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Nursing is a profession responsible for the ongoing care of the sick, injured, disabled, and dying. Nursing is also responsible in medical and community settings for promoting the health of individuals, families, and communities. Nurses play an active role in healthcare research, management, policy development, and patient advocacy. Nurses with postbaccalaureate training are self-sufficient in providing primary health care and speciality services to individuals, families, and communities.

Professional nurses work independently and collaboratively with other healthcare providers, such as physicians. Professional nurses supervise the work of licensed practical nurses (LPNs) in the United States and enrolled nurses (ENs) in Australia. Professional nurses also oversee nursing assistants in a variety of settings.

Nursing is the most numerous, diverse, and well-respected of all healthcare professions. There are over 2.9 million registered nurses in the United States alone, with many more millions worldwide. While accurate demographic representation remains elusive, nursing has a higher proportion of racial and ethnic minorities than other healthcare professions. Men, on the other hand, continue to be significantly underrepresented in some countries.

Nursing is still in high demand, and projections indicate that it will continue to rise. Advances in healthcare technology, rising patient expectations, and reorganization of healthcare systems necessitate an increase in highly educated professionals. This demand is also fueled by demographic changes, such as large ageing populations in many countries worldwide.

Nursing background
Although nursing predates the mid-nineteenth century, the history of professional nursing is traditionally associated with Florence Nightingale. Nightingale, the well-educated daughter of wealthy British parents, defied social conventions by pursuing a career as a nurse. Nursing strangers, whether in hospitals or at their homes, was not considered a respectable career for well-bred ladies, who were expected to nurse only sick family and intimate friends. In a radical departure from these views, Nightingale believed that well-educated women could dramatically improve the care of sick patients by applying scientific principles and providing informed education about healthy lifestyles. Furthermore, she believed that nursing provided an ideal independent calling with intellectual and social freedom for women, who had few other career options at the time.

Florence Nightingale was a nurse at the Barrack Hospital.
Florence Nightingale was a nurse at the Barrack Hospital.
During Britain’s Crimean War in 1854, Nightingale had the opportunity to put her beliefs to the test. Public opinion was stoked by newspaper reports that sick and wounded Russian soldiers nursed by religious orders fared far better than British soldiers. In response, the British government asked Nightingale to transport a small group of nurses to Scutari (modern-day Üsküdar, Turkey). Within days of their arrival, Nightingale and her nurses had reorganized the barracks hospital following 19th-century science: walls were scrubbed for sanitation, windows were opened for ventilation, nutritious food was prepared and served, and medications and treatments were administered efficiently. Within weeks, death rates had dropped dramatically, and soldiers were no longer sickened by infectious diseases caused by poor sanitary conditions. Within months, a grateful public had learned of the “Lady with the Lamp,” who made nightly rounds comforting the sick and injured. By the end of the nineteenth century, the Western world agreed with Nightingale on the value of educated nurses.

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Otis Nightingale’s achievements overshadowed other methods of nursing the sick. Stephen Girard, lithograph by A. Newsam after a portrait by B. For centuries, most sick care was provided at home by families, friends, and respected community members with reputations as effective healers. Men took on active nursing roles during epidemics such as cholera, typhus, and smallpox. For example, Stephen Girard, a wealthy French-born banker, won the hearts of Philadelphians for his courageous and compassionate nursing of yellow fever victims during the 1793 epidemic.

As cities and industries expanded, those without families to care for them found themselves in hospitals, where nursing care quality varied greatly. Some patients received outstanding care. Women from religious nursing orders were well-known for the high-quality nursing care they provided in the hospitals they founded. Other hospitals relied on recovering patients or hired men and women to provide nursing care. Sometimes the care was excellent, and sometimes appalling. The unreliability of hospital-based nursing care became a particular issue by the late nineteenth century when changes in medical practices and treatments necessitated competent nurses. Meeting hospital needs, physician desires, and women’s desire for meaningful work resulted in the birth of a new healthcare professional: the trained nurse.

Hospitals established their nurse training schools. Students provided the hospital with two or three years of skilled free nursing care in exchange for lectures and clinical instruction. This hospital-based educational model had far-reaching long-term consequences. It restricted nurse education to hospitals rather than colleges, a tie finally broken in the latter half of the twentieth century. The hospital-based training model reinforced segregation in society and the health care system. African American student nurses, for example, were barred from almost all American hospitals and training schools. They could only get training at African American hospitals’ schools. Most importantly, the hospital-based training model reinforced the cultural stereotype of nursing as a female occupation. Only a few hospitals provided training to keep men in traditional nursing roles.

