RN Careers in Michigan: Becoming and RN

What is a nurse? The Michigan Center for Nursing has tackled this question in a video. Nurses are many things. Even the generally known roles referenced at the beginning — care and comfort in clinics and hospitals, assistance in the operating room – take skill and dedication. For many nurses, this is where the appeal lies. But nurses can do more over the course of their careers. The Center for Nursing notes they are also conducting research, providing education and nutritional counsel, working with kids in community settings, and improving health systems.

Registered nursing represents the largest subgroup of nurses. It is considered professional level nursing. While it’s generalist from a licensing standpoint, there is some tendency toward specialization.

A prospective RN must complete an approved professional nursing program and pass a licensing examination and a background check. A person can enter the field with an associate’s degree, but some positions will require a bachelor’s (RN programs in Michigan). That extra education is valued; premier institutions even provide tuition reimbursement for BSN completion. The Michigan Center for Nursing has provided a Career Planning Toolkit that addresses academic progression (https://www.michigancenterfornursing.org/).

Some nurses progress to the level of healthcare practitioner. Some roles depicted in the career introduction video (e.g. prescribing medication) would require graduate clinical education and a more advanced nursing credential.

Michigan RN Work Settings

The Michigan Department of Health and Human Services provides support for an annual survey of the nursing workforce.

RNs, far more than LPNs, are hospital nurses. 53.7% of RNs in the 2016 report identified their practice setting as hospital inpatient. Hospital outpatient settings accounted for another 16%.

Those employed by organizations other than hospitals reported a wide range of practice settings. 6% were employed by nursing homes and long-term care facilities; another 5.3% were in the related home health field. Assisted living, also closely related, employed 1.3%. Hospice, meanwhile, employed about 3%. A 1963 Detroit nursing school graduate, profiled on the Center for Nursing website, notes that a big reward of long-term care is making last days “quality days”. Like many RNs employed in the long-term care industry, she has a leadership role that includes responsibilities to nurses as well as assistive personnel.

Physician’s office settings were home to 5.6% of Michigan registered nurses. Public and community health settings accounted for 3%. Federally qualified health center was considered a separate category, employing 1.3%.

RNs sometimes make significant changes over the course of their careers. The most recent survey looked at changes in practice setting. More than 80% had made no change during the time reported. However, 32.7% of those who made changes — nearly one-third — had gone from inpatient to outpatient. Only 12.1% had done the reverse.

25.9% of career changers reported going from a setting where direct care was provided to one where it was not. The study also found that younger nurses tended to put in the most time providing direct care. Here one may be seeing, in many instances, natural career progression. 8.9%, though, had made career changes in the opposite direction. The numbers moving between acute and sub-acute care were more balanced; slightly more (9.8% vs 7%) moved to acute care.

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RN Roles

Direct care specialty areas often reflect patient medical concern, procedure, or level of care; some are more broadly defined than others. The following specialties are among the most commonly reported by Michigan RNs:

  • Medical-surgical 16.8%
  • Critical care 10.8%
  • Emergency or urgent care 9.1%
  • Perioperative 6.8%
  • Cardiac care 6.7%
  • Obstetrics 5.5%
  • Geriatrics/ elder care 4.3%
  • Oncology 4.3%

Just 1.1% were floaters.

There are some commonalities among direct care positions. Munson Medical Center lists the following among the nursing duties:

  • Developing treatment plans
  • Evaluating patient response
  • Administering medication
  • Providing nursing care
  • Providing patient education

There are also some major differences. Patient care is going to look very different on a neonatal ward than a surgical ward.

Some hospitals have more in the way of specialized positions than others. Sparrow Hospital in Lansing, for example, notes that its status as a Level I Trauma Center and regional referral center for several conditions means plenty of opportunity for nurses.

Roles Outside Direct Patient Care

The workforce study also reported on roles outside direct care. The most common role in this category was care management/ care coordination (22.7%) This was followed by nurse administrator (18.4%).Other roles included nursing education (9.6%), quality improvement (8.3%), triage (4.5%), and utilization review (3.8%).Many roles are possible; nurse informatics may be considered an emerging role.

Participating in and Leading Healthcare Teams

Patient care involves a lot of teamwork. Michigan RNs reported engaging in a lot of intraprofessional activity. Approximately two-thirds of survey respondents engaged in clinical discussions (sometimes referred to as huddles). Discussion of the roles and responsibilities of individual team members were also very common. Approximately half participated in shared goal setting; participation in evaluation of patient health outcomes and team processes was also reported by about half. Participation in patient rounds with other team members was common as was virtual communication with other team members and attendance at team meetings that included patients and family.

Nursing organizations stress that communication and collaboration are about safety and improved outcomes. The Michigan Center for Nursing has also provided a teaching module about basic of interprofessional collaboration. While this module is designed for individuals at different stages – even student – some nurses go much further in developing expertise. Some modern nursing roles emphasize nurses as leaders on interdisciplinary teams. A clinical nurse leader in a hospital setting might count this among his or her key duties.

Public health nurses are among those who work across discipline lines, often working with groups outside the healthcare sector to implement policies that impact health. One will find the profile of a Calhoun County Public Health nurse on the Center website (https://www.michigancenterfornursing.org/nursing/servicing-under-served); she describes the responsibilities and the teams she would like to see forged to make public health more proactive and less like “putting out fires”.

Salary and Benefits

The Bureau of Labor Statistics reported an average hourly wage of $33.22 an hour for Michigan’s registered nurses in 2016.

Some healthcare systems are able to provide very generous benefits. “It’s emotionally rewarding,” proclaims a testimonial on the Munson Healthcare website. That is indeed the draw for many. Yet people often need more at points in their careers to avoid burnout and manage other aspects of life. Healthcare organizations are competing for the best employees and working to retain them. Work-life benefits can include use of fitness centers and on-site day care as well as economic protections.

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