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Nurse professionals are needed in almost every city in America. As a nurse, you get the opportunity to improve lives, to teach people how to achieve a healthier life style and also ensure patients that they have the best health care available to them.

Advancing in your nursing career. There are 4 paths that can help you advance quickly in your nursing career.

-(NPs) nurse practitioners average full-time salary $69,000 a year.

-(CRNAs) certified registered nurse anesthetists average full-time salary $113,00 a year.

-(CNMs) certified nurse-midwives average full-time salary $60,000 - $90,000 a year.

-(CNSes) clinical nurse specialists average full-time salary 51,000 a year.

All will require further schooling and experience but In the end you will proudly have your masters and state certifications. Salary normally is based on demand and location. NPs find themselves on the frontline conducting physicals, making diagnoses and providing treatment CRNAs work in all settings, from hospitals to private offices. They have to be one of the more educated nurse professionals.CNMs provide prenatal and gynecological care to women, delivering babies and providing postpartum care. CNSes are clinicians specializing in a specific areas of diseases, population or setting.

Sub-Fields of Nursing Professionals

Telephone-triage nursing. TTN is a subfield for nursing allowing you too support advice and consult patience over the phone. They help determine what type of care may be needed. They refer patients to a healthcare provider instead of clinics or emergency rooms, they help patients reduce unnecessary visits. Forensic nursing also a sub-field of nursing professionals it’s a fast growing and encompassing field. Forensic nursing allows you to become Clinical Nurse Specialist, Forensic Nurse Investigator, Nurse Coroner/Death Investigator, Sexual Assault Nurse Examiner, Legal Nurse Consultant, Forensic Gerontology Specialist, Forensic Psychiatric Nurse, and Correctional Nursing Specialist.

Evaluating a job offer.

The shortage of nursing professionals in the US is good news for you. It means that healthcare employers are more willing to conform to your requests and needs. If you are fortunate enough to have one or more offers take in consideration the work environments, compensation and long term benefits. Chose a job offer that will best suit your nursing background. If salary is one of your main concerns keep the option to relocate open. Some states offer higher salary and better benefits based on demand. Remember as a nurse you want to enjoy your surroundings so pick a place you can tolerate everyday.

In August of 2005, AORN conducted its annual survey on perioperative nursing compensation. The research initiative has two objectives: to track compensation on an annual basis and to keep members apprised of the status of perioperative nursing compensation and the factors that influence how much perioperative nurses currently are paid in the United States.

RESPONDENT PROFILE

For the second consecutive year, the survey was conducted via an online questionnaire. An e-mail invitation to participate in the survey was sent to 22,050 potential respondents in early August 2005. These individuals included 17,250 AORN members and 4,800 nonmembers who are perioperative RNs, managers, and educators and who have active e-mail addresses. By the end of August, 3,100 individuals had submitted completed surveys, and 2,394 individuals met the inclusion criteria (ie, an 11% net response rate). Among these respondents, 38% are staff nurses, 29% are nurse managers, 9.5% are directors or vice presidents (VPs), and 7.5% are in education/staff development (Figure 1).

The largest segment of respondents are between 50 and 59 years of age (ie, 39.1% compared to 36.5% in 2004). Thirty-six percent are between 40 and 49 years of age compared to 39.3% in 2004, and 16% are between 30 and 39 years of age compared to 14.5% in 2004. A total of 5% of the respondents are between 60 and 69 years of age, which is the same percentage as in 2004. About 4.9% of the respondents are younger than 30 years of age compared to 4.3% last year.

Approximately 89% of the respondents are female; 11% are male. Regarding compensation, 63.1% are paid on an hourly basis, and 36.9% are salaried employees.

Respondents represent all regions of the United States with approximately 58% of the responses coming from the Eastern half of the United States. The three most represented regions are

* the East North Central region (ie, 17%), which includes Wisconsin, Michigan, Illinois, Indiana, and Ohio;

* the South Atlantic region (ie, 16.2%), which includes West Virginia, Virginia, North Carolina, South Carolina, Georgia, and Florida; and

* the Mid-Atlantic region (ie, 13.8%), which includes New Jersey, Delaware, Maryland, Pennsylvania, New York, and Washington, DC (Table 1).

