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July, 2016 l Working World l WorkingWorld.com 7 supervised clinical experience. Bachelor's degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor's degree or higher is often necessary for administrative positions, research, consulting, and teaching. Generally, licensed graduates of any of the three types of education programs (bachelor's, associate's, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor's degree. Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor's degree through an RN- to-BSN program. There are also master's degree programs in nursing, combined bachelor's and master's programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor's degree in another field. Some employers offer tuition reimbursement. Clinical nurse specialists (CNSs) must earn a master's degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree. LICENSES, CERTIFICATIONS, AND REGISTRATIONS In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN). Other requirements for licensing vary by state. Each state's board of nursing can give details. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing. Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it. CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements. IMPORTANT QUALITIES Critical-thinking skills. Registered nurses must be able to assess changes in the health status of patients, including determining when to take corrective action and when to make referrals. Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to explain instructions, such as how to take medication, clearly. They must be able to work in teams with other health professionals and communicate the patients' needs. Compassion. Registered nurses should be caring and empathetic when caring for patients. Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time. Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses. Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care. Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift. JOB OUTLOOK Employment of registered nurses is projected to grow 16 percent from 2014 to 2024, much faster than the average for all occupations. Growth will occur for a number of reasons. Demand for healthcare services will increase because of the aging population, given that older people typically have more medical problems than younger people. Nurses also will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. In addition, the number of individuals who have access to health insurance is expected to continue to increase because of federal health insurance reform. People who previously were uninsured or found treatment to be cost prohibitive will obtain health insurance and have access to primary and preventive care services. More nurses will be needed to care for these patients in offices of physicians, clinics, and other ambulatory care settings. The financial pressure on hospitals to discharge patients as soon as possible may result in more people being admitted to long-term care facilities and outpatient care centers, and greater need for healthcare at home. Job growth is expected in facilities that provide long-term rehabilitation for stroke and head injury patients, and in facilities that treat people with Alzheimer's disease. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings. Growth also is expected to be faster than average in outpatient care centers, where patients do not stay overnight, such as those which provide same-day chemo- therapy, rehabilitation, and surgery. In ad- dition, an increased number of procedures, as well as more sophisticated procedures previously done only in hospitals, are being performed in ambulatory care settings and physicians' offices. JOB PROSPECTS Overall, job opportunities for registered nurses are expected to be good. However, the supply of new nurses entering the labor market has increased in recent years. This increase has resulted in competition for jobs in some areas of the country. Generally, registered nurses with a Bachelor of Science degree in nursing (BSN) will have better job prospects than those without one. Employers also may prefer candidates who have some related work experience. Job opportunities should be good because of the need to replace workers who retire over the coming decade and because of the growing number of people with access to healthcare services.