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The occupational duties of a registered nurse (RN) vary greatly according to work environment and job function, however, providing patient care is at the core of the Registered Nursing profession. RNs most often work for hospitals, but RNs are also employed by physician offices, medical clinics public health facilities, educational institutions, insurance organizations and consulting and regulatory agencies. The information contained in this report refers almost exclusively to RNs who are providing direct care to patients-RNs employed in another capacity may not necessarily perform the occupational duties outlined below.

RNs working in a patient care role perform assessments and examinations (vital signs, gathering information about changes in the patient's condition or behavior; complete physical exams); implement and coordinate a treatment plan (administering medications, fluids, interventions, etc.); monitor patient progress and respond to patient requests; provide education to patients and families; serve as a liaison between the patient and facility, answering questions and communicating information to the attending physician on behalf of patients; document and review observations in permanent medical records; and may attend to hygiene and nutritional needs (depending on the level of care needed-CNAs in the hospital and skilled nursing setting typically help patients bathe, dress and eat, but if enteral (tube) feeding is required, a registered nurse would oversee that task). Registered nurses may also have other duties specific to the unit or environment in which they work (i.e. surgical nurses may assist with surgical equipment during surgery, nurses who work in home health care include traveling in their occupational duties, and nurses who work in an independent physician office may perform more administrative or office tasks). In some institutional and emergent care settings, registered rurses attend to patients' hygiene and nutritional intake needs, but certified nurse assistants usually perform these tasks on medical-surgical floors.

Nurses are used around the clock in hospitals and nurse schedules vary according to work environment and job function. Nurses who work in a private doctor's office or in medical clinics may work 8am-5pm, while nurses working in a hospital may work 12-hour shifts, 3 days per week. Evenings, weekends, and holidays may be required. Rotating shift schedules are common.

Nurses comprise the largest group of healthcare professionals, and the role of nurses in patient care can never be replaced or outsourced. Job security is high.

RNs are highly coveted by healthcare employers and many RNs are offered employment at graduation through the healthcare organizations that hosted their clinical internships.

RN wages are currently $39-$55/hr in the hospital setting. Some nurses choose to work part-time, but part-time, full-time, per diem, and overtime opportunities are available at many Silicon Valley hospitals. RNs who decide to work per diem shifts for extra cash may earn more than $60/hr.

Some nurses choose to pursue employment as "travelers". Travelers perform contract work through a nurse staffing agency and work at a facility outside of their local area. These agencies offer food, housing, transportation, and personal stipends on top of higher than average salaries. Traveling nurses are expensive to hire but are a critical component in meeting nursing ratios at this time.

According to the Center for the Health Professions, California's Registered Nursing Shortage will worsen each year through 2030, because the growth rate of the supply of RNs is not projected to keep up with the growth rate of California's population. This will occur even though enrollment in nursing education programs is at a 5 year high.

A significant percentage of the incumbent nursing workforce is over the age of 50 and is nearing retirement. There is also a marked trend for older nurses and nurses with more experience to move into roles in healthcare that are not rooted in direct patient care, such as administration and workforce planning, which does not help healthcare organizations in meeting nurse to patient ratios.

According to EDD Select Careers, the distribution of RNs employed by setting in Santa Clara County in 2005 was as follows: 8,490 worked in the hospital setting, 1,470 worked in the medical office and clinic setting, 550 worked in public administration, 410 worked in skilled nursing facilities, 340 worked in psychiatric or mental health facilities, 310 worked in outpatient care centers, and 1,080 worked in a setting that did not fall into one of these categories.

RNs work closely with physicians and other healthcare professionals, most often under the supervision of a nurse manager. Though RNs work closely with physicians and do take direct orders from them regarding patient treatment plans, RNs are not disciplined or managed by physicians in the hospital setting-this is a common misconception.

Nursing is active, physically demanding work. Nurses spend the majority of their shift standing and walking and they must have the stamina to endure an 8 or 12 hour shift. Nurses must be able to assist with lifting and transfering patients, must be able to reach over patients and to manipulate large and heavy equipment as well as small objects for an extended period of time, such as needles and tubing, and must be able to bend down to the floor. Because not being able to perform the occupational duties at a moment's notice could compromise patient safety, nurses may be required to pass a physical or medical exam before beginning employment.

