In the health care professions, a nurse is someone who practices nursing professionally. Nurses are responsible for the safety and recovery of acutely ill or injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in all health care settings.
Nurses develop a plan of care and are often the only providers who do so collaboratively with physicians, therapists, the patient, and other team members. In the U.S., advanced practice nurses (APN's), such as clinical nurse specialists and nurse practitioners, diagnose problems and prescribe drugs or therapies. Nurses coordinate the patient care performed by other members of a health care team (therapists, 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."
In various parts of the world, the educational background for nurses varies widely. In some parts of eastern Europe, nurses are high school students with 12 to 18 months of training. In contrast, Chile requires any registered nurse to have at least a bachelor's degree.
Types of nurses (and non-nurses)
Nurses in the United States exist on several distinct levels, distinguished by increasing education, responsibility and skills. The major distinction is between task-based nursing and professional nursing.
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, but are not nurses. For example, certified medication aides are trained to administer medications but have no training in nursing decision-making. There are also blood collection technicians, and technicians trained to operate most kinds of diagnostic and laboratory equipment.
Medical practitioners (medical doctors) and allied health professionals (such as speech therapists, occupational therapists and physical therapists), are not nurses. Whilst they generally work together closely with nurses, they are members of their own separate professions, with distinct training, licensing, skills and roles.
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 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 and usually operate under the supervision of professional registered nurses (RNs) or physicians. They can administer most 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.
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 often have bachelor degrees or associate degrees in nursing, but in many states are not required to do so. 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 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.
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 Anesthetist (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, Nursing Doctor), 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.
All US states and territories require RNs to graduate from an accredited nursing program which allows the candidate to sit for the NCLEX 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 remainin 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.
In the UK all nurses are regulated by the Nursing and Midwifery Council
Where do nurses work?
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 specialty, 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.
History of nursing
In premodern times, nuns and the military often provided nursing services. the religious and military roots of modern nursing remain in evidence today. For example, in Britain, nurses are known as "sisters." Florence Nightingale is regarded as the founder of modern nursing, which flourished in response to the World Wars. New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12th of September 1901.
See also: wet nurse
- Nursing resources for students and professionals
- American Association of Critical Care Nurses
- American Nurses' Association
- Oncology Nursing Society
- Sigma Theta Tau International
- Rx Nurse Network
- NMAP The UKs Gateway to high quality Internet resources for Nurses, Midwives and Allied Professions