Registered Nurses - What They Do

Registered nurses and registered psychiatric nurses provide direct nursing care to patients, deliver health education programs and provide consultative services regarding issues relevant to the practice of nursing. They are employed in a variety of settings including hospitals, nursing homes, extended care facilities, rehabilitation centres, doctors' offices, clinics, community agencies, companies, private homes and public and private organizations or they may be self-employed.

Job duties

This group performs some or all of the following duties:

General duty registered nurses

Assess patients to identify appropriate nursing interventions
Collaborate with members of an interdisciplinary health team to plan, implement, co-ordinate and evaluate patient care in consultation with patients and their families
Administer medications and treatments as prescribed by a physician or according to established policies and protocols
Monitor, assess, address, document and report symptoms and changes in patients' conditions
Operate or monitor medical apparatus or equipment
Assist in surgery and other medical procedures
May supervise licensed practical nurses and other nursing staff
May develop and implement discharge planning process on admission of patients
May teach and counsel patients and their families on health-related issues in collaboration with other health care providers.
Registered nurses may specialize in areas such as surgery, obstetrics care, psychiatric care, critical care, pediatrics, geriatrics, community health, occupational health, emergency care, rehabilitation or oncology.

Occupational health nurses

Develop and implement employee health education programs and provide registered nursing care in private businesses and industry.

Community health nurses

Provide health education and registered nursing care in public health units and through home visits, manage complex home care cases, participate in community needs assessment and program development, conduct disease screening and deliver immunization programs.

Psychiatric nurses

Provide nursing care, supportive counselling and life skills programming to patients in psychiatric hospitals, mental health clinics, long-term care facilities and community-based settings.

Nursing consultants

Provide consultative services to institutes, associations and health care organizations regarding issues and concerns relevant to the nursing profession and nursing practice.

Nursing researchers

Engaged in research activities related to nursing, as self-employed or as employed by hospitals, public and private organizations and governments.

Clinical nurses

Provide leadership, advice and counsel on the provision of research-based care for specific patient groups within the care of particular health care organizations.

Job titles

emergency care nurse
public health nurse
community health nurse
critical care nurse
clinical nurse
occupational health nurse
private duty nurse
registered nurse (R.N.)
registered psychiatric nurse (R.P.N.)
nursing consultant
nurse researcher
intensive care nurse

Employment Requirements

This is what you typically need for the job:

Registered nurses

Completion of a university, college or other approved registered nursing program is required.
Additional academic training or experience is required to specialize in a specific area of nursing.
A master's or doctoral degree in nursing is usually required for clinical nurse specialists, clinical nurses, nursing consultants and nursing researchers.
Registration with a regulatory body is required in all provinces and territories.

Registered psychiatric nurses

Completion of a university or college registered psychiatric nursing program is required.
Registration with a regulatory body is required in Manitoba, Saskatchewan, Alberta, British Columbia and the Yukon.

Essential Skills

Reading

Read e-mail publicizing professional development opportunities such as upcoming seminars, workshops, conferences, and courses. (1)
May read instructions on laboratory requisition forms to confirm directives to be followed prior to testing. (1)
Read labels on medication or medical products to be informed of instructions to be followed for administration or manipulation. (1)
Read bulletins from national or provincial associations to keep abreast of changes in health care policies and standards; and learn about emerging trends in the profession, new techniques and practices. (2)
May refer to the Merck Manual of Diagnosis and Therapy to retrieve information on diseases and medications. For example, registered nurses may read about liver diseases to gain knowledge of signs, symptoms and treatments. (3)
Refer to policy and procedure manuals to verify and confirm rules and regulations during the establishment of work or treatment plans. (3)
May read protocols addressing treatment plans or assessment procedures to identify relevant patient queries when evaluating their medical conditions. These protocols are typically 5-10 pages in length and require specialized medical knowledge to understand and apply contents. (3)
Read the Compendium of Pharmaceutical and Specialties (CPS) manual to learn about medications, especially about their potential side effects, contraindications, interactions with other medications, and administration requirements. (4)
When working in hospital settings, read patients' files to gain information about their medical histories, current medical conditions, care requirements, test results and special needs. The information is reviewed and synthesized to assess patient status, determine appropriate care, brief other healthcare professionals, and establish whether additional interventions are required. (4)
Read nursing and medical handbooks and manuals such as the Strategies for Immunization Handbook, Fundamentals of Nursing, Clinical Practice, Child Protection Guidelines, or Care Beyond Care Handbook to obtain information about specific diseases, procedures and conditions. Registered nurses draw on this research when assessing patients' conditions and developing work or treatment plans. Specialized knowledge is required to apply this medical information. (4)
Read articles in nursing, medical and clinical journals such as Nursing Research, Journal of Nursing Care, or Medical Care to learn about new practices, products, and techniques; and to gain information about specific medical conditions and recommended treatments or programs. Registered nurses may need to analyze, synthesize and evaluate information reported in these articles. Specialized knowledge of medical terminology is required to integrate technical information into current practices. (5)

