Registered Nurse

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Job Outlook:
Faster than average
Education: Bachelor's degree
Salary
High: $129,400.00
Average: $89,010.00
Hourly
Average: $42.80

What they do:

Assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients. May advise patients on health maintenance and disease prevention or provide case management. Licensing or registration required.

On the job, you would:

  • Record patients' medical information and vital signs.
  • Administer medications to patients and monitor patients for reactions or side effects.
  • Maintain accurate, detailed reports and records.

Important Qualities

Critical-thinking skills. Registered nurses must assess changes in the health status of patients, such as determining when to take corrective action.

Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and evaluate their health conditions. Nurses need to clearly explain instructions, such as how to take medication. They must work in teams with other health professionals and communicate patients’ needs.

Compassion. Registered nurses should be caring and empathetic when working with patients.

Detail oriented. Registered nurses must be precise because they must ensure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional resilience and the ability to cope with human suffering, emergencies, and other stressors.

Organizational skills. Nurses often work with multiple patients who have a variety of health needs. The ability to coordinate numerous treatment plans and records is critical to ensure that each patient receives appropriate care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as lifting patients. They may be on their feet for most of their shift.

Personality

A3 Your Strengths Importance

Characteristics of this Career

91% Dependability  -  Job requires being reliable, responsible, and dependable, and fulfilling obligations.
89% Cooperation  -  Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
89% Attention to Detail  -  Job requires being careful about detail and thorough in completing work tasks.
87% Concern for Others  -  Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
87% Stress Tolerance  -  Job requires accepting criticism and dealing calmly and effectively with high-stress situations.
87% Integrity  -  Job requires being honest and ethical.
84% Adaptability/Flexibility  -  Job requires being open to change (positive or negative) and to considerable variety in the workplace.
84% Initiative  -  Job requires a willingness to take on responsibilities and challenges.
78% Self-Control  -  Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
78% Leadership  -  Job requires a willingness to lead, take charge, and offer opinions and direction.
78% Independence  -  Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
75% Social Orientation  -  Job requires preferring to work with others rather than alone, and being personally connected with others on the job.
75% Persistence  -  Job requires persistence in the face of obstacles.
75% Achievement/Effort  -  Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
75% Analytical Thinking  -  Job requires analyzing information and using logic to address work-related issues and problems.
A3 Your Strengths Importance

Strengths

100% Social  -  Work involves helping, teaching, advising, assisting, or providing service to others. Social occupations are often associated with social, health care, personal service, teaching/education, or religious activities.
78% Investigative  -  Work involves studying and researching non-living objects, living organisms, disease or other forms of impairment, or human behavior. Investigative occupations are often associated with physical, life, medical, or social sciences, and can be found in the fields of humanities, mathematics/statistics, information technology, or health care service.
61% Conventional  -  Work involves following procedures and regulations to organize information or data, typically in a business setting. Conventional occupations are often associated with office work, accounting, mathematics/statistics, information technology, finance, or human resources.
A3 Your Strengths Importance

Values of the Work Environment

89% Relationships  -  Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
83% Support  -  Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
72% Achievement  -  Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
72% Independence  -  Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
64% Working Conditions  -  Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
61% Recognition  -  Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.

Aptitude

A3 Your Strengths Importance

Abilities | Cognitive, Physical, Personality

78% Deductive Reasoning  -  The ability to apply general rules to specific problems to produce answers that make sense.
78% Problem Sensitivity  -  The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
75% Oral Expression  -  The ability to communicate information and ideas in speaking so others will understand.
75% Oral Comprehension  -  The ability to listen to and understand information and ideas presented through spoken words and sentences.
75% Written Comprehension  -  The ability to read and understand information and ideas presented in writing.
75% Inductive Reasoning  -  The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
72% Speech Clarity  -  The ability to speak clearly so others can understand you.
72% Information Ordering  -  The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
72% Near Vision  -  The ability to see details at close range (within a few feet of the observer).
69% Speech Recognition  -  The ability to identify and understand the speech of another person.
69% Written Expression  -  The ability to communicate information and ideas in writing so others will understand.

