Nursing Worldwide Licensure examination Completion of any one of these three educational routes allows a graduate nurse to take the NCLEX RN the test for licensure as a registered nurse and is accepted by every state as an adequate indicator of minimum competency for a new graduate However controversy exists over the appropriate entry level preparation of RNs Some professional organizations believe the BSN should be the sole method of RN preparation and ADN graduates should be licensed as technical nurses to work under the supervision of BSN graduates Others feel the on the job experiences of diploma and ADN graduates makes up for any deficiency in theoretical preparation Shortage in the United States RNs are the largest group of health care workers in the United States with about 2 7 million employed in 2011 91 It has been reported by whom that the number of new graduates and foreign trained nurses is insufficient to meet the demand for registered nurses this is often referred to as the nursing shortage and is expected by whom to increase for the foreseeable future There are data to support the idea that the nursing shortage is a voluntary shortage 92 citation needed In other words nurses are leaving nursing of their own volition In 2006 it was estimated that approximately 1 8 million nurses chose not to work as a nurse The Bureau of Labor Statistics BLS reported that 296 900 healthcare jobs were created in 2011 RNs make up the majority of the healthcare work force therefore these positions will be filled primarily by nurses The BLS also states that by 2020 there will be 1 2 million nursing job openings due to an increase in the workforce and replacements Causes The International Council of Nursing ICN the largest international health professional organization in the world recognizes the shortage of nurses as a growing crisis in the world This shortage impacts the healthcare of everyone worldwide One of the many reasons is that nurses who pursue to become nurses do so very late in their lives This leads to a non lengthy employment time A national survey prepared by the Federation of Nurses and Health Professionals in 2001 found that one in five nurses plans to leave the profession within five years because of unsatisfactory working conditions including low pay severe under staffing high stress physical demands mandatory overtime and irregular hours Approximately 29 8 percent of all nursing jobs are found in hospitals 91 However due to administrative cost cutting increased nurse s workload and rapid growth of outpatient services hospital nursing jobs will experience slower than average growth Employment in home care and nursing homes is expected by whom to grow rapidly Though more people are living well into their 80s and 90s many need the kind of long term care available at a nursing home Many nurses will also be needed to help staff the growing number of out patient facilities such as HMOs Health Maintenance Organizations group medical practices and ambulatory surgery centers Nursing specialties will be in great demand There are in addition many part time employment possibilities 94 95 Levsey Campbell and Green voiced their concern about the shortage of nurses citing Fang Wilsey Wisniewski Bednash 2006 who state that over 40 000 qualified nursing applicants were turned away in the 2005 2006 academic year from baccalaureate nursing programs due to a lack of masters and doctoral qualified faculty and that this number was increased over 9 000 from 32 000 qualified but rejected students from just two years earlier Several strategies have been offered to mitigate this shortage including Federal and private support for experienced nurses to enhance their education incorporating more hybrid blended nursing courses and using simulation in lieu of clinical hospital training experiences 95 96 Furthermore there is a shortage of academically qualified instructors to teach at schools of nursing worldwide The serious need for educational capacity is not being met which is the underlying most important preparation resource for the nurses of tomorrow The decrease in faculty everywhere is due to many factors including decrease in satisfaction with the workforce poor salaries and reduction in full time equivalent Throughout the span of 6 years the nursing faculty shortage has been written about an increasing amount There is no clear consensus or an organized plan on how to fix the ongoing issue Continuing education With health care knowledge growing steadily nurses can stay ahead of the curve through continuing education Continuing education classes and programs enable nurses to provide the best possible care to patients advance nursing careers and keep up with Board of Nursing requirements The American Nurses Association and the American Nursing Credentialing Center are devoted to ensuring nurses have access to quality continuing education offerings Continuing education classes are calibrated to provide enhanced learning for all levels of nurses Many States also regulate Continuing Nursing Education Nursing licensing boards requiring Continuing Nursing Education CNE as a condition for licensure either initial or renewal accept courses provided by organizations that are accredited by other state licensing boards by the American Nursing Credentialing Center ANCC or by organizations that have been designated as an approver of continuing nursing education by ANCC 98 There are some exceptions to this rule including the state of California Florida and Kentucky National Healthcare Institute 99 has created a list to assist nurses in determining their CNE credit hours requirements While this list is not all inclusive it offers details on how to contact nursing licensing boards directly Board certification Professional nursing organizations through their certification boards have voluntary certification exams to demonstrate clinical competency in their particular specialty Completion of the prerequisite work experience allows an RN to register for an examination and passage gives an RN permission to use a professional designation after their name For example passage of the American Association of Critical care Nurses specialty exam allows a nurse to use the initials CCRN after his or her name Other organizations and societies have similar procedures The American Nurses Credentialing Center the credentialing arm of the American Nurses Association is the largest nursing credentialing organization and