Nonetheless, nurses transformed hospitals. In addition to providing skilled, compassionate care to patients, they created an orderly, routine, and systemized environment in which patients could heal. They were in charge of increasingly complex treatments and medication regimens. They kept the aseptic and infection-control protocols in place, allowing more complex and invasive surgeries to take place. Furthermore, they experimented with various nursing intervention models that humanized increasingly technical and impersonal medical procedures.

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Training nurses became increasingly important outside hospitals in the fight against infectious diseases. The newly discovered “germ theory” of disease (the knowledge that many illnesses were caused by bacteria) caused widespread concern in countries worldwide in the early twentieth century. Teaching methods of disease prevention, such as tuberculosis, pneumonia, and influenza, became the domain of visiting nurses in the United States and district nurses in the United Kingdom and Europe. These nurses cared for infected patients in their homes and taught families and communities how to prevent the infection from spreading. They were primarily dedicated to working with low-income and immigrant communities, which frequently lacked access to other healthcare services. The work of these nurses contributed to a significant decrease in the mortality and morbidity rates associated with infectious diseases in both children and adults.

At the same time, private-duty nurses, or independent contractors, care for sick people in their homes. These nurses did important clinical work and assisted families who could afford care. Still, the unregulated healthcare labour market exposed them to competition from untrained nurses and each year’s class of newly graduated trained nurses. Almost immediately, the supply of private-duty nurses exceeded the demand from families. Nurses in industrialized countries began forming professional associations around the turn of the twentieth century to establish standards that distinguished the work of trained nurses from that of assistive-nursing personnel and untrained nurses. More importantly, they successfully obtained licensing protection for registered nursing practice. Later, nurses in some countries turned to collective bargaining and labour organizations to help them assert their and their patients’ rights to improve conditions and provide quality nursing care.

By the mid-1930s, the growing technological and clinical demands of patient care, patients’ increasing need for intensive nursing, and the resulting movement of such care out of homes and into hospitals necessitated hospital staff of trained rather than student nurses. By the mid-1950s, hospitals had become the single largest employer of registered nurses. This trend continues, though, as healthcare system changes have reemphasized home care, a proportionately more significant number of nurses work in outpatient clinics, home care, public health, and other community-based healthcare organizations.

Poster from World War II
Poster from World War II
Other significant changes in nursing occurred in the second half of the twentieth century. The profession has become more diverse. In the United States, for example, the National Organization of Colored Graduate Nurses (NOCGN) successfully lobbied for the desegregation of the military nursing corps and nursing associations during World War II. The American Nurses Association (ANA) was one of the first national professional organizations to desegregate in 1949. As a result, the NOCGN dissolved in 1951, having achieved its objectives. However, by the late 1960s, some African American nurses believed that the ANA needed more time and resources to address their concerns adequately. The National Black Nurses Association (NBNA) was founded in 1971 as a sister organization to the American Nurses Association (ANA).

The educational structure of nursing has also changed. Dependence on hospital-based training schools has declined, and these schools have been replaced by collegiate programs at community, technical, or university colleges. Furthermore, more systematic and widespread graduate education programs began to emerge. These programs train nurses not only for management and education positions but also for clinical specialists and nurse practitioners. Nurses were no longer required to pursue doctorates in fields other than nursing. By the 1970s, nurses established doctoral programs focused on the nursing knowledge, science, and research required to address pressing nursing care and care-delivery issues.

Nurses responded to rising numbers of sick patients in the second half of the twentieth century by reorganizing their care patterns in novel ways. Critical care units in hospitals, for example, began when nurses began grouping their most critically ill patients to make better use of modern technology. Furthermore, experiments with progressive patient care and primary nursing models reemphasized the responsibility of one nurse for one patient, despite hospitals’ often-overwhelming bureaucratic demands on nurses’ time.

The nursing profession has also benefited from a greater emphasis on national and international work in developing countries and advocacy for healthy and safe environments. The World Health Organization (WHO) supports the international scope of nursing by recognizing nursing as the backbone of most healthcare systems worldwide.

