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 Home > By Career > Medicine, Health Care > Nursing
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Nursing is a healthcare profession focused on the care of individuals, families,
and communities so they may attain, maintain, or recover optimal health and quality
of life from conception to death.
Nurses work in a large variety of specialties where they work independently and
as part of a team to assess, plan, implement and evaluate care. Nursing Science
is a field of knowledge based on the contributions of nursing scientist through
peer-reviewed scholarly journals and evidenced-based practice.
History of nursing
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In fifth century BC, Hippocrates was one of the first people in the world to study
healthcare, earning him the title of "the father of modern medicine". Western European
concepts of nursing were first practiced by male Catholic monks who provided for
the sick and ill during the Dark Ages of Europe.
During 17th century Europe, nursing care was provided by men and women serving punishment.
It was often associated with prostitutes and other female criminals serving time[citation
needed]. They had a reputation for being drunk and obnoxious, a view amplified by
the doctors of the time to make themselves seem more important and able[citation
needed]. It was not until Florence Nightingale, a well-educated woman from a wealthy
class family, became a nurse and improved it drastically that people began to accept
nursing as a respectable profession. Other aspects also helped in the acceptance
of nursing. In 1853 Theodore Fliedner set up a hospital where the nurses he employed
had to be of good nature. Many people were impressed with this facility, and because
of it, the British Institute of Nursing Sisters was set up.
Prior to the foundation of modern nursing, nuns and the military often provided
nursing-like services. The religious and military roots of modern nursing remain
in evidence today in many countries, for example in the United Kingdom, senior female
nurses are known as sisters. It was during time of war that a significant development
in nursing history arose when English nurse Florence Nightingale, working to improve
conditions of soldiers in the Crimean War, laid the foundation stone of professional
nursing with the principles summarised in the book Notes on Nursing. Other important
nurses in the development of the profession include: Mary Seacole, who also worked
as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards, who established
quality nursing schools in the USA and Japan, and Linda Richards who was officially
America's first professionally trained nurse, graduating in 1873 from the New England
Hospital for Women and Children in Boston.
New Zealand was the first country to regulate nurses nationally, with adoption of
the Nurses Registration Act on the 12 September 1901. It was here in New Zealand
that Ellen Dougherty became the first registered nurse. North Carolina was the first
state in the United States to pass a nursing licensure law in 1903.
Nurses in the United States Army actually started during the Revolutionary War when
a general suggested to George Washington that the he needed female nurses "to attend
the sick and obey the matron's orders. In July 1775, a plan was submitted to the
Second Continental Congress that provided one nurse for every ten patients and provided
that a matron be allotted to every hundred sick or wounded".
Nurses have experienced difficulty with the hierarchy in medicine that has resulted
in an impression that nurses' primary purpose is to follow the direction of physicians.
This tendency is certainly not observed in Nightingale's Notes on Nursing, where
the physicians are mentioned relatively infrequently, and often in critical tones—particularly
relating to bedside manner.
In the early 1900s, the autonomous, nursing-controlled, Nightingale era schools
came to an end – schools became controlled by hospitals, and formal "book learning"
was discouraged. Hospitals and physicians saw women in nursing as a source of free
or inexpensive labor. Exploitation was not uncommon by nurse’s employers, physicians
and educational providers. Nursing practice was controlled by medicine.
The modern era has seen the development of nursing degrees and nursing has numerous
journals to broaden the knowledge base of the profession. Nurses are often in key
management roles within health services and hold research posts at universities.
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World War II
United States
As Campbell (1984) shows, the nursing profession was transformed by World War Two.
The profession contained a basic tension between the tender loving care provided
sick people, on the one hand, and the well-trained efficient specialists on the
other was a historic tension in the nursing profession that was partially resolved
by the war. The military wanted well-trained efficient specialists. All the services
used enlisted men to handle the routine care of sick patients are wounded patients,
and use their nurses as officers who were trained specialists. In military units,
male doctors supervised female nurses, and both were officers, while the women in
practice supervised large numbers of enlisted men. Although enlisted medic could
become an officer, it was not easy, and none could become a nurse. Indeed there
were no male nurses in the American military until years later. Army and Navy nursing
was highly attractive and a larger proportion of nurses volunteered for service
higher than any other occupation in American society. The nation responded by a
dramatic increase in the numbers and functions of nurses, and a moderate modest
increase in their pay scales, with the expansion powered by the training of 200,000
nurses aides by the Red Cross, and the creation of a temporary new government agency,
the Cadet Nurse Corps, which enrolled 170,000 young women in speeding up training
programs in the nation's 1200 nursing schools. About 5% five percent of the Cadet
nurses, and Army nurses were black, but the Navy refused to accept black nurses
until it was forced to admit a handful by the White House near the end of the war.
