RN Career Paths in North Dakota: Becoming an RN
Registered nurses play a huge role in health care delivery. According to the North Dakota Center for Nursing, duties can include carrying out physical exams, performing wound care and other interventions, administering medication, coordinating care, carrying out health promotion activities, providing patient education and counseling, and supervising nursing staff who have more basic credentials. One RN can’t wear all the hats. But between the geography of North Dakota – rural, frontier — and the push to utilize nurses to change the status quo, one nurse may wear quite a few!
The hospital is the most common work setting for RNs around the country. The Center for Nursing notes though, that one can find them many places: ambulatory care centers, medical offices, schools, even faith communities and retail clinics.
The path begins with a nursing degree (RN programs in North Dakota). Some RNs begin their professional nursing careers with a two- or three-year degree. Others go straight for a bachelor’s.
North Dakota Hospitals
North Dakota boasts more than 50 hospitals, including 38 Critical Access Hospitals, three psychiatric hospitals, and two Indian Health Services facilities. A nurse’s experience will be different from one facility to the next, depending in part on the classification.
Critical Access Facilities (CAHs) are small: no more than 25 acute care beds. One may find a skilled nursing facility and/ or rural health clinic on-site. CAHs have facility agreements with hospitals that include transfer and transportation; transfers can be made for nonemergency as well as emergency purposes. A graphic supplied by the Center for Rural Health shows lines connecting North Dakota CAHs to hubs in Minot, Bismarck, Grand Forks, and Fargo (https://ruralhealth.und.edu/maps/mapfiles/north-dakota-critical-access-hospitals-referral-centers.pdf).
Nonprofit hospitals are expected to provide community needs assessments. The Center for Rural Health has provided a link to CAH community needs health assessments (https://ruralhealth.und.edu/projects/flex/hospitals). The documents provide an introduction to the community’s specific challenges and the role that the hospital and its associated facilities provide. In some cases, they provide a window into unique community features. Professionals with varied credentials worked to create the assessments. One will even see professional nurses listed as authors on some documents.
North Dakota boasts nationally recognized rural hospitals and systems. In 2010, six of North Dakota’s CAH facilities were on the Top 100 list nationwide. Rural Heath Innovations, meanwhile, spotlighted the North Dakota Critical Access Hospital Quality Network in August of 2017 (https://www.ruralcenter.org/rhi/network-ta/network-spotlights/network-spotlight-north-dakota-critical-access-hospital-quality).
Sanford Health lists rural nursing as a specialty; the term “expert generalist” is used to describe the role. The rural RN may work in multiple clinical areas across age groups. Among the other challenges: resource limitations — even weather. Sanford Health notes that RNs in rural areas are known by their communities and valued by what they do. Nurses in rural settings tend to rely on technology.
At the opposite end of the continuum, there are the large hospitals where nurses may have any of many specialized roles, where resources are more plentiful, and leadership opportunities may be more formal.
Sanford Bismarck, North Dakota’s one magnet hospital, notes shared governance among the features. This has become a buzzword among magnets facilities and those seeking the status. The parent organization, Sanford Health, advertises for units as specialized as Cardiac Cath Lab and Neonatal Intensive Care Unit (NICU).
Recognition of Specialty Practice
Many nurses nationwide seek validation of their skills in specialized areas. Often this takes the form of third party certification. The North Dakota Board officially recognizes specialty practice. The RN will submit evidence of a national certification as evidence of appropriate education or experiential preparation.
The Board recognizes a long list of specialty nursing certification exams (https://www.ndbon.org/NurseLicensure/SPRN/CertifyingExams.asp). Among them are the following:
- Occupational Health Nurse
- Diabetic Educator
- Registered Nurse First Assistant (CRNFA)
- Certified Registered Nurse Intravenous (CRNI)
- Inpatient Obstetric
- Psychiatric & Mental Health Nurse
- Gerontological Nurse
- Nursing Case Management
Finding One’s Niche
Job posts for registered nurse, staff nurse, or ‘med/surg RN’ are common, but a job search will turn up many roles, some uncommon, some very focused. The following is a sampling of North Dakota positions for which applicants were sought in early 2018:
- RN-Triage/ Ambulatory (Pediatric Sleep Center)
- RN – Public Health and Home Care
- RN Health Coach (Pediatrics)
- Registered Nurse –Progressive Care Unit
- Registered Nurse-Surgery
- Quality Risk Manager RN
- Private Duty Nurse
RNs find their niches in very different places. For some it’s the emergency department or critical care unit. For others, it’s long-term care or hospice. In Defining Hope, the North Dakota Center for Nursing describes why hospice might call to some in a way that the ER doesn’t; these nurses want to put life into people’s days moreso than days into their lives (https://www.ndcenterfornursing.org/2017/11/defining-hope/).
Salary and Career Outlook
The North Dakota Center for Nursing provided a 2017 Supply and Demand Projections Technical Report. The expectation is for a shortage continuing for all projected years.
North Dakota RNs averaged $29.25 an hour in 2016. Those at the 10th percentile made $21.64 while those at the 90th percentile made $37.59.
The North Dakota Center for Nursing can connect those considering nursing careers with real nurses who can answer their questions (https://www.ndcenterfornursing.org/).
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