A registered nurse provides direct patient care, from monitoring vital signs and administering medications to coordinating treatment plans and educating patients about their health. RNs are the largest group of healthcare professionals in the United States, with a median annual salary of $93,600 as of May 2024. Their work spans hospitals, clinics, schools, and home health settings, but the core of the job stays the same: assessing patients, carrying out treatments, and catching problems before they escalate.
A Typical Hospital Shift
Most hospital RNs work 12-hour shifts, and the day begins with a handoff report from the outgoing nurse. This is a detailed briefing on each patient’s condition, recent changes, current medications, and anything to watch for. From there, the nurse starts rounding on patients, which means physically visiting each one to check vital signs (blood pressure, heart rate, temperature, oxygen levels), ask about symptoms, and assess how they’re doing overall.
A hospital RN typically manages between five and eight patients at a time on a general medical-surgical floor, though this varies by unit. In an intensive care unit, nurses often care for just one or two patients because those individuals need constant, close monitoring. Emergency departments generally assign three to four patients per nurse, and critically unstable patients may require one-on-one care. Operating rooms also use a one-to-one ratio for the duration of a procedure.
Throughout the shift, an RN administers medications (oral pills, IV drips, injections, scheduled treatments like insulin or antibiotics), performs wound care, assists patients with mobility, and coordinates with doctors, physical therapists, pharmacists, and other team members. Documentation runs alongside all of this. Nurses log every vital reading, medication given, symptom reported, and conversation in electronic medical records. These records form the legal and clinical backbone of a patient’s care, so accuracy matters enormously.
Clinical Decision-Making
Nursing isn’t just task execution. RNs follow a structured decision-making framework that involves assessing the patient, identifying problems, setting goals, carrying out interventions, and evaluating whether those interventions worked. For example, a nurse caring for a patient in pain doesn’t just give medication. They also identify that the pain is causing anxiety, poor nutrition, or limited mobility, then build a care plan that addresses all of those connected issues.
That care plan might include goals like getting the patient out of bed and into a chair three times a day, switching to smaller and more frequent meals to maintain nutrition, or adjusting pain medication timing. The nurse writes these goals into the patient’s record so every provider on the team can follow the same plan. As the patient’s condition changes, the nurse re-evaluates and updates the plan. This continuous loop of assessment and adjustment is what separates nursing care from simply following orders.
Where RNs Work and How Duties Differ
The hospital floor is the most visible setting, but RNs work in dozens of environments, and the daily work shifts accordingly.
- Intensive care units: Nurses here manage ventilators, titrate IV medications that affect heart rate and blood pressure in real time, and monitor patients who may be paralyzed, sedated, or recovering from cardiac arrest. The most unstable patients require one-to-one nursing care for the entire shift.
- Emergency departments: ER nurses triage incoming patients, stabilize acute conditions, start IVs, and manage a rapid turnover of cases ranging from minor injuries to life-threatening emergencies.
- Pediatrics: Pediatric RNs care for infants, children, and adolescents. Communication looks different here because nurses often work through parents and guardians, and medication dosing requires precise weight-based calculations.
- Neonatal intensive care (NICU): These nurses specialize in premature and critically ill newborns, managing feeding tubes, monitoring oxygen levels, and supporting families through extended hospital stays.
- Telemetry: Telemetry nurses monitor patients on continuous heart rhythm tracking, interpreting electrocardiogram readings and catching dangerous rhythm changes early.
- Cardiovascular units: Nurses in these units care for patients recovering from heart attacks, heart surgery, or vascular procedures, often working closely with cardiologists in intensive settings.
- Outpatient and community health: RNs in clinics, schools, and public health departments focus more on education, preventive care, chronic disease management, and vaccination programs than acute bedside care.
How to Become an RN
There are two main educational paths. An Associate Degree in Nursing (ADN) is a two-year program, typically offered at community colleges, with some accelerated options finishing in 18 months. A Bachelor of Science in Nursing (BSN) is a four-year university degree that includes broader training in public health, nursing ethics, research, and leadership on top of the core clinical skills.
Both degrees qualify you to sit for the NCLEX-RN, the national licensing exam every RN must pass. BSN graduates have a slightly higher first-attempt pass rate (82.3%) compared to ADN graduates (77.9%), according to the National Council of State Boards of Nursing. Many hospitals now prefer or require a BSN, and some ADN-prepared nurses complete an RN-to-BSN bridge program while working.
Licensing is state-based, meaning each state’s nursing board sets its own rules through a nurse practice act. These acts define what an RN is legally permitted to do and what falls outside their scope. Once licensed, nurses must maintain their credentials through continuing education. Requirements vary by state, but a common standard is completing 30 contact hours of relevant coursework during each renewal cycle. Some states accept alternatives like completing a research project, publishing a nursing-related paper, or teaching a nursing course.
Salary and Job Outlook
The Bureau of Labor Statistics projects RN employment to grow 5% from 2024 to 2034, which is faster than the average for all occupations. An aging population, rising rates of chronic disease, and retirements within the nursing workforce are all driving demand. The median annual wage of $93,600 reflects the national midpoint, but pay varies significantly by state, specialty, and setting. Nurses in intensive care, operating rooms, and travel nursing assignments tend to earn above the median, while school nurses and clinic-based RNs may earn below it.
What Sets RNs Apart From Other Nursing Roles
The nursing profession includes several levels of licensure, and understanding the differences helps clarify what an RN specifically does. Licensed practical nurses (LPNs) complete a shorter training program (typically one year) and work under the supervision of RNs or physicians. They can take vital signs and provide basic bedside care, but their scope is more limited. They generally cannot interpret diagnostic data, develop care plans independently, or administer certain high-risk medications.
On the other end, nurse practitioners (NPs) hold advanced graduate degrees and can diagnose conditions, prescribe medications, and in many states practice independently without physician oversight. RNs sit in the middle: they have broad clinical authority to assess patients, carry out complex treatments, make judgment calls about changing conditions, and coordinate the full picture of a patient’s care. In many hospital settings, the RN is the provider who spends the most continuous time with each patient and is often the first to notice when something is going wrong.