hirtory of nursing

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Nursing

Nursing is ahealthcareprofessionfocused on the care of individuals, families, and communities so

they may attain, maintain, or recover optimalhealthandquality of lifefrom conception to death.

Nurseswork in a large variety ofspecialtieswhere they work independently and as part of a team to assess,

plan, implement and evaluate care. Nursing Science is a field of knowledge based on the contributions of

nursing scientist throughpeer-reviewedscholarly journalsandevidenced-based practice.

History of nursing

In fifth century BC,Hippocrateswas one of the first people in the world to study healthcare, earning

him the title of "the father of modern medicine".[1][2]Western European concepts of nursing were first practiced

by male Catholic monks who provided for the sick and ill during theDark Agesof Europe.

During 17th century Europe, nursing care was provided by men and women serving punishment. It was oftenassociated with prostitutes and other female criminals serving time[citation needed]. They had a reputation for being

drunk and obnoxious, a view amplified by the doctors of the time to make themselves seem more important

and able[citation needed]. It was not untilFlorence Nightingale, a well-educated woman from a wealthy class family,

became a nurse and improved it drastically that people began to accept nursing as a respectable profession.

Other aspects also helped in the acceptance of nursing. In 1853Theodore Fliednerset up a hospital where the

nurses he employed had to be of good nature. Many people were impressed with this facility, and because of it,

the British Institute of Nursing Sisters was set up.

Prior to the foundation of modern nursing,nunsand themilitaryoften provided nursing-like services.[3]The

religious and military roots of modern nursing remain in evidence today in many countries, for example in

theUnited Kingdom, senior female nurses are known as sisters. It was during time of war that a significant

development in nursing history arose whenEnglishnurseFlorence Nightingale, working to improve conditions

of soldiers in theCrimean War, laid the foundation stone of professional nursing with the principles summarised

in the bookNotes on Nursing. Other important nurses in the development of the profession include:Mary

Seacole, who also worked as a nurse in the Crimea;Agnes Elizabeth JonesandLinda Richards, who

established qualitynursing schoolsin theUSAandJapan, andLinda Richardswho was officially America's first

professionally trained nurse, graduating in 1873 from theNew England Hospital for Women and

ChildreninBoston.

New Zealandwas the first country to regulate nurses nationally, with adoption of theNurses Registration Acton

the 12 September 1901. It was here in New Zealand thatEllen Doughertybecame the firstregistered

nurse.North Carolinawas the first state in theUnited Statesto pass a nursing licensure law in 1903.[4]
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Nurses in the United States Army actually started during the Revolutionary War when a general suggested to

George Washington that the he needed female nurses "to attend the sick and obey the matron's orders. In July

1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients

and provided that a matron be allotted to every hundred sick or wounded".

Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that

nurses' primary purpose is to follow the direction of physicians.[5]This tendency is certainly not observed in

Nightingale's Notes on Nursing, where the physicians are mentioned relatively infrequently, and often in critical

tonesparticularly relating tobedside manner.[6]

The modern era has seen the development ofnursing degreesand nursing has numerousjournalsto broaden

the knowledge base of the profession. Nurses are often in key management roles within health services and

hold research posts atuniversities.

World War IIUnited States

As Campbell (1984) shows, the nursing profession was transformed by World War Two. The

profession contained a basic tension between the tender loving care provided sick people, on the one hand,

and the well-trained efficient specialists on the other was a historic tension in the nursing profession that was

partially resolved by the war. The military wanted well-trained efficient specialists. All the services used enlisted

men to handle the routine care of sick patients are wounded patients, and use their nurses as officers who

were trained specialists. In military units, male doctors supervised female nurses, and both were officers, while

the women in practice supervised large numbers of enlisted men. Although enlisted medic could become anofficer, it was not easy, and none could become a nurse. Indeed there were no male nurses in the American

military until years later. Army and Navy nursing was highly attractive and a larger proportion of nurses

volunteered for service higher than any other occupation in American society. The nation responded by a

dramatic increase in the numbers and functions of nurses, and a moderate modest increase in their pay scales,

with the expansion powered by the training of 200,000 nurses aides by the Red Cross, and the creation of a

temporary new government agency, the Cadet Nurse Corps, which enrolled 170,000 young women in speeding

up training programs in the nation's 1200 nursing schools. About 5% five percent of the Cadet nurses, and

