Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

. Nurses may be differentiated from other

health care providers A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

by their approach to patient care,

training Training is teaching, or developing in oneself or others, any skills and knowledge or fitness that relate to specific useful competencies. Training has specific goals of improving one's capability, capacity, productivity and performance. I ...

, and

scope of practice Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for ...

. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Many nurses provide care within the ordering scope of

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

s, and this traditional role has shaped the public image of nurses as care providers. Nurse practitioners are nurses with a graduate degree in advanced practice nursing. They are however permitted by most jurisdictions to practice independently in a variety of settings. Since the

postwar In Western usage, the phrase post-war era (or postwar era) usually refers to the time since the end of World War II. More broadly, a post-war period (or postwar period) is the interval immediately following the end of a war. A post-war period ...

period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing. Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe the correct medications and other therapies, depending on particular state regulations. Nurses may help coordinate the patient care performed by other members of a multidisciplinary health care team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals. In addition to providing care and support, nurses educate the public, and promote health and wellness.

History

Premodern

Nursing historians face the challenges of determining whether care provided to the sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the

Hippocratic Collection The Hippocratic Corpus (Latin: ''Corpus Hippocraticum''), or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus cove ...

in places describes skilled care and observation of patients by male "attendants," who may have been early nurses. Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of the nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts." Before the foundation of modern nursing, members of religious orders such as nuns and

monks A monk (, from el, μοναχός, ''monachos'', "single, solitary" via Latin ) is a person who practices religious asceticism by monastic living, either alone or with any number of other monks. A monk may be a person who decides to dedica ...

often provided nursing-like care. Examples exist in Christian, Islamic and

Buddhist Buddhism ( , ), also known as Buddha Dharma and Dharmavinaya (), is an Indian religion or philosophical tradition based on teachings attributed to the Buddha. It originated in northern India as a -movement in the 5th century BCE, and ...

traditions amongst others. Phoebe, mentioned in

Romans Roman or Romans most often refers to: *Rome, the capital city of Italy * Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *''Epistle to the Romans'', shortened to ''Romans'', a lette ...

16 has been described in many sources as "the first visiting nurse". These traditions were influential in the development of the

ethos Ethos ( or ) is a Greek word meaning "character" that is used to describe the guiding beliefs or ideals that characterize a community, nation, or ideology; and the balance between caution, and passion. The Greeks also used this word to refer to ...

of modern nursing. The religious roots of modern nursing remain in evidence today in many countries. One example in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

is the use of the historical title "sister" to refer to a senior nurse in the past. During the

Reformation The Reformation (alternatively named the Protestant Reformation or the European Reformation) was a major movement within Western Christianity in 16th-century Europe that posed a religious and political challenge to the Catholic Church and in ...

of the 16th century,

Protestant Protestantism is a branch of Christianity that follows the theological tenets of the Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century against what its followers perceived to b ...

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

19th century

During the

Crimean War The Crimean War, , was fought from October 1853 to February 1856 between Russia and an ultimately victorious alliance of the Ottoman Empire, France, the United Kingdom and Piedmont-Sardinia. Geopolitical causes of the war included the ...

the Grand Duchess Elena Pavlovna issued the call for women to join the Order of Exaltation of the Cross (Krestodvizhenskaya obshchina) for the year of service in the military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, went off to the Crimea early in November 1854. Florence Nightingale (H Hering NPG x82368)

Florence Nightingale (H Hering NPG x82368)

Florence Nightingale Florence Nightingale (; 12 May 1820 – 13 August 1910) was an English social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, i ...

laid the foundations of professional nursing after the

. Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman can help improve the care of the medically sick. Her '' Notes on Nursing'' (1859) became popular. The Nightingale model of professional education, having set up one of the first schools of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870. Nightingale was also a pioneer of the graphical presentation of statistical

data In the pursuit of knowledge, data (; ) is a collection of discrete Value_(semiotics), values that convey information, describing quantity, qualitative property, quality, fact, statistics, other basic units of meaning, or simply sequences of sy ...

. Florence Nightingale worked by sub concepts of the environmental theory. She included five factors that helped nurses in her time of working in poor sanitation and with uneducated nurses. These factors included (1) fresh air, (2) clean water, (3) a working drainage system, (4) cleanliness, and (5) good light or sunlight. Nightingale believed that a clean, working environment were important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around the patient for the better of their health. Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as

Mary Seacole Mary Jane Seacole (;Anionwu E.N. (2012) Mary Seacole: nursing care in many lands. ''British Journal of Healthcare Assistants'' 6(5), 244–248. 23 November 1805 – 14 May 1881) was a British-Jamaican nurse and businesswoman who set up t ...

, who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in the 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the

Colony of Jamaica The Crown Colony of Jamaica and Dependencies was a British colony from 1655, when it was captured by the English Protectorate from the Spanish Empire. Jamaica became a British colony from 1707 and a Crown colony in 1866. The Colony was prima ...

in the 18th century, and they included Seacole's mother, Mrs. Grant, Sarah Adams,

Cubah Cornwallis Cubah Cornwallis (died 1848) (often spelled Coubah, Couba, Cooba or Cuba) was a nurse or "doctress" and Obeah woman who lived in the colony of Jamaica during the late 18th and 19th century. Early life Little is known of her early life although re ...

, and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor. Other important nurses in the development of the profession include: *

Agnes Hunt Dame Agnes Gwendoline Hunt DBE RRC (31 December 1866 – 24 July 1948) was a British nurse, who is generally recognised as the first orthopaedic nurse. Early life She was born in London, daughter and sixth of eleven children of Rowland Hunt ( ...

from

Shropshire Shropshire (; alternatively Salop; abbreviated in print only as Shrops; demonym Salopian ) is a landlocked historic county in the West Midlands region of England. It is bordered by Wales to the west and the English counties of Cheshire to ...

was the first orthopedic nurse and was pivotal in the emergence of the orthopedic hospital The Robert Jones & Agnes Hunt Hospital in Oswestry, Shropshire. *

Valérie de Gasparin Valérie Boissier, comtesse de Gasparin (13 September 1813 – 1894) was a Swiss woman of letters. She was a spokeswoman in topics such as freedom, equality and creativity.Agénor de Gasparin, the first nursing school in the world : La Source, in

Lausanne , neighboring_municipalities= Bottens, Bretigny-sur-Morrens, Chavannes-près-Renens, Cheseaux-sur-Lausanne, Crissier, Cugy, Écublens, Épalinges, Évian-les-Bains (FR-74), Froideville, Jouxtens-Mézery, Le Mont-sur-Lausanne, Lugrin (FR ...

