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Chapter 4 : Patient Care: Nursing. Registered Nurses. Overview Most education & widest scope of practice of nurses Largest health care occupation in U.S. Large demand Diverse work settings Flexible working arrangements U.S. News & World Report: one of the best careers of 2010. - PowerPoint PPT Presentation
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 4: Patient Care: NursingChapter 4: Patient Care: Nursing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered NursesRegistered Nurses
• Overview
– Most education & widest scope of practice of nurses
– Largest health care occupation in U.S.
– Large demand
– Diverse work settings
– Flexible working arrangements
– U.S. News & World Report: one of the best careers of 2010
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• History of the Profession– Ancient times: women tending families during sickness
– Early Christian times: deaconesses & religious orders provided care
– Early 16th century: criminals served as nurses in lieu of jail time
– 18th & 19th centuries: reform in roles
– Florence Nightingale: elevated nursing to respected profession
– After WWII: universities & colleges set up schools of nursing
– States developed & adopted a national licensing exam for nurses
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
Florence Nightingale, Clara Barton, Isabel Hampton Robb, & Mary Mahoney (Courtesy of the Center for the Study of the History of Nursing, University of Pennsylvania)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Diploma Programs
– Offered by hospitals
– 3 years to complete
– Earliest of nursing programs
– Main source of graduates until 1960s
– Decreasing in number in recent years
– Emphasis on clinical experience in direct patient care
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Associate’s Degree Programs– Associate’s degree in nursing (ADN)
– Offered at community or junior colleges
– Typically 2-3 years
– Prepare nurses for various settings
• Hospitals
• Long-term care facilities
• Home health care
– Provide technical skills
– Prepare students to carry out nursing roles & functions
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Bachelor’s Degree Programs
– Bachelor of science in nursing (BSN)
– 4 years to complete
– Accelerated BSN programs for those who already have bachelor’s
– Built on general education base
– Concentration on nursing at upper levels
– Emphasis on working with health care team, research, foundation for graduate study, variety of practice settings
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Course Work
– Anatomy
– Physiology
– Microbiology
– Chemistry
– Nutrition
– Psychology
– Nursing practice
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Further Education– Bachelor’s degree
• RN-to-BSN bridge program
• Required for many administrative, managerial, & community health positions
• Accelerated master’s degree programs (combined BSN & MSN)
– Master’s degree programs
• Required for all advanced practice nurse specialties
– Doctoral degree programs
– In-service education (on-site training)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Licensure
– NCLEX-RN: licensing exam for RNs
– Exam & licensure is by states
– Nurse practice acts: regulation of nursing by states
– License renewal required
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Certification– Specialty certification available
– Leads to higher pay
– American Association of Critical-Care Nurses (AACN)
– American Nurses Association (ANA)
– Requires:
• Licensure
• Bachelor’s degree or graduate degree or work experience
– Must be renewed every 3 (AACN) or 5 (ANA) years
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• General Duties
– Care & treatment of patients
– Supervision of other nurses & nursing assistants
– Protection of patient rights
– Advice & emotional support to families of patients
– Communication with other health care professionals
– Patient education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Specialties– Emergency or trauma care
– Critical care
– Addiction
– Diabetes
– Specific organs & body systems (e.g., cardiovascular)
– Specific population (neonatal, pediatric, geriatric)
– Advanced practice
– Non-patient (infection control, forensics, informatics, case management)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Personal Characteristics
– Desire to help others
– Caring, sympathetic attitude
– Detail-oriented
– Flexible
– Good judgment
– Responsible
– Team work
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Employment Opportunities and Trends
– 32% growth from 2008 to 2018
– In demand due to:
• Improvements in medical technology
• Increased emphasis on preventive care
• Growth in number of older adults
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Registered Nurses (cont’d)Registered Nurses (cont’d)
• Professional Organization– ANA
– Formed from state nurses’ associations
– Founded in 1896
– Sets standards of practice
– Encourages research to advance nursing practice
– Advocates on behalf of nursing at state & federal levels
