title: Defense Intelligence Agency

text: Acting on the recommendations of the Joint Study Group, Defense Secretary Robert S. McNamara advised the Joint Chiefs of Staff (JCS) of his decision to establish the DIA in February 1961. He ordered them to develop a plan that would integrate all the military intelligence of the DoD, a move that met strong resistance from the service intelligence units, whose commanders viewed DIA as undesirable encroachment on their turf. Despite this resistance, during the spring and summer of 1961, as Cold War tensions flared over the Berlin Wall, Air Force Lieutenant General Joseph Carroll took the lead in planning and organizing this new agency. The JCS published Directive 5105.21, "Defense Intelligence Agency" on August 1, and DIA began operations with a handful of employees in borrowed office space on October 1, 1961.


title: Defense Intelligence Agency

text: DIA originally reported to the Secretary through the JCS. The new agency's mission was the continuous task of collecting, processing, evaluating, analyzing, integrating, producing, and disseminating military intelligence for DoD and related national stakeholders. Other objectives included more efficiently allocating scarce intelligence resources, more effectively managing all DoD intelligence activities, and eliminating redundancies in facilities, organizations, and tasks.


title: Defense Intelligence Agency

text: Following DIA's establishment, the Services reluctantly transferred intelligence functions and resources to it on a time-phased basis to avoid rapidly degrading the overall effectiveness of defense intelligence. A year after its formation, in October 1962, the agency faced its first major intelligence test during the superpower Cuban Missile Crisis confrontation that developed after Soviet missiles were discovered at bases in Cuba by Air Force spy planes.


title: Defense Intelligence Agency

text: In late 1962, DIA established the Defense Intelligence School (now the National Intelligence University), and on January 1, 1963, it activated a new Production Center. Several Service elements were merged to form this production facility, which occupied the "A" and "B" Buildings at Arlington Hall Station, Virginia.


title: Defense Intelligence Agency

text: The agency also added an Automated Data Processing (ADP) Center on February 19, a Dissemination Center on March 31, and a Scientific and Technical Intelligence Directorate on April 30, 1963. DIA assumed the staff support functions of the J-2, Joint Staff, on July 1, 1963. Two years later, on July 1, 1965, DIA accepted responsibility for the Defense Attaché System—the last function the Services transferred to DIA.


title: Defense Intelligence Agency

text: During the 1960s, DIA analysts focused on China's detonation of an atomic bomb and the launching of its Cultural Revolution; increasing unrest among African and South Asian nations; fighting in Cyprus and Kashmir; and the missile gap between the U.S. and the Soviet Union. In the late 1960s, crises that tested intelligence responsiveness included: the Tet Offensive in Vietnam; the Six-Day War between Egypt and Israel; continuing troubles in Africa, particularly Nigeria; North Korea's seizure of the ; and the Warsaw Pact invasion of Czechoslovakia.


title: Defense Intelligence Agency

text: The early 1970s were transitional years as the agency shifted its focus from consolidating its functions to establishing itself as a credible producer of national-level intelligence. This proved difficult at first since sweeping manpower decrements between 1968 and 1975 had reduced agency manpower by 31 percent and precipitated mission reductions and a broad organizational restructuring. Challenges facing DIA at this time included the rise of Ostpolitik in Germany; the emergence of the Palestine Liberation Organization in the Middle East; and the U.S. incursion into Cambodia from South Vietnam.


title: Defense Intelligence Agency

text: The agency's reputation grew considerably by the mid-1970s, as decision makers increasingly recognized the value of its products. Agency analysts in 1972 concentrated on Lebanon, President Richard Nixon's visit to China, the 1973 Chilean coup d'état, the formation of Sri Lanka, and the prisoners of war being held in Southeast Asia. Subsequent challenges involved: détente; the development of arms control agreements; the Paris peace talks (Vietnam); the Yom Kippur War; and global energy concerns.


title: Defense Intelligence Agency

text: Intense Congressional review during 1975–76 created turbulence within the Intelligence Community. The Murphy and Rockefeller Commission investigations of charges of intelligence abuse ultimately led to an Executive Order that modified many Intelligence Community functions. At the same time, with U.S. involvement in Vietnam ending, defense intelligence faced a significant decline in resources. During this period, DIA conducted numerous studies on ways of improving its intelligence products. Despite these and other Community-wide efforts to improve intelligence support, the loss of resources during the 1970s limited the Community's ability to collect and produce timely intelligence and ultimately contributed to intelligence shortcomings in Iran, Afghanistan, and other strategic areas.


title: Defense Intelligence Agency

text: Special DIA task forces were set up to monitor crises such as the Soviet invasion of Afghanistan, the overthrow of Iranian monarchy, and the taking of American hostages from the U.S. embassy in Tehran in 1979. Also, of serious concern were the Vietnamese takeover in Phnom Penh, the China–Vietnam border war, the overthrow of Idi Amin in Uganda, the north–south Yemen dispute, troubles in Pakistan, border clashes between Libya and Egypt, the Sandinista takeover in Nicaragua, and the Soviet movement of combat troops to Cuba during the signing of the Strategic Arms Limitation Treaty II.


title: Defense Intelligence Agency

text: Following the promulgation in 1979 of Executive Order 12036, which restructured the Intelligence Community and better outlined DIA's national and departmental responsibilities, the agency was reorganized around five major directorates: production, operations, resources, external affairs, and J-2 support.


title: Defense Intelligence Agency

text: By the 1980s, DIA had transformed into a fully integrated national-level intelligence agency. Its 1981 flagship publication "Soviet Military Power", the most comprehensive overview of Soviet military strength and capabilities at the time, was met with wide acclaim; SMP continued to be produced by DIA as a serialized publication roughly over the next decade. In 1983, in order to research the flow of technology to the Soviet Union, the Reagan Administration created Project Socrates within the agency. Over the following years Project Socrates's scope broadened to include monitoring of foreign advanced technology as a whole. Project Socrates ended in 1990 with Michael Sekora, the project's director, leaving in protest when the Bush Administration reduced funding.


title: Defense Intelligence Agency

text: In 1984, the Clandestine Services organization, designated STAR WATCHER, was created under DIA with the mission of conducting intelligence collection on perceived areas of conflict and against potential adversaries in developing countries. A critical objective was to create a Joint Services career path for case officers, since individual Services were inconsistent in their support of clandestine operations, and case officers were routinely sacrificed during reductions in force. Ultimately, the organization was created to balance CIA's espionage operations which primarily targeted Soviet KGB/GRU officers, but ignored and were dismissive of Third World targets in areas of potential military conflict.


title: Defense Intelligence Agency

text: Although there were previous attempts to establish such a DoD level espionage organization, there was no authorization document by which it could be established. This changed when Gregory Davis, a military intelligence officer, defined and established a clandestine services program under the U.S. Southern Command's "Plan Green". The program was then authorized by JCS Chairman John Vessey, and sanctioned by the Senate Select Committee on Intelligence ("SSCI"), with the sponsorship of Senator Jesse Helms (R-NC) and Senator Barry Goldwater (R-AZ). The Goldwater–Nichols DoD Reorganization Act was crafted partly to force military officers to serve in a Joint Services assignment in order to qualify for flag rank—ensuring the future of case officers from each Service. The clandestine organization within DIA grew and flourished, and was cited by the SSCI for its intelligence achievements. Personnel selection and training were rigorous, and the case officers were notable for their advanced educations, area knowledge, and multilingual capabilities. The program was partially gutted under President Bill Clinton as he foresaw no conflict which would justify its existence, but, it was resurrected under President George W. Bush.


title: Defense Intelligence Agency

text: Designated a combat support agency under the Goldwater–Nichols Act, DIA moved to increase cooperation with the Unified & Specified Commands and to begin developing a body of joint intelligence doctrine. Intelligence support to U.S. allies in the Middle East intensified as the Iran–Iraq War spilled into the Persian Gulf. DIA provided significant intelligence support to Operation Earnest Will while closely monitoring incidents such as the Iraqi rocket attack on the , the destruction of Iranian oil platforms, and Iranian attacks on Kuwaiti oil tankers. The "Toyota War" between Libya and Chad and the turmoil in Haiti added to DIA's heavy production workload, as did unrest in other parts of Latin America, Somalia, Ethiopia, Burma, Pakistan, and the Philippines.