, Switzerland. *

Agnes Jones Agnes Elizabeth Jones (1832 – 1868) of Fahan, County Donegal, Ireland became the first trained Nursing Superintendent of Liverpool Workhouse Infirmary. She gave all her time and energy to her patients and died at the age of 35 from ty ...

, who established a nurse training regime at the

Brownlow Hill infirmary Brownlow Hill infirmary was a large workhouse infirmary in Liverpool, notable for its role in advancing training of nurses. The workhouse was demolished in 1931, and the site is now occupied by Liverpool's Catholic cathedral. History Initial co ...

Liverpool Liverpool is a city and metropolitan borough in Merseyside, England. With a population of in 2019, it is the 10th largest English district by population and its metropolitan area is the fifth largest in the United Kingdom, with a populat ...

, in 1865. *

Linda Richards Linda Richards (July 27, 1841 – April 16, 1930) 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 recor ...

, who established quality

nursing schools Nurse education consists of the theoretical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. This education is provided to student nurses by experienced nurses and other med ...

in the United States and Japan, and was officially the first professionally trained nurse in the US, graduating in 1873 from the ''

New England Hospital for Women and Children The New England Hospital for Women and Children was founded by Marie Zakrzewska on July 1, 1862. The Hospitals goal was to provide patients with competent female physicians, educate women in the study of medicine and train nurses to care for the ...

'' in Boston. * Clarissa Harlowe "Clara" Barton, a pioneer American teacher, patent clerk, nurse, and humanitarian, and the founder of the American Red Cross. * Saint

Marianne Cope Marianne Cope, also known as Saint Marianne of Molokai, (January 23, 1838 – August 9, 1918) was a German-born American religious sister who was a member of the Sisters of St Francis of Syracuse, New York, and founding leader of its St. Jose ...

, a Sister of St. Francis who opened and operated some of the first general hospitals in the United States, instituting cleanliness standards which influenced the development of America's modern hospital system.

Red Cross The International Red Cross and Red Crescent Movement is a humanitarian movement with approximately 97 million volunteers, members and staff worldwide. It was founded to protect human life and health, to ensure respect for all human beings, and ...

chapters, which began appearing after the establishment of the

International Committee of the Red Cross The International Committee of the Red Cross (ICRC; french: Comité international de la Croix-Rouge) is a humanitarian organization which is based in Geneva, Switzerland, and it is also a three-time Nobel Prize Laureate. State parties (signato ...

in 1863, offered employment and professionalization opportunities for nurses (despite initial objections from

). Catholic orders such as

Little Sisters of the Poor The Little Sisters of the Poor (french: Petites Sœurs des pauvres) is a Catholic religious institute for women. It was founded by Jeanne Jugan. Having felt the need to care for the many impoverished elderly who lined the streets of French towns ...

Sisters of Mercy The Sisters of Mercy is a religious institute of Catholic women founded in 1831 in Dublin, Ireland, by Catherine McAuley. As of 2019, the institute had about 6200 sisters worldwide, organized into a number of independent congregations. They a ...

, Sisters of St. Mary, St. Francis Health Services, Inc. and

Sisters of Charity Many religious communities have the term Sisters of Charity in their name. Some ''Sisters of Charity'' communities refer to the Vincentian tradition, or in America to the tradition of Saint Elizabeth Ann Seton, but others are unrelated. The ...

built hospitals and provided nursing services during this period. In turn, the modern deaconess movement began in Germany in 1836. Within a half century, there were over 5,000 deaconesses in Europe. Formal use of nurses in the modern military began in the latter half of the nineteenth century. Nurses saw active duty in the

First Boer War The First Boer War ( af, Eerste Vryheidsoorlog, literally "First Freedom War"), 1880–1881, also known as the First Anglo–Boer War, the Transvaal War or the Transvaal Rebellion, was fought from 16 December 1880 until 23 March 1881 betwee ...

, the Egyptian Campaign (1882), and the

Sudan Campaign The Mahdist War ( ar, الثورة المهدية, ath-Thawra al-Mahdiyya; 1881–1899) was a war between the Mahdist Sudanese of the religious leader Muhammad Ahmad bin Abd Allah, who had proclaimed himself the "Mahdi" of Islam (the "Guided On ...

(1883).

20th century

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

World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...

, but the profession was transformed during the

Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposi ...

. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US

Army An army (from Old French ''armee'', itself derived from the Latin verb ''armāre'', meaning "to arm", and related to the Latin noun ''arma'', meaning "arms" or "weapons"), ground force or land force is a fighting force that fights primarily on ...

and

Navy A navy, naval force, or maritime force is the branch of a nation's armed forces principally designated for naval and amphibious warfare; namely, lake-borne, riverine, littoral, or ocean-borne combat operations and related functions. It in ...

than any other occupation. The Nazis had their own Brown Nurses, 40,000 strong. Two dozen German Red Cross nurses were awarded the

Iron Cross The Iron Cross (german: link=no, Eisernes Kreuz, , abbreviated EK) was a military decoration in the Kingdom of Prussia, and later in the German Empire (1871–1918) and Nazi Germany (1933–1945). King Frederick William III of Prussia es ...

for heroism under fire. The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of

professional organizations A professional association (also called a professional body, professional organization, or professional society) usually seeks to further a particular profession, the interests of individuals and organisations engaged in that profession, and th ...

and

academic journals An academic journal or scholarly journal is a periodical publication in which scholarship relating to a particular academic discipline is published. Academic journals serve as permanent and transparent forums for the presentation, scrutiny, and ...

. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice. In the 19th and early 20th century, nursing was considered a women's profession, just as doctoring was a men's profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially

gender-neutral Gender neutrality (adjective form: gender-neutral), also known as gender-neutralism or the gender neutrality movement, is the idea that policies, language, and other social institutions (social structures or gender roles) should avoid distinguish ...

profession, though in practice the percentage of male nurses remains well below that of female

s in the early 21st century.

Shortages

The biggest shortages of nurses and midwives are in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their current role in direct patient care in the next year. Nursing shortages are a rising risk in many countries. The top five factors which they said would make them stay were *A safe working environment *Work-life balance *Caring and trusting team-mates *Doing meaningful work *Flexible work schedule Pay was eighth on the list. An American survey in 2003 found about half the respondents were considering leaving.

Definition

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

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 Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concer ...

, standards, and competencies, and continuing their education.International Council of Nurses
Retrieved August 2007 There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of

nursing theory Nursing theory is defined as "a creative and rigorous structuring of ideas that project a tentative, purposeful, and systematic view of phenomena". Through systematic inquiry, whether in nursing research or practice, nurses are able to develop knowl ...

and practice as well as training in clinical skills. Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a

holistic Holism () is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. The term "holism" was coined by Jan Smuts in his 1926 book '' Holism and Evolution''."holism, n." OED On ...

manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals. To work in the nursing profession, all nurses hold one or more credentials depending on their

and

education Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty ...

. In the United States, a Licensed Practical Nurse (LPN) works independently or with a Registered Nurse (RN). The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees. In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as an RN. The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN). The

Bachelor of Science in Nursing The Bachelor of Science in Nursing (BSN, BScN) also known in some countries as a Bachelor of Nursing (BN) or Bachelor of Science (BS) with a Major in Nursing is an academic degree in the science and principles of nursing, granted by an accredited ...

(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 United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a standardized exam (including multiple choice, select all that apply, fill in the blank and "hot spot" questions) that nurses take to become licensed. It costs two-hundred dollars to take and examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase. Some nurses follow the traditional role of working in a hospital setting. Other options include: pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics (

eHealth eHealth (also written e-health) is a relatively recent healthcare practice supported by electronic processes and communication, dating back to at least 1999. Usage of the term varies as it covers not just "Internet medicine" as it was conceived ...

). There are many other options nurses can explore depending on the type of degree and education acquired. These options can also include, community health, mental health, clinical nursing specialists, and nurse midwives. RNs may also pursue different roles as advanced practice nurses. Nurses are not doctors' assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses. RNs treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. However, they also assist doctors in the emergency room or in trauma care when help is needed.

Gender issues

Male Nurses- Life at Runwell Hospital, Wickford, Essex, 1943 D14313

Despite equal opportunity legislation, nursing has continued to be a female-dominated profession in many countries; according to the

WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...

's 2020 ''State of the World's Nursing,'' approximately 90% of the nursing workforce is female. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is represented around the world. Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the

Democratic Republic of Congo The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...

, 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 , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = ''Plus ultra'' (Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , i ...

Portugal Portugal, officially the Portuguese Republic ( pt, República Portuguesa, links=yes ), is a country whose mainland is located on the Iberian Peninsula of Southwestern Europe, and whose territory also includes the Atlantic archipelagos of ...

Czech Republic The Czech Republic, or simply Czechia, is a landlocked country in Central Europe. Historically known as Bohemia, it is bordered by Austria to the south, Germany to the west, Poland to the northeast, and Slovakia to the southeast. The ...

and

Italy Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...

, over 20% of nurses are male. In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male. The number of male nurses in the United States doubled between 1980 and 2000. However female nurses are still more common, but male nurses receive more pay on average. Research has indicated that there can be negative effects of diversity within nursing. When there is a heavier focus on diversity in nursing, the quality of care or performance of the nurses can be hindered. Research demonstrates that as people begin to be different in a work setting, this can create issues if not addressed correctly. When hospitals begin to focus on diversity over their patients, the quality of care can be negatively affected if diversity becomes the main goal.

Minorities in U.S. nursing

Statistically speaking, in the United States 19.2% of nursing positions are held by people of minority backgrounds. The remaining 80.8% of positions are held by Caucasian individuals, particularly women. Diversity in nursing is lacking.

Theory and process

Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the

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. The diagnosis phase was ...

. This is based around a specific

which is selected in consideration with the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from

nursing research Nursing research is research that provides evidence used to support nursing practices. 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 rese ...

. The nursing process is made up of five steps: 1.evaluate, 2. implement, 3. plan, 4. diagnose, and 5. assess. Nurses are able to use this process from the American Nurses Association to determine the best care they can provide for the patient. There are many other diverse nursing theories as well. In general terms, the nursing process is the method used to assess and

diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

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 paradigms or

worldview A worldview or world-view or ''Weltanschauung'' is the fundamental cognitive orientation of an individual or society encompassing the whole of the individual's or society's knowledge, culture, and point of view. A worldview can include natural ...

s to help nurses direct their activities to accomplish specific goals.

Scope of activities

Activities of daily living assistance

Nurses manage and coordinate care to support activities of daily living (ADL). Often the provision of such care is delegated to

nursing assistant Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—includ ...

s. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed.

Medication

Medication management and administration are a part of most hospital nursing roles, however, prescribing authority varies between jurisdictions. In many areas, registered nurses administer and manage medications prescribed by a professional with full prescribing authority such as a

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe ...

or a

. As nurses are responsible for evaluating patients throughout their care - including before and after medication administration - adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. There may be legal implications when there is an error in a prescription, and the nurse could be expected to have noted and reported the error. In the United States, nurses have the right to refuse any medication administration that they deem to be potentially harmful to the patient. In the United Kingdom there are some nurses who have taken additional specialist training that allows them to prescribe any medications from their scope of practice.

Patient education

The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits. Many times, nurses are very busy and have a hard time giving information to the patient because they have so many other things going on. Educating the patient and their family increases the chance for a better patient experience. Giving the best care requires informing the patient of what is going on and support. While explaining procedure, recovery, and taking care of the patient, nurses also have to help patients and their families cope with different medical situations. When speaking with the patient, nurses have to be able to communicate in a way that can be understood by the patient. Informing the patient may involve speaking in broad, general terms, using visuals or different reading materials, and even including demonstrations if necessary. The more the patient and their family understand what the nurse is saying, the better healthcare the patient can receive without the assistance of a nurse.