The black Army nurses were used in all-black units, handle and to handle medical
services for prisoners of war.
The public image of the nurses was highly favorable during the war, as the simplified
by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under
enemy fire. Some nurses were captured by the Japanese,[10] but in practice they
were kept out of harm's way, with the great majority stationed on the homefront.
However 77 were stationed in the jungles of the Pacific, where their uniform consisted
of "khaki slacks, mud, shirts, mud, field shoes, mud, and fatigues."[11] The 20,000
nurses in Europe were safely behind the lines. They had two missions one provide
technical nursing services to military hospitals and second to train and the male
Army medics and male pharmacy mates in the Navy. These men handled frontline nursing
care, and also staffed homefront hospitals, where the nurses directly supervised
them.
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The medical services were large operations, with over 600,000 soldiers, and ten
enlisted men for every nurse. Nearly all the doctors were men, with women doctors
allowed only to examine the WAC. Forward medical units, were emergency surgery was
undertaken, was done without the benefit of nurses. Well behind the battlefield,
the nurses worked in evacuation hospitals, primarily in the role of supervising
the medics and the Navy’s pharmacy mates. The closer to the front, the more flexible
and autonomous was the nurse’s’ role. The women wanted to be much closer to the
front, but they had too weak a voice to counter the Pentagon’s highly protective
attitude.
Down to 1942, the American Red Cross controlled access to the military. The Red
Cross was controlled by civilian men, professional experts and social work and fundraising.
The new leaders emerging from the war had learned command skills, maneuvering in
complex bureaucracies, the taste of equal pay an officer status, and autonomy within
military medical system. New technical skills validated their demands for an autonomy
as they learned and employed in crisis situations the latest trauma and medical
techniques and technologies. The military nurses returned home as the nation’s experts
in blood transfusion and the application of new drugs like penicillin. When the
nurses returned home they used the previously powerless American Nurses Association
to take control of the nursing profession.
Britain
Military nursing had only a small role for women in Britain, where 10,500 nurses
enrolled in Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and the
Princess Mary's Royal Air Force Nursing Service. These services dated to 1902 and
1918, and enjoyed royal sponsorship. There also were VAD nurses who had been enrolled
by the Red Cross.
Germany
Germany had a very large and well organized nursing service, with three main organizations,
one for Catholics, one for Protestants, and the DRK (Red Cross). In 1934 the Nazis
set up their own nursing unit, the Brown nurses, and absorb one of the smaller groups,
bringing it up to 40,000 members. It set up kindergartens, hoping to seize control
of the minds of the younger Germans, in competition with the other nursing organizations.
Civilian psychiatric nurses who were Nazi party members participated in the killings
of invalids, although the process was shrouded in euphemisms and denials.
Military nursing was primarily handled by the DRK, which came under partial Nazi
control. Frontline medical services were provided by male medics and doctors. Red
Cross nurses served widely within the military medical services, staffing the hospitals
that perforce were close to the front lines and at risk of bombing attacks. Two
dozen were awarded the highly prestigious Iron Cross for heroism under fire. They
are among the 470,000 German women who served with the military.
Definition
Although nursing practice varies both through its various specialities and countries,
these nursing organizations offer the following definitions:
Nursing encompasses autonomous and collaborative care of individuals of all ages,
families, groups and communities, sick or well and in all settings. Nursing includes
the promotion of health, prevention of illness, and the care of ill, disabled and
dying people. Advocacy, promotion of a safe environment, research, participation
in shaping health policy and in patient and health systems management, and education
are also key nursing roles.
