Nursing Roles, Practice Settings, Role Socialization & Nursing Today N 333

Nurses fill an abundance of roles in varied health care settings.

Role Behavior oriented to the expectations of others We all have numerous roles

Elements of roles Ideal role – socially prescribed and agreed upon rights and responsibilities Role expectations – norms specific to the position Perceived role – how a person believes they should behave in a role Performed role – what the person actually does

Boundaries for Nursing Roles Concepts Person Environment Health Nursing Nursing Process Standards of Nursing Practice Nurse Practice Act & licensure laws National & International Code of Ethics

Professional Nursing Roles Caregiver Teacher (educator) Counselor Manager (leader) Advocate Change agent Entrepreneur Researcher Collaborator Consultant Case Manager

Caregiver Role Direct hands-on care in a variety of settings Assist client – Preserve client dignity Physical, psychosocial, developmental and spiritual realms Influenced by Holistic approach Essential attribute of the expert nurse

Teacher/Educator Role Teach patients, families, the community, other health care members, students, etc. Determine learning needs, motivation and readiness of learner

Counselor Role Help client recognize and cope with stressful situations One on One Groups (self Help)

Manager/Leader Role Management of resources

Characteristics of a Manager Officially appointed Official power Carry out predetermined policies, procedures & rules Attempt to maintain an orderly environment Relate to people according to roles Perform role as long as the appointment is held Rewarded by achieving the organization ’ s mission and goals May of may not be good leaders

Characteristics of a Leader May or may not have an official position Have power if followers allow it Influence followers to set goals Risktakers Intuitively and empathetically relate to people Feel rewarded by personal accomplishments May or may not be successful managers

Management Styles Traditional Focus on hierarchy and division of roles Behaviorist Interested in group dynamics Systems Focuses on the organization as a series of units or departments Contingency Blends all 3 styles

Leadership Styles Charismatic “ people person ” Autocratic Authoritarian Democratic Involves followers in decision making Laissez-faire Passive and uninvolved

Advocate Role Promotes what is best for the client Sees that the clients needs are met Protects client ’ s rights

Defining Attributes Nurse’s responsibility to advocate for pt Must value pt’s self-determination (their independence and decision making) Promote and protect pt’s rights- Realize that policies are important and should occasionally be broken

Challenges to advocacy Value conflict Role conflict- employee vs patient

Rewards of advocacy Self-satisfaction Respect from the public Respect from the interdisciplinary team

Change Agent Role Works to initiate and facilitate change Requisite skills Tact Energy Creativity Interpersonal skills

Entrepreneur/Consultant Role Gives advice & expertise to others May own business

Researcher Role Investigates whether current nursing actions achieve their expected outcomes Investigates what options of care are available and how to best provide nursing care

Collaborator Role Works with other health care professionals to ensure that everyone agrees on the same patient outcome Collaborates with patients and their families

Case Manager Role Critical pathways and variance analysis Came about due to: Change in reimbursement programs The need to manage clinical outcomes to limit costs

Nurse ’ s Roles and Settings Nurses fill an abundance of roles in a variety of health care settings.

Roles and Settings “ Jack of all trades ” Practice settings Hospitals Community health Entrepreneurs Office/clinic Occupational helath School Case management Informatics Academics Forensic Infection control Military Research

Professional Accountabilities Nurse have professional accountabilities inherent in any role in any setting. Professional accountabilities include: Quality improvement Research Education Management

ANA Standards of Professional Performance Quality of Care Performance Appraisal Education Collegiality Ethics Collaboration Research Resource Utilization

Role Socialization Socialization is defined as the process by which people learn to become members of groups and society, learn the social rules and define relationships into which they will enter. Socialization involves Behavior Feeling Seeing the world It is a lifelong process

Role Socialization Learn necessary cognitive and motor skills Adopt values of the profession Gain identity with the profession Balance the professional role with other roles.

Models that define the Process of Role Socialization Davis Model Student socialization Hinshaw ’ s Model 3-phrase general model of socialization Benner ’ s Stages of Proficiency Novice Advanced beginner Competent practitioner Proficient practitioner Expert practitioner

Ongoing Professional Socialization & Resocialization Models “ Reality Shock ” Dalton, Thompson & Price Career Stages Stage I - apprentice, subordinate Stage II - colleague Stage III - informal mentor, role model Stage IV - sponsor Kramer Resocialization Model Stage I - Skill and routine mastery Stage II - Social integration Stage III - Moral outrage Stage IV - Conflict resolution