Specialties and practice settings

Nursing is the most diverse of all health care 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 *mental health *informatics (

) *acute care hospitals *ambulatory settings (physician offices, urgent care settings, camps, etc.) *school/college infirmaries Nurses with higher degrees allow for specialization within the medical field. There are many specific nursing professions that can be separated into categories of care type, age, gender, certain age group, practice setting, etc. Nurses are able to specialize with a combination of these categories as well. There are also specialist areas such as

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 ...

, orthopedic nursing,

palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...

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, anaesthesiologists, nurse anaesthetists, surgical technologists, and nurs ...

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 have recently delivered. Obstetrical nurses help provide prenatal care and testin ...

oncology nursing An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can be ...

, nursing informatics,

telenursing Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points ...

, radiology, and emergency nursing. Nurses practice in a wide range of settings, including hospitals, private

homes A home, or domicile, is a space used as a permanent or semi-permanent residence for one or many humans, and sometimes various companion animals. It is a fully or semi sheltered space and can have both interior and exterior aspects to it. ...

schools A school is an educational institution designed to provide learning spaces and learning environments for the teaching of students under the direction of teachers. Most countries have systems of formal education, which is sometimes compulsor ...

, and

pharmaceutical companies The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...

. Nurses work in

occupational health Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...

settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics,

long-term care Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and ...

facilities and camps. They also work on

cruise ships Cruise ships are large passenger ships used mainly for vacationing. Unlike ocean liners, which are used for transport, cruise ships typically embark on round-trip voyages to various ports-of-call, where passengers may go on tours known as "sho ...

and in the

military service Military service is service by an individual or group in an army or other militia, air forces, and naval forces, whether as a chosen job ( volunteer) or as a result of an involuntary draft (conscription). Some nations (e.g., Mexico) require ...

. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the

health advocacy Health advocacy or health activism 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 pa ...

and

patient advocacy Patient advocacy is a process in health care concerned with advocacy for patients, survivors, and caregivers. The patient advocate may be an individual or an organization, concerned with healthcare standards or with one specific group of disord ...

fields at companies such as

Health Advocate Health Advocate, Inc. is a US national health advocacy, patient advocacy and assistance company. The privately held company was founded in 2001 by former Aetna executives and is headquartered in Plymouth Meeting, Pennsylvania, currently run by ...

, Inc. helping in a variety of clinical and administrative issues. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to 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. Nurse authors publish articles and books to provide essential reference materials.

Occupational hazards

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. Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios. The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor,

shift work Shift work is an employment practice designed to make use of, or provide service across, all 24 hours of the clock each day of the week (often abbreviated as '' 24/7''). The practice typically sees the day divided into shifts, set periods of ...

, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including

sleep disorders A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests ...

, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of

occupational burnout According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s ...

(40%) and

emotional exhaustion Emotional exhaustion is a chronic state of physical and emotional depletion that results from excessive job, personal demands, and/or continuous stress. It describes a feeling of being emotionally overextended and exhausted by one's work. It is ma ...

(43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision. Nurses are also at risk for violence and abuse in the workplace. Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by other hospital personnel. Of American nurses, 57% reported in 2011 that they had been threatened at work; 17% were physically assaulted. There are 3 different types of workplace violence that nurses can experience. First, physical violence, which can be hitting, kicking, beating, punching, biting, and using objects to inflict force upon someone. Second, psychological violence is when something is done to impair another person through threats and/or coercion. Third, sexual violence which can include any completed or attempted non-consensual sexual act. Workplace violence can also be categorized into two different levels, interpersonal violence and organizational coercion. Interpersonal violence could be committed by co-workers and/or patients by others in the hospital. The main form of this level is verbal abuse. Organizational coercion may include an irrationally high workload, forced shifts, forced placement in different wards of the hospital, low salaries, denial of benefits for overwork, poor working environment, and other workplace stressors. These problems can affect the quality of life for these nurses who may experience them. It can be extremely detrimental to nurses if their managers lack understanding of the severity of these problems and do not support the nurses through them. There are many contributing factors to workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. The environmental factors can include the specific setting (for example the emergency department), long patient wait times, frequent interruptions, uncertainty regarding the patients' treatment, and heavy workloads. Organizational factors can include inefficient teamwork, organizational injustice, lack of aggression and/or stress management programs, and distrust between colleagues. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills. Misunderstandings may also occur due to the communication barrier between nurses and patients. An example of this could be the patient's condition being affected by medication, pain, and/or anxiety. There are many causes of workplace violence. The most common perpetrators for harassment and/or bullying against nursing students were registered nurses including preceptors, mentors, and clinical facilitators. However, the main cause of workplace violence against nurses were patients. 80% of serious violence incidents in health care centers were due to the nurses' interactions with patients. There are many different effects of workplace violence in the field of Nursing. Workplace violence can have a negative impact on nurses both emotionally and physically. They feel depersonalized, dehumanized, fatigued, worn out, stressed out, and tired. Because of the severity of some incidents of violence, nurses have reported manifestations of burn-out due to the frequent exposure. This can heavily impact of a nurses' mental health and cause nurses to feel unsatisfied with their profession and unsafe in their work environment.

Prevention

There are a number of interventions that can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses. In some Japanese hospitals, powered exoskeletons are used. Lumbar supports (i.e.

back belt Back belts, or lumbar support belts, are generally lightweight belts worn around the lower back to provide support to the lumbar. Industrial back belts tend to be similar to weight lifting belts or special belts used in medical rehabilitation thera ...

s) have also been trialed.

Worldwide

Americas

United States

In the US, scope of practice is determined by the state or territory in which a nurse 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 A board of nursing is a regulatory body that oversees the practice of nursing within a defined jurisdiction, typically a state or province. The board typically approves and oversees schools of nursing within its jurisdiction. The board also handl ...

