Nursing education in Israel has been undergoing academic upgrading, including a revised post-basic certification course in Intensive Care Nursing allowing nurses increased clinical privileges and responsibilities.
Introduction Over 15 years ago the Israeli government through its Ministry of Health's Nursing Division enacted a major policy decision, determining that entry level into nursing practice in Israel would be at the registered nurse (RN), baccalaureate level. Since that time, major efforts have been underway to upgrade and increase the level of educational preparation of all nurses. Licensed Practical Nurse (LPN) programs have been slowly phased out while more programs to upgrade LPNs to RNs, RNs to baccalaureate nurses and non-nursing degree students to registered nurses have been encouraged. These courses are in response to the current shortage of registered nurses, projected to worsen in coming years, and the need to produce a minimum of 1300-1400 new registered nurses per year. The latest available statistics of the Ministry of Health Nursing Division (2007) show that over two thirds of the over 54,000 Israeli nurses are registered and almost a quarter have an academic degree.
Post-Basic Intensive Care Nursing Education Professional development has also been encouraged at the post-basic level. Almost half of all registered nurses have this level of certification. Over 12 different postbasic certifications are available, including those related to the acute and critical patient. This area includes several sub-specialties including combined intensive care, paediatric intensive care, neonatal intensive care and emergency medicine. Graduates of the intensive care post-basic course are permitted to perform several advanced procedures not allowed to regular registered nurses, such as removal of arterial lines, administration of IV push drugs-including into central lines, removal and attachment of patients to ventilators, care of Swan Ganz catheters, and defibrillation, to name a few. While in previous years all registered nurses were able to register for post-basic certification, nurses must now hold a baccalaureate degree and pass a qualification exam in order to be accepted into a post-basic certification program.
The intensive care post-basic course consists of 3 different sections, a common theoretical module for all acute, critical postbasic certifications (168 hours), an individual module for intensive care (261 hours) and a clinical experience (up to 300 hours, depending on previous critical care clinical experience). The basic module includes review of pathophysiology and principles of treatment of the cardiovascular, respiratory and neurological systems; laws related to nursing practice; fluids and electrolytes; physical assessment and imaging; suturing and gluing of wounds; and infection control. Content of the intensive care module includes assessment of signs and symptoms in complex and critical situations, diagnosis, treatment and evaluation. Situations changes in level of consciousness, urinary output dysfunction, shock, hematological disorders and skills related to support of families. Part of this module also includes an advanced cardiac life support course (ACLS). In order to receive accreditation for this post-basic course, nurses must sit for a national certification exam. The content and tone of this exam has been recently changed to an innovative format, which not only includes a computerised test of knowledge but also a simulation exam where students are tested on their clinical skills and decision making abilities.
At the present time there is no Nurse Practice Act in Israel. This fact has been described as one of the major reasons that the Advanced Practice Nurse role is also not officially recognised. However many nurses work in roles similar to those of Clinical Nurse Specialists or Nurse Practitioners without official recognition, usually in the community setting. There also is one Master's degree program in nursing in the country that trains advanced practice nurses for this potential position. It is hoped that such a role will be officially sanctioned in the future.