Document use

Read labels on medications to verify patients' names, dosages, administration schedules, ingredients and reconstitution instructions. (1)
Record daily activities, times and notes in log books to maintain permanent records of patient care administered, clinical work performed, research tasks undertaken and meetings attended. (1)
May request specific tests to be performed such as blood work or specimen sample by completing requisition forms. Registered nurses check off the performed tests from the provided lists and enter physicians' comments in the designated spaces. (1)
May plot height in centimetres and weight in kilograms on growth charts. Registered nurses read, interpret and compare these entries to assess growth patterns and identify anomalies. (2)
May use alphabet boards, pictures or other visual cues to communicate with patients. (2)
May record vital sign readings and other measurements such as blood pressures, temperatures, respiratory rates, pulse rates, oxygen saturation levels, fluid intake and outputs, heights and weights in patients' files. The data is entered and organized according to specific formats to promote quick retrieval by other health care professionals. (2)
May interpret flowcharts depicting protocols such as assessment procedures or treatment plan development. Registered nurses are expected to follow the instructions on the flowcharts to sequence tasks correctly and make decisions based on the processes described in the charts. (2)
May plot vital sign data such as temperatures, blood pressures, and heart rates on line graphs to track changes over a specific period of time. Registered nurses synthesize information from these graphs when assessing patients' conditions and determine their needs for possible interventions. (3)
May read and interpret graphs in medical and nursing journals to understand research findings. Registered nurses may also interpret bar graphs and pie charts in government reports to become informed about specific health issues such as health care needs in community settings, home care or ambulatory care. (3)
May read and interpret anatomical drawings and diagrams to explain medical conditions or disease processes to patients and their families. (3)
Scan tables of readings and test results, such as blood sugar, protein, and cholesterol levels, and hemoglobin and platelet counts. The data is used to establish appropriate treatments and interventions. Reading lab results requires an understanding of testing procedures and the relationships between results. (3)
Read and synthesize information from medical forms, graphs, radiographs and tables which comprise patients' files. These documents may include medical histories, prescribed medications, vital sign readings and clinical observations. Registered nurses refer to these documents to learn about patients' conditions, determine patients' care priorities and prepare test requisitions according to physicians' specifications. (4)

Writing

Write short notes to remember tasks or requests from patients. Registered nurses also document daily activities by noting them in log books. (1)
Write short e-mail to request information from colleagues, pharmacists, lab technicians, or other health professionals. For example, registered nurses may write e-mail to lab technicians to ask for clarifications on test results or to inquire when they will them so they can make follow-ups with the patients. (1)
May complete lab requisition forms which include instructions to lab technicians. (2)
Write comments in patients' files to record observations, test results and changes requested by physicians in relation to care and medications. The writing must be concise and accurate as other health professionals could review patients' files to make treatment decisions. (3)
Write reports several pages in length when transferring patients to another hospital, department or when discharging patients. These reports summarize the data collected from all the health professionals involved in the care of the patients. The reports also detail the treatments that were administered and the registered nurses' recommendations for follow-up actions. (4)
Write detailed procedures and protocols for patient assessments or elaboration of treatment plans. Information is researched and presented using guidelines established by the clinic, hospital or organization. These documents are several pages in length and require specialized knowledge. (4)
May write detailed assessments of multiple pages following visits to patients or calls from patients. Protocols are outlined, recommendations discussed and any new information added. The assessments are often sent to other health professionals for follow-up or filing. The information must be stated clearly and concisely for other medical personnel or government authorities to act upon the information and recommendations. (4)