, which performs day-to-day administration of these rules, licenses for nurses and nursing assistants, and makes decisions on nursing issues. 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). In the hospital setting, registered nurses often delegate tasks to LPNs and

unlicensed assistive personnel Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—includ ...

. RNs are not limited to employment as bedside nurses. They are employed by physicians, attorneys, insurance companies, governmental agencies, community/public health agencies, private industry, school districts, ambulatory surgery centers, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation (outcome and process) in many areas such as biology, psychology, human development, and health care systems. Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.United States Department of Labor Bureau of Labor Statistics Nursing is the nation's largest health care profession. In 2017, there were more than 4,015,250 registered nurses and 922,196 licensed practical nurses nationwide. Of all licensed RNs, 2.6 million or 84.8% are employed in nursing. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in nursing (BSN) degree. Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam. (The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system.)

=Educational and licensure requirements

Diploma in Nursing

The oldest method of nursing education is the hospital-based diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in

anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...

physiology Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...

, microbiology,

nutrition Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient ...

, 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.American Nurses Association
"Nursing Facts: Today's Registered Nurse – Numbers and Demographics"
Washington, D.C., American Nurses Association, 2006. 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.Health Resources and Service Administration
"Findings from the National Sample Survey Of Registered Nurses"
Washington, D.C., U.S. Department of Health and Human Services Health Resources and Service Administration Bureau of Health Professions Division of Nursing, 2000.

Associate Degree in Nursing

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

Bachelor of Science in Nursing

Another pathway into the profession, or a higher level of education for other nurses, is obtaining a

(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. In some new programs the first two years can be substituted for an active LPN license along with the required general studies. Advocates for the ADN and diploma programs state that such programs have an on the job training approach to educating students, while the BSN is an academic degree that emphasizes research and

. Some states require a specific amount of clinical experience that is the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions that would not usually be available to those with an ADN, but is not necessary for most patient care functions. Nursing schools may be accredited by either the

Accreditation Commission for Education in Nursing The National League for Nursing (NLN) 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 initiative ...

(ACEN) or the Commission on Collegiate Nursing Education (CCNE).

Graduate education

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

(NP), a certified

nurse midwife A nurse midwife is both a nurse (usually a registered nurse) and a midwife, having completed nursing and midwifery education leading to practice as a nurse midwife and sometimes credentialed in the specialty. Nurse midwives provide care of women ...

(CNM), a certified registered nurse anesthetist (CRNA), or a

clinical nurse specialist A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse w ...

(CNS). Nurse practitioners and CNSs work assessing, diagnosing and treating patients in fields as diverse as

family practice Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primar ...

, women's health care, emergency nursing, acute/critical care,

psychiatry Psychiatry is the specialty (medicine), medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psych ...

geriatrics Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros ...

, or pediatrics, additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.

=Licensure examination

= Completion of any one of these three educational routes allows a graduate nurse to take the

NCLEX-RN The National Council Licensure Examination (NCLEX) is a nationwide examination for the licensing of nurses in the United States, Canada and Australia since 1982, 2015 and 2020 respectively. There are two types, the NCLEX-RN and the NCLEX-PN. Aft ...

, the test for

licensure Licensure means a restricted practice or a restriction on the use of an occupational title, requiring a license. A license created under a "practice act" requires a license before performing a certain activity, such as driving a car on public roa ...

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.

=Shortage in the United States

= RNs are the largest group of health care workers in the United States, with about 2.7 million employed in 2011.Bureau of Labor Statistics – Registered Nurses
It has been reported that the number of new graduates and foreign-trained nurses is insufficient to meet the

demand In economics, demand is the quantity of a good that consumers are willing and able to purchase at various prices during a given time. The relationship between price and quantity demand is also called the demand curve. Demand for a specific item ...

for registered nurses; this is often referred to as the

nursing shortage A nursing shortage occurs when the demand for nursing professionals, such as Registered Nurses (RNs), exceeds the supply locallywithin a health care facilitynationally or globally. It can be measured, for instance, when the nurse-to-patient ...

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. The Bureau of Labor Statistics (BLS) reported that 296,900 healthcare jobs were created in 2011. RNs make up the majority of the healthcare work force, therefore these positions will be filled primarily by nurses. The BLS also states that by 2020, there will be 1.2 million nursing job openings due to an increase in the workforce, and replacements.

Causes

The International Council of Nursing (ICN), the largest international health professional organization in the world, recognizes the shortage of nurses as a growing crisis in the world. This shortage impacts the healthcare of everyone worldwide. One of the many reasons is that nurses who pursue to become nurses do so very late in their lives. This leads to a non-lengthy employment time. A national survey prepared by the Federation of Nurses and Health Professionals in 2001 found that one in five nurses plans to leave the profession within five years because of unsatisfactory working conditions, including low pay, severe under staffing, high stress, physical demands, mandatory overtime, and irregular hours. Approximately 29.8 percent of all nursing jobs are found in hospitals. However, due to 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. Many nurses will also be needed to help staff the growing number of out-patient facilities, such as HMOs (Health Maintenance Organizations), group medical practices, and ambulatory surgery centers. Nursing specialties will be in great demand. There are, in addition, many part-time employment possibilities.Nardi, Deena A., and Charlene C. Gyurko. "The Global Nursing Faculty Shortage: Status and Solutions for Change." (2013): 1–11. Web. 28 January 2015. Levsey, Campbell, and Green voiced their concern about the shortage of nurses, citing Fang, Wilsey-Wisniewski, & Bednash, 2006, who state that over 40,000 qualified nursing applicants were turned away in the 2005–2006 academic year from baccalaureate nursing programs due to a lack of masters and doctoral qualified faculty, and that this number was increased over 9,000 from 32,000 qualified but rejected students from just two years earlier. Several strategies have been offered to mitigate this shortage including; Federal and private support for experienced nurses to enhance their education, incorporating more hybrid/blended nursing courses, and using simulation in lieu of clinical (hospital) training experiences. Furthermore, there is a shortage of academically qualified instructors to teach at schools of nursing worldwide. The serious need for educational capacity is not being met, which is the underlying most important preparation resource for the nurses of tomorrow. The decrease in faculty everywhere is due to many factors including decrease in satisfaction with the workforce, poor salaries, and reduction in full-time equivalent. Throughout the span of 6 years the nursing faculty shortage has been written about an increasing amount. There is no clear consensus or an organized plan on how to fix the ongoing issue.

