Nursing
Encyclopedia
Nursing is a healthcare profession
focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health
and quality of life
from conception to death.
Nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care. Nursing Science is a field of knowledge based on the contributions of nursing scientists through peer-reviewed scholarly journals and evidenced-based practice
.
was one of the first people in the world to study healthcare, earning him the title of "the father of modern medicine".
Western European concepts of nursing were first practiced by male Catholic monks who provided for the sick and ill during the Dark Ages of Europe.
During 17th century Europe, nursing care was provided by men and women serving punishment. It was often associated with prostitutes and other female criminals serving time . They had a reputation for being drunk and obnoxious, a view amplified by the doctors of the time to make themselves seem more important and able . It was not until Florence Nightingale
, a well-educated woman from a wealthy class family, became a nurse and improved it drastically that people began to accept nursing as a respectable profession. Other aspects also helped in the acceptance of nursing. In 1853 Theodore Fliedner set up a hospital where the nurses he employed had to be of good nature. Many people were impressed with this facility, and because of it, the British Institute of Nursing Sisters was set up.
Prior to the foundation of modern nursing, nun
s and the military
often provided nursing-like services. The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdom
, senior female nurses are known as sisters.
It was during time of war that a significant development in nursing history arose when English
nurse Florence Nightingale
, working to improve conditions of soldiers in the Crimean War
, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing
. Other important nurses in the development of the profession include: Mary Seacole
, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards
, who established quality nursing schools in the USA and Japan
, and Linda Richards
who was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children
in Boston
.
New Zealand
was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act
on the 12 September 1901. It was here in New Zealand that Ellen Dougherty
became the first registered nurse
. North Carolina
was the first state in the United States
to pass a nursing licensure law in 1903.
Nurses in the United States Army actually started during the Revolutionary War when a general suggested to George Washington that the he needed female nurses "to attend the sick and obey the matron's orders. In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided that a matron be allotted to every hundred sick or wounded".
Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses' primary purpose is to follow the direction of physicians. This tendency is certainly not observed in Nightingale's Notes on Nursing, where the physicians are mentioned relatively infrequently, and often in critical tones—particularly relating to bedside manner.
In the early 1900s, the autonomous, nursing-controlled, Nightingale era schools came to an end – schools became controlled by hospitals, and formal "book learning" was discouraged. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation was not uncommon by nurse’s employers, physicians and educational providers. Nursing practice was controlled by medicine.
The modern era has seen the development of nursing degrees
and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.
Before the late 19th century, and into the early 20th century, women doing nursing work were generally members of religious orders or were effectively domestic servants, with the same lowly social status, caring for the sick either in private homes or at charity hospitals serving the poor. Florence Nightingale
's efforts to improve nursing standards in the mid-nineteenth century increased interest in occupational improvements that would benefit patients, with particular importance given to military settings. In 1860, Florence Nightingale's work resulted in Queen Victoria's order for a hospital to be built to train Army nurses and surgeons, the Royal Victoria Hospital
. The hospital opened in 1863 in Netley
and admitted and cared for military patients. Beginning in 1866, nurses were formally appointed to Military General Hospitals. The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War
(often called Zulu War) from 1879 to 1881. They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War
, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.
Sporadic progress was made on several continents, where medical pioneers established formal nursing schools. But even as late as the 1870s, "women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession they supported and society at large". Nursing had the same status in Great Britain and continental Europe before World War I.
Hospital nursing schools in the United States and Canada took the lead in applying Nightingale's model to their training program mes:
By the beginning of World War I, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandria's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service
. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were Voluntary Aid Detachment
(VAD) nurses who had been enrolled by the Red Cross.The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.
When Canadian nurses volunteered to serve during World War I, they were made commissioned officers by the Royal Canadian Army before being sent overseas, a move that would grant them some authority in the ranks, so that enlisted patients and orderlies would have to comply with their direction. Canada was the first country in the world to grant women this privilege. At the beginning of the War, nurses were not dispatched to the casualty clearing stations near the front lines, where they would be exposed to shell fire. They were initially assigned to hospitals a safe distance away from the front lines. As the war continued, however, nurses were assigned to casualty clearing stations. They were exposed to shelling, and caring for soldiers with "shell shock
" and casualties suffering the effects of new weapons such as poisonous gas, as Katherine Wilson-Sammie recollects in Lights Out! A Canadian Nursing Sister’s Tale. World War I was also the first war in which a clearly-marked hospital ship evacuating the wounded was targeted and sunk by an enemy submarine or torpedo boat, an act that had previously been considered unthinkable, but which happened repeatedly (see List of hospital ships sunk in World War I). Nurses were among the casualties.
Canadian women volunteering to serve overseas as nurses overwhelmed the army with applications. A total of 3,141 Canadian "nursing sisters" served in the Canadian Army Medical Corps and 2,504 of those served overseas in England, France and the Eastern Mediterranean at Gallipoli, Alexandria and Salonika. By the end of the First World War, 46 Canadian Nursing Sisters had given their lives. In addition to these nurses serving overseas with the military, others volunteered and paid their own way over with organizations such as the Canadian Red Cross
, the Victorian Order of Nurses
, and St. John Ambulance
. The sacrifices made by these nurses during the War in fact gave a boost to the women's suffrage movement in many of the countries that fought in the war. The Canadian Army nursing sisters were among the first women in the world to win the right to vote in a federal election; the Military Voters Act of 1917 extended the vote to women in the service such as Nursing Sisters.
The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the Japanese, but in practice they were kept out of harm's way, with the great majority stationed on the home front. However 77 were stationed in the jungles of the Pacific, where their uniform consisted of "khaki slacks, mud, shirts, mud, field shoes, mud, and fatigues." The 20,000 nurses in Europe were safely behind the lines. They had two missions one provide technical nursing services to military hospitals and second to train and the male Army medics and male pharmacy mates in the Navy. These men handled front line nursing care, and also staffed home front hospitals, where the nurses directly supervised them. The medical services were large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were men, with women doctors allowed only to examine the WAC. Forward medical units, were emergency surgery was undertaken, was done without the benefit of nurses. Well behind the battlefield, the nurses worked in evacuation hospitals, primarily in the role of supervising the medics and the Navy’s pharmacy mates. The closer to the front, the more flexible and autonomous was the nurse’s’ role. The women wanted to be much closer to the front, but they had too weak a voice to counter the Pentagon’s highly protective attitude.
Down to 1942, the American Red Cross controlled access to the military. The Red Cross was controlled by civilian men, professional experts and social work and fundraising. The new leaders emerging from the war had learned command skills, maneuvering in complex bureaucracies, the taste of equal pay an officer status, and autonomy within military medical system. New technical skills validated their demands for an autonomy as they learned and employed in crisis situations the latest trauma and medical techniques and technologies. The military nurses returned home as the nation’s experts in blood transfusion and the application of new drugs like penicillin. When the nurses returned home they used the previously powerless American Nurses Association to take control of the nursing profession.
Military nursing was primarily handled by the DARK, which came under partial Nazi control. Front line medical services were provided by male medics and doctors. Red Cross nurses served widely within the military medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks. Two dozen were awarded the highly prestigious Iron Cross for heroism under fire. They are among the 470,000 German women who served with the military.
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 becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory
and practice, and training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are 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.
In order 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 Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works independently or with a Registered nurse
. 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 in Canada an RN requires a bachelors degree and a LPN requires a 2 year diploma. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. Registered nurses may also earn additional credentials
or degrees
. In the USA, in addition to the LPN, Registered nurses can earn 2 different degrees that qualify a nurse for the title RN. The title RN AND is awarded to the nurse who has completed a 2 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. The title RN 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 programs in the USA graduates are then eligible to sit for the a licensing examination to become a nurse, the passing of which is required for the nursing license.
RN's may also pursue different roles as advanced practice registered nurses.
Nurses may 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.
Around the world, nurses have been traditionally female. Despite equal opportunity legislation nursing has continued to be a female dominated profession. For instance, in Canada and America the male-to-female ratio of nurses is approximately 1:19. This ratio is represented around the world. Notable exceptions include: Francophone Africa, which includes the countries of Benin
, Burkina Faso
, Cameroon
, Chad
, Congo
, Ivory Coast, 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 20% of nurses are male.
, generally mandated by the legislature of the country or area within which the nurse practices. Nurses are held legally responsible and accountable for their practice. The standard of care
is that of the "prudent nurse."
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 practice 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 other disciplines, the profession has developed different theories
derived from sometimes diverse philosophical beliefs and paradigm
s or worldviews to help nurses direct their activities to accomplish specific goals.
s 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 also work on cruise ships and in military service
. Nurses act as advisers and consultants to the health care
and insurance industries. Many nurses also 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 consultant
s, reviewing patient records to assure 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, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software.
concluded, "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs
. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that under loads also can be detrimental to performance (Mack worth, 1948). Both overloads and under loads are important to consider for improving performance." Each county/ state in which a nurse is licensed has laws concerning how many patients one nurse can tend to(depending on the acuity of the patients needs).
