Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they might attain, maintain, or recover optimal health and quality of life. Nursing is the nation's largest health care profession, with more than 3.1 million registered nurses nationwide. Of all licenced RNs, 2.6 million or 84.8% are employed in nursing. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in Nursing (BSN) degree . Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licencing exam. (The number of diploma programmes has declined steadily -- to less than 10 percent of all basic RN education programmes -- as nursing education has shifted from hospital-operated instruction into the college and university system.)

Nurses might be differentiated from additional health care providers by their approach to patient care, training, and scope of practice. Nurses practise in a wide diversity of practise areas with a different scope of practise and level of prescriber authority in each. Many nurses provide care within the ordering scope of physicians, and this traditional role has come to shape the historic public image of nurses as care providers. Notwithstanding nurses are permitted by most jurisdictions to practise independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialised credentials, and a large number of of the traditional regulations and provider roles are changing.

Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family and additional team members, that focuses on treating illness to improve quality of life. In the U.S. (and increasingly the United Kingdom), advanced practise nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and additional therapies, depending on individual state regulations. Nurses might help coordinate the patient care performed by additional members of an interdisciplinary health care team such as therapists, medical practitioners and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.

History

Traditional

Nursing historians face the challenge of determining whether care provided to the sick or injured in antiquity was nursing care. In the fifth century BC, for example, the Hippocratic Collection in places describes skilled care and observation of patients by male "attendants", who might have been early nurses. Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of nurse as "the different parts or members of the body as mentioned before including the skin, can't be correctly described by one who isn't well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts."

Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian, Islamic and Buddhist traditions amongst others. Phoebe, mentioned in Romans 16 has been described in a large number of sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. The religious roots of modern nursing remain in evidence today in a large number of countries. One example in the United Kingdom is the use of the honorific "sister" to refer to a senior nurse.

During the Reformation of the sixteenth century, Protestant reformers shut down the monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Those nuns who had been serving as nurses were given pensions or told to get married and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession suffered a major setback for approximately 200 years.

19th century

Florence Nightingale laid the foundations of professional nursing throughout the Crimean War. Her Notes on Nursing became popular. The Nightingale model of professional education, having set up the first school of nursing that's connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870.

Other important nurses in the development of the profession include:

Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services throughout this period. In turn, the modern deaconess movement began in Germany in 1836. Within a half century there were over 5,000 deaconesses in Europe.

Formal use of nurses in the modern military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign (1882) and the Sudan Campaign (1883).

20th century

A recruiting poster for Australian nurses from World War I.

Hospital-based training came to the fore in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses wasn't uncommon by employers, physicians and educational providers.

Many nurses saw active duty in World War I, but the profession was transformed throughout the second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any additional occupation. The Nazis had their own Brown Nurses, 40,000 strong. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.

The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organisation led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.

In the nineteenth and early twentieth century, nursing was considered a women's profession, just as doctoring was a men's profession. With increasing expectations of workplace equality throughout the late twentieth century, nursing became an officially gender-neutral profession, though in practise the percentage of male nurses remains well below that of female physicians in the early twenty-first century.

Definition

Although nursing practise varies both through its various specialties and countries, these nursing organisations offer the following definitions:

Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are additionally key nursing roles.

The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.

As a profession

A nurse in Indonesia examining a patient

The authority for the practise of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practise is defined and governed by law, and entrance to the profession is regulated at the national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to fitting a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practise as well as training in clinical skills.

Nurses care for individuals of all ages and cultural backgrounds who're healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. A licensed practical nurse (LPN) (also referred to as a licenced vocational nurse, registered practical nurse, enrolled nurse, and state enrolled nurse) works independently or with a registered nurse (RN). The most significant differentiation between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. For example, Canada requires a bachelor's degree for the RN and a two-year diploma for the LPN. A registered nurse provides scientific, psychological, and technological knowledge in the care of patients and families in a large number of health care settings. Registered nurses might earn additional credentials or degrees.

In the USA, multiple educational paths will qualify a candidate to sit for the licensure examination as a registered nurse. The (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is additionally referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN). The (BSN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programmes in the USA, graduates are eligible to sit for a licencing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a multiple choice exam nurses take to become licensed. It costs two-hundred dollars to take the NCLEX. It examines a nurses ability to properly care for a client. Study books and practise tests are available to purchase.

Nurses might follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting. Other options include: Pediatrics, Neonatal, Maternity, OBGYN, Geriatrics, Ambulatory, or Nurse Anesthetists. There are a large number of additional options nurses can explore depending on the type of degree and education acquired. RNs might additionally pursue different roles as advanced practise registered nurses.

