Nursing

Nurse

A British nurse caring for a baby in 2006 Occupation Names Nurse Occupation type Healthcare professional Activity sectors Nursing, Health care Description Caring for general well-being of Competencies patients Qualifications in terms of statutory Education regulations accor ing to national, state, or pro!incial legislation in required each country Nursing is a profession within the health care sector focuse on the care of in i!i uals, families, an communities so they may attain, maintain, or reco!er optimal health an "uality of life# Nurses may be ifferentiate from other health care pro!i ers by their approach to patient care, training, an scope of practice# Nurses practice in a wi e i!ersity of practice areas with a ifferent scope of practice an le!el of prescriber authority in each# $any nurses pro!i e care within the or ering scope of physicians, an this tra itional role has come to shape the historic public image of nurses as care pro!i ers# Howe!er, nurses are permitte by most %uris ictions to

practice in epen ently in a !ariety of settings epen ing on training le!el# &n the postwar perio , nurse e ucation has un ergone a process of i!ersification towar s a !ance an speciali'e cre entials, an many of the tra itional regulations an pro!i er roles are changing# Nurses e!elop a plan of care, wor(ing collaborati!ely with physicians, therapists, the patient, the patient)s family an other team members, that focuses on treating illness to impro!e "uality of life# &n the *#+# ,an increasingly the *nite -ing om., a !ance practice nurses, such as clinical nurse specialists an nurse practitioners, iagnose health problems an prescribe me ications an other therapies, epen ing on in i!i ual state regulations# Nurses may help coor inate the patient care performe by other members of a health care team such as therapists, me ical practitioners an ietitians# Nurses pro!i e care both inter epen ently, for e/ample, with physicians, an in epen ently as nursing professionals# 0he American Nurses Association ,ANA. states nursing is the protection, promotion, an optimi'ation of health an abilities, pre!ention of illness an in%ury, alle!iation of suffering through the iagnosis an treatment of human response, an a !ocacy in the care of in i!i uals, families, communities, an populations#123

Contents

2 History o 2#2 0ra itional nursing

o o o o o

2#2 24th century 2#5 Church sponsore hospitals an nursing 2#6 $ilitary nursing 2#7 Nursing schools 2#6 8orl 8ar &

2#6#2 Britain

2#9 8orl 8ar &&

2#9#2 *nite +tates 2#9#2 Britain 2#9#5 :ermany

2 ;efinition 5 Nursing as a profession 6 Nursing theory an process

7 <ractice settings
o

7#2 8or( en!ironment

6 Nursing worl wi e
o o o

6#2 Australia 6#2 =uropean *nion 6#5 *nite -ing om

6#5#2 >irst-le!el nurses 6#5#2 $anagers 6#5#5 Nurse e ucation

6#5#5#2 <re-registration 6#5#5#2 <ost-registration

6#6 Cana a

6#6#2 History 6#6#2 = ucation 6#6#5 <ublic opinion

6#7 ?apan

6#7#2 History 6#7#2 0ypes of nurses

6#7#2#2 <ublic health nursing 6#7#2#2 $i wifery 6#7#2#5 Assistant nursing

6#7#5 Nursing e ucation 6#7#6 Nursing in ?apan to ay

6#6 *nite +tates

6#6#2 = ucational an licensure re"uirements

6#6#2#2 ;iploma in Nursing 6#6#2#2 Associate ;egree in Nursing

6#6#2#5 Bachelor of +cience in Nursing 6#6#2#6 :ra uate nursing opportunities

6#6#2 @icensure e/amination 6#6#5 =arnings 6#6#6 0he nursing shortage in the *nite +tates

6#6#6#2 Causes of the nursing shortage in the *nite +tates

6#6#7 Continuing e ucation 6#6#6 Nursing boar certification

9 Nursing specialties A <icture gallery 4 +ee also 20 Beferences 22 >urther rea ing
o

22#2 Historical

22 =/ternal lin(s

History
$ain articlesC history of nursing an 0imeline of nursing history

Traditional nursing
Before the foun ation of mo ern nursing, nuns an the military often pro!i e nursing-li(e ser!ices#123 0he Christian churches ha!e been long term patrons of nursing an influential in the e!elopment of the ethos of mo ern nursing# =lsewhere, other nursing tra itions e!elope , such as in &slam# >rom its earliest ays, an following the e icts of ?esus, Christianity ha encourage its e!otees to ten the sic(# <riests were often also physicians# Accor ing to the historian :eoffrey Blainey, while pagan religions sel om offere help to the infirm, the early Christians were willing to nurse the sic( an ta(e foo to them - notably uring the small po/ epi emic of A; 267-2A0 an the measles outbrea( of aroun A; 270 an that D&n nursing the sic( an ying, regar less of religion, the Christians won frien s an sympathisersD#153 Christian emphasis on practical charity ga!e rise to the e!elopment of systematic nursing an hospitals after the en of the persecution of the early church#163 Ancient church lea ers li(e +t# Bene ict of Nursia ,6A0. emphasise

me icine as an ai to the pro!ision of hospitality# 173 Ancient Catholic or ers li(e the ;ominicans an Carmelites ha!e long li!e in religious communities that wor( for the care of the sic(#163 0he religious an military roots of mo ern nursing remain in e!i ence to ay in many countries, for e/ample in the *nite -ing om, senior female nurses are (nown as sisters# Nurses e/ecute the or ers of $#;#s, <As, an N<s in a ition to being responsible for their own practice# 0he first nurse was <hoebe, mentione in Bomans 26C2# ;uring the early years of the Christian Church, +t# <aul sent a eaconess <hoebe to Bome as the first !isiting nurse# +he too( care of both women an men#193 Accor ing to :eoffrey Blainey, uring the $i le Ages, the Catholic Church in =urope pro!i e many of the ser!ices of a welfare stateC D&t con ucte hospitals for the ol an orphanages for the youngE hospices for the sic( of all agesE places for the lepersE an hostels or inns where pilgrims coul buy a cheap be an mealD# &t supplie foo to the population uring famine an istribute foo to the poor# 0his welfare system the church fun e through collecting ta/es on a large scale an possessing large farmlan s an estates#1A3 $onasteries of this era were iligent in the stu y of me icine, as were con!ents# 0he =astern Frtho o/ Church ha establishe many hospitals in the $i =ast, but following the rise of &slam from the 9th century, Arabic me icine e!elope in this region, where a number of important a !ances were ma e an an &slamic tra ition of nursing begun# Arab i eas were later influential in =urope# 0he famous -nights Hospitaller arose as a group of in i!i uals associate with an Amalfitan hospital in ?erusalem, which was built to pro!i e care for poor, sic( or in%ure Christian pilgrims to the Holy @an # >ollowing the capture of the city by Crusa ers, the or er became a military as well as infirmarian or er#143 A number of saints an or ers li(e the >ranciscans are recalle for ten ing the sic( uring the e!astating bubonic plagues, but these e!ents e/pose the near impotence of the $e ie!al me icine to e/plain isease an prompte critical e/amination#1203 ;uring the Beformation of the 26th century, <rotestant reformers shut own the monasteries an con!ents, allowing a few to continue in operation hun re municipal hospices# 0hose nuns who ha been ser!ing as nurses were gi!en pensions or tol to get marrie an stay home#1223 Nursing care went to the ine/perience as tra itional careta(ers, roote in the Boman Catholic Church, were remo!e from their positions# 0hese careta(ers were scorne as the Dconsorts of prostitutes an run(s,D since many of the hospitali'e ill were in igent# 0he nursing profession suffere a ma%or setbac( for appro/imately 200 years, only to be rescue by in i!i uals, not organi'ations, in the nineteenth century#1223 &n Catholic nations an religiously tolerant areas howe!er, the role of the nursing sister continue uninterrupte #

