Working in the USA

The U.S. health system has been described as the most competitive, heterogeneous, inefficient, fragmented, and advanced system of care in the world. Although no country can claim to have eliminated inefficiency, the United States has high administrative costs, fragmented care, and stands out with regard to heterogeneity in treatment because of race, income, and geography.

Healthcare is the fastest-growing sector of the U.S. economy, employing over 18 million workers. Women represent nearly 80% of the healthcare work force. Healthcare workers face a wide range of hazards on the job, including sharps injuries, harmful exposures to chemicals and hazardous drugs, back injuries, latex allergy, violence, and stress. Although it is possible to prevent or reduce healthcare worker exposure to these hazards, healthcare workers continue to experience injuries and illnesses in the workplace. Cases of nonfatal occupational injury and illness with healthcare workers are among the highest of any industry sector.

ImageOccupationJob DutiesEntry-level Education2018 Median Pay
EMT’s & ParamedicsEmergency medical technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings. People’s lives often depend on the quick reaction and competent care provided by these workers. EMTs and paramedics respond to emergency calls, performing medical services and transporting patients to medical facilities.Postsecondary nondegree award$34,320
ChiropractorsChiropractors treat patients with health problems of the neuromusculoskeletal system, which includes nerves, bones, muscles, ligaments, and tendons. They use spinal adjustments and manipulation, as well as other clinical interventions, to manage patients’ health concerns, such as back and neck pain.Doctoral or professional degree$71,410
DentistsDentists diagnose and treat problems with patients’ teeth, gums, and related parts of the mouth. They provide advice and instruction on taking care of the teeth and gums and on diet choices that affect oral health.Doctoral or professional degree$156,240
Nurse Anaesthetists, Nurse Midwives, and Nurse PractitionersNurse anaesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), coordinate patient care and may provide primary and speciality healthcare. The scope of practice varies from state to state.Master’s degree$113,930
OptometristsOptometrists examine the eyes and other parts of the visual system. They also diagnose and treat visual problems and manage diseases, injuries, and other disorders of the eyes. They prescribe eyeglasses or contact lenses as needed.Doctoral or professional degree$111,790
Physician AssistantsPhysician assistants, also known as PAs, practice medicine on teams with physicians, surgeons, and other healthcare workers. They examine, diagnose, and treat patients.Master’s degree$108,610
PodiatristsPodiatrists provide medical and surgical care for people with foot, ankle, and lower leg problems. They diagnose illnesses, treat injuries, and perform surgery involving the lower extremities.Doctoral or professional degree$129,550
Registered NursesRegistered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.Bachelor’s degree$71,730
VeterinariansVeterinarians care for the health of animals and work to protect public health. They diagnose, treat, and research medical conditions and diseases of pets, livestock, and other animals.Doctoral or professional degree$93,830

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Working as a registered nurse

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.

What Registered Nurses Do

Duties

Registered nurses typically do the following:

  • Assess patients’ conditions
  • Record patients’ medical histories and symptoms
  • Observe patients and record the observations
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute information to existing plans
  • Consult and collaborate with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze the results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

Most registered nurses work as part of a team with physicians and other healthcare specialists. Some registered nurses oversee licensed practical nurses, nursing assistants, and home health aides.

Registered nurses’ duties and titles often depend on where they work and the patients they work with. For example, an oncology nurse may work with cancer patients or a geriatric nurse may work with elderly patients. Some registered nurses combine one or more areas of practice. For example, a pediatric oncology nurse works with children and teens who have cancer.

Many possibilities for working with specific patient groups exist. The following list includes just a few examples:

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.

Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.

Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.

Genetics nurses provide screening, counselling, and treatment for patients with genetic disorders, such as cystic fibrosis.

Neonatology nurses take care of newborn babies.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Public health nurses promote public health by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs.

Rehabilitation nurses care for patients with temporary or permanent disabilities.

Some nurses do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, public policy advisors, researchers, hospital administrators, salespeople for pharmaceutical and medical supply companies, or as medical writers and editors.

Clinical nurse specialists(CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working with other nurses and various other staff to improve the quality of care that patients receive. They often serve in leadership roles and may educate and advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.

Work Environment

Registered nurses work in hospitals, physicians’ offices, home healthcare services, and nursing care facilities. Others work in outpatient clinics and schools, or serve in the military.

How to Become a Registered Nurse

Registered nurses usually take one of three education paths: a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses must be licensed.

Education

In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. Diploma programs are typically offered by hospitals or medical centers, and there are far fewer diploma programs than there are BSN and ADN programs. All programs include supervised clinical experience.

