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A registered nurse ("RN"), is a health care professional responsible for implementing the practice of nursing through the use of the nursing process in concert with other health care professionals. The health care industry or health profession treats and tends to patients who are injured sick disabled or infirm Nursing is a Profession focused on assisting individuals families, and communities in attaining maintaining and recovering optimal Health The nursing process is a process by which nurses deliver care to patients supported by nursing models or philosophies. Registered nurses work as patient advocates for the care and recovery of the sick and maintenance of the healthy. A patient is any person who receives medical attention care or treatment. In their work as advocates for the patient, RNs ensure that the patient receives appropriate and professional care. RNs use the nursing process to assess, plan, implement, and evaluate nursing care of the sick and injured. The nursing process is a process by which nurses deliver care to patients supported by nursing models or philosophies. RNs have more training than licensed practical nurses. Licensed practical nurses (LPNs are also known as licensed vocational nurses (LVNs in California and Texas and as registered practical nurses (RPNs in Ontario

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United States

The scope of practice of registered nurses is the extent to and limits of which an RN may practice. In the United States, these limits are determined by a set of laws known as the Nurse Practice Act of the state or territory in which an RN is licensed. The United States of America —commonly referred to as the Law is a system of rules enforced through a set of Institutions used as an instrument to underpin civil obedience politics economics and society A US state is any one of the fifty subnational entities of the United States of America that share Sovereignty with the federal government Each state has its own laws, rules, and regulations governing nursing care. Usually the making of such rules and regulations is delegated to a state board of nursing, which performs day-to-day administration of these rules, qualifies candidates for licensure, licenses nurses and nursing assistants, and makes decisions on nursing issues. It should be noted that in some states the terms "nurse" or "nursing" may only be used in conjunction with the practice of a Registered Nurse(RN)or licensed practical or vocational nurse (LPN/LVN). Licensed practical nurses (LPNs are also known as licensed vocational nurses (LVNs in California and Texas and as registered practical nurses (RPNs in Ontario

The scope of practice for a registered nurse is wider than for an LPN/LVN because of the level and content of education as well as what the Nurse Practice Act says about the respective roles of each.

In the hospital setting, registered nurses are often assigned a supervisory role to oversee tasks performed by LPNs and unlicensed assistive personnel such as nursing assistants. In the United States, Certified Nursing Assistants ( CNA s Patient Care Assistants, State Tested Nurse Aid ( STNA)or Nursing Assistants-Registered However, the RN remains responsible for the safety and care of the patient.

RNs are not limited to employment as bedside nurses. Registered nurses are employed by physicians, attorneys, insurance companies, private industry, school districts, ambulatory surgery centers and fire departments, among others. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health An attorney at law (or attorney-at-law) in the United States is a practitioner in a court of law who is legally qualified to prosecute Insurance, in Law and Economics, is a form of Risk management primarily used to hedge against the Risk of a contingent loss Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Self-employment is the individual pursuit of Capitalism. To be self-employed an individual is normally highly skilled in a trade or has a niche product or service Research Nurses conduct or assist in the conduct of research or evaluation (outcome and process) in many areas such as biology, psychology, human development, and health care systems. The average salary for a staff RN in the United States in 2007 was $60,484.

Educational and licensure requirements

Two-year college degree

In the United States, there are three routes to initial licensure as a registered nurse. The shortest path (and the most widely utilized) is a two-year Associate of Science in Nursing, a two-year college degree referred to as an ADN; this is the most common initial preparation for licensure in the U. An Associate of Science in Nursing ( ASN) is an entry-level Tertiary education Nursing degree. A community college is a type of Educational institution. The term has different meanings in different countries S. Often in competitive metropolitan areas within the US, two-year programs can require several prerequisite courses which ultimately stretch out the degree-acquiring process to about 3 or, sometimes, even 4 years.

