Registered Nurse: A Career Guide
Overview
Registered nurses (RNs) are the essential bridge between patients and healthcare teams. While the work is often more demanding than the idealized view, it allows new nurses to make a real difference by caring for patients with complex needs across diverse settings. RNs work in hospitals, outpatient clinics, long-term care facilities, and home health services. They specialize in areas such as medical-surgical, emergency, or public health nursing. Beyond traditional bedside roles, nurses pursue opportunities in schools, physician offices, telehealth, nursing informatics, case management, education, and healthcare administration. If you are considering a career in nursing or want to better understand the profession, recognize the broad scope of what nurses do. As you pursue the RN path, examine the skills required and review your state’s Nurse Practice Act, which defines the legal scope of practice.
Job Description
Registered Nurses are licensed healthcare professionals who provide and coordinate patient care, educate individuals and families about health conditions, and promote overall wellness. Their responsibilities include assessing and monitoring patients, administering medications and treatments prescribed by licensed providers, and ensuring that care is delivered safely and effectively. In addition to direct patient care, RNs often take on leadership roles supervising staff, delegating tasks to trained personnel, and upholding standards of practice. They work across diverse settings, including hospitals, clinics, community health programs, and home-based care, always with a focus on patient safety, advocacy, and high-quality outcomes. Understanding the scope of practice enables nurses to work within the legal and professional limits. Always check your state’s Nurse Practice Act for guidance. In Washington, duties are listed in the Washington State Nurse Practice Act. The National Council of State Boards of Nursing (NCSBN) offers a "Find Your Nurse Practice Act" tool for use in other states.
Nursing Practice Areas
Practical Skills
1. Patient Assessment
Accurate assessment is the foundation of nursing care. Nurses evaluate patients by gathering their histories, checking vital signs, determining the severity of their illnesses, and prioritizing urgent concerns. Strong assessment skills enable the early recognition of warning signs, the application of critical thinking, sound clinical judgment, and the timely communication of findings.
2. Basic Certifications
Employers expect RNs to maintain certifications such as CPR and Basic Life Support (BLS). Because nurses are often the first responders in emergencies, these certifications demonstrate the ability to remain calm, alert, and respond to teams effectively, assess vital signs, and initiate lifesaving interventions quickly.
3. Medication Management
Safe medication administration is a fundamental aspect of nursing practice. Nurses must deliver medications via multiple routes (oral, IV, IM, topical, subcutaneous), verify dosages, monitor for side effects, and educate patients. Accurate documentation ensures continuity of care and compliance with legal and professional standards.
4. IV Line Placement and Infusion
Competence in IV therapy is essential. Nurses must skillfully insert catheters, initiate infusions, and monitor them for safety and effectiveness.
5. Patient Safety and Infection Control
Nurses protect patients and colleagues by implementing fall-prevention strategies, infection control measures, and workplace safety protocols to ensure a safe environment. These practices demonstrate a commitment to minimizing risk and fostering a culture of safety.
6. Electronic Medical Records (EMR)
Proficiency in EMR systems is crucial for accurately documenting care, reviewing patient histories, tracking test results, and updating treatment plans. Strong EMR skills ensure accuracy, continuity, and seamless communication across healthcare teams.
Soft Skills
7. Integrity
Nurses must consistently demonstrate honesty, accountability, and ethical decision-making, fostering trust with patients, families, and colleagues.
8. Communication
Clear, compassionate communication is vital. Nurses listen actively, explain care instructions in understandable terms, and collaborate effectively with other healthcare professionals.
9. Compassion
Beyond technical expertise, compassion allows nurses to support patients emotionally, reduce anxiety, and advocate for their needs during vulnerable moments.
10. Teamwork
Nursing is inherently collaborative. Strong teamwork skills ensure safe, coordinated, and effective care within multidisciplinary teams.
Licensure and Certification
LicensureAll RNs must hold a valid license to practice. Licensure requirements differ by state and may include passing an exam, completing continuing education, or undergoing a background check. The Nurse Licensure Compact (NLC) enables nurses to practice in multiple states with a single multistate license. Currently, 43 jurisdictions are part of the NLC.
- Compact States: Nurses can work in multiple states with one license.
- Non-Compact States: Nurses must apply separately for a license in each state where they intend to practice.
Certification
Certification is a form of professional recognition by a non-governmental body or association for meeting established standards or qualifications. Its purposes include validating competence, recognizing excellence, establishing eligibility for roles, or contributing to regulatory standards.
