1. No audio. Recording preparation.
Health IT Workforce Curriculum Version 4.0

2. The Culture of Health Care
Nursing Care Processes
Welcome to The Culture of Health Care: Nursing Care Processes. This is Lecture a.
The component, The Culture of Health Care, addresses job expectations in health care settings. It discusses how care is organized within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.
Lecture a
This material (Comp 2 Unit 6) 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. Nursing Care Processes Learning Objectives
Describe what nurses do and how they are trained (Lecture a).
Discuss the role of certified nursing assistants (Lecture a).
Describe how nurses make clinical decisions and assess patients (Lecture b).
Identify the settings where nurses work (Lectures a, c).
Discuss the procedures that nurses perform (Lecture c).
Identify nursing career opportunities, including those not involved with direct patient care (Lectures a, b, c).
By the end of this unit, Nursing Care Processes, students will be able to:
Describe what nurses do and how they are trained
Discuss the role of certified nursing assistants
Describe how nurses make clinical decisions and assess patients
Identify the settings where nurses work
Discuss the procedures that nurses perform
Identify nursing career opportunities, including those not involved with direct patient care.

4. What Do Nurses Do? Provide direct and indirect patient care:
Deliver direct, hands-on patient care
Screen, assess, and monitor patients
Perform or assist physicians with procedures
Administer medication
Write prescriptions (if licensed)
Coordinate care activities with other caregivers
RNs supervise LPNs, CNAs, and potentially other caregivers
This lecture discusses nursing roles, responsibilities, and work settings. It also describes what nurses do, how they are trained, and where they work.
Nurses fill a wide range of roles within health care, but usually they focus on caring for patients and teaching others about health issues. Many nurses provide direct patient care. Depending on their training and expertise, nurses might assist a patient with personal care, such as with dressing or bathing; provide care for a health problem, such as changing the dressing on a patient’s wound; screen a patient for diseases; assist doctors with procedures; or give a patient medication. Some highly trained nurses, such as nurse practitioners, may even write prescriptions depending on the scope of state licensure. The degree of direct patient care that nurses provide varies according to their job position and the provider type. For example, in a hospital inpatient setting, a certified nursing assistant, or CNA [C-N-A], may provide much of the care related to activities of daily living. The CNA frees up the nurse to focus on skilled care activities, such as medication administration, procedures, and wound care, as well as management duties. A CNA is one who has received training and education in patient care that resulted in a certification. CNAs are not licensed professionals and must work with direct supervision.

5. What Do Nurses Do? Continued
Educate patients and families on disease management, care activities, and health issues
Educate public on health issues
Advise organizations on health issues
Conduct research on health care topics
Teaching and patient education is also an important part of the job for many nurses. Because nurses have a lot of contact with patients and their families, they often educate patients and their families on ways to manage a health problem, such as diabetes. Some nurses teach health and wellness topics, such as how to avoid heart disease, to the public. Nurses with more advanced training can advise health care organizations about patient care or other health topics.
Nurses play a role in the overall management of a patient’s care. Often, many different people provide health care services to one patient. The nurse may function as the coordinator of care. In addition, a nurse may serve in a management role, providing oversight of a nursing department or a nursing unit. In this role, the nurse manages the additional nursing staff and nursing aides who care for the patients. Finally, nurses can assist in conducting research on health care and on health topics in many roles. 5

6. Nursing Specialties Several ways to specialize in nursing:
By body system (e.g., circulatory system)
By health problem (e.g., cancer)
By patient population (e.g., older people)
By location (e.g., schools)
Some specialties do not involve direct patient care (e.g., nursing informatics)
Just as many other health care professionals do, some nurses specialize in one or more areas of medicine. There are several specialty areas in nursing. A nurse can specialize in treating a particular body system, such as the circulatory system, or in treating certain health problems, such as cancer. Some nurses focus on treating certain patient populations, such as children or the elderly, or work in certain settings, such as schools, workplaces, or patients’ homes. They may develop expertise in specific treatment modalities, such as interventional radiology. Specific care setting also offer specialty opportunities for nurses, such as emergency department nursing, critical care nursing, or surgical/recovery department nursing. Although we often think of nurses as working at a patient’s bedside, nurses don’t always work directly with patients. Those who specialize in informatics, for example, help improve information technologies and communication in health care. Other areas include case management, quality reporting, patient safety, and other operational functions. 6

