1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 4: Patient Care: Nursing

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Registered Nurses (cont’d) History of the Profession –Ancient times: women tending families during sickness –Early Christian times: deaconesses & religious orders provided care –Early 16 th century: criminals served as nurses in lieu of jail time –18 th & 19 th 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Registered Nurses (cont’d) Course Work –Anatomy –Physiology –Microbiology –Chemistry –Nutrition –Psychology –Nursing practice

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Registered Nurses (cont’d) Personal Characteristics –Desire to help others –Caring, sympathetic attitude –Detail-oriented –Flexible –Good judgment –Responsible –Team work

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensed Practical Nurses (cont’d) Course Work –Basic nursing concepts –Anatomy & physiology –Medical-surgical nursing –Pediatric nursing –Obstetric nursing –Pharmacology –Nutrition –First aid

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensed Practical Nurses (cont’d) Professional Certification –Licensure required in all states –Requires: Graduation from state-approved program Passing the NCLEX-PN

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Licensed Practical Nurses (cont’d) Personal Characteristics –Empathetic –Emotionally steady –Observant –Good communication skills –Patient –Able to follow orders & work under supervision

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Certified Nursing Assistants Overview –Perform simple, basic nursing functions –Provide care of patients’ personal needs –Are under direction of LPN or RN

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Certified Nursing Assistants (cont’d) Personal Characteristics –Empathy –Patience –Emotional strength –Cooperation –Respect –Professionalism –Responsibility

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 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