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The nursing organizational structure in the US divides nurses into general and advanced practice groups, with state nursing boards overseeing the profession. Nurse educators and administrators train and prepare future nurses, while healthcare institutions choose care delivery models to ensure continuity of care.
The organizational structure of nursing in the United States begins with the general establishment of the division of nurses into two main groups: general and advanced practice. Qualified to work in any area of nursing, general nurses include those trained for basic practice. At the advanced practice level, nurses specialize in a particular area and are considered experts in that field. This would include Nurse Practitioners (NP) and Clinical Nurse Specialists (CNS), as well as both Certified Nurse Midwives (CNM) and Certified Nurse Anesthesiologists (CRNA).
The organizational structure in nursing shows that nursing role designation is commensurate with the type of license, whether as a practicing nurse (PN or VN) or as a registered nurse (RN). All advanced practice nurses are RNs; general nurses can be one of them. Although PN and RN perform many of the same functions, such as administering medications, assessing and treating wounds, the main differences between the two are mainly related to education. Licensed practical nurses typically do not receive a degree, only professional field training, while RNs earn an associate’s or bachelor’s degree (BSN). Additionally, RN training focuses on theory, leadership and case management, qualifying them for supervisory roles.
Responsible for setting educational standards and scope, in the United States, state nursing boards are organizations that oversee the nursing profession within a given region. Governed collectively by the National Council of State Nursing Boards (NCSBN), nursing member councils decide what duties and responsibilities nurses are legally able to perform in a particular jurisdiction. In most states, there is a separate organization for each type of nurse. Georgia, for example, has the Georgia Board of Examiners of Licensed Practical Nurses which governs PNs and the Georgia Board of Nursing which regulates RNs. NCSBN creates national licensing exams for all nurses, referred to as the National Council Licensure Examination (NCLEX).
Within educational institutions, the nursing organizational structure includes educators, administrators, or principals. Bringing with them a variety of experience and expertise, nurse educators are nursing school faculty members who train and prepare future nurses. Considered a leader in the nursing profession, a nurse educator is a registered nurse who has a master’s or doctoral degree in nursing (DNS or DNSc). Administrators, also known as nursing school deans, typically have doctoral degrees in nursing and oversee the entire program.
Nursing practice facilities such as hospitals, clinics, and homes provide modality-based nursing care, further contributing to the organizational structure in nursing. Each healthcare institution or agency is tasked with choosing an effective reporting structure or care delivery model that ensures continuity of care to patients, while also addressing their needs. Nursing care models address several issues, such as communication between health professionals, distribution of work activities, length of responsibility, and patient burden.
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