7. Types of Nurses
Three general categories of nurses based on education levels:
Licensed practical nurses (LPNs)
Registered nurses (RNs) (most common)
Advanced practice nurses (APNs) (most advanced level of responsibility)
There are many different types of nurses working in a variety of specialty areas in the United States. In general, most nurses fall into three categories: licensed practical nurse, or LPN [L-P-N], registered nurse, or RN [R-N], and advanced practice nurse, or APN [A-P-N]. Of the three categories, LPNs have the least amount of education. APNs have the greatest amount of education and the most responsibility.
For example, APNs can prescribe medications; LPNs and RNs cannot.
Most US nurses are RNs.
The next slides describe what each type of nurse does, how they are educated, and where they work. 7

8. What LPNs Do Licensed practical nurses (LPNs):
Provide patient care and help with self-care
Document in the patient’s medical record
Teach family members how to care for the patient
Some states call LPNs licensed vocational nurses
Licensed professional by state but must practiced under another professional
LPNs, similarly to RNs, provide basic patient care, such as medication administration, patient monitoring, assisting with patient procedures, taking patient vital signs, and documenting in the patient’s medical record. Like many direct care providers, LPNs provide teaching and education to the patient and family members. An LPN must function under the direct supervision of an RN or a physician.
Approximately half of LPNs work in hospitals or nursing care facilities. They also work in doctor’s offices, outpatient centers, and other settings. Depending on where they work, these nurses sometimes fill roles outside of providing direct patient care; examples of these roles include appointment scheduling, patient admissions, and even information technology.
In California and Texas, LPNs are called licensed vocational nurses.
As with other licensed professionals, LPNs must be state licensed and practice at the level of that state licensure. For example, there are limitations for LPNs administering medications in some states. 8

9. Education and Licensing of LPNs
Becoming an LPN is a three-step process:
Complete a state-approved training program that lasts about 1 year
Pass a national licensing exam for LPNs
Meet all state requirements for licensure to work, such as passing a background check
There are three steps to becoming an LPN in the US.
First, a student must complete about one year of nursing training in a program approved by his or her state. These training programs are offered at institutions such as vocational schools and community colleges. Students study science and nursing in the classroom and also perform supervised, hands-on patient care.
When they complete their training, students must take and pass a national exam for licensed practical nurses in order to earn their nursing license.
To work in their state, students who pass the national exam must also meet all of their state’s requirements. For example, a state might require that applicants pass a background check or that applicants provide proof that they graduated from high school. 9

10. What RNs Do
Registered nurses (RNs) are a large part of the health care workforce. They might
Plan patient care
Give medications and perform procedures
Manage and document in patient records
Teach patients, their families, and the public
Consult with doctors
Manage LPNs, CNAs, and other caregivers
Registered nurses are the most common type of nurse. According to the Bureau of Labor Statistics, as of 2014 there were about 2.7 million employed RNs in the U.S.—the highest number of employees of any health care profession. Employment of RNs is expected to grow by 16% between 2014 and 2024, much faster than the rate of growth expected in other occupations.
RNs have more education and, as a result, more responsibilities than LPNs. In direct patient care, RNs plan patient care, give medications and other therapies, and keep patient records. They teach patients, patient families, and the public how to prevent and manage medical problems. RNs consult with doctors about patient care, and they manage LPNs and other health care providers, such as nursing assistants.
Some LPNs who want greater career opportunities pursue further training to become RNs. 10

11. Where RNs Work Many RNs work in hospitals They also work in
Doctor’s offices, ambulatory care
Home health care services, hospice
Nursing care facilities
Workplaces and employer services
Schools
Military
As of 2014, more than 60% of RNs were employed by hospitals. They also work in physician practices, patients’ homes, nursing care facilities, workplaces, schools, and other settings. 11

12. Expanded Roles and Settings for Nurses
Administration/management
Leadership
Public health
Insurance companies
Health IT/informatics
Career options for nurses have greatly expanded beyond the direct patient care setting. Today, nurses can be found in administrative positions, such as chief operating officers, chief executive officers, and chief information officers, as well as in other operational roles in the provider setting. Other career areas for nursing include public health, insurance companies, legal firms, pharmaceutical companies, and state and federal agencies.
Health information technology and informatics have opened up significant opportunities for nurses both within the provider setting and externally, such as with consulting firms, software vendors, and other technology firms. New opportunities are expected to continue to grow in the future because technology experts understand the importance of having clinicians as part of their team in providing health care technology solutions. Clinicians assist in providing efficient clinical systems and technology that support the clinician’s ability to provide effective patient care.