19th century

>lorence Nightingale was influential figure in the e!elopment of mo ern nursing# No uniform ha been create when >lorence Nightingale was employe uring the Crimean 8ar# Both nursing role an e ucation were first efine by >lorence Nightingale#

+aint $arianne Cope was among many Catholic nuns to influence the e!elopment of mo ern hospitals an nursing# 0he Crimean 8ar was a significant e!elopment in nursing history when =nglish nurse >lorence Nightingale lai the foun ations of professional nursing# Her short boo(s Notes on Nursing became popular# Fther important nurses in the e!elopment of the profession inclu eC ;ame Agnes Hunt from +hropshire, was the first Dorthopae ic) nurse an was pi!otal in the emergence of the orthopae ic hospital calle )0he Bobert ?ones G Agnes Hunt Hospital)in Fswestry, +hropshire#

$ary +eacole, who also wor(e as a nurse in the Crimea Agnes =li'abeth ?ones an @in a Bichar s, who establishe "uality nursing schools in the *+A an ?apanE @in a Bichar s was officially America)s first professionally traine nurse, gra uating in 2A95 from the New England Hospital for Women and Children in Boston

Clarissa Harlowe DClaraD Barton, a pioneer American teacher, patent cler(, nurse, an humanitarian, an the foun er of the American Be Cross# +aint $arianne Cope, a +ister of +t >rancis who opene an operate some of the first general hospitals in the *nite +tates, instituting cleanliness stan ar s which influence the e!elopment of America)s mo ern hospital system#1253

New Healan was the first country to regulate nurses nationally, with a option of the Nurses Begistration Act on 22 +eptember 2402# Nurses ha!e e/perience ifficulty with the hierarchy in me icine that has resulte in an impression that nurses) primary purpose is to follow the irection of physicians#1263 0his ten ency is certainly not obser!e in Nightingale)s Notes on Nursing, where the physicians are mentione relati!ely infre"uently, an often in critical tonesIparticularly relating to be si e manner#1273 &n the early 2400s, the autonomous, nursing-controlle , Nightingale era schools came to an en J schools became controlle by hospitals, an formal Dboo( learningD was iscourage # Hospitals an physicians saw women in nursing as a source of free or ine/pensi!e labor# =/ploitation was not uncommon by nurseKs employers, physicians an e ucational pro!i ers# Nursing practice was controlle by me icine#1263 0he mo ern era has seen the e!elopment of nursing egrees an nursing has numerous %ournals to broa en the (nowle ge base of the profession# Nurses are often in (ey management roles within health ser!ices an hol research posts at uni!ersities#

Church sponsored hospitals and nursing

+ee alsoC eaconess an Catholic Church an health care

DAfter the Battle of :ra!elotte# 0he >rench +isters of $ercy of +t# Borromeo arri!ing on the battle fiel to succor the woun e #D *nsigne lithograph, 2A90 or 2A92# Catholic women)s religious institutes continue to sprea their ministry in nursing, with or ers li(e the @ittle +isters of the <oor ,age care., +isters of $ercy, +isters of +t# $ary, +t# >rancis Health +er!ices, &nc# an +isters of Charity e!eloping large international hospital an hospice networ(s that helpe shape the hospital an nursing systems of the mo ern worl #

0he <rotestant churches reentere the health fiel , especially by setting up or ers of women, calle eaconesses who e icate themsel!es to nursing ser!ices# 0he mo ern eaconess mo!ement began in :ermany in 2A56 when 0heo or >lie ner an his wife opene the first eaconess motherhouse in -aiserswerth on the Bhine# &t became a mo el an within a half century were o!er 7,000 eaconesses in =urope# 0he Church of =nglan name its first eaconess in 2A62# 0he North @on on ;eaconess &nstitution traine eaconesses for other ioceses an some ser!e o!erseas#1293 8illiam <assa!ant in 2A64 brought the first four eaconesses to <ittsburgh, in the *nite +tates, after !isiting -aiserswerth# 0hey wor(e at the <ittsburgh &nfirmary ,now <assa!ant Hospital.# 12A3 0he American $etho ists J the largest <rotestant enominationIengage in large scale missionary acti!ity in Asia an elsewhere in the worl , ma(ing me ical ser!ices a priority as early as the 2A70s# $etho ists in America too( note, an began opening their own charitable institutions such as orphanages an ol people)s homes after 2A60# &n the 2AA0s, $etho ists began opening hospitals in the *nite +tates, which ser!e people of all religious bac(groun s beliefs# By 2A47 25 hospitals were in operation in ma%or cities# well 1243 @utherans in the *#+# in 2AA6 brought se!en sisters from :ermany to run the :erman hospital in <hila elphia# By 2465 the @utheran Church in America ha centers for eaconess wor( in <hila elphia, Baltimore, an Fmaha#1203

Military nursing

A Be Cross recruiting poster for nurses from 8orl 8ar &#

Nursing sisters at a Cana ian military hospital in >rance !oting in the Cana ian fe eral election, 2429# 8ith British public opinion shoc(e by Nightingale)s re!elations about the poor care of sol iers in the Crimean 8ar, acti!ists pushe for reform# &n 2A60 Queen Lictoria or ere a hospital to be built to train Army nurses an surgeons, the Boyal Lictoria Hospital# 0he hospital opene in 2A65 in Netley an a mitte an care for military patients# Beginning in 2A66, nurses were formally appointe to $ilitary :eneral Hospitals# 0he Army Nursing +er!ice ,AN+. o!ersaw the wor( of the nurses starting in 2AA2# 0hese military nurses were sent o!erseas beginning with the >irst Boer 8ar ,often calle Hulu 8ar. from 2A94 to 2AA2#1223 0hey were also ispatche to ser!e uring the =gyptian Campaign in 2AA2 an the +u an 8ar of 2AA5 to 2AA6# ;uring the +u an 8ar members of the Army Nursing +er!ice nurse in hospital ships on the Nile as well as the Cita el in Cairo# Almost 2000 nurses ser!e uring the secon Boer 8ar, the Anglo-Boer 8ar of 2A44 to 2402, alongsi e nurses who were part of the colonial armies of Australia, Cana a an New Healan # 0hey ser!e in tente fiel hospitals# 25 Army Nursing sisters from Britain lost their li!es from isease outbrea(s#1223

Nursing schools
0he Nightingale mo el of professional e ucation sprea wi ely in =urope an North America after 2A90# =!en so, as late as the 2A90s, Dwomen wor(ing in North American urban hospitals typically were untraine , wor(ing class, an accor e lowly status by both the me ical profession they supporte an society at largeD# Nursing ha the same status in :reat Britain an continental =urope before 8orl 8ar &#1253 Hospital nursing schools in the *nite +tates an Cana a too( the lea in applying Nightingale)s mo el to their training programmersC stan ar s of classroom an on-the-%ob training ha risen sharply in the 2AA0s an 2A40s, an along with them the e/pectation of ecorous an professional con uct1253

orld
"ritain

ar !