Numeracy

Money Math

May add up the cost of items purchased when preparing expense reports. (1)
May calculate charges for travel to schools, hospitals or homes by multiplying the distance driven by a set rate per kilometre. (1)

Scheduling, Budgeting & Accounting Math

Consult daily work plans to learn about assigned tasks, appointments with patients and break scheduling. (1)
In hospital settings, may schedule appointments for patients; for example, x-rays, CT scans, occupational therapy, physiotherapy or ultrasounds. Registered nurses take into consideration emergencies and cancellations to ensure effective scheduling of these appointments. (2)
May analyze costs to choose which drug company to purchase medication for a clinic or heath centre. The analysis takes many factors into consideration such as cost and availability of medication. (2)
Adjust daily schedules to accommodate unforeseen special circumstances such as medical emergencies or crises. (2)
May verify appointment schedules for physicians working shifts in a hospital setting to ensure accuracy of bookings and efficient use of available time. Registered nurses make adjustments to physicians' schedules to accommodate cancellations and emergencies. (2)

Measurement and Calculation Math

May measure vaccines or medications in milligrams. (1)
May use measuring tapes to measure head circumferences, abdominal girths or limb lengths. (1)
Calculate the amount of time it will take to deplete an intravenous (IV) bag. For example, if there are 450 cc's left in an IV bag and it is running at 100 cc's per hour, then the bag will need to be replaced within 4 hours. (2)
Use specialized equipment such as glucometers to measure blood sugar levels, oximeters to measure the oxygen saturation levels, and digital thermometers to measure temperatures. (3)
May calculate and measure the amount of a drug to be administered when reconstituting a medication from solid to liquid. For example, when amoxicillin (Apo-amoxi), a medication to treat pneumonia, is reconstituted to 8 millilitres, it equals 1 gram. However, a patient may only need 325 milligrams. Registered nurses use proportion to, calculate the amount of millilitres to be administered. (3)
May calculate IV drip rates by counting the number of drips per 15 seconds to ensure patients are receiving the correct amount of fluids and medications. (3)

Data Analysis Math

Compares measurement readings from specialized equipment such as glucometers or oximeters to established norms to determine if the readings are within acceptable ranges. (1)
Plot patients' heights and weights on charts, and track gains or losses over time to assess health status. (1)
May measure fluid inputs and outputs and compare results over time to determine if patients are ingesting enough liquids or retaining fluids. (2)
Compare data such as patients' hemoglobin and platelet counts, blood sugar levels and protein levels, with established norms to determine if results fall within acceptable ranges. (2)
May monitor changes in vital sign indicators such as temperatures, blood pressures and heart rates to identify trends and medical conditions. For example, increases in temperature may be a sign of infection. (2)
May analyze survey results to determine community health priorities and ascertain public opinion on various health issues. This may involve computing means, analyzing trends or predicting future needs. (3)

Numerical Estimation

May estimate temperature by touching the patients' foreheads. (1)
Estimate the amount of time required to complete rounds in a hospital or to make visits in a community setting. They base their estimations on patients' medical conditions, location and accessibility, social interaction needs as well as time of day. (2)