title: Defense Intelligence Agency

text: With the end of the Cold War, defense intelligence began a period of reevaluation following the fall of the Soviet system in many Eastern European countries, the reunification of Germany, and ongoing economic reforms in the region. In response to Iraq's invasion of Kuwait in August 1990, DIA set up an extensive, 24-hour, crisis management cell designed to tailor national-level intelligence support to the coalition forces assembled to expel Iraq from Kuwait. By the time Operation Desert Storm began, some 2,000 agency personnel were involved in the intelligence support effort. Most of them associated in some way with the national-level Joint Intelligence Center (JIC), which DIA established at The Pentagon to integrate the intelligence being produced throughout the Community. DIA sent more than 100 employees into the Kuwaiti Theater of Operations to provide intelligence support.


title: Defense Intelligence Agency

text: The Armed Forces Medical Intelligence Center (AFMIC), and the Missile and Space Intelligence Center (MSIC), associated with the Army for over 20 and 50 years respectively, became part of DIA in January 1992. This was part of the continuing effort to consolidate intelligence production and make it more efficient.


title: Defense Intelligence Agency

text: On September 11, 2001, seven DIA employees lost their lives along with 118 other victims at the Pentagon in a terrorist attack when American Airlines Flight 77 piloted by five Al-Qaeda hijackers plowed into the western side of the building, as part of the September 11 attacks. The death of seven employees at once was the largest combined loss in DIA's history. On September 11, 2009, DIA dedicated a memorial to the seven employees lost in the terrorist attacks on the Pentagon. The memorial is located in the garden at the Defense Intelligence Agency Analysis Center in Washington D.C.


title: Defense Intelligence Agency

text: Since the September 11 attacks, DIA has been active in nuclear proliferation intelligence collection and analysis with particular interests in North Korea and Iran as well as counter-terrorism. DIA was also involved with the intelligence build-up to the invasion of Iraq in 2003 and was a subject in the Senate Report of Pre-war Intelligence on Iraq. After the invasion, DIA led the Iraq Survey Group to find the alleged Weapons of Mass Destruction. The agency has conflicted with the CIA in collection and analysis on the existence of weapons of mass destruction in Iraq and has often represented the Pentagon in the CIA–DoD intelligence rivalry due to DIA's own Clandestine HUMINT collection.


title: Defense Intelligence Agency

text: In 2012, DIA announced an expansion of clandestine collection efforts. The newly consolidated Defense Clandestine Service (DCS) would absorb the Defense HUMINT Service and expand DIA's overseas espionage apparatus to complement the work of corresponding elements at CIA. DCS would focus on military intelligence concerns—issues that the CIA has been unable to manage due to lack of personnel, expertise or time—and would initially deal with Islamist militia groups in Africa, weapons transfers between North Korea and Iran, and Chinese military modernization. The DCS works in conjunction with CIA's Directorate of Operations and the Joint Special Operations Command in overseas operations.


title: Defense Intelligence Agency

text: In October 2015, the Pentagon said that DIA appointed a British Royal Air Force officer as its first deputy director in charge of improving integration between U.S. intelligence units and spy agencies of other English-speaking countries in the Five Eyes alliance. This was the first time that a foreign national was appointed to a senior position at a U.S. intelligence agency.


title: Defense Intelligence Agency

text: Today, corporations carry out a large amount of DIA's workload. In fiscal year 2020 alone, such activity included work in DIA's Science & Technology Directorate, National Media Exploitation Center, and Missile & Space Intelligence Center. Corporations also worked on technology transfer analysis and assessments at DIA's Charlottesville branch, planned and analyzed DIA's workforce, carried out technical support, and conducted polygraph examinations and background investigations.


title: Defense Intelligence Agency

text: A memorial wall at the DIA headquarters is dedicated to those agency employees who lost their lives in the line of their intelligence work and whose deaths are not classified. The wall was first dedicated on December 14, 1988, by Director Leonard Perroots. It "commemorates the profound individual sacrifices made on behalf of the United States by DIA members and acts as a reminder of the selflessness, dedication, and courage required to confront national challenges..."


title: Defense Intelligence Agency

text: DIA also maintains a memorial in the headquarters courtyard dedicated to personnel lost in the attacks of 9/11 on the Pentagon. Additionally, the agency maintains the Torch Bearers Wall at its Headquarters. The Torch Bearers award is the highest honor bestowed to former DIA employees and recognizes their exceptional contributions to the agency's mission.


title: Defense Intelligence Agency

text: The flaming torch and its gold color represent knowledge, i.e., intelligence, and the dark background represents the unknown—"the area of the truth" still sought by the worldwide mission of the agency. The two red atomic ellipses symbolize the scientific and technical aspects of intelligence today and of the future. The 13 stars and the wreath are adopted from the Department of Defense seal and mean glory and peace, respectively, which the DoD secures as part of its work.


title: MetaMask

text: MetaMask is a software cryptocurrency wallet used to interact with the Ethereum blockchain. It allows users to access their Ethereum wallet through a browser extension or mobile app, which can then be used to interact with decentralized applications. MetaMask is developed by ConsenSys Software Inc., a blockchain software company focusing on Ethereum-based tools and infrastructure.


title: MetaMask

text: MetaMask allows users to store and manage account keys, broadcast transactions, send and receive Ethereum-based cryptocurrencies and tokens, and securely connect to decentralized applications through a compatible web browser or the mobile app's built-in browser.


title: MetaMask

text: Websites or other decentralized applications are able to connect, authenticate, and/or integrate other smart contract functionality with a user's MetaMask wallet (and any other similar blockchain wallet browser extensions) via JavaScript code that allows the website to send action prompts, signature requests, or transaction requests to the user through MetaMask as an intermediary.


title: MetaMask

text: The application includes an integrated service for exchanging Ethereum tokens by aggregating several decentralized exchanges (DEXs) to find the best exchange rate. This feature, branded as MetaMask Swaps, charges a service fee of 0.875% of the transaction amount.


title: MetaMask

text: Prior to 2019, MetaMask had only been available as a desktop browser extension for Google Chrome and Firefox browsers. Given the popularity of MetaMask among cryptocurrency users, and its lack of an official mobile app for several years, instances of malicious software posing as MetaMask became problematic for Google in regulating its Chrome Web Store and Google Play platforms. In one instance, Google Play unintentionally removed MetaMask's official beta app before reverting the decision a week later on January 1, 2020.


title: MetaMask

text: Starting in 2019, MetaMask began releasing mobile app versions for closed beta testing, followed by their official public release for iOS and Android in September 2020.


title: MetaMask

text: During October 2020, MetaMask Swaps, a built-in DEX aggregation service was added to the desktop extension. The product became available on mobile devices in March 2021.


title: MetaMask

text: While MetaMask and other "web3" focused applications aim to decentralize control over personal data and increase user privacy, critics have pointed to the potential for MetaMask's browser extension to leak identifiable information to data collection networks and web trackers as a fundamental flaw.


title: Liz Cambage

text: Elizabeth Folake Cambage (born 18 August 1991) is an Australian professional basketball player who last played for the Los Angeles Sparks of the Women's National Basketball Association (WNBA). Cambage currently holds the WNBA single-game scoring record with her 53-point performance against the New York Liberty on 17 July 2018.


title: Liz Cambage

text: She played for the Australia national team, the Opals, between 2009 and 2021, winning a gold medal in the 2018 Commonwealth Games, silver in the 2018 World Cup, and bronze in the 2012 Olympics.


title: Liz Cambage

text: Cambage was born on 18 August 1991 in London to a Nigerian father and Australian mother. Her parents separated when Cambage was three months old and she moved to Australia with her mother. First settling in Eden in New South Wales, the family moved to Melbourne when Cambage was 10 years of age and later the Mornington Peninsula.


title: Liz Cambage

text: Cambage is tall. She was teased about her height in school. At the age of ten she was tall, reaching by the time she was 14. She started playing basketball at her mother's suggestion when she was 10 as a way to make friends.


title: Liz Cambage

text: Cambage plays at the center position in basketball. In 2009, she played in the Under-20 Australian National Championships, and the ABC suggested she could be the next Lauren Jackson. The only international players surpassing Cambage in height at the time were Margo Dydek, at , and Sue Geh, at tall.