By the beginning of 8orl 8ar &, military nursing still ha only a small role for women in BritainE 20,700 nurses enrolle in Queen Ale/an ra)s &mperial $ilitary Nursing +er!ice

,QA&$N+. an the <rincess $ary)s Boyal Air >orce Nursing +er!ice# 0hese ser!ices ate to 2402 an 242A, an en%oye royal sponsorship# 0here also were Loluntary Ai ;etachment ,LA;. nurses who ha been enrolle by the Be Cross#1263 0he ran(s that were create for the new nursing ser!ices were $atron-in-Chief, <rincipal $atron, +ister an +taff Nurses# 8omen %oine stea ily throughout the 8ar# At the en of 2426, there were 2,225 regular an reser!e members of the QA&$N+ an when the war en e there were 20,606 traine nurses in the QA&$N+#1223

+ister :race 8ilson of the 5r Australian :eneral Hospital on @emnos# +he saile from +y ney, New +outh 8ales on boar B$+ Mooltan on 27 $ay 2427#1273 Australian nurses ser!e in the war as part of the Australian :eneral Hospital# Australia establishe two hospitals at @emnos an Heliopolis &slan s to support the ;ar anelles campaign at :allipoli# ;uring the course of the war, Australian nurses were grante their own a ministration rather than wor(ing un er me ical officers# 0heir wor( routinely inclu e a ministering ether uring haemostatic surgery an managing an training male me ical assistants ,or erlies.#1263

orld

ar !!

Australia 8orl 8ar && poster &n early 2462, si/ty-fi!e front line nurses from the :eneral Hospital ;i!ision in +ingapore were or ere bac( home aboar two ships# 0he ?apanese san( one shipE the 22 sur!i!ing nurses swam ashore but the ?apanese capture an shot them at the Ban(a &slan massacre# +ister Li!ian Bullwin(el was the only sur!i!or# +he became Australia)s premier nursing war hero#

#nited $tates 0his section re"uires e/pansion# (September 2012) As Campbell ,24A6. shows, the nursing profession was transforme by 8orl 8ar 0wo# Army an Na!y nursing was highly attracti!e an a larger proportion of nurses !olunteere for ser!ice higher than any other occupation in American society#129312A3 0he public image of the nurses was highly fa!orable uring the war, as the simplifie by such Hollywoo films as DCry )Ha!oc)D which ma e the selfless nurses heroes un er enemy fire# +ome nurses were capture by the ?apanese,1243 but in practice they were (ept out of harm)s way, with the great ma%ority statione on the home front# Howe!er, 99 were statione in the %ungles of the <acific, where their uniform consiste of D(ha(i slac(s, mu , shirts, mu , fiel shoes, mu , an fatigues#D15031523 0he me ical ser!ices were large operations, with o!er 600,000 men an women, ten enliste men for e!ery nurse# 0he nurses were all women an all officers# 8ACs ,enliste women. were use as hospital or erlies# Nearly all the octors were men, with women octors allowe only to e/amine the 8AC#1523 <resi ent >ran(lin ;# Boose!elt haile the ser!ice of nurses in the war effort in his final D>iresi e ChatD of ?anuary 6, 2467, an urge an in uction act to raise the number of nurses in the war ser!ice by Congress#1553 "ritain ;uring 8orl 8ar &&, nurses belonge to Queen Ale/an ra)s &mperial $ilitary Nursing +er!ice ,QA&$N+., as they ha uring 8orl 8ar &, an as they remain to ay# ,Nurses belonging to the QA&$N+ are informally calle DQADs#. $embers of the Army Nursing +er!ice ser!e in e!ery o!erseas British military campaign uring 8orl 8ar &&, as well as at military hospitals in Britain# At the beginning of 8orl 8ar &&, nurses hel officer status with e"ui!alent ran(, but were not commissione officers# &n 2462, emergency commissions an a ran( structure were create , conforming with the structure use in the rest of the British Army# Nurses were gi!en ran( ba ges an were now able to be promote to ran(s from @ieutenant through to Briga ier#1563 Nurses were e/pose to all angers uring the 8ar, an some were capture an became prisoners of war# %ermany :ermany ha a !ery large an well organi'e nursing ser!ice, with three main organi'ations, one for Catholics, one for <rotestants, an the ;B- ,Be Cross.# &n 2456 the Na'is set up their own nursing unit, the Brown Nurses, absorbing one of the smaller groups, bringing it up to 60,000 members# &t set up (in ergartens, hoping to sei'e control of the min s of the younger :ermans, in competition with the other nursing organi'ations# Ci!ilian psychiatric nurses who were Na'i party members participate in the (illings of in!ali s, although the process was shrou e in euphemisms an enials#1573

$ilitary nursing was primarily han le by the ;B-, which came un er partial Na'i control# >ront line me ical ser!ices were pro!i e by male me ics an octors# Be Cross nurses ser!e wi ely within the military me ical ser!ices, staffing the hospitals that perforce were close to the front lines an at ris( of bombing attac(s# 0wo o'en were awar e the highly prestigious &ron Cross for heroism un er fire# 0hey are among the 690,000 :erman women who ser!e with the military#1563

De&inition
Although nursing practice !aries both through its !arious specialties an countries, these nursing organi'ations offer the following efinitionsC Nursing encompasses autonomous an collaborati!e care of in i!i uals of all ages, families, groups an communities, sic( or well an in all settings# Nursing inclu es the promotion of health, pre!ention of illness, an the care of ill, isable an ying people# A !ocacy, promotion of a safe en!ironment, research, participation in shaping health policy an in patient an health systems management, an e ucation are also (ey nursing roles# I &nternational Council of Nurses1593 0he use of clinical %u gement in the pro!ision of care to enable people to impro!e, maintain, or reco!er health, to cope with health problems, an to achie!e the best possible "uality of life, whate!er their isease or isability, until eath# IBoyal College of Nursing *-15A3 Nursing is the protection, promotion, an optimi'ation of health an abilitiesE pre!ention of illness an in%uryE alle!iation of suffering through the iagnosis an treatment of human responsesE an a !ocacy in health care for in i!i uals, families, communities, an populations# IAmerican Nurses Association1543 0he uni"ue function of the nurse is to assist the in i!i ual, sic( or well, in the performance of those acti!ities contributing to health or its reco!ery ,or to peaceful eath. that he woul perform unai e if he ha the necessary strength, will or (nowle ge# ILirginia A!enel Hen erson1603

Nursing as a pro&ession
0he authority for the practice of nursing is base upon a social contract that elineates professional rights an responsibilities as well as mechanisms for public accountability# &n almost all countries, nursing practice is efine an go!erne by law, an entrance to the profession is regulate at the national or state le!el#