Nurses aren't truly doctor's assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting additional nurses. Registered Nurses treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses additionally help doctors perform diagnostic tests. Nurses are almost always working on their own or with additional nurses. Nurses will assist doctors in the emergency room or in trauma care when help is needed.

Gender issues

Despite equal opportunity legislation, nursing has continued to be a female-dominated profession. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is represented around the world. Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, which all have more male than female nurses. In Europe, in countries such as Spain, Portugal, Czechoslovakia and Italy, over twenty percent of nurses are male. The number of male-registered nurses in the United States between 1980 and 2000s doubled.

There are a large number of myths about nursing, including the profession and the people that work as a nurse. One of the most common myths is that all nurses are females. The nursing industry is dominated by females, but there are male nurses in the profession as well. A study in 2011 shows that 91 percent of all nurses in the United States were female, and nine percent were male. Although females are more common, male nurses receive more pay. In the same survey, male nurses average $60,700 per year and female nurses average $51,100 per year. Male nurses have the highest percentage as nurse anesthetists, rating at 41%.

Theory and process

Nursing practise is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected based on the care setting and population served. In providing nursing care, the nurse uses both nursing theory and best practise derived from nursing research.

In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like additional disciplines, the profession has developed different theories derived from at times diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to achieve specific goals.

Scope of activities

Activities of daily living assistance

Assisting in activities of daily living (ADL) are skills required in nursing as well as additional professions such as nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination.

Medication

Nurses don't have the authority to prescribe medications, with few exceptions. All medications administered by nurses must be from a medication order from a licenced practitioner. Nurses are legally responsible for the drugs they administer and there might be legal implications when there's an error in a drug order and the nurse can be expected to have noted and reported error. In the United States, nurses have the right to refuse any medication administration that they deem to be harmful to the patient. In the United Kingdom there are a few nurses who have taken additional specialist training that allows them to prescribe certain medications.

Patient education

The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits.

Specialities

Nursing is the most diverse of all healthcare professions. Nurses practise in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.

The major populations are:

  • communities/public
  • family/individual across the lifespan
  • adult-gerontology
  • pediatrics
  • neonatal
  • women's health/gender-related
  • psych/mental health

There are additionally specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing.

Practice settings

A convalescing woman trying in vain to rouse her slumbering hired nurse: the cat scavenges her food and the candle sets light to the carpet. Coloured etching by Nikolaus Heideloff, 1807, after Thomas Rowlandson

Nurses practise in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They additionally work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses additionally work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to guarantee that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, at times known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have additionally been delving into the world of informatics, acting as consultants to the creation of computerised charting programmes and additional software.

Occupational hazards

File:Sleep Deprivation – Shift Work & Long Work Hours Put Nurses at Risk.webm
A video describing occupational hazards that exist among nurses

Internationally, there's a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios.

The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to additional professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labour involved in nursing, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They additionally have quite high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.

In the United States, the Occupational Health Safety Network (OHSN) is an electronic surveillance system developed by the National Institute for Occupational Safety and Health (NIOSH) to address health and safety risks among health care personnel, including nurses. It focuses on three high risk and preventable events: musculoskeletal injuries from patient handling activities; slips, trips, and falls; and workplace violence. Hospitals and additional healthcare facilities can upload the occupational injury data they already collect for analysis and benchmarking with additional de-identified facilities, in order to identify and implement timely and targeted interventions.

Nurses are additionally at risk for violence and abuse in the workplace. Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by additional hospital personnel. 57 percent of American nurses reported in 2011 that they had been threatened at work; seventeen percent were physically assaulted.

Prevention

There are a number of interventions that can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customised to individuals. Stress management programmes can reduce anxiety, sleep disorders, and additional symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organisational and individual interventions together is most effective at reducing stress on nurses.

Worldwide

Australia

Catholic religious institutes were influential in the development of Australian nursing, founding a large number of of Australia's hospitals - the Irish Sisters of Charity were first to reach in 1838 and established St Vincent's Hospital, Sydney in 1857 as a free hospital for the poor. They and additional orders like the Sisters of Mercy, and in aged care the Sisters of the Little Company of Mary and Little Sisters of the Poor founded hospitals, hospices, research institutes and aged care facilities around Australia.

A census in the 1800s found several hundred nurses working in Western Australia throughout the colonial period of history, this included Aboriginal female servants who cared for the infirm.

The state nursing licencing bodies amalgamated in Australia in 2011 under the federal body AHPRA (Australian Health Practitioner Registration Authority). Several divisions of nursing licence is available and recognised around the country.