Army nurses were black, but the Navy refused to accept black nurses until it was forced to admit a handful by

the White House near the end of the war. The black Army nurses were used in all-black units, handle and to

handle medical services for prisoners of war.[7][8]

The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films

as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the

Japanese,[9]but in practice they were kept out of harm's way, with the great majority stationed on the

homefront. However 77 were stationed in the jungles of the Pacific, where their uniform consisted of "khaki
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slacks, mud, shirts, mud, field shoes, mud, and fatigues."[10]The 20,000 nurses in Europe were safely behind

the lines. They had two missions one provide technical nursing services to military hospitals and second to train

and the male Army medics and male pharmacy mates in the Navy. These men handled frontline nursing care,

and also staffed homefront hospitals, where the nurses directly supervised them. The medical services were

large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were

men, with women doctors allowed only to examine the WAC. Forward medical units, were emergency surgery

was undertaken, was done without the benefit of nurses. Well behind the battlefield, the nurses worked in

evacuation hospitals, primarily in the role of supervising the medics and the Navys pharmacy mates. The

closer to the front, the more flexible and autonomous was the nurses role. The women wanted to be much

closer to the front, but they had too weak a voice to counter the Pentagons highly protective attitude.[11]

Down to 1942, the American Red Cross controlled access to the military. The Red Cross was controlled by

civilian men, professional experts and social work and fundraising. The new leaders emerging from the war had

learned command skills, maneuvering in complex bureaucracies, the taste of equal pay an officer status, and

autonomy within military medical system. New technical skills validated their demands for an autonomy as they

learned and employed in crisis situations the latest trauma and medical techniques and technologies. The

military nurses returned home as the nations experts in blood transfusion and the application of new drugs like

penicillin. When the nurses returned home they used the previously powerless American Nurses Association to

take control of the nursing profession.[11]

Britain

Military nursing had only a small role for women in Britain, where 10,500 nurses enrolled inQueen Alexandra's

Imperial Military Nursing Service(QAIMNS) and thePrincess Mary's Royal Air Force Nursing Service. These

services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were VAD nurses who had been

enrolled by the Red Cross.[12]

Germany

Germany had a very large and well organized nursing service, with three main organizations, one for Catholics,

one for Protestants, and the DRK (Red Cross). In 1934 the Nazis set up their own nursing unit, the Brown

nurses, and absorb one of the smaller groups, bringing it up to 40,000 members. It set up kindergartens,

hoping to seize control of the minds of the younger Germans, in competition with the other nursing

organizations. Civilian psychiatric nurses who were Nazi party members participated in the killings of invalids,

although the process was shrouded in euphemisms and denials.[13]

Military nursing was primarily handled by the DRK, which came under partial Nazi control. Frontline medical

services were provided by male medics and doctors. Red Cross nurses served widely within the military

medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks.
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Two dozen were awarded the highly prestigious Iron Cross for heroism under fire. They are among the 470,000

German women who served with the military.[14]

Definition

Although nursing practice varies both through its various specialities 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.

International Council of Nurses[15]

The use of clinical judgement 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.

Royal College of NursingUK[16]

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.

American Nurses Association[17]

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.

Virginia Avenel Henderson[18]

Nursing as a profession

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.[15]There are a number of educational paths to becoming a professional nurse, which vary greatly

worldwide, but all involve extensive study ofnursing theoryand practice, and training in clinical skills.
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Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in aholisticmanner

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.

In order to work in the nursing profession, all nurses hold one or more credentials depending on theirscope of

practiceandeducation. ALicensed practical nurse(LPN) (also referred to as a Licensed vocational nurse,

Registered practical nurse, Enrolled nurse, and State enrolled nurse) works independently or with aRegistered

nurse. The most significant differentiation between an LPN and RN is found in the requirements for entry to

practice, which determines entitlement for their scope of practice, for example in Canada an RN requires a

bachelors degree and a LPN requires a 2 year diploma. A Registered nurse (RN) provides scientific,

psychological, and technological knowledge in the care of patients and families in many health care settings.