Oral communication

May talk to suppliers to obtain information about medical equipment options for patients recovering at home. (1)
May communicate with pharmacists to inform them of errors on medication orders, request information on specific medications or ask them to prepare orders for patients. (2)
Discuss work assignments and care procedures with other nurses. Registered nurses may provide recommendations pertaining to optimal practices and workload to other nurses. (2)
May have to negotiate with suppliers to obtain the best prices and services for patients for the purchase of specific medical equipment. (2)
Communicate with patients to obtain information on their current state, lend support when informed of pain or discomfort, explain medical procedures and respond to questions or concerns relating to their health status or treatment interventions. These discussions can be emotional and patients may require comforting and reassurance. (3)
Address health education topics with small groups within the community. For example, registered nurses share information about vaccination schedules with kindergarten classes and their parents, discuss healthy sexual practices with high school classes, or address breast self-examination with women's groups. (3)
Record clinical notes on audiotape to be transcribed or listened to by other health professionals involved in specific cases. The information is often very technical and must be communicated clearly and concisely. Registered nurses may also listen to clinical notes recorded by other nurses or health professionals involved in common cases. These notes may include information pertaining to patients' conditions and behaviours, ongoing or recommended treatments or requests for follow-up by physicians or other health professionals. (3)
Interact with physicians and other health professionals to exchange information about patients' treatment plans, request tests, recommend referrals, discuss communication strategies involving the patients and their families, provide information on test results, obtain information on medications prescribed to patients, or ask for clarifications of diagnoses. (3)
May participate in meetings with other health professionals to discuss observations relating to patient progress. Registered nurses exchange information with colleagues and make suggestions for improving treatment plans and implementing specific procedures. (3)
Communicate and coordinate with colleagues during emergencies. They may exchange information on patient status or provide directions in relation to what needs to be done to resolve the situation. The situation may be chaotic, stressful and life-threatening; therefore, communication must be clear, concise and accurate. (4)
Communicate with patients and their families when patients have been diagnosed with a critical illness. Because the discussions are emotional, registered nurses must ensure that the language and the tone used are appropriate. Registered nurses also reassure patients and family members, and listen carefully to their concerns. Communication may be difficult if patients are not able to verbalize their thoughts; in these cases, information is exchanged using alphabet boards, pictures and signs. (4)
May communicate information to police officers, distress centres or other authorities when faced with individuals displaying suicidal tendencies or abusive behaviours. Registered nurses follow established protocols to ensure all information required is transmitted efficiently. This communication takes place within a highly emotional context and demands a controlled response. Miscommunication in these situations can lead to serious injuries or death. (4)

Thinking

Problem Solving

May have patients awaiting treatment whose files are incomplete or outdated. They arrange for missing documents to be forwarded immediately and for outdated files to be amended. (1)
Do not have all the necessary equipment required to intervene in a specific situation. Registered nurses request the required equipment and make use of what they have available until additional resources are provided. (1)
Observe that a patient is not responding to treatment as expected. Registered nurses cease unsuccessful treatments to prevent further complications and inform the attending physicians. For example, registered nurses may observe that patients with high liquid intakes have low urine outputs, which can increase risk of renal failure or cardiac pulmonary problems. They reduce the IV flow and check patients' blood pressure, electrolyte levels and breathing patterns. (2)
Contend with abnormal infant and child growth patterns. For newborn babies, registered nurses explore possible causes for the lack of weight gain such as poor breast-feeding techniques. For older children, they may make a referral to a specialist for further testing. (2)
May have to move or reposition patients. Registered nurses ask for assistance from other nurses or staff members. If registered nurses have to move patients by themselves, they use proper techniques to decrease the risk of injuries. (2)
Discover that medications sent by the pharmacy do not match those indicated in patients' files. Registered nurses verify that physicians have not changed patients' prescriptions. They then contact the pharmacies to report the mistakes and request the correct prescription to be filled. (2)
May suspect that children under the age of 16 are being abused by their parents. Registered nurses contact the proper authorities such as social services or the police to report suspected cases. (2)
Face emergencies requiring immediate assistance. For example, registered nurses must contact anaesthetists regarding an adverse anaesthetic reaction as quickly as possible to prevent complications that could be fatal. (2)
Speak to extremely agitated patients on the phone. Registered nurses ask for the callers' names and identify specific problems by asking targeted questions. Registered nurses try to calm irate patients by adopting a non-confrontational communication style. They call the appropriate authorities should callers become abusive, irrational or potentially suicidal. (3)
Deal with patients whose medical conditions deteriorate suddenly and unexpectedly. Registered nurses follow specific protocols established for emergency cases; errors may be fatal. (3)
May have problems communicating with patients due to language barriers, patient disabilities or medical conditions such as stroke. In the case of language barriers, registered nurses try to find interpreters who can assist with communications. If the communication problems are attributable to disabilities or medical conditions, registered nurses may consult colleagues for assistance or develop systems of communication involving gestures and visual cues. (4)