About 83% of the respondents reside in an urban or suburban area; 17.3% live in a rural area.

Regarding education,

* more than one third of the respondents (36%) have a bachelor of science in nursing degree;

Payment for nursing home care is an important policy concern for federal and state governments. Total government expenditures for nursing home care in the United States amounted to $58.2 billion in 1999 (Centers for Medicare and Medicaid Services 2002). The federal government paid for more than half of these expenditures through the Medicare program and through matching contributions to state Medicaid programs. While Medicaid expenditures are nearly four times higher than Medicare expenditures, the Medicaid proportion has declined through the 1990s and Medicare expenditures have tripled, both in magnitude and as a proportion of government nursing home expenditures. To restrain cost growth, Medicare introduced a prospective payment system (PPS) for Part A skilled nursing facility (SNF) benefits in July of 1998. The PPS increases control over government expenditures by transferring the financial risk for Medicare residents to nursing home facilities (Grimaldi 1999, 2002). The change may affect nursing home resident treatments because PPS changes the factors that drive reimbursement rates. To date, there has been no research on the effect of PPS on treatment patterns for residents.

The purpose of the present research is to identify the effect of PPS on the delivery of rehabilitation therapy treatment. Rehabilitation therapy is an important focus for study because this treatment (1) is an expensive component of care and hence sensitive to payment; (2) is measurable at the individual resident level; (3) is provided to between one-third and one-half of all nursing home residents (Murray et al. 1999); and (4) is an important component of care that may have substantial effects on resident outcomes such as functional health and return to the community (Joseph and Wanlass 1993).

Although the number of surgical procedures being performed has increased dramatically during the past 20 years,’ nursing students today have fewer opportunities to care for surgical patients. Many surgical interventions take place in ambulatory care centers, and acute patients scheduled for coronary artery bypass surgery or transplantation often enter and leave the hospital through intensive care areas. Students observe in these clinical areas, but their practice in critical care settings is extremely limited. Students’ exposure to patients scheduled for other surgical interventions also is limited because these patients undergo preoperative testing as outpatients and arrive at the facility only a few hours before the scheduled surgery. As a result, faculty members assigned to clinical teaching are becoming more creative in their use and development of clinical sites to educate students and prepare them for realistic roles in health care.

A study was conducted to evaluate the effects of using a perioperative clinical learning setting for a medical-surgical nursing course in a baccalaureate nursing program. The study compared knowledge among nursing students who experienced a five-week or eight-week perioperative clinical rotation with knowledge among students who experienced a five-week or eight-week rotation in orthopedic, oncology, transplantation, cardiovascular, or neurological units. Two hypotheses were posed.
* Students who experience a five- or eight-week perioperative clinical rotation will demonstrate greater knowledge of surgical patient care than students in other clinical rotations.

* Students who experience a five- or eight-week perioperative clinical rotation will seek perioperative employment more frequently than those who have not worked in these settings.

The American Association of Colleges of Nursing released preliminary survey data on Dec. 12, 2005, which show that enrollment in entry-level baccalaureate nursing programs increased by 13 percent from 2004 to 2005.

Last year’s increase in enrollments is based on data supplied by the same 408 schools responding to AACN’s annual survey in both 2004 and 2005. This is the fifth consecutive year of enrollment increases.

AACN’s most recent data confirm that interest in nursing careers continues to grow, which is good news considering the projected demand for nursing care. According to the latest projections from the U.S. Bureau of Labor Statistics, more than 1 million new and replacement nurses will be needed by 2012. Also, the federal government is projecting a shortfall of 800,000 registered nurses by 2020.

