* Unless otherwise noted all entries are from the Medicare Glossary
A | B | C | D | E | F | G | H | I | J | K | L | M
N | O | P | Q | R | S | T | U | V | W | X | Y | Z
REFERRAL - A written OK from your primary care doctor for you to see a specialist or get
certain services. In many Medicare Managed Care Plans, you need to get a referral before you can get
care from anyone except your primary care doctor. If you don't get a referral first, the plan may not pay for your care.
REGISTERED NURSES (RN)*
Significant Points - Registered nurses constitute the largest healthcare occupation, with 2.3 million jobs. More new jobs are expected to be
created for registered nurses than for any other occupation. Job opportunities are expected to be very good. The three major educational paths to
registered nursing are a bachelor’s degree, an associate degree, and a diploma.
Nature of the Work - Registered nurses (RNs) work to promote health, prevent disease, and help patients cope with illness. They are advocates
and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions,
and progress in patients; assist physicians during surgeries, treatments, and examinations; administer medications; and assist in convalescence and
rehabilitation. RNs also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups
take steps to improve or maintain their health. While State laws govern the tasks that RNs may perform, it is usually the work setting that determines
their daily job duties.
Hospital nurses form the largest group of nurses. Most are staff nurses, who provide bedside nursing care and carry out medical regimens. They also may
supervise licensed practical nurses and nursing aides. Hospital nurses usually are assigned to one department, such as surgery, maternity, pediatrics,
the emergency room, intensive care, or the treatment of cancer patients. Some may rotate among departments
Office nurses care for outpatients in physicians’ offices, clinics, ambulatory surgical centers, and emergency medical centers. They prepare patients
for, and assist with, examinations; administer injections and medications; dress wounds and incisions; assist with minor surgery; and maintain records.
Some also perform routine laboratory and office work.
Nursing care facility nurses manage care for residents with conditions ranging from a fracture to Alzheimer’s disease. Although they often spend much
of their time on administrative and supervisory tasks, RNs also assess residents’ health, develop treatment plans, supervise licensed practical nurses
and nursing aides, and perform invasive procedures, such as starting intravenous fluids. They also work in specialty-care departments, such as long-term
rehabilitation units for patients with strokes and head injuries.
Home health nurses provide nursing services to patients at home. RNs assess patients’ home environments and instruct patients and their families. Home
health nurses care for a broad range of patients, such as those recovering from illnesses and accidents, cancer, and childbirth. They must be able to
work independently and may supervise home health aides.
Public health nurses work in government and private agencies, including clinics, schools, retirement communities, and other community settings. They
focus on populations, working with individuals, groups, and families to improve the overall health of communities. They also work with communities to
help plan and implement programs. Public health nurses instruct individuals, families, and other groups regarding health issues such as preventive care,
nutrition, and childcare. They arrange for immunizations, blood pressure testing, and other health screening. These nurses also work with community
leaders, teachers, parents, and physicians in community health education.
Occupational health nurses, also called industrial nurses, provide nursing care at worksites to employees, customers, and others with injuries and
illnesses. They give emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, conduct
health examinations and inoculations, and assess work environments to identify potential or actual health problems.
Head nurses or nurse supervisors direct nursing activities, primarily in hospitals. They plan work schedules and assign duties to nurses and aides,
provide or arrange for training, and visit patients to observe nurses and to ensure that the patients receive proper care. They also may ensure that
records are maintained and equipment and supplies are ordered.
At the advanced level, nurse practitioners provide basic, primary healthcare. They diagnose and treat common acute illnesses and injuries. Nurse
practitioners also can prescribe medications—but certification and licensing requirements vary by State. Other advanced practice nurses include clinical
nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. Advanced practice nurses must meet educational and clinical
practice requirements beyond the basic nursing education and licensing required of all RNs.
Training, Other Qualifications, and Advancement - In all States and the District of Columbia, students must graduate from an approved nursing
program and pass a national licensing examination in order to obtain a nursing license. Nurses may be licensed in more than one State, either by
examination, by the endorsement of a license issued by another State, or through a multi-State licensing agreement. All States require periodic renewal
of licenses, which may involve continuing education.
There are three major educational paths to registered nursing: a bachelor’s of science degree in nursing (BSN), an associate degree in Nursing (ADN),
and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2002, 678 nursing programs offered degrees at the
bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 700 RN programs in 2002 were at the
ADN level. Diploma programs, administered in hospitals, last about 3 years. Only a small and declining number of programs offer diplomas. Generally,
licensed graduates of any of the three types of educational programs qualify for entry-level positions as staff nurses.
Many ADN- and diploma-educated nurses later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find a staff
nurse position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing one of many RN-to-BSN programs.
Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving
into nursing. In 2002, more than 110 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a
BSN for individuals who already hold a degree. Accelerated master’s degree programs in nursing also are available and take about 3 years to complete.
Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN program, because, if they do, their
advancement opportunities usually are broader. In fact, some career paths are open only to nurses with bachelor’s or advanced degrees. A bachelor’s
degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting,
teaching, or a clinical specialization.
Nursing education includes classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses
in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Course work also includes the liberal
Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs
include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.
Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’
conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.
Experience and good performance can lead to promotion to more responsible positions. In management, nurses can advance to assistant head nurse or head
nurse and, from there, to assistant director, director, and vice president. Increasingly, management-level nursing positions require a graduate or an
advanced degree in nursing or health services administration. They also require leadership, negotiation skills, and good judgment. Graduate programs
preparing executive-level nurses usually last about 2 years.
Within patient care, nurses can move into a nursing specialty such as clinical nurse specialist, nurse practitioner, certified nurse midwife, or
certified registered nurse anesthetist. These positions require about 2 years of graduate education leading to a master’s degree.
Some nurses move into the business side of health care. Their nursing expertise and experience on a healthcare team equip them with the ability to
manage ambulatory, acute, home health, and chronic care services. Employers—including hospitals, insurance companies, pharmaceutical manufacturers,
and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality
assurance. Other nurses work as college and university faculty or conduct research.
* U.S. Department of Labor
REHABILITATION - Rehabilitative services are ordered by your doctor to help you recover from an illness or injury. These services
are given by nurses and physical, occupational, and
speech therapists. Examples include working with a physical therapist to help you walk and with an
occupational therapist to help you get dressed.
RESPITE CARE - Temporary or periodic care provided in a nursing home, assisted living residence,
Home Health Agency or other type of long-term care program so that the usual
caregiver (maybe a family member) can rest or take some time off.
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