, 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.
The titles used now are similar and with slight differences i.e. RNA (registered nurse adult), RNC (registered nurse child), RN (registered nurse mental health), ARNOLD (registered nurse learning disabilities).
Second level nurse training is no longer provided, however they are still legally able to practice in the United Kingdom as a 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.
They split into several major groups:
Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons
.
In order to become a registered nurse, and work as such in the NHS, one must complete a program recognized by the Nursing and Midwifery Council
. Currently, this involves completing a degree
or diploma
, 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 1st level registered nurse. Such a course is a 50/50 split of learning in university
(i.e. through lectures, essays and examinations) and in practice (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 program (CFP), and teaches the basic knowledge and skills required of all nurses. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are:
As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in England to hold a degree qualification.
Midwifery
training is similar in length and structure, but is sufficiently different that it is not 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 also exist for graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation program.
Student nurses currently receive a bursary
from the government to support them during their nurse training. Diploma students in England receive a non-means-tested bursary of around £6000 per year (with additional allowances for mature students or those with dependent children), whereas degree students have their bursary means tested (and so often receive less). Degree students are, however, eligible for a proportion of the government's student loan
, unlike diploma students. In Scotland
, however, all student nurses regardless of which course they are undertaking, receive the same bursary in line with the English diploma amount. In Wales
only the Degree level course is offered and all nursing students therefore receive a non-means-tested bursary.
Before Project 2000, nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.
After the point of initial registration, there is 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 practice (PREP) requirements.
There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation, venepuncture, intravenous drug therapy
and male cauterization
are the most common, although there are many others (such as advanced life support
) which some 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 is often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it is also much more lucrative, as diploma students get the full bursary during 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, some nurses undertake further training above bachelors degree level. Masters degrees exist in various healthcare related topics, and some nurses choose to study for PhD
s or other higher academic awards. District nurse
s and health visitor
s are also considered specialist nurses, and in order to become such they must undertake specialist training (often in the form of a top up degree (see above) or post graduate diploma).
All newly qualifying district nurse
s 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 also undertake training in independent and supplementary prescribing, which allows them (as of May 1, 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.
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 some 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 Florence Nightingale
who was training women in English Canada. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario
. Many programs popped up in hospitals across Canada after this one was established. Graduates and teachers from these programs began to fight for licensing legislation, nursing journals, university training for nurses, and for professional organizations for nurses.
The first instance of Canadian nurses and the military was in 1885 with the Northwest Rebellion. Some nurses came out to aid the wounded. In 1901 Canadian nurses were officially part of the Royal Canadian Army Medical Corps
. Georgina Fane Pope and Margaret Clothilde Macdonald were the first nurses officially recognized as military nurses. Nursing continued to expand and develop. In the early twentieth century more nursing programs were developed for public health nursing and disease prevention. More changes occurred after World War II
. The health care system expanded and medicare was introduced. Currently there are 260,000 nurses in Canada
but they face the same difficulties as most countries. Nurses are becoming more scarce and the population is aging which requires more nursing care.
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 also gives a nurse a more critical opinion which gives he or she more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian provinces 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. However, Canada
does have a condensed program that is two years long.
There are nineteen specialties that a nurse could choose from if he or she wanted to narrow down his or her field. According to the Canadian Nurses Association
some of those specialties are Cardiovascular Nursing, Community Health Nursing, Critical Care Nursing
, Emergency Nursing, Gerontology Nursing, Medical-Surgical Nursing, Neuroscience Nursing, Oncology Nursing, Orthopedic Nursing, Psychiatric/Mental Health Nursing, and Rehabilitation Nursing. Each specialty requires its own test and competencies. Many tests are offered online through 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 also 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". It is rather uncommon to see nurses with this much independence. In most countries nurses appear to be considered lesser than a physician like in the United States
or Japan
.
. A new law geared towards nurses was created during 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 programs for nurses. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public.
only recognizes four types of nursing and they are Public Health Nursing, Midwifery
, Registered Nursing and Assistant Nursing.
This type of nursing is designed to help the public and is also 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.
Nurses that are involved with midwifery are independent of any organization. A midwife takes care of a pregnant woman during labor and postpartum. They assist with things like breastfeeding and caring for the child.
Individuals who are assistant nurses follow orders from a registered nurse. They report back to the licensed nurse about a patient's condition. Assistant nurses are always supervised by a licensed registered nurse.
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 Bachelors 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 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 also 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 are out in the field. Physicians are the ones who are teaching the potential nurses because there are not 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 do not have the same educational background. The classes offered at nursing colleges and nursing schools are focused on more practical aspects of nursing. These institutions do not offer many general education classes, so students who attend these schools will solely be focusing on their nursing educations while they are 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 license for life.
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 some organizations that unite Japanese nurses like the Japanese Nursing Association
(JNA). The JNA is not to be confused with a union, it is simply a professional organization 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 practice through many 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 also provides certification for specialists in mental health, oncology and community health. JNA is the not the only nursing organization in Japan. There are other subgroups that are typically categorized 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 organization was involved with the Nursing Human Resource Law .
, these limits are determined by a set of laws known as the Nurse Practice Act of 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, qualifies candidates for licensure, licenses nurses and nursing assistants, and makes decisions on nursing issues. It should be noted that in some states the terms "nurse" or "nursing" may only be used in conjunction with the practice of a Registered Nurse (RN) or licensed practical or vocational nurse
(LPN/LVN).
The scope of practice for a registered nurse is wider than for an LPN/LVN because of the level and content of education as well as what the Nurse Practice Act says about the respective roles of each.
In the hospital setting, registered nurses are often assigned a role in which they delegate tasks to LPNs and unlicensed assistive personnel
.
RNs are not limited to employment as bedside nurses. Registered nurses 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 many areas such as biology, psychology, human development, and health care systems. The average salary for a staff RN in the United States in 2007 was over $60,000.
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 other 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 programs in the United States received their education at a Diploma School of 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 also offer the ADN. Associate degree nursing programs have many prerequisite and co-requisite courses which ultimately stretch out the degree-acquiring process to about 3 years or greater.
The third method is to obtain a Bachelor of Science in Nursing
(BSN), a four-year degree that also 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. The Bachelor of Science in Nursing degrees have many courses which stretches out the degree-acquiring process to over 4 years if the student does not go to summer school. Advocates for the ADN and diploma programs state that such programs have a on the job training approach to educating students, while the BSN is an academic degree
that emphasizes research and nursing theory
. However the BSN graduate has both more classroom and clinical hours of study in nursing than the ADN graduate. The BSN graduate is professionally degreed; and as such is called a professional nurse. However, some states require a specific amount of clinical experience that is the same for both BSN and ADN students. Nursing schools may or may not be accredited by either the National League for Nursing
Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education
(CCNE).
Advanced education in nursing is done at the master's and doctoral levels. It prepares the graduate for specialization as an advanced practice registered nurse (APRN) or for advanced roles in leadership, management, or education. Areas of advanced nursing practice 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 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
, while a CNS usually works for a facility to improve patient care, do research, or as a staff educator. 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 programs in nursing prepare the student for work in nursing education, health care administration, clinical research, or advanced clinical practice. Most programs confer the Ph.D in nursing and Doctor of Nursing Practice (DNP).
Employment services $68,160; General medical and surgical hospitals $63,880; Offices of physicians $59,210; Home health care services $58,740; Nursing care facilities $57,060.
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.
Top 10 Highest Paying Nursing Specialties
1) Certified Registered Nurse Anesthetist – $135,000
2) Nurse Researcher – $95,000
3) Psychiatric Nurse Practitioner – $95,000
4) Certified Nurse Midwife – $84,000
5) Pediatric Endocrinology Nurse – $81,000
6) Orthopedic Nurse – $81,000
7) Nurse Practitioner – $78,000
8) Clinical Nurse Specialist – $76,000
9) Gerontological Nurse Practitioner – $75,000
10) Neonatal Nurse – $74,000
RNs are the largest group of health care workers in the United States, numbering over 2.6 million. 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 other 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.
There has been a serious shortage of nurses for many years. 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. The shortage will also be exacerbated by the increasing numbers of baby-boomer aged nurses who are expected to retire, creating more open positions than there are graduates of nursing programs. The faster than average job growth in this field is also a result of improving medical technology that will allow for treatments of many more diseases and health conditions. Nurses will be strong in demand to work with the rapidly growing population of senior citizens in the United States. Approximately 60 percent of all nursing jobs are found in hospitals. However, 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, many need the kind of long-term care available at a nursing home. Also, because of financial reasons, patients are being released from hospitals sooner and admitted into nursing homes. Many nursing homes have facilities and staff capable of caring for long-term rehabilitation patients, as well as those afflicted with Alzheimer's. Many nurses will also 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, many part-time employment possibilities.
