Nurse

Overview
Nurses are responsible—along with other health care professionals—for the treatment, safety, and recovery of acutely or chronically ill or 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.

Education & regulation
Nursing education, regulation, roles, and titles vary in different countries, but in general reflect an increasing level of responsibility and status.

Nurses develop and implement a plan of care and work collaboratively with the patient, the patient's family, and other health care professionals and para-professionals. Nurses help coordinate the patient care performed by other members of a health care team such as physical therapists, medical practitioners, social workers, and dietitians. Nurses frequently act as patient advocates.

The nursing career structure varies considerably throughout the world. Typically there are several distinct levels of nursing practitioner distinguished by increasing education, responsibility, and skills. The major distinction is between task-based nursing and professional nursing. Nurses throughout the world are increasingly employed as advanced practice nurses, such as clinical nurse specialists and nurse practitioners, who diagnose health problems and prescribe medications and other therapies. 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 the U.S., only 5.4% of the registered nurse population was male in 2000, but that percent represented a 226% increase in two decades. .

Governments regulate the profession of nursing to protect the public.

Other healthcare workers
Health care settings generally involve a wide range of health care workers, who work in collaboration with nurses.

Examples include:
 * Nursing assistants, orderlies, auxiliary nurses, healthcare assistants. These types of healthcare workers work both in acute and primary settings, under 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.
 * 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 technologists (US) and operating department practitioners (UK), who are more or less equivalent to a registered nurse in theatres; and technicians trained to operate most kinds of diagnostic and laboratory equipment, such as X-ray machines, electrocardiographs, and so forth.
 * Physicians historically operated without nursing advice, but nowadays rely on nurses' skills, observations, and experience 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 as respiratory therapists, medical technologists, speech therapists, occupational therapists and physical therapists work closely with nursing staff and work collaboratively in multi-disciplinary teams.

Education
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.

There are options available for hospital trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest.

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 include a module that permits enrolled nurses to dispense oral, topical, enteral medications, and intramuscular and subcutaenous injections. In some areas of Australia NSW in particular Enrolled nurses are also allowed to admiister intravenous medications via a peripheral cannula up to a schedule 4d.

Legal regulation
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:
 * Nurse practitioner (NP)
 * Registered nurse (RN)
 * Enrolled nurse (EN)

Professional titles

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".

Nurse practitioners
Nurse practitioners 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.

Education
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

 * Registered nurse (RN).
 * Licensed practical nurse (LPN) or licensed vocational nurse (LVN), known as registered practical nurse (RPN) in Ontario.
 * Registered psychiatric nurse (RPN) - are licensed to practice only in British Columbia, Alberta, Saskatchewan, Manitoba, and the territories.

Legal regulation
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 Albertawhich also sets standards for scope of practice and provides practice support.

India
The Indian Nursing Council is the regulatory body for profession of nursing. A person practising 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 (BSc Nursing) postgraduate degrees (MSc Nursing) and Doctorates (PhD) are offered.

Ireland
Nursing in self regulated 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. a 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 diability, midwifery, public health and tutor.

Developments
Significant changes have occurred in Irish nursing since the publication of Report of The Commission on Nursing, A blueprint for the future.

Nurse education
Pre-registration nurse education in 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 occued in post registration nurse education with a variety of programmes available to nurses to support their practice and develop their career.

History
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 and universities. Within the hospital system were an array of titles and levels, which often focused upon clinical specialty rather than generic nursing knowledge.

Education
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.

Legal regulation
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 trade mark status, thus preventing those with the title from using it. In order to become 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 granted prescribing rights.

Ongoing issues
New Zealand has historically provided many nurses for the global market place; the salaries in overseas countries (notably Australia, USA, 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, India, South Africa and Philippines migrating to New Zealand.

Education
All registered nurses in the Philippines are required to have a Bachelor's Degree in Nursing.

Legal regulation
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.

Education
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:
 * Nursing history and ethics.
 * Basic nursing care.
 * Elementary nutrition.
 * First aid.
 * Elementary anatomy and physiology.
 * Introduction to comprehensive health care.

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:
 * General nursing care.
 * Nursing care of the aged.
 * Nursing care of mentally retarded persons.
 * Community nursing care.
 * Psychiatric nursing care.

Legal regulation
The South African Nursing Council (SANC) 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 nursing auxiliaries are required to wear "distinguishing devices" consisting of pins and colored epaulettes to identify them as licensed professionals.

Education
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.

Registered nurses
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:


 * Nursing
 * Midwifery
 * Specialist Community Public Health Nurses (which includes Health Visitors)

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, although technically loopholes exist to allow failed RN candidates to gain EN qualification.

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. Nurses in the United Kingdom can also complete an Independent Prescriber course (of which there are various types at present) which legally permits them to prescribe drugs independently of a doctor.

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.

NMC register
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 January 2006 payment for registration is made annually. 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 practising 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 practising 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.

Nursing titles

 *  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 sister/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.


 * Sister/charge nurse/ward manager: 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. Note that charge nurse is used when the "sister" is a male.

Education
Registered nurses (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, pharmacology and medication administration, psychology, ethics, nursing theory and legal issues. Additionally, extensive clinical training in nursing practice is required.
 * Diploma in Nursing
 * Associate of Science in Nursing
 * Bachelor of Science in Nursing
 * Master of Science in Nursing

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.

Legal regulation
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, medications, 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 supervise the tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and make decisions 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, carry out research, and educate the public and other professionals.