Job Details

Responsibilities
Maintain medical facility records.
Monitor patient conditions during treatments, procedures, or activities.
Record patient medical histories.
Inform medical professionals regarding patient conditions and care.
Record patient medical histories.
Evaluate patient outcomes to determine effectiveness of treatments.
Collaborate with healthcare professionals to plan or provide treatment.
Analyze test data or images to inform diagnosis or treatment.
Order medical diagnostic or clinical tests.
Supervise patient care personnel.
Assist healthcare practitioners during examinations or treatments.
Prepare patients physically for medical procedures.
Assess patient work, living, or social environments.
Design public or employee health programs.
Communicate health and wellness information to the public.
Prepare medical supplies or equipment for use.
Maintain inventory of medical supplies or equipment.
Inform medical professionals regarding patient conditions and care.
Administer anesthetics or sedatives to control pain.
Immunize patients.
Treat acute illnesses, infections, or injuries.
Examine patients to assess general physical condition.
Diagnose medical conditions.
Treat medical emergencies.
Test biological specimens to gather information about patient conditions.
Prescribe medications.
Prescribe assistive medical devices or related treatments.
Direct healthcare delivery programs.
Advise medical personnel regarding healthcare issues.
Manage healthcare operations.
Train caregivers or other non-medical personnel.
Refer patients to other healthcare practitioners or health resources.
Advise communities or institutions regarding health or safety issues.
Design public or employee health programs.
Conduct research to increase knowledge about medical issues.
Monitor patient conditions during treatments, procedures, or activities.
Administer non-intravenous medications.
A3 Your Strengths Importance

Attributes & Percentage of Time Spent

99% Face-to-Face Discussions  -  How often do you have to have face-to-face discussions with individuals or teams in this job?
99% Telephone  -  How often do you have telephone conversations in this job?
98% Work With Work Group or Team  -  How important is it to work with others in a group or team in this job?
97% Contact With Others  -  How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?
89% Indoors, Environmentally Controlled  -  How often does this job require working indoors in environmentally controlled conditions?
88% Deal With External Customers  -  How important is it to work with external customers or the public in this job?
86% Importance of Being Exact or Accurate  -  How important is being very exact or highly accurate in performing this job?
86% Coordinate or Lead Others  -  How important is it to coordinate or lead others in accomplishing work activities in this job?
83% Electronic Mail  -  How often do you use electronic mail in this job?
82% Impact of Decisions on Co-workers or Company Results  -  What results do your decisions usually have on other people or the image or reputation or financial resources of your employer?
81% Exposed to Disease or Infections  -  How often does this job require exposure to disease/infections?
80% Responsible for Others' Health and Safety  -  How much responsibility is there for the health and safety of others in this job?
78% Deal With Unpleasant or Angry People  -  How frequently does the worker have to deal with unpleasant, angry, or discourteous individuals as part of the job requirements?
78% Physical Proximity  -  To what extent does this job require the worker to perform job tasks in close physical proximity to other people?
77% Freedom to Make Decisions  -  How much decision making freedom, without supervision, does the job offer?
76% Frequency of Decision Making  -  How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?
75% Structured versus Unstructured Work  -  To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals?
75% Wear Common Protective or Safety Equipment such as Safety Shoes, Glasses, Gloves, Hearing Protection, Hard Hats, or Life Jackets  -  How much does this job require wearing common protective or safety equipment such as safety shoes, glasses, gloves, hard hats or life jackets?
75% Time Pressure  -  How often does this job require the worker to meet strict deadlines?
74% Importance of Repeating Same Tasks  -  How important is repeating the same physical activities (e.g., key entry) or mental activities (e.g., checking entries in a ledger) over and over, without stopping, to performing this job?
74% Consequence of Error  -  How serious would the result usually be if the worker made a mistake that was not readily correctable?
74% Responsibility for Outcomes and Results  -  How responsible is the worker for work outcomes and results of other workers?
71% Frequency of Conflict Situations  -  How often are there conflict situations the employee has to face in this job?
A3 Your Strengths Importance

