Nurses come in all shapes and sizes, with wildly varied skills and specialities and differing levels of education and training. It is important for the practicing nurse to understand the differences between each level of nurse, and understand the associated level of education that nurse has received.
Nurses have received increasing levels of continued education to fill gaps in the healthcare system, and alongside these continued training systems, new advanced practice roles have developed for the nurse to deliver ever increasingly complex care to their patient, allowing them to better support them through their recovery and promote healthier outcomes.
The Registered Nurse
Typically when we think of a nurse we imagine the Registered Nurse, as they are able to practice independently and possess a vast array of skills with a deep underpinning knowledge of the human body and its systems. The Registered Nurse, otherwise known as the RN, has received formal tertiary education in nursing theory and practical skills, and has met the requirements for registration as outlined by their local governing body. RN’s have an expanded scope of practice and are usually endorsed by a professional body, and governed by healthcare legislation. The ongoing registration of the Registered Nurse is usually dependent on the nurse receiving ongoing learning and maintaining an up-to-date knowledge of the current healthcare policies and practices, and attend various seminars and conferences to maintain their clinical knowledge.
Registered nurses are employed in all fields of nursing, from general medical-surgical wards, to emergency and critical care units, through to operating theaters and even mental health. This broad range of skills is due to the RN’s ability to specialise in a particular area of interest to them, honing and developing their skills in their chosen field.
The RN is often the highest nursing authority on shift, particularly in aged care and community health settings, and as such, they are often responsible for supervising care delivered by the rest of the healthcare team including enrolled nurses, nursing assistants and nursing students.
The title of Registered Nurse is a protected title in most countries and protected under law. This allowed nurses to align themselves with a consistent professional standard through uniform education requirements, whilst protecting their title from under-skilled and fraudulent nurses.
Since the early 1990’s, education requirements for registration as an entry-level RN have generally been defined as a minimum of bachelor degree level for most countries. These degrees can vary from accelerated 2-year programs, to four-year programs. Some institutions have combined the nursing degree into complementary skill sets in the form of double degrees, such as a dual degree in nursing and paramedic science, or nursing and psychology. Undergraduate nurses or student registered nurses may be denoted with the title of sRN (student Registered Nurse)
The registered nurse is required to balance many varied and complex facets of a patient and their condition, and as such, are required to study complex body systems. They achieve this knowledge through intensive study of all areas of the provision of healthcare, from human anatomy and physiology, through to pharmacology, medical terminology, health law and ethics, mental health, critical thinking, pathophysiology, health assessment, as well as practical training in complex medical procedures.
The Enrolled Nurse
Enrolled nurses care for sick and injured patients, usually under the supervision of the registered nurse and often provide basic bedside care. Enrolled nurses are able to measure patients vital signs, assist patients with activities of daily living, personal hygiene, bathing, dressing, ambulation, and feeing where appropriate.
Although Enrolled Nurses are able to measure vital signs, they are generally not qualified to interpret the results and should report adverse findings the registered nurse immediately, otherwise record and document their findings in the patient chart.
Enrolled nurses generally must be registered with the governing body the same as registered nurses, however, enrolled nurses often hold Diploma level or associates degree qualifications and do not study as intensive theory-based training as the registered nurse, focussing more on practical skills instead of deep understandings of body systems and physiology.
Due to an increased shortage of registered nurses, enrolled nurses have often required to step up and fill the gaps, leading to the creation of the Endorsed Enrolled Nurse.
The Endorsed Enrolled Nurse
Endorsed Enrolled Nurses are Enrolled Nurses who have completed additional training in medication administration. EEN’s may administer most medications via all routes except intravenous, epidural, intraventricular and intrathecal. Although able to administer medications, many medications still require the registered nurse to check and verify the drug prior to administration by an EEN.
The Assistant in Nursing (AIN)
Assistant in Nursing, also known as AIN’s are employees of the facility who work under the direction of the registered nurse to assist in the provision of nursing duties. AIN’s can also be called Personal care attendants (PCA’s), Aged Care workers (ACW’s) and Care Support Staff (CS).
The AIN operates with a restricted scope of practice but will generally assist the RN or EN with patient care activities, or activities of daily living, personal hygiene and mobilising/repositioning patients.
AIN’s have generally received limited training and hold a certificate level qualification, typically in aged care, for a duration of 5-6 months. AIN’s are not allowed to administer medications, or assist in the preparation of any medications.
The Clinical Nurse
A Clinical nurse is a registered nurse with expanded specialist training in their area of practice, combined with several years of experience in that speciality.
Due to their additional training, the clinical nurse will have an expanded scope of practice, allowing them to perform advanced clinical skills and procedures, whilst acting as a resource for other RN’s who may have any questions or other concerns.
Due to their seniority, Clinical nurses are also often involved in managerial tasks, such as scheduling and shift coordination in order to meets the patients needs, investigating and rectifying issues of professional misconduct of other nurses, actively liaise with the NUM and CNC to monitor staff to ensure compliance with policies and procedures.
The Nurse Practitioner
A nurse practitioner is an advanced practice nurse authorised to operate autonomously with other disciplines within the healthcare team. They are often granted diagnostic and referral rights along with the right to prescribe medications to patients under their care.
After a satisfactory period of practice as a registered nurse (usually more than 5 years), Nurse practitioners will undertake advanced postgraduate training and will usually graduate with a masters degree or higher, attending an additional 2 years of study to achieve an autonomous scope of practice.
The nurse practitioner role was originally introduced to fill the shortage of physicians in rural and remote areas where it was difficult to secure and retain doctors. To combat this, the registered nurse was trained to perform many of the diagnostic and prescribing duties of the doctor, and given the authority to operate autonomously, however, this expanded scope was met with resistance from the physician community, and remains a point of contention today. Since then, the nurse practitioner role has expanded to urban areas and they can often be seen working in major hospitals in more populated areas now.
The nurse practitioner is considered the highest level of clinical skills for a nurse, with any further career advancement likely to take them away from the clinical setting, into executive and managerial roles.
Nurse executives are usually highly experienced nurses who have shifted their focus from directly treating patients, to a leadership role focussed on managing patient needs and administration, as well as staff training and other requirements. The key role of the executive nurse is to design and implement patient care systems, fostering a healthy working environment for junior nurses, and serving as a role model for the rest of the staff under their direction.
Although nurse executives may be involved in treating patients, they do not often directly interact with the patient in a clinical capacity.
The nurse researcher is an advanced practice nurse who focusses on developing the profession of nursing through improving procedures, investigating nursing and patient problems and designs new standards of nursing care to expand the scope of nursing as a whole.
The nurse researcher is most often employed by a university in an academic setting, however some can be employed by hospitals and research laboratories.
An academic nurse, also known as a Nurse Educator works predominantly in universities and colleges to train and mentor student nurses. The nurse educator will often be a registered or clinical nurse with many years of experience, giving them a solid foundation of practical skills to educate new student nurses.
Academic nurses must remain up to date with the latest nursing and medical research to ensure they are not teaching outdated or superseded techniques to upcoming students.
The academic nurse may also work in research alongside a nurse researcher, however, the nurse researcher and academic nurse are often the same individuals.
The flight nurse is an advanced practice nurse with additional training in aeromedical retrieval and treating patients in the adverse environment of an aircraft cabin.
Flight nurses may be employed in aeromedical transport services, transporting patients between cities or hospitals via aircraft, or with additional specialist training, they may form a functional component of a helicopter rescue crew, and will affect rescues of critically injured and ill patients from dangerous and challenging conditions, administering emergent care until definitive care can be provided at the hospital.