— International Council of Nurses
The use of clinical judgement in the provision of care to enable people to improve,
maintain, or recover health, to cope with health problems, and to achieve the best
possible quality of life, whatever their disease or disability, until death.
—Royal College of Nursing UK
Nursing is the protection, promotion, and optimization of health and abilities;
prevention of illness and injury; alleviation of suffering through the diagnosis
and treatment of human responses; and advocacy in health care for individuals, families,
communities, and populations.
—American Nurses Association
The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful
death) that he would perform unaided if he had the necessary strength, will or knowledge.
—Virginia Avenel Henderson
Nursing as a profession
The authority for the practice of nursing is based upon a social contract that delineates
professional rights and responsibilities as well as mechanisms for public accountability.
In almost all countries, nursing practice is defined and governed by law, and entrance
to the profession is regulated at the national or state level.
The aim of the nursing community worldwide is for its professionals to ensure quality
care for all, while maintaining their credentials, code of ethics, standards, and
competencies, and continuing their education.[16] There are a number of educational
paths to becoming a professional nurse, which vary greatly worldwide, but all involve
extensive study of nursing theory and practice, and training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are healthy
and ill in a holistic manner based on the individual's physical, emotional, psychological,
intellectual, social, and spiritual needs. The profession combines physical science,
social science, nursing theory, and technology in caring for those individuals.
In order to work in the nursing profession, all nurses hold one or more credentials
depending on their scope of practice and education. A Licensed practical nurse (LPN)
(also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled
nurse, and State enrolled nurse) works independently or with a Registered nurse.
The most significant differentiation between an LPN and RN is found in the requirements
for entry to practice, which determines entitlement for their scope of practice,
for example in Canada an RN requires a bachelors degree and a LPN requires a 2 year
diploma. A Registered nurse (RN) provides scientific, psychological, and technological
knowledge in the care of patients and families in many health care settings. Registered
nurses may also earn additional credentials or degrees. In the USA, in addition
to the LPN, Registered nurses can earn 2 different degrees that qualify a nurse
for the title RN. The title RN ADN is awarded to the nurse who has completed a 2
year undergraduate academic degree awarded by community colleges, junior colleges,
technical colleges, and bachelor's degree-granting colleges and universities upon
completion of a course of study usually lasting two years. The title RN BSN is awarded
to the nurse who has earned an American four year academic degree in the science
and principles of nursing, granted by a tertiary education university or similarly
accredited school. After completing either the LPN or either RN education programs
in the USA graduates are then eligible to sit for the a licensing examination to
become a nurse, passing which is required for the nursing license.
RNs may also pursue different roles as advanced practice registered nurses. Nurses
may follow their personal and professional interests by working with any group of
people, in any setting, at any time. Some nurses follow the traditional role of
working in a hospital setting. Around the world, nurses have been traditionally
female. Despite equal opportunity legislation nursing has continued to be a female
dominated profession.[20] For instance, in Canada and America the male-to-female
ratio of nurses is approximately 1:19. This ratio is represented around the world.
Notable exceptions include: Francophone Africa, which includes the countries of
Benin, Burkino Faso, Cameroon, Chad, Congo, Ivory Coast, the Democratic Republic
of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and
Togo, which all have more male than female nurses.[23] In Europe, in countries such
as Spain, Portugal, Czechoslovakia, and Italy, over 20% of nurses are male.
Regulation of practice
The practice of nursing is governed by laws that define a scope of practice, generally
mandated by the legislature of the country or area within which the nurse practices.
Nurses are held legally responsible and accountable for their practice. The standard
of care is that of the "prudent nurse."
Nursing theory and process
Main articles: Nursing theory and Nursing process Nursing practice is the actual
provision of nursing care. In providing care, nurses implement the nursing care
plan using the nursing process. This is based around a specific nursing theory which
is selected based on the care setting and population served. In providing nursing
care, the nurse uses both nursing theory and best practice derived from nursing
research.
In general terms, the nursing process is the method used to assess and diagnose
needs, plan outcomes and interventions, implement interventions, and evaluate the
outcomes of the care provided. Like other disciplines, the profession has developed
different theories derived from sometimes diverse philosophical beliefs and paradigms
or worldviews to help nurses direct their activities to accomplish specific goals.
