RN Careers in Oregon: Becoming an RN

According to the Oregon Center for Nursing, nurses are the largest group of healthcare workers in Oregon and have among the most diverse sets of roles and duties. The largest subset are registered nurses or RNs. RNs have broad education in theory and practice in nursing; professional nursing education may take place at the associate’s level but the bachelor’s is becoming more common (RN programs in Oregon).

RN Roles

RNs are skilled at patient assessment. An RN’s duties can include directly carrying out some procedures and delegating others. There are many basic health duties that can be delegated to other personnel such as nursing assistants. In the latter instance, RNs have the responsibility for determining that patient condition is indeed stable and that someone with lesser health training can carry duties out safely. The work involves far more than needles, medications, and bandages. RNs also provide patient education, coordinate care, plan for discharge, analyze data, and participate in quality improvement initiatives.

Registered nurses are employed in multiple sectors. Hospitals and medical centers account for more than half of primary work settings, though the percentage has gone down slightly in recent years. Other sectors include practitioner’s offices, long-term care facilities, home health and hospice, and public health.

Even within sectors, one RN’s workday can look very different from another’s. Hospital nurses can work on very specialized units. While a majority have general direct patient care duties, others have roles such as care coordination and discharge planning. Public health, too, is a very broad category. In a 2016 report about nursing demand, OCN grouped many roles under public health, with the term encompassing school health, as well as public health clinic nurse and community outreach nurse; some nurse practitioners fall under this category.

A Snapshot of Current Needs

The Oregon Center for Nursing analyzes data about the potential workforce — the people who are obtaining and renewing licenses – as well as employer needs. Currently, the percentage of the RN workforce employed in hospitals settings is about 55%; office settings, the next most common, account for about 10%.This is on a par with what’s reported nationwide. Other common settings include long-term care and home health and hospice.

An OCN 2016 report was based on a survey of employers in four sectors: hospitals and medical centers, long-term care, home health and hospice, and public health. The most recent data shows an uptick in vacancy rates. While the vacancy rate is lowest in hospitals, the sheer numbers mean a higher total number of vacancies.

The positions that are hardest to fill for hospitals and health systems include administrative, executive, and unit management roles as well as adult critical care, pediatric/ neonatal, and clinical nurse leader positions — the last category is a master’s level nurse with special training. Operating room and labor and delivery are other areas where more than 50% of those surveyed reported that positions were very difficult to fill.

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Staff RN was the most difficult position in home health, though positions like case manager and care coordinator followed not far behind.

Vacant positions not necessarily unstaffed, and the difference is not necessarily being made up through overtime. Employers in different sectors rely in part on per diem employees and staffing nurses. Travel nurses are popular with hospitals and medical centers; travel nurses typically do stints of about three months. Some nurses enjoy seeing different locales – and enjoy the pay rate that comes with these gigs.Entry-Level Practice

Options for new graduates exist across common workplace settings but are higher in some than others. The percentage is highest in long-term care (82%), lowest in home health (21.4%). The home health percentage actually represents an increase; in a previous survey, new graduate RN roles in this sector had been 0. Just under one-third (32.4%) of hospital and medical center jobs were open to new grads while just under two-thirds (65.4%) of those in public health were.

The essentials are education and examination; a person typically earns the title RN soon after successful performance on the NCLEX-RN. Practice beyond the student level is not necessary for initial licensing. However, organizations recognize the potential value.

A career is about more than landing that first job – and heading off a shortage is about more than just attracting new people to the field. Organizations are focused on retention. Part of retention is effectively transitioning new workers and helping them feel prepared for the specific role they have taken on. ONC supports residency, noting research that shows residency increases retention — the percentage who actually stay on the job. It’s a minority who have the opportunity, but it’s become a significant minority. Residency can be a chance to gain skills in specialty areas straight out of college. Legacy Health, for example, lists more than a dozen specialties that might be pursued through residency, among them, behavioral health, burn center, oncology, operating room, and trauma step-down.

ONC research indicates retention rates are actually significantly better in hospitals and medical centers than in long-term care, home health, or public health. However, all these sectors need people with compassion and savvy.

While the need for registered nurses will increase in the coming years, it will not increase at the same pace in all sectors. Long-term care will see a steep increase in need — not surprising given the aging of the population.

Making Oregon Vital for Elders is among the many resources for people who are passionate about elder care (http://www.orculturechange.org/).

Average Salary

Oregon registered nurses averaged $41.83 an hour in 2016. BLS data puts Oregon number four for highest paying states for registered nurses.

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