Registered nurses may also earn additionalcredentialsordegrees.

RNs may also pursue different roles asadvanced practice registered nurses.

Nurses may follow their personal and professional interests by working with any group of people, in any setting,

at any time. Some nurses follow the traditional role of working in a hospital setting.

Around the world, nurses have been traditionally female. Despite equal opportunity legislation nursing has

continued to be a female dominated profession.[19]For instance, in Canada and America the male-to-female

ratio of nurses is approximately 1:19.[20][21]This ratio is represented around the world. Notable exceptions

include:Francophone Africa, which includes the countries ofBenin,Burkino

Faso,Cameroon,Chad,Congo,Ivory Coast, theDemocratic Republic of

Congo,Djibouti,Guinea,Gabon,Mali,Mauritania,Niger,Rwanda,Senegal, andTogo, which all have more

male than female nurses.[22]In Europe, in countries such as Spain, Portugal,Czechoslovakia, and Italy, over

20% of nurses are male.[22]

Regulation of practice

The practice of nursing is governed by laws that define ascope of practice, generally mandated by the

legislature of the country or area within which the nurse practices. Nurses are held legally responsible and

accountable for their practice. Thestandard of careis that of the "prudent nurse."

Nursing theory and process

Nursing practice is the actual provision of nursing care. In providing care, nurses implement thenursing care

planusing thenursing process. This is based around a specificnursing theorywhich is selected based on the

care setting and population served. In providing nursing care, the nurse uses bothnursing theoryand best

practice derived fromnursing research.
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In general terms, thenursing processis the method used toassessanddiagnoseneeds,planoutcomes and

interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines,

the profession has developed differenttheoriesderived from sometimes diverse philosophical beliefs

andparadigmsorworldviewsto help nurses direct their activities to accomplish specific goals.

Practice settings

Nurses practice in a wide range of settings, fromhospitalsto visiting people in theirhomesand caring for them

inschoolsto research inpharmaceutical companies. Nurses work inoccupational healthsettings (also called

industrial health settings), free-standing clinics and physician offices,nurse-led clinics,long-term carefacilities

and camps. They also work oncruise shipsand inmilitary service. Nurses act as advisers and consultants to

thehealth careand insurance industries. Many nurses also work in thehealth advocacyandpatient

advocacyfields at companies such asHealth Advocate, Inc. helping in a variety of clinical and administrative

issues.[23]Some areattorneysand others work with attorneys aslegal nurse consultants, reviewing patient

records to assure that adequate care was provided and testifying in court. 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 nursingor travel nursing. Nurses work as researchers inlaboratories,universities,

andresearch institutions. Nurses have also been delving into the world of informatics, acting as consultants to

the creation of computerized charting programs and other software.

Work environment

Internationally, there is a serious shortage of nurses.[24]One reason for this shortage is due to the work

environment in which nurses practice. In a recent review of the empirical human factors and ergonomicliterature specific to nursing performance, nurses were found to work in generally poor environmental

conditions. DeLucia, Ott, & Palmieri (2009)[25]concluded, "the profession of nursing as a whole is overloaded

because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of

patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive

overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual

overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient

lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work

hours and patient handling demands which leads to a high incidence ofMSDs. In short, the nursing work

system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to

determine how these overloads can be reduced and how the limits and capabilities of performance can be

accommodated. Ironically, the literature shows that there are studies to determine whether nurses can

effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such

tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When

reducing the overload, it should be kept in mind that underloads also can be detrimental to performance
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(Mackworth, 1948). Both overloads and underloads are important to consider for improving

performance."[25]Each county/ state in which a nurse is licenced has laws concerning how many patients one

nurse can tend to(depending on the accuity of the patients needs).

Nursing worldwide

Throughout the world nurses are known to be caring individuals that people look for as someone to advocate

for the sick and provide empathy towards the needy.