– Benefits: subscription to journals, discounts on certification, online continuing education, conferences, educational events
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical NursesLicensed Practical Nurses
• History of the Profession– 1892: first formal training program in U.S., at YWCA
– 1930: 11 practical nursing schools were operating
– Late 1930s: process of state licensure begun
– Expansion after WWII due to shortage of RNs & other factors
– 1941: Association of Practical Nurse Schools founded
– Renamed National Association for Practical Nurse Education and Service (NAPNES)
– 1955: All states had licensure laws
– 1966: Accreditation of schools by National League for Nursing begun
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Education
– Training in bedside nursing care
– Programs offered by:
• Technical & vocational schools
• Community/junior colleges
– Programs require HS diploma or equivalent
– Last about 1 year
– Classroom study & supervised clinical practice
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Course Work– Basic nursing concepts
– Anatomy & physiology
– Medical-surgical nursing
– Pediatric nursing
– Obstetric nursing
– Pharmacology
– Nutrition
– First aid
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Professional Certification
– Licensure required in all states
– Requires:
• Graduation from state-approved program
• Passing the NCLEX-PN
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Work Responsibilities
– Hands-on tasks
– Basic nursing care
– Collect lab samples
– Perform routine tests
– Assist physicians & RNs in administering tests
– Monitoring
– Cleaning medical equipment
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Personal Characteristics
– Empathetic
– Emotionally steady
– Observant
– Good communication skills
– Patient
– Able to follow orders & work under supervision
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Employment Opportunities and Trends
– Growing occupation: 21% between 2008 & 2018
– Best opportunities in:
• Home health care
• Nursing care facilities
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Licensed Practical Nurses (cont’d)Licensed Practical Nurses (cont’d)
• Professional Organization– NAPNES
• Founded by LPNs
• Develops practice & education standards for LPNs
• Represents LPNs in national meetings
– National Federation of Licensed Practical Nurses (NFLPN)
• Governed completely by LPNs
• Promotes high standards of education & practice
• Monitors legislation
• Represents LPNs before Congress
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing AssistantsCertified Nursing Assistants
• Overview
– Perform simple, basic nursing functions
– Provide care of patients’ personal needs
– Are under direction of LPN or RN
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• History of the Profession
– Delegation of nursing tasks to auxiliary personnel after WWII
– Assistants began to take over tasks of student nurses
– Assistants began working in long-term care facilities & hospitals
– 1980s: U.S. Institute of Medicine recommended formal training
– 1987: Law passed requiring all states to set up training programs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Education– Required for certification:
• Completion of state-approved training program
• Passing a competency test
– Training programs
• Minimum of 75 hours
• Available at vocational schools, community colleges, Red cross, health care facilities
– Recertification requires at least 12 hours of in-service education each year
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Course Work
– Anatomy & physiology
– Bathing, dressing, & other personal care skills
– Nutrition
– Safety & emergency procedures
– Communication skills
– Documentation skills
– Infection control
– Patient room upkeep
– Patient/resident rights
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Work Responsibilities
– Hands-on, personal patient care
– Assist with personal hygiene
– Serve meals
– Help patients eat & dress
– Transport patients
– Answer patient calls
– Take vital signs
– Assist other medical staff
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Personal Characteristics
– Empathy
– Patience
– Emotional strength
– Cooperation
– Respect
– Professionalism
– Responsibility
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Employment Opportunities and Trends
– Part of a category called nursing aides, orderlies, & attendants
– 19% growth between 2008 & 2018
– Growth is due to:
• Aging of population & need for long-term care
• Early discharges of patients from hospitals
• Life-extending technologies
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Certified Nursing Assistants (cont’d)Certified Nursing Assistants (cont’d)
• Professional Organization
– National Association of Health Care Assistants
– Provides development training & mentoring programs
– Advocates on issues related to caregivers & long-term care
– Membership benefits
• Educational opportunities
• A news magazine
• A national convention
• A national awards program