Nurses perform tasks that are invasive-they insert catheters, clean and dress wounds, obtain blood and fluid samples and insert IVs. These occupational duties are considered by many to be challenging and unappealing, but they are part of providing nursing care and individuals considering a career in nursing must know that it is not possible to avoid performing these duties while working as a nurse. Individuals who are not comfortable with performing these duties should consider employment in another occupation. It is imperative that individuals considering a career in nursing be able to handle the sight of blood, traumatic injury, human suffering and death. These are considered to be everyday aspects of the job in some work environments.

Nurses must be emotionally and socially mature. In addition to providing hands-on care to patients, nurses look after the emotional well being of patients and families and must assist people who are struggling with new diagnoses, injuries, terminal illnesses, pain and death. Nurses must be compassionate to their patients and must provide the highest level of care to all their patients, regardless of the patient's condition, attitude, socioeconomic status, cultural, religious or racial differences.

Nurses are members of several different teams within a hospital setting-they are a member and often the leader of each of their individual patient's care teams (which are often comprised of several different physicians, therapy professionals, auxillary workers, and several shift nurses) and are also members of nursing department teams. To be successful in this occupation, an individual must work well with others in a cooperative setting.

Nurses must be effective communicators (written and spoken language)-they must be able to quickly intrepret and respond to their patients needs and the commands of the care team. Nurses with English language challenges are strongly advised to seek vocational ESL courses and accent reduction courses when applicable.

Silicon Valley is a highly diverse community. Ethnic minorities represent a significant percentage of Silicon Valley's population, but non-white groups as well as men are still considered to be underrepresented in nursing. Click here to read UCSF's position paper on diversifying the nursing workforce.

Nurses must remember that healthcare is an industry and a business, and the patient is the customer. Nurses must have a desire to provide good customer service and must have positive attitudes and appropriate interpersonal interaction, even when the situation or duties are unpleasant. Dealing with negative comments and hostility from patients is something that many nurses feel comes with the job, and diffusing these negative situations is something that nurses must learn to do.

With advanced education, numerous opportunities for advancement exist in areas of the nursing profession outside of direct patient care in a hospital or clinic. Masters degree-prepared nurses may participate in research, teach nursing or health science at the post-secondary level, and hold high-level administrative positions. Many nurses with advanced degrees choose to work in an area of clinical specialty or to become nurse practitioners or anesthetists.

BSN prepared nurses are preferred by employers to ADN prepared nurses, though experience level dictates pay rate among Silicon Valley employers interviewed. Currently, demand is such that associate degree nurses are employed just as quickly as BSN nurses.

Many local healthcare organizations have internal career ladder programs in place to assist nurses in advancing their careers. Click here to visit the employer advancement programs section of the Financial Aid page. These programs most often are offered in a forgiveable loan format, where the employee's education is paid for and the debt is "worked off" by committing to remain with an employer for a period of years.

Registered nurse training is not currently offered at local vocational colleges.

RNs adhere to strict safety protocol to lessen the chances of infection from diseases such as tuberculosis and hepatitis, but the small chance of infection from a pathogen in the work environment does exist. This is not a deterrent to entering the field for most individuals.

Above all, nursing is a profession. It is important that individuals entering the field take pride in being a nurse, value caring for people, and have a compassionate attitude. Individuals who do not understand the complex and vital roles that nurses play in healthcare delivery systems may think that anyone can be a nurse, or that the high wages that nurses are currently earning is enough of a reason to enter the field. This is simply not the case.

Individuals applying for a nursing license are fingerprinted and must pass a background check. Individuals with a criminal history may not be eligible for licensure, and therefore would not be able to work as a registered nurse. It is imperative that individuals with concerns about this contact the Board of Registered Nursing directly before beginning a training program. Click here to read about the criminal background check policy and which infractions will render an individual ineligible for licensure.