Practice settings
Nurses practice in a wide range of settings, from hospitals to visiting people in
their homes and caring for them in schools to research in pharmaceutical companies.
Nurses work in occupational health settings (also called industrial health settings),
free-standing clinics and physician offices, nurse-led clinics, long-term care facilities
and camps. They also work on cruise ships and in military service. Nurses act as
advisers and consultants to the health care and insurance industries. Many nurses
also work in the health advocacy and patient advocacy fields at companies such as
Health Advocate, Inc. helping in a variety of clinical and administrative issues.[24]
Some are attorneys and others work with attorneys as legal nurse consultants, reviewing
patient records to assure that adequate care was provided and testifying in court.
Nurses can work on a temporary basis, which involves doing shifts without a contract
in a variety of settings, sometimes known as per diem nursing, agency nursing or
travel nursing. Nurses work as researchers in laboratories, universities, and research
institutions. Nurses have also been delving into the world of informatics, acting
as consultants to the creation of computerized charting programs and other software.
Work environment
Internationally, there is a serious shortage of nurses. One reason for this shortage
is due to the work environment in which nurses practice. In a recent review of the
empirical human factors and ergonomic literature specific to nursing performance,
nurses were found to work in generally poor environmental conditions. DeLucia, Ott,
& Palmieri (2009) [26] concluded, "the profession of nursing as a whole is overloaded
because there is a nursing shortage. Individual nurses are overloaded. They are
overloaded by the number of patients they oversee. They are overloaded by the number
of tasks they perform. They work under cognitive overload, engaging in multitasking
and encountering frequent interruptions. They work under perceptual overload due
to medical devices that do not meet perceptual requirements (Morrow et al., 2005),
insufficient lighting, illegible handwriting, and poor labeling designs. They work
under physical overload due to long work hours and patient handling demands which
leads to a high incidence of MSDs. In short, the nursing work system often exceeds
the limits and capabilities of human performance. HF/E research should be conducted
to determine how these overloads can be reduced and how the limits and capabilities
of performance can be accommodated. Ironically, the literature shows that there
are studies to determine whether nurses can effectively perform tasks ordinarily
performed by physicians. Results indicate that nurses can perform such tasks effectively.
Nevertheless, already overloaded nurses should not be given more tasks to perform.
When reducing the overload, it should be kept in mind that underloads also can be
detrimental to performance (Mackworth, 1948). Both overloads and underloads are
important to consider for improving performance." [26] Each county/ state in which
a nurse is licenced has laws concerning how many patients one nurse can tend to(depending
on the accuity of the patients needs).
Nursing worldwide
Throughout the world nurses are known to be caring individuals that people look
for as someone to advocate for the sick and provide empathy towards the needy.
United Kingdom
Main article: Nursing in the United Kingdom 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 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.
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) , RNMH (registered nurse (for
the) mentally handicapped).
The titles used now are similar and with slight differences i.e. RNA (registered
nurse adult), RNC (registered nurse child), RNMH (registered nurse mental health),
RNLD (registered nurse learning disabilities).
Main article: State Enrolled Nurse 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. They are entitled to refer to themselves as Registered Nurses as their registration
is on the Nursing & Midwifery Council register of nurses.
They split into several major groups:
• Nurse practitioners - These nurses obtain a minimum of a Master of Science in
Nursing or a doctoral degree. They often perform roles similar to those of physicians
and physician assistants, they can prescribe medications as independent or supplementary
prescribers. Most NP's have referral and admission rights to hospital specialities.
They commonly work in primary care (e.g. GP surgeries), A&E departments, or pediatrics
although they are increasingly being seen in other areas of practice. In the UK,
the title "nurse practitioner" is legally protected.
• Specialist community public health nurses - traditionally district nurses and
health visitors, this group of research and publication activities.
• Lecturer-practitioners - these nurses work both in the NHS, and in universities.
They typically work for 2–3 days per week in each setting. In university, they train
pre-registration student nurses (see below), and often teach on specialist courses
for post-registration nurses
• Lecturers - these nurses are not employed by the NHS. Instead they work full time
in universities, both teaching and performing research.