13. Education and Licensing of RNs
Three steps to becoming an RN:
Earn a nursing diploma, an associate’s degree in nursing, or a bachelor’s of science in nursing over 2 to 4 years
Pass a national licensing exam for RNs
Meet all state requirements for state licensure
Like LPNs, RNs must follow a three-step process to work in their state. Educational requirements, however, are more rigorous for RNs than for LPNs.
RNs study nursing for two to four years. In the past, nursing diploma programs were typically based in a hospital provider setting. These programs slowly evolved to academic-based programs. Today, a person may earn an associate’s degree in nursing from a two-year college or a bachelor’s of science degree in nursing from a four-year college or university. During the program, students study science and nursing in the classroom and receive supervised, hands-on experience with patients in a health care facility, such as a hospital or a public health department.
Students then must take a national licensing exam for registered nurses. Once they pass the exam and meet all their state requirements, they can work as an RN under a state license. 13

14. What APNs Do
RNs with extra training can become advanced practice nurses (APNs)
Depending on their training, APNs can
Give patients anesthesia (certified registered nurse anesthetist)
Provide gynecological and obstetrical care (certified nurse-midwife)
Provide primary care (nurse practitioner, NP)
Treat patients and conduct research (clinical nurse specialist, CNS)
Advanced practice nurses are RNs who have pursued additional education. APNs can provide a wider range of medical services than an RN can.
There are four types of APNs: certified registered nurse anesthetists [uh-NESS-thi-tists], certified nurse-midwives, nurse practitioners, and clinical nurse specialists. A certified registered nurse anesthetist can give anesthesia to patients. A certified nurse-midwife can provide certain kinds of gynecological and obstetrical care to women. A nurse practitioner often provides primary care to patients and may write prescriptions, depending on the state licensure laws. A clinical nurse specialist, who specializes in one area of medicine, can treat patients, conduct research, and work as an administrator, among other tasks. 14

15. Education and Licensing of APNs
Three steps to becoming an APN:
Earn an RN license and work as an RN
Earn a master’s degree or higher in nursing
Meet state requirements to work as an APN
APNs are also called advanced practice registered nurses
To obtain work, APNs must already be licensed as RNs and have work experience as RNs. They also must earn a master’s or higher degree in nursing, and they must meet their state’s requirements to work as an APN.
APNs are also called advanced practice registered nurses. 15

16. Continuing Education and Credentialing
All nurses pursue continuing education to meet various requirements
All nurses can become certified in a specialty by taking an exam from an approved organization
Like many health care providers, most nurses pursue continuing education to keep their skills updated, to maintain their license, and to meet their employer’s requirements. Nurses take continuing education courses online or in classrooms through accredited organizations.
Some nurses may also choose to earn a certificate in a specialty. Nurses who want to specialize in a particular area can become certified by taking an exam from an approved organization, such as the American Nurses Credentialing Center. The certificate is usually not required to work in the specialty, but it provides proof of the nurse’s skills and knowledge in that area. 16

17. ANCC Nurse Practitioner Certifications
Acute care
Adult nurse
Gerontology: Acute/primary care
Psychiatric-mental health
Family
Gerontology
Pediatric primary rare
Diabetes management—advanced
Emergency
Nurse practitioners, or NPs [N-Ps], can earn certifications to specialize in various areas of nursing care. This slide lists the NP specialty exams that are available from the American Nurses Credentialing Center, or ANCC [A-N-C-C].
NPs can practice completely independently of a physician in some states. In other states, they must collaborate with a physician or be supervised by a physician when making a diagnosis or prescribing treatment. The level of independent practice of an NP varies by state and is managed through the state licensure process.
American Nurses Credentialing Center (ANCC), 2016. 17

