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Health IT Workforce Curriculum Version 4.0

2. The Culture of Health Care
Health Professionals—The People in Health Care
Welcome to The Culture of Health Care: Health Professionals—The People in Health Care. This is Lecture b.
The component, The Culture of Health Care, addresses job expectations in health care settings, the organization of patient care within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.
Lecture b
This material (Comp2 Unit 2) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated in 2016 by Bellevue College under Award Number 90WT0002.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit

3. Health Professionals – The People in Health Care Learning Objectives
Define terms used in health care and in health professionals’ education and training, including clinician, patient/consumer, disease, and syndrome. (Lecture a)
Describe the education, training, certification, licensure, and roles of physicians, including those in primary care and other specialties. (Lecture a)
Describe the education, training, certification, licensure, and roles of nurses, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides. (Lecture b)
Describe the education, training, certification, licensure, and roles of physician assistants, pharmacists, therapists, and allied health professionals. (Lecture c)
Describe the education, training, certification, licensure, and roles of paramedics, emergency medical technicians, dental professionals, mental health professionals, and social workers. (Lecture c)
The objectives for Health Professionals—The People in Health Care are to:
Define terms used in health care and in health professionals’ education and training, including clinician, patient/consumer, disease, and syndrome.
Describe the education, training, certification, licensure, and roles of physicians, including those in primary care and other specialties.
Describe the education, training, certification, licensure, and roles of nurses, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides.
Describe the education, training, certification, licensure, and roles of physician assistants, pharmacists, therapists, and allied health professionals.
Describe the education, training, certification, licensure, and roles of paramedics, emergency medical technicians, dental professionals, mental health professionals, and social workers.

4. Nurses Education Clinical training Additional training programs
Diploma
Associate’s degree
Bachelor of science
Bridge programs for RN to BSN
Clinical training
Part of the education process
Additional training programs
This lecture describes the education, training, certification, licensure, and roles of nurses.
There are several ways to become a registered nurse, or RN. Diploma programs were more common in the past and were usually two- to three-year programs that focused mostly on clinical skills. An associate’s degree in nursing is a two-year program with a similar clinical focus. The BSN, or bachelor of science degree in nursing, is the preferred degree program. It includes general study requirements (math, science, social sciences, and humanities) along with preclinical and clinical course work. Nurses with a diploma or an associate’s degree may be able to attain a BSN using a bridge program that allows them to apply credit for courses already taken. Advance nurse practitioner opportunities require a BSN along with additional study in the area of specialization. Also, most nursing administration positions require a BSN and may require a graduate-level degree such as a master’s degree in nursing.
Clinical training is a part of all three types of training programs. It includes coursework to gain an understanding of clinical principles and clinical work in hospitals and other health care provider settings under direct supervision. New graduate entry-level nurses must work under the supervision of a licensed, experienced nurse until they obtain their state nursing license, which is achieved by passing an exam. Also, nurses may elect to specialize in their area of clinical practice, which is achieved through additional training programs provided by hospitals and other organizations.

5. Nurses Continued Certification Licensure
Certification is not required for licensure, but nurse licensure is required for nurse certification programs
Many specialty certification programs are available
Licensure
Requires successful completion of a accredited nursing school program
NCLEX-RN
Formal certification is not required for most nurses at the RN or BSN level. However, many nursing certifications are offered in a variety of clinical specialty areas, such as cardiac medicine, emergency nursing, medical-surgical nursing, and pediatric nursing. Specialty certification may be obtained for work settings other than the hospital environment. For example, a hospice nurse often works in patients’ homes and may earn a certified hospice and palliative nurse (CHPN) certification through the hospice and palliative credentialing center. (Hospice nurses provide care for patients and their families with life-limiting illness or injury.) Specialty certification may also be obtained for nonclinical nursing roles. For example, the American Nurses Association offers certification in nursing informatics.
Certification programs generally have prerequisites for eligibility and require participants to pass an exam.
Licensure requires completion of an accredited program and passing the National Council Licensure Exam–Registered Nurse (NCLEX-RN [en-klecks-R-N]). The NCLEX-RN is a nationally administered test required by all states and the District of Columbia. It is administered by the National Council of State Boards of Nursing. Like physician licensure, specific requirements are determined by the states, and there is some opportunity for obtaining reciprocal licenses in other states.

