A nurse is responsible—along with other health care professionals—for the treatment, safety, and recovery of acutely or chronically ill/injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-clinical functions necessary to the delivery of health care. Nurses also provide care at birth and death. There is currently a shortage of nurses in the United States and a number of other developed countries.
Education and regulation
The nursing career structure varies throughout the world. Typically there are several distinct levels of nursing practitioner distinguished by scope of practice. The major distinction is between task-based nursing and professional nursing. Nurses throughout the world are increasingly employed as registered nurses, advanced practice nurses, clinical nurse specialists and nurse practitioners. At the top of the educational ladder is the doctoral-prepared nurse. Nurses may gain a PhD or another doctoral degree, specializing in research, clinical nursing, and so forth. These nurses practice nursing, teach nursing, and carry out nursing research. As the science and art of nursing has advanced, so has the demand for doctoral-prepared nurses.
In various parts of the world, the educational background for nurses varies widely. In some parts of eastern Europe, nurses are high school graduates with twelve to eighteen months of training. In contrast, Chile requires any registered nurse to have at least a bachelor's degree.
Nurses are the largest group of providers in the health care system--there are over two million registered nurses in the United States of America (U.S.) alone, comprising about 13% of the fifteen million workers in the health care and social assistance category tracked by the U.S. Department of Labor.
Nursing is one of the most female-dominated occupations, but the number of males entering the profession is increasing. For example, in 2000 only 5.4% of registered nurses in the U.S. were male, however, that percentage represents a 226% increase over the previous two decades. In 2007, internationally, 10.7% of registered nurses and 10.4% of licensed practical nurses were male. Although the rise in the number of males entering and working in the nursing profession is an ongoing trend, females continue to predominate in nursing, as well as in the health care sector as a whole.
Governments regulate the profession of nursing to protect the public.
Other healthcare workers
Health care settings generally involve a wide range of medical professionals who work in collaboration with nurses.
- Nursing assistants, orderlies, auxiliary nurses, medical assistants. These types of health care workers work both in acute and primary settings, with the supervision of registered nurses or licensed practical nurses (in the US). They assist nurses by giving basic care, taking vital signs, administering hygienic care, assisting with feeding, giving basic psychosocial care, housekeeping, and similar duties. See also hospital volunteers.
- EMTs and Paramedics work closely with emergency and critical care nurses to stabilize life-threatening trauma and medical emergencies and to provide a seamless transfer of care from incoming ambulances to awaiting medical/surgical teams.
- Technicians: for example, certified medication aides in the US, are trained to administer medications in a long-term care setting. There are also phlebotomy technicians, who perform venipuncture; surgical technologist (US), and technicians trained to operate most kinds of diagnostic and laboratory equipment, such as X-ray machines, electrocardiographs, and so forth.
- Medical practitioners rely on nurses' ability to follow orders to ensure a continuity of patient care.
- Pharmacists are responsible for the safe dispensing of medicine and offering of expert advice on drug therapies.
- Allied health professionals such asrespiratory therapists, medical technologists, speech therapists, occupational therapists, nurses operating department practitioners (UK) and physical therapists work with nursing staff.
Registration as a registered nurse now requires an associate degree at least, considered the foundation for any future specialization within nursing any other type of medical ways. Postgraduate diplomas
provide further vocational training for specialist areas. Masters
level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available.
Australia has a long tradition of post-basic courses, usually of a six month (minor) or twelve month (major) duration, which included midwifery, maternal and child welfare, psychiatric, peri-operative ("theatre nursing"), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity.
Enrolled nurses are trained in the "technical and further education" (TAFE) sector of approximately twelve months duration. In some states, this length has been increased to 18 months to result in diploma level qualification rather than certificate 4. All Enrolled nurse training courses now include a module that permits enrolled nurses to dispense oral, topical, enteral medications, and intramuscular and subcutaneous injections. In some areas of Australia NSW in particular Enrolled nurses are also allowed to administer intravenous medications via a peripheral cannula up to a schedule 4d.
