A nurse is a health care professional who is engaged in the practice of nursing. Nurses are men and women who are responsible (along with other health care professionals) for the treatment, safety and recovery of acutely or chronically ill or injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-clinical functions necessary to the delivery of health care.
Nurses develop a plan of care, sometimes working collaboratively with physicians, therapists, the patient, the patient’s family and other team members. In the U.S. (and increasingly the United Kingdom), advanced practice nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and other therapies. Nurses may help coordinate the patient care performed by other members of a health care team such as therapists, medical practitioners, dietitians, etc. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
According to the US Department of Labor’s revised Occupational Outlook Handbook (2000), “Registered nurses (R.N.s) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, responses, and progress; assist physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation. R.N.s also develop and manage nursing care plans; instruct patients and their families in proper care; and help individuals and groups take steps to improve or maintain their health.”
The nursing career structure varies considerably throughout the world. Typically there are several distinct levels of nursing practitioner, distinguished by increasing education, responsibility and skills. The major distinction is between task-based nursing and professional nursing.
In various parts of the world, the educational background for nurses varies widely. In some parts of Eastern Europe, nurses are high school graduates with twelve to eighteen months of training. In contrast, Chile requires any Registered Nurse to have at least a bachelor’s degree.
At the top of the educational ladder is the doctoral-prepared nurse. Nurses may gain the PhD or another doctoral degree such as Doctor of Nursing Science (DNSc) or Doctor of Nursing Practice (DNP), specializing in research, clinical nursing, etc. These nurses practice nursing, teach nursing and carry out nursing research. As the science and art of nursing has advanced, so has the demand for doctoral-prepared nurses.
Registered Nurses generally receive their basic preparation through one of three basic avenues:
Graduation from an Associate of Science in Nursing degree-granting nursing program (two to three years of college level study with a strong emphasis on clinical knowledge and skills) earning the degree of ASN/AAS or ADN in Nursing.
Graduation with a three-year (Diploma in Nursing) certificate from a hospital-based school of nursing (non-degree). Few of these programs remain in the U.S. and the proportion of nurses practicing with a diploma is rapidly decreasing.
Graduation from a university with a Bachelor of Science in Nursing (a four – five year program conferring the BSN/BN degree with enhanced emphasis on leadership and research as well as clinically-focused courses).
There are also special programs for “LPN to RN”, for people who hold undergraduate degrees in other disciplines, and for paramedics or military medics. Graduates of all programs, once licensed, are eligible for employment as entry-level staff nurses.
A typical course of study at any level typically includes such topics as:
Anatomy and physiology
Pharmacology and medication administration
Legal issues in nursing practice
All pathways into practice require that the candidate undergo clinical training in nursing. Care is delivered by the student nurses under academic supervision in the hospital and in other practice settings. Clinical courses typically include:
Adult medical-surgical nursing
While in clinical training, student nurses are identified by a special uniform to distinguish them from licensed professionals.
In many nursing programs in the United States, a computerized exam is given before, during and upon completion to evaluate the student and nursing program outcomes. This exam upon completion of the nursing program is done to measure a student’s readiness for the NCLEX-RN or NCLEX-PN state board licensure exam. The exam identifies strengths and weaknesses and provides the need for remediation prior to taking the state board exam. This is not a requirement of all nursing programs in the United States, but has increased its usage in the past three to four years.
It is common for RNs to seek additional education to earn a Master of Science in Nursing or Doctor of Nursing Science to prepare for leadership or advanced practice roles within nursing. Management and teaching positions increasingly require candidates to hold an advanced degree in nursing. Many hospitals offer tuition reimbursement or assistance to nurses who want to continue their education beyond their basic preparation.
Many nurses pursue voluntary specialty certification through professional organizations and certifying bodies in order to demonstrate advanced knowledge and skills in their area of expertise.
All U.S. states and territories require RNs to graduate from an accredited nursing program which allows the candidate to sit for the NCLEX-RN, a standardized examination administered through the National Council of State Nursing Boards. Successful completion of the NCLEX-RN is required for state licensure as an RN.
Nurses from other countries are required to be proficient in English and have their educational credentials evaluated by an association known as the Council of Graduates of Foreign Nursing Schools prior to being permitted to take the U.S. licensing exam.
Government regulates the profession of nursing to protect the public. In the U.S., the individual states have authority over nursing practice. The scope of practice is defined by legislative and regulatory laws which are administered by State Nursing Boards.
Many states have adopted the Model Nursing Practice Act and Model Nursing Administrative Rules created by the National Council of State Nursing Boards (NCSNB). In addition, many State Nursing Boards model their licensure requirements on the Uniform Core Licensure Requirements which set forth competency development and competency assessment principles.
Nurses may be licensed in more than one state, either by examination or endorsement of a license issued by another state. In addition, the states which have adopted the Nurse Licensure Compact allow nurses licensed in one of the states to practice in all of them through mutual recognition of licensure.