United Kingdom

To practice lawfully as a registered nurse in theUnited Kingdom, the practitioner must hold a current and valid

registration with theNursing and Midwifery Council. The title "Registered Nurse" can only be granted to those

holding such registration. This protected title is laid down in the Nurses, Midwives and Health Visitors Act,

1997.[26]

First level Nurses

First level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles

such as RGN (registered general nurse), RSCN (registered sick children's nurse), RMN (registered mental

nurse) , RNMH (registered nurse (for the) mentally handicapped).

The titles used now are similar and with slight differences i.e. RNA (registered nurse adult), RNC (registered

nurse child), RNMH (registered nurse mental health), RNLD (registered nurse learning disabilities).

Second level nurse training is no longer provided, however they are still legally able to practice in the United

Kingdom as a nurse. Many have now either retired or undertaken conversion courses to become first level

nurses. They are entitled to refer to themselves as Registered Nurses as their registration is on the Nursing &

Midwifery Council register of nurses.

They split into several major groups:

Nurse practitioners - These nurses obtain a minimum of a Master of Science in Nursing or a doctoral

degree. They often perform roles similar to those of physicians and physician assistants, they can

prescribe medications as independent or supplementary prescribers. Most NP's have referral and

admission rights to hospital specialities. They commonly work inprimary care(e.g. GP surgeries),A&E

departments, or pediatrics although they are increasingly being seen in other areas of practice. The title

"nurse practitioner" is legally protected, except in the State of Tennessee. * Specialist community public

health nurses - traditionallydistrict nursesandhealth visitors, this group of research and publication

activities.

Lecturer-practitioners - these nurses work both in the NHS, and inuniversities. They typically work for 2

3 days per week in each setting. In university, they train pre-registration student nurses (see below), and
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often teach on specialist courses for post-registration nurses * Lecturers - these nurses are not employed

by the NHS. Instead they work full time in universities, both teaching and performing research.

Managers

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 organisations, some even

as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse

managers ormodern matrons.

Nurse education

Pre-registration

In order to become a registered nurse, and work as such in the NHS, one must complete a program recognized

by theNursing and Midwifery Council. Currently, this involves completing adegreeordiploma, available from a

range ofuniversities 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. Such a course is a 50/50 split of

learning inuniversity(i.e. through lectures, essays and examinations) and in practice (i.e. supervised patient

care within a hospital or community setting).

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. The remainder of the

program consists of training specific to the student's chosen branch of nursing. These are:

Adult nursing.

Child nursing.

Mental health nursing.

Learning disabilities nursing.

As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in England to hold a degree

qualification.

[27]

Midwiferytraining is similar in length and structure, but is sufficiently different that it is not considered a branch

of nursing. There are shortened (18 month) programmes to allow nurses already qualified in the adult branch to

hold dual registration as a nurse and a midwife. Shortened courses lasting 2 years also exist for graduates of

other disciplines to train as nurses. This is achieved by more intense study and a shortening of the common

foundation program.[28]
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Student nurses currently receive abursaryfrom the government to support them during their nurse training.

Diploma students in England receive a non-means-tested bursary of around 6000 per year (with additional

allowances for mature students or those with dependent children), whereas degree students have their bursary

means tested (and so often receive less). Degree students are, however, eligible for a proportion of the

government'sstudent loan, unlike diploma students. InScotland, however, all student nurses regardless of

which course they are undertaking, receive the same bursary in line with the English diploma amount.

InWalesonly the Degree level course is offered and all nursing students therefore receive a non-means-tested

bursary.

Before Project 2000, nurse education was the responsibility of hospitals and was not based in universities;

hence many nurses who qualified prior to these reforms do not hold an academic award.

Post-registration

After the point of initial registration, there is an expectation that all qualified nurses will continue to update their

skills and knowledge. TheNursing and Midwifery Councilinsists on a minimum of 35 hours of education every

three years, as part of its post registration education and practice (PREP) requirements.[29]

There are also opportunities for many nurses to gain additional clinical skills after

qualification.Cannulation,venepuncture,intravenous drug therapyandmale catheterisationare the most

common, although there are many others (such asadvanced life support) which some nurses will undertake.