=Continuing education

= With health care knowledge growing steadily, nurses can stay ahead of the curve through continuing education. Continuing education classes and 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. Continuing education classes are calibrated to provide enhanced learning for all levels of nurses. Many States also regulate Continuing Nursing Education. Nursing licensing boards requiring Continuing Nursing Education (CNE) as a condition for licensure, either initial or renewal, accept courses provided by organizations that are accredited by other state licensing boards, by the American Nursing Credentialing Center (ANCC), or by organizations that have been designated as an approver of continuing nursing education by ANCC. There are some exceptions to this rule including the state of California, Florida and Kentucky. National Healthcare Institute has created a list to assist nurses in determining their CNE credit hours requirements. While this list is not all inclusive, it offers details on how to contact nursing licensing boards directly.

=Board certification

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

American Nurses Credentialing Center The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the U ...

, the credentialing arm of the

American Nurses Association The American Nurses Association (ANA) is a 501(c)(6) 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. It is b ...

, is the largest nursing credentialing organization and administers more than 30 specialty examinations.American Nurses Credentialing Center
"ANCC Certification"
Washington, D.C., American Nurses Association, 2006.

=Correctional nursing

= Due to its large prison population, the United States needs many correctional nurses to help inmates receive proper health-care, including mental health treatments for prisoners with psychological issues. The demand for nurse is high everywhere. Nurses working in correctional care have to focus on the care of the patient, not what they did. They are to provide the best possible care because is a compassionate field and all nurses want is to better the patient. Nurses are not the only health care workers in correctional facilities. Some examples of people who work in correctional facilities are LPNS, RNs, nurse practitioners, doctors, pharmacists, therapists, and specialists.

Role of correctional nurse

When the individual arrives, nurses perform an initial exam that is just a basic checkup to determine what needs the patient may have while in prison. Here they can discover existing conditions or even signs of substance abuse. A correctional nurse can face a wide variety of healthcare issues including chronic medical conditions, mental health, infectious disease, and much more. Correctional nurses must follow stricter protocols then say in a hospital due to confidentiality. Assessing a patient can be difficult. A deputy or officer may have to be present during exams, which can make the patient feel restricted, and be less open with their medical information. Without the nurse knowing some information from the patient, prevent them from receiving the best care possible.

Canada

=History

= Canadian nursing dates back to 1639 in

Quebec Quebec ( ; )According to the Canadian government, ''Québec'' (with the acute accent) is the official name in Canadian French and ''Quebec'' (without the accent) is the province's official name in Canadian English is one of the thirtee ...

with the Augustine nuns.Link text
. These nuns were trying to open 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, some Catholic orders of nursing were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.

Education

All Canadian nurses and prospective nurses are heavily encouraged by the

Canadian Nurses Association The Canadian Nurses Association (CNA), known in French as the Association des infirmières et infirmiers du Canada (AIIC), is the national professional association representing registered nurses, nurse practitioners, licensed and registered pra ...

to continue their education to receive a

bachelor's degree A bachelor's degree (from Middle Latin ''baccalaureus'') or baccalaureate (from Modern Latin ''baccalaureatus'') is an undergraduate academic degree awarded by colleges and universities upon completion of a course of study lasting three to six ...

. This degree may result in better patient outcomes. All Canadian provinces and territories, with the exception of the

Yukon Yukon (; ; formerly called Yukon Territory and also referred to as the Yukon) is the smallest and westernmost of Canada's three territories. It also is the second-least populated province or territory in Canada, with a population of 43,964 as ...

and

, require that all nurses have a bachelor's degree. The length of time generally required to obtain this degree is four years. However, some Canadian universities offer a condensed program that is two years in length. Nursing specialty certification is available through the

in 22 practice areas, including: * cardiovascular nursing * community health 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 following extensive injury, surgery or life threatening diseases. Critical care nurses can be found working in a wide variety o ...

* pediatric critical care nursing * emergency nursing * gastroenterology nursing * gerontological nursing * hospice palliative care nursing * medical-surgical nursing * neonatal nursing * nephrology nursing * neuroscience nursing * occupational health nursing *

* orthopedic nursing * pediatric nursing * peri-anesthesia nursing *

* peri-operative nursing *

psychiatric and mental health nursing Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizoph ...

* rehabilitation nursing *

Wound, ostomy, and continence nursing Wound, ostomy, and continence nursing is a nursing specialty involved with the treatment of patients with acute and chronic wounds, patients with an ostomy (those who have had some kind of bowel or bladder diversion), and patients with incontinence ...

Nursing specialty certification generally requires practice, experience, and passing a test that is based on competencies for that specific medical or surgical domain in which nursing care is provided. The certification in gerontological nursing, which involves providing care to the elderly, is offered to not only RNs and NPs but also LPNs.

Latin America

Latin American nursing is based on three levels of training: (a) professional/registered, (b) technical, and (c) auxiliary. The nursing education in Latin America and the Caribbean includes the principles and values of the Universal Health and primary health care. These principles underpin transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. The Pan American Health Organization/World Health Organization (PAHO/WHO) proposes the Strategy for Universal Access to Health and Universal Health Coverage to improve health outcomes and other basic objectives of health systems based on the right of each person to receive the best standard of health, without exposing people to financial difficulties through nursing intervention.

Europe

Spain

See

Nursing in Spain Nursing in Spain is regulated by the General Council of Official Associations of Nursing (Organización Colegial de Enfermería). Migration Nurses and health visitors in Spain are required to accumulate points to demonstrate the accumulation of ex ...

United Kingdom

To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the

Nursing and Midwifery Council The Nursing and Midwifery Council (NMC) is the regulator for nursing and midwifery professions in the UK. The NMC maintains a register of all nurses, midwives and specialist community public health nurses and nursing associates eligible to pra ...

. 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.United Kingdom Governmen
Nurses, Midwives and Health Visitors Act, 1997.
London: HMSO, 1997. From April 2016, nurses in the United Kingdom are expected to revalidate every three years which involves providing evidence of further development and active practice.

