E.

The educational ladder

There are two basic educational options in a nursing career: practical (vocational) nursing
and registered nursing.
1. Practical/vocational nursing
During World War II, many nurses enlisted in the military. As a result, health care clinics
face a shortage of trained nurses. To fill the void expeditiously, abbreviated programs in
practical nursing were developed. The goal was to prepare graduates to care for the health
needs of infants, children, and adults who were mildly or chronically ill so that registered
nurses could be used effectively to care for acutely ill clients. Generally, this kind of nurses is
called by licensed practical nurses (LPN) or licensed vocation nurse (LVN).
LPN work under the supervision of a registered nurse, physician, or dentist. They provide
nursing care to clients with common health needs that have a predictable outcome.
2. Registered nursing
Registered nurses work under the direction of a physician or dentist in various health care
settings. They manage or provide direct care to clients who are stable but may have complex
health needs, or who are unstable with unpredictable outcomes. A person licensed as a
registered nurse may work directly at the bedside or supervise others in managing the
care of groups of clients. In USA, there are three paths for students who want to be registered
nurse, such as: a hospital-based program, an associate degree in nursing, or a baccalaureate
nursing program.
Nowadays, graduate nursing programs are available to enhance the skill of nurses not only
in practice and theory but also in education and research. This program offer master and
doctoral levels. Master’s-prepared nurses fill roles as clinical specialist, nurse practitioners,
administrators, and educators. Nurses with doctoral degrees conduct research and advise,
administer, and instruct nurses pursuing undergraduate and graduate degrees. Nurses are now
required to show proof of continuing education to renew their nursing license.
F. Future trends
growing of aging population with chronic health problems. Some factors contributing to
the nursing shortage include the following:
1. Increased aging population requiring health care,
2. Disappointing salaries for nurses with longevity employment,

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3. Job dissatisfaction as a result of stress and the unrelenting rigor of working in health care,
4. Heavier workloads and sicker clients, and many more.
G. Unique nursing skills
In keeping with Nightingale’s traditions, contemporary nursing practice continues to
include:
1. Assessment skills
Assessment skills are acts that involve collecting data. These skills include interviewing,
observing, and examining the client and in some cases the client’s family. At first, nurse must
determine the client’s needs and problems by using these skills.
2. Caring skills
Caring skills are nursing interventions that restore or maintain a person’s health. These
involve actions as simple as assisting with activities of daily living (ADLs). Nevertheless, the
nurse ultimately wants clients to become self-reliant to promote the client’s independence.
3. Counseling skills
Counseling skills are interventions that include communicating with clients, actively
listening during exchanges of information, offering pertinent health teaching, and providing
emotional support. A counselor is one who listens to a client’s needs, responds with
information based on his or her area of expertise, and facilitates the outcome that a client
desires. In these skills, nurses use therapeutic communication techniques to encourage verbal
expression. Nurses also use empathy (intuitive awareness of what the client is experiencing) to
perceive the client’s emotional state and need for support.
4. Comforting skills
Illness often causes feelings of insecurity that may threaten the client’s or family’s ability
to cope; they may feel vulnerable. Thus, the nurse uses comforting skills. Comforting skills are
interventions that provide stability and security during a health-related crisis. This
supportive relationship generally increases trust and reduces fear and worry.