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Florence Nightingale, in her Notes on Nursing: What It Is and What It Is Not, defined nursing as having “charge of the personal health of somebody … and what nursing has to do … is to put the patient in the best condition for nature to act upon him.” The philosophy has been restated and refined since 1859, but the essence is the same. In the words of nursing theorist Virginia Henderson, nurses help people, sick or well, to do those things needed for health or a peaceful death that people would do on their own if they had the strength, will, or knowledge.
The most current definition that reflects the evolution of professional nursing is from the 2003 edition of the American Nurses Association's Nursing’s Social Policy Statement:
Registered Nurses manage all aspects of the nursing process and the delivery of patient and family centered care. Registered nurses work as patient advocates for the care and recovery of the sick and maintenance of their health. In their work as advocates for the patient, RNs use the nursing process to assess, plan, implement, and evaluate nursing care of the sick and injured. RNs are responsible for the provision of skilled nursing assessment, planning and care in order to maximize the comfort and health of patients and families.
What defines nursing and sets it apart from other health care professions, particularly medicine with which it has long been considered part and parcel? It is nurses’ focus – in theory and practice – on the response of the individual and the family to actual or potential health problems. Nurses are educated to be attuned to the whole person, not just the unique presenting health problem. While a medical diagnosis of an illness may be fairly circumscribed, the human response to a health problem may be much more fluid and variable and may have a great effect on the individual’s ability to overcome the initial medical problem. It is often said that physicians cure, and nurses care. In what some describe as a blend of physiology and psychology, nurses build on their understanding of the disease and illness process to promote the restoration and maintenance of health in their clients.
Nurses’ broad-based education and holistic focus positions them as the logical network of providers on which to build a true health care system for the future. An acknowledged realization that individuals have considerable responsibility for their personal health has driven an increasing recognition that there is a professional group, whose focus is education and practice, that can facilitate individuals efforts to reach their fullest health potential. This profession is that of registered nurses.
Credentials and Regulation Bodies
To achieve the RN title, an individual must graduate from a state-approved school of nursing—either a four-year university program, a two-year associate degree program, or a three-year diploma program—and pass a state RN licensing examination called the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
The four-year university-based Bachelor of Science in Nursing (BSN) degree provides the nursing theory, sciences, humanities, and behavioral science preparation necessary for the full scope of professional nursing responsibilities, and provides the knowledge based necessary for advanced education in specialized clinical practice, research, or primary health care. In 2005, 573 U.S. colleges and universities offer the BSN or advanced nursing degree.
- First two years – Most programs concentrate studies on psychology, human growth and development, biology, microbiology, organic chemistry, nutrition, and anatomy and physiology.
- Final two years – This is when many programs begin the focused nursing curriculum including adult acute and chronic disease; maternal/child health; pediatrics; psychiatric/mental health nursing; and community health nursing. Also, nursing theory, bioethics, management, research and statistics, health assessment, pharmacology, pathophysiology, and electives in complex nursing processes are covered.
Most often, supervised clinical practice is obtained during the last two years in hospitals, nursing homes, and community settings.
Associate Degree in Nursing (AND)
A two-year program granting an Associate Degree in Nursing (ADN) prepares individuals for a defined technical scope of practice. Set in the framework of general education, the clinical and classroom components prepares ADN nurses for nursing roles that require nursing theory and technical proficiency. Many RNs whose first degree is an ADN return to school during their working life to earn a bachelor’s degree or higher. In 2006, many students find the ADN program to be longer than 2 years, often 3 years or more. In 2005, Associate Degree programs were 58.9% of all U.S. basic programs.
Usually associated with a hospital, the Diploma in Nursing program combines classroom and clinical instruction, usually over three years. Although once a common educational route for RNs, diploma programs have diminished steadily—to 4 percent of all basic RN education programs in 2006—as nursing education has shifted from hospitals to academic institutions.
Upon graduation, an individual must pass the NCLEX-RN to obtain a license to practice registered nursing and use the RN title. State boards of nursing govern licensing requirements, set continuing education or competency requirements, and handle disciplinary actions against RNs. Once an RN, the nurse must practice following the requirements of the nurse practice act in the state in which they function as an RN.Pricing
Registered nurses can be found in hospitals, private practices, schools and residential care facilities. Often times costs for the nurses are built into the overall costs for treatments at those facilities.