Hospital diploma program

Another method is to attend a diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy, physiology, microbiology, nutrition, chemistry, and other subjects at a college or university, then move on to intensive nursing classes. Anatomy (from the Greek anatomia, from ana separate apart from and temnein, to cut up cut open is a branch of Biology that is the consideration Physiology (from Greek grc φύσις physis, "nature origin" and grc -λογία -logia) is the study of the mechanical physical Microbiology (from Greek grc μῑκρος mīkros, "small" grc βίος bios, " Life " and grc -λογία Nutrition (also called nourishment or aliment) is the provision to cells and Organisms of the materials necessary (in the form of food to support Chemistry (from Egyptian kēme (chem meaning "earth") is the Science concerned with the composition structure and properties Until 1996, most RNs in the US were initially educated in nursing by diploma programs. Year 1996 ( MCMXCVI) was a Leap year starting on Monday (link will display full 1996 Gregorian calendar) [1]

The Bachelor of Science in Nursing

The third method is to obtain a Bachelor of Science in Nursing, a four-year degree that also prepares nurses for graduate-level education. The Bachelor of Science in Nursing ( BSN) is a four year Academic degree in the science and principles of Nursing, granted by a Tertiary education For the first two years in a BSN program, students usually obtain general education requirements in the same manner as ADN and diploma graduates; they spend the remaining time in nursing courses. Advocates for the ADN and diploma programs state that such programs have a more "hands-on" approach to educating students, while the BSN is an academic degree that emphasizes research and nursing theory. A degree is any of a wide range of status levels conferred by institutions of Higher education, such as universities, normally as the result of successfully completing Nursing theory is the term given to the body of knowledge that is used to support Nursing practice. Nursing schools must be accredited by either the National League for Nursing Accrediting Commission(NLNAC) or the Commission on Collegiate Nursing Education (CCNE). As the voice for nursing education the National League for Nursing is the premier organization for nurse faculty and leaders in nursing education offering faculty development networking opportunities The Commission on Collegiate Nursing Education (CCNE is an autonomous Nursing education accrediting agency that contributes to the improvement of the public's health

The Master's Entry Program

There is a relatively new method to obtain an RN, through a Master's of Science in Nursing program. A Master of Science in Nursing ( MSN) is an advanced-level Quaternary education degree for Registered Nurses It is required This type of program combines the state Board of Registered Nursing (BRN) education requirements to obtain an RN with the education necessary to receive an MSN. The requirements to enter this type of program are that a student has an undergraduate degree in a nursing or related field and has completed the prerequisites required by a standard RN program. The student graduates with the ability to take the state boards to receive an RN and a Master's degree.

Licensure examination

Completion of any one of these three educational routes allows a graduate nurse to take the NCLEX-RN, the test for licensure as a registered nurse, and is accepted by every state as an adequate indicator of minimum competency for a new graduate. The NCLEX-RN ( N ational C ouncil L icensure EX amination- R egistered N urse is a Computer-adaptive test (CAT of However, controversy exists over the appropriate entry-level preparation of RNs. Some professional organizations believe the BSN should be the sole method of RN preparation and ADN graduates should be licensed as "technical nurses" to work under the supervision of BSN graduates. Others feel the hands-on skill of diploma and ADN graduates makes up for any deficiency in theoretical preparation. Regardless of this debate, it is highly unlikely that the BSN will become the standard for initial preparation any time soon, because of the nursing shortage and the lack of faculty to teach BSN students.