title: Liz Cambage

text: Cambage played her junior basketball with Dandenong Rangers, joining their WNBL team for the 2007–08 season. In 2007, she accepted a scholarship to the Australian Institute of Sport (AIS), and played for the AIS team, based in Canberra, in the Women's National Basketball League (WNBL), for the remainder for the 2007–08 season and the following one In August 2020, Cambage made her return to the WNBL, signing with the Southside Flyers for the 2020–21 season.


title: Liz Cambage

text: In March 2011, Cambage expressed a reluctance to play for the Women's National Basketball Association (WNBA) team that drafted her, the Tulsa Shock, stating, "I don't want to play at Tulsa, I've made that clear. They want to make me a franchise player, but I'm not going to the WNBA for that. I'm going there to learn and improve my game. But what can you do?" She played in the 2011 WNBA All-Star Game.


title: Liz Cambage

text: After the 2012 Summer Olympics, Cambage was due to head back to the United States to complete the WNBA season with the Tulsa Shock, but announced on the morning her flight was due to leave, 27 August 2012, that she would not be returning to finish the 2012 season. Her agent released a statement saying she was exhausted after playing for the national team.


title: Liz Cambage

text: Cambage returned to play for the Shock for the 2013 season, but did not return to the WNBA for five years after. In February 2018, she signed a multi-year contract with the Dallas Wings.


title: Liz Cambage

text: In June 2012, Cambage signed with Zheijang Chouzhou basketball club in China, reportedly for a salary of $400,000 (Australian dollars), which made her one of the highest-paid female basketballers in the world. Yet in an article in the Australian newspaper "The Age" published on 8 March 2019, Cambage bemoaned being poorly compensated and unable to meet her mortgage payments, noting that she had not been paid since September 2018 after an injury prevented her from playing in China. She was quoted as saying: "It's funny, we make all these sacrifices for our nation, but are we getting looked after properly at the end of the day?"


title: Liz Cambage

text: In February 2018, Cambage signed a multi-year contract with the Dallas Wings. On 17 July 2018, in a game against the New York Liberty, Cambage scored a WNBA record 53 points. The Wings won the game, 104–87. Cambage was voted into the 2018 WNBA All-Star Game, making it her second all-star appearance. Following her 53-point performance, she scored 35 points in a 90–81 victory over the Washington Mystics making it the highest two-game point total in league history. By the end of the season, Cambage led the league in scoring and the Wings finished with a 15–19 record as the number 8 seed in the league. In the first-round elimination game, the Wings lost, 101–83, to the Phoenix Mercury.


title: Liz Cambage

text: On 22 January 2019 Cambage requested a trade from the Wings. On 16 May 2019 she was traded to the Las Vegas Aces. During the 2019 season, Cambage was voted into the All-Star Game, making it her third all-star appearance. At the end of the season, the Aces finished 21–13 and the number 4 seed, receiving a bye to the second round. In the second-round elimination game, the Aces advanced to the semi-finals after defeating the Chicago Sky, 93–92, off a play by teammate Dearica Hamby in which she came up with a steal and nailed a desperation three-pointer from half court. In the semi-finals, the Aces' playoff run came to an end as they were defeated by the eventual champions, the Washington Mystics, in four games.


title: Liz Cambage

text: On July 5, 2020, it was announced that Cambage would sit out the 2020 WNBA season due to health concerns and preexisting risk factors surrounding the COVID-19 pandemic after an evaluation by the team doctor. Without Cambage, the Aces finished the season 18–4 with the number one seed in the shortened 22-game season, they reached the Finals but were swept by the Seattle Storm. On 23 May 2021, during a game against the Connecticut Sun, the opposing coach Curt Miller lobbied the referee for a foul call on Cambage, while hyperbolically claiming Cambage was "300 pounds". Cambage responded with a post on Instagram, calling out Connecticut Sun coach Curt Miller calling him a "little white man".


title: Liz Cambage

text: Cambage signed with the Los Angeles Sparks in 2022. On July 26, 2022, Cambage was released by the Sparks on an according "contract divorce".


title: Liz Cambage

text: Cambage, on August 15, 2022, announced her retirement from the WNBA. Her retirement came three weeks after she was released by the Sparks.


title: Liz Cambage

text: In 2009, Cambage was a member of the Australian junior women's national team that won a gold medal at the Oceania World Qualification series, and a silver medal at the William Jones Cup in Taiwan. The following year, she was a member of the Australian junior women's team that competed at the World Championships in Thailand.


title: Liz Cambage

text: Her first call up to the senior national side was in 2008, and she had her first cap for the Australian Opals in 2009 in a test series against China, went she played in the third game in the series. On 2 September 2009, she played in the Canberra hosted return game against New Zealand in the Oceania Championship, and she was a member of the Australian senior women's team that won a gold medal at the Oceania World Qualification Series. She was a member of the national team again in 2010. In June 2010, she was viewed by national team coach Carrie Graf as one of a quartet of strong players that would represent Australia in a tour of China, the United States and Europe. In 2010, she participated in the Salamanca Invitational Basketball Tournament in Spain. Her team beat Spain 85–64. They also beat the United States. She scored 20 points in the game against Spain.


title: Liz Cambage

text: In 2010, she was a member of the senior women's national team that competed at the World Championships in the Czech Republic. She was important to the team's success. In July 2010, she participated in a four-day training camp and one game test match against the United States in Connecticut, but missed the Olympic qualification series in July 2011 because of WNBA commitments. Nonetheless, she was named to the 2012 Australia women's national basketball team.


title: Liz Cambage

text: In February 2012, she was named to a short list of 24 eligible players to represent Australia at the 2012 London Olympics. In late April and early May 2012, she was one of four Australian "big" players to participate in a special training camp for the team, and participated in the national team training camp held from 14 to 18 May 2012 at the Australian Institute of Sport. Cambage was seen as a key component if Australia was to beat the United States in London.


title: Liz Cambage

text: At the 2012 Olympic Games on 2 August, Cambage successfully dunked the basketball with one hand in a 70–66 victory over Russia. Cambage and the Opals won a bronze medal in London with an 83–74 win over Russia.


title: Liz Cambage

text: Just before the 2014 World Championships, she ruptured her Achilles tendon, causing her to miss eight months of playing time.


title: Liz Cambage

text: At the 2016 Olympics in Rio, she was the leading scorer and rebounder for the team that reached the quarterfinals. She was also part of the Australian team that won gold at the 2018 Commonwealth Games.


title: Liz Cambage

text: Cambage was named to the national team for the Tokyo Olympics but withdrew from the team in July 2021, less than two weeks before the tournament. She stated this was due to mental health issues. In May 2022, it was came out that Cambage had racially taunted players on the Nigerian team during a pre-Olympics training game, calling the players "monkeys" and telling the Nigerian players to "Go back to your Third World Country". She was later found to have elbowed and slapped players on the Nigerian team, causing the training game to be called off.


title: Billy Madison

text: Billy Madison is a 1995 American comedy film directed by Tamra Davis. It stars Adam Sandler in the title role, Bradley Whitford, Bridgette Wilson, Norm Macdonald, Darren McGavin, Mark Beltzman, and Larry Hankin. The film was written by Sandler and Tim Herlihy and produced by Robert Simonds, and was Macdonald's feature film debut. It made over $26.4 million worldwide and debuted at number one at the box office.


title: Billy Madison

text: Despite receiving mixed reviews from critics at the time of its release, the film is now considered one of Sandler's best and has garnered a cult following over the years.


title: Billy Madison

text: William “Billy” Madison is the dimwitted, childish, and spoiled 27-year-old heir to Madison Hotels, a Fortune 500 chain of 650 hotels founded by his father, retiring tycoon Brian Madison. Billy spends his days drinking with friends and creating disturbances across his father's estate. One evening, Billy ruins an important dinner meeting between his father and his associates by acting obnoxiously. Brian loses confidence in his son and chooses his devious executive vice president Eric Gordon to take over Madison Hotels. When Billy begs his father to reconsider his decision, as he knows how callous and cruel Eric is, Brian reveals that he secretly bribed Billy's school teachers to give him passing grades. The two finally compromise: Billy must complete all 12 grades of school, with two weeks for each grade, to prove he is competent enough to manage the company.


