A nurse is 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 also provide care at birth and death. Nursing education, regulation, roles, and titles vary in different countries, but in general reflect an increasing level of responsibility and status. The nursing career structure does not vary 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. Nurses throughout the world are increasingly employed as advanced practice nurses, such as clinical nurse specialists and nurse practitioners, who diagnose health problems and prescribe medications and other therapies. At the top of the educational ladder is the doctoral-prepared nurse. Nurses may gain a PhD or another doctoral degree, specializing in research, clinical nursing, and so forth. 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. 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. Nursing assistants, orderlies, auxiliary nurses, healthcare assistants. These types of healthcare workers work both in acute and primary settings, under the supervision of registered nurses or licensed practical nurses (in the US). They assist nurses by giving basic care, taking vital signs, administering hygienic care, assisting with feeding, giving basic psychosocial care, housekeeping, and similar duties. See also hospital volunteers. Registration as a registered nurse now requires an associate degree at least, considered the foundation for any future specialization within nursing any other type of medical ways. Postgraduate diplomas provide further vocational training for specialist areas. Masters level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available. Australia has a long tradition of post-basic courses, usually of a six month (minor) or twelve month (major) duration, which included midwifery, maternal and child welfare, psychiatric, peri-operative ("theatre nursing"), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity. There are options available for hospital trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest. Enrolled nurses are trained in the "technical and further education" (TAFE) sector of approximately twelve months duration. In some states, this length has been increased to 18 months to result in diploma level qualification rather than certificate 4. All Enrolled nurse training courses now include a module that permits enrolled nurses to dispense oral, topical, enteral medications, and intramuscular and subcutaneous injections. In some areas of Australia NSW in particular Enrolled nurses are also allowed to administer intravenous medications via a peripheral cannula up to a schedule 4d. Most provinces in Canada prefer any registered nurse to have at least a bachelor's degree (preferably a Bachelor of Science in Nursing (BScN)), although Quebec grants RN status to graduates from CEGEP. Many practicing nurses are still college graduates, but those entering nursing now are required or encouraged to enter at the university level. The profession of nursing is regulated at the provincial and territorial level in keeping with the principles of professional regulation endorsed by the International Council of Nurses. The College of Nurses of Ontario regulates both RNs and RPNs in contrast to the other provinces and territories where RNs and LPNs are regulated by separate bodies. In the western provinces, psychiatric nurses are governed by distinct legislation. All registered nurses and nurse practitioners in the province of Alberta are expected to maintain their clinical competence in order receive an annual practice permit from the College and Association of Registered Nurses of Alberta which also sets standards for scope of practice and provides practice support. The Indian Nursing Council is the regulatory body for profession of nursing. A person practising nursing must be registered with the nursing council. For a person to be registered, he or she has to undergo and pass the prescribed course stipulated by the council. In India, diplomas, bachelor degrees (BSc Nursing) postgraduate degrees (MSc Nursing) and Doctorates (PhD) are offered. Nursing is self regulated in Ireland. The regulatory body is An Bord Altranais (The Nursing Board). The board was established under the 1950 Nurses Act and currently operates under the 1985 Nurses Act. a There are currently over 82,000 nurses registered by An Bord Altranais of which over 65,000 are on the active register ABA Statistics 2006. New Zealand originally had nurse education as a part of the hospital system, but, as early as the 1900s, post registration and post graduate programs of study for nurses were in existence. Reforms in the 1970s disestablished the original hospital-based schools and moved these into the tertiary education sector, namely polytechnics and universities. Within the hospital system were an array of titles and levels, which often focused upon clinical specialty rather than generic nursing knowledge. Today all nurses in New Zealand are educated to degree level via a three year, two semesters per annum, program, with an approximate 50/50 mix of theory to practice. All current students graduate as a registered comprehensive nurse. Legislation exists keeping the number of schools to no more than 21, although some schools run courses in more than one geographical location. Recently, attempts were made to reintroduce the title enrolled nurse with this causing some disagreement between trade unions, the registering body, and health providers.