The American Nurses Credentialing Center
, the credentialing arm of the American Nurses Association
, is the largest nursing credentialing organization and administers more than 30 specialty examinations.
The major populations are:-
There are also specialist areas such as cardiac nursing
, orthopedic nursing, palliative care
, perioperative nursing
, obstetrical nursing
, and oncology nursing
.
Profession
A profession is a vocation founded upon specialized educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain....
focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and quality of life
Quality of life (healthcare)
Quality of Life is a phrase used to refer to an individual’s total wellbeing. This includes all emotional, social, and physical aspects of the individual’s life. However, when the phrase is used in reference to medicine and healthcare as Health Related Quality of Life, it refers to how the...
from conception to death.
Nurses work in a large variety of specialties where they work independently and as part of a team to assess, plan, implement and evaluate care. Nursing Science is a field of knowledge based on the contributions of nursing scientists through peer-reviewed scholarly journals and evidenced-based practice
Evidence-Based Nursing
Evidence-Based Nursing or EBN is a type of evidence-based healthcare, drawing on some of the traditions of evidence-based medicine. It involves identifying solid research findings and implementing them in nursing practices, in order to increase the quality of patient care. The goal of EBN is to...
.
History of nursing
In fifth century BC, HippocratesHippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
was one of the first people in the world to study healthcare, earning him the title of "the father of modern medicine".
Western European concepts of nursing were first practiced by male Catholic monks who provided for the sick and ill during the Dark Ages of Europe.
During 17th century Europe, nursing care was provided by men and women serving punishment. It was often associated with prostitutes and other female criminals serving time . They had a reputation for being drunk and obnoxious, a view amplified by the doctors of the time to make themselves seem more important and able . It was not until Florence Nightingale
Florence Nightingale
Florence Nightingale OM, RRC was a celebrated English nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night...
, a well-educated woman from a wealthy class family, became a nurse and improved it drastically that people began to accept nursing as a respectable profession. Other aspects also helped in the acceptance of nursing. In 1853 Theodore Fliedner set up a hospital where the nurses he employed had to be of good nature. Many people were impressed with this facility, and because of it, the British Institute of Nursing Sisters was set up.
Prior to the foundation of modern nursing, nun
Nun
A nun is a woman who has taken vows committing her to live a spiritual life. She may be an ascetic who voluntarily chooses to leave mainstream society and live her life in prayer and contemplation in a monastery or convent...
s and the military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
often provided nursing-like services. The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, senior female nurses are known as sisters.
It was during time of war that a significant development in nursing history arose when English
English people
The English are a nation and ethnic group native to England, who speak English. The English identity is of early mediaeval origin, when they were known in Old English as the Anglecynn. England is now a country of the United Kingdom, and the majority of English people in England are British Citizens...
nurse Florence Nightingale
Florence Nightingale
Florence Nightingale OM, RRC was a celebrated English nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night...
, working to improve conditions of soldiers in the Crimean War
Crimean War
The Crimean War was a conflict fought between the Russian Empire and an alliance of the French Empire, the British Empire, the Ottoman Empire, and the Kingdom of Sardinia. The war was part of a long-running contest between the major European powers for influence over territories of the declining...
, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing
Notes on Nursing
Notes on Nursing: What it is and What it is Not is a book first published by Florence Nightingale in 1859. A 136-page volume, it was intended to give hints on nursing to those entrusted with the health of others...
. Other important nurses in the development of the profession include: Mary Seacole
Mary Seacole
Mary Jane Seacole , sometimes known as Mother Seacole or Mary Grant, was a Jamaican nurse best known for her involvement in the Crimean War. She set up and operated boarding houses in Panama and the Crimea to assist in her desire to treat the sick...
, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards
Linda Richards
Linda Richards was the first professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients.-Early life:...
, who established quality nursing schools in the USA and Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, and Linda Richards
Linda Richards
Linda Richards was the first professionally trained American nurse. She established nursing training programs in the United States and Japan, and created the first system for keeping individual medical records for hospitalized patients.-Early life:...
who was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children
New England Hospital for Women and Children
New England Hospital for Women and Children was opened in Boston, Massachusetts on July 1, 1862 by Dr. Marie Zakrzewska and Ednah Dow Cheney. The Hospital remained dedicated to women and children until the 1950s when it became financially deficient and after recommendations from the United...
in Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
.
New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act
Nurses Registration Act
The Nurses Registration Act was passed on 12 September 1901 in New Zealand, providing for the registration of trained nurses.The legislation came into effect on 1 January 1902, leading New Zealand to become the first country in the world to regulate nurses nationally. On 10 January 1902 Ellen...
on the 12 September 1901. It was here in New Zealand that Ellen Dougherty
Ellen Dougherty
Ellen Dougherty , a New Zealand nurse, was the first Registered Nurse in the world. She trained at Wellington Hospital from 1885 and completed a certificate in nursing in 1887...
became the first registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
. North Carolina
North Carolina
North Carolina is a state located in the southeastern United States. The state borders South Carolina and Georgia to the south, Tennessee to the west and Virginia to the north. North Carolina contains 100 counties. Its capital is Raleigh, and its largest city is Charlotte...
was the first state in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
to pass a nursing licensure law in 1903.
Nurses in the United States Army actually started during the Revolutionary War when a general suggested to George Washington that the he needed female nurses "to attend the sick and obey the matron's orders. In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided that a matron be allotted to every hundred sick or wounded".
Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses' primary purpose is to follow the direction of physicians. This tendency is certainly not observed in Nightingale's Notes on Nursing, where the physicians are mentioned relatively infrequently, and often in critical tones—particularly relating to bedside manner.
In the early 1900s, the autonomous, nursing-controlled, Nightingale era schools came to an end – schools became controlled by hospitals, and formal "book learning" was discouraged. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation was not uncommon by nurse’s employers, physicians and educational providers. Nursing practice was controlled by medicine.
The modern era has seen the development of nursing degrees
Nurse education
Nurse education consists in the theorical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to nursing students by experienced nurses and other medical professionals who have qualified or...
and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.
World War I
Florence Nightingale
Florence Nightingale OM, RRC was a celebrated English nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night...
's efforts to improve nursing standards in the mid-nineteenth century increased interest in occupational improvements that would benefit patients, with particular importance given to military settings. In 1860, Florence Nightingale's work resulted in Queen Victoria's order for a hospital to be built to train Army nurses and surgeons, the Royal Victoria Hospital
Royal Victoria Hospital
The Royal Victoria Hospital, or as it is popularly known, the "Royal Vic", is located at 687 Pine Avenue, Montreal, Quebec, Canada.The Royal Vic is located in downtown Montreal, on the slopes of Mount Royal. There are a number of buildings, including the Surgical, Medical, Ross and Women's...
. The hospital opened in 1863 in Netley
Netley
Netley, sometimes called Netley Abbey, is a village on the south coast of Hampshire, England, situated on the east side of the city of Southampton...
and admitted and cared for military patients. Beginning in 1866, nurses were formally appointed to Military General Hospitals. The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War
First Boer War
The First Boer War also known as the First Anglo-Boer War or the Transvaal War, was fought from 16 December 1880 until 23 March 1881-1877 annexation:...
(often called Zulu War) from 1879 to 1881. They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War
Boer War
The Boer Wars were two wars fought between the British Empire and the two independent Boer republics, the Oranje Vrijstaat and the Republiek van Transvaal ....
, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.
Sporadic progress was made on several continents, where medical pioneers established formal nursing schools. But even as late as the 1870s, "women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession they supported and society at large". Nursing had the same status in Great Britain and continental Europe before World War I.
Hospital nursing schools in the United States and Canada took the lead in applying Nightingale's model to their training program mes:
By the beginning of World War I, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandria's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service
Princess Mary's Royal Air Force Nursing Service
Princess Mary's Royal Air Force Nursing Service is the nursing branch of the British Royal Air Force.It was established as the Royal Air Force Temporary Nursing Service in 1918, and became part of the permanent establishment as the Royal Air Force Nursing Service on 27 January 1921...
. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were Voluntary Aid Detachment
Voluntary Aid Detachment
The Voluntary Aid Detachment was a voluntary organisation providing field nursing services, mainly in hospitals, in the United Kingdom and various other countries in the British Empire. The organisation's most important periods of operation were during World War I and World War II.The...
(VAD) nurses who had been enrolled by the Red Cross.The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.