Decision Making

May decide which community resources to refer to help them understand specific health issues. Registered nurses use many kinds of resources such as pamphlets, websites, books, films, health centres and subject experts. Registered nurses make these decisions according to the relevance and accessibility of resources and people's immediate needs. (1)
When working in hospital settings, decide in what order they will visit patients. Registered nurses determine their priorities after reviewing all patients' files and taking into account emergencies and critical cases. (2)
When working in community settings or clinics, decide whether to send patients to hospitals depending on the criticality of the patients' medical conditions. (2)
May decide the content of health-related brochures or pamphlets to be distributed in the community. Registered nurses take into consideration factors such as public interest, demographics and the type of information to be communicated. (2)
When working in a hospital setting, decide when it is appropriate to order medication from the pharmacy. Registered nurses base their decision on the amount of medication remaining and the quantity required in the short term. (2)
May decide the dosage of non-prescription medication to recommend to patients over the phone. To make this decision, registered nurses take into consideration age, weight and relevant medical conditions. (3)
May decide to change protocols when assessing callers' medical conditions over the phone. Registered nurses make their decisions based on information provided by callers as well as changes in callers' tones, attitudes, responses and levels of cooperation. (3)
May decide to increase or decrease percentage of oxygen provided to patients according to saturation readings. Experience and background knowledge are important when making these decisions. Failure to intervene appropriately can cause cardiac failure. (3)
Decide when to contact physicians if patients' medical conditions are deteriorating. Registered nurses assess criticality by reviewing the patients' files, examining the patients and, if warranted, ordering specific tests. Based on the results, registered nurses decide whether the immediate involvement of physicians is necessary. The accuracy of their decisions is crucial since mistakes or errors in judgment can have major impacts on patients' health. (4)

Critical Thinking

Assess and prioritize each assigned task in order to decide which tasks need immediate attention. Registered nurses may also evaluate task assignments to determine if assistance is required. (2)
May evaluate various pharmaceutical providers by taking into consideration factors such as response times, prices, educational services, communications and support from sale representatives. (2)
Assess conditions to determine if patients are improving, deteriorating or stabilizing by monitoring vital signs such as blood pressures, temperatures and heart and pulse rates. Results may indicate a necessity for further testing, a modification of diet or fluid intake or a change in medication. (3)
May assess patients' functioning using a variety of tests such as the Functional Motor Skills Inventory. Registered nurses may reference test results to patient performance on other tests and to patient observation sessions to determine appropriate treatment plans. (3)
Prioritize emergency cases by considering the criticality of injuries or medical conditions, number of specialists on duty and availability of beds and equipment. Registered nurses may be dealing with life and death situations in which errors in judgement could have fatal consequences. (4)
May assess the probability of problems arising during surgery following a review of patients' files. Registered nurses review patients' medical histories, the severity of medical conditions, patients' ages, and the length and complexity of surgeries to be performed to identify support measures and contingency plans. (4)
May, via telephone, evaluate the urgency and authenticity of a reported abusive situation. This requires adherence to specific assessment protocols. Incorrect assessments of situation's severity could result in serious injury or continued abuse. (4)

Job Task Planning and Organizing

Own Job Planning and Organizing

Registered nurses are responsible for organizing their tasks according to workload assignments. When working in a hospital setting, registered nurses are appointed to specific patient cases. They review patients' files to establish priorities and task sequencing. They need to take into account medication and treatment schedules as well as patients' appointments in other departments, such as the x-ray, orthopaedic or physiotherapy units. Registered nurses must remain flexible to accommodate unplanned events, emergencies, and on-going interruptions from colleagues, other health professionals, and patients. When working in a medical clinic or a health centre, registered nurses plan their days according to patient appointment schedules. They also must respond appropriately to emergencies and simultaneous demands from patients, technicians, doctors and receptionists. Registered nurses often need to coordinate their work efforts with those of other nurses or health professionals. Registered nurses plan their work activities in compliance with established work procedures and protocols, as well as in accordance with the mission statements of establishments or organizations that employ them. (3)

Planning and Organizing for Others

Registered nurses may have to delegate tasks to other registered nurses, licensed practical nurses or nurse aides. Senior RN's with supervisory responsibilities also organize daily schedules and determine priorities for their co-workers. They coordinate their work with that of colleagues and other health professionals to provide efficient health care to patients. (3)

