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. nurses care for individuals of all ages and backgrounds along the wellness continuum 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 individuals and communities. 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. 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. 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. 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. gender issues a male nurse at runwell hospital, wickford, essex, in 1943 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, although female nurses are still more common. on average, male nurses receive more pay than female nurses. minorities in u.s. nursing 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. theory and process 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. 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. scope of activities activities of daily living assistance main article: activities of daily living 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. medication 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. 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. patient education