Bachelor’s degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.

Registered nurses with an ADN or diploma may go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).

Other requirements for licensing, such as passing a criminal background check, vary by state. Each state’s board of nursing provides specific requirements. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it.

In addition, registered nursing positions may require certification in cardiopulmonary resuscitation (CPR), basic life support (BLS) certification, and/or advanced cardiac life support (ACLS).

CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.

Important Qualities

Critical-thinking skills. Registered nurses must assess changes in the health status of patients, such as determining when to take corrective action and when to make referrals.

Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to clearly explain instructions, such as how to take medication. They must work in teams with other health professionals and communicate the patients’ needs.

Compassion. Registered nurses should be caring and empathetic when looking after patients.

Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses.

Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift.

Advancement

Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses can advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs may become nurse anaesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRN positions require a master’s degree, and many have a doctoral degree. APRNs may provide primary and specialty care, and in many states, they may prescribe medications.

Other nurses work as postsecondary teachers or researchers in colleges and universities, which typically requires a Ph.D.

Pay

The median annual wage for registered nurses was $71,730 in May 2018.

Job Outlook

Employment of registered nurses is projected to grow 15 percent from 2016 to 2026, much faster than the average for all occupations. Growth will occur for a number of reasons, including an increased emphasis on preventive care; growing rates of chronic conditions, such as diabetes and obesity; and demand for healthcare services from the baby-boom population, as they live longer and more active lives.

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Working as a Physician and Surgeon

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Physicians and surgeons diagnose and treat injuries or illnesses. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumours; and deformities, such as cleft palates.

What Physicians and Surgeons do

Physicians and surgeons typically do the following:

  • Take a patient’s medical history
  • Update charts and patient information to show current findings and treatments
  • Order tests for nurses or other healthcare staff to perform
  • Review test results to identify any abnormal findings
  • Recommend and design a plan of treatment
  • Address concerns or answer questions that patients have about their health and well-being
  • Help patients take care of their health by discussing topics such as proper nutrition and hygiene

Physicians and surgeons work in one or more specialties. The following are examples of types of physicians and surgeons:

Anesthesiologists focus on the care of surgical patients and pain relief. They administer drugs (anaesthetics) that reduce or eliminate the sensation of pain during an operation or another medical procedure. During surgery, they are responsible for adjusting the amount of anaesthetic as needed, and monitoring the patient’s heart rate, body temperature, blood pressure, and breathing. They also work outside of the operating room, providing pain relief for patients in the intensive care unit, for women in labour and delivery of babies, and for patients who suffer from chronic pain. Anaesthesiologists work with other physicians and surgeons to decide on treatments and procedures before, during, and after surgery.

Family and general physicians assess and treat a range of conditions that occur in everyday life. These conditions include sinus and respiratory infections to broken bones. Family and general physicians typically have regular, long-term patients.

General internists diagnose and provide nonsurgical treatment for a range of problems that affect internal organ systems such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. They work mostly with adult patients.

General paediatricians provide care for infants, children, teenagers, and young adults. They specialize in diagnosing and treating problems specific to younger people. Most paediatricians treat common illnesses, minor injuries, and infectious diseases, and administer vaccinations. Some paediatricians specialize in paediatric surgery or serious medical conditions that commonly affect younger patients, such as autoimmune disorders or chronic ailments.

Obstetricians and gynaecologists (OB/GYNs) provide care related to pregnancy, childbirth, and the female reproductive system. They treat and counsel women throughout their pregnancy and deliver babies. They also diagnose and treat health issues specific to women, such as breast cancer, cervical cancer, hormonal disorders, and symptoms related to menopause.

Psychiatrists are primary mental health physicians. They diagnose and treat mental illnesses through a combination of personal counselling (psychotherapy), psychoanalysis, hospitalization, and medication. Psychotherapy involves regular discussions with patients about their problems. The psychiatrist helps them find solutions through changes in their behavioural patterns, explorations of their past experiences, or group and family therapy sessions. Psychoanalysis involves long-term psychotherapy and counselling for patients. Psychiatrists may prescribe medications to correct chemical imbalances that cause some mental illnesses.

Surgeons treat injuries, diseases, and deformities through operations. Using a variety of instruments, a surgeon corrects physical deformities, repairs bone and tissue after injuries, or performs preventive or elective surgeries on patients. Although a large number perform general surgery, many surgeons choose to specialize in a specific area. Specialties include orthopaedic surgery (the treatment of the musculoskeletal system), neurological surgery (treatment of the brain and nervous system), cardiovascular surgery, and plastic or reconstructive surgery. Like other physicians, surgeons examine patients, perform and interpret diagnostic tests, and counsel patients on preventive healthcare. Some specialist physicians also perform surgery.