Managers
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 program recognized by the Nursing and Midwifery Council. Currently, this involves
completing a degree or diploma, available from a range of universities offering
these courses, in the chosen branch specialty (see below), leading to both an academic
award and professional registration as a 1st level registered nurse. Such a course
is a 50/50 split of learning in university (i.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 program (CFP), and teaches the basic knowledge and skills
required of all nurses. The remainder of the program consists of training specific
to the student's chosen branch of nursing. These are:
• Adult nursing.
• Child nursing.
• Mental health nursing.
• Learning disabilities nursing.
As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying
in England to hold a degree qualification.
Midwifery training is similar in length and structure, but is sufficiently different
that it is not considered a branch of nursing. 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 program.
Student nurses currently receive a bursary from the government to support them during
their nurse training. 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. In Scotland, however,
all student nurses regardless of which course they are undertaking, receive the
same bursary in line with the English diploma amount. 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.
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.
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. 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).
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. Many of these (and other) nurses will
also undertake training in independent and supplementary prescribing, which allows
them (as of May 1, 2006) to prescribe almost any drug in the British National Formulary.
This has been the cause of a great deal of debate in both medical and nursing circles.
Canada
Main article: Nursing in Canada
History
Canadian nursing dates all the way back to 1639 in Quebec with the Augustine nuns.
These nuns were trying to open up a mission that cared for the spiritual and physical
needs of patients. The establishment of this mission created the first nursing apprenticeship
training in North America.[33] In the nineteenth century there were some Catholic
orders of nursing that were trying to spread their message across Canada. Most nurses
were female and only had an occasional consultation with a physician. Towards the
end of the nineteenth century hospital care and medical services had been improved
and expanded. Much of this was due to Florence Nightingale who was training women
in English Canada. In 1874 the first formal nursing training program was started
at the General and Marine Hospital in St. Catharines in Ontario. Many programs popped
up in hospitals across Canada after this one was established. Graduates and teachers
from these programs began to fight for licensing legislation, nursing journals,
university training for nurses, and for professional organizations for nurses.
The first instance of Canadian nurses and the military was in 1885 with the Northwest
Rebellion. Some nurses came out to aid the wounded. In 1901 Canadian nurses were
officially part of the Royal Canadian Army Medical Corps.[33] Georgina Fane Pope
and Margaret Clothilde Macdonald were the first nurses officially recognized as
military nurses.[33] Nursing continued to expand and develop. In the early twentieth
century more nursing programs were developed for public health nursing and disease
prevention. More changes occurred after World War II. The health care system expanded
and medicare was introduced. Currently there are 260,000 nurses in Canada but they
face the same difficulties as most countries. Nurses are becoming more scarce and
the population is aging which requires more nursing care.
Education
All Canadian nurses and prospective nurses are heavily encouraged by the Canadian
Nurses Association to continue their education to receive a Baccalaureate degree.
They believe that this is the best degree to work towards because it results in
better patient outcomes. In addition to helping patients, nurses that have a Baccalaureate
degree will be less likely to make small errors because they have a higher level
of education. A Baccalaureate degree also gives a nurse a more critical opinion
which gives he or she more of an edge in the field. This ultimately saves the hospital
money because they deal with less problematic incidents. All Canadian provinces
except for the Yukon and Quebec require that all nurses must have a Baccalaureate
degree. The basic length of time that it takes to obtain a Baccalaureate degree
is four years. However, Canada does have a condensed program that is two years long.
There are nineteen specialties that a nurse could choose from if he or she wanted
to narrow down his or her field. According to the Canadian Nurses Association some
of those specialties are Cardiovascular Nursing, Community Health Nursing, Critical
Care Nursing, Emergency Nursing, Gerontology Nursing, Medical-Surgical Nursing,
Neuroscience Nursing, Oncology Nursing, Orthopedic Nursing, Psychiatric/Mental Health
Nursing, and Rehabilitation Nursing.[33] Each specialty requires its own test and
competencies. Many tests are offered online through the Canadian Nurses Association.