title: Billy Madison

text: Shortly after enrolling into elementary school, Billy becomes attracted to a third grade teacher named Veronica Vaughn, who initially ignores him. Nevertheless, Billy successfully progresses through his first two grades. He finds himself as one of Veronica's students in third grade and earns her respect by standing up for Ernie, his friend and classmate. Billy becomes popular among the third graders and misses them as he advances through school. Billy's progress alarms Eric. Desperate to take over Madison Hotels, he blackmails Billy's elementary school principal, Max Anderson, into lying that Billy bribed him for passing grades, with a wrestling magazine containing pictures of Max's previous career as the "Revolting Blob", a masked wrestler who accidentally killed a man in the ring.


title: Billy Madison

text: Angered, Brian calls off his deal with Billy and renames Eric as chairman to the company. Billy grows distraught and reverts to his previous carefree lifestyle. Veronica motivates him to return to school, while his grade school classmates convince Max to retract his false accusations, infuriating Eric. Brian agrees to give Billy another chance but Eric cites that Billy failed the challenge by not finishing ninth grade within two weeks. He then threatens to sue Brian if he does not pass the company onto him. Billy intervenes and challenges Eric to an academic decathlon to finally settle their feud with the winner getting to take over Madison Hotels.


title: Billy Madison

text: Both men excel in different activities, but Billy manages to take a single-point lead before the contest's final event, a "Jeopardy!"-style academic test. Billy gives a completely dimwitted answer for the opening question in the event, and Eric is given the chance to win the contest by answering a question regarding business ethics. Eric, being a highly unscrupulous businessman, cannot conceive of an answer and breaks down. He brandishes a revolver, but Max (in his wrestling gear) tackles Eric from backstage before he can harm Billy. Eric recovers from the attack and attempts to shoot Veronica, but he is shot in the buttock by Danny McGrath, a rifle-wielding madman whom Billy apologized to earlier for bullying him years ago.


title: Billy Madison

text: At his graduation ceremony, Billy, deciding that he is not fit for running a hotel company, announces he will pass Madison Hotels to Carl Alphonse, Brian's polite and loyal operations manager, and reveals he plans to attend college in order to become a teacher. Eric, recently fired by Brian and now walking on crutches due to his wound, watches on and fumes in frustration over Billy's decision.


title: Billy Madison

text: Filming took place from June 26 to August 29, 1994, in Ontario, Canada. Sandler had initially tapped Stephen Kessler to direct the film, however after two weeks of production, Universal was unhappy with the footage and had replaced him with Tamra Davis. The Madison's Mansion exterior and grounds were shot at the Parkwood Estate in Oshawa while the interior was filmed in Casa Loma in Toronto. The entrance to the mansion was filmed at Marylake Augustinian Monastery in King City.


title: Billy Madison

text: While on "Norm Macdonald Live," Adam Sandler revealed that the role of Jack was intended for Allen Covert. Sandler wanted Bob Odenkirk for the role of Eric Gordon but the studio rejected it. Sandler also wanted Philip Seymour Hoffman for the role, Hoffman auditioned and later turned it down.


title: Billy Madison

text: On the film review aggregation site Rotten Tomatoes, the film holds an approval rating of 41% based on 49 reviews, with an average rating of 4.8/10. The website's critical consensus reads, "Audiences who enjoy Adam Sandler's belligerent comic energy may find him in joyously obnoxious form as "Billy Madison", but this thinly-plotted starring vehicle surrounds its star with an aggressively pedestrian movie." On Metacritic, the film received a weighted average score of 16 out of 100, based on 13 critics, indicating "overwhelming dislike".


title: Billy Madison

text: Richard Schickel panned the film, calling it "one of the most execrable movies ever made". Peter Rainer of the "Los Angeles Times" commented; "Sandler has a bad habit of thinking he is funnier than we are". On "At the Movies", Gene Siskel and Roger Ebert both gave the film thumbs down, and Roger Ebert said of Sandler, "...Not an attractive screen presence. He might have a career as a villain or as a fall guy or the butt of a joke, but as the protagonist his problem is that he recreates the fingernails on the blackboard syndrome." Gene Siskel added "...you don't have a good motivation for the character's behavior". Owen Gleiberman also panned the film, saying "By the end, you feel like a drill sergeant—you want to wipe that stupid grin off Sandler's face". Rita Kempley of "The Washington Post" said the film was trying to be "A more kid-friendly version of "Dumb and Dumber".' And there's even a moral: 'Yahoo for education,' though the movie doesn't really put any muscle behind it."


title: Billy Madison

text: Janet Maslin of "The New York Times" gave the film a mixed review, saying "It succeeds as a reasonably smart no-brainer. If you've ever had a yearning to relive the third grade, this must be the next best thing." Brian Lowry of "Variety" also gave the film a mixed review, saying "There are a few bursts of sheer, irresistible idiocy—along the lines of "Wayne's World" or even "Pee-wee's Big Adventure"—but not enough to sustain the more arid stretches."


title: Billy Madison

text: Billy Mowbray of Film4 gave the film a positive review, writing: "When you get that Sandler's comedic persona is meant to be annoying, like Beavis and Butthead or Cartman, the laughs come thick and fast". Kevin N. Laforest said, "Okay, the plot is inane, but it's the basis of a series of really funny scenes."


title: Danielle Rose Russell

text: Danielle Rose Russell (born October 31, 1999) is an American actress. She is known for her role as Hope Mikaelson in the fifth and final season of The CW supernatural drama series "The Originals" and as the star of the spinoff series, "Legacies", which premiered on October 25, 2018, and aired four seasons, ending on June 16, 2022. She also has played supporting roles in films such as "A Walk Among the Tombstones" (2014), "Aloha" (2015), "Pandemic" (2016), and "Wonder" (2017).


title: Danielle Rose Russell

text: Russell was born in Pequannock Township, New Jersey, and raised in West Milford, New Jersey. She is the daughter of Rosemary Rado, a former dancer and Rockette, and Ricky Russell, a former singer. She initially pursued modeling in her youth, appearing in print ads and commercials, before pursuing regional theater and appearing in several school plays at Holy Spirit School in Pequannock, New Jersey. , she was finishing high school via online coursework.


title: Danielle Rose Russell

text: Russell's first role was in the film "A Walk Among the Tombstones" (2014), playing the 14-year-old daughter of a Russian drug dealer. The next year, she appeared in "Aloha" (2015), as the daughter of Bradley Cooper's character. In 2016, Russell appeared in six episodes of the short lived TV series "The Last Tycoon". Russell played a supporting role in the 2017 film "Wonder".


title: Danielle Rose Russell

text: In July 2017, she was cast as the teenage Hope Mikaelson in the fifth and final season of The CW television series "The Originals". In May 2018, it was reported that she would continue her role as Hope Mikaelson on The CW's "Legacies", a spinoff of "The Originals". She was nominated for Teen Choice Award for Choice Sci-Fi/Fantasy TV Actress in 2019 for the role. Russell continued on "Legacies" for four seasons, with the series concluding on June 16, 2022.


title: Sideways

text: Sideways is a 2004 American comedy-drama road film directed by Alexander Payne and written by Jim Taylor and Payne. A film adaptation of Rex Pickett's 2004 novel of the same name, "Sideways" follows two men in their forties, Miles Raymond (Paul Giamatti), a depressed teacher and unsuccessful writer, and Jack Cole (Thomas Haden Church), a past-his-prime actor, who take a week-long road trip to Santa Barbara County wine country to celebrate Jack's upcoming wedding. Sandra Oh and Virginia Madsen also star as women they encounter during their trip. The film premiered at the Toronto International Film Festival on September 13, 2004, and was released in the United States on October 22, 2004. "Sideways" received widespread acclaim from critics and regarded as one of the greatest films of the 2000s. It was nominated for Best Picture, Best Director, Best Supporting Actor (Haden Church) and Best Supporting Actress (Madsen), winning Best Adapted Screenplay at the 77th Academy Awards.


title: Sideways

text: Miles Raymond is an unpublished writer, a wine aficionado, and a depressed, middle-aged English teacher living in San Diego. He takes Jack Cole, his soon-to-be-married actor friend and former college roommate, on a road trip through the Santa Ynez Valley wine country. Jack now does commercial voice-overs and plans to enter his future father-in-law's successful real estate business. Soon after the trip begins, Miles insists on stopping to see his mother in Oxnard, as it is the day before her birthday. He steals a thousand dollars from her room that night. The men sneak out the next morning to avoid the birthday gathering.