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part

time. Many nurses prefer this option to gaining a degree initially, as there is often an opportunity to study in a

specialist field as a part of this upgrading. Financially, in England, it is also much more lucrative, as diplomastudents get the full bursary during their initial training, and employers often pay for the degree course as well

as the nurse's salary.[30]

In order to become specialist nurses (such as nurse consultants, nurse practitioners etc.) or nurse educators,

some nurses undertake further training above bachelors degree level.Masters degreesexist in various

healthcare related topics, and some nurses choose to study forPhDsor other higher academic awards.District

nursesandhealth visitorsare also considered specialist nurses, and in order to become such they must

undertake specialist training (often in the form of a top up degree (see above) or post graduate diploma).

All newly qualifyingdistrict nursesandHealth Visitorsare trained to prescribe from theNurse Prescribers'

Formulary, a list of medications and dressings typically useful to those carrying out these roles. Many of these

(and other) nurses will also undertake training in independent and supplementary prescribing, which allows

them (as of May 1, 2006) to prescribe almost any drug in theBritish National Formulary. This has been the

cause of a great deal of debate in both medical and nursing circles.[31]

Canada
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ki/Student_loanhttp://en.wikipedia.org/wiki/Bursary


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History

Canadian nursing dates all the way back to 1639 inQuebecwith the Augustine nuns.[32]These nuns were

trying to open up a mission that cared for the spiritual and physical needs of patients. The establishment of this

mission created the first nursing apprenticeship training inNorth America.[32]In the nineteenth century there

were some Catholic orders of nursing that were trying to spread their message acrossCanada. Most nurses

were female and only had an occasional consultation with a physician. Towards the end of the nineteenth

century hospital care and medical services had been improved and expanded. Much of this was due

toFlorence Nightingalewho was training women in English Canada. In 1874 the first formal nursing training

program was started at the General and Marine Hospital in St. Catharines inOntario.[32]Many programs

popped up in hospitals across Canada after this one was established. Graduates and teachers from these

programs began to fight for licensing legislation, nursing journals, university training for nurses, and for

professional organizations for nurses.

The first instance of Canadian nurses and the military was in 1885 with theNorthwest Rebellion. Some nurses

came out to aid the wounded. In 1901 Canadian nurses were officially part of theRoyal Canadian Army

Medical Corps.[32]Georgina Fane Pope and Margaret Clothilde Macdonald were the first nurses officially

recognized as military nurses.[32]Nursing continued to expand and develop. In the early twentieth century more

nursing programs were developed for public health nursing and disease prevention. More changes occurred

afterWorld War II. The health care system expanded and medicare was introduced. Currently there are

260,000 nurses inCanadabut they face the same difficulties as most countries. Nurses are becoming more

scarce and the population is aging which requires more nursing care.

Education

All Canadian nurses and prospective nurses are heavily encouraged by theCanadian Nurses Associationto

continue their education to receive aBaccalaureate degree. They believe that this is the best degree to work

towards because it results in better patient outcomes. In addition to helping patients, nurses that have

aBaccalaureate degreewill be less likely to make small errors because they have a higher level of education.

ABaccalaureate degreealso gives a nurse a more critical opinion which gives he or she more of an edge in the

field. This ultimately saves the hospital money because they deal with less problematic incidents. All Canadian

provinces except for theYukonandQuebecrequire that all nurses must have aBaccalaureate degree.[32]The

basic length of time that it takes to obtain aBaccalaureate degreeis four years. However,Canadadoes have a

condensed program that is two years long.[32]

There are nineteen specialties that a nurse could choose from if he or she wanted to narrow down his or her

field. According to theCanadian Nurses Associationsome of those specialties are Cardiovascular Nursing,

Community Health Nursing,Critical Care Nursing, Emergency Nursing, Gerontology Nursing, Medical-Surgical

Nursing, Neuroscience Nursing, Oncology Nursing,Orthopedic Nursing, Psychiatric/Mental Health Nursing,
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.wikipedia.org/wiki/Canadahttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/North_Americahttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Quebec


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and Rehabilitation Nursing.[32]Each specialty requires its own test and competencies. Many tests are offered

online through theCanadian Nurses Association.