The practice of nursing is governed by state and territorial
nursing regulation authorities. The Australian Nursing and Midwifery Council
(ANMC) was established in 1992 and works with these authorities to facilitate a national approach to nursing and midwifery regulation.
Types of nurses
In all states other than Victoria, nurses fall into the following major categories:
The professional courtesy title "sister" has fallen into disuse and disapproval, even though it was formerly used by both male and female registered general nurses. The title "nurse" was used when addressing enrolled nurses. The term "matron" is inadvisable.
In keeping with the relaxed attitude to formalities in Australia, most nurses are happy to be addressed by their first name and describe themselves either as "an RN" or "an EN". In Victoria, an enrolled nurse will commonly describe themselves as a "Div. 2".
are being introduced into the Australian healthcare community, with Victoria having had nurse practitioners since 2000 .
In some instances, it could be argued that this is as a natural professional evolution and recognition of the outstanding clinical expertise some nurses have attained over the course of their careers in areas such as wound management.
Most provinces in Canada
prefer any registered nurse to have at least a bachelor's degree (preferably a Bachelor of Science in Nursing
(BScN)), although Quebec
grants RN status to graduates from CEGEP
. Many practicing nurses are still college graduates, but those entering nursing now are required or encouraged to enter at the university level.
Types of nurses
The profession of nursing is regulated at the provincial and territorial level in keeping with the principles of professional regulation endorsed by the International Council of Nurses
. The College of Nurses of Ontario
regulates both RNs and RPNs in contrast to the other provinces and territories where RNs and LPNs are regulated by separate bodies. In the western provinces, psychiatric nurses
are governed by distinct legislation.
All registered nurses and nurse practitioners in the province of Alberta are expected to maintain their clinical competence in order receive an annual practice permit from the College and Association of Registered Nurses of Alberta which also sets standards for scope of practice and provides practice support.
The Indian Nursing Council is the regulatory body for the profession of nursing. A person practicing nursing must be registered with the nursing council. For a person to be registered, he or she has to undergo and pass the prescribed course stipulated by the council. In India, diplomas, bachelor degrees(B.Sc Nursing), postgraduate degrees(M.Sc Nursing) and Doctorates (PhD) are offered.
Some postgraduate nursing specialities include medical, pediatric, obstetric, surgical and community health nursing which are offered by a large number of colleges and universities throughout India. Some institutes such as the National Institute of Mental Health and Neurological Sciences (NIMHANS) offer specialization in psychiatric nursing, neurosurgical nursing.
The nursing staff at institutes and hospitals are segregated into teaching and clinical divisions.
In the clinical division, the nurses' stages are- ward nurse, nursing superintendent grade 3, nursing superintendent grade 2, and nursing superintendent grade 1. And in the teaching section they are called nursing tutor grade 2 and grade 1.
Nursing is selfregulated in Ireland. The regulatory body is An Bord Altranais
(The Nursing Board). The board was established under the 1950 Nurses Act and currently operates under the 1985 Nurses Act
There are currently over 82,000 nurses registered by An Bord Altranais of which over 65,000 are on the active register ABA Statistics 2006
There are seven divisions of the register; general, psychiatric, children's, intellectual disability, midwifery, public health and tutor.
Significant changes have occurred in Irish nursing since the publication of Report of The Commission on Nursing, A blueprint for the future
Pre-registration nurse education is university and college based. All pre-registration programmes are at degree level (NQAI level 8). Nurse registration education programmes are governed An Bord Altranais Requirements & Standards
Significant developments have occurred in post registration nurse education with a variety of programs available to nurses to support their practice and develop their career.
New Zealand originally had nurse education as a part of the hospital system, but, as early as the 1900s, post registration and post graduate programs of study for nurses were in existence. Reforms in the 1970s disestablished the original hospital-based schools and moved these into the tertiary education sector, namely polytechnics
. Within the hospital system were an array of titles and levels, which often focused upon clinical specialty rather than generic nursing knowledge.