title: Sideways

text: Miles wants to spend the week relaxing, playing golf, and enjoying good food and wine. However, much to Miles' consternation, Jack is on the prowl and wants one last sexual fling before settling into domestic life. In the wine country, the pair dine at The Hitching Post II. Jack sees that Maya, a waitress with whom Miles is casually acquainted, is interested in Miles; Miles thinks she is only being professionally friendly. Jack lies to Maya that Miles' manuscript has been accepted for publication, although it is only being considered. At a wine tasting the next day, Jack arranges a double date with a wine pourer named Stephanie, who is also acquainted with Maya.


title: Sideways

text: During the date, Miles gets drunk and telephones Victoria, his ex-wife, after learning from Jack that she has remarried and will be bringing her new husband to Jack's wedding. The two couples go to Stephanie's home, where she and Jack adjourn to her bedroom for sex. Miles and Maya connect through their mutual interest in wine, and Miles kisses her awkwardly. As they are leaving separately, Miles gives her a copy of his manuscript, which Maya had earlier expressed interest in reading.


title: Sideways

text: Jack claims to have fallen in love with Stephanie and tells Miles he wants to move to Santa Ynez Valley to be closer to her. After spending time with Jack and Stephanie at wineries and a picnic, Miles and Maya return to her apartment and have sex. The next day, Miles lets it slip that Jack is to be married. Disgusted with the men's dishonesty, Maya dumps Miles.


title: Sideways

text: Jack and Miles go to a winery that Miles finds subpar. After hearing from his literary agent that his manuscript has been rejected, an upset Miles pesters the pourer for a "full pour" of wine. When the server refuses, Miles drinks from the spit bucket, creating a scene. Jack intervenes and drives Miles back to the motel. Upon arrival, Stephanie approaches Jack knowing about his engagement and breaks Jack's nose with her motorcycle helmet, screaming about being lied to. Miles takes Jack to the ER and leaves Maya an apologetic voice message, admitting that his book is not going to be published. That night, Jack hooks up with a waitress named Cammi, despite Miles's protests. Later, Jack returns to the motel naked, having been caught having sex with Cammi by her husband. Jack begs Miles to help him retrieve his wallet, which contains custom wedding rings. Miles sneaks into the house, where he discovers Cammi and her husband having sex. Miles grabs the wallet and runs, barely escaping the nude and irate husband, screaming he will find them.


title: Sideways

text: Jack intentionally drives Miles's car into a tree so it looks as if he broke his nose in an accident. The pair return to the fiancée's home, where Jack is warmly received by the family.


title: Sideways

text: Following the wedding ceremony, Miles runs into his ex-wife Victoria and meets her new husband, Ken. Victoria tells Miles that she is pregnant. Miles absconds before the reception, driving back to his San Diego apartment. Alone, he drinks his prized wine, a 1961 Château Cheval Blanc, from a disposable styrofoam soda cup at a fast-food restaurant. Miles returns to the routine of teaching school. One day he receives a voicemail from Maya, who says she enjoyed his manuscript and invites him to visit. Miles drives back to wine country and knocks on Maya's door.


title: Sideways

text: The film drew attention and increased tourism to the Santa Ynez Valley wine-growing region of California's Central Coast. During the film, Miles speaks fondly of the red wine varietal pinot noir while denigrating merlot. After the film's U.S. release in October 2004, merlot sales dropped 2% while pinot noir sales increased 16% in the Western United States. A similar trend occurred in British wine outlets.


title: Sideways

text: A 2009 study by Sonoma State University found that "Sideways" slowed the growth in merlot sales volume and caused its price to fall, but the film's main effect on the U.S. wine industry was a rise in the sales volume and price of pinot noir and in overall wine consumption.


title: Sideways

text: A 2022 study in the "Journal of Wine Economics" found that "Sideways" caused a reduction in demand for merlot and an increase in demand for pinot noir, which led large winemakers to grow pinot noir grapes in low-quality land and blend those grapes with the grapes grown in high-quality areas just to meet demand, ultimately leading to worse pinot noir wines.


title: Sideways

text: Rex Pickett, author of the novel "Sideways", after a three-month research trip in Chile for his 2015 "Sideways 3 Chile" novel, fell in love with the country, the people, and their wines. In 2018, Pickett launched his own pinot noir, named "Sideways".


title: Sideways

text: The original soundtrack album features 15 jazz instrumentals composed and produced by Rolfe Kent and was orchestrated and arranged for the band by Tony Blondal. The album was nominated for the Golden Globe Award for "Best Original Score", and the music proved so popular there was demand for a national tour. Eventually a few cities were chosen to perform in as the composer was too busy to commit to more. The romantic leitmotif shared by Miles and Maya is excerpted from "Symbiosis" by Claus Ogerman and Bill Evans.


title: Sideways

text: On review aggregator Rotten Tomatoes, "Sideways" has an approval rating of 97% based on 233 reviews, and an average rating of 8.60/10. The website's critical consensus reads: "Charming, thoughtful, and often funny, "Sideways" is a decidedly mature road trip comedy full of excellent performances." On Metacritic, the film has a weighted average score of 94 out of 100 based on 42 reviews, indicating "universal acclaim". Audiences polled by CinemaScore gave the film an average grade of "B" on an A+ to F scale.


title: Sideways

text: "Time Out" described the film as "intelligent, funny and moving", and Roger Ebert of the "Chicago Sun-Times" gave it four stars out of four, writing that, "what happens during the seven days adds up to the best human comedy of the year – comedy, because it is funny, and human, because it is surprisingly moving."


title: Sideways

text: With the exception of Giamatti, who had already starred in the critically acclaimed film "American Splendor" (2003), the film was a career breakthrough for the stars. Church and Madsen were each nominated for the Screen Actors Guild Award, Golden Globe Award, and Academy Award for their performances, winning the Broadcast Film Critics Association Award and Independent Spirit Award for their respective categories. Giamatti was described as "The World's Best Character Actor" by "Time" magazine. In 2005 Sandra Oh went on to star in the ABC medical drama "Grey's Anatomy", for which she won two Screen Actors Guild Awards and one Golden Globe Award.


title: Sideways

text: "Sideways" was ranked 494th on "Empire"s 2008 list of the 500 greatest movies of all time. "Total Film" put "Sideways" on its list of 100 Greatest Movies of All Time. In 2013, the Writers Guild of America also ranked its script as the 90th greatest ever written.


title: Sideways

text: In 2019, it was announced that "Sideways" was scheduled to be adapted for a stage musical. Kathleen Marshall is expected to be the director and choreographer for the musical, which was aiming for a spring or summer 2020 tryout in a regional venue prior to Broadway. The musical will have a book by Rex Pickett and the score by Anthony Leigh Adams.


title: Sideways

text: A play adapted by author Rex Pickett from the "Sideways" novel was produced at multiple theaters in the United States and the United Kingdom, including at the La Jolla Playhouse.


title: Sideways

text: In addition to the musical, it was reported that Pickett had written screenplays based on his two "Sideways" sequels already in print, "Vertical" and "Sideways 3 Chile".


title: Sideways

text: As of 2022, Payne and Taylor are the only two screenwriters to ever sweep the rarest achievements known as "The Big Four" critics awards (LAFCA, NBR, NYFCC, NSFC) as well as the Oscar, Globe, BAFTA, WGA, and Critic's Choice for Best Writer to win for a single film.


title: Sideways

text: Fox International Productions and Fuji TV released a Japanese-language remake of the film in October 2009, サイドウェイズ, often rendered in Romaji as "Saidoweizu". The film is directed by Cellin Gluck and stars Katsuhisa Namase, Fumiyo Kohinata, Kyōka Suzuki, and Rinko Kikuchi, and has a soundtrack composed and performed by Hawaiian-born ukulele virtuoso Jake Shimabukuro.


title: Sideways

text: The remake shifts the setting of the film to Napa Valley. Although listed as an executive producer, Payne was not involved with the remake, although he gave it his blessing. Giamatti declined an invitation to make an unspecified cameo appearance in the film.


title: Sideways

text: Pickett wrote a sequel to his novel, "Vertical", in 2011, following Miles and Jack on a road trip to Oregon with Miles' mother. Payne has declined to consider a sequel to the film. Fox Searchlight owns the rights to the characters, but Payne's lack of interest makes the film a non-starter for Fox.