0he aim of the nursing community worl wi e is for its professionals to ensure "uality care for all, while maintaining their cre entials, co e of ethics, stan ar s, an competencies, an continuing their e ucation#1593 0here are a number of e ucational paths to becoming a professional nurse, which !ary greatly worl wi eE all in!ol!e e/tensi!e stu y of nursing theory an practice as well as training in clinical s(ills# Nurses care for in i!i uals of all ages an cultural bac(groun s who are healthy an ill in a holistic manner base on the in i!i ual)s physical, emotional, psychological, intellectual, social, an spiritual nee s# 0he profession combines physical science, social science, nursing theory, an technology in caring for those in i!i uals# 0o wor( in the nursing profession, all nurses hol one or more cre entials epen ing on their scope of practice an e ucation# A @icense practical nurse ,@<N. ,also referre to as a @icense !ocational nurse, Begistere practical nurse, =nrolle nurse, an +tate enrolle nurse. wor(s in epen ently or with a Begistere nurse ,BN.# 0he most significant ifferentiation between an @<N an BN is foun in the re"uirements for entry to practice, which etermines entitlement for their scope of practice# >or e/ample, Cana a re"uires a bachelors egree for the BN an a twoyear iploma for the @<N# A Begistere nurse ,BN. pro!i es scientific, psychological, an technological (nowle ge in the care of patients an families in many health care settings# Begistere nurses may earn a itional cre entials or egrees# &n the *+A, multiple e ucational paths will "ualify a can i ate to sit for the licensure e/amination as a registere nurse# 0he Associate ;egree in Nursing ,A;N. is awar e to the nurse who has complete a two-year un ergra uate aca emic egree awar e by community colleges, %unior colleges, technical colleges, an bachelor)s egree-granting colleges an uni!ersities upon completion of a course of stu y usually lasting two years# 0he Bachelor of +cience in Nursing ,B+N. is awar e to the nurse who has earne an American four-year aca emic egree in the science an principles of nursing, grante by a tertiary e ucation uni!ersity or similarly accre ite school# After completing either the @<N or either BN e ucation programs in the *+A, gra uates are eligible to sit for the a licensing e/amination to become a nurse, the passing of which is re"uire for the nursing license# BNs may also pursue ifferent roles as a !ance practice registere nurses# Nurses may follow their personal an professional interests by wor(ing with any group of people, in any setting, at any time# +ome nurses follow the tra itional role of wor(ing in a hospital setting# Aroun the worl , nurses ha!e been tra itionally female# ;espite e"ual opportunity legislation, nursing has continue to be a female- ominate profession#1623 >or instance, the male-to-female ratio of nurses is appro/imately 2C24 in Cana a an America#16231653 0his ratio is represente aroun the worl # Notable e/ceptions inclu e >rancophone Africa, which inclu es the countries of Benin, Bur(ina >aso, Cameroon, Cha , Congo, CMte )&!oire, the ;emocratic Bepublic of Congo, ;%ibouti, :uinea, :abon, $ali, $auritania, Niger, Bwan a, +enegal, an 0ogo, which all ha!e more male than female nurses#1663 &n =urope, in countries such as +pain, <ortugal, C'echoslo!a(ia, an &taly, o!er 20N of nurses are male#1663

Nursing theory and process

$ain articlesC Nursing theory an Nursing process Nursing practice is the actual pro!ision of nursing care# &n pro!i ing care, nurses implement the nursing care plan using the nursing process# 0his is base aroun a specific nursing theory which is selecte base on the care setting an population ser!e # &n pro!i ing nursing care, the nurse uses both nursing theory an best practice eri!e from nursing research# &n general terms, the nursing process is the metho use to assess an iagnose nee s, plan outcomes an inter!entions, implement inter!entions, an e!aluate the outcomes of the care pro!i e # @i(e other isciplines, the profession has e!elope ifferent theories eri!e from sometimes i!erse philosophical beliefs an para igms or worl !iews to help nurses irect their acti!ities to accomplish specific goals#

'ractice settings
Nurses practice in a wi e range of settings, from hospitals to !isiting people in their homes an caring for them in schools to research in pharmaceutical companies# Nurses wor( in occupational health settings1673 ,also calle in ustrial health settings., free-stan ing clinics an physician offices, nurse-le clinics, long-term care facilities an camps# 0hey also wor( on cruise ships an in military ser!ice# Nurses act as a !isers an consultants to the health care an insurance in ustries# $any nurses also wor( in the health a !ocacy an patient a !ocacy fiel s at companies such as Health A !ocate, &nc# helping in a !ariety of clinical an a ministrati!e issues#1663 +ome are attorneys an others wor( with attorneys as legal nurse consultants, re!iewing patient recor s to assure that a e"uate care was pro!i e an testifying in court# Nurses can wor( on a temporary basis, which in!ol!es oing shifts without a contract in a !ariety of settings, sometimes (nown as per diem nursing, agen ! nursing or tra"el nursing# Nurses wor( as researchers in laboratories, uni!ersities, an research institutions# Nurses ha!e also been el!ing into the worl of informatics, acting as consultants to the creation of computeri'e charting programs an other software#

or( environment
&nternationally, there is a serious shortage of nurses#1693 Fne reason for this shortage is ue to the wor( en!ironment in which nurses practice# &n a recent re!iew of the empirical human factors an ergonomic literature specific to nursing performance, nurses were foun to wor( in generally poor en!ironmental con itions# ;e @ucia, Ftto, G <almier ,2004.16A3 conclu e , Dthe profession of nursing as a whole is o!erloa e because there is a nursing shortage# &n i!i ual nurses are o!erloa e # 0hey are o!erloa e by the number of patients they o!ersee# 0hey are o!erloa e by the number of tas(s they perform# 0hey wor( un er cogniti!e o!erloa , engaging in multitas(ing an encountering fre"uent interruptions# 0hey wor( un er perceptual o!erloa ue to me ical e!ices that o not meet perceptual re"uirements ,$orrow et al#, 2007., insufficient lighting, illegible han writing, an poor labeling esigns# 0hey wor( un er physical o!erloa ue to long wor( hours an patient han ling eman s which lea s to a high inci ence of $+;s# &n short, the

nursing wor( system often e/cee s the limits an capabilities of human performance# H>O= research shoul be con ucte to etermine how these o!erloa s can be re uce an how the limits an capabilities of performance can be accommo ate # &ronically, the literature shows that there are stu ies to etermine whether nurses can effecti!ely perform tas(s or inarily performe by physicians# Besults in icate that nurses can perform such tas(s effecti!ely# Ne!ertheless, alrea y o!erloa e nurses shoul not be gi!en more tas(s to perform# 8hen re ucing the o!erloa , it shoul be (ept in min that un er loa s also can be etrimental to performance ,$ac( worth, 246A.# Both o!erloa s an un er loa s are important to consi er for impro!ing performance#D16A3 +ome countries an states ha!e passe legislation regar ing acceptable nurseto-patient ratios#

Nursing )orld)ide
Australia
Catholic religious institutes were influential in the e!elopment of Australian nursing, foun ing many of Australia)s hospitals - the &rish +isters of Charity were first to arri!e in 2A5A an establishe +t Lincent)s Hospital, +y ney in 2A79 as a free hospital for the poor# 0hey an other or ers li(e the +isters of $ercy, an in age care the +isters of the @ittle Company of $ary an @ittle +isters of the <oor foun e hospitals, hospices, research institutes an age care facilities aroun Australia#16431703 A census in the 2A00s foun se!eral hun re nurses wor(ing in 8estern Australia uring the colonial perio of history, this inclu e Aboriginal female ser!ants who care for the infirm#1723 0he state nursing licensing bo ies amalgamate in Australia in 2022 to become a fe eral bo y AH<BA ,Australian Health <ractitioner Begistration Authority.# +e!eral i!isions of nursing license is a!ailable an recogni'e aroun the country#

=nrolle Nurses may initiate some oral me ication or ers with a specific competency now inclu e in national curricula but !ariable in application by agency# Begistere nurses hol a uni!ersity egree, Nursing <ractitioners ha!e starte emerging from postgra uate programs an wor( in pri!ate practise# $i wi!es ha!e recently been gi!en access to public liability insurance which enables them to wor( in pri!ate practise at free stan ing birth centres or as homebirth mi wi!es1723 $ental Health nurses must complete further training as A !ance $ental Health <ractitioners in or er to a minister client referrals un er the mental health act#

Australia en%oys the lu/ury of a national curriculum for !ocational nurses, traine at 0A>= colleges or pri!ate B0F# Both =nrolle an Begistere Nurses are i entifie by the epartment

of immigration as an occupational area of nee , although registere nurses are always in shorter supply, an this increases in proportion with specialisation# &n 24A6 there were a number of rolling in ustrial actions aroun the country, culminating when fi!e thousan Lictorian nurses went on stri(e for eighteen ays# 0he hospitals were able to function by hiring casual staff from each other)s stri(ing members, but the increase cost force a ecision in the nurses) fa!our 1753

