Unit 1: Role of the RN in the Health
Care System
Nancy Pares, RN, MSN

• Cert. Nurse Assistant, Med Aide
• LPN; LPN-C
• ASN
• BSN
• MSN; APRN
• PhD
• Specialists: Wound Care, Ostomy, Care
Management, Diabetes,

• Direct care provider
• Communicator
• Educator
• Advocate
• Counselor
• Change agent
• Leader
• Manager/case manager
• Research consumer

• Administrator
• Researcher
• Clinic setting
• Hospice
• Clinical Nurse Specialist

• 1. decision making
• 2. relating
• 3. influencing
• 4. facilitating

• Nebr Statute 38-2212
• Practice of nursing defined:
– The practice of nursing by a registered nurse means assuming responsibility and accountability for nursing actions

• Nursing actions include, but are not limited to
– Assessing human responses to actual or potential health conditions
– Establishing nursing diagnosis
– Establishing goals and outcomes to meet identified health care needs
– Establishing and maintaining a plan of care
– Prescribing nursing interventions to implement the plan of care
– Teaching health care practices
– Delegating, directing, or assigning nursing interventions that may be performed by others and that do not conflict with the Nurse Practice
Act
– Maintaining safe and effective nursing care rendered directly or indirectly

– Evaluating responses to interventions, including, but not limited to, performing physical and psycholological assessments of patients under restraint and seclusion as required by federal law, if the registered nurse has been trained in the use of emergency intervention
– Teaching theory and practice of nursing
– Conducting, evaluating and utilizing nursing research
– Administering, managing and supervising the practice of nursing
– Collaborating with other health professionals in the management of health care
• Visit NHHS web site
• http://dhhs.ne.gov/crl/nursing/rnlpn/apps.htm

Compact states https://www.ncsbn.org/nlc.htm

• Advisory Opinions
– Pronouncement of death
– Meds when pharm closed
– PICC lines
– Arterial lines
– IV sedation
– Casting
– CPR
– cardioversion

Benner’s stages of nursing expertise
• Stage I Novice
– Nursing student
• Stage II, Advanced Beginner
– Demonstrates marginal performance
• Stage III, Competent
– Licensure, 2-3 years experience
• Stage IV, Proficient
– Licensure, 3-5 years experience
• Stage V, Expert
– Highly skilled, fluid, intuitive, analytical

• The integration of best research with clinical expertise and patient values
• Levels
– 1 : evidence obtained of all randomized control trials (RCT)
– 2: properly designed study-non RCT
– 3:A: controlled trials/non randomized
• B: case controlled analysis/ > one center/group
• C: multiple time series with dramatic results
– 4: opinions, clinical expertise reports

• Quantitative
– Conclusions that produce new knowledge
• Descriptive*
• Retrospective
• Prospective
• Correlational*
• Experimental*
• Quasi experimental

• Phase I--conceptual
• Phase 2-design/planning
• Phase 3-empirical
• Phase 4-analysis
• Phase 5-dissemination

• Subjective, small sample, events as they occur; often biased-
– Biographical
– Case Study
– Ethnography
– Phenomenology
– Literature Review

• Sampling
• Measurement techniques
• Data collection and analysis
• Results
• Implications for nursing

• Research utilization
• Changing of nursing practice
• Application of legal/ethical principles
• Role of ADN
– Identify what needs to be changed
– Assist in data collection
– Put findings into practice

• Heart failure centers
• Saline vs heparin lock
• Vent tube changes
• Music in the hospitals
• Fall risk assessment

• Multi dimensional skill, involves reasoning, systematic, reflective, rational, outcome directed thinking based on knowledge and available information.

• Ask questions
• Gather information to consider all factors
• Validate the information
• Analyze the information
• Draw on past experiences; acknowledge personal bias
• Maintain flexible attitude
• Consider options related to advantages and disadvantages
• Formulate decisions that reflect creativity and independent decision making

• What does this tell me?
• What is the most important?
• Is anything missing?
• Do I need more help?
• What are the risks?
• What are the complications?
• What do I want to happen?
• What should I do first?
• Do family dynamics have affect?
• Is culture an issue?
• Are my ethics in line?
• What does nursing research support?

Characteristics of Nurses with critical thinking skills
• Creative
• Logical, rational
• Prudent, inquisitive
• Self regulating judgment
• Intellectual humility
• Independent thinking
• Willing to take risks
• Action oriented
• Recognizes patterns in phenomenon
• Focused thoughts
• Blends logic and intuition
• Anticipates events
• Works collaboratively and respects perspectives of others

• Physical/emotional states
• Personal characteristics
• Agency policy
• Intellectual courage (or lack of)

• Interpretation
– Catagorize,clarify
• Analyze
• Infer
• Explain
• evaluate