Nurse

For information on the televsion show Nurses see Nurses (TV series).

A nurse is a health care professional who is engaged in the practice of nursing. Nurses are men and women who are responsible (along with other health care professionals) for the safety and recovery of acutely 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.

Overview

Nurses develop a plan of care, often working collaboratively with physicians, therapists, the patient, the patient's family and other team members. In the United States, advanced practice nurses (APN's), such as clinical nurse specialists and nurse practitioners, diagnose problems and prescribe drugs or therapies. Nurses may help coordinate the patient care performed by other members of a health care team (eg therapists, medical practitioners, dietitians, etc). Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.

According to the US Department of Labor's revised Occupational Outlook Handbook (2000), "Registered nurses (R.N.s) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, responses, and progress; assist physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation. R.N.s also develop and manage nursing care plans; instruct patients and their families in proper care; and help individuals and groups take steps to improve or maintain their health."

Types of nurses (and non-nurses)

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.

United States

Licensed Practical Nurses (LPN; they are known as Licensed Vocational Nurses, LVN, in California and Texas, and Registered Practical Nurses, RPN, in Ontario) exist in most states. These individuals usually have eighteen months to two years of training in body function & structure, drugs and practical patient care. They must pass state or national boards and renew their license periodically. They can perform simple as well as complex medical procedures, but must operate under the supervision of either a professional registered nurse (RN) or a physician. They can administer most medications (usually with the exception of IV push medications), perform measurements (blood pressure, temperature, etc), record-keeping, help with patient-care planning, first aid, CPR, sterile and isolation procedure and basic care. Licensed Practical Nurses are often found working under the supervision of physicians in clinics. In long term care facilities, they sometimes supervise nursing assistants and orderlies. The United States Department of Labor's Bureau of Labor Statistics estimates that there are about 700,000 (1) persons employed as licensed practical and licensed vocational nurses in the U.S.

Registered Nurses 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. They have a diploma, associate's degree, or bachelor's of degree in nursing at entry level, and after passing state board examininations are granted the title Registered Nurse. Regardless of degree, they have many hours of clinical experience. They are the largest group of healthcare workers in the United States, numbering over 2.6 million. It is estimated that an additional 750,000 RNs will be needed by 2005 in the U.S. Much research has shown that RNs are the first-line defense of hospitalized patients against disability or death from infection, cardiopulmonary arrest, and other serious complications. Higher ratios of registered nurses to patients has been shown to decrease certain complications of illness including death in patients. Registered nurses are educators, managers, executives, therapists, intensive care experts, symptom managers, professional mentors, researchers and community members. In hospitals, registered nurses perform diverse roles such as writing policies, responding to emergencies, managing professional, technical and ancillary staff, determining budgets, performing strategic planning, and supervising construction projects.

Many nurses pursue voluntary specialty certification through professional organizations and certifying bodies. A registered nurse certified in critical care is a CCRN; in school nursing is a NCSN; in oncology the credential is OCN, and WOCN signifies certification in wound, continence and ostomy care, for example. Similar acronyms are used for certification in many other nursing specialties.

The Bureau of Labor Statistics estimates that there are about 2.3 million (1) persons employed as registered nurses in the U.S.

Advanced Practice Nurses perform primary health care, mental health services, diagnosis and prescribing, carry out research, and educate the public and other professionals. Some APNs diagnose illness and prescribe drugs. APNs possess a Masters' Degree or higher in Nursing, and may also sit for additional certification examinations. APNs may operate as a Certified Nurse Midwife (CNM), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS) or Certified Registered Nurse Anesthetists (CRNA).

All advanced practice certifications require continuing education and other requirements (such as periodic reexamination) to maintain the credential. Advanced practice nurses can expect to earn above-average salaries, especially as the population of the US ages and the demand for highly-skilled healthcare workers grows proportionally.

At the top of the educational ladder is the doctorally-prepared nurse. Nurses may gain the PhD or another doctoral degree (Doctor of Nursing Science (DNSc), Nutrix Doctorae (ND), Doctor of Nursing Practice (DNP), or one of a few others), specializing in research and/or clinical nursing treatment. These nurses practice nursing, teach nursing and carry out nursing research. As the science of nursing has advanced, so has the demand for doctorally-prepared nurses.

Non-nurses

Health care settings generally involve a wide range of health care workers other than nurses. Examples include:

Nursing assistants, orderlies, and patient care assistants are not nurses. In acute-care hospitals, their duties are limited to tasks delegated by the registered or licensed practical nurse. Most orderlies are trained to perform heavy patient-movement or other muscular tasks. Orderlies were originally the "police" of hospitals, to keep the patients "orderly." Certified nursing assistants assist nurses by taking vital signs, administering hygienic care, assisting with feeding, giving basic psychosocial care, and similar duties. See also candystriper; hospital volunteers; nurse assistant skills.