Significant Use of Memory

Remember patients' and family members' names and faces.
When working in a hospital setting, remember the health condition of patients for whom they are responsible.
Recall the contact information for physicians and medical laboratories.
Remember policies and procedures adhered to by hospitals, medical clinics or health centres.
Remember tasks and priorities assigned at the beginning of each day.
Memorize acronyms, formulae and drug names when preparing prescriptions, administering medications or providing advice about non-prescription drugs.
If they are surgical nurses, recall what equipment is necessary for particular surgeries.
Remember specific medical devices that can assist patients when they return home after hospitalization.
Keep in mind patients' requests for follow-up actions.

Finding Information

Use the Compendium of Pharmaceutical and Specialties (CPS) manual to retrieve information about medications. (1)
May search for lab test results or treatment paths in organization-specific databases. (1)
Consult other registered nurses or health professionals to gather information and opinions related to patient cases, treatment plans, procedures and protocols. (2)
Consult patients' files to find information about patient health status to make appropriate decisions concerning treatment plans or follow-ups. Information from several documents and data sets must be cross-referenced. (2)
May refer to policy and procedure manuals to verify rules and regulations during the establishment of a work plan. They need to go through multiple pages to locate particular information and select the appropriate information to use when building the work plan. (2)
May use the internet to research community and government health services available. Registered nurses may also use the internet to learn about medical conditions or diseases, treatments and recommended medications. They need to analyze and synthesize this information. (3)
Consult patients when assessing their health conditions to gain the information required by physicians or other health professionals to recommend appropriate treatment plans. (3)
When dealing with unusual cases or diseases, conduct research using the internet, medical and nursing manuals, journals, and health department publications. Registered nurses integrate and synthesize information from these sources to identify appropriate treatments. (4)

Digital technology

Use word processing. For example, they use basic features of word-processing software to create letters, memos and reports or enter comments in patients' files using pre-set formats. (1)
May use spreadsheets. For example, they may record numerical information such as glucose levels, medications or follow-up appointments. (1)
Use databases. For example, they enter data into or search patient records for information about test results, treatments and medical conditions. (2)
May use graphics software. For example, they use presentation software to create clinical presentations for colleagues or groups of students about topics such as awareness and prevention of Sexually Transmitted Infections. These presentations may include graphical representations and tables. (2)
Use communications software. For example, they use e-mail to send and receive health-related attachments and documents. (2)
Use the internet. For example, they conduct keyword searches using a search engine to locate information on specific diseases or medical conditions, medications or recommended treatment plans. (2)
May use other computer and software applications. For example, they may use E-Learning platforms. This requires a basic understanding of drag and drop functions, scrolling and data entry. (2)

Other Essential Skills:

Working with Others

Depending on various factors, registered nurses may work independently or as part of a team. They sometimes work independently when meeting with patients, organizing daily tasks or developing individualized treatment plans. They also work independently when there are limited health care resources, such as in smaller organizations or establishments. They may also provide mentoring to new employees. However, they need to coordinate their activities with other nurses and health professionals when providing health care to patients in larger organizations or facilities. For example, they must consult other health professionals to get details on patients' medical conditions before deciding on treatment plans. They may work in a team with registered nurses and other health professionals to ensure that appropriate care is provided to patients in a timely manner. Co-ordination and integration of team tasks and responsibilities may be critical to ensure that health services are effective and efficient. (3)

Continuous Learning

There is a need for on-going training and learning in the field of nursing. Upon graduation, registered nurses are not necessarily familiar with all the protocols and procedures that may be specific to certain situations, organizations or establishments. They keep abreast of new technologies, diseases, practices and treatments by attending conferences, seminars and workshops or by reading medical and nursing journals, books, professional association bulletins or papers on the internet. They also have opportunities for on-site learning from other more experienced nurses or health professionals. They are required to renew their CPR certification on an annual basis or every two years according to provincial regulations. They are primarily responsible for setting their own learning goals, although some provincial nursing associations may have specific requirements. For example, some nursing associations may require registered nurses to participate to conferences or professional development seminars and give credits for these participations. (3)