When Canadian nurses volunteered to serve during World War I, they were made commissioned officers by the Royal Canadian Army before being sent overseas, a move that would grant them some authority in the ranks, so that enlisted patients and orderlies would have to comply with their direction. Canada was the first country in the world to grant women this privilege. At the beginning of the War, nurses were not dispatched to the casualty clearing stations near the front lines, where they would be exposed to shell fire. They were initially assigned to hospitals a safe distance away from the front lines. As the war continued, however, nurses were assigned to casualty clearing stations. They were exposed to shelling, and caring for soldiers with "shell shock
Shell Shock
Shell Shock, also known as 82nd Marines Attack was a 1964 film by B-movie director John Hayes. The film takes place in Italy during World War II, and tells the story of a sergeant with his group of soldiers....
" and casualties suffering the effects of new weapons such as poisonous gas, as Katherine Wilson-Sammie recollects in Lights Out! A Canadian Nursing Sister’s Tale. World War I was also the first war in which a clearly-marked hospital ship evacuating the wounded was targeted and sunk by an enemy submarine or torpedo boat, an act that had previously been considered unthinkable, but which happened repeatedly (see List of hospital ships sunk in World War I). Nurses were among the casualties.
Canadian women volunteering to serve overseas as nurses overwhelmed the army with applications. A total of 3,141 Canadian "nursing sisters" served in the Canadian Army Medical Corps and 2,504 of those served overseas in England, France and the Eastern Mediterranean at Gallipoli, Alexandria and Salonika. By the end of the First World War, 46 Canadian Nursing Sisters had given their lives. In addition to these nurses serving overseas with the military, others volunteered and paid their own way over with organizations such as the Canadian Red Cross
Canadian Red Cross
The Canadian Red Cross Society is a Canadian humanitarian charitable organization and one of 186 national Red Cross and Red Crescent societies....
, the Victorian Order of Nurses
Victorian Order of Nurses
The Victorian Order of Nurses is a non-profit charitable organization founded in Ottawa, Ontario, Canada on January 29, 1897 created as a gift for Queen Victoria for the purposes of home care and social services. It is registered as a charity the Canada Revenue Agency, charity number...
, and St. John Ambulance
St. John Ambulance
St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...
. The sacrifices made by these nurses during the War in fact gave a boost to the women's suffrage movement in many of the countries that fought in the war. The Canadian Army nursing sisters were among the first women in the world to win the right to vote in a federal election; the Military Voters Act of 1917 extended the vote to women in the service such as Nursing Sisters.
United States
As Campbell (1984) shows, the nursing profession was transformed by World War Two. The profession contained a basic tension between the tender loving care provided sick people, on the one hand, and the well-trained efficient specialists on the other was a historic tension in the nursing profession that was partially resolved by the war. The military wanted well-trained efficient specialists. All the services used enlisted men to handle the routine care of sick patients are wounded patients, and use their nurses as officers who were trained specialists. In military units, male doctors supervised female nurses, and both were officers, while the women in practice supervised large numbers of enlisted men. Although enlisted medic could become an officer, it was not easy, and none could become a nurse. Indeed there were no male nurses in the American military until years later. Army and Navy nursing was highly attractive and a larger proportion of nurses volunteered for service higher than any other occupation in American society. The nation responded by a dramatic increase in the numbers and functions of nurses, and a moderate modest increase in their pay scales, with the expansion powered by the training of 200,000 nurses aides by the Red Cross, and the creation of a temporary new government agency, the Cadet Nurse Corps, which enrolled 170,000 young women in speeding up training programs in the nation's 1200 nursing schools. About 5% five percent of the Cadet nurses, and Army nurses were black, but the Navy refused to accept black nurses until it was forced to admit a handful by the White House near the end of the war. The black Army nurses were used in all-black units, handle and to handle medical services for prisoners of war.The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the Japanese, but in practice they were kept out of harm's way, with the great majority stationed on the home front. However 77 were stationed in the jungles of the Pacific, where their uniform consisted of "khaki slacks, mud, shirts, mud, field shoes, mud, and fatigues." The 20,000 nurses in Europe were safely behind the lines. They had two missions one provide technical nursing services to military hospitals and second to train and the male Army medics and male pharmacy mates in the Navy. These men handled front line nursing care, and also staffed home front hospitals, where the nurses directly supervised them. The medical services were large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were men, with women doctors allowed only to examine the WAC. Forward medical units, were emergency surgery was undertaken, was done without the benefit of nurses. Well behind the battlefield, the nurses worked in evacuation hospitals, primarily in the role of supervising the medics and the Navy’s pharmacy mates. The closer to the front, the more flexible and autonomous was the nurse’s’ role. The women wanted to be much closer to the front, but they had too weak a voice to counter the Pentagon’s highly protective attitude.
Down to 1942, the American Red Cross controlled access to the military. The Red Cross was controlled by civilian men, professional experts and social work and fundraising. The new leaders emerging from the war had learned command skills, maneuvering in complex bureaucracies, the taste of equal pay an officer status, and autonomy within military medical system. New technical skills validated their demands for an autonomy as they learned and employed in crisis situations the latest trauma and medical techniques and technologies. The military nurses returned home as the nation’s experts in blood transfusion and the application of new drugs like penicillin. When the nurses returned home they used the previously powerless American Nurses Association to take control of the nursing profession.
Britain
During World War II, nurses belonged to Queen Alexandra's Imperial Military Nursing Service (QAIMNS), as they had during World War I, and as they remain today. (Nurses belonging to the QAIMNS are informally called "QA"s.) Members of the Army Nursing Service served in every overseas British military campaign during World War II, as well as at military hospitals in Britain. At the beginning of World War II, nurses held officer status with equivalent rank, but were not commissioned officers. In 1941, emergency commissions and a rank structure were created, conforming with the structure used in the rest of the British Army. Nurses were given rank badges and were now able to be promoted to ranks from Lieutenant through to Brigadier. Nurses were exposed to all dangers during the War, and some were captured and became prisoners of war.Germany
Germany had a very large and well organized nursing service, with three main organizations, one for Catholics, one for Protestants, and the DARK (Red Cross). In 1934 the Nazis set up their own nursing unit, the Brown nurses, and absorb one of the smaller groups, bringing it up to 40,000 members. It set up kindergartens, hoping to seize control of the minds of the younger Germans, in competition with the other nursing organizations. Civilian psychiatric nurses who were Nazi party members participated in the killings of invalids, although the process was shrouded in euphemisms and denials.Military nursing was primarily handled by the DARK, which came under partial Nazi control. Front line medical services were provided by male medics and doctors. Red Cross nurses served widely within the military medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks. Two dozen were awarded the highly prestigious Iron Cross for heroism under fire. They are among the 470,000 German women who served with the military.
Definition
Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:Nursing as a profession
The authority for the practice 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 practice 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 becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
and practice, and training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic
Holistic health
Holistic health is a concept in medical practice upholding that all aspects of people's needs, psychological, physical and social should be taken into account and seen as a whole. As defined above, the holistic view on treatment is widely accepted in medicine...
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.
In order to work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice
Scope of Practice
Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education...
and education
Nurse education
Nurse education consists in the theorical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to nursing students by experienced nurses and other medical professionals who have qualified or...
. A Licensed practical nurse
Licensed Practical Nurse
Licensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...
(LPN) (also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works independently or with a Registered nurse
Registered nurse
A registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
. 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 in Canada an RN requires a bachelors degree and a LPN requires a 2 year diploma. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. Registered nurses may also earn additional credentials
Nursing credentials and certifications
A nurse's postnominal credentials usually follow his or her name in this order:* Highest earned academic degree in or related to nursing * Nursing licensure * Nursing certification...
or degrees
Academic degree
An academic degree is a position and title within a college or university that is usually awarded in recognition of the recipient having either satisfactorily completed a prescribed course of study or having conducted a scholarly endeavour deemed worthy of his or her admission to the degree...
. In the USA, in addition to the LPN, Registered nurses can earn 2 different degrees that qualify a nurse for the title RN. The title RN AND is awarded to the nurse who has completed a 2 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. The title RN 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 programs in the USA graduates are then eligible to sit for the a licensing examination to become a nurse, the passing of which is required for the nursing license.
RN's may also pursue different roles as advanced practice registered nurses.
Nurses may 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.
Around the world, nurses have been traditionally female. Despite equal opportunity legislation nursing has continued to be a female dominated profession. For instance, in Canada and America the male-to-female ratio of nurses is approximately 1:19. This ratio is represented around the world. Notable exceptions include: Francophone Africa, which includes the countries of Benin
Benin
Benin , officially the Republic of Benin, is a country in West Africa. It borders Togo to the west, Nigeria to the east and Burkina Faso and Niger to the north. Its small southern coastline on the Bight of Benin is where a majority of the population is located...