Graduate nursing opportunities

Advanced education in nursing is done at the masters and doctoral levels. A Master of Science in Nursing or a Master of Nursing takes about three years of full-time study to complete and prepares the graduate for specialization as a nurse practitioner, a clinical nurse leader (CNL), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). A Master of Science in Nursing ( MSN) is an advanced-level Quaternary education degree for Registered Nurses It is required A Nurse Practitioner (NP is a Registered nurse who has completed specific advanced Nursing education (generally a Master's degree) and training in the The Clinical Nurse Leader (CNL is a generalist who focuses on the improvement of outcomes for patients A nurse anesthetist ( AE) is a Registered nurse and advanced practice nurse who has acquired additional education and training to administer Anesthesia. A clinical nurse specialist (CNS is an Advanced practice nurse, with graduate preparation (earned master's or doctorate from a program that prepares CNSs Nurse practitioners work in fields as diverse as midwifery, family practice, psychiatry, gerentology, or pediatrics, while a CNS usually works for a facility to improve patient care, do research, or as a staff educator. In the United States, a nurse-midwife is an Advanced practice nurse who has specialized in the practice of obstetrical and gynecological care of relatively Family medicine differs from the traditional European general practitioner Psychiatry is a medical specialty which exists to study, prevent, and treat Mental disorders in Humans Psychiatric Gerontology (from Greek γερο gero, "old age" and λόγος Logos, "speech" lit Pediatrics (also spelled paediatrics) is the branch of Medicine that deals with the medical care of Infants Children and Adolescents Doctoral programs in nursing prepare the student for work in nursing education, health care administration, clinical research, or advanced clinical practice. Most programs confer the Ph.D in nursing, but some confer the Doctor of Nursing Science (DNS or DNSc), Doctor of Nursing Practice (DNP), Doctor of Science in Nursing (DSN), or the Doctor of Education (Ed. "PhD" redirects here for other uses see PhD (disambiguation. There are multiple doctorate degrees in nursing Doctor of Nursing Practice ( DNP or DrNP) Doctor of Nursing Science ( DNSc DNS or DSN) and Doctor The Doctor of Education degree ( EdD or DEd) is a discipline-based doctorate that prepares the student for academic administrative clinical or research positions D. ). Doctoral programs take from three to five years of full-time study to complete.

Nursing board certification

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

The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organization and administers more than 30 specialty examinations. The American Nurses Association (ANA is a professional organization to advance and protect the profession of Nursing. [2]

The nursing shortage in the United States

RNs are the largest group of health care workers in the United States, numbering over 2. 6 million. It has been reported that the number of new graduates and foreign-trained nurses is insufficient to meet the market-place demand for registered nurses; this is often referred to as the nursing shortage and is expected to increase for the foreseeable future. Supply and demand is an Economic model describing effects on price and quantity in a Market. Nursing shortage refers to a situation where the demand for nurses is greater than the supply as is currently the case in the United States and several other developed nations

Causes of the nursing shortage in the United States

Among the many cited causes for the nursing shortage is the lack of qualified doctoral or master degree prepared faculty for college RN programs. Students cannot be admitted to school if there is no faculty to teach them. [3] Furthermore, there is evidence that faculty positions for RN programs do not command equivalent salaries to those of their peers in other fields.

Another factor affecting the nursing shortage is that after education, Registered Nurses typically do not remain long in the profession, especially those working in more traditional hospital health care roles. The two primary reasons given for leaving the profession are poor working conditions (e. g. long and irregular hours and an absence of sufficient numbers of health care providers, such as aides); and salaries which are not commensurate with the responsibilities of the profession.

Other factors such as a high index of accountability, role-limited autonomy, and physical labor demanded of clinical positions are also seen as deterrents to those considering becoming a Registered Nurse. As well, many systems and practices in nursing are heavily oriented toward the social and gender patterns and practices of women, which can hinder consideration of nursing as a profession by men. Finally, the hierarchical nature of health care in the USA places physicians in a "power-over" position in relation to the status of Registered Nurses, limiting the services of the profession, despite the growing numbers of advanced preparation nurses (APN) or extensive clinical and professional knowledge, skills, and abilities of nursing staff.

Solutions to the nursing shortage

The American Association of Colleges of Nursing (AACN) is concerned about the labor shortage in the field of nursing and has been working to enact legislation, identify strategies, and form cooperative efforts with all interested people and groups to address this problem. In its narrowest definition a labor shortage is an economic condition in which there are insufficient qualified candidates (employees to fill the market-place demands The AACN has also published a no containing current statistics related to the shortage (found here [1]).

