Contemporary Nursing Roles and Career Opportunities

NURSING . . . MUCH THE SAME, BUT BIGGER AND BETTER The proliferation of career opportunities for nurses is growing.

Professional Nursing Roles Care provider Educator and counselor Client advocate Change agent Leader and manager Researcher Coordinator of the transdisciplinary health care team

Change Agent When nurses first adopted the role of "change agent," few individuals visualized to what extent nurses would fulfill this role. nurses have expanded their role as change agents in many ways. The profession continues to identify client and health care delivery problems, assess their motivation and capacity for change, determine alternatives, explore possible outcomes of the alternatives, and assess cost-effective resources in infinite health-related situations.

Leader and Manager The leadership role of the professional nurse is paramount to the health care system. Nursing leadership varies according to the level of application and includes: • Improving the health status and potential of individuals or families. • Increasing the effectiveness and level of satisfaction among professional colleagues providing care. • Managing multiple resources in a health care facility. • Raising citizens' and legislators' attitudes toward and expectations of the nursing profession and the health care system.

Leader and Manager There is little doubt that the management role of the nurse has become more important. Nursing management includes planning; giving direction; and monitoring and evaluating. Nursing care of individuals, groups, families, and communities.

Researcher The majority of researchers in nursing are prepared at the doctoral and postdoctoral levels, an increasing number of clinicians with master's degrees are beginning to participate in research as part of their advanced practice role.

Researcher Nurses prepared at the baccalaureate and associate degree levels are also participating in research. These nurses may be assisting with data collection, critiquing research findings, and using these findings in practice. More nursing interventions are based on nursing research than in the past.

Coordinator of the Transdisciplinary Health Care Team Transdisciplinary teams consist of collaborative practice relationships among several disciplines of health care professionals. The disciplines include nursing, medicine, pharmacy, nutrition, social work, and other allied health professionals such as physical therapists, respiratory therapists,occupational therapists, and speech therapists.

Coordinator of theTransdisciplinary Health CareTeam Transdisciplinary teams are valuable because professional members bring their in-depth and specialized knowledge and skills to the interaction process. A plan of care developed by the transdisciplinary team is usually considered a valuable health management tool (Van Ess Coeling and Cukr, 1998).

Transdisciplinary health care team The term transdisciplinary health care team may not be as familiar as the term multidisciplinary or interdisciplinary team. Multidisciplinary health care teams consist of many disciplines involved in meeting client care needs. Interdisciplinary teams refer to coordination between and among disciplines involved in providing client care.

Transdisciplinary health care team The more global and inclusive term transdisciplinary health care teams can be described as including multiple disciplines bonding, interacting, and uniting toward common goals of client care. The collaborative process involved in transdisciplinary health care incorporates the definitions of multidisciplinary and interdisciplinary health care and, in fact, transcends a single health profession to create comprehensive work outcomes.

Transdisciplinary health care team Studies that investigate the process of transdisciplinary health care teams in action report improved quality of care, increased client satisfaction, increased nursing satisfaction, and reduced hospital cost by decreasing hospital length of stay and increasing nursing retention (Wasserman, 1997; Baggs, 1989; Baggs et al., 1992; Knaus et al., 1986).

Transdisciplinary health care team Successful health care team models that use concepts related to transdisciplinary health care include pain management, nutritional support, skin care, rehabilitation, mental health, and hospice.

Transdisciplinary health care team Client education is another area in which collaboration and disciplines working together are absolutely essential. Health care professionals must understand one another's contributions to client education and ensure that the information clients and families receive is consistent and complete. This will lead to the best possible health outcomes for clients and families.

NURSES TODAY: WHO ARE THEY AND WHAT ARE THEY DOING? The phrase "a typical nurse" has become a misnomer as the profession enters the twenty-first century. Nursing roles are so diverse that there literally is no typical role or practice setting.

Registered Nurse Demographics Eighty-one percent of these RNs hold active licenses and are employed in nursing. Approximately 58.5% of this group are employed full time in the profession, with 23.3% of nurses working part time.

Registered Nurse Demographics In 2000 the average age of the RN population was 45.2 years. In 2000 31.7% are under 40 years of age, 18.3% under 35 years, and 9.1% under 30 years. Some speculate that the increase in the average age of RNs may represent the aging society or "second-career" nurses, with younger persons may be choosing other professions.

Registered Nurse Demographics Although the profession continues to be predominantly female, the number of men working as RNs significantly increased. The 2000 report indicates that the number of male RNs increased to 5.9%, up from 5.4% in 1996 data (Division of Nursing-Bureau of Health Professions, National Sample Survey, 2001).