The nursing profession
Nursing Practice scope
Nursing practice, according to the International Council of Nurses (ICN), “encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings.” National nursing associations further define the scope of nursing practice by establishing specific standards and codes of ethics. National and state agencies also govern the scope of nursing practice. These organizations work together to establish legal parameters and guidelines for nurses working as clinicians, educators, administrators, or researchers.

Nursing practice education
Nurses begin their careers as generalists. Individuals and families of all ages are cared for in their homes, hospitals, schools, long-term care facilities, outpatient clinics, and medical offices. Many countries require three to four years of university education for generalist practice, though this varies by country. In the United States, for example, nurses can enter generalist practice through a two-year community college program or a four-year college or university program.

At the master’s level, students are typically prepared for specialization in nursing or advanced nursing practice. Most master’s programs require a bachelor’s degree in nursing from a college or university. These programs emphasize illness assessment and management, pharmacology, health education, and supervised practice in speciality fields such as paediatrics, mental health, women’s health, community health, and geriatrics.

Nursing research preparation takes place at the doctoral level. Nursing knowledge, science, and research methods are emphasized in the coursework. The completion of the doctoral degree requires an original and substantive research study.

General nursing practice forms
Nursing practice in hospitals
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Hospital nursing is the most well-known type of nursing practice. However, there are many different types of practices within hospitals. Some nurses care for patients with diabetes or heart failure, while others care for patients before, during, and after surgery or in pediatric, psychiatric, or childbirth units. Nurses work in technologically advanced critical care units like intensive care or cardiac care. They work in emergency rooms, operating rooms, recovery rooms, and outpatient clinics. Nurses’ skilled care and comfort to patients and families are only a tiny part of their job. They also teach individuals and families how to manage illnesses or injuries at home while recovering. They teach patients how to cope with chronic conditions when necessary. The majority of hospital nurses are generalists. Advanced nursing degrees enable individuals to provide clinical oversight and consultation, work in management, and conduct patient-care research.

Nursing practice in community health
Various titles describe the work of nurses in community settings in community health nursing. Community health nurses have been referred to as district nurses, visiting nurses, public health nurses, home-care nurses, and community health nurses over the centuries and in various parts of the world. Today, the most common titles used by nurses focusing on promoting and protecting population health are community health nursing and public health nursing. Community health nursing practices are informed by nursing, social, and public health science knowledge. Providing needed health services to the most vulnerable and disadvantaged groups is central to community health nursing practice in many countries. Community health nurses work in various settings in the United States, such as state and local health departments, school health programs, migrant health clinics, neighbourhood health centres, senior centres, occupational health programs, nursing homes, and home care programs. Care at home is frequently regarded as the preferred care method for the sick. Home-care nurses today provide sophisticated, complex care in patient’s homes. Globally, home care is being investigated as a solution to the growing number of older adults needing assistance.

Nursing Practice in Mental Health
Mental health (or psychiatric) nursing cares for people experiencing emotional or stress-related problems. Nurses work with individuals, groups, and families in hospital inpatient units or outpatient mental health clinics. Advanced-practice mental health nurses also work in private practice to provide psychotherapy to individuals, groups, and families, consult with community organizations to provide mental health support and collaborate with other nurses in both inpatient and outpatient settings to meet the emotional needs of patients and families dealing with physical illnesses or injuries.

Vaccines for the care of children
Children’s nursing, also known as pediatric nursing, focuses on caring for infants, children, and adolescents. The care of families, the most crucial source of support in children’s lives, is also a critical component of child care. Pediatric nurses work to meet the average developmental needs of children and families while also treating the symptoms of serious illnesses or injuries. These nurses also promote children’s health through immunization programs, child abuse interventions, nutrition and physical activity education, and health-screening initiatives. Pediatric nurses, both generalist and specialist, work in hospitals, outpatient clinics, schools, day-care centres, and almost anywhere else children are found.

Women’s Healthcare
Women’s care has long been a nursing concern, particularly for childbearing and childrearing women (often referred to as maternal-child nursing). Nurses collaborated with national and local governments, private charities, and other concerned professionals as early as the 1920s to ensure that mothers and children received adequate nutrition, social support, and medical care. Later, nurses began collaborating with national and international organizations to ensure rights to adequate health care, human rights respect, protection from violence, access to quality reproductive health services, and nutritional and educational support. Women’s health generalists and specialist nurses work on obstetrical and gynaecological units in hospitals and in various outpatient clinics, medical offices, and policy boards. Many have particular expertise in osteoporosis, breastfeeding support, domestic violence, and women’s mental health issues.