United Kingdom

See Nursing in the United Kingdom for more information. Nursing in the United Kingdom has a long history but in its current form probably dates back to the era of Florence Nightingale, who initiated schools of nursing

To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located Established in 2002 the Nursing & Midwifery Council (NMC is a statutory body set up by Parliament through the Nursing and Midwifery Order 2001 The title "registered nurse" can only be granted to those holding such registration, this protected title is laid down in the Nurses, Midwives and Health Visitors Act, 1997. [4]

First level nurses

First level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles such as RGN (registered general nurse), RSCN (registered sick children's nurse), RMN (registered mental nurse, RNLD (registered nurse learning disabilities) and SRN (state registered nurse) etc.

The majority of first level nurses are employed as staff nurses with the minority in management and specialised roles.

Second level nurses

See state enrolled nurse for more information. Licensed practical nurses (LPNs are also known as licensed vocational nurses (LVNs in California and Texas and as registered practical nurses (RPNs in Ontario

Second level nurse training is no longer provided, however they are still legally able to practice in the United Kingdom as a nurse. Many have now either retired or undertaken conversion courses to become first level nurses.

Specialist nurses

The NHS employs a huge variety of specialist nurses. These nurses have many years of experience in their field, in addition to extra education and training (see below).

They split into several major groups:

Managers

There are many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles (see above), this has become a less attractive option.

Nonetheless, many nurses fill positions in the senior management structure of NHS organisations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons

Nurse education

Pre-registration

In order to become a registered nurse, and work as such in the NHS, one must complete a programme recognised by the Nursing and Midwifery Council. Matron is the job title of a very senior Nurse in several countries including the United Kingdom and the Republic of Ireland although the title Clinical Established in 2002 the Nursing & Midwifery Council (NMC is a statutory body set up by Parliament through the Nursing and Midwifery Order 2001 Currently, this involves completing a degree or diploma, available from a range of universities offering these courses, in the chosen branch speciality (see below), leading to both an academic award and professional registration as a 1st level registered nurse. A degree is any of a wide range of status levels conferred by institutions of Higher education, such as universities, normally as the result of successfully completing A diploma (from Greek δίπλωµα diploma, meaning "folded paper" is a Certificate or Deed issued by an educational institution Such a course is a 50/50 split of learning in university (i. A university is an institution of Higher education and Research, which grants Academic degrees in a variety of subjects e. through lectures, essays and examinations) and in practice (i. e. supervised patient care within a hospital or community setting).

These courses are three (occasionally four) years' long. The first year is known as the common foundation programme (CFP), and teaches the basic knowledge and skills required of all nurses. The remainder of the programme consists of training specific to the student's chosen branch of nursing. These are:

Midwifery training is similar in length and structure, but is sufficiently different that it is not considered a branch of nursing. Midwifery is a Health care profession where providers give Prenatal care to expecting Mothers attend the birth of the Infant There are shortened (18 month) programmes to allow nurses already qualified in the adult branch to hold dual registration as a nurse and a midwife. Shortened courses lasting 2 years also exist for graduates of other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common foundation programme. [5]

Student nurses currently receive a bursary from the government to support them during their nurse training. A bursary is strictly an office for a Bursar and his or her staff in a school or college Diploma students in England receive a non-means-tested bursary of around £6000 per year (with additional allowances for mature students or those with dependent children), whereas degree students have their bursary means tested (and so often receive less). Degree students are, however, eligible for a proportion of the government's student loan, unlike diploma students. Student loans are loans offered to students to assist in payment of the costs of professional Education. In Scotland, however, all student nurses regardless of which course they are undertaking, receive the same bursary in line with the English diploma amount. Scotland ( Gaelic: Alba) is a Country in northwest Europethat occupies the northern third of the island of Great Britain. In Wales only the Degree level course is offered and all nursing students therefore receive a non-means-tested bursary.