=First and second level

= First-level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles such as Registered General Nurse (RGN), Registered Sick Children's Nurse (RSCN), Registered Mental Nurse (RMN), and Registered Nurse (for the) Mentally Handicapped (RNMH). The titles used now are similar, including Registered Nurse Adult (RNA), Registered Nurse Child (RNC), Registered Nurse Mental Health (RNMH), and Registered Nurse (of) Learning Disabilities (RNLD). Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse. Many have now either retired or undertaken conversion courses to become first-level nurses. They are entitled to refer to themselves as registered nurses as their registration is on the Nursing & Midwifery Council register of nurses, although most refer to themselves as Enrolled Nurses (ENs) or State Enrolled Nurses (SENs).

=Advanced practice

= * ''Nurse practitioners'' – Most of these nurses obtain a minimum of a master's degree and a desired post grad certificate. They often perform roles similar to those of physicians and physician assistants. They can prescribe medications as independent or supplementary prescribers, although they are still legally regulated, unlike physician's assistants. Most Nurse Practitioners (NPs) have referral and admission rights to hospital specialties. They commonly work in

primary care Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care ...

(e.g. General Practitioner (GP) surgeries), Accident and Emergency (A&E) departments, 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 nurse District Nurses work manage care within the community and lead teams of community nurses and support workers. The role requires registered nurses to take a NMC approved specialist practitioner course. Duties generally include visiting house-bound ...

s and health visitors, this group oversees research and publication activities. * ''Lecturer-practitioners (also called practice education facilitators)'' – these nurses work both in the National Health Service (NHS), and in universities. They typically work 2–3 days per week in each setting. In university, they train pre-registration student nurses (see below), and often teach on specialist courses 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''.

=Nurse education

Pre-registration

To become a registered nurse, one must complete a program recognised by the

(NMC). Currently, this involves completing a degree, available from a range of universities offering these courses, in the chosen branch specialty (see below), leading to both an academic award and professional registration as a 1st level registered nurse. Such a course is a 50/50 split of learning in university (i.e. through lectures, assignments 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. Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are: * Child nursing * Mental health nursing * Learning disabilities nursing As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification. However, those nurses who hold a diploma, or even a certificate in nursing are still able to legally practice in the UK, although they are able to undertake university modules to obtain enough credits to top up to a degree.

Midwifery Midwifery is the health science and health profession that deals with pregnancy, childbirth, and the postpartum period (including care of the newborn), in addition to the sexual and reproductive health of women throughout their lives. In many ...

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) programs 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.Nursing and Midwifery Counci
Pre-registration training.
London: NMC, 2003. student nurses in England and Wales can apply for a

bursary A bursary is a monetary award made by any educational institution or funding authority to individuals or groups. It is usually awarded to enable a student to attend school, university or college when they might not be able to, otherwise. Some awa ...

from the government to support them during their nurse training, and may also be eligible for a student loan, although there has been speculation that this will not be available in the future. Student nurses in Scotland still receive a standard bursary which is not means tested, and their tuition fees continue to be paid – however, they are not eligible for student loans. 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 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 A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...

venipuncture In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is performed by medical labor ...

, intravenous drug therapy and male catheterization are the most common, although there are many others (such as

advanced life support Advanced Life Support (ALS) 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 (breathing). Components These include: * Tracheal in ...

), which some nurses 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 was 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.Nursing and Midwifery Education, 2007 To become specialist nurses (such as nurse consultants, nurse practitioners etc.) or nurse educators, some nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards.

District nurse District Nurses work manage care within the community and lead teams of community nurses and support workers. The role requires registered nurses to take a NMC approved specialist practitioner course. Duties generally include visiting house-bound ...

s and health visitors are also considered specialist nurses, and to become such they must undertake specialist training. This is a one-year full-time degree. All newly qualifying

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 1 May 2006) to prescribe almost any drug in the

British National Formulary The ''British National Formulary'' (BNF) is a United Kingdom (UK) pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about many medicine ...

. This has been the cause of a great deal of debate in both medical and nursing circles.

European Union

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

Asia

India

Nursing education is governed in

India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...

by the central body

Indian Nursing Council Indian Nursing Council is a national regulatory body for nurses and nurse education in India. It is an autonomous body under the Government of India, Ministry of Health & Family Welfare, constituted by the Central Government under section 3(1) ...

and its norms are implemented through respective State Nursing councils. The list of state nursing councils are available in the official web page of Indian Nursing Council. First formal education in nursing was offered in Madras Medical college, in Madras presidency. Indian Nursing Council Act, 1947. Act Year Number: Act No. 19 of December enactment Date of enactment: 1 December 19actAct Objective: An Act to constitute the Nursing Council of India. To establish uniform standards of training for nurses, midwives, and health visitors. It is implemented with 17 sections and each section indicates the specific legislative role of the council. The nursing profession was dominated by females in the British colonial period, but in Madras Presidency, men were actively engaged in the profession.

Iran

Israel

Nurses in

Israel Israel (; he, יִשְׂרָאֵל, ; ar, إِسْرَائِيل, ), officially the State of Israel ( he, מְדִינַת יִשְׂרָאֵל, label=none, translit=Medīnat Yīsrāʾēl; ), is a country in Western Asia. It is situated ...

have a wide variety of responsibilities, including hospital care, patient education, wound care, prenatal and other monitoring, midwifery, and well-baby clinics. Nursing in Israeli Jewish culture traces its origins to Shifra and Puah, two

Hebrew Hebrew (; ; ) is a Northwest Semitic language of the Afroasiatic language family. Historically, it is one of the spoken languages of the Israelites and their longest-surviving descendants, the Jews and Samaritans. It was largely preserved ...

midwives depicted in the

Book of Exodus The Book of Exodus (from grc, Ἔξοδος, translit=Éxodos; he, שְׁמוֹת ''Šəmōṯ'', "Names") is the second book of the Bible. It narrates the story of the Exodus, in which the Israelites leave slavery in Biblical Egypt through ...

helping women in ancient Egypt give birth and keep their infants safe. Modern-day nursing was established by nurses sent to

Mandatory Palestine Mandatory Palestine ( ar, فلسطين الانتدابية '; he, פָּלֶשְׂתִּינָה (א״י) ', where "E.Y." indicates ''’Eretz Yiśrā’ēl'', the Land of Israel) was a geopolitical entity established between 1920 and 1948 ...

and later Israel by the Hadassah organization, as well as a nursing school founded by Henrietta Szold in 1918. During those times, the United Kingdom regulated midwifery in Mandatory Palestine, but the nurses were not mentioned in the regulation decree. Today, nurses and midwives are regulated by the Israeli Ministry of Health.