6. Nursing Roles
Provide direct patient care and coordinate care activities with other ancillary/allied health professionals based on physician orders and the patient’s plan of care
Continuous patient assessment, monitoring, and planning of care
Diagnostic tests and treatments
Medication administration
Patient and family education
Emotional support
Nurses provide direct patient care and are responsible for coordinating patient care activities with other ancillary or allied health professionals based on physician orders and the patient’s plan of care. In the last decade, nursing assistants, medical assistants, or patient care associates have assumed much of the direct bedside patient care, such as obtaining vital signs and assisting patients with activities of daily living, such as eating, sleeping, and hygiene. These positions work under the supervision of nursing staff, freeing nurses to provide highly skilled care to more patients. Nursing duties include taking a medical history, starting and maintaining intravenous fluids, bedside laboratory testing, medication administration, wound care, and ongoing assessment and patient monitoring of physiological [fiz-ee-uh-loj-i-kuhl] parameters. Also, nurses have a prominent role in providing education and emotional support to patients and their families.

7. Specific Nursing Roles in a Hospital Setting
Hospital medical-surgical nurse
Care for patients with medical and surgical problems
May obtain certification but not always required
Specialized nursing roles
Specific disease or specialty
Diabetic nursing
Emergency nursing
Rehabilitation nursing
Neurosurgery nursing
A significant amount of nursing care in hospitals occurs on medical-surgical units. In some hospitals, both medical and surgical patients are cared for in a single unit; other hospitals have separate units for these patients. Medical-surgical nurses may be certified, but certification is not required by most hospitals.
There is an increased need for specialized nursing units or departments in larger and tertiary care hospitals. Nurses may elect to obtain additional training and education when working in these areas. Examples of specialized nursing roles include the following:
Diabetic nursing plays a prominent role in the education of clients newly diagnosed with diabetes.
Emergency nursing provides highly skilled care in emergency departments and trauma centers.
Rehabilitation nursing focuses on patients recovering from serious injuries or illnesses that require specialized care in recovering activities of daily living.
Neurosurgery nursing provides care to patients who have brain and/or spinal cord injury or disease.
Many hospitals have evolved to become integrated delivery networks or systems with separate physical buildings on one campus or many buildings across a geographic location. This organizational arrangement enables the hospital to provide more services to a larger number of patients. The more common type of patient care services that are located in a separate building at a single location or across multiple locations include pediatric care, cardiac care, rehabilitation, and cancer care.

8. Specific Nursing Roles in Other Provider Settings
Ambulatory care facilities
Similar to hospital-based units
Home health, hospice, patient’s medical home
Medication administration, wound care, postoperative care, physical therapy
Long-term care, nursing homes
Provides constant care and assistance with activities of daily living
Public health clinics
Focus on population health with health promotion and disease prevention
Nurses serve a critical role in providing patient care not only in hospital settings but also in many other types of provider settings, such as physician offices, outpatient clinics, clients’ homes, and more. Nurses may choose to further their education with specialized training and/or certification for working in a non-hospital setting. A few examples of these other setting types include the following:
Ambulatory care facilities such as walk-in (general care) clinics, outpatient surgery clinics, urgent care centers: Nursing roles are similar to those of their hospital counterparts. The main difference is that the patient is at the facility for a very short duration and will not stay overnight.
Home health, hospice, patient’s medical home: Nurses provide care through daily or frequent visits to the patient’s home. Activities include medication administration, wound care, postoperative care, and physical therapy.
Long-term care, nursing homes: Nurses provide care and/or assist the patient with routine activities of daily living.
Public health clinics, community health facilities: The public health nurse provides screenings, disease surveillance, health promotion, and education.

9. Advanced Practice Nursing
Nurse practitioner
Education: Usually requires a master’s degree in nursing with specific clinical and diagnostic training
Training: Programs include clinical training in physical diagnosis, managing acute and chronic disease, wellness care, and prescribing medication
Nurse practitioners are usually required to earn a master’s degree in nursing with specific clinical and diagnostic training. This includes training in physical diagnosis, managing acute and chronic disease, wellness care, and prescribing medication.

10. Advanced Practice Nursing Continued
Nurse practitioner
Certification: Most states require certification in their area of specialty
Examples: Family nurse practitioner (FNP), pediatric nurse practitioner (PNP), geriatric nurse practitioner (GNP)
Licensure
States vary on the roles allowed to nurse practitioners, including prescription privileges and whether they may practice independently
Roles
Nurse practitioners function most often as primary care providers, including preventive, acute, and chronic care
Most states require certification for a nurse practitioner regardless of the specialty. Most practitioner specialties focus on a specific population. A few example are family nurse practitioner, pediatric nurse practitioner, and geriatric nurse practitioner.
All states license nurse practitioners, but states vary on the role of the nurse practitioner. About half of the states allow nurses to practice independently, and some states allow nurse practitioners to prescribe medication without physician oversight. Nurse practitioners typically provide primary care services, including preventive, acute, and chronic care.

