promotion.
• Though often working collaboratively, nursing does not "assist" medicine or other fields. Nursing operates independent of, not auxiliary to, medicine and other disciplines. Nurses' roles range from direct patient care to case management, establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.
• With more than four times as many RNs in the United States as physicians, nursing delivers an extended array of health care services, including primary and preventive care by advanced, independent nurse practitioners in such clinical areas as pediatrics, family health, women's health, and gerontological care. Nursing's scope also includes care by certified nurse-midwives and nurse anesthetists, as well as care in cardiac, oncology, neonatal, neurological, and obstetric/gynecological nursing and other advanced clinical specialties. 
• The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science degree in nursing (BSN). Registered nurses are prepared either through a BSN program; a two-year community college program, receiving an associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam. (The number of diploma programs has declined steadily -- to less than 10 percent of all basic RN education programs -- as nursing education has shifted from hospital-operated instruction into the college and university system.)

THE NEED FOR THE BACCALAUREATE NURSE 

The Bachelor of Science degree in nursing is the critical first step for a career in professional nursing. The American Association of Colleges of Nursing (AACN) and other leading nursing organizations recognize the BSN degree as the minimum educational requirement for professional nursing practice. While graduates can begin practice as an RN with an associate degree or hospital diploma, the BSN degree is essential for nurses seeking to perform at the case-manager or supervisory level or move across employment settings.

The BSN nurse is prepared for a broader role -- The BSN nurse is the only basic nursing graduate prepared to practice in all health care settings -- critical care, ambulatory care, public health, and mental health -- and thus has the greatest employment flexibility of any entry-level RN. The BSN curriculum includes a broad spectrum of scientific, critical-thinking, humanistic, communication, and leadership skills, including specific courses on community health nursing not typically included in diploma or associate-degree tracks. These abilities are essential for today's professional nurse who must be a skilled provider, designer, manager, and coordinator of care. Nurses must make quick, sometimes life-and-death decisions; understand a patient's treatment, symptoms, and danger signs; supervise other nursing personnel; coordinate care with other health providers; master advanced technology; guide patients through the maze of health resources in a community; and teach patients how to comply with treatment and adopt a healthy lifestyle. In particular, a recent report by the National Advisory Council on Nurse Education and Practice, an advisory panel to the federal Division of Nursing, noted that baccalaureate nursing programs are far more likely than other entry-level tracks to provide students with on-site clinical training in non-institutional settings outside the hospital. As a result, the BSN graduate is well-prepared for practice in such sites as home health agencies, outpatient centers, and neighborhood clinics where opportunities are fast expanding as hospitals focus more on acute care and health services move beyond the hospital to more primary and preventive care throughout the community. 

The BSN nurse is preferred -- More nurse executives are indicating their desire for the majority of their hospital staff nurses to be prepared at the baccalaureate level to meet the more complex demands of today's patient care. In fact, the words "BSN preferred" are appearing more frequently in classified ads for registered nurses nationwide. Aware of the expanding opportunities, RNs are seeking the BSN degree in increasing numbers. In 1980, almost 55 percent of registered nurses held a hospital diploma as their highest educational credential, 22 percent held the bachelor's degree, and 18 percent an associate degree, according to figures from the federal Division of Nursing. By 1996, a diploma was the highest educational credential for only 27 percent of RNs, while the number with bachelor's degrees had climbed to 31 percent, with 32 percent holding an associate degree. Between 1975 and 1998, the number of RNs (with diplomas or associate degrees) graduating from BSN programs rose from approximately 3,700 a year to more than 11,000 annually, according to AACN data. Indeed, enrollment of RNs who returned to school full-time in 1998 to pursue the BSN degree rose more than 7 percent above the previous year. Such numbers indicate the high premium that nurses place on advanced education in today's growing market, and the demand by employers for RNs who are baccalaureate-prepared.