  • Enrolled nurses might initiate a few oral medication orders with a specific competency now included in national curricula but variable in application by agency.
  • Registered nurses hold a university degree (enrolled nurses can progress to registered nurse status and do get credit for previous study)
  • Nurse practitioners have started emerging from postgraduate programmes and work in private practice.
  • Mental health nurses must complete further training as advanced mental health practitioners in order to administer client referrals under the Mental Health Act.

Australia enjoys the luxury of a national curriculum for vocational nurses, trained at TAFE colleges or private RTO. Enrolled and registered nurses are identified by the department of immigration as an occupational area of need, although registered nurses are always in shorter supply, and this increases in proportion with specialization.

In 1986 there were a number of rolling industrial actions around the country, culminating when five thousand Victorian nurses went on strike for eighteen days. The hospitals were able to function by hiring casual staff from each other's striking members, but the increased cost forced a decision in the nurses' favour

European Union

In the European Union, the profession of nurse is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for nurse in the EU member states, EEA countries and Switzerland. This list is covered by the Directive 2005/36/EC .

Iran

Nursing educational programme in Iran is similar to the nursing educational programme in additional countries from a few aspects. Holding secondary school diploma and passing the entrance exam is necessary for the admission in this course. Entrance exam to governmental universities and Azad University is held on separate basis. Duration of associate degree course of operating room and anaesthesia is 2 years, bachelor's degree in nursing is 4 years and master's degree in nursing is 2- 2.5 years and PhD degree in nursing is 4–5 years.

In the beginning, nursing educational programme was the part of medical educational program. On the basis of this structure, the nurse follows the instruction of physician without any question. Nowadays, nursing educational programme in Iran has been progressed and after the year 1992 considering the community base care, the nursing educational programme additionally has changed. At present nursing education is held in 43 governmental nursing colleges and 63 nursing colleges of Azad University. Governmental universities' students don't have to pay tuition fee, but in Azad University which is a private university, the students have to pay necessary expenses. PhD degree programme is held only in governmental universities under the supervision of Ministry of Health and Ministry of Sciences.

In bachelor's degree program, nursing students start the clinical work from second term and pass till the completion of sixth term simultaneously with theoretical subjects. seventh and eighth terms are allocated for training program. At present nursing educational programme in throughout Iran is the same and is compiled under the supervision of Supreme Council of Ministry of Health, Treatment and Medical Education. Nursing students take the theoretical subjects, training and internship courses in various sections of educational hospitals and hospitals that affiliated to universities. Students' learning, in clinical sections is performed under the direct supervision and guidance of nursing instructors, but in the final year, activities of students mainly performs under the supervision of nursing personnel and alternate supervision of nursing instructors.

Students, throughout the years of study have opportunity to create relation with patients in the various sections especially intensive care units and to achieve experiences. Students' progress in clinical environments is from simple issues toward harder issues. At present practical nursing degree and associate degree Nursing Program has been cancelled and Iranian nurses must hold bachelor's degree in order to work in Iran from accredited universities confirmed by the Ministry of Health.

Nursing Groups in Iran

  • Nurse

Nurse is a person who's holding four years university degree and executes works relating to nursing profession including taking care of patients, perform health and medical services, educational, research and managerial affairs. At present annually 6000 persons are graduated in the bachelor's degree programme in nursing.

  • Practical Nurse

A person who's holding secondary school diploma in nursing and have completed 2 years programme in nursing and cooperate in activities of nurses in medical sections under the supervision of nurses.

  • Nursing Assistant

A person who's holding secondary school diploma and passing short term programme for the execution of initial cares of patients under the supervision of nurses.

  • Operating Room Technician

These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years programme are in charge of performing professional duties in operation room for preparing patients for surgery and necessary cooperation with surgeons at the time of surgery. These persons by passing the exam are eligible to continue uncontinuous bachelor's degree course in nursing.

  • Anesthesia Technician

These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years programme in Anesthesia, are in charge of performing profession duties in the operating room in the field of anaesthesia including preparing the patients for anaesthesia and necessary cooperation with anesthesiologists at the time of operation. These persons by passing exam are eligible to continue uncontinuous bachelor's degree course in nursing.

  • Emergency medical technician

These persons after obtaining secondary school diploma and passing entrance exam of university and obtaining technician diploma are in change of performing affairs including rendering first aid services to the patients and emergency victims resulting from accidents with motor vehicles, explosion, debris, falling from height, fractures, burns, poisonings, cuts, drowning, industrial accidents (cutting of limbs), patients with heart diseases and baby delivering.

