A registered nurse (RN) is a licensed healthcare professional who assesses patients, develops care plans, administers medications, and coordinates treatment across nearly every medical setting. With over 3 million employed in the United States, RNs form the largest segment of the healthcare workforce and serve as the primary point of contact between patients and the rest of the medical team.
What Registered Nurses Actually Do
The core of an RN’s job is evaluating a patient’s overall health status and making clinical judgments based on what they find. This goes well beyond taking vital signs. RNs interpret lab results, recognize changes in a patient’s condition, identify potential complications, and use all of that information to build or adjust a plan of care. They administer medications ordered by physicians or nurse practitioners, verifying the right patient, the right drug, and the correct dose each time. They also educate patients and families on managing conditions at home, coordinate with specialists, and advocate for patients when treatment decisions are being made.
The American Nurses Association defines nursing as the protection, promotion, and optimization of health; prevention of illness and injury; facilitation of healing; and alleviation of suffering. In practice, that means an RN’s day could include anything from monitoring a post-surgical patient’s recovery to teaching a newly diagnosed diabetic how to manage blood sugar to helping a family navigate end-of-life care decisions.
How RNs Differ From LPNs
Licensed practical nurses (LPNs) and registered nurses both provide direct patient care, but the scope of responsibility is different. RNs carry a broader level of decision-making authority, particularly around assessment and diagnosis. An LPN might take a patient’s vital signs and report the numbers, but the RN is the one responsible for interpreting those numbers, identifying what they mean for the patient’s condition, and adjusting the care plan accordingly.
RNs develop care plans. LPNs carry out tasks within those plans. RNs can administer medications in all states, while LPN medication authority varies by state, with some states allowing LPNs to handle IV drips and others restricting them to oral medications only. These distinctions matter day to day: an RN in a hospital unit is typically the one coordinating the full picture of a patient’s care, while an LPN focuses on executing specific parts of that plan.
Education: ADN vs. BSN
There are two main educational routes to becoming an RN. The first is an Associate Degree in Nursing (ADN), a two-year program typically offered at community colleges, with some accelerated versions finishing in 18 months. ADN programs cover prerequisites like anatomy, chemistry, biology, and psychology, then move into nursing-specific coursework: fundamentals, medical-surgical nursing, pediatrics, psychiatric nursing, and community health.
The second path is a Bachelor of Science in Nursing (BSN), a four-year program at a college or university. BSN programs include the same clinical skills training but add coursework in nursing theory, public health, ethics, and pathophysiology. Both degrees qualify graduates to sit for the same licensing exam, and both produce registered nurses with the same legal title. The difference shows up later: many hospitals now prefer or require a BSN for hiring, and a bachelor’s degree is the starting point for advancing into leadership, education, or graduate-level roles like nurse practitioner.
Licensing Requirements
Every state requires RNs to pass the NCLEX-RN, a standardized licensing exam, after completing an accredited nursing program. But the specific rules governing what an RN can and cannot do are set at the state level through nurse practice acts, laws passed by each state legislature. Regulatory boards then create detailed rules based on those laws. This means the day-to-day scope of practice for an RN in Texas may look slightly different from one in California or New York, even though the foundational training and exam are the same. You need an active license in the state where you practice, and maintaining that license requires ongoing continuing education.
Where RNs Work
Hospitals employ the majority of registered nurses. Of the roughly 3 million RNs working in the U.S., about 1.7 million work in general medical and surgical hospitals. But hospitals are far from the only option. Around 209,000 RNs work in physicians’ offices, 174,000 in home health care, 152,000 in outpatient care centers, and 125,000 in skilled nursing facilities.
The setting shapes the work significantly. A hospital RN on a medical-surgical floor might manage six patients simultaneously, monitoring post-operative recovery and coordinating discharge plans. A home health RN visits patients in their homes, managing chronic conditions with more autonomy and less immediate backup. An RN in an outpatient clinic might focus on patient education, pre-procedure assessments, or chronic disease management with a more predictable schedule. The variety of settings is one reason nursing attracts people with very different lifestyle preferences.
Common Specialties
After gaining experience, many RNs pursue specialty certifications to deepen their expertise and expand their career options. Some of the most common specialty areas include:
- Medical-surgical nursing: the broadest specialty, covering care for adult patients before and after surgery or during acute illness
- Cardiac-vascular nursing: focused on patients with heart disease, heart failure, and circulatory conditions
- Pediatric nursing: care for infants, children, and adolescents
- Ambulatory care nursing: outpatient settings where patients are seen and released the same day
- Informatics nursing: the intersection of nursing practice and health information technology, managing electronic health records and clinical data systems
Specialty certifications are offered through organizations like the American Nurses Credentialing Center and typically require a combination of clinical hours in the specialty area and passing an exam. Certification isn’t legally required to work in most specialties, but it signals expertise and often comes with higher pay.
Salary and Job Outlook
The median annual wage for registered nurses was $93,600 as of May 2024, according to the Bureau of Labor Statistics. That median means half of all RNs earn more and half earn less. Pay varies widely by geography, specialty, and setting. RNs in metropolitan areas and high-cost states tend to earn more, and specialties like critical care or operating room nursing often command higher wages than general medical-surgical positions.
Employment of registered nurses is projected to grow 5 percent from 2024 to 2034, which is roughly in line with the average for all occupations. But the overall numbers mask a more uneven picture. Federal projections estimate a nationwide shortage of nearly 109,000 RN positions, with the gap hitting rural areas hardest. By 2038, nonmetropolitan areas face a projected 11 percent shortage of RNs, compared to just 2 percent in metropolitan areas. For people considering nursing, this means strong job security nearly everywhere and especially high demand in smaller communities and rural hospitals.