Japan

=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 Japan. A new law geared towards nurses was created during

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...

: the ''Public Health Nurse, Midwife and Nurse Law'', 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.

=Types of nurses

= Japan only recognizes four types of nursing and they are

Public Health Nursing Public health nursing, also known as community health nursing is a nursing specialty focused on public health. The term was coined by Lillian Wald of the Henry Street Settlement, or, Public health nurses (PHNs) or community health nurses "integra ...

, Registered Nursing and Assistant Nursing.

Public health

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 A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; co ...

takes care of a pregnant woman during labour and postpartum. They assist with things like breastfeeding and caring for the child.

Nursing assistant

Nursing assistants, also known as nurse assistants or CNAs (Certified Nursing Assistants), assist patients with basic daily tasks. 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.

=Education

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

doctorate A doctorate (from Latin ''docere'', "to teach"), doctor's degree (from Latin ''doctor'', "teacher"), or doctoral degree is an academic degree awarded by universities and some other educational institutions, derived from the ancient formalism ''li ...

-level degrees of nursing in a good number of its universities. There are three ways that an individual could become a registered nurse in Japan. After obtaining a high school degree the person could go to a nursing university for four years and earn a bachelor's degree, go to a junior nursing college for three years or go to a nursing school for three years. Regardless of where the individual attends school they must take the national exam. Those who attended a nursing university have a bit of an advantage over those who went to a nursing school. They can take the national exam to be a registered nurse, public health nurse or midwife. In the cases of becoming 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 as one who graduated from a nursing university would, 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

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.

=Today

= Like the United States, Japan is in need of more nurses. The driving force behind this need is the fact that country is aging and needs more medical care for its people. However, the number of available nurses does not seem to be increasing. Nurses face poor working conditions and low social status, and there is a cultural idea that married women quit their jobs for family responsibilities. On average, Japanese nurses make around 280,000 yen a month, and it is one of the higher paying jobs. However, physicians make twice as much as nurses. Similar to other cultures, the Japanese people view nurses as subservient to physicians. According to the

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.'" There are organizations that unite Japanese nurses like the Japanese Nursing Association (JNA); the JNA is a professional organization and not a union. 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. There are other organizations, including some that categorize nurses by 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.

Philippines

Philippines is well known for migrant nurses working in other countries especially in the west like the United States of America. It accounts a quarter of overseas nurses in the world. Every year, around 20,000 nurses leave the Philippines to work in more developed countries looking for better pay. Nurses in the Philippines must be licenced by the Professional Regulatory Commission.

Taiwan

Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the nort ...

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

Australia

Catholic religious institutes were influential in the development of Australian nursing, founding many of Australia's hospitals – the Irish

were first to arrive in 1838 and established

St Vincent's Hospital, Sydney St Vincent's Hospital, Sydney is a leading tertiary referral hospital and research facility located in Darlinghurst, Sydney. Though funded and integrated into the New South Wales state public health system, it is operated by St Vincent's He ...

in 1857 as a free hospital for the poor. They and other orders like the

, and in aged care the Sisters of the Little Company of Mary and

founded hospitals, hospices, research institutes and aged care facilities around Australia. A census in the 1800s found several hundred nurses working in Western Australia during the colonial period of history, this included Aboriginal female servants who cared for the infirm. The state nursing licensing bodies amalgamated in Australia in 2011 under the federal body AHPRA (Australian Health Practitioner Registration Authority). Several divisions of nursing license is available and recognized around the country. * Enrolled nurses may initiate some oral medication orders with a specific competency now included in national curricula but variable in application by agency. * Registered nurses hold a university degree (enrolled nurses can progress to registered nurse status and do get credit for previous study). * Nurse practitioners have started emerging from postgraduate programs and work in both private practice and public hospitals and clinics. * Mental health nurses must complete further training as advanced mental health practitioners in order to administer client referrals under the ''Mental Health Act''. Australia enjoys the luxury of a national curriculum for vocational nurses, trained at Technical and Further Education (TAFE) colleges or private Registered Training Organization (RTO). Enrolled and registered nurses are identified by the department of immigration as an occupational area of need, although registered nurses are always in shorter supply, and this increases in proportion with specialization. Nurses' militancy stemmed from two different kinds of experiences
Anu.edu.au (19 November 1983). Retrieved 28 July 2013. In 1986 there were a number of rolling industrial actions around the country, culminating when five thousand Victorian nurses went on strike for eighteen days. The hospitals were able to function by hiring casual staff from each other's striking members, but the increased cost forced a decision in the nurses' favor.

References

Bibliography

External links

UNCG Library Betty H. Carter Women Veterans Historical Project: Nurse
* {{Authority control Military supporting service occupations Rehabilitation team Health care occupations Hospital staff

History

Premodern

19th century

20th century

Shortages

Definition

As a profession

Gender issues

Minorities in U.S. nursing

Theory and process

Scope of activities

Activities of daily living assistance

Medication

Patient education

Specialties and practice settings

Occupational hazards

Prevention

Worldwide

Americas

United States

=Educational and licensure requirements

=Licensure examination

=Shortage in the United States

=Continuing education

=Board certification

=Correctional nursing

Canada

=History

Education

Latin America

Europe

Spain

United Kingdom

=First and second level

=Advanced practice

=Managers

=Nurse education

European Union

Asia

India

Iran

Israel

Japan

=History

=Types of nurses

=Education

=Today

Philippines

Taiwan

Australia

See also

References

Bibliography

Further reading

Historical

External links