Today all nurses in New Zealand are educated to degree level via a three year, two semesters per annum, program, with an approximate 50/50 mix of theory to practice. All current students graduate as a registered comprehensive nurse. Legislation exists keeping the number of schools to no more than 21, although some schools run courses in more than one geographical location. Recently, attempts were made to reintroduce the title enrolled nurse
with this causing some disagreement between trade unions
, the registering body, and health providers.
All nurses in New Zealand are expected to maintain both professional knowledge and clinical competence in order to receive an annual practicing certificate from the Nursing Council of New Zealand
(NCNZ). Recent legislation (the 2004 Health Practitioners Competency Assurance Act) sets standards for both scope of practice and requirements in terms of ongoing development.
Similarly the NCNZ caused minor controversy when they gave the title nurse practitioner, thus preventing those with the title from using it. As a nurse practitioner, the nurse must undertake an approved course of study and present a portfolio of evidence to NCNZ for approval. There are now approximately 20 NP's in New Zealand with a smaller number of granted prescribing rights.
has historically provided many nurses for the global market place; the salaries in overseas countries (notably Australia
, United Kingdom
and the Middle East
) have proved attractive to NZ nurses. This has resulted in a drop in the number of NZ-educated nurses practicing within New Zealand; recently the flow has been decreased by a substantial pay award for hospital based nurses. This pay award was given to those employed within district health boards
but not other public sector providers which caused a degree of conflict within the profession and a return to hospital practice for many in the primary healthcare
sector. There has also been an increase in nurses from the United Kingdom
, South Africa
migrating to New Zealand
All registered nurses in the Philippines are required to have a Bachelor's Degree in Nursing
The Professional Regulation Commission oversees the licensing of registered nurses as authorized by the Philippine Nursing Act of 2002.
A Professional Regulatory Nursing Board implements and enforces the Nursing Act. The board is composed of a chairperson and six additional members, all of whom are nurses with at least a master's degree and ten years of nursing experience. The board inspects nursing schools, conducts licensure examinations, issues and monitors certificates of licensure, promulgates a code of ethics, participates in recognizing nursing specialty organizations, and prescribes guidelines and regulations governing the profession under the Nursing Act.
South African Nursing Council
was initially established by the Nursing Act, No. 45 of 1944, and currently by the Nursing Act, No. 50 of 1978 as amended.
In order to be examined to practice as an enrolled nurse, students must complete a two-year academic course which includes 2,000 hours of clinical practice.
Subjects studied in the first year include:
The second year includes study of sciences fundamental to basic nursing and, depending upon the area for which the nursing school has been approved, one of the following subjects:
The South African Nursing Council
) was created by the Nursing Act of 1957. Currently, it functions under the authority of the Nursing Act of 1978 and subsequent amendments. SANC inspects and approves nursing schools and education programs; examines, registers, and enrolls nurses, midwives, and nursing auxiliaries; licenses nursing agencies; and monitors nursing employers. Nurses and nurse auxiliaries are required to wear "distinguishing devices" consisting of pins
and colored epaulettes
to identify them as licensed professionals.
Since the 1990s, UK nurses are educated to diploma, bachelor's and even undergraduate master's degree levels. There are also post-graduate courses for graduates with a degree in a health related subject. They undertake their training at universities and in placements in healthcare services. The student will train in adult, child, mental health, or learning disabilities branch.
To become a nurse within the United Kingdom
, one must at the very minimum hold a Diploma in Nursing
and have trained for three years, or two years on an 'accelerated' course, (or equivalent if from overseas). After training, the opportunities are vast, with many different areas of nursing, from general ward to teaching or management. Also the practise areas can be in hospital, or in the community or both.
The Nursing and Midwifery Council in the UK is the regulatory body for nurses, midwives, and specialist practitioners. It maintains a register that is split into three parts:
In addition to this, there are two levels of nurse: first-level nurses trained for three or four years (RGN, RMN, RSCN, RNMH, RNchild, RNadult, RNmental health, RN Learning Disability) whereas second-level nurses are the state enrolled nurses (SENs) who trained for two years. The SEN training has been phased out, with many SENs retiring or converting to level one through further study.