Certification may be voluntary or required for certain roles. In either case, it indicates that a nurse has met the standards in a specialty. For instance, the MEDSURG-BC credential signifies passing a board exam for entry-level competency in medical-surgical nursing following initial licensure. When listing credentials, use the following order: highest degree earned first (e.g., BSN), followed by licensure (e.g., RN), then certifications (e.g., MEDSURG-BC), and finally any honorary recognitions. For example: BSN, RN, MEDSURG-BC.
Because regulations and requirements vary, nurses should always verify the most current information with their state board of nursing.
See the American Nurse Credentialing Center Handbook here.
Salary
The map below illustrates data from the U.S. Bureau of Labor Statistics, showing the hourly mean wage of RNs by state as of May 2024. Wages vary widely across the country, ranging from approximately $19.94 per hour on the low end to $71.31 per hour on the high end, which translates to annual earnings of approximately $41,500 to $148,300, depending on location and work setting. Among the highest-paying states (dark blue, $49.17–$71.31) are California, Oregon, Hawaii, Alaska, Massachusetts, and New York; these consistently top the list due to higher living costs, strong demand for nurses, and large healthcare systems. In contrast, lower-paying states (lightest blue, $19.94–$42.32) are found primarily in the South and parts of the Midwest, including Alabama, Mississippi, Arkansas, and South Dakota. While wages are lower in these areas, a generally lower cost of living partially explains the difference. For nurses considering relocation, this data highlights the importance of comparing pay rates with the regional cost of living and job opportunities. High wages may not stretch as far in states with elevated living expenses, while lower-paying states may still offer a comfortable standard of living relative to costs.
Benefits
Job Stability
Nursing remains one of the most in-demand professions in healthcare, driven by an aging population, the rise of chronic health conditions, and increased access to medical services. Currently, there are approximately 3.28 million nurses in the U.S. workforce, yet the demand continues to grow. Projections show a significant nursing shortage over the coming decade. The National Center for Health Workforce Analysis published by the Health Resources and Services Administration (HRSA), projects a 10% shortage of RNs in 2027 and a 6% shortage by 2037. However, despite national nursing shortages, a significant maldistribution of nurses remains an issue, particularly in terms of geography. While Washington State is one of the ten states with the largest projected RN shortages in 2037 (22%), Wyoming is projected to have an oversupply (77%) by 2037.
Personal Fulfillment
Many nurses describe their career as deeply rewarding because of the impact they have on patients’ lives. Beyond providing medical treatments, nurses are there to listen, comfort, and support individuals during some of their most vulnerable moments. This human connection, whether it’s calming a patient’s fears before surgery, helping a family navigate a diagnosis, or celebrating a patient’s recovery, creates a sense of purpose and meaning in everyday work.
Nursing also offers fulfillment through advocacy and empowerment. Nurses often act as the patient’s voice, ensuring care decisions respect their needs, values, and dignity. For many in the profession, this advocacy role is one of the most meaningful aspects of the job.
Additionally, personal growth stems from the variety and challenges inherent in nursing. No two days are the same, and each interaction provides opportunities to learn, adapt, and improve skills. This constant learning environment can be highly motivating for individuals who value lifelong learning and development.
References
American Nurses Credentialing Center. (2025). Certification handbook. https://www.nursingworld.org/globalassets/certification/ancc-certification-handbook.pdf
Bureau of Labor Statistics. (2020). Registered nurses (Occupational Employment Statistics, 29-1141). U.S. Department of Labor. https://www.bls.gov/oes/2020/may/oes291141.htm
Health Resources and Services Administration. (2024). Nurse workforce projections, 2022–2037. U.S. Department of Health and Human Services. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nursing-projections-factsheet.pdf
National Council of State Boards of Nursing. (n.d.). Licensure. https://www.ncsbn.org/nursing-regulation/licensure.page
National Council of State Boards of Nursing. (n.d.). Find your nurse practice act. https://www.ncsbn.org/npa
National Council of State Boards of Nursing. (n.d.). Nurse licensure compact (NLC). https://www.nursecompact.com/
Washington State Legislature. (n.d.). Advanced registered nursing practice defined—Exceptions (RCW 18.79.050). https://app.leg.wa.gov/rcw/default.aspx?cite=18.79.050
Washington State Legislature. (n.d.). Washington State’s Nurse Practice Act. https://app.leg.wa.gov/rcw/default.aspx?Cite=18.79
Author Disclaimer: The content authored by Dr. Karis Casseus is provided for educational and informational purposes only and does not constitute legal, medical, clinical, employment, or professional advice. Information reflects general healthcare and nursing considerations and may not apply to every discipline, jurisdiction, or practice setting. This content does not establish a professional, advisory, or consultative relationship. Readers are responsible for verifying current requirements and guidance with their applicable licensing boards, employers, or official regulatory authorities.