Public Opinion
Canadian nurses hold a lot of responsibility in the medical field and are considered
vital. According to the Canadian Nurses Association, "They expect RNs to develop
and implement multi-faceted plans for managing chronic disease, treating complex
health conditions and assisting them in the transition from the hospital to the
community. Canadians also look to RNs for health education and for strategies to
improve their health. RNs assess the appropriateness of new research and technology
for patients and adjust care plans accordingly". It is rather uncommon to see nurses
with this much independence. In most countries nurses appear to be considered lesser
than a physician like in the United States or Japan.
Japan
Main article: Nursing in Japan
History
Nursing was not an established part of Japan's healthcare system until 1899 with
the Midwives Ordinance.[33] From there the Registered Nurse Ordinance came into
play in 1915. This established a legal substantiation to registered nurses all over
Japan. A new law geared towards nurses was created during World War II. This law
was titled the Public Health Nurse, Midwife and Nurse Law and it was established
in 1948.[33] It established educational requirements, standards and licensure. There
has been a continued effort to improve nursing in Japan. In 1992 the Nursing Human
Resource Law was passed.[33] This law created the development of new university
programs for nurses. Those programs were designed to raise the education level of
the nurses so that they could be better suited for taking care of the public.
Types of Nurses
Japan only recognizes four types of nursing and they are Public Health Nursing,
Midwifery, Registered Nursing and Assistant Nursing.
Public Health Nursing
This type of nursing is designed to help the public and is also driven by the public's
needs. The goals of public health nurses are to monitor the spread of disease, keep
vigilant watch for environmental hazards, educate the community on how to care for
and treat themselves, and train for community disasters.
Midwifery
Nurses that are involved with midwifery are independent of any organization. A midwife
takes care of a pregnant woman during labor and postpartum. They assist with things
like breastfeeding and caring for the child.
Assistant Nursing
Individuals who are assistant nurses follow orders from a registered nurse. They
report back to the licensed nurse about a patient's condition. Assistant nurses
are always supervised by a licensed registered nurse.
Nursing Education
In 1952 Japan established the first nursing university in the country.An Associate
Degree was the only level of certification for years. Soon people began to want
nursing degrees at a higher level of education. Soon the Bachelors Degree in Nursing
(BSN) was established. Currently Japan offers doctorate level degrees of nursing
in a good number of its universities. There are three ways that an individual could
become a registered nurse in Japan. After obtaining a high school degree the person
could go to a nursing university for four years and earn a Bachelor degree, go to
a junior nursing college for three years or go to a nursing school for three years.[33]
Regardless of where the individual attends school they must take the national exam.
Those who attended a nursing university have a bit of an advantage over those who
went to a nursing school. They can take the national exam to be a registered nurse,
public health nurse or midwife. In the cases of become a midwife or a public health
nurse, the student must take a one year course in their desired field after attending
a nursing university and passing the national exam to become a registered nurse.
The nursing universities are the best route for someone who wants to become a nurse
in Japan.[33] They offer a wider range of general education classes and they also
allow for a more rigid teaching style of nursing. These nursing universities train
their students to be able to make critical and educated decisions when they are
out in the field. Physicians are the ones who are teaching the potential nurses
because there are not enough available nurses to teach students. This increases
the dominance that physicians have over nurses.
Students that attend a nursing college or just a nursing school receive the same
degree that one would who graduated from a nursing university, but they do not have
the same educational background. The classes offered at nursing colleges and nursing
schools are focused on more practical aspects of nursing. These institutions do
not offer many general education classes, so students who attend these schools will
solely be focusing on their nursing educations while they are in school. Students
who attend a nursing college or school do have the opportunity to become a midwife
or a public health nurse. They have to go through a training institute for their
desired field after graduating from the nursing school or college.[33] Japanese
nurses never have to renew their licenses. Once they have passed their exam, they
have their license for life.
Nursing in Japan Today
Like the United States, Japan is in need of more nurses. The driving force behind
this need this is the fact that country is aging and needs more medical care for
its people. The country needs a rapid increase of nurses however things do not seem
to be turning around. Some of the reasons that there is a shortage are poor working
conditions, an increase in the number of hospital beds, the low social status of
nurses, and the cultural idea that married women quit their jobs for family responsibilities.[33]
On average, Japanese nurses will make around 280,000 yen a year, which is one of
the higher paying jobs. however, physicians make twice the amount that nurses do
in a year.[33] Similar to other cultures, the Japanese people view nurses as subservient
to physicians. They are considered lesser and oftentimes negative connotations are
associated with nurses. According to the American Nurses Association article on
Japan, "nursing work has been described using negative terminology such as "hard,
dirty, dangerous, low salary, few holidays, minimal chance of marriage and family,
and poor image".