  • Master in Nursing

Nurses after obtaining bachelor's degree and passing the entrance exam are eligible to continue their study in geriatric nursing, paediatric nursing, medical surgical nursing, community health nursing, psychiatric nursing and nursing education. These persons after graduation mainly become in charge of nurses' education or management of medical sections. Duration of this programme is 2.5 years. At present annually 150 persons are graduated in master's degree programme in nursing.

  • PhD in Nursing

Nurses by holding master's degree after passing entrance exam, are eligible to continue their study in PhD in the field of Nursing. Duration of this programme is 4 years and the graduates mainly will work in educational and research sections. At present annually 20 persons are graduated in this program.

Nursing jobs in Iran

According to the censes at present approximately 120,000 nurses are working in Iran in various sections. Most of them are working in hospitals and health centres belong to Ministry of Health, Treatment & Medical Education. Also, nurses are working in the hospitals affiliated to social security organization, armed forces, private sector and charity sector.

Within the last years of independence, nurses' activities are established in offices of consultancy and rendering nursing services at home. Nurses by establishment these centres can render consultant and care services to the client.

At present to work as a nurse only holding accredited academic degree is sufficient, but there are programmes for nurses to take RN examination after graduation.

Also, upon the approval and execution of continuous educational act, the Iranian nurses should obtain score of 15 every year in various educational courses held by the Ministry of Health of Universities, Scientific Associations and Nursing organization.

Iranian Nursing Organization (INO)

Having an independent organisation which can defend the rights of nurses and to follow up nurses' problems was the long time wishes of Iranian nurses. Before Islamic revolution in 1979, a few efforts were taken in this respect which finally results to establishment of Iranian Nurses Association and activities were taken in this respect. After the victory of Islamic revolution, this association additionally cancelled its activities and after that, number of associations mainly with political and professional formation was established, but the main problem of nurses was still present. Gradually in the year 1994 with the efforts of numbers of persons mostly nursing students and faculty member, the preliminary step was taken for the establishment of nursing organization. This preliminary nucleus started its work in the name of Nursing Coordination council with the instruction of students.

This council had correspondences with the president, speaker of parliament, ministry of health, treatment and medical education in connexion with problems of nursing society. Also this organisation had correspondence with nursing colleges for unity throughout the country.

After this date till March 2001, number of state seminars were held in various cities and finally on March 5.2001, generalities of formation of Nursing Organization which was in the agenda of Islamic Consultative Assembly and approved, was finally approved in an open session on Aug.12.2001. Finally with the procurement of comments of Guardian's Organization in Jan.2002, Establishment Act of Nursing Organization was approved by the parliament.

The first election of board of directors throughout the country was performed on Sept.20.2002 and members of 85 boards of directors of districts were elected throughout the country with the direct vote of nurses. The board of directors of the first Supreme of Organization, was elected on Dec.8.2002.

United Kingdom

To practise lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "Registered Nurse" can only be granted to those holding such registration. This protected title is laid down in the Nurses, Midwives and Health Visitors Act, 1997. From April 2016, nurses in the United Kingdom are expected to revalidate every three years.

First and second level

First-level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles such as RGN (registered general nurse), RSCN (registered sick children's nurse), RMN (registered mental nurse) and RNMS (registered nurse (for the) mentally subnormal). The titles used now are similar, including RNA (registered nurse adult), RNC (registered nurse child), RNMH (registered nurse mental health) and RNLD (registered nurse learning disabilities).

Second-level nurse training is no longer provided, however they're still legally able to practise in the United Kingdom as a registered nurse. Many have now either retired or undertaken conversion courses to become first-level nurses. They are entitled to refer to themselves as registered nurses as their registration is on the Nursing & Midwifery Council register of nurses, although most refer to themselves as ENs or SENs.

Advanced practice

  • Nurse practitioners – Most of these nurses obtain a minimum of a master's degree, and a desired post grad certificate. They often perform roles similar to those of physicians and physician assistants. They can prescribe medications as independent or supplementary prescribers, although are still legally regulated, unlike physician's assistants. Most NPs have referral and admission rights to hospital specialties. They commonly work in primary care (e.g. GP surgeries), A&E departments, or paediatrics although they're increasingly being seen in additional areas of practice. In the UK, the title "nurse practitioner" is legally protected.
  • Specialist community public health nurses – traditionally district nurses and health visitors, this group of research and publication activities.
  • Lecturer-practitioners (also called practise education facilitators) – these nurses work both in the NHS, and in universities. They typically work for 2–3 days per week in each setting. In university, they train pre-registration student nurses (see below), and often teach on specialist courses for post-registration nurses
  • Lecturers – these nurses aren't employed by the NHS. Instead they work full-time in universities, both teaching and performing research.