Physicians and surgeons may work in several other medical and surgical specialties and subspecialties. The following specialists are some of the most common examples:

  • Allergists (specialists in diagnosing and treating hay fever or other allergies)
  • Cardiologists (heart specialists)
  • Dermatologists (skin specialists)
  • Gastroenterologists (digestive system specialists)
  • Ophthalmologists (eye specialists)
  • Pathologists (specialists who study body tissue to see if it is normal or abnormal)
  • Radiologists (specialists who review and interpret x rays and other images and deliver radiation treatments for cancer and other illnesses)

Physicians in healthcare establishments work daily with other healthcare staff, such as registered nurses, other physicians, medical assistants, and medical records and health information technicians. Some physicians may choose to work in fields that do not involve patient care, such as medical research or public policy.

Work Environment

Many physicians and surgeons worked in physicians’ offices. Others worked in hospitals, in academia, or for the government.

How to Become a Physician or Surgeon

Physicians and surgeons have demanding education and training requirements. Physicians typically need a bachelor’s degree, a degree from a medical school, which takes 4 years to complete, and, depending on their specialty, 3 to 7 years in internship and residency programs.

Background info

The Health Care Debate

The debate over whether the government should provide health care support and how much should be provided is a long one.

In the 1910s, when many European countries were passing legislation to nationalize medical care for their citizens, President Theodore Roosevelt tried to push the same type of legislation through in the U.S. However, he was defeated in his attempts by politicians from both main parties. The main arguments of the debate continue to be based on similar ideas today.

Those that are for universalized health care in the U.S. assert that only the federal government can ensure that all citizens are covered. In addition, the money the federal government spends now to cover emergency care for those without insurance is so high that it would be more efficient if they could have a formal system that covers everyone. One unified system would have a much greater ability to bargain with pharmaceutical companies, hospitals and equipment providers allowing them to bring down the costs of care.

However, there is a long history in the United States of wariness of federal power. The U.S. was originally designed with a weak federal government and strong state governments to protect against tyranny. Although that balance has changed dramatically over the years, many Americans still prefer to limit the power of the federal government. They argue that if health care was run by the government it would be more bureaucratic and would take choice out of patients’ hands. They feel their care would be more regulated and less individualized. They are also afraid that a large healthcare system would cost an enormous amount of money and contribute to significantly higher taxes.

American Health Insurance System

Although there are several different types of coverage and states often have their own health insurance regulations, there are some aspects of the system that are similar throughout the U.S. Hospitals, clinics, doctors’ offices and other health care facilities are owned by a variety of private and public entities. Health insurance providers are generally separate companies from these and deal with a wide range of different healthcare providers.

Patients pay monthly health insurance fees to ensure that they will be covered when they need to go to the doctor, clinic or hospital. Insurance providers cover thousands of patients, so they can negotiate with health care providers for reduced fees and then pay for services. The Medicare or Medicaid insurance works the same way but on a bigger scale. Because they need to be able to negotiate, insurance providers generally have a network of doctors that they have agreements with, and patients are covered for visits to doctors within that network but may not be covered, or fully covered, for visits to doctors out of their network. Insurance providers will usually cover services considered necessary by doctors, but often will not cover services which are considered “elective.” Insurance companies aim to keep their costs down while still covering necessary health care.

The Affordable Care Act

The Patient Protection and Affordable Care Act, commonly referred to as “Obamacare,” was voted into law in 2010. Since insurance companies are private, for-profit companies, many Americans had been left uninsured because they could not afford or did not want insurance, or because they were rejected because of pre-existing conditions. The Obama administration attempted to address some of these issues with the Patient Protection and Affordable Care Act. These are some of the major provisions of the law:

  • Insurers are not allowed to refuse coverage because of pre-existing conditions
  • Minimum standards for health insurance policies were established
  • Medicaid eligibility expanded
  • Medicare underwent reforms aimed at greater efficiency
  • Individuals without employer-provided insurance are required to purchase health insurance
  • Health Exchanges were set up to offer consumers a good way to find suitable health insurance and to provide subsidies for those who need it

Under the Patient Protection and Affordable Care Act, 11 million more Americans are insured than previously. But this legislation has come under fire from Republicans even though it was passed by both houses of Congress. Repeated attempts to stop the legislation through the courts have mostly failed, though there have been a few rulings partially in their favour. The debate over health care is likely to continue as it has for the last hundred years.

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