Some nurses in Japan are trying to be advocates. They are promoting better nursing
education as well as promoting the care of the elderly. There are some organizations
that unite Japanese nurses like the Japanese Nursing Association (JNA). The JNA
is not to be confused with a union, it is simply a professional organization for
the nurses. Members of the JNA lobby politicians and produces publications about
nursing. According to the American Nurses Association's article on Japan the JNA,
"works toward the improvement in nursing practice through many activities including
the development of a policy research group to influence policy development, a code
of ethics for nurses, and standards of nursing practice". The JNA also provides
certification for specialists in mental health, oncology and community health. JNA
is the not the only nursing organization in Japan. There are other subgroups that
are typically categorized by the nurses' specialty, like emergency nursing or disaster
nursing. One of the older unions that relates to nursing is the Japanese Federation
of Medical Workers Union which was created in 1957.[33] It is a union that includes
physicians as well as nurses. This organization was involved with the Nursing Human
Resource Law
United States
Main article: Nursing in the 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. 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).
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 role in which they
delegate tasks to LPNs and unlicensed assistive personnel.
RNs are not limited to employment as bedside nurses. Registered nurses are employed
by physicians, attorneys, insurance companies, governmental agencies, community/public
health agencies, private industry, school districts, ambulatory surgery centers,
among others. Some registered nurses are independent consultants who work for themselves,
while others work for large manufacturers or chemical companies. 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 over $60,000.
Educational and licensure requirements
Diploma in Nursing
Main article: Diploma in Nursing
The oldest method of nursing education is the hospital-based 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. Until 1996, most
RNs in the US were initially educated in nursing by diploma programs. According
to the Health Services Resources Administration's 2000 Survey of Nurses only six
percent of nurses who graduated from nursing programs in the United States received
their education at a Diploma School of Nursing.
Associate Degree in Nursing
Main article: Associate of Science in Nursing
The most common initial nursing education is a two-year Associate Degree in Nursing
(Associate of Applied Science in Nursing, Associate of Science in Nursing, Associate
Degree in Nursing), a two-year college degree referred to as an ADN. Some four-year
colleges and universities also offer the ADN. Associate degree nursing programs
have many prerequisite and co-requisite courses which ultimately stretch out the
degree-acquiring process to about 3 years or greater.
Bachelor of Science in Nursing
Main article: Bachelor of Science in Nursing
The third method is to obtain a Bachelor of Science in Nursing (BSN), a four-year
degree that also prepares nurses for graduate-level education. For the first two
years in a BSN program, students usually obtain general education requirements and
spend the remaining time in nursing courses. The Bachelor of Science in Nursing
degrees have many courses which stretches out the degree-acquiring process to over
4 years if the student does not go to summer school. Advocates for the ADN and diploma
programs state that such programs have a on the job training approach to educating
students, while the BSN is an academic degree that emphasizes research and nursing
theory. However the BSN graduate has both more classroom and clinical hours of study
in nursing than the ADN graduate. The BSN graduate is professionally degreed; and
as such is called a professional nurse. However, some states require a specific
amount of clinical experience that is the same for both BSN and ADN students. Nursing
schools may or may not be accredited by either the National League for Nursing Accrediting
Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE).
Graduate nursing opportunities
Further information: Master of Science in Nursing
Further information: Doctor of Nursing Practice
Advanced education in nursing is done at the master's and doctoral levels. It prepares
the graduate for specialization as an advanced practice registered nurse (APRN)
or for advanced roles in leadership, management, or education. Areas of advanced
nursing practice include that of a nurse practitioner (NP), a certified nurse midwife
(CNM), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist
(CNS). Nurse practitioners work assessing, diagnosing and treating patients in fields
as diverse as family practice, women's health care, emergency nursing, acute/critical
care, psychiatry, geriatrics, or pediatrics, while a CNS usually works for a facility
to improve patient care, do research, or as a staff educator. The clinical nurse
leader (CNL) is an advanced generalist who focuses on the improvement of quality
and safety outcomes for patients or patient populations from an administrative and
staff management focus. 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 and Doctor of Nursing
Practice (DNP).