Managers

Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles (see above), this has become a less attractive option.

Nonetheless, a large number of nurses fill positions in the senior management structure of NHS organizations, a few even as board members. Others choose to stay a little closer to their clinical roots by fitting clinical nurse managers or modern matrons.

Nurse education

Nursing in the United Kingdom

Pre-registration

In order to become a registered nurse, one must complete a programme recognised by the Nursing and Midwifery Council (NMC) . Currently, this involves completing a degree, available from a range of universities offering these courses, in the chosen branch specialty (see below), leading to both an academic award and professional registration as a first level registered nurse. Such a course is a 50/50 split of learning in university (i.e. through lectures, assignments and examinations) and in practise (i.e. supervised patient care within a hospital or community setting).

These courses are three (occasionally four) years' long. The first year is known as the common foundation programme (CFP), and teaches the basic knowledge and skills required of all nurses. Skills included in the CFP might include communication, taking observations, administering medication and providing personal care to patients. The remainder of the programme consists of training specific to the student's chosen branch of nursing. These are:

  • Adult nursing.
  • Child nursing.
  • Mental health nursing.
  • Learning disabilities nursing.

As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification. Notwithstanding those nurses who hold a diploma, or even a certificate in nursing are still able to legally practise in the UK, although they're able to undertake university modules to obtain enough credits to top up to a degree.

Midwifery training is similar in length and structure, but is sufficiently different that it isn't considered a branch of nursing. There are shortened (18 month) programmes to allow nurses already qualified in the adult branch to hold dual registration as a nurse and a midwife. Shortened courses lasting 2 years additionally exist for graduates of additional disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation program.

As of 2016 student nurses in the UK can apply a bursary from the government to support them throughout their nurse training, and might additionally be eligible for a student loan, although there has been speculation that this won't be available in the future.

Before Project 2000, nurse education was the responsibility of hospitals and wasn't based in universities; hence a large number of nurses who qualified prior to these reforms don't hold an academic award.

Post-registration

After the point of initial registration, there's an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practise (PREP) requirements.

There are additionally opportunities for a large number of nurses to gain additional clinical skills after qualification. Cannulation, venipuncture, intravenous drug therapy and male catheterization are the most common, although there are a large number of others (such as advanced life support) which a few nurses will undertake.

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part-time. Many nurses prefer this option to gaining a degree initially, as there's often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it was additionally much more lucrative, as diploma students get the full bursary throughout their initial training, and employers often pay for the degree course as well as the nurse's salary.

In order to become specialist nurses (such as nurse consultants, nurse practitioners etc.) or nurse educators, a few nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and a few nurses choose to study for PhDs or additional higher academic awards. District nurses and health visitors are additionally considered specialist nurses, and in order to become such they must undertake specialist training. This is a one-year full-time degree.

All newly qualifying district nurses and health visitors are trained to prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings typically useful to those carrying out these roles. Many of these (and other) nurses will additionally undertake training in independent and supplementary prescribing, which allows them (as of 1 May 2006) to prescribe almost any drug in the British National Formulary. This has been the cause of a great deal of debate in both medical and nursing circles.

Canada

History

Canadian nursing dates all the way back to 1639 in Quebec with the Augustine nuns. These nuns were trying to open up a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America. In the nineteenth century there were a few Catholic orders of nursing that were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training programme was started at the General and Marine Hospital in St. Catharines in Ontario.

Education

All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses Association to continue their education to receive a baccalaureate degree. They believe that this is the best degree to work towards because it results in better patient outcomes. In addition to helping patients, nurses that have a baccalaureate degree will be less likely to make small errors because they have a higher level of education. A baccalaureate degree additionally gives a nurse a more critical opinion, which gives him or her more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian provinces and territories except for the Yukon and Quebec require that all nurses must have a baccalaureate degree. The basic length of time that it takes to obtain a baccalaureate degree is four years. Notwithstanding Canada does have a condensed programme that's two years long.

Nursing specialty certification is available through the Canadian Nurses Association in nineteen practise areas. Some of those specialties are cardiovascular nursing, community health nursing, critical care nursing, emergency nursing, gerontological nursing, medical-surgical nursing, neuroscience nursing, oncology nursing, orthopedic nursing, psychiatric/mental health nursing, and rehabilitation nursing. Certification requires practise experience and passing a test that's based on competencies for that specialty.