In the 1980s and 1990s, nurse workloads increased and some nurses were laid off as a cost saving measure, individuals started leaving the occupation for other opportunities outside of healthcare, enrollment in nursing schools plummeted, and salaries did not keep pace with inflation for a number of years. Nursing was viewed negatively and fewer nurses were trained during this period, in spite of population growth. In the late 1990s, demand for services grew rapidly (largely due to the aging population and changes in managed care), creating an unparalleled demand for nursing services and medical care. In part because too few individuals pursued nurse training in the 1980s and 90s, the average age of nurses is also in the mid-to-late 40s and many are contemplating retirement.

California is currently experiencing a critical Registered Nursing shortage. Employment opportunities for RNs in Silicon Valley are expected to be excellent through 2020 and some predict that the nursing shortage will continue through 2030 if California continues to train nurses at its current rate. The demand for registered nurses is high in part due to new growth resulting from population growth in California, but is largely due to replacements needs because a disporportionate percentage of the nurse workforce is nearing retirement while the nurse to patient ratio legislation continues to drive demand.

Registered nurses with advanced degrees and significant clinical experience are considered to be most desirable to employers (and they are paid accordingly), but every registered nurse is in high demand right now in the Silicon Valley, including new graduates, re-entry workers, individuals changing from inactive to active license and traveling nurses. There are multiple opportunities for part-time, full-time, per diem, and over-time work.

Registered Nursing is getting a great deal of attention, and thousands of individuals in Northern California are currently applying for registered nurse programs-training became highly sought immediately following the first signs of the tech bust and has been impacted since-and the end result is that the workforce is disportionately inexperienced. The ideal breakdown is 1/3 inexperienced worker, 1/3 mid career, 1/3 late career, but the majority of the workforce falls into one of two categories: new graduate/inexperienced worker or late/end career. Though employers would prefer to hire nurses that fit into the middle category (5-10 years of experience), most hiring that occurs is for new graduates both locally trained and recruited from out of state.

Click here to view the breakdown for demand for Registered Nurses in San Jose and here for San Mateo according to Employment Development Department-Labor Market Information Division. Click here for a factsheet on the nursing shortage from the American Association of Colleges of Nurses and here to read a report from the UCSF Center for the Health Professions on the Nursing Workforce Shortage.

Areas of particular demand in the South Bay Area (as indicated by individuals contributing information to the Healthcare Navigator study) include Cardiovascular nursing (due to the planned opening of the Kaiser Cardiovascular Center in March 2008); Operating Room Nursing; and Labor and Delivery. Practice areas in demand change frequently due to individual employer needs. There is also an increased need for masters prepared nurses to work in an administrative capacity and for doctorally prepared nurses to teach at the college level.

Because of the unmet need for nurses, union lobbying, and the efforts to attract individuals to the nursing profession and to retain the incumbent workforce, wages for registered nurses have skyrocketed. The wage range for registered nurses in Silicon Valley is approximately $42-$59/hr with benefits, which equates to more than $80,000 per year. Hiring bonuses are common. Many new nurses take advantage of every overtime opportunity and with shift pay differential, and it is possible for some nurses to earn $100k in their first year of employment. Nurses with 15 years of experience typically earn more than $50/hr. Click here for the Santa Clara County RN wage survey and here for the San Mateo County wage survey.

Advanced practice nurses (clinical nurse specialists, nurse practitioners, certified nurse midwives, nurse anesthetists, public health nurses) usually earn between $45-60/hr, depending on experience. Nurse anesthetists and nurse administrators salaries vary significantly depending on experience and work environment, but it is not uncommon for these nursing professionals to make more than $150,000/yr.

Registered nurse training programs are offered at California Community Colleges, California State Universities, private universities and the University of California system (graduate level nursing only).

Space in registered nurse training programs is highly coveted and all programs statewide are experiencing a dramatic spike in the number of applications they are receiving-this means that additional admissions criteria generally apply. An individual's educational background dictates their eligibility for programs (Associate Degree of Nursing (ADN) is offered at community colleges, Bachelor of Science in Nursing and Accelerated Second Bachelor of nursing (BSN and ASBSN) at state and private universities, and Entry-level Masters (ELMS) at California State University, private universities and the University of California). These programs all have different entry requirements.