Public Opinion

Canadian nurses hold a lot of responsibility in the medical field and are considered vital. According totheCanadian Nurses Association, "They expect RNs to develop and implement multi-faceted plans for

managing chronic disease, treating complex health conditions and assisting them in the transition from the

hospital to the community. Canadians also look to RNs for health education and for strategies to improve their

health. RNs assess the appropriateness of new research and technology for patients and adjust care plans

accordingly". It is rather uncommon to see nurses with this much independence. In most countries nurses

appear to be considered lesser than a physician like in theUnited StatesorJapan.

Japan

History

Nursing was not an established part of Japan's healthcare system until 1899 with the Midwives

Ordinance.[32]From there the Registered Nurse Ordinance came into play in 1915. This established a legal

substantiation to registered nurses all overJapan. A new law geared towards nurses was created duringWorld

War II. This law was titled the Public Health Nurse, Midwife and Nurse Law and it was established in 1948.[32]It

established educational requirements, standards and licensure. There has been a continued effort to improve

nursing inJapan. In 1992 the Nursing Human Resource Law was passed.[32]This law created the development

of new university programs for nurses. Those programs were designed to raise the education level of the

nurses so that they could be better suited for taking care of the public.

Types of Nurses

Japanonly recognizes four types of nursing and they are Public Health Nursing,Midwifery, Registered Nursing

and Assistant Nursing.

Public Health Nursing

This type of nursing is designed to help the public and is also driven by the public's needs. The goals of public

health nurses are to monitor the spread of disease, keep vigilant watch for environmental hazards, educate the

community on how to care for and treat themselves, and train for community disasters.

Midwifery

Nurses that are involved with midwifery are independent of any organization. Amidwifetakes care of a

pregnant woman during labor and postpartum. They assist with things like breastfeeding and caring for the

child.

Assistant Nursing
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Individuals who are assistant nurses follow orders from a registered nurse. They report back to the licensed

nurse about a patient's condition. Assistant nurses are always supervised by a licensed registered nurse.

Nursing Education

In 1952Japanestablished the first nursing university in the country.

[32]

AnAssociate Degreewas the only levelof certification for years. Soon people began to want nursing degrees at a higher level of education. Soon

theBachelors Degree in Nursing(BSN) was established. CurrentlyJapanoffersdoctoratelevel degrees of

nursing in a good number of its universities.

There are three ways that an individual could become a registered nurse in Japan. After obtaining a high

school degree the person could go to a nursing university for four years and earn a Bachelor degree, go to a

junior nursing college for three years or go to a nursing school for three years.[32]Regardless of where the

individual attends school they must take the national exam. Those who attended a nursing university have a bit

of an advantage over those who went to a nursing school. They can take the national exam to be a registered

nurse, public health nurse or midwife. In the cases of become a midwife or a public health nurse, the student

must take a one year course in their desired field after attending a nursing university and passing the national

exam to become a registered nurse. The nursing universities are the best route for someone who wants to

become a nurse inJapan.[32]They offer a wider range of general education classes and they also allow for a

more rigid teaching style of nursing. These nursing universities train their students to be able to make critical

and educated decisions when they are out in the field. Physicians are the ones who are teaching the potential

nurses because there are not enough available nurses to teach students. This increases the dominance that

physicians have over nurses.

Students that attend a nursing college or just a nursing school receive the same degree that one would who

graduated from a nursing university, but they do not have the same educational background. The classes

offered at nursing colleges and nursing schools are focused on more practical aspects of nursing. These

institutions do not offer many general education classes, so students who attend these schools will solely be

focusing on their nursing educations while they are in school. Students who attend a nursing college or school

do have the opportunity to become amidwifeor a public health nurse. They have to go through a training

institute for their desired field after graduating from the nursing school or college.[32]Japanese nurses never

have to renew their licenses. Once they have passed their exam, they have their license for life.[32]

Nursing in Japan Today

Like the United States, Japan is in need of more nurses. The driving force behind this need this is the fact that

country is aging and needs more medical care for its people. The country needs a rapid increase of nurses

however things do not seem to be turning around. Some of the reasons that there is a shortage are poor

working conditions, an increase in the number of hospital beds, the low social status of nurses, and the cultural

idea that married women quit their jobs for family responsibilities.[32]On average, Japanese nurses will make
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around 280,000yena year, which is one of the higher paying jobs. however, physicians make twice the

amount that nurses do in a year.[32]Similar to other cultures, the Japanese people view nurses as subservient

to physicians. They are considered lesser and oftentimes negative connotations are associated with nurses.