Public opinion

Canadian nurses hold a lot of responsibility in the medical field and are considered vital. According to the Canadian Nurses Association, "They expect RNs to develop and implement multi-faceted plans for managing chronic disease, treating complex health conditions and assisting them in the transition from the hospital to the community. Canadians additionally look to RNs for health education and for strategies to improve their health. RNs assess the appropriateness of new research and technology for patients and adjust care plans accordingly".

Japan

History

Nursing wasn't an established part of Japan's healthcare system until 1899 with the Midwives Ordinance. From there the Registered Nurse Ordinance came into play in 1915. This established a legal substantiation to registered nurses all over Japan. A new law geared towards nurses was created throughout World War II. This law was titled the Public Health Nurse, Midwife and Nurse Law and it was established in 1948. It established educational requirements, standards and licensure. There has been a continued effort to improve nursing in Japan. In 1992 the Nursing Human Resource Law was passed. This law created the development of new university programmes for nurses. Those programmes were designed to raise the education level of the nurses so that they can be better suited for taking care of the public.

Types of nurses

Japan only recognises four types of nursing and they're Public Health Nursing, Midwifery, Registered Nursing and Assistant Nursing.

Public health

This type of nursing is designed to help the public and is additionally driven by the public's needs. The goals of public health nurses are to monitor the spread of disease, keep vigilant watch for environmental hazards, educate the community on how to care for and treat themselves, and train for community disasters.

Midwifery

Nurses that are involved with midwifery are independent of any organization. A midwife takes care of a pregnant woman throughout labour and postpartum. They assist with things like breastfeeding and caring for the child.

Nursing Assistant

Individuals who're assistant nurses follow orders from a registered nurse. They report back to the licenced nurse about a patient's condition. Assistant nurses are always supervised by a licenced registered nurse.

Education

In 1952 Japan established the first nursing university in the country. An Associate Degree was the only level of certification for years. Soon people began to want nursing degrees at a higher level of education. Soon the Bachelor's degree in Nursing (BSN) was established. Currently Japan offers doctorate level degrees of nursing in a good number of its universities.

There are three ways that an individual could become a registered nurse in Japan. After obtaining a high school degree the person could go to a nursing university for four years and earn a bachelor's degree, go to a junior nursing college for three years or go to a nursing school for three years. Regardless of where the individual attends school they must take the national exam. Those who attended a nursing university have a bit of an advantage over those who went to a nursing school. They can take the national exam to be a registered nurse, public health nurse or midwife. In the cases of become a midwife or a public health nurse, the student must take a one-year course in their desired field after attending a nursing university and passing the national exam to become a registered nurse. The nursing universities are the best route for someone who wants to become a nurse in Japan. They offer a wider range of general education classes and they additionally allow for a more rigid teaching style of nursing. These nursing universities train their students to be able to make critical and educated decisions when they're out in the field. Physicians are the ones who're teaching the potential nurses because there aren't enough available nurses to teach students. This increases the dominance that physicians have over nurses.

Students that attend a nursing college or just a nursing school receive the same degree that one would who graduated from a nursing university, but they don't have the same educational background. The classes offered at nursing colleges and nursing schools are focused on more practical aspects of nursing. These institutions don't offer a large number of general education classes, so students who attend these schools will solely be focusing on their nursing educations while they're in school. Students who attend a nursing college or school do have the opportunity to become a midwife or a public health nurse. They have to go through a training institute for their desired field after graduating from the nursing school or college. Japanese nurses never have to renew their licenses. Once they have passed their exam, they have their licence for life.

Today

Like the United States, Japan is in need of more nurses. The driving force behind this need this is the fact that country is ageing and needs more medical care for its people. The country needs a rapid increase of nurses however things don't seem to be turning around. Some of the reasons that there's a shortage are poor working conditions, an increase in the number of hospital beds, the low social status of nurses, and the cultural idea that married women quit their jobs for family responsibilities. On average, Japanese nurses will make around 280,000 yen a month, which is one of the higher paying jobs. however, physicians make twice the amount that nurses do in a year. Similar to additional cultures, the Japanese people view nurses as subservient to physicians. They are considered lesser and oftentimes negative connotations are associated with nurses. According to the American Nurses Association article on Japan, "nursing work has been described using negative terminology such as 'hard, dirty, dangerous, low salary, few holidays, minimal chance of marriage and family, and poor image'".