, Burkina Faso
Burkina Faso
Burkina Faso – also known by its short-form name Burkina – is a landlocked country in west Africa. It is surrounded by six countries: Mali to the north, Niger to the east, Benin to the southeast, Togo and Ghana to the south, and Côte d'Ivoire to the southwest.Its size is with an estimated...
, Cameroon
Cameroon
Cameroon, officially the Republic of Cameroon , is a country in west Central Africa. It is bordered by Nigeria to the west; Chad to the northeast; the Central African Republic to the east; and Equatorial Guinea, Gabon, and the Republic of the Congo to the south. Cameroon's coastline lies on the...
, Chad
Chad
Chad , officially known as the Republic of Chad, is a landlocked country in Central Africa. It is bordered by Libya to the north, Sudan to the east, the Central African Republic to the south, Cameroon and Nigeria to the southwest, and Niger to the west...
, Congo
Republic of the Congo
The Republic of the Congo , sometimes known locally as Congo-Brazzaville, is a state in Central Africa. It is bordered by Gabon, Cameroon, the Central African Republic, the Democratic Republic of the Congo , the Angolan exclave province of Cabinda, and the Gulf of Guinea.The region was dominated by...
, Ivory Coast, the Democratic Republic of Congo, Djibouti
Djibouti
Djibouti , officially the Republic of Djibouti , is a country in the Horn of Africa. It is bordered by Eritrea in the north, Ethiopia in the west and south, and Somalia in the southeast. The remainder of the border is formed by the Red Sea and the Gulf of Aden at the east...
, Guinea
Guinea
Guinea , officially the Republic of Guinea , is a country in West Africa. Formerly known as French Guinea , it is today sometimes called Guinea-Conakry to distinguish it from its neighbour Guinea-Bissau. Guinea is divided into eight administrative regions and subdivided into thirty-three prefectures...
, Gabon
Gabon
Gabon , officially the Gabonese Republic is a state in west central Africa sharing borders with Equatorial Guinea to the northwest, Cameroon to the north, and with the Republic of the Congo curving around the east and south. The Gulf of Guinea, an arm of the Atlantic Ocean is to the west...
, Mali
Mali
Mali , officially the Republic of Mali , is a landlocked country in Western Africa. Mali borders Algeria on the north, Niger on the east, Burkina Faso and the Côte d'Ivoire on the south, Guinea on the south-west, and Senegal and Mauritania on the west. Its size is just over 1,240,000 km² with...
, Mauritania
Mauritania
Mauritania is a country in the Maghreb and West Africa. It is bordered by the Atlantic Ocean in the west, by Western Sahara in the north, by Algeria in the northeast, by Mali in the east and southeast, and by Senegal in the southwest...
, Niger
Niger
Niger , officially named the Republic of Niger, is a landlocked country in Western Africa, named after the Niger River. It borders Nigeria and Benin to the south, Burkina Faso and Mali to the west, Algeria and Libya to the north and Chad to the east...
, Rwanda
Rwanda
Rwanda or , officially the Republic of Rwanda , is a country in central and eastern Africa with a population of approximately 11.4 million . Rwanda is located a few degrees south of the Equator, and is bordered by Uganda, Tanzania, Burundi and the Democratic Republic of the Congo...
, Senegal
Senegal
Senegal , officially the Republic of Senegal , is a country in western Africa. It owes its name to the Sénégal River that borders it to the east and north...
, and Togo
Togo
Togo, officially the Togolese Republic , is a country in West Africa bordered by Ghana to the west, Benin to the east and Burkina Faso to the north. It extends south to the Gulf of Guinea, on which the capital Lomé is located. Togo covers an area of approximately with a population of approximately...
, which all have more male than female nurses. In Europe, in countries such as Spain, Portugal, Czechoslovakia
Czechoslovakia
Czechoslovakia or Czecho-Slovakia was a sovereign state in Central Europe which existed from October 1918, when it declared its independence from the Austro-Hungarian Empire, until 1992...
, and Italy, over 20% of nurses are male.
Regulation of practice
The practice of nursing is governed by laws that define a scope of practiceScope of Practice
Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education...
, generally mandated by the legislature of the country or area within which the nurse practices. Nurses are held legally responsible and accountable for their practice. The standard of care
Standard of care
In tort law, the standard of care is the degree of prudence and caution required of an individual who is under a duty of care.The requirements of the standard are closely dependent on circumstances. Whether the standard of care has been breached is determined by the trier of fact, and is usually...
is that of the "prudent nurse."
Nursing theory and process
Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care planNursing care plan
A nursing care plan outlines the nursing care to be provided to an individual/family/community. It is a set of actions the nurse will implement to resolve/support nursing diagnoses identified by nursing assessment. The creation of the plan is an intermediate stage of the nursing process...
using the nursing process
Nursing process
The nursing process is a modified scientific method. Nursing practise was first described as a four stage nursing process by Ida Jean Orlando in 1958,. It should not be confused with nursing theories or Health informatics...
. This is based around a specific nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
which is selected based on the care setting and population served. In providing nursing care, the nurse uses both nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
and best practice derived from nursing research
Nursing research
Nursing research is the term used to describe the evidence used to support nursing practice. Nursing, as an evidence based area of practice, has been developing since the time of Florence Nightingale to the present day, where many nurses now work as researchers based in universities as well as in...
.
In general terms, the nursing process
Nursing process
The nursing process is a modified scientific method. Nursing practise was first described as a four stage nursing process by Ida Jean Orlando in 1958,. It should not be confused with nursing theories or Health informatics...
is the method used to assess
Nursing assessment
Nursing assessment is the gathering of information about a patient's physiological, psychological, sociological, and spiritual status.-Stage one of the nursing process:...
and diagnose
Nursing diagnosis
A nursing diagnosis may be part of the nursing process and is a clinical judgement about individual, family, or community experiences/responses to actual or potential health problems/life processes...
needs, plan
Nursing care plan
A nursing care plan outlines the nursing care to be provided to an individual/family/community. It is a set of actions the nurse will implement to resolve/support nursing diagnoses identified by nursing assessment. The creation of the plan is an intermediate stage of the nursing process...
outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
derived from sometimes diverse philosophical beliefs and paradigm
Paradigm
The word paradigm has been used in science to describe distinct concepts. It comes from Greek "παράδειγμα" , "pattern, example, sample" from the verb "παραδείκνυμι" , "exhibit, represent, expose" and that from "παρά" , "beside, beyond" + "δείκνυμι" , "to show, to point out".The original Greek...
s or worldviews to help nurses direct their activities to accomplish specific goals.
Practice settings
Nurses practice in a wide range of settings, from hospitalHospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s to visiting people in their homes
Home care
Home Care, , is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as domiciliary care or social care), is health care or supportive care provided in the patient's home by healthcare professionals Home Care, (also referred to as...
and caring for them in schools
School nursing
School nursing is a specialized practice of professional nursing that advances the well being, academic success, and lifelong achievement of students...
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
Long-term care
Long-term care is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time....
facilities and camps. They also work on cruise ships and in military service
Armed Forces
Armed Forces is Elvis Costello's third album, his second with the Attractions, and the first to officially credit the Attractions on the cover. It was released in the UK by Radar Records and in the U.S. by Columbia in 1979...
. Nurses act as advisers and consultants to the health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
and insurance industries. Many nurses also work in the health advocacy
Health Advocacy
Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve...
and patient advocacy
Patient advocacy
A Patient Advocate acts as a support structure and if legally contracted to do so may act as a liaison between a patient and their Health Care Provider. Most health care professionals see themselves as advocates for their patients, however their time and scope are limited by their job function...
fields at companies such as Health Advocate
Health Advocate
Health Advocate, Inc. is a national health advocacy, patient advocacy and assistance company, serving more than 6,000 clients and 18 million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions...
, Inc. helping in a variety of clinical and administrative issues. Some are attorneys
Lawyer
A lawyer, according to Black's Law Dictionary, is "a person learned in the law; as an attorney, counsel or solicitor; a person who is practicing law." Law is the system of rules of conduct established by the sovereign government of a society to correct wrongs, maintain the stability of political...
and others work with attorneys as legal nurse consultant
Legal nurse consultant
A legal nurse consultant is a registered nurse who uses expertise as a health care provider and specialized training to consult on medical-related legal cases. LNCs assist attorneys in reading medical records and understanding medical terminology and healthcare issues to achieve the best results...
s, reviewing patient records to assure 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, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software.
Work environment
Internationally, there is 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. De Lucia, Otto, & Palmier (2009)concluded, "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs
Musculoskeletal disorders
Musculoskeletal disorders can affect the body's muscles, joints, tendons, ligaments and nerves. Most work-related MSDs develop over time and are caused either by the work itself or by the employees' working environment...
. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that under loads also can be detrimental to performance (Mack worth, 1948). Both overloads and under loads are important to consider for improving performance." Each county/ state in which a nurse is licensed has laws concerning how many patients one nurse can tend to(depending on the acuity of the patients needs).
Nursing worldwide
Throughout the world nurses are known to be caring individuals that people look for as someone to advocate for the sick and provide empathy towards the needy.United Kingdom
To practice lawfully as a registered nurse in the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council
Nursing and Midwifery Council
Established in 2002, the Nursing and Midwifery Council is a statutory body set up by the Parliament of the United Kingdom through the . The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public...
. 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.
First level Nurses
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) , RN (registered nurse (for the) mentally handicapped).The titles used now are similar and with slight differences i.e. RNA (registered nurse adult), RNC (registered nurse child), RN (registered nurse mental health), ARNOLD (registered nurse learning disabilities).
Second level nurse training is no longer provided, however they are still legally able to practice in the United Kingdom as a 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.
They split into several major groups:
- Nurse practitioners - These nurses obtain a minimum of a Master of Science in Nursing or a doctoral degree. They often perform roles similar to those of physicians and physician assistants, they can prescribe medications as independent or supplementary prescribe rs. Most NP's have referral and admission rights to hospital specialties. They commonly work in primary carePrimary carePrimary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
(e.g. GP surgeries), A&E departmentsEmergency departmentAn emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
, or pediatrics although they are increasingly being seen in other areas of practice. In the UK, the title "nurse practitioner" is legally protected. - Specialist community public health nurses - traditionally district nurseDistrict nurseDistrict Nurses are senior nurses who manage care within the community, leading teams of community nurses and support workers. Typically much of their work involves visiting house-bound patients to provide advice and care, for example, palliative care, wound management, catheter and continence...
s and health visitorHealth visitorHealth visitors are UK community health nurses who have undertaken further training to work as part of a primary health care team. As their name suggests, their role is to promote mental, physical and social well-being in the community by giving advice and support to families in all age groups...
s, this group of research and publication activities. - Lecturer-practitioners - these nurses work both in the NHS, and in universitiesUniversityA university is an institution of higher education and research, which grants academic degrees in a variety of subjects. A university is an organisation that provides both undergraduate education and postgraduate education...
. 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 are not 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, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons
Matron
Matron is the job title of a very senior nurse in several countries, including the United Kingdom, its former colonies, including the Republic of Ireland, although the title Clinical Nurse Manager has become acceptable as an alternative.-History:...
.
Pre-registration
In order to become a registered nurse, and work as such in the NHS, one must complete a program recognized by the Nursing and Midwifery Council
Nursing and Midwifery Council
Established in 2002, the Nursing and Midwifery Council is a statutory body set up by the Parliament of the United Kingdom through the . The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public...
. Currently, this involves completing a degree
Academic degree
An academic degree is a position and title within a college or university that is usually awarded in recognition of the recipient having either satisfactorily completed a prescribed course of study or having conducted a scholarly endeavour deemed worthy of his or her admission to the degree...
or diploma
Diploma
A diploma is a certificate or deed issued by an educational institution, such as a university, that testifies that the recipient has successfully completed a particular course of study or confers an academic degree. In countries such as the United Kingdom and Australia, the word diploma refers to...
, 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 1st level registered nurse. Such a course is a 50/50 split of learning in university
University
A university is an institution of higher education and research, which grants academic degrees in a variety of subjects. A university is an organisation that provides both undergraduate education and postgraduate education...
(i.e. through lectures, essays and examinations) and in practice (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 program (CFP), and teaches the basic knowledge and skills required of all nurses. The remainder of the program 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 England to hold a degree qualification.
Midwifery
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
training is similar in length and structure, but is sufficiently different that it is not 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 also exist for graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation program.
Student nurses currently receive a bursary
Bursary
A bursary is strictly an office for a bursar and his or her staff in a school or college.In modern English usage, the term has become synonymous with "bursary award", a monetary award made by an institution to an individual or a group to assist the development of their education.According to The...
from the government to support them during their nurse training. Diploma students in England receive a non-means-tested bursary of around £6000 per year (with additional allowances for mature students or those with dependent children), whereas degree students have their bursary means tested (and so often receive less). Degree students are, however, eligible for a proportion of the government's student loan
Student loan
A student loan is designed to help students pay for university tuition, books, and living expenses. It may differ from other types of loans in that the interest rate may be substantially lower and the repayment schedule may be deferred while the student is still in education...
, unlike diploma students. In Scotland
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
, however, all student nurses regardless of which course they are undertaking, receive the same bursary in line with the English diploma amount. In Wales
Wales
Wales is a country that is part of the United Kingdom and the island of Great Britain, bordered by England to its east and the Atlantic Ocean and Irish Sea to its west. It has a population of three million, and a total area of 20,779 km²...
only the Degree level course is offered and all nursing students therefore receive a non-means-tested bursary.
Before Project 2000, nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.
Post-registration
After the point of initial registration, there is an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council
Nursing and Midwifery Council
Established in 2002, the Nursing and Midwifery Council is a statutory body set up by the Parliament of the United Kingdom through the . The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public...
insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice (PREP) requirements.
There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation, venepuncture, intravenous drug therapy
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
and male cauterization
Urinary catheterization
In urinary catheterization , a latex, polyurethane or silicone tube known as a urinary catheter is inserted into a patient's bladder via his or her urethra. Catheterization allows the patient's urine to drain freely from the bladder for collection. It may be used to inject liquids used for...
are the most common, although there are many others (such as advanced life support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
) which some 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 is often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it is also much more lucrative, as diploma students get the full bursary during 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, some nurses undertake further training above bachelors degree level. Masters degrees exist in various healthcare related topics, and some nurses choose to study for PhD
PHD
PHD may refer to:*Ph.D., a doctorate of philosophy*Ph.D. , a 1980s British group*PHD finger, a protein sequence*PHD Mountain Software, an outdoor clothing and equipment company*PhD Docbook renderer, an XML renderer...
s or other higher academic awards. District nurse
District nurse
District Nurses are senior nurses who manage care within the community, leading teams of community nurses and support workers. Typically much of their work involves visiting house-bound patients to provide advice and care, for example, palliative care, wound management, catheter and continence...
s and health visitor
Health visitor
Health visitors are UK community health nurses who have undertaken further training to work as part of a primary health care team. As their name suggests, their role is to promote mental, physical and social well-being in the community by giving advice and support to families in all age groups...
s are also considered specialist nurses, and in order to become such they must undertake specialist training (often in the form of a top up degree (see above) or post graduate diploma).
All newly qualifying district nurse
District nurse
District Nurses are senior nurses who manage care within the community, leading teams of community nurses and support workers. Typically much of their work involves visiting house-bound patients to provide advice and care, for example, palliative care, wound management, catheter and continence...
s 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 also undertake training in independent and supplementary prescribing, which allows them (as of May 1, 2006) to prescribe almost any drug in the British National Formulary
British National Formulary
The British National Formulary is a medical and pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about all medicines available on the National Health Service , including indication,...
. This has been the cause of a great deal of debate in both medical and nursing circles.
History
Canadian nursing dates all the way back to 1639 in QuebecQuebec
Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....
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
North America
North America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
. In the nineteenth century there were some Catholic orders of nursing that were trying to spread their message across Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. 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 Florence Nightingale
Florence Nightingale
Florence Nightingale OM, RRC was a celebrated English nurse, writer and statistician. She came to prominence for her pioneering work in nursing during the Crimean War, where she tended to wounded soldiers. She was dubbed "The Lady with the Lamp" after her habit of making rounds at night...
who was training women in English Canada. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
. Many programs popped up in hospitals across Canada after this one was established. Graduates and teachers from these programs began to fight for licensing legislation, nursing journals, university training for nurses, and for professional organizations for nurses.
The first instance of Canadian nurses and the military was in 1885 with the Northwest Rebellion. Some nurses came out to aid the wounded. In 1901 Canadian nurses were officially part of the Royal Canadian Army Medical Corps
Royal Canadian Army Medical Corps
The Royal Canadian Army Medical Corps was an administrative corps of the Canadian Army. The Militia Medical Service was established in 1899. The Militia Medical Service was redesignated the Canadian Army Medical Corps in 1904. The Canadian Army Medical Corps was redesignated The Royal Canadian...
. Georgina Fane Pope and Margaret Clothilde Macdonald were the first nurses officially recognized as military nurses. Nursing continued to expand and develop. In the early twentieth century more nursing programs were developed for public health nursing and disease prevention. More changes occurred after World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. The health care system expanded and medicare was introduced. Currently there are 260,000 nurses in Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
but they face the same difficulties as most countries. Nurses are becoming more scarce and the population is aging which requires more nursing care.