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.
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 on-the-job experiences 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, hospital lobbyist,
and the lack of faculty to teach BSN students.
Earnings
Median annual wages of registered nurses were $62,450 in May 2008. The middle 50
percent earned between $51,640 and $76,570. The lowest 10 percent earned less than
$43,410, and the highest 10 percent earned more than $92,240. Median annual wages
in the industries employing the largest numbers of registered nurses in May 2008
were: Employment services $68,160; General medical and surgical hospitals $63,880;
Offices of physicians $59,210; Home health care services $58,740; Nursing care facilities
$57,060.
Many employers offer flexible work schedules, child care, educational benefits,
and bonuses. About 21 percent of registered nurses are union members or covered
by union contract.
Top 10 Highest Paying Nursing Specialties 1) Certified Registered Nurse Anesthetist
– $135,000 2) Nurse Researcher – $95,000 3) Psychiatric Nurse Practitioner – $95,000
4) Certified Nurse Midwife – $84,000 5) Pediatric Endocrinology Nurse – $81,000
6) Orthopedic Nurse – $81,000 7) Nurse Practitioner – $78,000 8) Clinical Nurse
Specialist – $76,000 9) Gerontological Nurse Practitioner – $75,000 10) Neonatal
Nurse – $74,000 [37] 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 demand for registered nurses; this is often referred
to as the nursing shortage and is expected to increase for the foreseeable future.
There are data to support the idea that the nursing shortage is a voluntary shortage.
In other words, nurses are leaving nursing of their own volition. In 2006 it was
estimated that approximately 1.8 million nurses chose not to work as a nurse.
Causes of the nursing shortage in the United States
There has been a serious shortage of nurses for many years. A national survey prepared
by the Federation of Nurses and Health Professionals in 2001 found that one in five
nurses plans to leave the profession within five years because of unsatisfactory
working conditions, including low pay, severe under staffing, high stress, physical
demands, mandatory overtime, and irregular hours. The shortage will also be exacerbated
by the increasing numbers of baby-boomer aged nurses who are expected to retire,
creating more open positions than there are graduates of nursing programs. The faster
than average job growth in this field is also a result of improving medical technology
that will allow for treatments of many more diseases and health conditions. Nurses
will be strong in demand to work with the rapidly growing population of senior citizens
in the United States. Approximately 60 percent of all nursing jobs are found in
hospitals. However, because of administrative cost cutting, increased nurse's workload,
and rapid growth of outpatient services, hospital nursing jobs will experience slower
than average growth. Employment in home care and nursing homes is expected to grow
rapidly. Though more people are living well into their 80s and 90s, many need the
kind of long-term care available at a nursing home. Also, because of financial reasons,
patients are being released from hospitals sooner and admitted into nursing homes.
Many nursing homes have facilities and staff capable of caring for long-term rehabilitation
patients, as well as those afflicted with Alzheimer's. Many nurses will also be
needed to help staff the growing number of out-patient facilities, such as HMOs,
group medical practices, and ambulatory surgery centers. Nursing specialties will
be in great demand. There are, in addition, many part-time employment possibilities.
Continuing Education
With health care knowledge growing steadily, nurses can stay ahead of the curve
through continuing education. Continuing education classes and programs enable nurses
to provide the best possible care to patients, advance nursing careers, and keep
up with Board of Nursing requirements. The American Nurses Association and the American
Nursing Credentialing Center are devoted to ensuring nurses have access to quality
continuing education offerings.
Nursing board certification
Main article: Nursing credentials and certifications
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.
Nursing specialties
Main article: List of nursing specialties Nursing is the most diverse of all healthcare
professions. Nurses practice in a wide range of settings but generally nursing is
divided depending on the needs of the person being nursed.
The major populations are:-
• communities/public
• family/individual across the lifespan
• adult-gerontology
• pediatrics
• neonatal
• women’s health/gender-related
• psych/mental health
There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative
care, perioperative nursing, obstetrical nursing, and oncology nursing.
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