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Introduction: The need for a new style of leadership

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However, nurse practitioners are permitted by most jurisdictions to practice independently in a variety of settings. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials , and many of the traditional regulations and provider roles are changing. Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family and other team members, that focuses on treating illness to improve quality of life.

In the United States and the United Kingdom, advanced practice nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and other therapies, depending on individual state regulations. Nurses may help coordinate the patient care performed by other members of a multidisciplinary health care team such as therapists, medical practitioners and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.

Nursing historians face the challenge of determining whether care provided to the sick or injured in antiquity was nursing care. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts. Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care. Phoebe , mentioned in Romans 16 has been described in many sources as "the first visiting nurse". The religious roots of modern nursing remain in evidence today in many countries.

One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse in the past. During the Reformation of the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Those nuns who had been serving as nurses were given pensions or told to get married and stay home.

The nursing profession suffered a major setback for approximately years. Florence Nightingale laid the foundations of professional nursing after the Crimean War. The Nightingale model of professional education, having set up the first school of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after Mary , St.

Francis Health Services, Inc. Formal use of nurses in the modern military began in the latter half of the nineteenth century. Hospital-based training came to the fore in the early s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and educational providers. Many nurses saw active duty in World War I , but the profession was transformed during the second World War.

British nurses of the Army Nursing Service were part of every overseas campaign. The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.

In the 19th and early 20th century, nursing was considered a women's profession, just as doctoring was a men's profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remains well below that of female physicians in the early 21st century. Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well, and in all settings.

Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery or to peaceful death that he would perform unaided if he had the necessary strength, will or knowledge. The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics , standards, and competencies, and continuing their education. Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees. In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as a RN.

The Associate Degree in Nursing ADN is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years.

After completing either the LPN or either RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination NCLEX test is a standardized exam including multiple choice, select all that apply, fill in the blank and "hot spot" questions that nurses take to become licensed.

It examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase. Some nurses follow the traditional role of working in a hospital setting. Other options include: pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics eHealth. There are many other options nurses can explore depending on the type of degree and education acquired. RNs may also pursue different roles as advanced practice nurses. Nurses are not doctors' assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses.

Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. Nurses will assist doctors in the emergency room or in trauma care when help is needed. Despite equal opportunity legislation, nursing has continued to be a female-dominated profession. Although females are more common, male nurses receive the same pay. Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected in consideration with the care setting and the population served.

In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research. In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.

Assisting in activities of daily living ADL are skills required in nursing as well as other professions such as nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination. Nurses do not have the authority to prescribe medications, although there are some exceptions.

All medications administered by nurses must be from a medication prescription from a licensed practitioner, such as a physician. Nurses are legally responsible for the drugs they administer. There may be legal implications when there is an error in a prescription, and the nurse could be expected to have noted and reported the error.

In the United States, nurses have the right to refuse any medication administration that they deem to be potentially harmful to the patient. The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits.

Nursing is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed. There are also specialist areas such as cardiac nursing , orthopedic nursing , palliative care , perioperative nursing , obstetrical nursing , oncology nursing , nursing informatics , telenursing and emergency nursing. Nurses practice in a wide range of settings, including hospitals, private homes , schools , and pharmaceutical companies.

Nurses work in occupational health settings [51] also called industrial health settings , free-standing clinics and physician offices, nurse-led clinics , long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate , Inc.

Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing , agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software. Internationally, there is a serious shortage of nurses. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions.

Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios. The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work , and high workload.

This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders , depression , mortality , psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress , which can worsen mental health. Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision. Nurses are also at risk for violence and abuse in the workplace. There are a number of interventions that can mitigate the occupational hazards of nursing.

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 defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses. Catholic religious institutes were influential in the development of Australian nursing, founding many of Australia's hospitals — the Irish Sisters of Charity were first to arrive in and established St Vincent's Hospital, Sydney in 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. A census in the s found several hundred nurses working in Western Australia during the colonial period of history, this included Aboriginal female servants who cared for the infirm. 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.

In 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 [60].

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. To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "Registered Nurse" can only be granted to those holding such registration. First-level nurses make up the bulk of the registered nurses in the UK. Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse.

Many have now either retired or undertaken conversion courses to become first-level nurses. Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles see above , this has become a less attractive option.

Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons. Currently, this involves completing a degree , available from a range of universities offering these courses , in the chosen branch specialty see below , leading to both an academic award and professional registration as a 1st level registered nurse.

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:.