European #nion
&n the =uropean *nion, the profession of nurse is regulate # A profession is sai to be regulate when access an e/ercise is sub%ect to the possession of a specific professional "ualification# 0he regulate professions atabase contains a list of regulate professions for nurse1763 in the =* member states, ==A countries an +wit'erlan # 0his list is co!ere by the ;irecti!e 2007O56O=C #

#nited *ingdom
$ain articleC Nursing in the *nite -ing om 0o practice lawfully as a registere nurse in the *nite -ing om, the practitioner must hol a current an !ali registration with the Nursing an $i wifery Council# 0he title DBegistere NurseD can only be grante to those hol ing such registration# 0his protecte title is lai own in the Nurses, $i wi!es an Health Lisitors Act, 2449#1773 +irst,level nurses >irst-le!el nurses ma(e up the bul( of the registere nurses in the *-# 0hey were pre!iously (nown by titles such as B:N ,registere general nurse., B+CN ,registere sic( chil ren)s nurse., B$N ,registere mental nurse. an BN$+ ,registere nurse ,for the. mentally subnormal.# 0he titles use now are similar, inclu ing BNA ,registere nurse a ult., BNC ,registere nurse chil ., BN$H ,registere nurse mental health. an BN@; ,registere nurse learning isabilities.# $ain articleC +tate =nrolle Nurse +econ -le!el nurse training is no longer pro!i e , howe!er they are still legally able to practice in the *nite -ing om as a registere nurse# $any ha!e now either retire or un erta(en con!ersion courses to become first-le!el nurses# 0hey are entitle to refer to themsel!es as registere nurses as their registration is on the Nursing G $i wifery Council register of nurses, although most refer to themsel!es as =Ns or +=Ns# 0here is also scope for a !ance practiceC

Nurse practitioners J $ost of these nurses obtain a minimum of a $asters egree, an a esire post gra certificate# 0hey often perform roles similar to those of physicians an physician assistants# 0hey can prescribe me ications as in epen ent or supplementary

prescribers, although are still legally regulate , unli(e physician)s assistants# $ost N<)s ha!e referral an a mission rights to hospital specialties# 0hey commonly wor( in primary care ,e#g# :< surgeries., AG= epartments, or pe iatrics although they are increasingly being seen in other areas of practice# &n the *-, the title Dnurse practitionerD is legally protecte # $pecialist community pu-lic health nurses J tra itionally istrict nurses an health !isitors, this group of research an publication acti!ities# .ecturer,practitioners /also called practice education &acilitators0 J these nurses wor( both in the NH+, an in uni!ersities# 0hey typically wor( for 2J5 ays per wee( in each setting# &n uni!ersity, they train pre-registration stu ent nurses ,see below., an often teach on specialist courses for post-registration nurses .ecturers J these nurses are not employe by the NH+# &nstea they wor( full-time in uni!ersities, both teaching an performing research#

Managers $any nurses who ha!e wor(e in clinical settings for a long time choose to lea!e clinical nursing an %oin the ran(s of the NH+ management# 0his use to be seen as a natural career progression for those who ha reache war management positions, howe!er with the a !ent of specialist nursing roles ,see abo!e., this has become a less attracti!e option# Nonetheless, many nurses fill positions in the senior management structure of NH+ organi'ations, some e!en as boar members# Fthers choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons# Nurse education
're,registration

&n or er to become a registere nurse, an wor( as such in the NH+, one must complete a program recogni'e by the Nursing an $i wifery Council# Currently, this in!ol!es completing a egree or iploma, a!ailable from a range of uni!ersities offering these courses, in the chosen branch specialty ,see below., lea ing to both an aca emic awar an professional registration as a 2st le!el registere nurse# +uch a course is a 70O70 split of learning in uni!ersity ,i#e# through lectures, essays an e/aminations. an in practice ,i#e# super!ise patient care within a hospital or community setting.# 0hese courses are three ,occasionally four. years) long# 0he first year is (nown as the common foun ation program ,C><., an teaches the basic (nowle ge an s(ills re"uire of all nurses# 0he remain er of the program consists of training specific to the stu ent)s chosen branch of nursing# 0hese areC

A ult nursing# Chil nursing#

$ental health nursing# @earning isabilities nursing#

As of 2025, the Nursing an $i wifery Council will re"uire all new nurses "ualifying in =nglan to hol a egree "ualification#1763 $i wifery training is similar in length an structure, but is sufficiently ifferent that it is not consi ere a branch of nursing# 0here are shortene ,2A month. programmes to allow nurses alrea y "ualifie in the a ult branch to hol ual registration as a nurse an a mi wife# +hortene courses lasting 2 years also e/ist for gra uates of other isciplines to train as nurses# 0his is achie!e by more intense stu y an a shortening of the common foun ation program#1793 +tu ent nurses currently recei!e a bursary from the go!ernment to support them uring their nurse training# ;iploma stu ents in =nglan recei!e a non-means-teste bursary of aroun P6000 per year ,with a itional allowances for mature stu ents or those with epen ent chil ren., whereas egree stu ents ha!e their bursary means teste ,an so often recei!e less.# ;egree stu ents are, howe!er, eligible for a proportion of the go!ernment)s stu ent loan, unli(e iploma stu ents# &n +cotlan , howe!er, all stu ent nurses regar less of which course they are un erta(ing, recei!e the same bursary in line with the =nglish iploma amount# &n 8ales only the ;egree le!el course is offere an all nursing stu ents therefore recei!e a non-means-teste bursary# Before <ro%ect 2000, nurse e ucation was the responsibility of hospitals an was not base in uni!ersitiesE hence many nurses who "ualifie prior to these reforms o not hol an aca emic awar #
'ost,registration

After the point of initial registration, there is an e/pectation that all "ualifie nurses will continue to up ate their s(ills an (nowle ge# 0he Nursing an $i wifery Council insists on a minimum of 57 hours of e ucation e!ery three years, as part of its post registration e ucation an practice ,<B=<. re"uirements#17A3 0here are also opportunities for many nurses to gain a itional clinical s(ills after "ualification# Cannulation, !enepuncture, intra!enous rug therapy an male catheteri'ation are the most common, although there are many others ,such as a !ance life support. which some nurses will un erta(e# $any nurses who "ualifie with a iploma choose to upgra e their "ualification to a egree by stu ying part-time# $any nurses prefer this option to gaining a egree initially, as there is often an opportunity to stu y in a specialist fiel as a part of this upgra ing# >inancially, in =nglan , it is also much more lucrati!e, as iploma stu ents get the full bursary uring their initial training, an employers often pay for the egree course as well as the nurse)s salary# 1743 &n or er to become specialist nurses ,such as nurse consultants, nurse practitioners etc#. or nurse e ucators, some nurses un erta(e further training abo!e bachelors egree le!el# $asters egrees

e/ist in !arious healthcare relate topics, an some nurses choose to stu y for <h;s or other higher aca emic awar s# ;istrict nurses an health !isitors are also consi ere specialist nurses, an in or er to become such they must un erta(e specialist training ,often in the form of a top up egree ,see abo!e. or post gra uate iploma.# All newly "ualifying istrict nurses an Health Lisitors are traine to prescribe from the Nurse <rescribers) >ormulary, a list of me ications an ressings typically useful to those carrying out these roles# $any of these ,an other. nurses will also un erta(e training in in epen ent an supplementary prescribing, which allows them ,as of 2 $ay 2006. to prescribe almost any rug in the British National >ormulary# 0his has been the cause of a great eal of ebate in both me ical an nursing circles#1603

