Chapter 4 : Patient Care: Nursing

1. Chapter 4: 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