Key Responsibilities and Required Skills for Acute Care Registered Nurse

🎯 Role Definition

An Acute Care Registered Nurse (RN) delivers high-quality, evidence-based nursing care to adult and/or pediatric patients in inpatient settings such as medical-surgical units, telemetry, step-down units, and short-stay acute care. The role is accountable for comprehensive patient assessment, individualized care planning, safe medication administration, clinical monitoring, interdisciplinary collaboration, and timely, accurate electronic health record (EHR) documentation. The Acute Care RN acts as an advocate for patients and families, ensures clinical compliance with institutional and regulatory standards, and drives positive patient outcomes through proactive clinical judgment and effective communication.

📈 Career Progression

Typical Career Path

Entry Point From:

New graduate RN residency or hospital RN internship programs
Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) transitioning to RN
Travel nurse or agency RN with acute-care med/surg or telemetry experience

Advancement To:

Charge Nurse / Shift Lead
Clinical Nurse Specialist (CNS) or Nurse Educator
Nurse Manager / Unit Director
Advanced Practice Registered Nurse (APRN) — e.g., Nurse Practitioner (NP)

Lateral Moves:

Telemetry or Progressive Care Unit (PCU) Nurse
Emergency Department (ED) Nurse
Case Manager or Discharge Planner

Core Responsibilities

Primary Functions

Conduct comprehensive, head-to-toe patient assessments on admission, during shift, and at transitions of care, synthesizing history, physical findings, diagnostics, and risk factors to construct individualized nursing diagnoses and prioritized care plans that improve clinical outcomes.
Administer medications and IV therapy safely and accurately (including push medications, continuous and intermittent IV infusions, PCA, titratable drips), following the Five Rights, institutional policies, and medication reconciliation procedures while monitoring for adverse reactions and reporting concerns to the prescribing clinician.
Monitor cardiac telemetry and interpret rhythm changes, recognizing and escalating arrhythmias, ischemic changes, or hemodynamic instability to the multidisciplinary team in a timely manner to prevent decompensation.
Provide post-operative and post-procedure nursing care, including pain assessment and management, wound and drain care, assessment for surgical complications, and coordination of specialty consults and diagnostics to facilitate recovery and timely discharge.
Perform evidence-based wound care (including staging, dressing selection, negative pressure wound therapy set-up and monitoring), assess for infection, and coordinate with wound care teams and specialists for complex wound management.
Manage sepsis screening and rapid intervention bundles (laudable sepsis protocols), initiating sepsis order sets, drawing time-sensitive labs, administering appropriate antibiotics, fluids, and monitoring lactate clearance per hospital guidelines.
Triage and prioritize multiple complex patients using strong clinical judgment and critical thinking — balancing acuity, safety, and flow while anticipating clinical deterioration and reallocating resources or calling rapid response as needed.
Provide patient and family education tailored to literacy and cultural needs, including medication teaching, disease process education, discharge instructions, and post-hospital care planning to reduce readmissions and improve adherence.
Accurately document assessments, interventions, medication administration, and interdisciplinary communication in the EHR (e.g., Epic, Cerner) in real time to support continuity of care, billing, and regulatory compliance.
Collaborate proactively with physicians, advanced practice providers, social workers, physical/occupational therapists, case managers, pharmacy, and ancillary services to drive coordinated care plans, expedite diagnostics, and facilitate safe discharges.
Respond to codes (Code Blue, rapid response) and emergencies, performing ACLS/BLS interventions, airway management support, chest compressions, and defibrillation per role competency while communicating effectively with the resuscitation team.
Initiate and maintain central line and PICC line care, including dressing changes, sterile access technique, flushing protocols, and infection surveillance to prevent catheter-related bloodstream infections.
Perform specimen collection and timely transport (blood cultures, arterial blood gases, urinalysis, wound cultures), interpret basic lab trends, and escalate abnormal results to the treatment team to expedite diagnosis and treatment.
Implement fall prevention, skin integrity and restraint protocols, conducting hourly rounding, bed alarm management, and patient safety education to minimize adverse events.
Provide venipuncture, IV starts, and blood product administration following blood bank policies, monitoring for transfusion reactions and completing required documentation and reporting.
Lead bedside shift report that communicates acuity, safety risks, and plan-of-care to ensure seamless handoffs and reduce information gaps during transitions.
Participate in medication reconciliation at admission, transfer, and discharge, identifying discrepancies and coordinating with pharmacy and prescribing clinicians to ensure medication safety.
Supervise, delegate, and mentor nursing assistive personnel (CNA, PCA) and new staff, ensuring tasks are assigned appropriately according to scope of practice and unit needs while maintaining accountability for delegated care.
Apply infection prevention best practices (hand hygiene, isolation precautions, PPE use) and adhere to hospital infection control policies to limit hospital-acquired infections and maintain a safe environment.
Use clinical pathways, protocols, and order sets to standardize care for common acute conditions (e.g., CHF exacerbation, COPD, DKA, stroke, pneumonia) and contribute to improved throughput and outcomes.
Conduct ongoing pain assessment and multimodal pain management, coordinating with pharmacy and pain services for complex pain control regimens while monitoring for side effects and opioid stewardship.
Support safe patient transitions by completing discharge planning activities, patient education, home health referrals, equipment orders, and follow-up appointment coordination to reduce readmission risk.
Maintain competency with bedside equipment (monitors, infusion pumps, ventilator basics, suction, oxygen delivery devices) and report malfunctioning equipment per policy to ensure uninterrupted patient care.
Participate in daily interdisciplinary rounds, presenting patient status, goals, and barriers to discharge while advocating for needed resources to achieve timely, safe transitions of care.