According to theAmerican Nurses Associationarticle onJapan, "nursing work has been described using

negative terminology such as "hard, dirty, dangerous, low salary, few holidays, minimal chance of marriage and

family, and poor image".

Some nurses in Japan are trying to be advocates. They are promoting better nursing education as well as

promoting the care of the elderly. There are some organizations that unite Japanese nurses like theJapanese

Nursing Association(JNA). The JNA is not to be confused with a union, it is simply a professional organization

for the nurses. Members of the JNA lobby politicians and produces publications about nursing. According to the

American Nurses Association's article on Japan the JNA, "works toward the improvement in nursing practice

through many activities including the development of a policy research group to influence policy development, a

code of ethics for nurses, and standards of nursing practice". The JNA also provides certification for specialists

in mental health, oncology and community health.[32]JNA is the not the only nursing organization in Japan.

There are other subgroups that are typically categorized by the nurses' specialty, like emergency nursing or

disaster nursing. One of the older unions that relates to nursing is the Japanese Federation of Medical Workers

Union which was created in 1957.[32]It is a union that includes physicians as well as nurses. This organization

was involved with the Nursing Human Resource Law[32].

Nurses and Physicians

As stated earlier, nurses are considered to be subservient to physicians. The public sees nurses as simply

assisting the physicians with whatever they need. It is true that the majority of the time nurses are just helping

out the physicians, which takes away from time that could be spent tending to patients. However nurses that

have higher levels of education like public health nurses or midwives have more independence than a

registered nurse. Many nurses are desiring more education which could result in more independence overall for

Japanese nurses.

United States

The scope of practice of registered nurses is the extent to and limits of which an RN may practice. In theUnited

States, these limits are determined by a set oflawsknown as the Nurse Practice Act of thestateor territory in

which an RN is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually

the making of such rules and regulations is delegated to a stateboard of nursing, which performs day-to-day

administration of these rules, qualifies candidates for licensure, licenses nurses and nursing assistants, and

makes decisions on nursing issues. It should be noted that in some states the terms "nurse" or "nursing" may

only be used in conjunction with the practice of a Registered Nurse (RN) orlicensed practical or vocational

nurse(LPN/LVN).
http://en.wikipedia.org/wiki/Yenhttp://en.wikipedia.org/wiki/Yenhttp://en.wikipedia.org/wiki/Yenhttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/American_Nurses_Associationhttp://en.wikipedia.org/wiki/American_Nurses_Associationhttp://en.wikipedia.org/wiki/American_Nurses_Associationhttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/Lawshttp://en.wikipedia.org/wiki/Lawshttp://en.wikipedia.org/wiki/Lawshttp://en.wikipedia.org/wiki/U.S._statehttp://en.wikipedia.org/wiki/U.S._statehttp://en.wikipedia.org/wiki/U.S._statehttp://en.wikipedia.org/w/index.php?title=Board_of_nursing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Board_of_nursing&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=Board_of_nursing&action=edit&redlink=1http://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/wiki/Licensed_Practical_Nursehttp://en.wikipedia.org/w/index.php?title=Board_of_nursing&action=edit&redlink=1http://en.wikipedia.org/wiki/U.S._statehttp://en.wikipedia.org/wiki/Lawshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/United_Stateshttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Japanese_Nursing_Associationhttp://en.wikipedia.org/wiki/Japanhttp://en.wikipedia.org/wiki/American_Nurses_Associationhttp://en.wikipedia.org/wiki/Nursing#cite_note-test-31http://en.wikipedia.org/wiki/Yen


14/17

The scope of practice for a registered nurse is wider than for an LPN/LVN because of the level and content of

education as well as what the Nurse Practice Act says about the respective roles of each.

In the hospital setting, registered nurses are often assigned a role in which they delegate tasks to LPNs

andunlicensed assistive personnel.

RNs are not limited to employment as bedside nurses. Registered nurses are employed

byphysicians,attorneys

hirtory of nursing

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