Registered Nurses are able to undertake advanced practice training, commonly at advanced degree level to become specialist nurses in various fields, such as Emergency Nurse Practitioner. These nurses will have obtained, in addition to the basic registration with the NMC, an advanced recordable qualification.
Many nurses are members of trade unions, which represent them both individually and as a profession. The two main unions are UNISON and the Royal College of Nursing.
All UK nurses are listed on a register
and are regulated by the Nursing & Midwifery Council
(NMC). Nurses need to register every three years, although from 1st of January 2006 payment for registration is annual. They are required to have demonstrated that they have kept up-to-date by undertaking at least 35 hours of professional development
and 450 hours of nursing practice
within the last three years.
Prior to the creation of the new three-part register on August 1, 2004, nurses and midwives were divided into a part of the register they held a qualification in. This may be now described as a 'sub-part' of the nursing register. All newly qualified nurses register in 'sub-part' 12, 13, 14 or 15, showing their branch qualification. However, nurses still practicing and holding qualifications in 'sub-parts' 1-9 are registered as such.
There are approximately 689,000 nurses and midwives on the NMC's register, including those not practicing within the UK who have maintained their registration. Approximately 12% of registrants are male, and this is increasing. As of August 2005, the NMC register split into three parts: nurses, midwives, and specialist community public health nurses. There are 'sub-parts' that the nurse or midwife is registered to practice in.
- State enrolled nurse (SEN) These nurses are expected to perform to a lower level scope of practice, although in reality enrolled nurses often perform to a similar or higher level as staff nurses. Some areas specifically exclude aspects of practice such as the administration of medications. As such enrolled nurses are technically supposed to work under the supervision of an RN.
- Staff nurse/senior staff nurse: All newly qualified nurses begin at this level and make up the majority of the registered nursing staff. Senior staff nurses are more experienced and usually take "charge" in the absence of senior staff.
- Junior charge nurse/deputy ward manager: These nurses are deputy to the ward manager/charge nurse and as such have more of a managerial role.
- Charge nurse/ward manager/sister: Responsible for the management of their ward/clinic/unit usually with budgetary control.
- Clinical nurse manager: Usually manages an area, for example, accident and emergency.
- Matron: Usually manages a directorate, such as medical or surgical. Historically managed the hospital, although this role is obsolete.
There are various other higher managerial and specialist nurse roles; however these are less well defined on a national scale and vary from country-to-country.
(RN) in the U.S. generally receive their basic preparation through one of four avenues:
An academic course of study at any level typically includes such topics as anatomy and physiology, ethics, psychology, nursing theory and legal issues. Additionally, extensive training in nursing practice is required.
All U.S. states and territories require graduation from an accredited nursing program and successful completion of the NCLEX-RN to obtain state licensure as an RN.
In the U.S.
, the individual states
have authority over nursing practice
and its scope
. Nurses may be licensed in more than one state, either by examination or endorsement of a license issued by another state. Licenses must be periodically renewed. Some states require continuing education
in order to renew licenses.
Types of nurses
- Licensed practical nurses (LPNs) usually have eighteen months to two years of training in anatomy and physiology, rehabilitation medication, and practical patient care.
- Licensed vocational nurses (LVNs) is a title used in some states which is roughly equivalent to Licensed practical nurse.
- Registered nurses (RNs) are professional nurses who often delegate tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and occasionally make suggestions regarding plans of care for individuals and groups of healthy, ill, and injured people. RNs are the largest healthcare occupation in the U.S.
- Advanced practice nurses (APNs) are registered nurses with advanced education, knowledge, skills, and scope of practice. They perform primary health care, provide mental health services, diagnose and prescribe physical therapy and minor rehabilitation treatments, carry out research, and educate the public and other professionals.
- Doctorate of Nursing Practice (DNPs) advanced nursing degree. They focus more on evidence-based practice and systems leadership that has an immediate impact on the quality of healthcare delivery, rather than on developing programs of original research (as the traditional PhD program graduates do). Very few nurses are prepared at the doctoral level with the skills to transform the practice environment in an immediate way, so the professional opportunities for graduates of the DNP program will be extensive.