11. Nurse Midwives Education Training Postgraduate or graduate program
Must have a BSN to become a certified nurse midwife
Training
Most include courses in advanced practice nursing (physical diagnosis, pharmacology, pathophysiology)
Clinical course and practice in ante-, intra-, and postpartum care and care of the newborn
A BSN is required to become a certified nurse midwife, and most complete a master’s degree in nursing. Training entails courses in advanced practice nursing, including pharmacology, pathophysiology [path-oh-fiz-ee-ol-uh-jee], and physical diagnosis. Nurse midwife certification requires course work in antepartum [an-tee-pahr-tuhm] care (prenatal or before delivery), intrapartum [in-truh-pahr-tuhm] care (during delivery), and postpartum [post-pahr-tuhm] care (after delivery). It also involves clinical course work and training in the routine care of women’s health.

12. Nurse Midwives Continued
Certification
Only a few of the nurse midwife programs are post-baccalaureate programs
Licensure
Licensed in all 50 states and the District of Columbia
Role
Provide routine gynecology services and prenatal, delivery, and postnatal care
Only a few nurse midwife programs are post-baccalaureate certificate programs.
Licensure is required in all fifty states and the District of Columbia. Nurse midwives provide routine gynecology services, prenatal, delivery and postnatal care.

13. Nurse Anesthetist Education Training Must have a BSN
Certified registered nurse anesthetist (CRNA) programs are master’s degree programs
Training
Most include courses in advanced practice nursing (physical diagnosis, pharmacology, pathophysiology)
Clinical course in anesthesia simulation labs and practicums in clinical anesthesia
Nurse anesthetists [ah-nes-thi-tists] must have a BSN degree. A master’s degree is required to be eligible for a certified registered nurse anesthetist (CRNA). Training courses in advanced practice nursing include pharmacology, pathophysiology, and physical diagnosis. Clinical courses include training in anesthesia [an-uhs-thee-zhuh] simulation labs and supervised training in clinical anesthesia.

14. Nurse Anesthetist Continued
Certification
National certification exam
Must have 40 hours of continuing education every two years to renew
Licensure
Most are licensed by the state board of nursing
Roles
Provide a significant amount of anesthesia care in the United States and usually practice with physicians but are relatively autonomous
Certification as a CRNA requires graduation from an accredited master’s degree program and passing the National Certification Exam administered by the Council on Certification of Nurse Anesthetists. Although there is no recertification exam, there is a requirement of forty hours of continuing education every two years. CRNA’s are licensed in every state; however, there is some variation in whether they are able to practice independently.

15. Nonclinical Roles of Nursing
Administration
Research
Education
Nursing school
Continuing nursing education
Case management
Nursing/clinical informatics
As with any health care profession, there are opportunities for nonclinical roles. They sometimes require additional nursing or other graduate degrees. Nurse administrators are common in both hospitals and ambulatory settings. Nurses can serve an active role in both basic and clinical research. They provide clinical and nonclinical teaching in nursing schools and in continuing nursing education. There is also a need for nurses to be involved in case management and quality improvement. As it is for physicians, informatics is a relatively new role for nurses. Informatics focuses on the effective use of information systems in providing patient care services.

16. Licensed Practical Nurse
Education
12 to 18 months of training post–high school
Training
Includes training in medical terminology, introduction to anatomy and physiology, introduction to pharmacology, and practical nursing clinical course
Certification
Usually results in a certificate of attendance
A licensed practical nurse (LPN) has a shorter period of training, usually twelve-to-eighteen months after high school graduation. Preclinical training includes basic sciences such as pharmacology, anatomy, and physiology and preclinical nursing courses such as medical terminology. Clinical courses include practical nursing studies with patient care under supervision, including infusing IV fluids and administration of oral and some IV medications. LPNs often receive a certificate of completion.

17. Licensed Practical Nurse Continued
Licensing
All states and the District of Columbia require a licensing exam
Licensed by the state board of nursing
Role
Provide more direct care
Work under supervision of registered nurse or physician
State laws vary but most allow LPNs to start and administer IV therapy, and many allow LPNs to administer IV medications except IV push
All states and the District of Columbia require the National Council Licensure Exam–Practical Nurse (NCLEX-PN [en-klecks-P-N]) administered by the National Council of State Boards of Nursing (NCSBN). LPNs provide direct patient care and must be under the supervision of an RN or physician. State laws vary on whether LPNs may start and monitor IV fluids and administer IV medications. Most states that allow IV medication administration do not allow LPNs to “push” or rapidly infuse medications.