[4] Similarly the NCNZ caused minor controversy when they gave the title nurse practitioner trade mark status, thus preventing those with the title from using it. In order to become a nurse practitioner, the nurse must undertake an approved course of study and present a portfolio of evidence to NCNZ for approval. There are now approximately 20 NP's in New Zealand with a smaller number granted prescribing rights. New Zealand has historically provided many nurses for the global market place; the salaries in overseas countries (notably Australia, USA, United Kingdom and the Middle East) have proved attractive to NZ nurses. This has resulted in a drop in the number of NZ-educated nurses practicing within New Zealand; recently the flow has been decreased by a substantial pay award for hospital based nurses. This pay award was given to those employed within district health boards but not other public sector providers which caused a degree of conflict within the profession and a return to hospital practice for many in the primary healthcare sector. There has also been an increase in nurses from the United Kingdom, India, South Africa and Philippines migrating to New Zealand. A Professional Regulatory Nursing Board implements and enforces the Nursing Act. The board is composed of a chairperson and six additional members, all of whom are nurses with at least a master's degree and ten years of nursing experience. The board inspects nursing schools, conducts licensure examinations, issues and monitors certificates of licensure, promulgates a code of ethics, participates in recognizing nursing specialty organizations, and prescribes guidelines and regulations governing the profession under the Nursing Act. The South African Nursing Council (SANC) was created by the Nursing Act of 1957. Currently, it functions under the authority of the Nursing Act of 1978 and subsequent amendments. SANC inspects and approves nursing schools and education programs; examines, registers, and enrolls nurses, midwives, and nursing auxiliaries; licenses nursing agencies; and monitors nursing employers. Nurses and nursing auxiliaries are required to wear "distinguishing devices" consisting of pins and colored epaulettes to identify them as licensed professionals. To become a nurse within the United Kingdom, one must at the very minimum hold a Diploma in Nursing and have trained for three years, or two years on an 'accelerated' course, (or equivalent if from overseas). After training, the opportunities are vast, with many different areas of nursing, from general ward to teaching or management. Also the practise areas can be in hospital, or in the community or both. In addition to this, there are two levels of nurse: first-level nurses trained for three or four years (RGN, RMN, RSCN, RNMH, RNchild, RNadult, RNmental health, RN Learning Disability) whereas second-level nurses are the state enrolled nurses (SENs) who trained for two years. The SEN training has been phased out, with many SENs retiring or converting to level one through further study. Registered Nurses are able to undertake advanced practice training, commonly at advanced degree level to become specialist nurses in various fields, such as Emergency Nurse Practitioner. These nurses will have obtained, in addition to the basic registration with the NMC, an advanced recordable qualification. Nurses in the United Kingdom can also complete an Independent Prescriber course (of which there are various types at present) which legally permits them to prescribe drugs independently of a doctor. State enrolled nurse (SEN) These nurses are expected to perform to a lower level scope of practice, although in reality enrolled nurses often perform to a similar or higher level as staff nurses. Some areas specifically exclude aspects of practice such as the administration of medications. As such enrolled nurses are technically supposed to work under the supervision of an RN. There are various other higher managerial and specialist nurse roles; however these are less well defined on a national scale and very from country-to-country. Note, "sister" is becoming less used as a nurse title, but it was commonly used and preferred as a title in the past. Registered nurses (RNs) are professional nurses who often supervise the tasks performed by LPNs, orderlies, and nursing assistants. They provide direct care and make decisions regarding plans of care for individuals and groups of healthy, ill, and injured people. RNs are the largest healthcare occupation in the U.S. Doctorate of Nursing Practice (DNPs) advanced nursing degree. They focus more on evidence-based practice and systems leadership that has an immediate impact on the quality of healthcare delivery, rather than on developing programs of original research (as the traditional PhD program graduates do). Very few nurses are prepared at the doctoral level with the skills to transform the practice environment in an immediate way, so the professional opportunities for graduates of the DNP program will be extensive.
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