Tasks & Values

99% Assisting and Caring for Others  -  Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.
97% Documenting/Recording Information  -  Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
94% Getting Information  -  Observing, receiving, and otherwise obtaining information from all relevant sources.
91% Updating and Using Relevant Knowledge  -  Keeping up-to-date technically and applying new knowledge to your job.
90% Communicating with Supervisors, Peers, or Subordinates  -  Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
89% Performing General Physical Activities  -  Performing physical activities that require considerable use of your arms and legs and moving your whole body, such as climbing, lifting, balancing, walking, stooping, and handling materials.
89% Identifying Objects, Actions, and Events  -  Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
89% Making Decisions and Solving Problems  -  Analyzing information and evaluating results to choose the best solution and solve problems.
88% Organizing, Planning, and Prioritizing Work  -  Developing specific goals and plans to prioritize, organize, and accomplish your work.
88% Evaluating Information to Determine Compliance with Standards  -  Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
85% Establishing and Maintaining Interpersonal Relationships  -  Developing constructive and cooperative working relationships with others, and maintaining them over time.
85% Working with Computers  -  Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
79% Monitoring Processes, Materials, or Surroundings  -  Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
78% Interpreting the Meaning of Information for Others  -  Translating or explaining what information means and how it can be used.
77% Handling and Moving Objects  -  Using hands and arms in handling, installing, positioning, and moving materials, and manipulating things.
76% Guiding, Directing, and Motivating Subordinates  -  Providing guidance and direction to subordinates, including setting performance standards and monitoring performance.
75% Judging the Qualities of Objects, Services, or People  -  Assessing the value, importance, or quality of things or people.
75% Inspecting Equipment, Structures, or Materials  -  Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.
74% Developing and Building Teams  -  Encouraging and building mutual trust, respect, and cooperation among team members.
73% Analyzing Data or Information  -  Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
72% Coaching and Developing Others  -  Identifying the developmental needs of others and coaching, mentoring, or otherwise helping others to improve their knowledge or skills.
71% Thinking Creatively  -  Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
70% Training and Teaching Others  -  Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.
68% Coordinating the Work and Activities of Others  -  Getting members of a group to work together to accomplish tasks.
68% Processing Information  -  Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
68% Resolving Conflicts and Negotiating with Others  -  Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
67% Performing for or Working Directly with the Public  -  Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.

What Registered Nurses Do

Registered nurses
Registered nurses set up plans for patient care.

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their families.

Duties

Registered nurses typically do the following:

  • Assess patients’ conditions
  • Record patients’ medical histories and symptoms
  • Observe patients and record the observations
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute information to existing plans
  • Consult and collaborate with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze the results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

Most registered nurses work as part of a team with physicians and other healthcare specialists. Some registered nurses oversee licensed practical nurses, nursing assistants, and home health aides.

Registered nurses’ duties and titles often depend on where they work and the patients they work with. For example, an oncology nurse works with cancer patients and a geriatric nurse works with elderly patients. Some registered nurses combine one or more areas of practice. For example, a pediatric oncology nurse works with children and teens who have cancer.

Many possibilities exist for working with specific patient groups. The following list includes some examples:

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.

Cardiovascular nurses care for patients who have heart disease or heart conditions and people who have had heart surgery.

Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need close monitoring and treatment.

Genetics nurses provide screening, counseling, and treatment for patients with genetic disorders, such as cystic fibrosis.

Neonatal nurses take care of newborn babies who have health issues.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Public health nurses promote public health by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs.

Rehabilitation nurses care for patients who have temporary or permanent disabilities or have chronic illnesses.

Some nurses do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, or hospital administrators.

Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care by working with other nurses and medical staff to improve the quality of care that patients receive. They often serve in leadership roles and may educate and advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.

Work Environment

Registered nurses held about 3.2 million jobs in 2022. The largest employers of registered nurses were as follows:

Hospitals; state, local, and private 59%
Ambulatory healthcare services 18
Nursing and residential care facilities 6
Government 5
Educational services; state, local, and private 3

Ambulatory healthcare services includes industries such as physicians’ offices, home healthcare, and outpatient care centers. Nurses who work in home health travel to patients’ homes; public health nurses may travel to community centers, schools, and other sites.

Some nurses travel frequently in the United States and throughout the world to help care for patients in places where there are not enough healthcare workers.

Injuries and Illnesses

Registered nurses may spend a lot of time walking, bending, stretching, and standing. They are vulnerable to back injuries because they often must lift and move patients.

The work of registered nurses may put them in close contact with people who have infectious diseases, and they frequently come into contact with potentially harmful and hazardous drugs and other substances. Therefore, registered nurses must follow strict guidelines to guard against diseases and other dangers, such as accidental needle sticks and exposure to radiation or to chemicals used in creating a sterile environment.

Work Schedules

Nurses who work in hospitals and nursing care facilities usually work in shifts to provide round-the-clock coverage. They may work nights, weekends, and holidays. They may be on call, which means that they are on duty and must be available to work on short notice.

Nurses who work in offices, schools, and other places that do not provide 24-hour care are more likely to work regular business hours.

Getting Started

Education:
56%
Bachelor's Degree
23%
Post-Secondary Certificate - awarded for training completed after high school (for example, in agriculture or natural resources, computer services, personal or culinary services, engineering technologies, healthcare, construction trades, mechanic and repair technologies, or precision production)

How to Become a Registered Nurse

Registered nurses
Registered nurses must be able to effectively communicate with patients to understand their concerns and assess their health conditions.

Registered nurses usually take one of three education paths: a bachelor’s degree in nursing, an associate’s degree in nursing, or a diploma from an approved nursing program. Registered nurses must be licensed.