Education
All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses AssociationCanadian Nurses Association
The Canadian Nurses Association is a federation of 11 provincial and territorial registered nurses associations representing more than 139,893 Canadian registered nurses and nurse practitioners...
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 also gives a nurse a more critical opinion which gives he or she more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian provinces except for the Yukon
Yukon
Yukon is the westernmost and smallest of Canada's three federal territories. It was named after the Yukon River. The word Yukon means "Great River" in Gwich’in....
and Quebec
Quebec
Quebec or is a province in east-central Canada. It is the only Canadian province with a predominantly French-speaking population and the only one whose sole official language is French at the provincial level....
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. However, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
does have a condensed program that is two years long.
There are nineteen specialties that a nurse could choose from if he or she wanted to narrow down his or her field. According to the Canadian Nurses Association
Canadian Nurses Association
The Canadian Nurses Association is a federation of 11 provincial and territorial registered nurses associations representing more than 139,893 Canadian registered nurses and nurse practitioners...
some of those specialties are Cardiovascular Nursing, Community Health Nursing, Critical Care Nursing
Critical care nursing
Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency departments and the intensive care units.- Training and education...
, Emergency Nursing, Gerontology Nursing, Medical-Surgical Nursing, Neuroscience Nursing, Oncology Nursing, Orthopedic Nursing, Psychiatric/Mental Health Nursing, and Rehabilitation Nursing. Each specialty requires its own test and competencies. Many tests are offered online through the Canadian Nurses Association
Canadian Nurses Association
The Canadian Nurses Association is a federation of 11 provincial and territorial registered nurses associations representing more than 139,893 Canadian registered nurses and nurse practitioners...
.
Public Opinion
Canadian nurses hold a lot of responsibility in the medical field and are considered vital. According to the Canadian Nurses AssociationCanadian Nurses Association
The Canadian Nurses Association is a federation of 11 provincial and territorial registered nurses associations representing more than 139,893 Canadian registered nurses and nurse practitioners...
, "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 also 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". It is rather uncommon to see nurses with this much independence. In most countries nurses appear to be considered lesser than a physician like in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
or Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
.
History
Nursing was not 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 JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
. A new law geared towards nurses was created during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. 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
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
. In 1992 the Nursing Human Resource Law was passed. This law created the development of new university programs for nurses. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public.
Types of Nurses
JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
only recognizes four types of nursing and they are Public Health Nursing, Midwifery
Midwifery
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding....
, Registered Nursing and Assistant Nursing.
Public Health Nursing
This type of nursing is designed to help the public and is also 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 during labor and postpartum. They assist with things like breastfeeding and caring for the child.
Assistant Nursing
Individuals who are assistant nurses follow orders from a registered nurse. They report back to the licensed nurse about a patient's condition. Assistant nurses are always supervised by a licensed registered nurse.
Nursing Education
In 1952 JapanJapan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
established the first nursing university in the country. An Associate Degree
Associate of Science in Nursing
An Associate of Science in Nursing is a tertiary education nursing degree. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some four year colleges also offer this degree...
was the only level of certification for years. Soon people began to want nursing degrees at a higher level of education. Soon the Bachelors Degree in Nursing
Bachelor of Science in Nursing
The Bachelor of Science in Nursing is an American four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school...
(BSN) was established. Currently Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
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 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
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
. They offer a wider range of general education classes and they also 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 are out in the field. Physicians are the ones who are teaching the potential nurses because there are not 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 do not have the same educational background. The classes offered at nursing colleges and nursing schools are focused on more practical aspects of nursing. These institutions do not offer many general education classes, so students who attend these schools will solely be focusing on their nursing educations while they are 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 license for life.
Nursing in Japan 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 aging and needs more medical care for its people. The country needs a rapid increase of nurses however things do not seem to be turning around. Some of the reasons that there is 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 year, which is one of the higher paying jobs. however, physicians make twice the amount that nurses do in a year. Similar to other 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 AssociationAmerican Nurses Association
The American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
article on Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, "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 some organizations that unite Japanese nurses like the Japanese Nursing Association
Japanese Nursing Association
The Japanese Nursing Association is the group of midwives and nurses in Japan and it governs each of the 47 prefectures' individual nursing associations....
(JNA). The JNA is not to be confused with a union, it is simply a professional organization 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 practice through many 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 also provides certification for specialists in mental health, oncology and community health. JNA is the not the only nursing organization in Japan. There are other subgroups that are typically categorized 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 organization was involved with the Nursing Human Resource Law .
United States
The scope of practice of registered nurses is the extent to and limits of which an RN may practice. In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, these limits are determined by a set of laws known as the Nurse Practice Act of the state
U.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...
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, qualifies candidates for licensure, licenses nurses and nursing assistants, and makes decisions on nursing issues. It should be noted that in some states the terms "nurse" or "nursing" may only be used in conjunction with the practice of a Registered Nurse (RN) or licensed practical or vocational nurse
Licensed Practical Nurse
Licensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...
(LPN/LVN).
The scope of practice for a registered nurse is wider than for an LPN/LVN because of the level and content of education as well as what the Nurse Practice Act says about the respective roles of each.
In the hospital setting, registered nurses are often assigned a role in which they delegate tasks to LPNs and unlicensed assistive personnel
Unlicensed assistive personnel
Unlicensed assistive personnel is an umbrella term to describe a job class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living and provide bedside care — including basic nursing...
.
RNs are not limited to employment as bedside nurses. Registered nurses are employed by physicians, attorneys
Lawyer
A lawyer, according to Black's Law Dictionary, is "a person learned in the law; as an attorney, counsel or solicitor; a person who is practicing law." Law is the system of rules of conduct established by the sovereign government of a society to correct wrongs, maintain the stability of political...
, insurance companies
Insurance
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
, 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 many areas such as biology, psychology, human development, and health care systems. The average salary for a staff RN in the United States in 2007 was over $60,000.
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
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, microbiology
Microbiology
Microbiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
, nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....
, chemistry
Chemistry
Chemistry is the science of matter, especially its chemical reactions, but also its composition, structure and properties. Chemistry is concerned with atoms and their interactions with other atoms, and particularly with the properties of chemical bonds....
, and other 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 programs 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
Community college
A community college is a type of educational institution. The term can have different meanings in different countries.-Australia:Community colleges carry on the tradition of adult education, which was established in Australia around mid 19th century when evening classes were held to help adults...
degree referred to as an ADN. Some four-year colleges and universities also offer the ADN. Associate degree nursing programs have many prerequisite and co-requisite courses which ultimately stretch out the degree-acquiring process to about 3 years or greater.
Bachelor of Science in Nursing
The third method is to obtain a Bachelor of Science in Nursing
Bachelor of Science in Nursing
The Bachelor of Science in Nursing is an American four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school...
(BSN), a four-year degree that also 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. The Bachelor of Science in Nursing degrees have many courses which stretches out the degree-acquiring process to over 4 years if the student does not go to summer school. Advocates for the ADN and diploma programs state that such programs have a on the job training approach to educating students, while the BSN is an academic degree
Academic degree
An academic degree is a position and title within a college or university that is usually awarded in recognition of the recipient having either satisfactorily completed a prescribed course of study or having conducted a scholarly endeavour deemed worthy of his or her admission to the degree...
that emphasizes research and nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
. However the BSN graduate has both more classroom and clinical hours of study in nursing than the ADN graduate. The BSN graduate is professionally degreed; and as such is called a professional nurse. However, some states require a specific amount of clinical experience that is the same for both BSN and ADN students. Nursing schools may or may not be accredited by either the National League for Nursing
National League for Nursing
The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. It offers faculty development, networking opportunities, testing services, nursing research grants, and public policy initiatives to more than 25,000 individual and 1,200 education and...
Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education
Commission on Collegiate Nursing Education
The Commission on Collegiate Nursing Education is an autonomous nursing education accrediting agency that contributes to the improvement of the public's health. The CCNE is recognized by the U.S...
(CCNE).
Graduate nursing opportunities
Advanced education in nursing is done at the master's and doctoral levels. It prepares the graduate for specialization as an advanced practice registered nurse (APRN) or for advanced roles in leadership, management, or education. Areas of advanced nursing practice include that of a nurse practitioner
Nurse practitioner
A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...
(NP), a certified nurse midwife
Nurse midwife
In the United States, a Certified Nurse-Midwife is an Advanced Practice Nurse who has specialized education and training in both Nursing and Midwifery. CNM's function as primary healthcare providers for women and most often provide medical care for relatively healthy women, whose birth is...