Secondary Functions

Serve as a preceptor or mentor for new hires and student nurses, delivering structured orientation, competency validation, and constructive feedback to ensure clinical readiness.
Participate in unit-based performance improvement initiatives (e.g., reducing CLABSI, CAUTI, falls) by collecting data, testing interventions, and implementing evidence-based changes.
Attend and contribute to unit meetings, nurse practice councils, and hospital committees to influence policy, practice updates, and quality improvement priorities.
Document and report incidents, near-misses, and sentinel events in the safety reporting system and engage in root cause analysis and corrective action planning as requested.
Maintain inventory control of unit supplies, medications, and specialty equipment; coordinate with supply chain and pharmacy for timely replenishment.
Assist with staffing flexibility and float assignments as needed to cover short staffing or patient surge while maintaining safe nurse-patient ratios and continuity of care.
Support clinical research activities and protocol-driven care by identifying eligible patients, obtaining informed consent per study protocol, collecting data, and ensuring adherence to research requirements.
Contribute to training initiatives such as mock code drills, simulation-based education, and competency weeks to sustain clinical skills and emergency preparedness.

Required Skills & Competencies

Hard Skills (Technical)

Acute patient assessment and advanced clinical judgment for inpatient populations (med-surg, telemetry, post-op)
Medication administration competency, IV infusion management, and titratable drip experience
Cardiac telemetry monitoring and recognition of dysrhythmias
Electronic Health Record (EHR) proficiency (Epic, Cerner, MEDITECH — documentation, order entry, MAR)
Wound care and ostomy management, dressing selection, and negative pressure wound therapy basics
Central line/PICC maintenance, sterile dressing changes, and CLABSI prevention practices
Basic and advanced certifications: BLS (required), ACLS (required/preferred), PALS (preferred for pediatric or mixed units)
Venipuncture and phlebotomy skills, blood administration, and transfusion protocol adherence
Triage, prioritization, and rapid assessment skills for emergent situations
Familiarity with sepsis bundles, DVT prophylaxis protocols, and hospital-acquired condition prevention
Use and troubleshooting of bedside technology: cardiac monitors, infusion pumps, oxygen delivery systems, and suction devices

Soft Skills

Strong clinical judgment and critical thinking under pressure
Clear, compassionate patient and family education skills with cultural sensitivity
Effective verbal and written communication for multidisciplinary collaboration and handoffs
Time management, organization, and ability to prioritize competing demands during high-acuity shifts
Teamwork, adaptability, and the ability to lead bedside teams or act as shift resource RN
Professionalism, accountability, and ethical decision-making in clinical practice
Emotional resilience, stress management, and self-awareness to maintain patient-focused care
Conflict resolution and negotiation skills when coordinating care with providers and services

Education & Experience

Educational Background

Minimum Education:

Associate Degree in Nursing (ADN) or Nursing Diploma from an accredited program; active RN license in the state of practice.

Preferred Education:

Bachelor of Science in Nursing (BSN) strongly preferred for professional development and leadership trajectory; Magnet-recognized facilities often prefer BSN-prepared nurses.

Relevant Fields of Study:

Nursing
Healthcare / Health Sciences
Clinical Practice / Medical-Surgical Nursing

Experience Requirements

Typical Experience Range:

0–3 years (new graduate RN residency programs accepted) up to 1–3 years preferred for med-surg/telemetry roles.

Preferred:

1–3+ years of acute inpatient nursing experience, telemetry experience or progressive care/step-down background preferred for higher-acuity units.
Prior experience with EHR systems (Epic/Cerner), code team participation, and basic quality improvement project involvement is advantageous.
Current certifications: BLS required; ACLS preferred/required depending on unit; specialty certifications (e.g., CCRN, TNCC) are a plus.

Keywords: Acute Care Registered Nurse, RN, inpatient nursing, medical-surgical, telemetry, EHR, Epic, medication administration, wound care, IV therapy, ACLS, BLS, patient assessment, care coordination, discharge planning, quality improvement, sepsis bundle, telemetry nurse, clinical judgment.