title: Liquid Death

text: Liquid Death is a canned-water company founded by Mike Cessario. Its tagline is "murder your thirst". The drink is sold in a "tallboy" drink can. Its water is supposedly sourced from the Austrian Alps, however, it is canned by the Austrian beverage company Starzinger in the Upper Austrian town of Frankenmarkt (altitude 1,759 ft). The drink began selling to consumers on its website in January 2019. Its manufacturer is Supplying Demand, Inc. , the company is valued at $525 million.


title: Liquid Death

text: The drink is sold in a "tallboy" drink can. Its water is sourced from the Austrian Alps, where it is also canned. In 2020, the brand introduced a sparkling water variety. Its manufacturer is Supplying Demand, Inc. In addition to the original sparkling water, Liquid Death also introduced three flavored carbonated beverages including Mango Chainsaw, Severed Lime, and Berry It Alive. Unlike their unflavored seltzer these flavored carbonated beverages (“sparkling waters”) are actually akin to all-natural, low-calorie sodas as they not only contained added natural flavorings/extracts but also acidulants and some added sugar "(from agave nectar)" as well.


title: Liquid Death

text: Delaware native Mike Cessario, who previously worked as a Netflix creative director, filed a trademark application for the term "Liquid Death" with the United States Patent and Trademark Office on July 6, 2017. Before the water was available to consumers for purchase, Cessario produced a video advertisement to gauge market interest in the product. In 2019, Cessario stated the company's plan was to expand to bars, tattoo parlors, and certain barber shops in Los Angeles and Philadelphia as a "lifestyle play". Cessario stated the brand was initially marketed towards straight edge adherents and fans of heavy metal music and punk rock. The drink began selling to consumers on its website in January 2019.


title: Liquid Death

text: Liquid Death raised US$1.6 million in seed funding from a round led by Science Inc. in 2019 (for a total amount raised to $2.25 million at that point), $9 million in a series A round in February 2020, and $23 million in a series B round in September 2020.


title: Liquid Death

text: In February 2020, the brand expanded into Whole Foods Market in the United States, and in August 2020, the brand expanded into two hundred 7-Eleven stores in the Los Angeles and San Diego markets as part of a trial run.


title: Liquid Death

text: In May 2021, the company raised an additional $15 million in a Series C funding round completed with Live Nation, who said they would exclusively sell the drink in their events and venues for a period of time. As of December 2021, the drink has begun selling in large supermarket chains such as Publix and Sprouts stores. In January 2022, the company raised $75 million in Series C funding. The company received a $525 million valuation at the time. Cessario stated that the company's revenue rose to $45 million in 2021.


title: Liquid Death

text: In May 2020, the company released "Greatest Hates", an album of death metal music created with lyrics from hate comments the company received online; a second album of hate comments, described as "punk rock", was released in November. In February 2022, during Super Bowl LVI, the company released an advertisement featuring children enjoying the beverage with metal music. Parodying advertisements for alcoholic beverages, the advertisement ends with the tagline - "Don't be scared, it's just water".


title: Nursing

text: Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care 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. Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. Nurse practitioners are nurses with a graduate degree in advanced practice nursing. They are however permitted by most jurisdictions to practice independently in a variety of settings. 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.


title: Nursing

text: Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family, and other team members that focuses on treating illness to improve quality of life. In the United Kingdom and the United States, clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe the correct medications and other therapies, depending on particular state regulations. Nurses may help coordinate the patient care performed by other members of a multidisciplinary health care team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals. In addition to providing care and support, nurses educate the public, and promote health and wellness.


title: Nursing

text: Nursing historians face the challenges of determining whether care provided to the sick or injured in antiquity is called nursing care. In the fifth century BC, for example, the Hippocratic Collection in places describes skilled care and observation of patients by male "attendants," who may have been early nurses. Around 600 BC in India, it is recorded in Sushruta Samhita, Book 3, Chapter V about the role of the nurse as "the different parts or members of the body as mentioned before including the skin, cannot be correctly described by one who is not well versed in anatomy. Hence, any one desirous of acquiring a thorough knowledge of anatomy should prepare a dead body and carefully, observe, by dissecting it, and examine its different parts."


title: Nursing

text: Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care. Examples exist in Christian, Islamic and Buddhist traditions amongst others. Phoebe, mentioned in Romans 16 has been described in many sources as "the first visiting nurse". These traditions were influential in the development of the ethos of modern nursing. The religious roots of modern nursing remain in evidence today in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse in the past.


title: Nursing

text: During the Reformation of the 16th century, Protestant reformers shut down the monasteries and convents, allowing a few hundred municipal hospices to remain in operation in northern Europe. Those nuns who had been serving as nurses were given pensions or told to get married and stay home. Nursing care went to the inexperienced as traditional caretakers, rooted in the Roman Catholic Church, were removed from their positions. The nursing profession suffered a major setback for approximately 200 years.


title: Nursing

text: During the Crimean War the Grand Duchess Elena Pavlovna issued the call for women to join the Order of Exaltation of the Cross (Krestodvizhenskaya obshchina) for the year of service in the military hospitals. The first section of twenty-eight "sisters", headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, went off to the Crimea early in November 1854.


title: Nursing

text: Florence Nightingale laid the foundations of professional nursing after the Crimean War. Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman can help improve the care of the medically sick. Her "Notes on Nursing" (1859) became popular. The Nightingale model of professional education, having set up one of the first schools of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870. Nightingale was also a pioneer of the graphical presentation of statistical data.


title: Nursing

text: Florence Nightingale worked by sub concepts of the environmental theory. She included five factors that helped nurses in her time of working in poor sanitation and with uneducated nurses. These factors included (1) fresh air, (2) clean water, (3) a working drainage system, (4) cleanliness, and (5) good light or sunlight. Nightingale believed that a clean, working environment were important in caring for patients. In the 19th century, this theory was ideal for helping patients, providing a guide for nurses to alter the environment around the patient for the better of their health.


title: Nursing

text: Nightingale's recommendations built upon the successes of Jamaican "doctresses" such as Mary Seacole, who like Nightingale, served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers and those suffering from diseases in the 19th century in the Crimea, Central America, and Jamaica. Her predecessors had great success as healers in the Colony of Jamaica in the 18th century, and they included Seacole's mother, Mrs. Grant, Sarah Adams, Cubah Cornwallis, and Grace Donne, the mistress and doctress to Jamaica's wealthiest planter, Simon Taylor.


title: Nursing

text: Red Cross chapters, which began appearing after the establishment of the International Committee of the Red Cross in 1863, offered employment and professionalization opportunities for nurses (despite initial objections from Florence Nightingale). Catholic orders such as Little Sisters of the Poor, Sisters of Mercy, Sisters of St. Mary, St. Francis Health Services, Inc. and Sisters of Charity built hospitals and provided nursing services during this period. In turn, the modern deaconess movement began in Germany in 1836. Within a half century, there were over 5,000 deaconesses in Europe.


title: Nursing

text: Formal use of nurses in the modern military began in the latter half of the nineteenth century. Nurses saw active duty in the First Boer War, the Egyptian Campaign (1882), and the Sudan Campaign (1883).


title: Nursing

text: Hospital-based training came to the fore in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and educational providers.


title: Nursing

text: Many nurses saw active duty in World War I, but the profession was transformed during the Second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, 40,000 strong. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.


title: Nursing

text: The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.


title: Nursing

text: In the 19th and early 20th century, nursing was considered a women's profession, just as doctoring was a men's profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remains well below that of female physicians in the early 21st century.


title: Nursing

text: The biggest shortages of nurses and midwives are in South East Asia and Africa. A global survey by McKinsey & Company in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave their current role in direct patient care in the next year. Nursing shortages are a rising risk in many countries. The top five factors which they said would make them stay were


title: Nursing

text: Pay was eighth on the list. An American survey in 2003 found about half the respondents were considering leaving.


title: Nursing

text: Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:


title: Nursing

text: The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.


title: Nursing

text: The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practice as well as training in clinical skills.


title: Nursing

text: Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.


title: Nursing

text: To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. In the United States, a Licensed Practical Nurse (LPN) works independently or with a Registered Nurse (RN). The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees.


title: Nursing

text: In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as an RN. The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN). The Bachelor of Science in Nursing (BSN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a standardized exam (including multiple choice, select all that apply, fill in the blank and "hot spot" questions) that nurses take to become licensed. It costs two-hundred dollars to take and examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase.


