RN Careers in New Hampshire: Common Nursing Career Paths

New Hampshire depends on its RNs. They take on roles that are traditional, nontraditional, and, in some cases, invisible to the general public.

The most common work setting for RNs is the hospital. Common specialties are medical-surgical nursing, critical care, and emergency. RNs have more training than LPNs; this prepares them to work in acute care settings.

While hospitals have a greater proportion of positions that require registered nursing training than do some other healthcare organizations, there are many nursing positions across sectors where the RN credential is required. Often these positions are ones that require more in the way of assessment, treatment planning, and nursing judgment. Ambulatory care is among the more common non-hospital positions. RNs also work in long-term care, home health and hospice, and in various community settings. Some work to promote health or prevent chronic disease.

New Hampshire Hospitals and Health Care Systems

The hospital experience varies, depending on the hiring unit and even the size of the facility.

The bulk of New Hampshire hospitals are rural. The state has 13 critical access hospitals. Most of these CAHs have 25 acute care beds. Upper Connecticut Valley Hospital has just 16 beds, but is still a large part of its community. Among the services it provides: ambulatory nursing services such as IV infusions, chemotherapy, wound care, and cardiac monitor diagnostic test application.

Integrated health systems are not limited to big cities and big corporations. UCVH joined the three other North Country critical access hospitals to form an integrated health system and make the most of limited resources. The system hires nursing staff to do more than just provide inpatient and emergency care.

Nonprofit hospitals, even very small ones, are responsible for documenting the benefits they provide to the community. UCVH, for example, notes free health screenings among the many benefits offered.

Even small facilities may offer some opportunities for specialization. Cottage Hospital, a CAH located just to the South of the North Country system, is known for among other things, the Ray of Hope geriatric psychiatric program. Ray of Hope draws patients from a relatively broad area

Large hospitals hire RNs for a wider variety of specialized positions. Some of New Hampshire’s larger facilities are recognized for nursing excellence on a national level. New Hampshire has three magnet hospitals: Exeter Hospital, Wentworth-Douglass Hospital, and Southern New Hampshire Medical Center. Exeter Hospital is just 100 beds; the hospital is, however, affiliated with a multi-specialty physician practice group and a home health organization.

U.S. News and World Report has ranked Exeter, St. Joseph Hospital, and Dartmouth-Hitchcock Medical Center as New Hampshire’s top hospitals.

While staff nurse is the most common RN position, it is far from the only one. It has become common to hire for roles that involve management and coordination not of other staff but of the care that a patient receives across settings. Duties can include everything from pre-authorization and determination that care at a particular level is indeed medically necessary to carrying out post-discharge follow-up with the patient.

Ambulatory Care

Ambulatory care can mean many things, including work at specialty clinics. Ambulatory nurses may perform specialized procedures, much like inpatient RNs at major hospitals. An example is wound care; multiple New Hampshire organizations provide wound care centers. Exeter Center for Wound Healing, for example, treats a variety of wound types, including diabetic and circulatory-related ulcers and surgical wounds that aren’t healing properly. The organization notes that their wound care nurses are certified; that means they have an adjunct third party credential that indicates expertise in the specialty area.

Wentwoth Douglass boasts multiple wound centers, including one specialized for hyperbaric treatment. The Hyperbaric Oxygen Treatment Center boasts a Certified Wound Ostomy Continence Nurse and more than one Certified Wound Specialist.

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Home Care

In the area of home care, too, a single setting can utilize nurses with multiple specialties. Rockingham VNA & Hospice, for example, hires RNs into positions such as home care diabetes educator and hospice nurse. Duties of a home care RN can include directing Licensed Nursing Assistants (LNAs) and LPNs.

Tender Loving Care staff profiles describe the diverse elements that can make up the workweek of an experienced nursing professional (http://www.tlcnursing.com/home-care-meet-team-tlc). On board is an RN case manager who also leads dementia and Alzheimer’s support groups, provides client foot care, and teaches future LNAs. The TLC Director of Nursing, notably, has had his Bachelor of Science in Nursing since the mid-70s and his MSN almost as long.

Home care can be an area where there are staffing challenges. A report prepared for the Governor’s Commission on Health Care Workforce notes problems faced by home care organizations during times of shortage (https://www.dhhs.nh.gov/ombp/caremgt/health-care/index.htm). A 2016 survey noted a 9% RN vacancy rate in this sector, based on 25 agencies responding.

School Nursing

School nursing represents yet another option. School nurses enjoy ample vacation time as well as the opportunity to work with children. The role of the school nurse has become more complex, in part because of the rise in chronic illness among the school age population. Opportunities to affect positive change have also gone up. Among the populations school nurses come to know well: children with severe disabling conditions.

This is another practice area where a nurse can expect to meet more than the minimum RN requirement. Formal increase in requirements has been controversial. New Hampshire passed legislation requiring a bachelor’s degree, prior pediatric experience, and credentialing through the Board of Education, then postponed mandates so as not to burden districts. Some wish to have the law rescinded. Others say this level of education and oversight is necessary for such a challenging field.

Traditionally, it’s been more of a challenge for smaller districts to attract highly credentialed staff.

Career Outlook and Average Salary

New Hampshire registered nurses averaged $33.02 in 2016.

The New Hampshire registered nursing occupation has been projected to increase 15.4% over the course of the 2014 to 2024 decade.

In early 2018, the demand is such that one finds healthcare organizations offering sign-on bonuses for their hard-to-fill positions.

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