Healthcare is one of the strongest sectors of the American economy. Indeed, some believe it is currently driving the economy. There is a great demand for nurses that is projected to continue for at least the next 15 years. Given the trend toward an aging population, there is an especial need for nurses to work in home care and long term care, as well as hospitals. Nurses who speak a second language beyond English are extremely well-suited to provide care in many parts of the U.S. As the industry moves toward focusing payment on evidence-based care, well educated nurses who know how to access current information and continuing their learning will be the most valuable and will earn top salaries.
According to the U.S. Department of Labor, the average annual salary for RNs was $52,330 in May 2004. Three out of five jobs for RNs are in hospitals. However, because less expensive alternatives to hospital care, such as home care and outpatient care, are growing, more new RN jobs are expected outside of hospitals. Generally, RNs with at least a bachelor's degree will have better job prospects than those without a bachelor's. In addition, all four advanced practice specialties--clinical nurse specialists, nurse practitioners, midwives and anesthetists--will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Relative to physicians, these RNs increasingly serve as lower-cost primary care providers.
The following are a number of the exciting new developments in health care and the nursing industry today, such as direct payment, nurse-managed centers, retail pharmacy clinics and alternative care.
Direct payment
Direct payment to Advanced Practice Nurses--as described above, NPs have received direct reimbursement from federal Medicaid and Medicare, as well as a number of private health insurers. Except for Medicare payment at 85 percent of the physician rate, the payment to NPs is generally the same as to physicians. CNMs, CNSs and CRNAs also receive direct reimbursement in many areas. When nurses receive payment directly, rather than through an employer or a physician, they have the ability to run their own businesses.
Nurse-managed centers
These are some of the businesses that NPs run with direct payment and with funding from Schools or Nursing and other agencies. Currently there are an estimated 200 nurse-managed centers; most are affiliated with Schools of Nursing and provide primary health care as well as clinical training for nursing and other health occupations. Many nurse-managed centers have joined together to promote their work. The National Nursing Centers Consortium (NNCC) represents nurse-managed health centers serving vulnerable people across the country (http://nncc.us/) and The Institute for Nursing Centers (INC) (http://www.nursingcenters.org/) is developing a national data center for nursing centers. The founding members of the INC are the Michigan Academic Consortium, the American Association of Colleges of Nursing, the Nursing Centers Research Network, the Michigan Primary Care Association, the National Nursing Center Consortium (NNCC), and the National Organization of Nurse Practitioner Faculties.
Retail pharmacy walk-in clinics
These have suddenly gained momentum and are springing up all over. They are not usually owned or managed by NPs but they do employ NPs to provide basic, fast care for common acute problems such as cough, fever and minor injuries. Their locations in retail pharmacies and groceries are meant to be convenient and they are low-cost for people without health insurance.
Alternative care
Many nurses combine their education in Western allopathic medical care with alternative care, such as nutritional therapy, yoga or massage. The market for alternative care is large and consumers are willing to pay out-of-pocket for these services when they are not covered by health insurance. Nurses are ideal providers of alternative care because of their solid education in physiology, nutrition, health risk assessment, and cross-cultural aspects of care. They combine knowledge of Western medicine with alternatives and can judge the safety of combining the two. Even when nurses do not provide alternative therapy themselves, they often have helpful information about the modalities and practitioners of a variety of therapies. Research on NPs showed that nine out of 10 referred patients when relevant to a variety of alternative providers for massage therapy, chiropractic care, acupuncture or acupressure, nutritional therapy and herbal treatment.
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