Canada
$ain articleC Nursing in Cana a History Cana ian nursing ates all the way bac( to 2654 in Quebec with the Augustine nuns#1623 0hese nuns were trying to open up a mission that care for the spiritual an physical nee s of patients# 0he establishment of this mission create the first nursing apprenticeship training in North America#1623 &n the nineteenth century there were some Catholic or ers of nursing that were trying to sprea their message across Cana a# $ost nurses were female an only ha an occasional consultation with a physician# 0owar s the en of the nineteenth century hospital care an me ical ser!ices ha been impro!e an e/pan e # $uch of this was ue to Nightingale)s influence# &n 2A96 the first formal nursing training program was starte at the :eneral an $arine Hospital in +t# Catharines in Fntario#1623 Education All Cana ian nurses an prospecti!e nurses are hea!ily encourage by the Cana ian Nurses Association to continue their e ucation to recei!e a baccalaureate egree# 0hey belie!e that this is the best egree to wor( towar s because it results in better patient outcomes# &n a ition to helping patients, nurses that ha!e a baccalaureate egree will be less li(ely to ma(e small errors because they ha!e a higher le!el of e ucation# A baccalaureate egree also gi!es a nurse a more critical opinion which gi!es he or she more of an e ge in the fiel # 0his ultimately sa!es the hospital money because they eal with less problematic inci ents# All Cana ian pro!inces e/cept for the Qu(on an Quebec re"uire that all nurses must ha!e a baccalaureate egree#1623 0he basic length of time that it ta(es to obtain a baccalaureate egree is four years# Howe!er, Cana a oes ha!e a con ense program that is two years long#1623 Nursing specialty certification is a!ailable in nineteen practice areas# Accor ing to the Cana ian Nurses Association some of those specialties are car io!ascular nursing, community health nursing, critical care nursing, emergency nursing, gerontology nursing, me ical-surgical nursing, neuroscience nursing, oncology nursing, orthope ic nursing, psychiatricOmental health nursing,

an rehabilitation nursing#1623 =ach specialty re"uires its own test an competencies# $any tests are offere online through the Cana ian Nurses Association# 'u-lic opinion Cana ian nurses hol a lot of responsibility in the me ical fiel an are consi ere !ital# Accor ing to the Cana ian Nurses Association, D0hey e/pect BNs to e!elop an implement multi-facete plans for managing chronic isease, treating comple/ health con itions an assisting them in the transition from the hospital to the community# Cana ians also loo( to BNs for health e ucation an for strategies to impro!e their health# BNs assess the appropriateness of new research an technology for patients an a %ust care plans accor inglyD#

1apan
$ain articleC Nursing in ?apan History Nursing was not an establishe part of ?apan)s healthcare system until 2A44 with the $i wi!es Fr inance#1623 >rom there the Begistere Nurse Fr inance came into play in 2427# 0his establishe a legal substantiation to registere nurses all o!er ?apan# A new law geare towar s nurses was create uring 8orl 8ar &&# 0his law was title the <ublic Health Nurse, $i wife an Nurse @aw an it was establishe in 246A#1623 &t establishe e ucational re"uirements, stan ar s an licensure# 0here has been a continue effort to impro!e nursing in ?apan# &n 2442 the Nursing Human Besource @aw was passe #1623 0his law create the e!elopment of new uni!ersity programs for nurses# 0hose programs were esigne to raise the e ucation le!el of the nurses so that they coul be better suite for ta(ing care of the public# Types o& nurses ?apan only recogni'es four types of nursing an they are <ublic Health Nursing, $i wifery, Begistere Nursing an Assistant Nursing#
'u-lic health nursing

0his type of nursing is esigne to help the public an is also ri!en by the public)s nee s# 0he goals of public health nurses are to monitor the sprea of isease, (eep !igilant watch for en!ironmental ha'ar s, e ucate the community on how to care for an treat themsel!es, an train for community isasters#
Mid)i&ery

Nurses that are in!ol!e with mi wifery are in epen ent of any organi'ation# A mi wife ta(es care of a pregnant woman uring labour an postpartum# 0hey assist with things li(e breastfee ing an caring for the chil #
Assistant nursing

&n i!i uals who are assistant nurses follow or ers from a registere nurse# 0hey report bac( to the license nurse about a patient)s con ition# the Assistant nurses are always super!ise by a license registere nurse# Nursing education &n 2472 ?apan establishe the first nursing uni!ersity in the country# 1623 An Associate ;egree was the only le!el of certification for years# +oon people began to want nursing egrees at a higher le!el of e ucation# +oon the Bachelors ;egree in Nursing ,B+N. was establishe # Currently ?apan offers octorate le!el egrees of nursing in a goo number of its uni!ersities# 0here are three ways that an in i!i ual coul become a registere nurse in ?apan# After obtaining a high school egree the person coul go to a nursing uni!ersity for four years an earn a Bachelor egree, go to a %unior nursing college for three years or go to a nursing school for three years#1623 Begar less of where the in i!i ual atten s school they must ta(e the national e/am# 0hose who atten e a nursing uni!ersity ha!e a bit of an a !antage o!er those who went to a nursing school# 0hey can ta(e the national e/am to be a registere nurse, public health nurse or mi wife# &n the cases of become a mi wife or a public health nurse, the stu ent must ta(e a one year course in their esire fiel after atten ing a nursing uni!ersity an passing the national e/am to become a registere nurse# 0he nursing uni!ersities are the best route for someone who wants to become a nurse in ?apan#1623 0hey offer a wi er range of general e ucation classes an they also allow for a more rigi teaching style of nursing# 0hese nursing uni!ersities train their stu ents to be able to ma(e critical an e ucate ecisions when they are out in the fiel # <hysicians are the ones who are teaching the potential nurses because there are not enough a!ailable nurses to teach stu ents# 0his increases the ominance that physicians ha!e o!er nurses# +tu ents that atten a nursing college or %ust a nursing school recei!e the same egree that one woul who gra uate from a nursing uni!ersity, but they o not ha!e the same e ucational bac(groun # 0he classes offere at nursing colleges an nursing schools are focuse on more practical aspects of nursing# 0hese institutions o not offer many general e ucation classes, so stu ents who atten these schools will solely be focusing on their nursing e ucations while they are in school# +tu ents who atten a nursing college or school o ha!e the opportunity to become a mi wife or a public health nurse# 0hey ha!e to go through a training institute for their esire fiel after gra uating from the nursing school or college#1623 ?apanese nurses ne!er ha!e to renew their licenses# Fnce they ha!e passe their e/am, they ha!e their license for life#1623 Nursing in 1apan today @i(e the *nite +tates, ?apan is in nee of more nurses# 0he ri!ing force behin this nee this is the fact that country is aging an nee s more me ical care for its people# 0he country nee s a rapi increase of nurses howe!er things o not seem to be turning aroun # +ome of the reasons that there is a shortage are poor wor(ing con itions, an increase in the number of hospital be s, the low social status of nurses, an the cultural i ea that marrie women "uit their %obs for family responsibilities#1623 Fn a!erage, ?apanese nurses will ma(e aroun 2A0,000 yen a month, which is one of the higher paying %obs# howe!er, physicians ma(e twice the amount that nurses o in a

