NursingNursing

In the past, nursing was viewed primarily In the past, nursing was viewed primarily in terms of direct patient care roles, in terms of direct patient care roles, mainly in hospitalsmainly in hospitals

Now - nearly 50% of nurses work in Now - nearly 50% of nurses work in settings outside of hospitalssettings outside of hospitals ((hospice hospice care, home care, and nursing home care)care, home care, and nursing home care)

Nurses develop their own group Nurses develop their own group practicespractices

Nurses can build careers in the Nurses can build careers in the "business" side of nursing"business" side of nursing

In the first edition of the In the first edition of the Random Random House DictionaryHouse Dictionary (1966) the verb "to (1966) the verb "to nurse" means to foster or cherish nurse" means to foster or cherish ((доглядатидоглядати, , бавитибавити), to treat or ), to treat or handle with adroit care; to bring up, handle with adroit care; to bring up, train, or nurture; to handle carefully train, or nurture; to handle carefully or fondly; to preserve. "Nurse" or fondly; to preserve. "Nurse" suggests attendance and service; its suggests attendance and service; its antonym is neglect (antonym is neglect (зневагазневага).).

IIn n Random House Collegiate Random House Collegiate Dictionary (Dictionary (1995)1995),, the first meaning the first meaning of "nurse" is "a person formally of "nurse" is "a person formally educated in the care of the sick or educated in the care of the sick or infirm, especially a registered nurse" infirm, especially a registered nurse"

Legal definitionsLegal definitions in nurse practice in nurse practice acts exist to protect the public and to acts exist to protect the public and to protect the protect the title.title.

North Carolina was the first state to North Carolina was the first state to pass a licensing law (1903), and it was pass a licensing law (1903), and it was intended to protect the title, not to intended to protect the title, not to define the practice. The early statutes define the practice. The early statutes were certification laws, permissive were certification laws, permissive rather than mandatory, and in general rather than mandatory, and in general permitted anyone to perform legally permitted anyone to perform legally the functions of a nurse, even for the functions of a nurse, even for compensation, but only those who compensation, but only those who were licensed could use the RN title were licensed could use the RN title (Hadley, 1989).(Hadley, 1989).

Inclusion ... of the diagnostic function would authorize the nursing practitioner to make nursing diagnoses, not medical diagnoses. Whereas the diagnostic function as an intellectual process is central to the practice of any number of professions, including medicine and nursing, the focus of this function varies among these professions. For example, the focus in medicine is the nature and degree of pathology or deviaion from normality; within nursing the focus is the individal's response to an actual or potential health problem and the nursing needs arising from such responses. [Driscoll, 1976, p. 61; italics in original]

"Nursing is the diagnosis and "Nursing is the diagnosis and treatment of human responses to treatment of human responses to actual or potential health problems" actual or potential health problems" (ANA, 1980)(ANA, 1980)

Staff Nurses Working in Staff Nurses Working in HospitalsHospitals

At present, 59.6% of all employed nurses work in At present, 59.6% of all employed nurses work in hospitals, and this number is projected to hospitals, and this number is projected to decrease to 52.8% by 2008decrease to 52.8% by 2008

In 1992, 84% of all registered nurses 30 years In 1992, 84% of all registered nurses 30 years old or younger worked in hospitals, whereas only old or younger worked in hospitals, whereas only 50% of nurses over 50 worked in hospitals. 50% of nurses over 50 worked in hospitals.

Most hospital nurses work in general medical and Most hospital nurses work in general medical and surgical units (40%), but many work in acute surgical units (40%), but many work in acute care units such as critical care (18%), operating care units such as critical care (18%), operating rooms (7%), and emergency rooms (8%). rooms (7%), and emergency rooms (8%).

The current demographics of The current demographics of RNs in the United States in RNs in the United States in

1996.1996. 2,558,874 people were licensed as RNs2,558,874 people were licensed as RNs 82.7% were currently employed as RNs, 82.7% were currently employed as RNs,

and 60% were working in hospitalsand 60% were working in hospitals The number of male RNs in 1996 was The number of male RNs in 1996 was

5.4%, which is a substantial increase 5.4%, which is a substantial increase from the 3% in 1980. Moreover, in 1996 from the 3% in 1980. Moreover, in 1996 nearly 12% of newly licensed RNs were nearly 12% of newly licensed RNs were men men

About 10% of RNs come from racial or ethnic About 10% of RNs come from racial or ethnic minorities:minorities:

4.2% were African American; 4.2% were African American; 3.4% were Asian or Pacific Islander; 3.4% were Asian or Pacific Islander; 1.6% were Hispanic; 1.6% were Hispanic; and 0.5% were Native American. and 0.5% were Native American. Again, when we look at the numbers of Again, when we look at the numbers of

newly licensed RNs, we see steady newly licensed RNs, we see steady change: 5.5% were African American; 6% change: 5.5% were African American; 6% were Asian or Pacific Islander; 3% were were Asian or Pacific Islander; 3% were Hispanic; and 0.8% were Native American Hispanic; and 0.8% were Native American (NCSBN, 2000).(NCSBN, 2000).

The average salary of a full-time RN The average salary of a full-time RN in 1996 was $42,000, which was an in 1996 was $42,000, which was an 11% increase over RN salaries in 11% increase over RN salaries in 1992 1992

Most employed RNs (58.4%) had less Most employed RNs (58.4%) had less than a baccalaureate degree: 31.8% than a baccalaureate degree: 31.8% had a baccalaureate as their highest had a baccalaureate as their highest degree; 9.1% had a masters as their degree; 9.1% had a masters as their highest de gree; and 0.6% were highest de gree; and 0.6% were doctorally prepared. doctorally prepared.

For nurses working in large hospital For nurses working in large hospital centers, increased specialization is centers, increased specialization is common. common.

In small rural hospitals, however, In small rural hospitals, however, nurses are often called upon to be nurses are often called upon to be generalists, to be competent in generalists, to be competent in caring for an older person with a caring for an older person with a cardiac condition as well as in cardiac condition as well as in emergency room treatment of an emergency room treatment of an injured child.injured child.

Within hospitals, nurses are caring for sicker Within hospitals, nurses are caring for sicker patients for shorter periods of time with ever patients for shorter periods of time with ever more sophisticated technology. Hospital staff more sophisticated technology. Hospital staff nurses require expert clinical and nurses require expert clinical and communication skills to:communication skills to: 1. Monitor and care for their patients1. Monitor and care for their patients 2. Counsel their patients' families2. Counsel their patients' families 3. Interface and collaborate with other health 3. Interface and collaborate with other health

care pcare prroviders as part of a health care teamoviders as part of a health care team 4. Keep up with rapid technological advances4. Keep up with rapid technological advances 5. Effectively use information systems to 5. Effectively use information systems to

manage patient caremanage patient care 6. Participate in clinical research.6. Participate in clinical research.

Today's hospital nurses have to Today's hospital nurses have to supervise and delegate nursing duties supervise and delegate nursing duties to unlicensed assistive personnel to unlicensed assistive personnel

1. Staff nurses need to know exactly what is 1. Staff nurses need to know exactly what is allowed under their state practice acts; for allowed under their state practice acts; for example, they should not delegate nursing example, they should not delegate nursing assessments and judgment.assessments and judgment.

2. Staff nurses need to be the ones who train 2. Staff nurses need to be the ones who train the unlicensed assistive personnel to perform the unlicensed assistive personnel to perform the tasks or to monitor the patients so that the tasks or to monitor the patients so that they know exactly what the assistant can do.they know exactly what the assistant can do.

3. Staff nurses need to develop protocols for 3. Staff nurses need to develop protocols for the unlicensed assistive personnel to work the unlicensed assistive personnel to work under.under.

4. Staff nurses need to supervise the care 4. Staff nurses need to supervise the care given (King, 1999).given (King, 1999).

Causes of staff shortage Causes of staff shortage overworkoverwork work-related stresswork-related stress mandatory overtimemandatory overtime drops in student enrollmentdrops in student enrollment cost cutting by hospitalscost cutting by hospitals increased job opportunities for womenincreased job opportunities for women health risks at the workplace (risk of health risks at the workplace (risk of

infection, sensitivity to latex)infection, sensitivity to latex) workplace violenceworkplace violence

Hospitals and nursing homes account Hospitals and nursing homes account for 64% of workplace violence, and for 64% of workplace violence, and health care workers have a 16 times health care workers have a 16 times greater risk of sustaining a fatal greater risk of sustaining a fatal injury on the job than the general injury on the job than the general population has (ANA, 2000c; Smith-population has (ANA, 2000c; Smith-Pittman & McKoy, 1999).Pittman & McKoy, 1999).