NursingWorldwideLicensure examinationCompletion of any one of these three educational routes allows a graduatenurse to take the NCLEX-RN, the test for licensure as a registered nurse,and is accepted by every state as an adequate indicator of minimumcompetency for a new graduate. However, controversy exists over theappropriate entry-level preparation of RNs. Some professionalorganizations believe the BSN should be the sole method of RNpreparation and ADN graduates should be licensed as "technical nurses" towork under the supervision of BSN graduates. Others feel the on-the-jobexperiences of diploma and ADN graduates makes up for any deficiency intheoretical preparation.Shortage in the United StatesRNs are the largest group of health care workers in the United States, withabout 2.7 million employed in 2011.[91] It has been reported[by whom?]that the number of new graduates and foreign-trained nurses is insufficientto meet the demand for registered nurses; this is often referred to as thenursing shortage and is expected[by whom?] to increase for theforeseeable future. There are data to support the idea that the nursingshortage is a voluntary shortage.[92][citation needed] In other words,nurses are leaving nursing of their own volition. In 2006 it was estimatedthat approximately 1.8 million nurses chose not to work as a nurse. TheBureau of Labor Statistics (BLS) reported that 296,900 healthcare jobswere created in 2011. RNs make up the majority of the healthcare workforce, therefore these positions will be filled primarily by nurses. The BLSalso states that by 2020, there will be 1.2 million nursing job openings dueto an increase in the workforce, and replacements.Causes The International Council of Nursing (ICN), the largest international healthprofessional organization in the world, recognizes the shortage of nursesas a growing crisis in the world. This shortage impacts the healthcare ofeveryone worldwide. One of the many reasons is that nurses who pursue tobecome nurses do so very late in their lives. This leads to a non-lengthyemployment time. A national survey prepared by the Federation of Nursesand Health Professionals in 2001 found that one in five nurses plans toleave the profession within five years because of unsatisfactory workingconditions, including low pay, severe under staffing, high stress, physicaldemands, mandatory overtime, and irregular hours. Approximately 29.8percent of all nursing jobs are found in hospitals.[91] However, due toadministrative cost cutting, increased nurse's workload, and rapid growth ofoutpatient services, hospital nursing jobs will experience slower thanaverage growth. Employment in home care and nursing homes isexpected[by whom?] to grow rapidly. Though more people are living wellinto their 80s and 90s, many need the kind of long-term care available at anursing home. Many nurses will also be needed to help staff the growingnumber of out-patient facilities, such as HMOs (Health MaintenanceOrganizations), group medical practices, and ambulatory surgery centers.Nursing specialties will be in great demand. There are, in addition, manypart-time employment possibilities.[94][95]Levsey, Campbell, and Green voiced their concern about the shortage ofnurses, citing Fang, Wilsey-Wisniewski, & Bednash, 2006, who state thatover 40,000 qualified nursing applicants were turned away in the 2005–2006 academic year from baccalaureate nursing programs due to a lack ofmasters and doctoral qualified faculty, and that this number was increasedover 9,000 from 32,000 qualified but rejected students from just two yearsearlier. Several strategies have been offered to mitigate this shortageincluding; Federal and private support for experienced nurses to enhancetheir education, incorporating more hybrid/blended nursing courses, andusing simulation in lieu of clinical (hospital) training experiences.[95][96]Furthermore, there is a shortage of academically qualified instructors toteach at schools of nursing worldwide. The serious need for educationalcapacity is not being met, which is the underlying most importantpreparation resource for the nurses of tomorrow. The decrease in facultyeverywhere is due to many factors including decrease in satisfaction withthe workforce, poor salaries, and reduction in full-time equivalent.Throughout the span of 6 years the nursing faculty shortage has beenwritten about an increasing amount. There is no clear consensus or anorganized plan on how to fix the ongoing issue.Continuing educationWith health care knowledge growing steadily, nurses can stay ahead of thecurve through continuing education. Continuing education classes andprograms 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 CredentialingCenter are devoted to ensuring nurses have access to quality continuingeducation offerings. Continuing education classes are calibrated to provideenhanced learning for all levels of nurses. Many States also regulateContinuing Nursing Education. Nursing licensing boards requiringContinuing Nursing Education (CNE) as a condition for licensure, eitherinitial or renewal, accept courses provided by organizations that areaccredited by other state licensing boards, by the American NursingCredentialing Center (ANCC), or by organizations that have beendesignated 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 toassist nurses in determining their CNE credit hours requirements. Whilethis list is not all inclusive, it offers details on how to contact nursinglicensing boards directly.Board certificationProfessional nursing organizations, through their certification boards, havevoluntary certification exams to demonstrate clinical competency in theirparticular specialty. Completion of the prerequisite work experience allowsan RN to register for