Chapter 9: 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

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

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)

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

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

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

Registered Nurses (cont’d) Course Work Anatomy Physiology Microbiology Chemistry Nutrition Psychology Nursing practice

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)

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

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

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

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)

Registered Nurses (cont’d) Personal Characteristics Desire to help others Caring, sympathetic attitude Detail-oriented Flexible Good judgment Responsible Team work

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

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

Licensed 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

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

Licensed Practical Nurses (cont’d) Course Work Basic nursing concepts Anatomy & physiology Medical-surgical nursing Pediatric nursing Obstetric nursing Pharmacology Nutrition First aid

Licensed Practical Nurses (cont’d) Professional Certification Licensure required in all states Requires: Graduation from state-approved program Passing the NCLEX-PN

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

Licensed Practical Nurses (cont’d) Personal Characteristics Empathetic Emotionally steady Observant Good communication skills Patient Able to follow orders & work under supervision

Licensed Practical Nurses (cont’d) Employment Opportunities and Trends Growing occupation: 21% between 2008 & 2018 Best opportunities in: Home health care Nursing care facilities

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

Certified Nursing Assistants Overview Perform simple, basic nursing functions Provide care of patients’ personal needs Are under direction of LPN or RN

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

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

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

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

Certified Nursing Assistants (cont’d) Personal Characteristics Empathy Patience Emotional strength Cooperation Respect Professionalism Responsibility

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

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