Some nurses in Japan are trying to be advocates. They are promoting better nursing education as well as promoting the care of the elderly. There are a few organisations that unite Japanese nurses like the Japanese Nursing Association (JNA). The JNA isn't to be confused with a union, it is simply a professional organisation for the nurses. Members of the JNA lobby politicians and produces publications about nursing. According to the American Nurses Association's article on Japan the JNA, "works toward the improvement in nursing practise through a large number of activities including the development of a policy research group to influence policy development, a code of ethics for nurses, and standards of nursing practice". The JNA additionally provides certification for specialists in mental health, oncology and community health. The JNA isn't the only nursing organisation in Japan. There are additional subgroups that are typically categorised by the nurses' specialty, like emergency nursing or disaster nursing. One of the older unions that relates to nursing is the Japanese Federation of Medical Workers Union which was created in 1957. It is a union that includes physicians as well as nurses. This organisation was involved with the Nursing Human Resource Law.

Taiwan

  • In Taiwan, the Ministry of Health and Welfare is in charge of the regulation of nursing. The Taiwan Union of Nurses Association (TUNA) is the union unit in Taiwan, fighting for nurses on payment and working time issues.

United States

Two nurses in Arizona, 1943

In the US, scope of practise is determined by the state or territory in which an RN is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually the making of such rules and regulations is delegated to a state board of nursing, which performs day-to-day administration of these rules, licences nurses and nursing assistants, and makes decisions on nursing issues. It should be noted that in a few states the terms "nurse" or "nursing" might only be used in conjunction with the practise of a registered nurse (RN) or licensed practical or vocational nurse (LPN/LVN).

In the hospital setting, registered nurses often delegate tasks to LPNs and unlicensed assistive personnel.

RNs aren't limited to employment as bedside nurses. They are employed by physicians, attorneys, insurance companies, governmental agencies, community/public health agencies, private industry, school districts, ambulatory surgery centers, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation (outcome and process) in a large number of areas such as biology, psychology, human development, and health care systems.

Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.

Educational and licensure requirements

Diploma in Nursing

The oldest method of nursing education is the hospital-based diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy, physiology, microbiology, nutrition, chemistry, and additional subjects at a college or university, then move on to intensive nursing classes. Until 1996, most RNs in the US were initially educated in nursing by diploma programs. According to the Health Services Resources Administration's 2000 Survey of Nurses only six percent of nurses who graduated from nursing programmes in the United States received their education at a Diploma School of Nursing.

Associate Degree in Nursing

The most common initial nursing education is a two-year Associate Degree in Nursing (Associate of Applied Science in Nursing, Associate of Science in Nursing, Associate Degree in Nursing), a two-year college degree referred to as an ADN. Some four-year colleges and universities additionally offer the ADN. Associate degree nursing programmes have prerequisite and corequisite courses (which might include English, Math and Human Anatomy and Physiology) and ultimately stretch out the degree-acquiring process to about three years or greater.

Bachelor of Science in Nursing

The third method is to obtain a Bachelor of Science in Nursing (BSN), a four-year degree that additionally prepares nurses for graduate-level education. For the first two years in a BSN program, students usually obtain general education requirements and spend the remaining time in nursing courses. In a few new programmes the first two years can be substituted for an active LPN licence along with the required general studies. Advocates for the ADN and diploma programmes state that such programmes have an on the job training approach to educating students, while the BSN is an academic degree that emphasises research and nursing theory. Some states require a specific amount of clinical experience that's the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions that wouldn't usually be available to those with an ADN, but isn't necessary for most patient care functions. Nursing schools might be accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).

Graduate education

Advanced education in nursing is done at the master's and doctoral levels. It prepares the graduate for specialisation as an advanced practise registered nurse (APRN) or for advanced roles in leadership, management, or education. The clinical nurse leader (CNL) is an advanced generalist who focuses on the improvement of quality and safety outcomes for patients or patient populations from an administrative and staff management focus. Doctoral programmes in nursing prepare the student for work in nursing education, health care administration, clinical research, or advanced clinical practice. Most programmes confer the PhD in nursing and Doctor of Nursing Practice (DNP).

Advanced practise registered nurse (APRN)

Areas of advanced nursing practise include that of a nurse practitioner (NP), a certified nurse midwife (CNM), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). Nurse practitioners and CNSs work assessing, diagnosing and treating patients in fields as diverse as family practice, women's health care, emergency nursing, acute/critical care, psychiatry, geriatrics, or pediatrics, additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.

Licensure examination

Completion of any one of these three educational routes allows a graduate nurse to take the NCLEX-RN, the test for licensure as a registered nurse, and is accepted by every state as an adequate indicator of minimum competency for a new graduate. Notwithstanding controversy exists over the appropriate entry-level preparation of RNs. Some professional organisations believe the BSN should be the sole method of RN preparation and ADN graduates should be licenced as "technical nurses" to work under the supervision of BSN graduates. Others feel the on-the-job experiences of diploma and ADN graduates makes up for any deficiency in theoretical preparation.