Though interest in nursing careers is strong, access to professional nursing education is becoming more difficult. AACN’s preliminary findings show that 32,617 qualified applications to entry-level baccalaureate programs were not accepted in 2005 based on responses from 432 schools. The primary barriers to accepting all qualified students at nursing colleges and universities continue to be insufficient faculty, clinical placement sites, and classroom space.

AACN has worked with colleagues in the health-care community to introduce new legislation to address the faculty shortage and other nursing school resource constraints, including the Nurse Education, Expansion and Development Act and the Nurse Faculty Education Act. Without increased federal support, the potential for future growth in nursing education programs may be limited at a time when the demand for well-educated nurses is rising.

Help is also coming from other sources. To assist in relieving the challenges contributing to the nation’s nursing shortage, the Robert Wood Johnson Foundation and the Northwest Health Foundation have together developed a new initiative, Partners Investing in Nursing’s Future, that will support partnerships led by local foundations to address the most pressing nursing issues in their communities.

The United States is experiencing a nursing shortage that is expected to worsen significantly during the next two decades. Specialty units that require additional and unique training for nurses, including perioperative nursing units, already are reporting critical shortages. (1,2) The current perioperative nursing shortage is the result of several trends:

* an aging nursing workforce,

* an aging population that requires more health care services,

* technological innovations that create a constantly changing work environment, and

* the lack of exposure of nursing students to perioperative clinical experiences. (3)

The majority of future specialty nurses are new graduates from nursing programs; however, if new graduates have had little or no experience in perioperative clinical areas, it is unlikely that they will choose to work in these units. (4 )After graduation, nurses generally choose to work in areas in which they had the most clinical experience as students. (1)

The most aggressively recruited specialists today are perioperative nurses, clinical nurse specialists, medical/surgical specialists, critical care nurses, emergency services nurses, and obstetric nurses. (5) Insufficient numbers of trained perioperative nurses may lead to the hiring of staff members who are not nurses but who can be trained in technical tasks. Patients are most vulnerable when they are sedated or anesthetized, however, and one of a perioperative nurse’s major responsibilities is to be the patient’s advocate in the OR. (6) If there is no professional nurse to speak for the patient, patient care may suffer.

The seniors housing and care industry continues to show signs of stability and recovery, particularly for independent living, assisted living, and CCRCs. But that trend doesn’t necessarily hold true for the skilled nursing sector.

Every quarter since 1999, the nation’s leading senior living lenders, owners/operators, and appraisal professionals have reported their key financial and performance data to the National Investment Center for the Seniors Housing & Care Industry (NIC). The information is then posted as the NIC Key Financial Indicators[TM] on www.NIC.org and accessed free of charge.

For the third quarter of 2005, these indicators showed that loan volume rose to more than $1.2 billion–the highest amount ever tracked by NIC. At the same time, the percentage of performing loans also ticked up to 98.75%–again, the highest ever reported to NIC. That percentage is noteworthy, because it puts seniors housing on the same footing as the long-established office, industrial, retail, and multifamily asset classes.

Problems Remain for Skilled Nursing

The financial indicators also showed that occupancy rates were at a good level for seniors housing and care properties–with the exception of skilled nursing. During the third quarter, the median occupancy rates for independent living (at 92%) and assisted living (at 88.5%) remained stable from the second quarter, when they had reached the highest levels that NIC had tracked since the second and third quarters of 2000. The median occupancy rate also held steady in the third quarter of 2005 for CCRCs, at 91%.

But the skilled nursing sector showed a decline–continuing a slow, but perceptible change that has been taking place year after year. The median occupancy rate for free-standing skilled nursing went down from 87% in the second quarter of 2005 to 86% in the third quarter. For skilled nursing within CCRCs, the median occupancy declined from 86.5 to 84%.

A similar pattern can be found within the nation’s top markets, although overall occupancies are higher. The NIC Market Area Profiles[TM] (NICMAP), a quarterly service that tracks properties specifically in the 30 largest cities or metro areas, show that the median occupancy rate averages 96% for independent living, 95% for assisted living, and 96% for dementia care. But once again, skilled nursing care is the lowest, averaging 93%.