Technicians may wear uniforms similar to those of nurses and perform some duties traditionally associated with nurses, but are not nurses. For example, certified medication aides are trained to administer medications in a long-term care setting, but have no training in nursing decision-making; thus, their use is controversial. There are also phlebotomy technicians, who draw blood; surgical technologists, who are more or less equivalent to a Registered Nurse in the first scrub role during a surgery; and technicians trained to operate most kinds of diagnostic and laboratory equipment, such as X-ray machines, electrocardiographs, and so forth.

Medical practitioners (medical doctors) and allied health professionals (such as speech therapists, occupational therapists and physical therapists), are not nurses. Whilst they may work closely with nurses, they are members of their own separate professions, with distinct training, licensing, skills and roles.

Educational preparation

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.

Canada

Most provinces in Canada prefer any registered nurse to have at least a bachelor's degree. Many practicing nurses are still college graduates but those entering nursing now are required or encouraged to enter at the university level.

US

All US states and territories require RNs to graduate from an accredited nursing program which allows the candidate to sit for the NCLEX-RN examination, a standardized examination administered through the National Council of State Boards of Nursing. Successful completion of the NCLEX examination confers state licensure as an RN. 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.

Registered nurses may receive their basic preparation through one of three avenues:

Graduation from an Associate-Degree nursing program (approximately 3 years of college level study with a strong emphasis on clinical knowledge and skills)earning the degree of ASN/AAS in Nursing.
Graduation with a three-year (diploma) certificate from a hospital-based school of nursing (non-degree). Few of these programs remain in the U.S.
Graduation from a University with a Bachelor's Degree in Nursing (a 4 - 5 year program conferring the BSN/BN degree with enhanced emphasis on leadership and research as well as clinically-focused courses).

All pathways into practice require that the candidate complete some clinical training in nursing. While in clinical training, student nurses are identified by a special uniform. Graduates of all programs, once licensed, are generally eligible for employment as entry-level staff nurses.

It is common for RNs to seek additional education to prepare themselves to assume leadership or advanced practice roles within nursing. Management and teaching positions increasingly require candidates to hold an advanced degree in nursing. Many hospitals offer tuition remission or assistance to nurses who want to continue their education beyond their basic preparation.

Nurses from other countries who want to take the US nursing licensure exam are required to be proficient in English and have their educational credentials evaluated by an association known as the Council of Graduates of Foreign Nursing Schools (www.cgfns.org) prior to being permitted to take the US licensing exam.

UK

Since the 1990s, UK nurses are now educated to Diploma or Bachelor's Degree level. They undertake their training at universities and in placements in healthcare settings. Following a common foundation programme, nurses then choose to specialise in a branch programme that reflects the area of nursing in which they wish to work. On qualification all nurses take the title of registered nurse.

All UK nurses are listed on a register and are regulated by the Nursing and Midwifery Council. Nurses need to re-register every three years and are required in this time to have demonstrated that they have kept up-to-date by undertaking a set number of hours of professional development and nursing practice.

Legal regulation

Government regulates the profession of nursing to protect the public.

U S

In the US, the individual states have authority over nursing practice. The scope of practice is defined by legislative and regulatory law administered by State Nursing Boards.

Many states have adopted the Model Nursing Practice Act and Model Nursing Administrative Rules created by the National Council of State Nursing Boards. In addition, many State Nursing Boards model their license requirements on the Uniform Core Licensure Requirements which set forth competency development and competency assessment principles.

Work settings

For a full list of nursing specialties see: List of nursing specialties

Most RNs work in a hospital. A registered nurse has a very portable job skill. In many cities, RNs can enter their names in a "registry" and work a wide variety of temporary jobs. Beside hospitals, RNs work in schools, home health care, in office and occupational or industrial health settings, free-standing clinics and physician offices, nurse-run clinics, long-term care facilities, camps, and as advisors and consultants to the healthcare and insurance industries. Some RNs work with attorneys as Legal Nurse Consultants, reviewing patient records to assure that adequate care was provided. Some RNs are attorneys.

There are many different nursing specialties, encompassing care throughout the human lifespan and based upon patient needs. Many nurses who choose a specialty become certified in that area, signifying that they possess expert knowledge of the specialty. There are over 200 nursing specialties and sub-specialties. Certified nurses often earn a salary differential over their non-certified colleagues, and studies from the Institute of Medicine have demonstrated that specialty certified nurses have higher rates of patient satisfaction, as well as lower rates of work-related errors in patient care.

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