title: Nursing

text: Some nurses follow the traditional role of working in a hospital setting. Other options include: pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics (eHealth). There are many other options nurses can explore depending on the type of degree and education acquired. These options can also include, community health, mental health, clinical nursing specialists, and nurse midwives. RNs may also pursue different roles as advanced practice nurses.


title: Nursing

text: Nurses are not doctors' assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses. RNs treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. However, they also assist doctors in the emergency room or in trauma care when help is needed.


title: Nursing

text: Despite equal opportunity legislation, nursing has continued to be a female-dominated profession in many countries; according to the WHO's 2020 "State of the World's Nursing," approximately 90% of the nursing workforce is female. For instance, the male-to-female ratio of nurses is approximately 1:19 in Canada and the United States. This ratio is represented around the world. Notable exceptions include Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, which all have more male than female nurses. In Europe, in countries such as Spain, Portugal, Czech Republic and Italy, over 20% of nurses are male. In the United Kingdom, 11% of nurses and midwives registered with the Nursing and Midwifery Council (NMC) are male. The number of male nurses in the United States doubled between 1980 and 2000. However female nurses are still more common, but male nurses receive more pay on average.


title: Nursing

text: Research has indicated that there can be negative effects of diversity within nursing. When there is a heavier focus on diversity in nursing, the quality of care or performance of the nurses can be hindered. Research demonstrates that as people begin to be different in a work setting, this can create issues if not addressed correctly. When hospitals begin to focus on diversity over their patients, the quality of care can be negatively affected if diversity becomes the main goal.


title: Nursing

text: Statistically speaking, in the United States 19.2% of nursing positions are held by people of minority backgrounds. The remaining 80.8% of positions are held by Caucasian individuals, particularly women. Diversity in nursing is lacking.


title: Nursing

text: Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected in consideration with the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research. The nursing process is made up of five steps: 1.evaluate, 2. implement, 3. plan, 4. diagnose, and 5. assess. Nurses are able to use this process from the American Nurses Association to determine the best care they can provide for the patient. There are many other diverse nursing theories as well.


title: Nursing

text: In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.


title: Nursing

text: Nurses manage and coordinate care to support activities of daily living (ADL). Often the provision of such care is delegated to nursing assistants. This includes assisting in patient mobility, such as moving an activity intolerant patient within bed.


title: Nursing

text: Medication management and administration are a part of most hospital nursing roles, however, prescribing authority varies between jurisdictions. In many areas, registered nurses administer and manage medications prescribed by a professional with full prescribing authority such as a nurse practitioner or a physician. As nurses are responsible for evaluating patients throughout their care - including before and after medication administration - adjustments to medications are often made through a collaborative effort between the prescriber and the nurse. Regardless of the prescriber, nurses are legally responsible for the drugs they administer. There may be legal implications when there is an error in a prescription, and the nurse could be expected to have noted and reported the error. In the United States, nurses have the right to refuse any medication administration that they deem to be potentially harmful to the patient.


title: Nursing

text: In the United Kingdom there are some nurses who have taken additional specialist training that allows them to prescribe any medications from their scope of practice.


title: Nursing

text: The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits. Many times, nurses are very busy and have a hard time giving information to the patient because they have so many other things going on. Educating the patient and their family increases the chance for a better patient experience. Giving the best care requires informing the patient of what is going on and support. While explaining procedure, recovery, and taking care of the patient, nurses also have to help patients and their families cope with different medical situations.


title: Nursing

text: When speaking with the patient, nurses have to be able to communicate in a way that can be understood by the patient. Informing the patient may involve speaking in broad, general terms, using visuals or different reading materials, and even including demonstrations if necessary. The more the patient and their family understand what the nurse is saying, the better healthcare the patient can receive without the assistance of a nurse.


title: Nursing

text: Nursing is the most diverse of all . Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.


title: Nursing

text: Nurses with higher degrees allow for specialization within the medical field. There are many specific nursing professions that can be separated into categories of care type, age, gender, certain age group, practice setting, etc. Nurses are able to specialize with a combination of these categories as well. There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing, radiology, and emergency nursing.


title: Nursing

text: Nurses practice in a wide range of settings, including hospitals, private homes, schools, and pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They also work on cruise ships and in the military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as "per diem nursing", "agency nursing" or "travel nursing". Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software. Nurse authors publish articles and books to provide essential reference materials.


title: Nursing

text: Internationally, there is a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios.


title: Nursing

text: The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress. Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions. This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work, and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders, depression, mortality, psychiatric disorders, stress-related illnesses, and illness in general. Nurses are at risk of developing compassion fatigue and moral distress, which can worsen mental health. They also have very high rates of occupational burnout (40%) and emotional exhaustion (43.2%). Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision.


title: Nursing

text: Nurses are also at risk for violence and abuse in the workplace. Violence is typically perpetrated by non-staff (e.g. patients or family), whereas abuse is typically perpetrated by other hospital personnel. Of American nurses, 57% reported in 2011 that they had been threatened at work; 17% were physically assaulted.


title: Nursing

text: There are 3 different types of workplace violence that nurses can experience. First, physical violence, which can be hitting, kicking, beating, punching, biting, and using objects to inflict force upon someone. Second, psychological violence is when something is done to impair another person through threats and/or coercion. Third, sexual violence which can include any completed or attempted non-consensual sexual act.


title: Nursing

text: Workplace violence can also be categorized into two different levels, interpersonal violence and organizational coercion. Interpersonal violence could be committed by co-workers and/or patients by others in the hospital. The main form of this level is verbal abuse. Organizational coercion may include an irrationally high workload, forced shifts, forced placement in different wards of the hospital, low salaries, denial of benefits for overwork, poor working environment, and other workplace stressors. These problems can affect the quality of life for these nurses who may experience them. It can be extremely detrimental to nurses if their managers lack understanding of the severity of these problems and do not support the nurses through them.


title: Nursing

text: There are many contributing factors to workplace violence. These factors can be divided into environmental, organizational, and individual psychosocial. The environmental factors can include the specific setting (for example the emergency department), long patient wait times, frequent interruptions, uncertainty regarding the patients' treatment, and heavy workloads. Organizational factors can include inefficient teamwork, organizational injustice, lack of aggression and/or stress management programs, and distrust between colleagues. Individual psychosocial factors may include nurses being young and inexperienced, previous experiences with violence, and a lack of communication skills. Misunderstandings may also occur due to the communication barrier between nurses and patients. An example of this could be the patient's condition being affected by medication, pain, and/or anxiety.


title: Nursing

text: There are many causes of workplace violence. The most common perpetrators for harassment and/or bullying against nursing students were registered nurses including preceptors, mentors, and clinical facilitators. However, the main cause of workplace violence against nurses were patients. 80% of serious violence incidents in health care centers were due to the nurses' interactions with patients.


title: Nursing

text: There are many different effects of workplace violence in the field of Nursing. Workplace violence can have a negative impact on nurses both emotionally and physically. They feel depersonalized, dehumanized, fatigued, worn out, stressed out, and tired. Because of the severity of some incidents of violence, nurses have reported manifestations of burn-out due to the frequent exposure. This can heavily impact of a nurses' mental health and cause nurses to feel unsatisfied with their profession and unsafe in their work environment.


title: Nursing

text: There are a number of interventions that can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress. Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses. In some Japanese hospitals, powered exoskeletons are used. Lumbar supports (i.e. back belts) have also been trialed.


title: Nursing

text: In the US, scope of practice is determined by the state or territory in which a nurse is licensed. Each state has its own laws, rules, and regulations governing nursing care. Usually the making of such rules and regulations is delegated to a state board of nursing, which performs day-to-day administration of these rules, licenses for nurses and nursing assistants, and makes decisions on nursing issues. In some states, the terms "nurse" or "nursing" may only be used in conjunction with the practice of a registered nurse (RN) or licensed practical or vocational nurse (LPN/LVN).


title: Nursing

text: In the hospital setting, registered nurses often delegate tasks to LPNs and unlicensed assistive personnel.


title: Nursing

text: RNs are not limited to employment as bedside nurses. They are employed by physicians, attorneys, insurance companies, governmental agencies, community/public health agencies, private industry, school districts, ambulatory surgery centers, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation (outcome and process) in many areas such as biology, psychology, human development, and health care systems.