Before Project 2000, nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.

Post-registration

After the point of initial registration, there is an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice (PREP) requirements. Established in 2002 the Nursing & Midwifery Council (NMC is a statutory body set up by Parliament through the Nursing and Midwifery Order 2001

There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation, venepuncture, intravenous drug therapy and male catheterisation are the most common, although there are many others (such as advanced life support) which some nurses will undertake. A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal In medicine venipuncture or venepuncture (also known as phlebotomy, venesection, blood draw, drawing blood or taking blood Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. In urinary catheterization, a plastic tube known as a urinary Catheter (such as a Foley catheter) is inserted into a patient's bladder via their Advanced Life Support (ALS- Implies that a EMT is capable of performing advanced life support skills as either an EMT-I (Intermediate or an EMT-P (Paramedic commonly referred

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part time. Many nurses prefer this option to gaining a degree initially, as there is often an opportunity to study in a specialist field as a part of this upgrading. Financially, in England, it is also much more lucrative, as diploma students get the full bursary during their initial training, and employers often pay for the degree course as well as the nurse's salary.

In order to become specialist nurses (such as nurse consultants, nurse practitioners etc. ) or nurse educators, some nurses undertake further training above bachelors degree level. Masters degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. "PhD" redirects here for other uses see PhD (disambiguation. District nurses and health visitors are also considered specialist nurses, and in order to become such they must undertake specialist training (often in the form of a top up degree (see above) or post graduate diploma). District Nurses are senior Nurses who manage care within the community leading teams of community nurses and support workers Health visitors are UK registered Nurses or midwives who have undertaken further training to work as part of the Primary health care team

All newly qualifying district nurses and health visitors are trained to prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings typically useful to those carrying out these roles. District Nurses are senior Nurses who manage care within the community leading teams of community nurses and support workers Many of these (and other) nurses will also undertake training in independent and supplementary prescribing, which allows them (as of May 1st 2006) to prescribe almost any drug in the British National Formulary. The British National Formulary (BNF contains a wide spectrum of information on prescribing and Pharmacology, among others indications Side effects and This has been the cause of a great deal of debate in both medical and nursing circles.

Further reading

References

  1. ^ American Nurses Association. "Nursing Facts: Today's Registered Nurse - Numbers and Demographics" Washington, D. C. , American Nurses Association, 2006.
  2. ^ American Nurses Credentialing Center. "ANCC Certification" Washington, D. C. , American Nurses Association, 2006.
  3. ^ Anderson, Carole A. "The Nurse Ph.D.: A Vital Profession Needs Leaders" Thomson-Peterson's,2006.
  4. ^ United Kingdom Government Nurses, Midwives and Health Visitors Act, 1997. London: HMSO, 1997.
  5. ^ Nursing and Midwifery Council Pre-registration training. London: NMC, 2003.

See also

External links

Advanced Practice Nurses (APNs also known as Advanced Practice Registered Nurses ( APRN s are Registered Nurses with advanced education knowledge skills and scope Nursing theory is the term given to the body of knowledge that is used to support Nursing practice. The nursing process is a process by which nurses deliver care to patients supported by nursing models or philosophies. A nurse is responsible—along with other Health care Professionals —for the treatment safety and recovery of acutely or chronically A nurse registry, nursing registry, or register of nurses is a list of nurses who are legally licensed to practice Nursing. Nursing is a Profession focused on assisting individuals families, and communities in attaining maintaining and recovering optimal Health In the US and Canada many nurses who choose a specialty become certified in that area signifying that they possess expert knowledge Nurse education consists in the theorical and practical training provided to Nurses with the purpose to prepare them for their duties as Nursing care professionals Nursing shortage refers to a situation where the demand for nurses is greater than the supply as is currently the case in the United States and several other developed nations
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