year#1623 +imilar to other cultures, the ?apanese people !iew nurses as subser!ient to physicians# 0hey are consi ere lesser an oftentimes negati!e connotations are associate with nurses# Accor ing to the American Nurses Association article on ?apan, Dnursing wor( has been escribe using negati!e terminology such as Dhar , irty, angerous, low salary, few holi ays, minimal chance of marriage an family, an poor imageD# +ome nurses in ?apan are trying to be a !ocates# 0hey are promoting better nursing e ucation as well as promoting the care of the el erly# 0here are some organi'ations that unite ?apanese nurses li(e the ?apanese Nursing Association ,?NA.# 0he ?NA is not to be confuse with a union, it is simply a professional organi'ation for the nurses# $embers of the ?NA lobby politicians an pro uces publications about nursing# Accor ing to the American Nurses Association)s article on ?apan the ?NA, Dwor(s towar the impro!ement in nursing practice through many acti!ities inclu ing the e!elopment of a policy research group to influence policy e!elopment, a co e of ethics for nurses, an stan ar s of nursing practiceD# 0he ?NA also pro!i es certification for specialists in mental health, oncology an community health#1623 ?NA is the not the only nursing organi'ation in ?apan# 0here are other subgroups that are typically categori'e by the nurses) specialty, li(e emergency nursing or isaster nursing# Fne of the ol er unions that relates to nursing is the ?apanese >e eration of $e ical 8or(ers *nion which was create in 2479#1623 &t is a union that inclu es physicians as well as nurses# 0his organi'ation was in!ol!e with the Nursing Human 2esource .a)#1623

#nited $tates
$ain articleC Nursing in the *nite +tates 0he scope of practice of registere nurses is the e/tent to an limits of which an BN may practice# &n the *nite +tates, these limits are etermine by a set of laws (nown as the Nurse <ractice Act of the state or territory in which an BN is license # =ach state has its own laws, rules, an regulations go!erning nursing care# *sually the ma(ing of such rules an regulations is elegate to a state boar of nursing, which performs ay-to- ay a ministration of these rules, "ualifies can i ates for censurer, licenses nurses an nursing assistants, an ma(es ecisions on nursing issues# &t shoul be note that in some states the terms DnurseD or DnursingD may only be use in con%unction with the practice of a Begistere Nurse ,BN. or license practical or !ocational nurse ,@<NO@LN.# 0he scope of practice for a registere nurse is wi er than for an @<NO@LN because of the le!el an content of e ucation as well as what the Nurse <ractice Act says about the respecti!e roles of each# &n the hospital setting, registere nurses are often assigne a role in which they elegate tas(s to @<Ns an unlicense assisti!e personnel# BNs are not limite to employment as be si e nurses# Begistere nurses are employe by physicians, attorneys, insurance companies, go!ernmental agencies, communityOpublic health agencies, pri!ate in ustry, school istricts, ambulatory surgery centers, among others# +ome registere nurses are in epen ent consultants who wor( for themsel!es, while others wor( for

large manufacturers or chemical companies# Besearch Nurses con uct or assist in the con uct of research or e!aluation ,outcome an process. in many areas such as biology, psychology, human e!elopment, an health care systems# 0he a!erage salary for a staff BN in the *nite +tates in 2009 was o!er R60,000# Educational and licensure requirements
Diploma in Nursing

$ain articleC ;iploma in Nursing 0he ol est metho of nursing e ucation is the hospital-base iploma program, which lasts appro/imately three years# +tu ents ta(e between 50 an 60 cre it hours in anatomy, physiology, microbiology, nutrition, chemistry, an other sub%ects at a college or uni!ersity, then mo!e on to intensi!e nursing classes# *ntil 2446, most BNs in the *+ were initially e ucate in nursing by iploma programs#1623 Accor ing to the Health +er!ices Besources A ministration)s 2000 +ur!ey of Nurses only si/ percent of nurses who gra uate from nursing programs in the *nite +tates recei!e their e ucation at a ;iploma +chool of Nursing#1653
Associate Degree in Nursing

$ain articleC Associate of +cience in Nursing 0he most common initial nursing e ucation is a two-year Associate ;egree in Nursing ,Associate of Applie +cience in Nursing, Associate of +cience in Nursing, Associate ;egree in Nursing., a two-year college egree referre to as an A;N# +ome four-year colleges an uni!ersities also offer the A;N# Associate egree nursing programs ha!e many prere"uisite an co-re"uisite courses which ultimately stretch out the egree-ac"uiring process to about 5 years or greater#
"achelor o& $cience in Nursing

$ain articleC Bachelor of +cience in Nursing 0he thir metho is to obtain a Bachelor of +cience in Nursing ,B+N., a four-year egree that also prepares nurses for gra uate-le!el e ucation# >or the first two years in a B+N program, stu ents usually obtain general e ucation re"uirements an spen the remaining time in nursing courses# 0he Bachelor of +cience in Nursing egrees ha!e many courses which stretches out the egree-ac"uiring process to o!er 6 years# A !ocates for the A;N an iploma programs state that such programs ha!e an on the %ob training approach to e ucating stu ents, while the B+N is an aca emic egree that emphasi'es research an nursing theory# +ome states re"uire a specific amount of clinical e/perience that is the same for both B+N an A;N stu ents# A B+N egree "ualifies its hol er for a ministrati!e, research, consulting an teaching positions that woul not usually be a!ailable to those with an A;N, but is not necessary for most patient care functions, although some hospitals are beginning to gi!e preference in hiring to B+N prepare nurses as a rule# Nursing schools may be accre ite by either the National @eague for Nursing Accre iting Commission ,N@NAC. or the Commission on Collegiate Nursing = ucation ,CCN=.#

%raduate nursing opportunities

>urther informationC $aster of +cience in Nursing >urther informationC ;octor of Nursing <ractice A !ance e ucation in nursing is one at the master)s an octoral le!els# &t prepares the gra uate for speciali'ation as an a !ance practice registere nurse ,A<BN. or for a !ance roles in lea ership, management, or e ucation# Areas of a !ance nursing practice inclu e that of a nurse practitioner ,N<., a certifie nurse mi wife ,CN$., a certifie registere nurse anesthetist ,CBNA., or a clinical nurse specialist ,CN+.# Nurse practitioners wor( assessing, iagnosing an treating patients in fiel s as i!erse as family practice, women)s health care, emergency nursing, acuteOcritical care, psychiatry, geriatrics, or pe iatrics, while a CN+ usually wor(s for a facility to impro!e patient care, o research, or as a staff e ucator# 0he clinical nurse lea er ,CN@. is an a !ance generalist who focuses on the impro!ement of "uality an safety outcomes for patients or patient populations from an a ministrati!e an staff management focus# ;octoral programs in nursing prepare the stu ent for wor( in nursing e ucation, health care a ministration, clinical research, or a !ance clinical practice# $ost programs confer the <h; in nursing an ;octor of Nursing <ractice ,;N<.# .icensure e3amination Completion of any one of these three e ucational routes allows a gra uate nurse to ta(e the NC@=S-BN, the test for licensure as a registere nurse, an is accepte by e!ery state as an a e"uate in icator of minimum competency for a new gra uate# Howe!er, contro!ersy e/ists o!er the appropriate entry-le!el preparation of BNs# +ome professional organi'ations belie!e the B+N shoul be the sole metho of BN preparation an A;N gra uates shoul be license as Dtechnical nursesD to wor( un er the super!ision of B+N gra uates# Fthers feel the on-the-%ob e/periences of iploma an A;N gra uates ma(es up for any eficiency in theoretical preparation# Begar less of this ebate, it is highly unli(ely that the B+N will become the stan ar for initial preparation any time soon, because of the nursing shortage, hospital lobbyist, an the lac( of faculty to teach B+N stu ents# Earnings $e ian annual wages of registere nurses were R62,670 in $ay 200A# 0he mi le 70 percent earne between R72,660 an R96,790# 0he lowest 20 percent earne less than R65,620, an the highest 20 percent earne more than R42,260# $e ian annual wages in the in ustries employing the largest numbers of registere nurses in $ay 200A wereC =mployment ser!ices R6A,260E :eneral me ical an surgical hospitals R65,AA0E Fffices of physicians R74,220E Home health care ser!ices R7A,960E Nursing care facilities R79,060# $any employers offer fle/ible wor( sche ules, chil care, e ucational benefits, an bonuses# About 22 percent of registere nurses are union members or co!ere by union contract#1663 Top 14 Highest 'aying Nursing $pecialties

