1. Chapter 9: Patient Care: Nursing

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

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

9. 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)

10. 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

11. 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

12. 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

13. 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)

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

15. 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

16. 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

17. 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

18. 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

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

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

21. 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

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

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

24. 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

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

26. 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

27. 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

28. 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

29. 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

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

31. 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

32. 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