Individuals applying for ADN programs will need to complete 5 prerequisite courses to enter the lottery. This number is a bit misleading, because while Anatomy and Physiology is considered to be one of the 5 prerequisite courses for DeAnza's lottery, the course is completed over 3 quarters (offered as Biology 40 A, B, C). This course also requires completion of a college chemistry course prior to enrollment, and several other pre-nursing prerequisite courses also require English or Math courses to be completed prior to enrollment. Individuals who have completed previous degrees may find that they have satisfied some of the foundational course requirements and they may only have to complete the 5 courses required for the lottery at some schools. Most students who have completed a bachelor's degree but are going back to school for nursing will still have to take 4-9 classes before becoming eligible for the lottery.

Nursing prerequisite courses generally fill to capacity during the first day of registration (several colleges reported courses that filled within 1 hour of the first day of priority registration) and because laboratory space is limited (regulated by law) it is not often easy to add these courses on the first day of class. Because the pre-nursing training period (which is essentially the period in which individuals actively complete prerequisites and wait to be selected for admission to programs) is most often between 1 and 3 years long, it is essential that individuals considering registered nurse training programs in California meet with the admissions representatives of the desired programs as soon as possible to establish an individualized education plan. Many prerequisites also carry expiration dates (programs may stipulate that a prerequisite course must be completed within 5 years of entry) so it is advised that students complete courses in an ordered sequence (which is required by some schools) and apply for programs immediately. Students without proper academic advising (they are either misinformed by friends or attempt to build a plan independently) may waste time taking courses they do not need, and find that they have not completed the necessary prerequisites for the prerequisites, which can impede progression into the program and can significantly lengthen the pre-nursing component of training. Click here to read an article about standardized prerequisite requirements for nursing programs.

For the community college system, individuals that have completed 5 standardized core prerequisites with the minimum gpa (3.0 cumulative) along with the Math, English, and any other required coursework (Nursing 50 at DeAnza), must submit transcripts, a completed application, and all required supporting materials to enter the nursing lottery, which is essentially a raffling off of the spots in the training program. Some programs will set aside a limited number of spots for individuals who completed the prerequisites at the host school and who earned a perfect 4.0, but others use just the lottery in admissions criteria. Lotteries are held 1-3 times per year, depending on how many times per year the school admits a new nursing cohort.

Approximately 300 students entered the DeAnza lottery in Spring 2006 for 24 spots; however, individuals are given multiple tickets for each lottery that they enter without being selected, so a first-time lottery student's chances are not 1/300-they may actually be significantly lower. It is important to keep in mind that students from all over California enter multiple lotteries, and that some individuals are selected by several lotteries or have personal circumstances that require them to withdraw even if selected in the lottery. When a student is not chosen after 5 lottery entries (1.5 years of waiting after completing prerequisites), s/he is placed in a special lottery where the program alternates are pulled.

Many argue that the lottery situation does not award the most qualified students (several individuals interviewed indicated that there are enough students with 4.0 GPA and work experience to fill every slot in training programs), but the argument is that a 4.0 GPA does not always produce the best nurse. The lottery is also thought to increase diversity in nursing and is designed to eliminate any sort of favoritism or corruption in the admissions process. Because so many qualified individuals (3.0 GPA or above is considered qualified) are vying for very limited space in nursing programs, the lottery is considered to be the most fair method of selection at this time by many individuals. The lottery is required statewide in the community college system. Click here to read an article about the nursing lottery.

Individuals who are licensed as vocational nurses and who complete the ADN prerequisite coursework can apply to enter community college RN programs with advanced standing. This would allow the LVN to complete an ADN in approximately 1 1/2 years. Many schools offer these programs, including Gavilan College, Hartnell College, Chabot College, DeAnza College, Ohlone College . LVNs do not have to enter the lottery for this option. Individuals who completed a previous associates degree and earned their LVN credential at a community college will have the most transferable credit toward the ADN degree, and will not have to spend extra time fulfilling general education requirements. LVNs are also eligible for the 30-unit option, which is discussed in the LVN profile.

San Jose State offers advanced placement for qualified LVNs. LVNs still have to complete the prerequisite courses and general education, but they can enter in the third year of training and complete the nursing theory and clinical experience component of training. As with the LVN-ADN, this program is most seamless for individuals who completed LVN training in the community college setting because some of their educational credit will transfer. The LVN-BSN program provides for an exciting career ladder pathway for well-qualified LVNs and admission is competitive and limited to individuals with a demonstrated record of professional and academic experience.

ADN nurses often decide to complete BSN programs, and these individuals are eligible for advanced placement in BSN programs. ADN prepared nurses would take theory and additional nursing courses, as well as general requirements, but do not have to take the foundational nursing courses. Many employers offer forgiveable loans or special programs designed to help individuals work flexible schedules while attending school. ADNs often choose to complete a bachelor degree in nursing because it can open the door for supervisory opportunities, increase earning potential later on, and is a critical step for individuals with career goals such as nurse specialist, nurse practioner or nursing administration. Programs are available at San Jose State, San Francisco State, California State University East Bay, and at the University of San Francisco, Dominican University-San Rafael, and Samuel Merritt-Holy Names University.

It is important to note that employers interviewed indicated that they would prefer to hire nurses with BSN degrees because these individuals have completed more theory and supporting coursework and are eligible for some supervisory positions (with work experience), but BSN prepared nurses earn the same starting wages as ADN prepared nurses right now and employers are not able to be picky in their hiring.

Individuals applying to BSN programs in the California State University system and most private programs complete 12 prerequisite courses and should have a minimum cumulative GPA of 3.0 to be competitive for admission. The nursing major is impacted at all CSU campuses, and additional admissions criteria are used (individuals with a 3.5 GPA are more competitive than individuals with a 3.0). Essays and work experience are not weighed in admissions decisions, so individuals should strive to earn the highest grades they can for admission. The lottery is not used, and most universities admit students twice per year. Prerequisite courses may be taken at community colleges, but it is imperative that individuals be familiar with articulation agreements and be sure to take courses that transfer. Training is available at San Jose State University, San Francisco State University and California State University East Bay.

BSN programs are also offered at private colleges and universities. Each program has its own set of entry requirements, but all have selective admissions and do look at factors other than just numbers. These programs tend to receive fewer applications because the tuition is much higher than in state-funded institutions. Private undergraduate nursing programs are offered at the University of San Francisco, Dominican University-San Rafael, and Samuel Merritt-Holy Names University.

Samuel Merritt also has an accelerated bachelor degree option that allows individuals with a previous non-nursing baccalaureate degree to earn a BSN in just 12 months. Tuition for this program is $42,000 (not including fees) and individuals must complete 11 prerequisites. Admission is considered to be competitive for this program-individuals should have a 3.0 GPA to be competitive in the admissions process. San Jose State also has an accelerated second bachelor degree option. The program is 18 months long and admission is highly competitive (minimum 3.4 GPA in 12 prerequisites and overall coursework to be considered). Students in the program receive financial assistance in exchange for a commitment to work for one of the organizations that is helping to fund the program. University of San Francisco has an accelerated second bachelor degree option also.

University of California-San FranciscoUniversity of California-San Francisco, San Francisco State University, and Samuel Merritt offer programs that train individuals with a non-nursing baccalaureate degree to become advanced practice nurses in as little as three years. Most programs are structured so that students are eligible to take the NCLEX after the first year of study so that they can work as nurses through the masters component of the program. Admission to these programs is highly competitive (University of California San Francisco is among the most selective program of its kind in the country-acceptance rates have ranged from 2-10% in recent years) and most individuals who are accepted have been successful in areas other than nursing and have earned high grades in their prerequisite and undergraduate coursework. Demand is high for experienced advanced practice nurses, and individuals who graduate from these programs are most often employed at graduation at a pay rate higher than BSN-prepared nurses. These programs are incredibly rigorous, and program selection often consists of several rounds of interviews and supplemental admissions materials over a period of six months so that admissions committees can select the most suitable candidates. Click here to view a list of programs statewide.

Immediately following graduation from a Registered Nursing program accredited by the Board of Registered Nursing, an individual takes the NCLEX-RN examination. Receiving eligibility to take the examination generally takes 4-6 weeks, so individuals often complete the paperwork while they are enrolled in a training program. Click here to read about the process of applying to take the examination.

The NCLEX examination is offered by computer (the test vendor is Pearson Vue and the test is offered at multiple locations) and tests an individual's knowledge of nursing principles and science, clinical and practical skills, and intellectual abilities essential to the practice of nursing. An individual must earn a passing score on each section of the NCLEX to be eligible for licensure in California. Individuals receive either their permanent RN license or a letter informing them that they did not pass the exam within 4 weeks of taking the exam. Click here to read frequently asked questions from the Board of Registered Nursing about the registered nursing licensing process. Nurses must renew their license every 2 years

Every year, there are individuals that complete accredited training programs but are not able to pass the exam on the first attempt, though this number is not considered to be abnormally high. Click here to view the NCLEX passage rates for graduates of accredited California nursing schools.

As a group, individuals who completed nurse training outside of the United States have significantly lower NCLEX-RN passage rates than US trained individuals. The NCLEX-RN is specific to United States nursing practice, training and measurement systems, and is offered only in English. There are programs to assist foreign-trained nurses with the NCLEX. One such program is offered through Jewish Vocational Services in San Francisco.

Click here to view the Nursing Career Ladder designed by the Healthcare Navigator.

Most individuals pursue an entry-level healthcare support position that can be completed in less than a year and that will allow them to work while completing prerequisite coursework and waiting for admission to RN programs. Individuals most often pursue certified nursing assistant/home health aide training because these programs are short and allow for heavy patient contact, but some choose to invest more than a year in training for an entry-level occupation. Phlebotomy programs in private schools (vocational colleges) take 4-8 months to complete, and there is an additional waiting period for licensure (waiting periods average 4-6 months) before the individual is able to work in the occupation. This can make phlebotomy training impractical for many One-Stop users. Medical Assisting is often a more attractive career option to individuals because programs can usually be completed 6-10 months(sometimes getting a clinical internship is a challenge and graduation is delayed), there is not a mandatory credential or waiting period before the individual is able to work, and medical assistants spend a significant part of their day interacting with patients and medical office staff, which is important for individuals who are looking to build transferable skills (to clarify, there is a dramatic gap between the duties and clinical skills of medical assistants and registered nurses. Medical assistant training is not transferable to nursing programs. However, getting experience in the medical office environment may be valuable because it will introduce the individual to working with patients and medical staff and may help them figure out if nursing suits them.). Though licensed vocational nurse would appear to be the most logical entry-level career option, prerequisites must be completed before applying to community colleges, programs are in high demand at the community college level (several hundred individuals apply for 25-35 spots), training takes 15 months to complete, and LVN training programs from vocational colleges are not often an option because cost is prohibitive (program costs range from $17,000-30,000), making LVN an impractical option for some individuals. Because LVN-RN transition programs are available in the Bay Area and some community college coursework does transfer to these programs, LVN may be a great option for individuals using the career ladder approach to become a registered nurse. Ultimately, individuals pursuing a career ladder to get to nursing must thoroughly investigate each entry-level occupation and demand for workers before making a decision. One-Stop advisors are available to assist clients through the career exploration process.

Arguably, the most difficult part of climbing the career ladder in nursing is moving from the first rung-which in the case of individuals using the One-Stop system translates to moving from an entry-level healthcare occupation such as Medical Assistant to Registered Nurse. This transition or career ladder step is complicated for a variety of reasons, but can almost feel impossible at times because of the factors associated with getting into programs, such as the extensive prerequisite requirements, prerequisite expiration dates, and lottery admission in the California Community College system. For individuals that do get into RN programs, the opportunities are virtually limitless once the first nursing degree is in hand and the individual passes the NCLEX-RN and gets licensed with the Board of Registered Nurses.

Many associate degree of nursing (ADN) prepared registered nurses choose to complete a bachelor of science-nursing (BSN) degree through accelerated study or extended study. For individuals with work experience, this can open up opportunities at the department supervisor level, which may increase annual earnings by $5-12/hr. ADN-BSN programs are available locally through Holy Names University (Oakland), JFK University-UCSF pathway program (this program awards a bachelor and masters degree), San Jose State University, San Francisco State, and the University of Phoenix (distance learning).