Home-care nurse practice Geriatric nursing practice
Geriatric nursing is one of the most rapidly expanding areas of nursing practice. This expansion corresponds to demographic demand. In the United States, for example, projections indicate that longer life expectancies and the impact of the “baby boom” generation will significantly increase the number of people over the age of 65. Individuals over 65 accounted for approximately 13% of the total population in 2005; however, they are expected to account for nearly 20% of the total population by 2030. Furthermore, people over 65 use more health care and nursing services than any other demographic. The majority of nursing schools include geriatric nursing content in their curricula. All generalist nurses are increasingly prepared to care for elderly patients in various settings such as hospitals, outpatient clinics, medical offices, nursing homes, rehabilitation facilities, assisted living facilities, and individual homes. Specialists focus on more specific aspects of elder care, such as maintaining function and quality of life, providing mental health services, providing environmental support, managing medications, reducing the risks of problems such as falling, confusion, skin breakdown, and infections, and dealing with the ethical issues that come with frailty and vulnerability.

Nursing practice at the highest level
Licensed practical nurses
Nurse practitioners receive master’s degrees to provide various diagnostic and treatment services to individuals and families. This type of advanced nursing practice emerged in the 1960s in the United States, following the passage of healthcare legislation (Medicare and Medicaid) that guaranteed citizens over 65 and low-income citizens access to healthcare services. In response, some nurses obtained additional training and expanded their practice by taking on responsibility for diagnosing and treating common acute and stable chronic illnesses in children and adults in collaboration with physicians. Nurse practitioners began their careers in primary care settings, where they treated essentially healthy children with frequent colds, infections, or developmental issues, performed physical exams on adults, and worked with both individuals and families to ensure symptom stability in illnesses such as diabetes, heart disease, and emphysema. Nurse practitioners are now essential to primary health care, and their practice has expanded into speciality areas. Specialized nurse practitioners in emergency rooms, intensive care units, nursing homes, and medical practices frequently collaborate with physicians.

Clinical nursing experts
Clinical nursing specialists are educated at the master’s level in universities. Their clinical education focuses on specialities such as neurology, cardiology, rehabilitation, and psychiatry. Clinical nursing specialists can provide direct care to patients with complex nursing needs or consult with generalist nurses. Clinical nursing specialists also oversee continuing education programs for staff. Clinical nursing specialists typically work in hospitals and outpatient clinics, though some establish independent practices.

Midwives who work as nurses
Nurse midwives are rooted in the centuries-old tradition of at-home childbirth. Midwives, rather than obstetricians, have traditionally been the primary providers of care to pregnant women, and they continue to be so in many parts of the developed and developing world. In the 1930s, some nurses in the United States began combining their skills with midwives to offer birthing women alternatives to obstetrical care. Nurse-midwifery grew slowly, primarily serving poor and geographically disadvantaged women and their families. Beginning in the 1960s, the women’s movement created a surge in demand for nurse-midwives from women who desired both the naturalness of standard delivery and the safety of available technology if any problems arose. Nurse-midwives increased in the United States from fewer than 300 in 1963 to over 7,000 in 2007. Most nurse-midwives today receive master’s degrees from universities. Nurse midwives deliver nearly 300,000 babies each year, and unlike traditional midwives, who deliver in homes, they do so primarily in hospitals and formal birthing centres. Global demand for nurse-midwifery care is expected to skyrocket.

Anaesthetists who work as nurses
Nurse anaesthetists first practised in the late 1800s. Trained nurses, who were becoming more visible in operating rooms at the time, were in charge of administering anaesthesia and providing individualized patient monitoring for any reactions during surgical procedures. During World War I, nurse anaesthetists proved their worth as the sole anaesthesia providers in all military hospitals. Nurse anaesthetists are now well-established healthcare providers. They provide two-thirds of all anaesthesia services in the United States and are the sole providers of anaesthesia services in most rural American hospitals. Nurse anaesthetists receive postgraduate training in master’s programs in nursing schools or affiliated programs in departments of health sciences. They are used in operating rooms, obstetrical delivery suites, ambulatory surgical centres, and medical offices where anaesthesia is administered.
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