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What is a nurse? Is there an international consensus?


Roy Carr-Hill, Centre for Health Economics, University of York, York YO10 5DD, UK; Tel: 07799 096173; Fax: 01904 321402; E-mail:


CURRIE E.J. & CARR HILL R.A. (2013) What is a nurse? Is there an international consensus? International Nursing Review60, 67–74

Background:  Historical experience and health service modernization partly account for the variation seen in definitions of what a ‘nurse’ is from country to country. It is unclear if international disparities in nursing provision, apparent in health data for developed countries, demonstrate real differences in staffing patterns or simply reflect the wide variations in understanding and use of terms for different categories of nurse.

Aim:  This paper is an opinion piece of international interest discussing the need for standardization in definitions of different categories of nurse internationally.

Discussion:  The International Council for Nurses (ICN), the World Health Organization and the Organisation for Economic Cooperation and Development (OECD) all have different ways of defining a nurse. The wide variation in terms is particularly apparent from OECD countries however, where nursing density data present wide disparities, not readily accounted for by gross national product. Skill mix and clinical role developments may account for these better.

Conclusion:  Until proper consensus is reached on what a nurse is and does, any skill mix or clinical role developments will only have limited international relevance, especially in OECD countries. If nursing qualifications are to be valid even across the European Union, then recommended standards such as those of the ICN, must be specified in terms of what different categories of nurses actually can do, and their responsibilities and roles within that scope of practice. Standardization of definitions of categories of nurse internationally should reduce confusion and promote better understanding of patterns of nurse staffing and the effect these may have on patient outcomes.