(CNM), a certified registered nurse anesthetist
Nurse anesthetist
A nurse anesthetist is a nurse who specializes in the administration of anesthesia.In the United States, a Certified Registered Nurse Anesthetist is an advanced practice registered nurse who has acquired graduate-level education and board certification in anesthesia...
(CRNA), or a clinical nurse specialist
Clinical nurse specialist
A clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
(CNS). Nurse practitioners work assessing, diagnosing and treating patients in fields as diverse as family practice, women's health care, emergency nursing
Emergency nursing
Emergency Nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury.While this is common to many nursing specialties, the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis...
, acute/critical care, psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, geriatrics
Geriatrics
Geriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
, or pediatrics
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, while a CNS usually works for a facility to improve patient care, do research, or as a staff educator. The clinical nurse leader
Clinical nurse leader
The Clinical Nurse Leader is a relatively new nursing role that was developed to prepare highly skilled nurses focused on the improvement of quality and safety outcomes for patients or patient populations...
(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 programs in nursing prepare the student for work in nursing education, health care administration, clinical research, or advanced clinical practice. Most programs confer the Ph.D in nursing and Doctor of Nursing Practice (DNP).
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. However, controversy exists over the appropriate entry-level preparation of RNs. Some professional organizations believe the BSN should be the sole method of RN preparation and ADN graduates should be licensed 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. Regardless of this debate, it is highly unlikely that the BSN will become the standard for initial preparation any time soon, because of the nursing shortage, hospital lobbyist, and the lack of faculty to teach BSN students.Earnings
Median annual wages of registered nurses were $62,450 in May 2008. The middle 50 percent earned between $51,640 and $76,570. The lowest 10 percent earned less than $43,410, and the highest 10 percent earned more than $92,240. Median annual wages in the industries employing the largest numbers of registered nurses in May 2008 were:Employment services $68,160; General medical and surgical hospitals $63,880; Offices of physicians $59,210; Home health care services $58,740; Nursing care facilities $57,060.
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.
Top 10 Highest Paying Nursing Specialties
1) Certified Registered Nurse Anesthetist – $135,000
2) Nurse Researcher – $95,000
3) Psychiatric Nurse Practitioner – $95,000
4) Certified Nurse Midwife – $84,000
5) Pediatric Endocrinology Nurse – $81,000
6) Orthopedic Nurse – $81,000
7) Nurse Practitioner – $78,000
8) Clinical Nurse Specialist – $76,000
9) Gerontological Nurse Practitioner – $75,000
10) Neonatal Nurse – $74,000
The nursing shortage in the United States
RNs are the largest group of health care workers in the United States, numbering over 2.6 million. It has been reported that the number of new graduates and foreign-trained nurses is insufficient to meet the demand
Demand
- Economics :*Demand , the desire to own something and the ability to pay for it*Demand curve, a graphic representation of a demand schedule*Demand deposit, the money in checking accounts...
for registered nurses; this is often referred to as the nursing shortage
Nursing shortage
Nursing shortage refers to a situation where the demand for nursing professionals, such as Registered Nurses , exceeds the supply, either locally , nationally or globally...
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 other 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.
Causes of the nursing shortage in the United States
There has been a serious shortage of nurses for many years. 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. The shortage will also be exacerbated by the increasing numbers of baby-boomer aged nurses who are expected to retire, creating more open positions than there are graduates of nursing programs. The faster than average job growth in this field is also a result of improving medical technology that will allow for treatments of many more diseases and health conditions. Nurses will be strong in demand to work with the rapidly growing population of senior citizens in the United States. Approximately 60 percent of all nursing jobs are found in hospitals. However, 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, many need the kind of long-term care available at a nursing home. Also, because of financial reasons, patients are being released from hospitals sooner and admitted into nursing homes. Many nursing homes have facilities and staff capable of caring for long-term rehabilitation patients, as well as those afflicted with Alzheimer's. Many nurses will also 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, many part-time employment possibilities.
Continuing Education
With health care knowledge growing steadily, nurses can stay ahead of the curve through continuing education. Continuing education classes and programs 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.Nursing 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 his or her name. Other organizations and societies have similar procedures.The American Nurses Credentialing Center
American Nurses Credentialing Center
The American Nurses Credentialing Center , a subsidiary of the American Nurses Association , is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the United States , currently certifying over 75,000 APRNs...
, the credentialing arm of the American Nurses Association
American Nurses Association
The American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
, is the largest nursing credentialing organization and administers more than 30 specialty examinations.
Nursing specialties
Nursing is the most diverse of all healthcare professions. Nurses practice 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 also specialist areas such as cardiac nursing
Cardiac nursing
Cardiac nursing is a nursing specialty that works with patients who suffer from various conditions of the cardiovascular system. Cardiac nurses help treat conditions such as unstable angina, cardiomyopathy, coronary artery disease, congestive heart failure, myocardial infarction and cardiac...
, orthopedic nursing, palliative care
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
, perioperative nursing
Perioperative nursing
Perioperative nursing is a nursing specialty that works with patients who are having operative or other invasive procedures. Perioperative nurses work closely with surgeons, nurse anesthetists, surgical technologists, and nurse practitioners...
, obstetrical nursing
Obstetrical nursing
Obstetrical nursing, also called perinatal nursing, is a nursing specialty that works with patients who are attempting to become pregnant, are currently pregnant, or are recently delivered. Obstetrical nurses help provide prenatal care and testing, care of patients experiencing pregnancy...
, and oncology nursing
Oncology nursing
-Certification in the United States:The Oncology Nursing Certification Corporation offers several different options for board certification in oncology nursing...
.
See also
- Registered nurseRegistered nurseA registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
- Licensed practical nurseLicensed Practical NurseLicensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...
- Advanced practice registered nurse
- Nightingale PledgeNightingale PledgeThe Nightingale Pledge is a traditional pledge that was taken by new nurses. Named after Florence Nightingale, it was composed by a committee chaired by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring...
- Nursing care planNursing care planA nursing care plan outlines the nursing care to be provided to an individual/family/community. It is a set of actions the nurse will implement to resolve/support nursing diagnoses identified by nursing assessment. The creation of the plan is an intermediate stage of the nursing process...
- Nursing theoryNursing theoryNursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
- Health promotionHealth promotionHealth promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...
- Family centered careFamily centered careFamily-centered care or Family-centered service has been discussed and promoted most prominently in the context of child health, and especially concerning chronic conditions of childhood. This approach provides an expanded view of how to work with children and families...
- List of nursing specialties
- Nursing specialties category
- List of nurses
- Prominent nurses category
- Nurse-client relationshipNurse-client relationshipThe nurse–client relationship in Hildegard E. Peplau's Interpersonal Relations Model theory is essential to nursing practice. It is the nurse–client interaction that is toward enhancing the client's well-being, and the client may be an individual, a family, a group or a community...
- Nursing schoolNursing schoolA nursing school is a type of educational institution, or part thereof, providing education and training to become a fully qualified nurse. The nature of nursing education and nursing qualifications varies considerably across the world.-United Kingdom:...
- Traditional Nurse's UniformNurse uniformA nurse uniform is attire worn by nurses for hygiene and identification. The traditional nurse uniform consists of a dress, apron and cap. It has existed in many variants, but the basic style has remained recognizable.-History:...
- Modern Nurse's Uniform (Scrubs)Scrubs (clothing)Scrubs are the shirts and trousers or gowns worn by nurses , surgeons, and other operating room personnel when "scrubbing in" for surgery. In the United Kingdom, they are sometimes known as Theatre Blues. They are designed to be simple with minimal places for dirt to hide, easy to launder, and...
- Transcultural nursingTranscultural nursingTranscultural nursing is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice. It is a specific cognitive specialty in nursing that focuses on global cultures and comparative cultural caring,...
- Decision makingDecision makingDecision making can be regarded as the mental processes resulting in the selection of a course of action among several alternative scenarios. Every decision making process produces a final choice. The output can be an action or an opinion of choice.- Overview :Human performance in decision terms...
- Nursing assistive personnelUnlicensed assistive personnelUnlicensed assistive personnel is an umbrella term to describe a job class of paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living and provide bedside care — including basic nursing...
Further reading
- D'Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the Meaning of Work (2010), 272pp excerpt and text search
- Donahue, M. Patricia. Nursing, The Finest Art: An Illustrated History (3rd ed. 2010), includes over 400 illustrations; 416pp; excerpt and text search
- Judd, Deborah. A History of American Nursing: Trends and Eras (2009) 272pp excerpt and text search
- Reverby, Susan M. Ordered to Care: The Dilemma of American Nursing, 1850-1945 (1987) excerpt and text search
- Snodgrass, Mary Ellen. Historical Encyclopedia of Nursing (2004), 354pp; from ancient times to the present