The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.(October 2023) |
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Health professional requisites refer to the regulations used by countries to control the quality of health workers practicing in their jurisdictions and to control the size of the health labour market. They include licensure, certification and proof of minimum training for regulated health professions. [1]
In the health care system, a health professional who offers medical, nursing or other types of health care services is required to meet specific requisites put into effect by laws governing health care practices. The number of professions subject to regulation, the requisites for an individual to receive professional licensure or certification, the scope of practice that is permitted for the individual to perform, and the nature of sanctions that can be imposed for failure to comply vary across jurisdictions.
Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history. The processes for professional certification and licensure vary across professions and countries. Certification to practise a profession usually does not need to be renewed, while a licence usually needs to be periodically renewed based on certain criteria such as passing a renewal exam, demonstrating continuing learning, being employed in the field or simply paying a fee. [2] Most health care industry employers publish the specific requisites for persons seeking employment by means of job boards, ads and solicitations for employment. Practicing health care without the appropriate license is generally a crime.
Most countries require individuals to demonstrate proof of graduation from a recognized medical school, such as one meeting the quality assurance standards of the World Federation of Medical Education, [3] as requisite to obtain professional certification for practice as a physician or physician assistant.
In the United States, once obtaining the appropriate medical degree, physicians can apply to attain licensure via Board certification.
In India, practitioners of both modern medicine and traditional medicine are subject to professional regulation. Doctors are regulated by the Medical Council of India, while practitioners of Ayurved, Siddha and Unani medicine are regulated by the Central Council of Indian Medicine. [4]
Registered nurses and licensed practical nurses (or the equivalent national titles, e.g. enrolled nurses) must typically complete nursing school and pass a national examination in order to obtain their license. For example, in the United States, nurses must pass the National Council Licensure EXamination (NCLEX). They must then obtain a nursing license by applying to appropriate board of nursing. In Uganda, nurses must complete a Bachelor of Science or other diploma in nursing recognized by the Nurses and Midwives Council and pass national qualifying examinations; several years of work experience in a hospital or other health unit is further required in order to be eligible for a licence to engage in private practice. [5]
The legal requisites as well as scope of practice for nurses (and also midwives and nurse midwives) vary across countries. For instance, in some countries nurses are trained and authorized to provide emergency childbirth care, including administration of oxytocins and newborn resuscitation, whereas in other countries these clinical functions are only authorized for physicians. [6]
Respiratory Therapists or Respiratory Care Practitioners in many countries are required to have graduated from an accredited and recognized college or university and additionally pass a registry exam prior to being eligible for licensure. In the United States, Respiratory Therapists are granted either Registry or Certificate credentials by the National Board for Respiratory Care (NBRC). The credential granted by the NBRC must be maintained to continue to hold a state licence to practice, and a fee must be paid every two years to the NBRC to maintain that credential.
Dentists and many other categories of allied health professions typically also require professional certification or licensure for legal practice. Training and knowledge in basic life support is required by regulation for certification for many practicing individuals, including emergency medical technicians.
Requisites and regulations for other professions, such as paramedics, clinical officers, dietitians, and homeopaths, vary across countries. They may also vary over time within countries. For example, previously no academic qualifications were needed to work as a Dental nurse in the United Kingdom; however now, hospitals, community dental services and other employers require all Dental nurses to have obtained recognized qualifications and be registered with the General Dental Council.
Practicing without a license is typically illegal. In most jurisdictions, individuals found to be providing medical, nursing or other professional services without the appropriate certification or licence may face sanctions including even criminal charges leading to prison. The number of professions subject to regulation and nature of sanctions that can be imposed for failure to comply vary across jurisdictions.