BSN prepared nurses may elect to pursue further training and earn a masters degree to become a clinical nurse specialist (CNS). CNSs are trained to be experts in a specific area of nursing, such as neonatology, emergency care, medical-surgical, nursing administration, gerontology, or public health, to name a few. Clinical nurse specialists are leaders in their particular nursing department or area, and their advanced degree and experience makes them sought after in the area of education as well. Demand for experienced clinical nurse specialists is very high, and most CNSs can earn $45-60/hr, depending on their specialty (because public health nurses work in public sector or non-profit roles more frequently, their wages may be considerably lower). These programs are held only at the master level and training options are available at San Francisco State University, University of San Francisco, University of California-San Francisco, San Jose State University, and Dominican University San Rafael.

Nurses with a bachelor degree may also elect to pursue additional training to become a nurse practitioner. Nurse practitioners (NP) complete master level training with specific emphasis on assessment and diagnosis. They may order laboratory tests, make diagnoses and prescribe under limited supervision by a physician. NPs are increasingly used in healthcare systems as a cost-saving complement to physician care, and there is strong demand for NPs, particularly in gerontology. NPs may earn $110k-150k/yr, depending on their schedule, level of experience, work environment and specialty area, and whether or not they are working in research (research may be less lucrative than clinical practice). NP training is available through Holy Names University, Samuel Merritt College, Stanford University (Primary Associate certificate for Family Nurse Practitioner only), San Francisco State University, San Jose State University, University of California-San Francisco, University of San Francisco, and the University of Phoenix.

Certified registered nurse anesthetists (CRNA) have been around for quite some time, but this is an area of advanced practice, master level nursing that is unfamiliar to many people. Accordinging to the American Association of Nurse Anesthetists, Certified Registered Nurse Anesthetists administer nearly two-thirds of all anesthetics given to patients each year in the United States and in some states, CRNAs are the sole anesthia providers in nearly 100% of the rural hospitals. Job prospects are strong for CRNA, but more than demand, most CRNAs are attracted to the profession because of the professional respect they garner and the high degree of autonomy and flexibility that CRNAs enjoy. CRNA work can be extremely lucrative–the Navigator interviewed one individual who earned more than $200,000 working as as a CRNA in 2005–but CRNAs also carry incredible amounts of responsibility. Approximately 1/2 of US CRNAs are men, which is highly significant considering the nursing workforce is less than 10% male. CRNA training is offered at the master level and is available locally through Samuel Merritt College.

Certified Nurse-Midwives are licensed to provide care and treatment to pregnant women and often deliver babies in patients' homes. In addition to hospitals, Nurses work for doctors and medical groups, public health agencies, and home care services. Nurse Midwifery training is available through University of California-San Francisco.

Nurses who complete a masters degree are highly sought after in the areas of education, research and administration. Nurses who complete a Ph.D in Nursing (offered locally through University of California-San Francisco) or a Doctor of Nursing Practice, a clinical nursing degree or a doctoral degree in a related discipline (sociology, education, educational psychology, and public health are popular choices-most individuals seek out a discipline related to their research interests), most often work in education at the university level, in research or in high level administration. There is a desperate need for doctoral degree-prepared nurses who can teach at the master level. Many individuals find this work highly rewarding-they are, in fact, shaping the nurse leaders and educators for their community and beyond-and individuals interested in a career in education or public administration are advised to seek out a faculty member to learn more about the vast opportunities for doctoral degree-prepared nurses.

NursingWorld - Web site for the American Nurses Association (contains links to other nursing associations)

Discover Nursing - Use this site to search for training programs by state and to get information on national shortages, scholarships, and career opportunities in nursing.

California Board of Registered Nursing (contains information on nursing schools, license application procedure, legislative and regulatory issues, and information about the NCLEX)

California Association for Nurse Practitioners - Professional Association for Nurse Practioners (Note: CANP has a Bay Area Chapter that is active in promoting NP education and career opportunities. Click here to visit the South Bay/Santa Cruz/Monterey chapter site, and here to visit the San Francisco/San Mateo chapter. This is a great association to get in touch with for individuals who are in a nursing program and want to know more about NP opportunities, and also for individuals who are contemplating a career change to nursing.