Individuals who work in hospitals, physicians' offices, outpatient treatment facilities, nursing facilities or patients' homes and provide supportive services for patients under the direction of a physician. When providing direct patient care, they observe, assess and record symptoms, reactions and progress in patients; assist physicians during surgeries, treatments and examinations; administer medications; and assist in convalescence and rehabilitation. Registered nurses also develop and manage nursing care plans, instruct patients and their families in proper care, and help individuals and groups take steps to improve or maintain their health. Included are advance practice nurses such as nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Advanced practice nursing is practiced by RNs who have specialized formal, post-basic education and who function in highly autonomous and specialized roles.