18. Medical Assistants
Variable education: One year (certificate) to two years (associate’s degree)
Most receive training in medical terminology, office administration, coding and reimbursement, laboratory procedures, office patient care, medications
Not licensed
Role includes routine administrative and clinical duties
Medical assistants usually complete a one-year certificate or a two-year associate’s degree. The training involves both medical and office administration courses, which often include medical terminology, coding and reimbursement, laboratory procedures, office patient care, and medications. Medical assistants are not licensed, and roles include administrative and clinical duties.

19. Medication Aides
Extremely variable education/training ranging from 15 to 70 contact hours
Most states require an exam and supervised administration for some period of time
Some states specify training as a certified nursing assistant as a prerequisite
Most states license medication aides
Roles are variable but usually include the administration oral, topical, and nebulized or metered inhaled medication. Many states restrict medication aides to long-term care or assisted living facilities
The education and training of medication aides ranges widely from fifteen to seventy contact hours. The training is predominantly on the administration of non-intravenous medications. Most states require an exam and a period of supervised medication administration. Some states require training as a certified nursing assistant as a prerequisite. In most states, medication aides can administer oral, topical, and nebulized or metered inhaled medication. Many states restrict medication aides to long-term care or assisted living facilities. Certification may be obtained for successful completion of the educational course.

20. Nursing in 2025
Nursing supply could exceed demand, but availability will be uneven, and several factors could cause a shortfall
The need for nurses (RNs) and advanced nurse practitioners will increase with the anticipated physician shortage
Colleges and universities are not able to keep up with demand due to lack of qualified faculty
Employment projections released in December 2013 anticipated a shortage of nurses by In contrast, a 2014 HRSA study projected that nursing supply could outpace demand by The contrasting studies reflect the changing employment environment for clinical workers. The HRSA study, for instance, further stated that uneven distribution of nurses will result in shortfalls in several states and noted that retirements and other factors could shift projections.
One factor that could limit the expansion of nursing supply is a shortage of nursing faculty. In addition to the current shortage, existing faculty are aging and retiring, and there are not enough qualified applicants available to replace them.
In addition, the need for advanced nurse practitioners is anticipated to increase to supplement the physician’s role in providing direct patient care. This is due in part to the anticipated physician shortage along with the need of skilled clinicians in the ambulatory setting as patient care shifts from the inpatient setting to the outpatient and home settings.
American Association of Colleges of Nursing, 2014

21. Nursing in 2025 Continued
Solving the potential shortage requires a multipronged approach that involves:
Innovation in care delivery
Effective use of technology
Efficient use of all health professionals on the care team
As with the physician shortage, offsetting a potential nursing shortage will require a multipronged approach with industrywide collaborators.

22. Health Professionals—The People in Health Care Summary – Lecture b
In this lecture, we
Described the education, training, certification, licensure, and roles of
Nurses
Advance practice nurse
Licensed practical nurse
Medical assistants
Medication assistants
Discussed some specific type of nurses and nursing setting
Described nonclinical roles of nurses
This concludes Lecture b of Health Professionals—The People in Health Care. In summary, this lecture described the education, training, certification, licensure, and roles of nursing personnel, including nurses with RN and BSN degrees, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides. Roles are also described for nurses in specific work settings, specialty areas, and nonclinical positions.

23. Health Professionals—The People in Health Care References – Lecture b
American Association of Colleges of Nursing (AACN). (2014). Nursing shortage. Retrieved from
American Board of Medical Specialties. (2016). Board certification and maintenance of certification. Retrieved from
American Medical Association. (2016). Obtaining a medical license. Retrieved from
American Medical Association. (2016). Becoming a physician. Retrieved from
American Nurses Association. (2016). American Nurses Credentialing Center. Retrieved from
Explore Health careers.org. (2016). Career explorer. Retrieved from
HRSA (Health Resources and Services Administration Health Workforce). (2016). Health workforce research. Retrieved from
MedlinePlus. (2014). Health occupations. Retrieved from
MedlinePlus. (2012). Medical dictionary. Retrieved from
No audio.

24. Health Professionals—The People in Health Care References – Lecture b Continued
National Association of Advisors for the Health Professions. (2013). Health professions links. Retrieved from
NIH MedlinePlus. (2011). Life works: Explore health and medical science careers. NIH MedlinePlus. Summer. Retrieved from
U.S. News and World Report. (2016). Best health care jobs. Retrieved from
No audio.

25. The Culture of Health Care Health Professionals—The People in Health Care Lecture b
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated in 2016 by Bellevue College under Award Number 90WT0002.
No audio.
Health IT Workforce Curriculum Version 4.0