title: Nursing

text: Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.


title: Nursing

text: Nursing is the nation's largest health care profession. In 2017, there were more than 4,015,250 registered nurses and 922,196 licensed practical nurses nationwide. Of all licensed RNs, 2.6 million or 84.8% are employed in nursing. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in nursing (BSN) degree. Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam. (The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system.)


title: Nursing

text: The oldest method of nursing education is the hospital-based diploma program, which lasts approximately three years. Students take between 30 and 60 credit hours in anatomy, physiology, microbiology, nutrition, chemistry, and other subjects at a college or university, then move on to intensive nursing classes. Until 1996, most RNs in the US were initially educated in nursing by diploma programs. According to the Health Services Resources Administration's 2000 Survey of Nurses only six percent of nurses who graduated from nursing programs in the United States received their education at a Diploma School of Nursing.


title: Nursing

text: The most common initial nursing education is a two-year Associate Degree in Nursing (Associate of Applied Science in Nursing, Associate of Science in nursing, Associate Degree in Nursing), a two-year college degree referred to as an ADN. Some four-year colleges and universities also offer the ADN. Associate degree nursing programs have prerequisite and corequisite courses (which may include English, Math and Human Anatomy and Physiology) and ultimately stretch out the degree-acquiring process to about three years or greater.


title: Nursing

text: Another pathway into the profession, or a higher level of education for other nurses, is obtaining a Bachelor of Science in Nursing (BSN), a four-year degree that also prepares nurses for graduate-level education. For the first two years in a BSN program, students usually obtain general education requirements and spend the remaining time in nursing courses. In some new programs the first two years can be substituted for an active LPN license along with the required general studies. Advocates for the ADN and diploma programs state that such programs have an on the job training approach to educating students, while the BSN is an academic degree that emphasizes research and nursing theory. Some states require a specific amount of clinical experience that is the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions that would not usually be available to those with an ADN, but is not necessary for most patient care functions. Nursing schools may be accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).


title: Nursing

text: Advanced education in nursing is done at the master's and doctoral levels. It prepares the graduate for specialization as an advanced practice registered nurse (APRN) or for advanced roles in leadership, management, or education. The clinical nurse leader (CNL) is an advanced generalist who focuses on the improvement of quality and safety outcomes for patients or patient populations from an administrative and staff management focus. Doctoral programs in nursing prepare the student for work in nursing education, health care administration, clinical research, public policy, or advanced clinical practice. Most programs confer the PhD in nursing or Doctor of Nursing Practice (DNP).


title: Nursing

text: Areas of advanced nursing practice include that of a nurse practitioner (NP), a certified nurse midwife (CNM), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). Nurse practitioners and CNSs work assessing, diagnosing and treating patients in fields as diverse as family practice, women's health care, emergency nursing, acute/critical care, psychiatry, geriatrics, or pediatrics, additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.


title: Nursing

text: 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.


title: Nursing

text: RNs are the largest group of health care workers in the United States, with about 2.7 million employed in 2011. It has been reported 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 to increase for the foreseeable future. There are data to support the idea that the nursing shortage is a voluntary shortage. 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.


title: Nursing

text: 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. 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 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.


title: Nursing

text: 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.


title: Nursing

text: 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.


title: Nursing

text: 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. There are some exceptions to this rule including the state of California, Florida and Kentucky. National Healthcare Institute 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.<ref name="http://www.nursingworld.org/"></ref><ref name="http://www.NHInstitute.org/"></ref>


title: Nursing

text: 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.


title: Nursing

text: The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organization and administers more than 30 specialty examinations.


title: Nursing

text: Due to its large prison population, the United States needs many correctional nurses to help inmates receive proper health-care, including mental health treatments for prisoners with psychological issues. The demand for nurse is high everywhere. Nurses working in correctional care have to focus on the care of the patient, not what they did. They are to provide the best possible care because is a compassionate field and all nurses want is to better the patient.


title: Nursing

text: Nurses are not the only health care workers in correctional facilities. Some examples of people who work in correctional facilities are LPNS, RNs, nurse practitioners, doctors, pharmacists, therapists, and specialists.


title: Nursing

text: When the individual arrives, nurses perform an initial exam that is just a basic checkup to determine what needs the patient may have while in prison. Here they can discover existing conditions or even signs of substance abuse. A correctional nurse can face a wide variety of healthcare issues including chronic medical conditions, mental health, infectious disease, and much more. Correctional nurses must follow stricter protocols then say in a hospital due to confidentiality. Assessing a patient can be difficult. A deputy or officer may have to be present during exams, which can make the patient feel restricted, and be less open with their medical information. Without the nurse knowing some information from the patient, prevent them from receiving the best care possible.


title: Nursing

text: Canadian nursing dates back to 1639 in Quebec with the Augustine nuns. These nuns were trying to open a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America. In the nineteenth century, some Catholic orders of nursing were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.


title: Nursing

text: All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses Association to continue their education to receive a bachelor's degree. This degree may result in better patient outcomes. All Canadian provinces and territories, with the exception of the Yukon and Quebec, require that all nurses have a bachelor's degree. The length of time generally required to obtain this degree is four years. However, some Canadian universities offer a condensed program that is two years in length.


title: Nursing

text: Nursing specialty certification is available through the Canadian Nurses Association in 22 practice areas, including:


title: Nursing

text: Nursing specialty certification generally requires practice, experience, and passing a test that is based on competencies for that specific medical or surgical domain in which nursing care is provided. The certification in gerontological nursing, which involves providing care to the elderly, is offered to not only RNs and NPs but also LPNs.


title: Nursing

text: Latin American nursing is based on three levels of training: (a) professional/registered, (b) technical, and (c) auxiliary. The nursing education in Latin America and the Caribbean includes the principles and values of the Universal Health and primary health care. These principles underpin transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. The Pan American Health Organization/World Health Organization (PAHO/WHO) proposes the Strategy for Universal Access to Health and Universal Health Coverage to improve health outcomes and other basic objectives of health systems based on the right of each person to receive the best standard of health, without exposing people to financial difficulties through nursing intervention.


title: Nursing

text: To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council. The title "Registered Nurse" can only be granted to those holding such registration. This protected title is laid down in the Nurses, Midwives and Health Visitors Act, 1997. From April 2016, nurses in the United Kingdom are expected to revalidate every three years which involves providing evidence of further development and active practice.


title: Nursing

text: First-level nurses make up the bulk of the registered nurses in the UK. They were previously known by titles such as Registered General Nurse (RGN), Registered Sick Children's Nurse (RSCN), Registered Mental Nurse (RMN), and Registered Nurse (for the) Mentally Handicapped (RNMH). The titles used now are similar, including Registered Nurse Adult (RNA), Registered Nurse Child (RNC), Registered Nurse Mental Health (RNMH), and Registered Nurse (of) Learning Disabilities (RNLD). Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse. Many have now either retired or undertaken conversion courses to become first-level nurses. They are entitled to refer to themselves as registered nurses as their registration is on the Nursing & Midwifery Council register of nurses, although most refer to themselves as Enrolled Nurses (ENs) or State Enrolled Nurses (SENs).


title: Nursing

text: Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles (see above), this has become a less attractive option.


title: Nursing

text: Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members. Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or "modern matrons".


title: Nursing

text: To become a registered nurse, one must complete a program recognised by the Nursing and Midwifery Council (NMC). Currently, this involves completing a degree, available from a range of , in the chosen branch specialty (see below), leading to both an academic award and professional registration as a 1st level registered nurse. Such a course is a 50/50 split of learning in university (i.e. through lectures, assignments and examinations) and in practice (i.e. supervised patient care within a hospital or community setting).


title: Nursing

text: These courses are three (occasionally four) years' long. The first year is known as the common foundation program (CFP), and teaches the basic knowledge and skills required of all nurses. Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are:


title: Nursing

text: As of 2013, the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification.<ref name="http://www.nmc-uk.org/Get-involved/Consultations/Past-consultations/By-year/Pre-registration-nursing-education-Phase-2/Changes-to-pre-registration-nursing-programmes-FAQs-/2"></ref> However, those nurses who hold a diploma, or even a certificate in nursing are still able to legally practice in the UK, although they are able to undertake university modules to obtain enough credits to top up to a degree.