18. ANCC Clinical Nurse Certifications
Adult health
Gerontology: Acute/primary care
Home health
Psychiatric-mental health: Adult/child/adolescent
Pediatric
Public/community health
A clinical nurse specialist, or CNSs [C-N-S], can also earn certifications to specialize in particular areas of nursing care. This slide lists the CNS specialty exams that are available from the American Nurses Credentialing Center.
American Nurses Credentialing Center (ANCC), 2016 18

19. Examples of Other Nursing Specialties
Cardiac rehabilitation
Case management
College health
Genetics
Informatics
Medical-surgical
Nurse executive
Pain management
Perinatal (newborns)
LPNs and RNs can also earn specialty certificates. This slide lists just some of the RN specialty exams that are available from the American Nurses Credentialing Center.
American Nurses Credentialing Center (ANCC), 2016 19

20. Advanced Degrees for Nurses
Nurses can pursue advanced degrees for career growth:
A master’s degree lets an RN become an APN if he or she meets the other requirements
Doctoral degrees
PhD: Prepares nurses for research and teaching
DNP: Degree names and programs vary, but they always emphasize advanced nursing practice and usually also leadership and management
Like specialty certificates, higher education can help nurses advance. As discussed, RNs can earn a master’s degree in nursing to become an advanced practice nurse. They can also earn doctoral degrees in nursing, either a doctor of philosophy, or PhD, or a doctor of nursing practice, or DNP. The PhD program trains a nurse to do research and teaching, and the DNP program trains a nurse in leadership and other skills. Today, many nurses may seek advanced degrees in disciplines such as informatics or business, which support other roles that nurses hold in today’s industry. 20

21. Nursing Care Processes Summary – Lecture a
Nursing roles include patient care, teaching, research, and administration
Specialization lets nurses gain expertise in certain areas of medicine
All nurses must have formal training, pass a national exam, and meet state requirements
Nurses stay licensed and build their careers by pursuing continuing medical education, certification, and advanced degrees
This concludes Lecture a of Nursing Care Processes. In summary, nurses have a wide variety of roles in the health care system. They might provide bedside care to a patient, teach the public about health issues, conduct research, or work as administrators in a health care organization. Many nurses specialize by working with patients with certain kinds of health problems, working with certain patient populations, and/or working in certain types of health care settings. Most nurses work directly with patients, providing care and teaching them about health issues, for employers as diverse as hospitals, schools, clinics, and home health care services.
All nurses have formal training in nursing, must pass a national nursing exam, and must meet any state requirements. RNs, the most common type of nurse, can become APNs and take on greater responsibility if they pursue additional training.
Nurses can add to their skills by pursuing continuing medical education and certification in their area of specialty. Some nurses pursue a master’s degree or doctoral degree to increase their knowledge and advance their careers.

22. Nursing Care Processes References – Lecture a
American Association of Nurse Practitioners. (2015). Quality of nurse practitioner practice. Retrieved from
 American Medical Informatics Association. (2016). Nursing informatics. Retrieved from
American Nurses Association. (2016). How to become a nurse. Retrieved from
American Nurses Association, Center for Continuing Education and Professional Development. (2016). Nursing Knowledge Center. Retrieved from
American Nurses Credentialing Center. (2016). ANCC Certification Center. Retrieved from
Gordon, Suzanne. (2006). What do nurses really do? Topics in Advanced Practice Nursing eJournal, 6(1). Retrieved from
Stinson, S. (2014). Roles outside the hospital. Advance Healthcare Network for Nurses. Retrieved from
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23. Nursing Care Processes References – Lecture a Continued
U.S. Department of Labor, Bureau of Labor Statistics. (2015). Licensed practical and licensed vocational nurses. In Occupational Outlook Handbook, 2014–15 ed. Retrieved from
U.S. Department of Labor, Bureau of Labor Statistics. (2015). Registered nurses. In Occupational Outlook Handbook, 2014–15 ed. Retrieved from
U.S. Department of Labor, Bureau of Labor Statistics. (2015, Aug. 19). Registered nurses employment and wages by state and metropolitan area. Retrieved from
No audio.
Health IT Workforce Curriculum Version 4.0

24. The Culture of Health Care Nursing Care Processes Lecture a
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