For instance, in the United States, under Michigan state laws, an individual is guilty of a felony if he practices or holds himself out as practicing a health profession subject to regulation without a license or registration or under a suspended, revoked, lapsed, void, or fraudulently obtained license or registration, or exceeding what a limited license or registration allows, or who uses the license or registration of another person as his own. The "practice of medicine" may be defined as any diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts. [7]
According to the MDCH the following professions must be licensed for practice in Michigan:
In Florida, such crime is classified as a third degree felony, [8] which may give imprisonment up to five years. [9] Practicing a health care profession without a license which results in serious bodily injury classifies as a second degree felony, [8] providing up to 15 years' imprisonment. [9]
In the United Kingdom, healthcare professionals are regulated by the state; the Council for Healthcare Regulatory Excellence oversees the work of various regulatory bodies including the Nursing and Midwifery Council, the General Dental Council, and the Health Professions Council (HPC). Each Council protects the 'title' of each profession it regulates. For example, it is illegal for someone to call themself an Occupational Therapist or Radiographer if they are not on the register held by the HPC. [10]
Similarly, in South Africa, at least 12 professional titles are protected by law, subject to regulation by the Health Profession Council of South Africa. [11]
In Uganda, a person who calls themself a "nurse" or "midwife" without having the appropriate licence from the Nurses and Midwives Council can be subject to a fine and/or up to three years of imprisonment. [5]
A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respiratory therapists sometimes graduate from a college or university with a degree in respiratory therapy and have passed a national board certifying examination. The NBRC is responsible for credentialing as a CRT, or RRT,
A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.
A medical license is an occupational license that permits a person to legally practice medicine. In most countries, a person must have a medical license bestowed either by a specified government-approved professional association or a government agency before they can practice medicine. Licenses are not granted automatically to all people with medical degrees. A medical school graduate must receive a license to practice medicine to legally be called a physician. The process typically requires testing by a medical board. The medical license is the documentation of authority to practice medicine within a certain locality. An active license is also required to practice medicine as an assistant physician, a physician assistant or a clinical officer in jurisdictions with authorizing legislation.
A Physician Assistant or Physician Associate (PA) is a type of healthcare professional. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes between smaller jurisdictions such as states or provinces. Depending on location, PAs practice semi-autonomously under the supervision of a physician, or autonomously performing a subset of medical services classically provided by physicians.
Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training, and define scope of practice.
A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.
A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.
Allied health professions are health care professions that provide a range of diagnostic, technical, therapeutic, and support services in connection with health care. Their services are allied with and support the work of a number of other professions not considered allied health professions, such as medicine, nursing, dentistry, optometry, pharmacy, and others listed below as "excluded professions".
A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion. One study found that although reasons for referrals to specialists are similar for both physicians and NPs, the quality of documentation in the referrals may be lower for NPs.
An advanced practice nurse (APN) is a nurse with post-graduate education and training in nursing. Nurses practicing at this level may work in either a specialist or generalist capacity. APNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
Nurses in the United States practice nursing in a wide variety of specialties and departments.
Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses in Canada practise in a wide variety of settings, with various levels of training and experience. They provide evidence-based care and educate their patients about health and disease.
A paraveterinary worker is a professional of veterinary medicine who performs procedures autonomously or semi-autonomously, as part of a veterinary assistance system. The job role varies throughout the world, and common titles include veterinary nurse, veterinary technician, and veterinary assistant, and variants with the prefix of "animal health".
Nursing in Japan did not develop as an occupation until the end of the nineteenth century. Initially introduced only in Tokyo in the late 1860s, small schools utilizing Western models were being opened by the late 1880s. In response to disaster relief, the Japanese Red Cross became an integral part of nursing development. By 1915, nurse registration had been established and public health nurses began working throughout the country. Nursing universities were established in the twentieth century and regulations were passed to develop standards for training and public health.
In the United States, certified nurse midwives (CNMs) are advanced practice registered nurses in nurse midwifery, the nursing care of women during pregnancy and the postpartum period. CNMs are considered as midwives.
Midwives in the United States assist childbearing women during pregnancy, labor and birth, and the postpartum period. Some midwives also provide primary care for women including well-woman exams, health promotion, and disease prevention, family planning options, and care for common gynecological concerns. Before the turn of the 20th century, traditional midwives were informally trained and helped deliver almost all births. Today, midwives are professionals who must undergo formal training. Midwives in the United States formed the Midwifery Education, Regulation, and Association task force to establish a framework for midwifery.
A direct-entry midwife is a midwife who has become credentialed without first becoming a nurse. There are direct-entry midwifery programs that prepare students to become Certified Nurse Midwives (CNMs) or Certified Professional Midwives (CPMs). Certified Professional Midwives are known for being "more natural and less intervention oriented." In other words, these midwives typically work outside of the hospital setting in homes and birth centers and do not employ methods for childbirth that physicians in hospitals commonly use such as caesarean section, forceps and other types of equipment and drugs.
A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.