2# Certifie Begistere Nurse Anesthetist J R257,000 2# Nurse Besearcher J R47,000 5# <sychiatric Nurse <ractitioner J R47,000 6# Certifie Nurse $i wife J RA6,000 7# <e iatric =n ocrinology Nurse J RA2,000 6# Frthope ic Nurse J RA2,000 9# Nurse <ractitioner J R9A,000 A# Clinical Nurse +pecialist J R96,000 4# :erontological Nurse <ractitioner J R97,000 20# Neonatal Nurse J R96,0001673 The nursing shortage in the #nited $tates $ain articleC Nursing shortage BNs are the largest group of health care wor(ers in the *nite +tates, with about 2#9 million employe in 2022#1663 &t has been reporte 1b! whom#3 that the number of new gra uates an foreigntraine nurses is insufficient to meet the eman for registere nursesE this is often referre to as the nursing shortage an is e/pecte 1b! whom#3 to increase for the foreseeable future# 0here are ata to support the i ea that the nursing shortage is a !oluntary shortage#1 itation needed3 &n other wor s, nurses are lea!ing nursing of their own !olition# &n 2006 it was estimate that appro/imately 2#A million nurses chose not to wor( as a nurse# 0he Bureau of @abor +tatistics reporte that 246,400 healthcare %obs were create in 2022# BNKs ma(e up the ma%ority of the healthcare wor( force, therefore these positions will be fille primarily by nurses# 0he B@+ also states that by 2020, there will be 2#2 million nursing %ob openings ue to an increase in the wor(force, an replacements# ,Bosseter, 2022.#
Causes o& the nursing shortage in the #nited $tates

0his article may contain unsourced predictions5 speculative material or accounts o& events that might not occur# <lease help impro!e it by remo!ing unsource speculati!e content# ($ul! 2012) A national sur!ey prepare by the >e eration of Nurses an Health <rofessionals in 2002 foun that one in fi!e nurses plans to lea!e the profession within fi!e years because of unsatisfactory wor(ing con itions, inclu ing low pay, se!ere un er staffing, high stress, physical eman s, man atory o!ertime, an irregular hours# 0he shortage will also be e/acerbate by the increasing numbers of baby-boomer age nurses who are e/pecte to retire, creating more open positions than there are gra uates of nursing programs# 0he faster than a!erage %ob growth in this fiel is also a result of impro!ing me ical technology that will allow for treatments of many more iseases an health con itions# Nurses will be strong in eman to wor( with the rapi ly

growing population of senior citi'ens in the *nite +tates# Appro/imately 24#A percent of all nursing %obs are foun in hospitals#1663 Howe!er, because of a ministrati!e cost cutting, increase nurse)s wor(loa , an rapi growth of outpatient ser!ices, hospital nursing %obs will e/perience slower than a!erage growth# =mployment in home care an nursing homes is e/pecte 1b! whom#3 to grow rapi ly# 0hough more people are li!ing well into their A0s an 40s, many nee the (in of long-term care a!ailable at a nursing home# Also, because of financial reasons, patients are being release from hospitals sooner an a mitte into nursing homes# $any nursing homes ha!e facilities an staff capable of caring for long-term rehabilitation patients, as well as those afflicte with Al'heimer)s# $any nurses will also be nee e to help staff the growing number of out-patient facilities, such as H$Fs, group me ical practices, an ambulatory surgery centers# Nursing specialties will be in great eman # 0here are, in a ition, many part-time employment possibilities#1693 Aggra!ating the alrea y isparate ratio of "ualifie nurses to nee e nurses is the e!er shrin(ing "ualifie nursing faculty pool# @e!sey, Campbell, an :reen !oice their concern about the shortage of nurses, citing >ang, 8ilsey-8isniews(i, G Be nash, 2006 who state that o!er 60,000 "ualifie nursing applicants were turne away in the 2007-2006 aca emic year from baccalaureate nursing programs ue to a lac( of masters an octoral "ualifie faculty, an that this number was increase o!er 4,000 from 52,000 "ualifie but re%ecte stu ents from %ust two years earlier# +e!eral strategies ha!e been offere to mitigate this shortage inclu ingE >e eral an pri!ate support for e/perience nurses to enhance their e ucation, incorporating more hybri Oblen e nursing courses, an using simulation in lieu of clinical ,hospital. training e/periences#16A31643 Continuing education 8ith health care (nowle ge growing stea ily, nurses can stay ahea of the cur!e through continuing e ucation# Continuing e ucation classes an programs enable nurses to pro!i e the best possible care to patients, a !ance nursing careers, an (eep up with Boar of Nursing re"uirements# 0he American Nurses Association an the American Nursing Cre entialing Center are e!ote to ensuring nurses ha!e access to "uality continuing e ucation offerings# Continuing e ucation classes are calibrate to pro!i e enhance learning for all le!els of nurses# $any +tates also regulate Continuing Nursing = ucation# Nursing licensing boar s re"uiring Continuing Nursing = ucation ,CN=. as a con ition for licensure, either initial or renewal, accept courses pro!i e by organi'ations that are accre ite by other state licensing boar s, by the American Nursing Cre entialing Center ,ANCC., or by organi'ations that ha!e been esignate as an appro!er of continuing nursing e ucation by ANCC# 0here are some e/ceptions to this rule inclu ing the state of California, >lori a an -entuc(y# National Healthcare &nstitute1903 has create a list to assist nurses in etermining their CN= cre it hours re"uirements# 8hile this list is not all inclusi!e, it offers etails on how to contact nursing licensing boar s irectly#19231923 Nursing -oard certi&ication $ain articleC Nursing cre entials an certifications

<rofessional nursing organi'ations, through their certification boar s, ha!e !oluntary certification e/ams to emonstrate clinical competency in their particular specialty# Completion of the prere"uisite wor( e/perience allows an BN to register for an e/amination, an passage gi!es an BN permission to use a professional esignation after their name# >or e/ample, passage of the American Association of Critical-care Nurses specialty e/am allows a nurse to use the initials )CCBN) after his or her name# Fther organi'ations an societies ha!e similar proce ures# 0he American Nurses Cre entialing Center, the cre entialing arm of the American Nurses Association, is the largest nursing cre entialing organi'ation an a ministers more than 50 specialty e/aminations#1953

Nursing specialties
$ain articleC @ist of nursing specialties Nursing is the most i!erse of all healthcare professions# Nurses practice in a wi e range of settings but generally nursing is i!i e epen ing on the nee s of the person being nurse # 0he ma%or populations areC

communitiesOpublic familyOin i!i ual across the lifespan a ult-gerontology pe iatrics neonatal womenKs healthOgen er-relate psychOmental health

0here are also specialist areas such as car iac nursing, orthope ic nursing, palliati!e care, perioperati!e nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing#