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{{Short description|Health care profession}}
{{Other uses|Nursing (disambiguation)}}
 
{{pp|small=yes}}
<references group="The U.S. Nursing Workforce in 2018 and Beyond Journal of Nursing Regulation , Volume 8, Issue 4, S3 - S6" />
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'''Nursing''' is a [[health care]] profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence".<ref>{{Cite book |last=Association |first=American Nurses |url=https://books.google.com/books?id=nBH1zQEACAAJ&dq=Nursing:+Scope+and+Standards+of+Practice,+Fourth+Edition&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwi75r_26e2FAxUmLEQIHWdaADEQ6AF6BAgGEAE |title=Nursing: Scope and Standards of Practice |date=2021-05-30 |publisher=American Nurses Association |isbn=978-0-9993088-6-8 |language=en}}</ref> Nurses practice in many [[List of nursing specialties|specialties]] with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments.<ref>{{Cite journal |doi=10.1097/01.NEP.0000000000000659|title=Who Wants to be a Nurse? Understanding Emirati Female Students' Knowledge and Attitudes About Nursing as a Career |year=2020 |last1=Maymoun |first1=Nazneen |last2=Sohail |first2=M. Sadiq |journal=Nursing Education Perspectives |volume=41 |issue=3 |pages=E14–E19 |pmid=32310910 |s2cid=216046198 }}</ref><ref>{{Cite journal |doi=10.1186/s12960-017-0223-2 |doi-access=free|title=The Human Resources for Health Effort Index: A tool to assess and inform Strategic Health Workforce Investments |year=2017 |last1=Fort |first1=Alfredo L. |last2=Deussom |first2=Rachel |last3=Burlew |first3=Randi |last4=Gilroy |first4=Kate |last5=Nelson |first5=David |journal=Human Resources for Health |volume=15 |issue=1 |page=47 |pmid=28724381 |pmc=5518138 }}</ref> Shortages of qualified nurses are found in many countries.<ref>{{Cite journal |doi=10.1515/emj-2017-0019 |doi-access=free|title=Nurses in Poland — Immediate Action Needed |year=2017 |last1=Haczyński |first1=Józef |last2=Skrzypczak |first2=Zofia |last3=Winter |first3=Małgorzata |journal=Engineering Management in Production and Services |volume=9 |issue=2 |pages=97–104 }}</ref>
 
Nurses develop a plan of care, working collaboratively with [[physicians]], [[Therapist|therapiststherapist]]s, the patientpatients, the patientpatients's familyfamilies, and other team members that focuses on treating illness to improve quality of life.
 
In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe the correct medications and other therapies, depending on regulations that vary by state.<ref>{{Cite web|title=Nursing {{!}} The SAGE Encyclopedia of Economics and Society - Credo Reference|url=https://search.credoreference.com/content/entry/sageeas/nursing/0|access-date=2022-02-18|website=search.credoreference.com|language=en}}</ref> Nurses may help coordinate care performed by other providers or act independently as nursing professionals. In addition to providing care and support, nurses educate the public and promote health and wellness.<ref>{{Cite web |last=Freeman |first=Veronica |title=The role of nurses in our society today |url=https://www.cerner.com/ae/en/blog/the-role-of-nurses-in-our-society-today |access-date=2023-03-31 |website=www.cerner.com |language=en}}</ref>
 
In the U.S., nurse practitioners are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications. They practice independently in a variety of settings in more than half of the United States. In the [[Post-war|postwar]] period, nurse education has diversified, awarding [[Nursing credentials and certifications|advanced and specialized credentials]], and many traditional regulations and roles are changing.<ref>Coulehan J. L., Block M. R. (2005): The Medical Interview: Mastering skills for clinical practice, 5th Ed. F. A. Davis. {{ISBN|0-8036-1246-X}}. {{OCLC|232304023}}.</ref><ref>Dunphy L. M., Winland-Brown J. E. (2011): Primary care: The art and science of advanced practice nursing. F.A. Davis. {{ISBN|9780803626478}}.</ref>{{TOC limit|3}}
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===Premodern===
Nursing historians face challenges of determining whether care provided to the sick or injured in antiquity is called nursing care.<ref name="OLYNN2007">{{cite book|last1=O'Lynn|first1=CE|editor1-last=O'Lynn|editor1-first=CE|editor2-last=Tranbarger|editor2-first=RE|title=Men in Nursing: History, Challenges, and Opportunities|date=2007|publisher=Springer Pub.|location=New York|isbn=9780826103499|pages=6–8|chapter=History of men in nursing: a review}}</ref> In the fifth century BC, for example, the [[Hippocratic Collection]] in places described skilled care and observation of patients by male "attendants," who may have provided care now provided by nurses.<ref name="LEVINE1965">{{cite journal|last1=Levine|first1=EB|last2=Levine|first2=ME|title=Hippocrates, father of nursing, too?|journal=The American Journal of Nursing|year=1965|volume=65|issue=12|pages=86–8|pmid=5319739|doi=10.1097/00000446-196512000-00022|s2cid=38921319}}</ref> Around 600&nbsp;BC in India, it is recorded in ''[[Sushruta Samhita|]]''Sushruta Samhita'']], Book 3, Chapter V about the role of the nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, anyone desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examining its different parts."
 
In the [[Middle Ages]], members of [[religious orders]] such as [[nuns]] and [[monks]] often provided nursing-like care.<ref name="BLOY">{{cite web|last=Bloy|first=M|url=http://www.victorianweb.org/history/crimea/florrie.html|title=Florence Nightingale (1820–1910)|website=The Victorian Web|access-date=24 November 2014}}</ref> Examples exist in [[Christianity|Christian]],<ref name="FERNGREN2009">{{cite book|last1=Ferngren|first1=GB|title=Medicine & health care in early Christianity|date=2009|publisher=Johns Hopkins University Press|location=Baltimore|isbn=9780801895227|page=121}}</ref> [[Islamic]],<ref name="SACHEDINA2009">{{cite book|last1=Sachedina|first1=Abdulaziz|title=Islamic biomedical ethics: principles and application|url=https://archive.org/details/islamicbiomedica00sach_109|url-access=limited|date=2009|publisher=Oxford University Press|location=Oxford|isbn=9780195378504|pages=[https://archive.org/details/islamicbiomedica00sach_109/page/n103 93]–94}}</ref> [[Buddhist]],<ref name="DEBARY2011">{{cite book|editor1-last=de Bary|editor1-first=WT|title=The Buddhist tradition in India, China & Japan|date=2011|publisher=Vintage eBooks|location=New York|isbn=9780307778796|pages=35–36|edition=Unabridged.}}</ref> and other traditions. [[Phoebe (biblical figure)|Phoebe]], mentioned in {{Bibleverse|Romans|16}}, is described in many sources as "the first visiting nurse".<ref name="EGENES2009">{{cite book|last1=Egenes|first1=KJ|editor1-last=Halstead|editor1-first=J|editor2-last=Roux|editor2-first=G|title=Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow|date=2009|publisher=Jones and Bartlett|location=Sudbury, MA|isbn=9780763752255|page=[https://archive.org/details/issuestrendsinnu0000unse/page/2 2]|chapter=History of nursing|chapter-url=https://archive.org/details/issuestrendsinnu0000unse/page/2}}</ref><ref name="STRIEPE1992">{{cite journal|last1=Striepe|first1=JM|title=Reclaiming the church's healing role|journal=Journal of Christian Nursing|year=1992|volume=10|issue=1|pages=4–7|doi=10.1097/00005217-199310010-00002|pmid=8418284}}</ref> These traditions were influential in the development of the [[ethos]] of modern nursing. Its religious roots remain in evidence in many countries. One example in the [[United Kingdom]] is the use of the historical title "sister" to refer to a senior nurse.<ref name="WAND2004">{{cite journal|last1=Wand|first1=T|title=The 'Sister' title: past the use by date?|journal=Collegian|date=January 2004|volume=11|issue=1|pages=35–39|doi=10.1016/S1322-7696(08)60442-4}}</ref>
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[[Florence Nightingale]] laid the foundations of professional nursing after the [[Crimean War]],<ref name="WINKEL2009">{{cite journal|last1=Winkel|first1=W|title=Florence Nightingale|journal=Epidemiology|year=2009|volume=20|issue=2|pages=311|doi=10.1097/EDE.0b013e3181935ad6 |doi-access=free|pmid=19234417}}</ref> in light of a comprehensive statistical study she made of [[sanitation]] in India, leading her to emphasize the importance of sanitation. "After 10&nbsp;years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per&nbsp;1,000".<ref name="Cohen1984">{{cite journal |last=Cohen |first=I. Bernard |author-link=I. Bernard Cohen |date=March 1984 |title=Florence Nightingale |journal=Scientific American |volume=250 |issue=3 |pages=128–137 |bibcode=1984SciAm.250c.128C |doi=10.1038/scientificamerican0384-128 |pmid=6367033 |s2cid=5409191}} (alternative pagination depending on country of sale: 98–107, bibliography on p. 114) [http://www.unc.edu/~nielsen/soci708/ online article – see documents link at left] {{Webarchive|url=https://web.archive.org/web/20100705052627/http://www.unc.edu/~nielsen/soci708/|date=5 July 2010}}</ref>{{rp|page=107}}
 
Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman could help improve the care of the ill.<ref>{{Cite web |title=nursing {{!}} History, Education, & Practices {{!}} Britannica |url=https://www.britannica.com/science/nursing |access-date=2022-03-31 |website=www.britannica.com |language=en}}</ref> Her ''[[Notes on Nursing]]'' (1859) was a popular call to action. The Nightingale model of nursing education led to one of the [[Florence Nightingale Faculty of Nursing and Midwifery|first schools of nursing]] to be connected to a hospital and medical school. It spread widely in Europe and North America after 1870.<ref name="Quinn">{{cite book|last=Quinn|first=Shawna M.|title=Agnes Warner and the Nursing Sisters of the Great War|url=http://www.gooselane.com/media/741.pdf|publisher=Goose Lane editions and the New Brunswick Military Heritage Project |date=2010|isbn=978-0-86492-633-3|access-date=29 November 2014|archive-url=https://web.archive.org/web/20150924023052/http://www.gooselane.com/media/741.pdf|archive-date=24 September 2015}}</ref>
 
Nightingale included five factors that helped nurses in her time who worked amidst poor sanitation and little education. These factors included (1) fresh air, (2) clean water, (3) a working drainage system, (4) cleanliness, and (5) good light. Nightingale believed that a clean working environment was important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around the patientpatients for the betterment of their health.<ref>{{Cite web |first=Angelo |last=Gonzalo |date=August 4, 2014 |title=Florence Nightingale: Environmental Theory |url=https://nurseslabs.com/florence-nightingales-environmental-theory/ |access-date=2022-09-02 |website=Nurseslabs |language=en-US}}</ref>
 
Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as [[Mary Seacole]], who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in the 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the [[Colony of Jamaica]] in the 18th century, and they included Seacole's mother (Mrs. Grant), Sarah Adams, [[Cubah Cornwallis]], and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, [[Simon Taylor (sugar planter)|Simon Taylor]].<ref>{{Cite book |last=Ferguson |first=Moira |url=https://www.taylorfrancis.com/books/mono/10.4324/9780203760697/nine-black-women-moira-ferguson |title=Nine Black Women: An Anthology of Nineteenth-Century Writers from the United States, Canada, Bermuda and the Caribbean |date=2016-01-04 |publisher=Routledge |isbn=978-0-203-76069-7 |location=New York |doi=10.4324/9780203760697}}</ref>
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==Definition==
 
According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, complicating the task of distinguishing the professions.{{sfn|Mulhall|1998|p=4–5}} Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:
 
{{Blockquote | 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]]<ref name="ICN"/>}}
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Nurses provide care based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology.
 
Nurses typically hold one or more formal credentials. Roles and responsibilities follow the level of education. For example, in the United States, [[Licensed Practical Nurse]]<nowiki/>s (LPN) have less education than [[Registered Nurse|Registered Nurses]]s (RN) and accordingly, a narrower scope of practice.
 
=== United StatesDiversity ===
{{Main article|Men in nursing}}
[[File:Male Nurses- Life at Runwell Hospital, Wickford, Essex, 1943 D14313.jpg|thumb|right|upright=0.9|A male nurse at Runwell Hospital, Wickford, Essex, in 1943]]
 
Nursing is a female-dominated profession in many countries; according to the [[World Health Organization|WHO's]] 2020 ''State of the World's Nursing,'' approximately 90% of the nursing workforce is female.<ref>{{cite web|url=https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf|publisher=World Health Organization|title=State of the World's Nursing 2020|access-date=16 March 2021}}</ref> For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States.<ref>{{cite journal|author=Patrick Sullivan |url=http://www.cmaj.ca/cgi/content/full/164/12/1738-b?ck=nck |title=Canada Medical Association Journal 12 June 2001; 164 (12) |journal = CMAJ|publisher=Cmaj.ca |date=12 June 2001 |volume = 164|issue = 12|pages = 1738–1738–b|access-date=4 September 2013}}</ref><ref>[http://bhpr.hrsa.gov/healthworkforce/reports/nursing/samplesurvey00/chapter3.htm 2000 National Sample Survey of Registered Nurses] {{webarchive |url=https://web.archive.org/web/20110422161539/http://bhpr.hrsa.gov/healthworkforce/reports/nursing/samplesurvey00/chapter3.htm |date=22 April 2011 }}</ref> This ratio is matched in many other countries. Notable exceptions include [[Francophone Africa]], which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, [[Côte d'Ivoire]], the [[Democratic Republic of Congo]], [[Djibouti]], [[Guinea]], [[Gabon]], [[Mali]], [[Mauritania]], [[Niger]], [[Rwanda]], [[Senegal]], and [[Togo]], which all have more male than female nurses.<ref name="MIN">{{cite book|first1=Chad E. |last1=O'Lynn |first2=Russell E. |last2=Tranbarger |title=Men in Nursing: History, Challenges, and Opportunities|url=https://books.google.com/books?id=-Ag7TqTyIC0C&pg=PA225|year=2006|publisher=Springer Publishing Company|isbn=978-0-8261-0349-9|page=225}}</ref> In Europe, in countries such as [[Spain]], [[Portugal]], [[Czech Republic]] and [[Italy]], over 20% of nurses are male.<ref name="MIN"/> In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male.<ref>{{cite web|url=https://www.nmc.org.uk/globalassets/sitedocuments/annual_reports_and_accounts/equality-and-diversity-report-2015-16.pdf |title=Annual Equality and Diversity Profile, NMC 2015–2016}}</ref> The number of male nurses in the United States doubled between 1980 and 2000.<ref>{{cite news|last1=Weintraub|first1=Arlene|title=Nursing: On the Critical List|work=Business Week|date=3 June 2002}}</ref> On average, male nurses in the US receive more pay than female nurses.<ref>{{Cite web|url = https://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf|title = Men in Nursing Occupations|date = February 2013|access-date = 6 October 2015|website = Census.gov|publisher = American Community Survey|archive-url = https://web.archive.org/web/20170713210226/https://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf|archive-date = 13 July 2017}}</ref>
==== Registered Nurse ====
In the United States, multiple educational paths qualify a candidate to sit for the licensure examination as an RN. An [[Associate of Science in Nursing|Associate Degree in Nursing]] (ADN) is awarded to those who earn a two-year undergraduate degree. This degree is also referred to as an Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN).<ref>{{Cite web|title = Associate Degree in Nursing (ADN/ASN)|url = http://www.collegeatlas.org/associate-degree-in-nursing.html|website = collegeatlas.org|access-date = 29 October 2015}}</ref> A [[#Bachelor of Science in Nursing|Bachelor of Science in Nursing]] (BSN) is awarded to those who have earned an American four-year academic nursing degree. LPNs and those who complete either an RN education program in the United States are eligible to sit for the [[National Council Licensure Examination|National Licensure Examination]] (NCLEX) test, a standardized exam that they must pass to become licensed.<ref>{{Cite web|title = NCLEX Exam {{!}} National Council Licensure Examination|url = http://www.allnursingschools.com/nursing-careers/article/nclex-exam/|website = allnursingschools.com|access-date = 29 October 2015}}</ref>
 
== Theory and process ==
Some nurses follow the traditional role of working in a hospital setting. Options there include: pediatrics, neonatal, maternity, OBGYN, geriatrics, orthopedics, medical-surgical, operating room, ambulatory, and nurse anesthetists and informatics ([[eHealth]]). Other options include community health, mental health, clinical nursing specialists, and nurse midwives.<ref>{{Cite web |title=nursing - Advanced nursing practice {{!}} Britannica |url=https://www.britannica.com/science/nursing/Advanced-nursing-practice |access-date=2022-03-10 |website=www.britannica.com |language=en}}</ref> RNs may also pursue roles as [[advanced practice nurse]]s.
 
{{Main article|Nursing theory|Nursing process}}
Nurses are not doctors' assistants. They may act in that capacity, such as in the [[emergency department]] or in trauma care, but more often independently care for their patients or assist other nurses.<ref>{{Cite web|title = 5 Myths about Registered Nurses – Ameritech College of Healthcare|url = http://ameritech.edu/blog/5-myths-registered-nurses-busted/|website = Ameritech College of Healthcare|date = 6 November 2014|access-date = 15 October 2015|archive-date = 30 November 2015|archive-url = https://web.archive.org/web/20151130014128/http://ameritech.edu/blog/5-myths-registered-nurses-busted/|url-status = dead}}</ref> RNs treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests.<ref>{{Cite web|title = Registered Nurse (RN) Career and Job Information|url = http://www.careerprofiles.info/nurse-career.html|website = careerprofiles.info|access-date = 15 October 2015}}</ref>
Nursing practice is the actual provision of nursing care. In providing care, nurses implement a [[nursing care plan]] defined using the [[nursing process]]. This is based around a specific [[nursing theory]] that is selected based on the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from [[nursing research]].<ref name=Weber2014>{{cite book | last = Weber | first = Janet | title = Nurses' handbook of health assessment | publisher = Wolters Kluwer/Lippincott Williams & Wilkins Health | location = Philadelphia | year = 2014 | isbn = 9781451142822 }}</ref> Many nursing theories are in use.<ref name=":3" /> Like other disciplines, the profession has developed multiple theories derived reflecting varying philosophical beliefs and [[paradigm]]s or [[worldview]]s.
 
In general terms, the nursing process is the method used to [[Nursing assessment|assess]] and [[Nursing diagnosis|diagnose]] needs, plan outcomes and interventions, implement interventions, and evaluate outcomes. The nursing process as defined by the [[American Nurses Association]] is made up of five steps: 1) evaluate, 2) implement, 3) plan, 4) diagnose, and 5) assess.<ref name=":3">{{Cite web |title=Nursing {{!}} The SAGE Encyclopedia of Economics and Society - Credo Reference |url=https://search.credoreference.com/content/entry/sageeas/nursing/0 |access-date=2022-02-18 |website=search.credoreference.com |language=en}}</ref>
==== Race/ethnicity ====
As of 2020, in the United States 19.4% of nursing positions are held by people of non-white backgrounds. The remaining 80.6% of positions are held by Caucasians.<ref>{{Cite web |title=AACN Fact Sheet - Enhancing Diversity in the Nursing Workforce |url=https://www.aacnnursing.org/news-information/fact-sheets/enhancing-diversity |access-date=2021-09-24 |website=www.aacnnursing.org}}</ref>
 
== Healthcare staffing platforms ==
===Gender ===
[[Digital health]] platforms connect nurses and nurse assistants with job openings in healthcare facilities such as skilled nursing homes, home health agencies, and hospitals. Platforms offer an app to facilitate communication and allow nurses to find work opportunities based on their preferences. Healthcare partners and facilities benefit from access to qualified nurses.<ref>{{Cite journal |last1=Han |first1=Xinxin |last2=Pittman |first2=Patricia |last3=Barnow |first3=Burt |date=2021-09-09 |title=Alternative Approaches to Ensuring Adequate Nurse Staffing |url=http://dx.doi.org/10.1097/mlr.0000000000001614 |journal=Medical Care |volume=59 |issue=Suppl 5 |pages=S463–S470 |doi=10.1097/mlr.0000000000001614 |issn=0025-7079 |pmc=8428863 |pmid=34524244}}</ref> In 2017, the UK's National Health Service began trialing such a platform.<ref>{{Cite magazine |title=The NHS is going to trial a gig economy app for nurses |url=https://www.wired.co.uk/article/nhs-app-nurses-flexible-working-jeremy-hunt-gig-economy |access-date=2024-01-24 |magazine=Wired UK |language=en-GB |issn=1357-0978}}</ref>
{{Main article|Men in nursing}}
[[File:Male Nurses- Life at Runwell Hospital, Wickford, Essex, 1943 D14313.jpg|thumb|right|upright=0.9|A male nurse at Runwell Hospital, Wickford, Essex, in 1943]]
 
Platforms such as [[United States]]-based ConnectRN, Nomad Health, Gale Healthcare solutions or Lantum add resources, career development tools, and networking opportunities.<ref>{{Cite journal |last1=Mayer |first1=Miguel Angel |last2=Rodríguez Blanco |first2=Octavi |last3=Torrejon |first3=Antonio |title=Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study (Preprint) |date=2019-06-26 |journal=JMIR mHealth and uHealth |doi=10.2196/preprints.15195 |doi-access=free}}</ref>
Despite attempts to correct the imbalance, nursing is a female-dominated profession in many countries; according to the [[World Health Organization|WHO's]] 2020 ''State of the World's Nursing,'' approximately 90% of the nursing workforce is female.<ref>{{cite web|url=https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf|publisher=World Health Organization|title=State of the World's Nursing 2020|access-date=16 March 2021}}</ref> For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States.<ref>{{cite journal|author=Patrick Sullivan |url=http://www.cmaj.ca/cgi/content/full/164/12/1738-b?ck=nck |title=Canada Medical Association Journal 12 June 2001; 164 (12) |journal = CMAJ|publisher=Cmaj.ca |date=12 June 2001 |volume = 164|issue = 12|pages = 1738–1738–b|access-date=4 September 2013}}</ref><ref>[http://bhpr.hrsa.gov/healthworkforce/reports/nursing/samplesurvey00/chapter3.htm 2000 National Sample Survey of Registered Nurses] {{webarchive |url=https://web.archive.org/web/20110422161539/http://bhpr.hrsa.gov/healthworkforce/reports/nursing/samplesurvey00/chapter3.htm |date=22 April 2011 }}</ref> This ratio is matched in many other countries. Notable exceptions include [[Francophone Africa]], which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, [[Côte d'Ivoire]], the [[Democratic Republic of Congo]], [[Djibouti]], [[Guinea]], [[Gabon]], [[Mali]], [[Mauritania]], [[Niger]], [[Rwanda]], [[Senegal]], and [[Togo]], which all have more male than female nurses.<ref name="MIN">{{cite book|first1=Chad E. |last1=O'Lynn |first2=Russell E. |last2=Tranbarger |title=Men in Nursing: History, Challenges, and Opportunities|url=https://books.google.com/books?id=-Ag7TqTyIC0C&pg=PA225|year=2006|publisher=Springer Publishing Company|isbn=978-0-8261-0349-9|page=225}}</ref> In Europe, in countries such as [[Spain]], [[Portugal]], [[Czech Republic]] and [[Italy]], over 20% of nurses are male.<ref name="MIN"/> In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male.<ref>{{cite web|url=https://www.nmc.org.uk/globalassets/sitedocuments/annual_reports_and_accounts/equality-and-diversity-report-2015-16.pdf |title=Annual Equality and Diversity Profile, NMC 2015–2016}}</ref> The number of male nurses in the United States doubled between 1980 and 2000.<ref>{{cite news|last1=Weintraub|first1=Arlene|title=Nursing: On the Critical List|work=Business Week|date=3 June 2002}}</ref> On average, male nurses in the US receive more pay than female nurses.<ref>{{Cite web|url = https://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf|title = Men in Nursing Occupations|date = February 2013|access-date = 6 October 2015|website = Census.gov|publisher = American Community Survey|archive-url = https://web.archive.org/web/20170713210226/https://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf|archive-date = 13 July 2017}}</ref>
 
== TheoryNursing andas processa science ==
{{Main article|Nursing research}}
 
Florence Nightingale's [[Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army|seminal epidemiological study]] examining mortality among British soldiers during the [[Crimean War]] was published in 1858.{{sfn|Boswell|Cannon|2014|p=30–31}} With the exception of her works, nursing practice remained an oral tradition until the mid-20th century. The inaugural issue of ''[[Nursing Research]]'', the first scientific journal specialized in nursing, came in in 1952. During the 1960s, interest in attaining PhDs increased among nurses in the US, but nursing remained a fledgling area of research, with few journals until the 1970s.{{sfn|Watson|2021|loc=From Oral Tradition to Written Scholarship}} Nursing research is increasingly presented as a valid discipline, although lacking a prevailing definition.{{sfn|Manhart Barrett|2017|p=129}} The question is further complicated by the numerous interpretations of nursing's defining essence.{{sfn|Manhart Barrett|2002|p=51}}{{sfn|Mulhall|1998|p=4}}
{{Main article|Nursing theory|Nursing process}}
Nursing practice is the actual provision of nursing care. In providing care, nurses implement a [[nursing care plan]] defined using the [[nursing process]]. This is based around a specific [[nursing theory]] that is selected based on the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from [[nursing research]].<ref name=Weber2014>{{cite book | last = Weber | first = Janet | title = Nurses' handbook of health assessment | publisher = Wolters Kluwer/Lippincott Williams & Wilkins Health | location = Philadelphia | year = 2014 | isbn = 9781451142822 }}</ref> Many nursing theories are in use.<ref name=":3" /> Like other disciplines, the profession has developed multiple theories derived reflecting varying philosophical beliefs and [[paradigm]]s or [[worldview]]s.
 
=== Evidence-based practice ===
In general terms, the nursing process is the method used to [[Nursing assessment|assess]] and [[Nursing diagnosis|diagnose]] needs, plan outcomes and interventions, implement interventions, and evaluate outcomes. The nursing process as defined by the [[American Nurses Association]] is made up of five steps: 1) evaluate, 2) implement, 3) plan, 4) diagnose, and 5) assess.<ref name=":3">{{Cite web |title=Nursing {{!}} The SAGE Encyclopedia of Economics and Society - Credo Reference |url=https://search.credoreference.com/content/entry/sageeas/nursing/0 |access-date=2022-02-18 |website=search.credoreference.com |language=en}}</ref>
{{Main article|Evidence-based nursing|Evidence-based medicine}}
 
During the 1980s there was an increased focus on [[research utilization]] (RU). Nursing research took an interest in clinical issues and US nursing schools began teaching research methods to facilitate interpretation and integration of scientific findings in routine practice. Several RU initiatives were active during the late 20th century, but the RU movement was superseded by evidence-based practice in the 1990s.{{sfn|Polit|Tatano Beck|2014|p=21}} Evidence-based practice (EBP) is about using research, but unlike RU it allows for the integration of research findings with clinical expertise and patient preferences.{{sfn|Polit|Tatano Beck|2014|p=20–21}} The EBP movement had originated in the field of [[medicine]] with [[Archie Cochrance]] publishing ''Effectiveness and Efficiency'' in 1972, leading up to the founding of the [[Cochrane Collaboration]] in 1993.{{sfn|Nieswiadomy|2012|p=278–279}} The emerging area of evidence-based medicine also applies to nursing.{{sfn|Boswell|Cannon|2014|pp=3–4}} Common barriers to the study and integration of research findings into clinical decision making include: a lack of opportunity, inexperience, and the rapid pace of evidence accumulation.{{sfn|Mulhall|1998|p=4}}{{sfn|Nieswiadomy|2012|p=268–270}}
 
==Scope of activities==
 
===Daily living assistance===
{{main article|Activities of daily living}}
Nurses manage and coordinate care to support activities of daily living (ADL). This includes assisting in patient mobility, such as moving an activity intolerant patient within a bed. They often delegate such care to [[nursing assistant]]s.
 
===Medication===
Line 154 ⟶ 158:
Effective patient/family education leads to better outcomes. Nurses explain procedure, recovery, and ongoing care, while helping everyone cope with the medical situation.<ref name=":4">{{Cite news |title=nursing {{!}} History, Education, & Practices {{!}} Britannica |url=https://www.britannica.com/science/nursing |access-date=2022-03-07 |newspaper=Encyclopedia Britannica |language=en}}</ref>
 
Many times, nurses are busy, leaving little time time to educate patients.<ref name=":6" />
 
The patientPatients's familyfamilies needs similar education.<ref name=":6">Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 468.</ref> Educating both the patient and their familyfamilies increases the chance for a better outcome.<ref>{{Cite journal |last1=Smith |first1=Jackie A. |last2=Zsohar |first2=Helen |date=October 2013 |title=Patient-education tips for new nurses |url=https://journals.lww.com/nursing/fulltext/2013/10000/patient_education_tips_for_new_nurses.24.aspx |journal=Nursing2022 |language=en-US |volume=43 |issue=10 |pages=1–3 |doi=10.1097/01.NURSE.0000434224.51627.8a |pmid=24045809 |issn=0360-4039|doi-access=free }}</ref>
 
Nurses have to communicate in a way that can be understood by the patientpatients. Education techniques encompass conversations, visuals, reading materials, and demonstrations.<ref name=":4" />
 
==Specialties ==
{{Main article|List of nursing specialties}}
 
Nursing is the most diverse of all [[:category:health care occupations|health care professions]]. Nurses practice in a wide range of settings, but generally follows the needs of the patient.
Nursing is the most diverse of all [[:category:health care occupations|health care professions]]. Nurses practice in a wide range of settings, but generally follows the needs of their patients.
 
The major specialties are:
Line 174 ⟶ 179:
*mental health
*[[Health informatics|informatics]] ([[eHealth]])
*acute care
*ambulatory settings (physician offices, urgent care settings, camps, etc.)
*school/college/institutional infirmaries
Line 187 ⟶ 192:
*[[emergency nursing|emergency care]]
 
Nurses with additional degrees allow for specialization. Nursing professions can be separated into categories by care type, age, gender, certain age group, practice setting, individually or in combination.<ref name=":5">{{Cite web |title=Nursing {{!}} The SAGE Encyclopedia of Economics and Society - Credo Reference |url=https://search.credoreference.com/content/entry/sageeas/nursing/0 |access-date=2022-03-31 |website=search.credoreference.com |language=en}}</ref>
 
== Settings ==
Nurses practice in a wide range of settings, including hospitals, private [[home care|homes]], [[school nursing|schools]], and [[pharmaceutical companies]]. Nurses work in [[Occupational health nursing|occupational health]] settings<ref>{{cite journal |author1=Draper Elaine |author2=LaDou Joseph |author3=Tennenhouse Dan J | year = 2011 | title = Occupational Health Nursing and the Quest for Professional Authority | journal = New Solutions | volume = 21 | issue = 1| pages = 57–88 | doi=10.2190/ns.21.1.i|pmid=21411426 |bibcode=2011NewSo..21...57D |s2cid=207317324 }}</ref> (also called industrial health settings), free-standing clinics, physician offices, [[nurse-led clinics]], [[long-term care]] facilities and camps. They work on [[cruise ships]], [[Armed Forces|military bases]], and in combat settings.
 
Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in [[health advocacy]] and [[patient advocacy]], helping in clinical and administrative domains.<ref>Schneider, John. "Healthcare advocacy experts aid workers." Miami Herald 31 August 2010</ref> Some are [[lawyer|attorneys]] and others work with attorneys as [[legal nurse consultant]]s, 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 work in informatics, acting as consultants to the creation of computerized charting programs and other software. Nurse authors publish articles and books to provide essential reference materials.
Line 203 ⟶ 208:
 
=== Patient handling ===
Healthcare has consistently ranked among the industries with the highest rates of musculoskeletal injuries, largely related to patient handling. Anywhere from 30- to 70% of reported musculoskeletal injuries are related to patient handling. Nurses are routinely tasked with lifting, repositioning, and mobilizing patients. According to the [[National Institute for Occupational Safety and Health|National Institute for Occupational Safety and Health (NIOSH)]] the single greatest factor in overexertion injuries is the manual lifting, moving and repositioning of patients.<ref>{{Cite web |date=2023-04-17 |title=Safe Patient Handling and Mobility (SPHM) {{!}} NIOSH {{!}} CDC |url=https://www.cdc.gov/niosh/topics/safepatient/default.html |access-date=2024-04-16 |website=www.cdc.gov |language=en-us}}</ref> These tasks present unique ergonomic hazards that results in a high rate of acute and cumulative musculoskeletal injuries.<ref>{{Cite journal |last1=Morse |first1=Tim |last2=Fekieta |first2=Renee |last3=Rubenstein |first3=Harriet |last4=Warren |first4=Nick |last5=Alexander |first5=Darryl |last6=Wawzyniecki |first6=Patricia |date=2008-05-29 |title="Doing the Heavy Lifting: Health Care Workers Take Back Their Backs" |url=https://doi.org/10.2190/NS.18.2.j |journal=NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy |language=en |volume=18 |issue=2 |pages=207–219 |doi=10.2190/ns.18.2.j |pmid=18511397 |bibcode=2008NewSo..18..207M |issn=1048-2911}}</ref><ref name=":12">{{Cite journal |last1=Aslam |first1=Imran |last2=Davis |first2=Scott A. |last3=Feldman |first3=Steven R. |last4=Martin |first4=Willis E. |date=June 2015 |title=A Review of Patient Lifting Interventions to Reduce Health Care Worker Injuries |url=https://doi.org/10.1177/2165079915580038 |journal=Workplace Health & Safety |language=en |volume=63 |issue=6 |pages=267–275 |doi=10.1177/2165079915580038 |pmid=26135600 |issn=2165-0799}}</ref>
 
The most frequently injured body part is the back, with up to 72% of nurses reporting non-specific [[low back pain]].<ref>{{Cite web |title=Unsafe patient handling |url=https://www.who.int/tools/occupational-hazards-in-health-sector/unsafe-patient-handling |access-date=2024-02-22 |website=www.who.int |language=en}}</ref> The US Bureau of Labor Statistics reported that for 2021-2022 the rate of overexertion injuries leading to days away from work for nurses was 45.4 per 10,000 full time employees, while nursing aids came in at 145.5 compared to the average for all industries of 26.1.<ref>{{Cite web |title=Survey of Occupational Injuries and Illnesses Data : U.S. Bureau of Labor Statistics |url=https://www.bls.gov/iif/nonfatal-injuries-and-illnesses-tables.htm |access-date=2024-03-26 |website=www.bls.gov |language=en-us}}</ref>
 
Traditionally, nurses are trained in manual patient handling techniques.<ref name=":02">{{Cite journal |last=Waters |first=Thomas R. |date=2007 |title=For CE Credit: When Is It Safe to Manually Lift a Patient? |url=https://www.jstor.org/stable/29746479 |journal=The American Journal of Nursing |volume=107 |issue=8 |pages=53–59 |doi=10.1097/01.NAJ.0000282296.18688.b1 |jstor=29746479 |pmid=17667392 |issn=0002-936X}}</ref> The body of evidence has demonstrated, however, that such interventions arearea ineffective.<ref name=":02" />
 
=== Workplace violence ===
Nurses are at risk for workplace violence and abuse.<ref>{{cite web |url = http://blogs.cdc.gov/niosh-science-blog/2013/08/12/hcwviolence-prevention/ |title = Free On-line Violence Prevention Training for Nurses |date = 12 August 2013 |first1 = Dan |last1 = Hartley |first2 = Marilyn |last2 = Ridenour |access-date = 15 January 2015 |publisher = National Institute for Occupational Safety and Health}}</ref> Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically is by hospital personnel. In the US in 2011, 57% of nurses reported that they had been threatened at work; 17% were physically assaulted.<ref name=":0" />
 
The three types of workplace violence that nurses can experience are: physical violence (hitting, kicking, beating, punching, biting, and using objects);<ref>{{Citation|title=Gender Matters: Discourses of Violence in Early Modern Literature and the Arts|date=2014-01-01|work=Gender Matters|pages=5–15|publisher=BRILL|doi=10.1163/9789401210232_002|isbn=9789401210232 |last1=Wade |first1=Mara R. }}</ref> psychological violence (threats and/or coercion); sexual violence (attempted/completed non-consensual sex act).<ref>{{Cite web|date=September 2021|title=Sexual Harassment in the Workplace|url=https://www.workplacesrespond.org/harassment-facts/ |website=Work Places Respond}}</ref>
 
Workplace violence can be in another way: interpersonal violence and organizational coercion. Interpersonal violence is committed by workers and/or patients and their families. Its predominant form is verbal abuse. Organizational coercion may include excessive workloads, mandatory shifts, involuntary placement in another part of the workplace, low salaries, denial of benefits/overtime, poor working environment, and other stressors.<ref>{{Cite journal|last1=Faghihi|first1=Mitra|last2=Farshad|first2=Aliasghar|last3=Abhari|first3=Maryam Biglari|last4=Azadi|first4=Nammamali|last5=Mansourian|first5=Morteza|date=2021-05-19|title=The components of workplace violence against nurses from the perspective of women working in a hospital in Tehran: a qualitative study|journal=BMC Women's Health|volume=21|issue=1|page=209|doi=10.1186/s12905-021-01342-0|pmid=34011330|issn=1472-6874|pmc=8136170 |doi-access=free }}</ref> These issues affect [[quality of life]]. Managers who lack understanding of the severity of these problems and do not support workers increase worker stress.
 
Many factors contribute to workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. The environmental factors can include the specific setting (for example the emergency department), long patient wait times, frequent interruptions, uncertainty regarding the patients' treatment, and heavy workloads.<ref name=":1">{{Cite journal|last1=Zhang|first1=Liuyi|last2=Wang|first2=Anni|last3=Xie|first3=Xia|last4=Zhou|first4=Yanhong|last5=Li|first5=Jing|last6=Yang|first6=Lijun|last7=Zhang|first7=Jingping|date=July 2017|title=Workplace violence against nurses: A cross-sectional study|journal=International Journal of Nursing Studies|volume=72|pages=8–14|doi=10.1016/j.ijnurstu.2017.04.002|pmid=28412581|issn=0020-7489}}</ref> Organizational factors can include inefficient teamwork, organizational injustice, lack of aggression- and/or stress -management programs, and distrust between colleagues.<ref name=":1" /> Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills.<ref name=":1" /> Misunderstandings may also occur due to the communication barrier between nurses and patients.<ref name=":2">{{Cite journal|last1=Alkorashy|first1=Hanan A. Ezzat|last2=Al Moalad|first2=Fawziah Bakheet|date=June 2016|title=Workplace violence against nursing staff in a Saudi university hospital|url=https://onlinelibrary.wiley.com/doi/10.1111/inr.12242|journal=International Nursing Review|language=en|volume=63|issue=2|pages=226–232|doi=10.1111/inr.12242|pmid=26830364}}</ref> An example of this could be the patientpatients's conditionconditions being affected by medicationmedications, pain, and/or anxiety.
 
Workplace violence has many causes. The most common perpetrators forof harassment and/or bullying againstof nursing students were registered nurses including preceptors, mentors, and clinical facilitators.<ref name=":2" /> However, the main perpetrators of workplace violence against nurses were patients. 80% of serious violent incidents in health care centers were by patients.
 
Workplace violence has many effects. It has negative emotional and physical impacts on nurses. They feel depersonalized, dehumanized, worn out, and stressed out.<ref>{{Cite journal|last1=Vrablik|first1=Marie C|last2=Chipman|first2=Anne K|last3=Rosenman|first3=Elizabeth D|last4=Simcox|first4=Nancy J|last5=Huynh|first5=Ly|last6=Moore|first6=Megan|last7=Fernandez|first7=Rosemarie|date=August 2019|title=Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study|journal=BMJ Open|volume=9|issue=8|pages=e031781|doi=10.1136/bmjopen-2019-031781|pmid=31462490|issn=2044-6055|pmc=6720251}}</ref> Nurses have reported burn-out due to frequent exposure to this violence.
 
=== Interventions ===
Interventions can mitigate these occupational hazards. They can be individual-focused or organization-focused. Individual-focused interventions include [[stress management]] programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by identifying stress generators and developing solutions to them. Combining organizational and individual interventions is most effective at reducing stress.<ref name=":0" /> In some Japanese hospitals, [[Powered exoskeleton#Medical|powered exoskeletons]] are used to reduce physical loads.<ref>{{cite news|last1=Gilhooly|first1=Rob|title=Exoskeletons await in work/care closet|url=http://www.japantimes.co.jp/life/2012/06/17/general/exoskeletons-await-in-workcare-closet/|access-date=21 August 2013|work=The Japan Times|date=17 June 2012}}</ref> Lumbar supports (i.e. [[back belt]]s) have been trialed.<ref>{{cite journal | pmc=2078392 | year=2007 | last1=Dawson | first1=A. P. | last2=McLennan | first2=S. N. | last3=Schiller | first3=S. D. | last4=Jull | first4=G. A. | last5=Hodges | first5=P. W. | last6=Stewart | first6=S. | title=Interventions to prevent back pain and back injury in nurses: A systematic review | journal=Occupational and Environmental Medicine | volume=64 | issue=10 | pages=642–650 | doi=10.1136/oem.2006.030643 | pmid=17522134 }}</ref>
 
==National variations==
==Worldwide==
===AmericasAfrica===
====United States====
[[File:Poston, Arizona. Registered nurse, Mrs. Edythe Sasser, is assisited by Yoshiko Konatsu, nurse's aid . . . - NARA - 537104.jpg|thumb|Two nurses in Arizona, 1943]]
{{Main article|Nursing in the United States|History of nursing in the United States}}
In the US, scope of practice is determined by the licensing state or territory. Each has its own laws, rules, and regulations governing licensing and care. Usually a [[board of nursing]] makes rules and regulations and handles administration of these rules for the jurisdiction.
 
==== Kenya ====
RNs are employed by physicians, attorneys, insurance companies, governmental agencies, community/public health agencies, private industry, school districts, ambulatory surgery centers, device or pharmaceutical manufacturers, or chemical companies. Some work as independent consultants. Research nurses conduct or assist in research or evaluation in areas such as biology, psychology, human development, and health care systems.
{{Excerpt|Nursing in Kenya}}
 
==== South Africa ====
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.<ref name="United States Department of Labor Bureau of Labor Statistics">United States Department of Labor Bureau of Labor Statistics</ref>
{{Excerpt|Nursing in South Africa}}
 
===Americas===
Nursing is the nation's largest health care profession. As of 2023, 3,175,390 registered nurses were employed, paid a median income of $86,070.<ref>{{Cite web |title=Registered Nurses |url=https://www.bls.gov/oes/current/oes291141.htm |archive-url=https://web.archive.org/web/20240503221036/https://www.bls.gov/oes/current/oes291141.htm |archive-date=May 3, 2024 |access-date=2024-05-03 |website=Bureau of Labor Statistics |language=en-us}}</ref>
====United States====
 
{{Excerpt|Nursing in the United States}}
The primary pathway to professional nursing is the four-year Bachelor of Science in nursing (BSN) degree. Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same licensing exam. The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system.
 
=====Educational and licensure requirements=====
Nursing schools may be accredited by either the [[Accreditation Commission for Education in Nursing]] (ACEN) or the [[Commission on Collegiate Nursing Education]] (CCNE).
 
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.{{Citation needed|date=December 2022}}
 
======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.<ref name="ANA">American Nurses Association. [http://www.ana.org/readroom/fsdemogr2.htm#education "Nursing Facts: Today's Registered Nurse – Numbers and Demographics"] {{Webarchive|url=https://web.archive.org/web/20070809113102/http://www.ana.org/readroom/fsdemogr2.htm#education |date=9 August 2007 }} Washington, D.C., American Nurses Association, 2006.</ref> According to the Health Services Resources Administration's 2000 Survey of Nurses only six percent of nurses who graduated from nursing programs received their education at a Diploma School of Nursing.<ref name="HRSA">Health Resources and Service Administration. "Findings from the National Sample Survey Of Registered Nurses" Washington, D.C., U.S. Department of Health and Human Services Health Resources and Service Administration Bureau of Health Professions Division of Nursing, 2000.</ref>
 
======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]] (ADN, or Associate of Applied Science in Nursing, Associate of Science in nursing, Associate Degree in Nursing), a [[community college|two-year college]] degree. Some four-year schools offer the ADN. Associate degree nursing programs have prerequisite and corequisite courses (which may include English, Math and Human Anatomy and Physiology) and consume three years or longer.
 
======Bachelor of Science in Nursing======
{{main article|Bachelor of Science in Nursing}}
Another pathway into the profession 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, students complete general education requirements along with nursing courses. In some new programs an active LPN license can replace the first two years of nursing classes. Advocates for ADN and diploma programs claim that such programs take an [[on-the-job training]] approach, and that the BSN should remain an [[academic degree]] that emphasizes research and [[nursing theory]]. Some states require a specific amount of clinical experience that is the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions not typically available to ADN holders, but is not necessary for most patient care functions.
 
======Graduate education======
{{Further|Master of Science in Nursing|Doctor of Nursing Practice}}
 
Advanced education in nursing includes master's and doctoral degrees. Graduate education prepares the graduate for specialization as an [[advanced practice registered nurse]] (APRN) or for advanced roles in leadership, management, or education. 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 prepare the student for work in nursing education, health care administration, clinical research, public policy, or advanced clinical practice. Most programs confer the PhD in nursing or [[Doctor of Nursing Practice]] (DNP).
 
Areas of advanced nursing practice include that of a [[nurse practitioner]] (NP), a certified [[nurse midwife]] (CNM), a [[nurse anesthetist|certified registered nurse anesthetist]] (CRNA), or a [[clinical nurse specialist]] (CNS). Nurse practitioners and CNSs 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]], additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.
 
=====Licensure exam=====
 
Completion of any one of these three educational routes allows a graduate nurse to take the [[NCLEX-RN]], the test for [[nurse licensure|licensure]] as a registered nurse. This test is accepted nationwide as an indicator of competency.
 
=====Staffing=====
{{Main article|Nursing shortage}}
It has been reported{{By whom|date=July 2012}} 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]]. One study reported that the nursing shortage is voluntary,<ref>{{cite book | vauthors = Haddad LM, Annamaraju P, Toney-Butler TJ | title = Nursing Shortage
| publisher = Stat Pearls | date=January 2020 | url = https://www.ncbi.nlm.nih.gov/books/NBK493175/ | access-date = 10 May 2020 | pmid = 29630227}}</ref> {{Citation needed|date=July 2012}} caused by nurses voluntarily leaving the profession. In 2006 it was estimated that approximately 1.8&nbsp;million licensed nurses chose not to work as a nurse. The [[Bureau of Labor Statistics]] (BLS) estimated that by 2020, 1.2&nbsp;million nursing job openings would be available.<ref>{{cite web |author=Rosseter, R. |date=6 August 2012 |title=Media Relations/ Nursing Shortage |publisher=American Association of Colleges of Nursing |url=http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage |access-date=4 June 2013 |archive-date=9 August 2017 |archive-url=https://web.archive.org/web/20170809162859/http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage }}</ref>
 
=====Board certification=====
{{main article|Nursing credentials and certifications}}
 
Professional nursing certification boards offer voluntary certification exams to demonstrate clinical competency in particular specialties. Completion of prerequisites enables an RN to register for an examination, and passage gives an RN permission to use a corresponding professional designation. For example, passage of the American Association of Critical-care Nurses specialty exam allows a nurse to use the initials CCRN.
 
The [[American Nurses Credentialing Center]] (ANCC) is the largest nursing credentialing organization and administers more than 30 specialty examinations.<ref name="ANCC">American Nurses Credentialing Center. [http://www.ana.org/ancc/cert/index.html "ANCC Certification"] {{Webarchive|url=https://web.archive.org/web/20070607205339/http://www.ana.org/ancc/cert/index.html |date=7 June 2007 }} Washington, D.C., American Nurses Association, '''2006'''.</ref>
 
===== Continuing education =====
[[Continuing education]] classes and programs enable nurses to provide the best possible care to patients, advance nursing careers, and keep up with certification requirements. ANCC ensures nurses have access to quality continuing education offerings. Continuing education classes are calibrated to educate all levels of nurses. Many States require continuing education. Nursing licensing boards typically accept courses provided by organizations accredited by other licensing boards, by the ANCC, or its designees.<ref>{{cite web |title=FAQs: Contact Hours (CNE Credit) |url=http://www.nursecredentialing.org/AccredContactHoursFAQ |archive-url=https://web.archive.org/web/20150211024758/http://www.nursecredentialing.org/AccredContactHoursFAQ |archive-date=11 February 2015 |access-date=10 February 2015}}</ref> The National Healthcare Institute maintains a list of continuing education requirements.<ref name="nhinstitute">{{cite web |title=Continuing Education for Nurses and Medics |url=http://www.nhinstitute.com |access-date=10 December 2017 |website=NHI}}</ref><ref name="http://www.nursingworld.org/">{{cite web |title=American Nurses Association |url=http://www.nursingworld.org/ |access-date=21 August 2011 |publisher=Nursingworld.org}}</ref><ref name="http://www.NHInstitute.org/">{{cite web |title=National Healthcare Institute Continuing Education Requirements by Board of Nursing |url=http://www.nhinstitute.com/item/education-requirements-by-board-of-nursing.html |access-date=14 February 2012 |publisher=NHInstitute.com}}</ref>
 
===== Correctional nursing =====
{{main article|Correctional nursing}}
 
The United States needs many [[Correctional nursing|correctional nurses]] to provide proper health-care to inmates, including [[Mentally ill people in United States jails and prisons|mental health treatments]].
 
Correctional health care encompasses LPNS, RNs, nurse practitioners, doctors, pharmacists, therapists, and specialists.<ref name=":52">{{Cite web |date=2019-08-12 |title=What to Expect as a Correctional Care Nurse and How to Avoid Burnout in Challenging Settings |url=https://nursing.usc.edu/blog/correctional-nurse-career/ |access-date=2022-03-10 |website=USC-MSN |language=en-US}}</ref>
 
Upon an inmate's arrival, nurses perform a basic checkup. They can discover existing conditions. Issues including chronic medical conditions, mental health, infectious disease, and substance abuse. Correctional nurses must follow stricter protocols than in a hospital due to confidentiality. Assessing a patient can be difficult. A deputy or officer may have to be present during exams, which can discomfort the patient, compromising the information provided.<ref name=":52" />
 
====Canada====
{{Main articleExcerpt|Nursing in Canada}}
 
=====History=====
Canadian nursing dates back to 1639 in [[Quebec]], launched by Augustine nuns.<ref name="test2">[http://www.cna-nurses.ca/CNA/nursing/certification/specialties/default_e.aspx Link text] {{webarchive|url=https://web.archive.org/web/20111229233442/http://www.cna-nurses.ca/cna/nursing/certification/specialties/default_e.aspx|date=29 December 2011}}.</ref> These nuns were trying to open a mission that cared for people's spiritual and physical needs. This mission created the first nursing apprenticeship program in North America.<ref name="test2" /> In the nineteenth century, some Catholic nursing orders were trying to spread their message across Canada. Most nurses were female and had only occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.<ref name="test2" />
 
====Education====
All Canadian nurses and prospective nurses are encouraged by the [[Canadian Nurses Association]] to complete a [[bachelor's degree]]. All Canadian provinces and territories, with the exception of the [[Yukon]] and [[Quebec]], require that all nurses have a bachelor's degree.<ref name="test2" /> The length of time typically required to obtain this degree is four years. However, some Canadian universities offer a two year alternative.<ref name="test2" />
 
Nursing specialty certification is available through the [[Canadian Nurses Association]] in 22 practice areas,<ref name="test2" /> including:
 
* cardiovascular nursing
* community health nursing
* [[critical care nursing]]
* pediatric critical care nursing
* [[emergency nursing]]
* gastroenterology nursing
* [[gerontological nursing]]
* hospice palliative care nursing
* [[medical-surgical nursing]]
* [[neonatal nursing]]
* nephrology nursing
* [[neuroscience nursing]]
* [[occupational health nursing]]
* [[oncology nursing]]
* [[orthopedic nursing]]
* [[pediatric nursing]]
* peri-anesthesia nursing
* [[obstetrical nursing]]
* peri-operative nursing
* [[psychiatric and mental health nursing]]
* rehabilitation nursing
* [[Wound, ostomy, and continence nursing]]
 
Nursing specialty certification generally requires practice, experience, and passing a test based on competencies for a specific medical or surgical domain.
 
====Latin America/Caribbean====
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=== Europe ===
 
====Spain European Union ====
In the European Union, the profession of nurse requires a specific professional qualification. The qualification of nurses responsible for general care in the EU is regulated in [[Directive 2005/36/EC]].<ref name="Directive 2005/36/EC">[http://data.europa.eu/eli/dir/2005/36/oj Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications, Official Journal of the European Union, 30.9.2005]</ref> The list of regulated nursing professions is held in the regulated professions database.<ref name="europa2">{{cite web |title=Regulated professions database – European Commission |url=https://ec.europa.eu/growth/tools-databases/regprof/home |access-date=21 June 2024 |publisher=European Commission}}</ref>
 
===== Germany =====
{{Excerpt|Nursing in Germany}}
 
===== Spain =====
{{Excerpt|Nursing in Spain|paragraphs=1}}
 
====United Kingdom====
{{Main articleExcerpt|Nursing in the United Kingdom}}
To practice lawfully as a registered nurse, the practitioner must hold a valid registration with the [[Nursing and Midwifery Council]].<ref name="ACT2">United Kingdom Government [http://www.opsi.gov.uk/ACTS/acts1997/1997024.htm Nurses, Midwives and Health Visitors Act, 1997.] London: HMSO, 1997.</ref> From April 2016, nurses in the United Kingdom are expected to revalidate every three years by providing evidence of further development and active practice.<ref>{{cite news|last=Jackson|first=Linda|date=24 February 2016|title=How revalidation will work for nurses and midwives|work=The Guardian|url=https://www.theguardian.com/healthcare-network/2016/feb/24/revalidation-nurses-midwives-how-it-works|access-date=8 October 2016}}</ref><ref>{{Cite news|date=16 October 2015|title=NMC Revalidation to begin in April 2016|language=en-GB|work=NursingNotes|url=https://nursingnotes.co.uk/news/professional/nmc-revalidation-to-begin-in-april-2016/|access-date=1 June 2017}}</ref>
 
=====First and second level=====
First-level nurses make up the bulk of the registered nurses in the UK. Titles include Registered Nurse Adult (RNA), Registered Nurse Child (RNC), Registered Nurse Mental Health (RNMH), and Registered Nurse (of) Learning Disabilities (RNLD). Second-level nurse training is no longer provided; however, such earlier-certified nurses are able to practice in the United Kingdom as a registered nurse. Most refer to themselves as Enrolled Nurses (ENs) or State Enrolled Nurses (SENs).
 
=====Advanced practice=====
 
* Nurse practitioners – Most of these nurses obtain a minimum of a master's degree and a desired post grad certificate. They typically perform roles similar to those of physicians and physician assistants. They can prescribe medications as independent or supplementary prescribers, although they are still regulated, unlike physician's assistants. Most Nurse Practitioners (NPs) have referral and admission rights to hospital specialties. They commonly work in [[primary care]] (e.g. General Practitioner (GP) surgeries), [[Emergency department|Accident and Emergency (A&E) departments]], or pediatrics although they increasingly practicein other areas. In the UK, the title "nurse practitioner" is legally protected.
* Specialist community public health nurses – traditionally [[district nurse]]s and [[health visitor]]s, this group oversees research and publication activities.
* Lecturer-practitioners (also practice education facilitators) – work in the [[National Health Service]] (NHS), and in universities. They typically work 2–3 days per week in each setting. In university, they train pre-registration student nurses and often teach specialist courses for post-registration nurses.
* Lecturers – these nurses work full-time in universities, teaching and performing research.
 
=====Managers=====
Many nurses who have substantial experience in clinical settings join the ranks of NHS management. This used to be seen as a natural career progression for ward managers positions, however with the advent of specialist nursing roles, this has become a less attractive option.
 
Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or ''[[Matron|modern matrons]]''.
 
=====Nurse education=====
======Pre-registration======
To become a registered nurse, one must complete a program recognised by the [[Nursing and Midwifery Council]] (NMC). Currently, this involves completing a [[Academic degree|degree]], available from a range of [[:Category:Nursing schools in the United Kingdom|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, assignments 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. Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are:
 
* Child nursing
* Mental health nursing
* Learning disabilities nursing
 
{{As of|2013}}, the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification.<ref name="http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/Pre-registration-nursing-education-Phase-2/Changes-to-pre-registration-nursing-programmes-FAQs-/2">{{cite web|title=Changes to pre-registration nursing programmes: FAQs &#124; Nursing and Midwifery Council|url=http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/Pre-registration-nursing-education-Phase-2/Changes-to-pre-registration-nursing-programmes-FAQs-/|date=20 April 2010|publisher=Nmc-uk.org|archive-url=https://web.archive.org/web/20110727073118/http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/Pre-registration-nursing-education-Phase-2/Changes-to-pre-registration-nursing-programmes-FAQs-/|archive-date=27 July 2011|access-date=21 August 2011}}</ref> However, those nurses who hold a diploma, or even a certificate in nursing are still able to legally practice in the UK, although they are able to undertake university modules to obtain enough credits to top up to a degree.
 
[[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) programs 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.<ref name="NMC2">Nursing and Midwifery Council [http://www.nmc.org.uk Pre-registration training.] London: NMC, 2003.</ref>
 
{{As of|2016}} student nurses in England and Wales can apply for a [[bursary]] from the government to support them during their nurse training, and may also be eligible for a student loan, although there has been speculation that this will not be available in the future.<ref name="nursingtimes2">{{cite web|title=Student bursary system 'unsustainable', claims minister in response to editors|url=https://www.nursingtimes.net/news/education/bursary-system-unsustainable-claims-minister-03-10-2016/|website=Nursing Times|date=3 October 2016|access-date=10 December 2017}}</ref> Student nurses in Scotland still receive a standard bursary which is not means tested, and their tuition fees continue to be paid – however, they are not eligible for student loans.
 
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.<ref name="http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Post-Registration-Education-and-Practice-Prep-requirements-for-midwives/2">{{cite web|title=Post Registration Education and Practice (Prep) requirements for midwives &#124; Nursing and Midwifery Council|url=http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Post-Registration-Education-and-Practice-Prep-requirements-for-midwives/|publisher=Nmc-uk.org|archive-url=https://web.archive.org/web/20101126092059/http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Post-Registration-Education-and-Practice-Prep-requirements-for-midwives/|archive-date=26 November 2010|access-date=21 August 2011}}</ref>
 
There are also opportunities for many nurses to gain additional clinical skills after qualification. [[Cannulation]], [[venipuncture]], [[Intravenous therapy|intravenous drug therapy]] and [[Urinary catheterization|male catheterization]] are the most common, although there are many others (such as [[advanced life support]]), which some nurses 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 was 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.<ref name="Nursing and Midwifery Education, 20072">Nursing and Midwifery Education, 2007</ref>
 
To become specialist nurses (such as nurse consultants, nurse practitioners etc.) or nurse educators, some nurses undertake further training above bachelor's degree level. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. [[District nurse]]s and [[health visitor]]s are also considered specialist nurses, and to become such they must undertake specialist training. This is a one-year full-time degree.
 
All newly qualifying [[district nurse]]s and [[health visitor]]s 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 1 May 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.<ref name="BFN2">{{cite web|title=BNF Publications|url=http://bnf.org/bnf/index.htm|author=BNF Publications}}</ref>
 
====European Union====
In the European Union, the profession of nurse is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for nurse<ref name="europa2">{{cite web|title=Regulated professions database – European Commission|url=http://ec.europa.eu/internal_market/qualifications/regprof/index.cfm?action=profession&id_profession=12402&tab=countries|publisher=European Commission|access-date=10 December 2017}}</ref> in the European Union (EU) member states, European Economic Area (EEA) countries, and Switzerland. This list is covered by the Directive 2005/36/EC.
 
=== Asia ===
 
====India====
{{Excerpt|Nursing in India}}
Nursing education is governed in [[India]] by the central body [[Indian Nursing Council]] and its norms are implemented through respective State Nursing councils. The list of state nursing councils are available in the official web page of Indian Nursing Council. First formal education in nursing was offered in Madras Medical college, in Madras presidency.
Indian Nursing Council Act, 1947. Act Year Number: Act No. 19 of December enactment Date of enactment: [31 December 19act] Act Objective: An Act to constitute the Nursing Council of India. To establish uniform standards of training for nurses, midwives, and health visitors. It is implemented with 17 sections and each section indicates the specific legislative role of the council.
 
=== Hong Kong ===
The nursing profession was dominated by females in the British colonial period, but in Madras Presidency, men were actively engaged in the profession.<ref>Jayapal SK, Arulappan J. Historical Trajectory of Men in Nursing in India. SAGE Open Nurs. 2020 May 13; 6:1-10. doi: 10.1177/2377960820920128. PMID 33415276; PMCID: PMC7774447</ref>
{{Excerpt|Nursing in Hong Kong}}
 
====Iran====
{{main|Nursing in Iran}}
 
====Israel====
Nurses in [[Israel]] have a wide variety of responsibilities, including hospital care, patient education, wound care, prenatal and other monitoring, midwifery, and well-baby clinics.
 
Nursing in Israeli Jewish culture traces its origins to [[Shiphrah and Puah|Shifra and Puah]], two [[Hebrews|Hebrew]] midwives depicted in the [[Book of Exodus]] helping women in ancient Egypt give birth and keep their infants safe.
 
Modern-day nursing was established by nurses sent to [[Mandatory Palestine]] and later Israel by the [[Hadassah Women's Zionist Organization of America|Hadassah]] organization, as well as a nursing school founded by [[Henrietta Szold]] in 1918. During those times, the United Kingdom regulated midwifery in Mandatory Palestine, but the nurses were not mentioned in the regulation decree.
 
Today, nurses and midwives are regulated by the [[Israeli Ministry of Health]].
 
====Japan====
{{main articleExcerpt|Nursing in Japan}}
 
=====History== Pakistan ===
{{Excerpt|Nursing in Pakistan}}
Nursing was not an established part of Japan's healthcare system until 1899 with the Midwives Ordinance.<ref name="nurse3">{{cite web|title=Nursing in Japan – Overview of Japanese Nursing System|url=http://www.nurse.or.jp/jna/english/nursing/system.html|website=nurse.or.jp|access-date=25 February 2018|archive-date=11 March 2018|archive-url=https://web.archive.org/web/20180311091329/http://www.nurse.or.jp/jna/english/nursing/system.html|url-status=dead}}</ref> 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]]: the ''Public Health Nurse, Midwife and Nurse Law'', established in 1948.<ref name="test2" /> 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.<ref name="test2" /> 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======
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 labour and postpartum. They assist with things like breastfeeding and caring for the child.
 
======Nursing assistant======
Nursing assistants, also known as nurse assistants or CNAs (Certified Nursing Assistants), assist patients with basic daily tasks. 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.
 
=====Education=====
In 1952 Japan established the first nursing university in the country.<ref name="test2" /> An [[Associate of Science in Nursing|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 [[Bachelor of Science in Nursing|Bachelor's Degree in Nursing]] (BSN) was established. Currently, Japan offers [[Doctorate in Nursing|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's degree, go to a junior nursing college for three years or go to a nursing school for three years.<ref name="test2" /> 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 becoming 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.<ref name="test2" /> 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 as one who graduated from a nursing university would, 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.<ref name="test2" /> Japanese nurses never have to renew their licenses. Once they have passed their exam, they have their license for life.<ref name="test2" />
 
=====Today=====
Like the United States, Japan is in need of more nurses. The driving force behind this need is the fact that country is aging and needs more medical care for its people. However, the number of available nurses does not seem to be increasing. Nurses face poor working conditions and low social status, and there is a cultural idea that married women quit their jobs for family responsibilities.<ref name="nurse22">{{cite web|title=Nursing in Japan – Working conditions in Japan|url=http://www.nurse.or.jp/jna/english/nursing/employment.html|website=nurse.or.jp|access-date=25 February 2018|archive-date=25 February 2021|archive-url=https://web.archive.org/web/20210225151221/https://www.nurse.or.jp/jna/english/nursing/employment.html|url-status=dead}}</ref> On average, Japanese nurses make around 280,000 yen a month, and it is one of the higher paying jobs. However, physicians make twice as much as nurses.<ref name="worldsalaries2">{{cite web|title=Professional Nurse Salaries – International Comparison|url=http://www.worldsalaries.org/professionalnurse.shtml|website=worldsalaries.org|access-date=25 February 2018}}</ref> Similar to other cultures, the Japanese people view nurses as subservient to physicians. 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.'"
 
There are organizations that unite Japanese nurses like the [[Japanese Nursing Association]] (JNA); the JNA is a professional organization and not a union. 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.<ref name="test2" /> There are other organizations, including some that categorize nurses by 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.<ref name="test2" /> It is a union that includes physicians as well as nurses. This organization was involved with the '''Nursing Human Resource Law'''.<ref name="test2" />
 
====Philippines====
{{main articleExcerpt|Nursing in the Philippines|paragraphs=1}}
Philippines is well known for migrant nurses working in other countries especially in the west like the United States of America. It accounts a quarter of overseas nurses in the world. Every year, around 20,000 nurses leave the Philippines to work in more developed countries looking for better pay.<ref>{{cite news |title=The Worlds Largest Supplier of Nurses: The Philippines |work=Hawk Herald |url=https://www.hawkherald.com/2021/11/the-worlds-largest-supplier-of-nurses-the-philippines/|access-date=6 December 2022|archive-date=20 November 2021|archive-url=https://web.archive.org/web/20211120041136/https://www.hawkherald.com/2021/11/the-worlds-largest-supplier-of-nurses-the-philippines/|url-status=live}}</ref> Nurses in the Philippines must be licensed by the [[Professional Regulatory Commission]].
 
====Taiwan====
{{main article|Nursing in Taiwan}}
 
In [[Taiwan]], the [[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]] is in charge of the regulation of nursing.<ref>{{cite web|title=Ministry of Health and Welfare|url=http://www.mohw.gov.tw/EN/Ministry/Index.aspx|access-date=6 May 2016|archive-date=28 April 2017|archive-url=https://web.archive.org/web/20170428230510/http://www.mohw.gov.tw/EN/Ministry/Index.aspx}}</ref> The Taiwan Union of Nurses Association (TUNA) is the union unit in Taiwan, fighting for nurses on payment and working time issues.<ref>{{Cite web|url=https://www.nurse.org.tw/|title=中華民國護理師護士公會全國聯合會|website=www.nurse.org.tw}}</ref>
In [[Taiwan]], the [[Ministry of Health and Welfare (Taiwan)|Ministry of Health and Welfare]] regulates nursing.<ref>{{cite web|title=Ministry of Health and Welfare|url=http://www.mohw.gov.tw/EN/Ministry/Index.aspx|access-date=6 May 2016|archive-date=28 April 2017|archive-url=https://web.archive.org/web/20170428230510/http://www.mohw.gov.tw/EN/Ministry/Index.aspx}}</ref> The Taiwan Union of Nurses Association (TUNA) organizes nurses.<ref>{{Cite web|url=https://www.nurse.org.tw/|title=中華民國護理師護士公會全國聯合會|website=www.nurse.org.tw}}</ref>
 
===Australia===
{{main articleExcerpt|Nursing in Australia|paragraphs=1}}
Catholic religious institutes were influential in the development of Australian nursing, founding many of Australia's hospitals – the Irish [[Sisters of Charity of Australia|Sisters of Charity]] were first to arrive in 1838 and established [[St Vincent's Hospital, Sydney]] in 1857 as a free hospital for the poor. They and other orders like the [[Sisters of Mercy]], and in aged care the Sisters of the Little Company of Mary and [[Little Sisters of the Poor]] founded hospitals, hospices, research institutes and aged care facilities around Australia.<ref>{{cite web|url=http://national.stvincents.com.au/history.php|date=6 July 2011|archive-url=https://web.archive.org/web/20100402062826/http://national.stvincents.com.au/history.php|archive-date=2 April 2010|access-date=31 July 2012|title=Sisters of Charity Health Service }}</ref><ref>{{cite web|title=Little Sisters of the Poor Oceania|url=http://www.littlesistersofthepoor.org.au/|publisher=Littlesistersofthepoor.org.au|access-date=31 July 2012}}</ref>
 
=== Middle East ===
A census in the 1800s found several hundred nurses working in Western Australia during the colonial period of history, this included Aboriginal female servants who cared for the infirm.<ref>"But Westward Look" by author</ref>
 
====Iran====
The state nursing licensing bodies amalgamated in Australia in 2011 under the federal body AHPRA (Australian Health Practitioner Registration Authority).<ref>{{cite journal|last1=Ralph|first1=Nicholas|last2=Birks|first2=Melanie|last3=Chapman|first3=Ysanne|date=November 2013|title=The accreditation of nursing education in Australia|url=http://eprints.usq.edu.au/25901/14/Ralph_Birks_Coll_SV.pdf|journal=Collegian|volume=22|issue=1|pages=3–7|doi=10.1016/j.colegn.2013.10.002|pmid=26285403}}</ref> Several divisions of nursing license is available and recognized around the country.
{{Excerpt|Nursing in Iran|paragraphs=1}}
 
=== Islam ===
* Enrolled nurses may initiate some oral medication orders with a specific competency now included in national curricula but variable in application by agency.
{{Excerpt|Nursing in Islam}}
* Registered nurses hold a university degree (enrolled nurses can progress to registered nurse status and do get credit for previous study).
* Nurse practitioners have started emerging from postgraduate programs and work in both private practice and [[Public hospital|public hospitals and clinics]].
* Mental health nurses must complete further training as advanced mental health practitioners in order to administer client referrals under the ''Mental Health Act''.
 
====Israel====
Australia enjoys the luxury of a national curriculum for vocational nurses, trained at Technical and Further Education (TAFE) colleges or private Registered Training Organization (RTO). Enrolled and registered nurses are identified by the department of immigration as an occupational area of need, although registered nurses are always in shorter supply, and this increases in proportion with specialization.
{{Unreferenced section|date=May 2024}}
Nurses in [[Israel]] has responsibilities including hospital care, patient education, wound care, prenatal and other monitoring, midwifery, and well-baby clinics.
 
Nurses and midwives are regulated by the [[Israeli Ministry of Health]].
<ref>[http://www.anu.edu.au/polsci/marx/interventions/rebelwomen/nurses.htm Nurses' militancy stemmed from two different kinds of experiences]. Anu.edu.au (19 November 1983). Retrieved 28 July 2013.</ref>
 
Nursing in Israeli Jewish culture traces its origins to [[Shiphrah and Puah|Shifra and Puah]], two [[Hebrews|Hebrew]] midwives depicted in the [[Book of Exodus]] helping women in ancient Egypt give birth and keep their infants safe.
In 1986 there were a number of rolling industrial actions around the country, culminating when five thousand Victorian nurses went on strike for eighteen days. The hospitals were able to function by hiring casual staff from each other's striking members, but the increased cost forced a decision in the nurses' favor.
 
== Online Healthcare Staffing Platforms ==
The early 2010s saw the emergence of [[digital health]] platforms that connect nurses and nurse assistants with vacant job openings in healthcare facilities like skilled nursing homes, home health agencies, and hospitals. They commonly use an app to facilitate communication and allow nurses to find flexible work opportunities based on their preferences. Healthcare partners and facilities benefit from access to a qualified pool of nurses to fill staff shortages quickly and efficiently.<ref>{{Cite journal |last1=Han |first1=Xinxin |last2=Pittman |first2=Patricia |last3=Barnow |first3=Burt |date=2021-09-09 |title=Alternative Approaches to Ensuring Adequate Nurse Staffing |url=http://dx.doi.org/10.1097/mlr.0000000000001614 |journal=Medical Care |volume=59 |issue=Suppl 5 |pages=S463–S470 |doi=10.1097/mlr.0000000000001614 |pmid=34524244 |issn=0025-7079|pmc=8428863 }}</ref> They now compete with large, traditional staffing agencies. In 2017, the National Health Service in the United Kingdom had begun trialling an app for nurses, for short-term placements.<ref>{{Cite magazine |title=The NHS is going to trial a gig economy app for nurses |url=https://www.wired.co.uk/article/nhs-app-nurses-flexible-working-jeremy-hunt-gig-economy |access-date=2024-01-24 |magazine=Wired UK |language=en-GB |issn=1357-0978}}</ref>
 
Some online healthcare staffing platforms, such as [[United States]]-based ConnectRN, Nomad Health, Gale Healthcare solutions or Lantum go beyond simply connecting nurses with jobs. They aim to couple staffing applications with fostering a community for nurses, offering resources, career development tools, and networking opportunities.<ref>{{Cite web |last1=Mayer |first1=Miguel Angel |last2=Rodríguez Blanco |first2=Octavi |last3=Torrejon |first3=Antonio |date=2019-06-26 |title=Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study (Preprint) |doi=10.2196/preprints.15195 |doi-access=free }}</ref>
 
== Nursing as a Science ==
{{Main article|Nursing research}}
Florence Nightingale's [[Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army|seminal epidemiological study]], examining mortality among British soldiers during the [[Crimean War]] had been published in 1858,{{sfn|Boswell|Cannon|2014|p=30–31}} but with the exception of her works, nursing was largely transferred as an oral tradition until the mid 20th century. The inaugural issue of ''[[Nursing Research]]'', the first scientific journal specialized in nursing, was released in 1952. During the 1960s, there was an increased interest in attaining PhDs among nurses in the US, but nursing science was still a fledgling area of research, with only a few journals in print until the 1970s.{{sfn|Watson|2021|loc=From Oral Tradition to Written Scholarship}} It has been increasingly argued that nursing research is a sub-discipline in its own right, although there is no prevailing definition of its distinct nature, and many scholars do not attempt giving one.{{sfn|Manhart Barrett|2017|p=129}} The question is further complicated by the numerous interpretations of what the defining nature of nursing itself is.{{sfn|Manhart Barrett|2002|p=51}}{{sfn|Mulhall|1998|p=4}}
 
=== Evidence-Based Practice ===
{{Main article|Evidence-based nursing|Evidence-based medicine}}
The need to integrate up-to-date scientific evidence into clinical practice, in order to achieve quality care has been increasingly recognized.{{sfn|Boswell|Cannon|2014|p=3–4}} This does not preclude the application of personal expertise, as well as adapting to the wants and needs of the client, especially in cases where scientific evidence is sparse, or not applicable to the specific situation.{{sfn|Boswell|Cannon|2014|p=3–8}} Common barriers to the study and integration of research findings into clinical decision making include: a lack of opportunity due to demanding working conditions, inexperience in assessing scientific material, and the rapid accumulation of new evidence.{{sfn|Mulhall|1998|p=4}}
 
Modern-day nursing was established by nurses sent to [[Mandatory Palestine]] and later Israel by the [[Hadassah Women's Zionist Organization of America|Hadassah]] organization, as well as at a nursing school founded by [[Henrietta Szold]] in 1918. The United Kingdom regulated midwifery in Mandatory Palestine, but nurses were not mentioned in the regulation decree.
== Nursing and Medicine ==
According to the traditional interpretation physicians are concerned with curing or treating medical conditions, while nurses focus on care. In healthcare settings this line is often blurred, and a more acute difference would be how nurses work in close proximity to their patients for longer periods of time.{{sfn|Mulhall|1998|p=4–5}}
 
== See also ==
{{Portal|Medicine}}
{{col div|colwidth=20em}}
*[[Advanced practice registered nurse]]
*[[Deaconess]]
Line 505 ⟶ 329:
*[[Nursing care plan]]
*[[Nursing ethics]]
*[[Nursing in Australia]]
*[[Nursing in Germany]]
*[[Nursing in Hong Kong]]
*[[Nursing in India]]
*[[Nursing in Islam]]
*[[Nursing in Japan]]
*[[Nursing in Kenya]]
*[[Nursing in Pakistan]]
*[[Nursing in Taiwan]]
*[[Nursing in the Philippines]]
*[[Nursing in the United States]]
*[[Nursing school]]
*[[Nurse stereotypes]]
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* {{cite book |date=2014 |edition=3rd |editor-last=Boswell |editor-first=Carol |editor2-last=Cannon |editor2-first=Sharon |isbn=9781449681968 |location=Burlington, MA |publisher=Jones & Bartlett Learning |title=Introduction to Nursing Research: Incorporating Evidence-based Practice}}<!-- auto-translated from Swedish by Module:CS1 translator -->
* {{Cite book |last=Eliopoulos |first=Charlotte |url=https://www.worldcat.org/title/265657164 |title=Gerontological Nursing |date=2010 |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |isbn=978-0-7817-5344-9 |edition=7th|location=Philadelphia |oclc=265657164}}
* {{cite book |date=2017 |edition=7th |editor=Joyce Newman, Giger |isbn=9780323399920 |language=engen |location=St. Louis, Missouri |publisher=Mosby/Elsevier |title=Transcultural Nursing: Assessment & Intervention}}<!-- auto-translated from Swedish by Module:CS1 translator -->
* {{Cite book |last1=Muñoz |first1=Cora C. |title=Transcultural Communication in Nursing |last2=Luckmann |first2=Joan |date=2005 |publisher=Thomson/Delmar Learning |isbn=978-0-7668-4877-1 |edition=2nd |location=Clifton Park, NY}}
* {{cite book |date=2012 |edition=6th International |first=Rose Marie |isbn=0132756234 |last=Nieswiadomy |location=Boston, Mass. |publisher=Pearson |title=Foundations of nursing research}}<!-- auto-translated from Swedish by Module:CS1 translator -->
* {{cite book |date=2014 |edition=8th |first=Denise F. |first2=Cheryl |isbn=9781451176797 |last=Polit |last2=Tatano Beck |location=Philadelphia |publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |title=Essentials of nursing research: appraising evidence for nursing practice}}<!-- auto-translated from Swedish by Module:CS1 translator -->
 
=== Journal articles ===
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