Shortage in the United States

RNs are the largest group of health care workers in the United States, with about 2.7 million employed in 2011. It has been reported that the number of new graduates and foreign-trained nurses is insufficient to meet the demand for registered nurses; this is often referred to as the nursing shortage and is expected to increase for the foreseeable future. There are data to support the idea that the nursing shortage is a voluntary shortage. In additional words, nurses are leaving nursing of their own volition. In 2006 it was estimated that approximately 1.8 million nurses chose not to work as a nurse. The Bureau of Labor Statistics reported that 296,900 healthcare jobs were created in 2011. RNs make up the majority of the healthcare work force, therefore these positions will be filled primarily by nurses. The BLS additionally states that by 2020, there will be 1.2 million nursing job openings due to an increase in the workforce, and replacements. (Rosseter, 2012).

Causes

The International Council Of Nursing (ICN), the largest international health professional organisation in the world, recognises the shortage of nurses as a growing crisis in the world. This shortage impacts the healthcare of everyone worldwide. One of the a large number of reasons is that nurses who pursue to become nurses do so quite late in their lives. This leads to a non-lengthy employment time. A national survey prepared by the Federation of Nurses and Health Professionals in 2001 found that one in five nurses plans to leave the profession within five years because of unsatisfactory working conditions, including low pay, severe under staffing, high stress, physical demands, mandatory overtime, and irregular hours. Approximately 29.8 percent of all nursing jobs are found in hospitals. Notwithstanding because of administrative cost cutting, increased nurse's workload, and rapid growth of outpatient services, hospital nursing jobs will experience slower than average growth. Employment in home care and nursing homes is expected to grow rapidly. Though more people are living well into their 80s and 90s, a large number of need the kind of long-term care available at a nursing home. Many nurses will additionally be needed to help staff the growing number of out-patient facilities, such as HMOs, group medical practices, and ambulatory surgery centers. Nursing specialties will be in great demand. There are, in addition, a large number of part-time employment possibilities.

Levsey, Campbell, and Green voiced their concern about the shortage of nurses, citing Fang, Wilsey-Wisniewski, & Bednash, 2006 who state that over 40,000 qualified nursing applicants were turned away in the 2005-2006 academic year from baccalaureate nursing programmes due to a lack of masters and doctoral qualified faculty, and that this number was increased over 9,000 from 32,000 qualified but rejected students from just two years earlier. Several strategies have been offered to mitigate this shortage including; Federal and private support for experienced nurses to enhance their education, incorporating more hybrid/blended nursing courses, and using simulation in lieu of clinical (hospital) training experiences.

Furthermore, there's a shortage of academically qualified instructors to teach at schools of nursing worldwide. The serious need for educational capacity isn't being met, which is the underlying most important preparation resource for the nurses of tomorrow. The decrease in faculty everywhere is due to a large number of factors including decrease in satisfaction with the workforce, poor salaries, and reduction in full-time equivalent. Throughout the span of 6 years the nursing faculty shortage has been written about an increasing amount. Unfortunately, there's no clear consensus or an organised plan on how to fix the ongoing issue.

Continuing education

With health care knowledge growing steadily, nurses can stay ahead of the curve through continuing education. Continuing education classes and programmes enable nurses to provide the best possible care to patients, advance nursing careers, and keep up with Board of Nursing requirements. The American Nurses Association and the American Nursing Credentialing Center are devoted to ensuring nurses have access to quality continuing education offerings. Continuing education classes are calibrated to provide enhanced learning for all levels of nurses. Many States additionally regulate Continuing Nursing Education. Nursing licencing boards requiring Continuing Nursing Education (CNE) as a condition for licensure, either initial or renewal, accept courses provided by organisations that are accredited by additional state licencing boards, by the American Nursing Credentialing Center (ANCC), or by organisations that have been designated as an approver of continuing nursing education by ANCC. There are a few exceptions to this rule including the state of California, Florida and Kentucky. National Healthcare Institute has created a list to assist nurses in determining their CNE credit hours requirements. While this list isn't all inclusive, it offers details on how to contact nursing licencing boards directly.

Board certification

Professional nursing organizations, through their certification boards, have voluntary certification exams to demonstrate clinical competency in their particular specialty. Completion of the prerequisite work experience allows an RN to register for an examination, and passage gives an RN permission to use a professional designation after their name. For example, passage of the American Association of Critical-care Nurses specialty exam allows a nurse to use the initials 'CCRN' after their name. Other organisations and societies have similar procedures.

The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organisation and administers more than 30 specialty examinations.