Education

Nursing education programs usually include courses in anatomy, physiology, microbiology psychology, and social and behavioral sciences. Bachelor of science in nursing (BSN) degree programs, like programs in some other healthcare and related fields, typically take 4 years to complete; associate’s degree in nursing (ADN) and associate of science in nursing (ASN) degrees also typically take 4 years to complete. Diploma programs, usually offered by hospitals or medical centers, typically take 2 to 3 years to complete. There are far fewer diploma programs than there are BSN, ADN, and ASN programs. All programs include supervised clinical experience.

In addition to science courses, bachelor's degree programs usually include education in communication, leadership, and critical thinking. A bachelor’s or higher degree is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.

Registered nurses with an ADN, ASN, or diploma may go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the field of nursing and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 year or more of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

Registered nurses must have a nursing license issued by the state in which they work. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).

Other requirements for licensing, such as passing a criminal background check, vary by state. Each state’s board of nursing provides specific requirements. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, or pediatrics. Although certification is usually voluntary, it demonstrates adherence to a specific level of competency, and some employers require it.

In addition, registered nursing positions may require cardiopulmonary resuscitation (CPR), basic life support (BLS), or advanced cardiac life support (ACLS) certification.

CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.

Advancement

Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuing education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses may advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions require a graduate degree in nursing or health services administration. Administrative positions require leadership skills, communication ability, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs may become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs need a master’s degree but many have a doctoral degree. APRNs may provide primary and specialty care, and in many states they may prescribe medications.

Other nurses work as postsecondary teachers or researchers in colleges and universities, which typically requires a Ph.D.

Job Outlook

Employment of registered nurses is projected to grow 6 percent from 2022 to 2032, faster than the average for all occupations.

About 193,100 openings for registered nurses are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.

Employment

Demand for healthcare services will increase because of the large number of older people, who typically have more medical problems than younger people. Registered nurses also will be needed to educate and care for patients with chronic conditions, such as diabetes and obesity.

Job growth is expected across most types of healthcare settings, including hospitals and outpatient care centers that provide same-day services, such as chemotherapy, rehabilitation, and surgery. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings.

Contacts for More Information

For more information about registered nurses, including credentialing, visit

American Nurses Association

For more information about nursing education and being a registered nurse, visit

American Society of Registered Nurses

Johnson & Johnson, Discover Nursing

National League for Nursing

National Student Nurses' Association

For more information about undergraduate and graduate nursing education, nursing career options, and financial aid, visit

American Association of Colleges of Nursing

For more information about the National Council Licensure Examination (NCLEX-RN) and a list of individual state boards of nursing, visit

National Council of State Boards of Nursing

For more information about clinical nurse specialists, including a list of accredited programs, visit

National Association of Clinical Nurse Specialists

Occupational Requirements Survey

For a profile highlighting selected BLS data on occupational requirements, see

Registered nurses (PDF)

Similar Occupations

This table shows a list of occupations with job duties that are similar to those of registered nurses.

Occupation Job Duties Entry-Level Education Median Annual Pay, May 2022
Dental hygienists Dental Hygienists

Dental hygienists examine patients for signs of oral diseases, such as gingivitis, and provide preventive care, including oral hygiene.

Associate's degree $81,400
Diagnostic medical sonographers Diagnostic Medical Sonographers and Cardiovascular Technologists and Technicians

Diagnostic medical sonographers and cardiovascular technologists and technicians operate special equipment to create images or to conduct tests.

Associate's degree $78,210
EMTs and paramedics EMTs and Paramedics

Emergency medical technicians (EMTs) and paramedics assess injuries and illnesses, provide emergency medical care, and may transport patients to medical facilities.

Postsecondary nondegree award $39,410
Licensed practical and licensed vocational nurses Licensed Practical and Licensed Vocational Nurses

Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) provide basic medical care.

Postsecondary nondegree award $54,620
nurse anesthetists nurse midwives and nurse practitioners image Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

Nurse anesthetists, nurse midwives, and nurse practitioners coordinate patient care and may provide primary and specialty healthcare.

Master's degree $125,900
Physician assistants Physician Assistants

Physician assistants examine, diagnose, and treat patients under the supervision of a physician.

Master's degree $126,010
Social workers Social Workers

Social workers help people prevent and cope with problems in their everyday lives.

See How to Become One $55,350
Respiratory therapists Respiratory Therapists

Respiratory therapists care for patients who have trouble breathing—for example, because of a chronic condition such as asthma.

Associate's degree $70,540

Information provided by CareerFitter, LLC and other sources.

Sections of this page includes information from the O*NET 27.3 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license.

CareerFitter, LLC has modified all or some of this information. USDOL/ETA has not approved, endorsed, or tested these modifications.