Registered Nurse Demographics Changes also are occurring in the educational preparation of RNs: increasing in the number of nurses graduating from associate degree nursing programs and baccalaureate-prepared nurses. In 2000 graduates from basic nursing programs were 40.3% associate degree, 29.6% baccalaureate degree, and 29.3% diploma graduates. In 2000 nurses reported their highest degree as 22.3% diploma, 34.3% associate degree, 7% baccalaureate degree, and 10.2% master's or doctoral degree (Division of Nursing-Bureau of Health Professions, National Sample Survey, 2001).

Registered Nurse Demographics Advanced practice nurses now comprise 7.3% of the RN population, up from 6.3% in 1996. Nurse practitioners lead this group in numbers, followed by clinical nurse specialists (CNSs), nurse anesthetists, and nurse midwives. Nurse practitioners and CNSs make up 80% of the advance practice group. (Division of Nursing-Bureau of Health Professions, National Sample Survey,2001).

Hospital Opportunities In the hospital the nurse in a direct-care role provides care for people who are ill and unable to provide for themselves. Hospital positions can range from staff nurse to administrator and, in a general hospital, entail any of the clinical specialties and most of the target populations.

Trends in Health Care Delivery Systems From To Acute inpatient care - » Lifespan care Treating illness - » Maintaining health Focus on the individual - » Focus on aggregates/populations Product of care orientation - » Value of care orientation Number of hospital admissions - » Number of lives covered (capitation) Managing organizations - » Managing networks Managing departments - » Managing markets Coordinating services - » Documenting quality and outcomes

Trends in Health Care Delivery Systems The clinical setting has been based on experiences as a student, the new graduate needs to be prepared to have different perceptions in a new role. At a minimum, experiences that are highly enjoyable on the limited-time basis of a student schedule may feel different when the new graduate functions in that role full time. It also is good to have a mix of experiences and learning opportunities before making a definitive decision.

Trends in Health Care Delivery Systems Nursing within hospitals offers almost endless opportunities for diversity. Staff level positions in a hospital can be on many different units, and working different shifts on those units presents different work environments, approaches to work, and priorities of client care.

Quality Management The parameters of a position in quality management or quality control vary from institution to institution, the basic premise is to ensure that outcomes in client care services are consistent with established standards. Quality management nurses assess the compliance of the institution with established standards and explore variations from established standards. Chart reviews and ongoing interaction with the staff of the agency are integral components of a quality management position.

Quality Manager The health care providers to assess opportunities for process improvement, implement changes, measure outcomes, and then start the improvement process over again. Quality management nurses research and describe findings and look for opportunities to improve care.

Quality Manager Quality studies produce critical pathways or algorithms defining care and expected client outcomes. Basic and advanced knowledge of quality management tools is essential, although practice may vary from setting to setting. In the inpatient setting the quality management nurse needs strong clinical skills as might be acquired in medical surgical practice, intensive care units, or the operating room.

Quality Manager Experience in home care would be an advantage for a quality management nurse in that setting. Interpersonal skills are important because to be successful this role requires building relationships and rapport. The role of quality manager is one that promotes improved care for health care recipients in a variety of settings.

Case Manager This role has had a rich tradition in community and public health nursing, and in acute care. Case managers coordinate resources to achieve health care outcomes based on quality, access, and cost. The complexity of case management practice is obvious in the era of chaotic systems caused in which providers, services, and coverage details are constantly changing. Case managers identify the best resources at the lowest cost to achieve the optimum health outcome for the client (Stanhope and Lancaster, 2000).

WHAT ABOUT THE FUTURE OF NURSING? Growth of the nursing profession be prompted by technologic advances in client care, which allow an increased number of health problems to be detected early and managed quickly. Health maintenance organizations, ambulatory surgicenters, and church health centers are only a few of the places where the public will receive their health care. Nursing can be a vital component of the "alternative setting" movement that is on the forefront of health care reform.

WHAT ABOUT THE FUTURE OF NURSING? Professional nursing services should be viewed as a cost-effective way to provide disease prevention and health-promotion activities in multiple areas of the community, including industry, business, and commerce. Wellness and disease prevention, historically fundamental to the nursing profession, are now becoming more meaningful and revitalized concepts within the larger health care system.

WHAT ABOUT THE FUTURE OF NURSING? The nursing profession historically has requested a chance to prove its worth in producing cost-effective, quality health care. Encouragement for nurses who are interested in developing new roles is provided by examples of nurses who envisioned and created new roles. Traditional, nontraditional, and advanced practice nursing roles offer many exciting opportunities for professional growth and satisfaction.