Policymakers continue to grapple with the escalating growth of the elderly population in the United States. The current and predicted strains on an already resource-strapped sector of the health care system are major concerns for both researchers and the general public. Of particular interest is the quality of care provided to this vulnerable population. Nursing homes trying to meet the requirements of the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203; 101 Stat. 1330) deal with a resident population that is very vulnerable due to chronic disease and disability. When adverse events occur within the elderly population, a common response is to seek legal remedy through the court system. The nursing home industry believes that many of these lawsuits are driven by monetary greed, while families, trial lawyers, and other advocates see the court system as a legitimate check on a long-term care industry known for high-profile examples of poor quality of care.

There are very few studies that use data aimed at disentangling the relationship between quality of care and litigation activity against nursing homes. Studies are beginning to emerge that examine Florida’s experience within its litigious environment. Lobbying groups funded most of the recent national studies for various interests concerned about the ramifications of policy changes to various regulatory statutes around the country (Bourdon and Dubin 2002). The few national studies not funded by these groups show an increase in both the numbers of lawsuits filed against nursing homes and the costs of these suits to the industry (Stevenson and Studdert 2003). Much of this independent empirical work is exploratory in nature and is limited by sample size or geography, but it is providing the first objective evidence about the nursing home litigation climate in the United States.

National and statewide assessments of hospital nurse staffing frequently utilize a measure that averages counts of the number of nurses or hours of nursing care given the number of patients or patient days of care per hospital (Aiken, Sochalski, and Anderson 1996; Anderson and Kohn 1996; Spetz 1998; Buerhaus and Staiger 1999; Kovner, Jones, and Gergen 2000; Unruh 2002). These calculations provide a rough measure of nursing staff resources given patient volume, but they do not consider the intensity of nursing care that must be provided for that patient volume.

Intensity of nursing care, or the intensive effort spent at work (Green 2001), is important to consider because staffing needs vary not only with the number of patients being cared for, but also with the type of care provided for each of those patients. As nursing care intensity increases, the amount of nursing staff required to properly care for patients will increase (Moores 1970).

Factors that contribute to the level of intensity include: (1) other human resources, such as support staff; (2) physical resources, such as unit layout; (3) the work design and technology, such as the level of computerization and model of nursing care; (4) administrative practices; (5) the severity of the patients being cared for; and (6) the turnaround time to produce the product (patient turnover or throughput) (Cooper and Zaske 1987; Nichols 1991; Shamian et al. 1994; O’Brien-Pallas et al. 1997; Allan 1998; Cavouras 2002; Seago 2002).

Nursing homes provide a complex array of services to a heterogeneous group of patients. They offer both clinical care and a living environment that serves as the residents’ home. Nursing homes allocate their revenue-constrained resources between these various products in ways that depend on the market environment they face.

In this study, we examine costs associated with clinical care, hotel services, and administration in New York State (NYS) nursing homes during the 1990s. We choose this time period because throughout this decade nursing homes experienced several major changes in their environment, which may have had an impact on their resource allocation decisions. In the next section, we describe these changes and discuss how they might have affected costs. We then examine data for 1991, 1996, and 1999 to determine if these changes have occurred and to what degree.

Nursing home activities and, hence, costs can be divided into three major categories: clinical (medical and personal) care, hotel services, and administration. This typology is useful because as we discuss below, each type of cost is subject to different influences and is likely to exhibit different trends. Furthermore, each influences different aspects of nursing home care. Table 1 defines these three cost categories in terms of cost centers as reported by nursing homes in their annual financial reports.

During the 1990s, the environment for nursing homes changed in ways that likely affected all three cost categories: sub-acute care continued to grow and became an important line of business for many nursing facilities, the competitive environment changed with many nursing homes markets no longer exhibiting excess demand, and the introduction of the Minimum Data Set (MDS) reporting system and increased regulations and fraud investigations increased the administrative burden that nursing homes had to meet.