Chapter 14
Nursing
Health Care
Science
Technology
Copyright © The McGraw-Hill Companies, Inc.
Objectives
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2
Summarize the roles and responsibilities of
unlicensed nursing personnel, including
certified/certificated nursing assistants, home
health aides, dialysis technicians, and surgical
technicians.
Differentiate between the roles and
responsibilities of licensed nurses, including
licensed practical nurses and licensed vocational
nurses, registered nurses, and advanced practice
nurses.
Successfully complete 16 nursing procedures.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Careers in Nursing 14-1
Unlicensed Nursing Personnel
 Licensed Nursing Personnel
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3
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Careers in Nursing

Nursing offers many career
opportunities.
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4
Aging population, increasing
turnover because of age, and
people exiting the nursing field
create need for new trainees.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Careers in Nursing (cont.)

Nursing can be divided into two
areas:
–
Unlicensed nursing personnel
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5
Certified or certificated nursing
assistant.
Home health aide.
Dialysis technician.
Surgical technician.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Careers in Nursing (cont.)
–
Licensed nursing personnel
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6
Licensed practical nurse or licensed
vocational nurse.
Registered nurse.
Advanced practice nurse.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel
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Need generated by the rapidly rising
cost of health care.
Work under licensed nurses.
Perform nursing tasks that can be
safely done by people with specific
training.
There are unresolved issues on
which tasks can be delegated.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing
Assistant
–
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8
Regulated by state law – not federal.
Federal government issued guidelines
for training in Omnibus Budget
Reconciliation Act (OBRA).
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing
Assistant (cont.)
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Nursing assistant is often primary caregiver.
Often involves working evenings, nights,
weekends, and holidays.
Typically works in 3 types of facilities:
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9
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Acute care.
Long-term care.
Residential care.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing
Assistant (cont.)
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Tasks delegated may include:
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Answering call lights.
Setting up rooms for new admissions.
Keeping rooms neat to ensure safety.
Delivering messages, supplies, and equipment.
Serving and assisting with meals.
Assisting with daily personal care.
Assisting with toileting.
Chapter 14
Copyright © The McGraw-Hill Companies, Inc.
Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing
Assistant (cont.)
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Tasks delegated may include (cont.):
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Making beds.
Providing oral care.
Assisting with oral care.
Assisting with skin care.
Helping with shaving.
Taking and reporting vital signs.
Assisting with bathing and/or showering.
Reporting changes in client’s condition.
Helping clients transfer and/or ambulate.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing
Personnel (cont.)

The Certified or Certificated Nursing
Assistant – Long-Term Care
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Perform the same duties as in acute care,
but additional duties may include:
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12
Emptying bedpans.
Cleaning incontinent patients.
Reporting significant changes, including changes
in mental status or self-care capabilities.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing
Personnel (cont.)

The Certified or Certificated
Nursing Assistant – Residential
Care
–
Perform same duties as in acute care and
long-term care, but additional duties may
include:
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13
Assisting with medications.
Assisting with taking clients shopping or
other outings.
Providing assistance with transportation to
medical appointments.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing
Personnel (cont.)

The Home Health Aide
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Works with clients in their homes.
 May work in one or multiple homes.
 Clients are often elderly, disabled, or
ill.
Works independently with occasional
supervisory oversight.
 Supervisor is home health nurse who
writes detailed plan of care.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Home Health Aide (cont.)
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Performs same tasks as certified or
certificated nursing assistant.
Assists with medications.
Assists with personal care.
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Cooks meals.
Assists with eating, bathing, and dressing.
Does light housekeeping and laundry.
Changes bed linens.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Home Health Aide (cont.)
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Assists with shopping.
Takes clients to medical appointments.
Provides assistance that allows client
to remain safely in home.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Dialysis Technician
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Also known as hemodialysis or
renal dialysis technician.
Operate kidney dialysis
machines.
May perform maintenance and
repairs on dialysis equipment.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Dialysis Technician (cont.)
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Must minimize exposure of client’s blood to
minimize spread of disease.
Tasks may include any or all of the following:
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Getting machines ready.
Obtaining and recording client’s weight and
vital signs before procedure.
Administering anesthetics and medications
before, during, and after procedure.
Beginning the procedure.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Dialysis Technician (cont.)
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Tasks may include any or all of the following
(cont.):
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Monitoring the client and process.
Checking for signs or symptoms of adverse
reactions.
Administering emergency care if needed.
Cleaning equipment after procedure.
Training clients on how to perform the
procedure at home.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Surgical Technician
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Also known as operating
room technician.
Assist during surgical
procedures.
Work under supervision
from surgeons, registered
nurses, and others.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Unlicensed Nursing Personnel (cont.)

The Surgical Technician (cont.)
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Work in operating or delivery room.
May work in outpatient facility for
physicians or dentists.
May set up an operating room before
surgery.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Surgical Technician
Job Responsibilities (cont.)

The Surgical Technician (cont.)
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Other duties may include:
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Maintaining a sterile environment for surgery.
Learning required surgical tools.
Knowing the order in which surgical tools are
required during surgery.
Setting up and testing non-sterile equipment.
Preparing for surgery by shaving, cleaning, and
disinfecting client.
Taking client’s vital signs.
Checking medical charts for the surgeon.
Transporting clients to the recovery room.
Cleaning and restocking after surgery.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel
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Attend postsecondary education
courses and pass a test.
Obtain a license through a state
agency.
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Licensed nurses include:
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Licensed practical or vocational nurse.
Registered nurse.
Advanced practice nurse.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational
Nurse
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Perform care under supervision of physician
or registered nurse.
Typically receives training from vocational or
technical school.
Are required by all states to pass a licensing
examination.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational Nurse
Job Responsibilities:
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Taking vital signs.
Treating bedsores.
Administering injections.
Giving enemas.
Administering medications.
Applying dressings.
Applying ice packs and hot water bottles.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational
Nurse Job Responsibilities (cont.):
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Inserting and caring for urinary catheters.
Assessing clients for effects of medication
and treatments.
Assisting with meals.
Recording intake and output.
Helping with personal needs of clients.
Helping with emotional needs of clients.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational
Nurse Job Responsibilities (cont.):
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Assisting with the delivery of infants.
Caring for and feeding infants.
Supervising nursing assistants.
Helping evaluate client needs and developing care
plans.
Making appointments and keeping records in
physicians’ offices.
Teaching clients how to care for themselves.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Nurse
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Types of registered nurses:
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Hospital nurse.
Office nurse.
Nursing home nurse.
Home health nurse.
Public health nurse.
Occupational or industrial nurse.
Head or supervisory nurse.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Nurse (cont.)
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Must pass national licensing exam and be
licensed in state where they work.
Three training paths:
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Hospital training program.
Associate degree from community college.
Bachelor of science in nursing.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Hospital
Nurse
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Job responsibilities may include:
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Providing all care given by
LPN/LVNs.
Providing bedside nursing care.
Starting IVs.
Carrying out medical regimes as
ordered by physicians.
Supervising LPN/LVNs and
unlicensed assisting personnel.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Office Nurse
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Job responsibilities may include:
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Providing care for outpatient clients.
Preparing clients for examinations.
Assisting physicians with examinations.
Administering injections and IV solutions.
Performing wound care.
Assisting with minor surgeries.
Maintaining documentation.
Performing routine specimen collection and
lab work.
Chapter 14
Copyright © The McGraw-Hill Companies, Inc.
Licensed Nursing Personnel (cont.)

The Registered Nursing Home Nurse
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Job responsibilities may include:
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Managing the nursing care for clients.
Filling management positions.
Participating in staff education.
Handling administrative and supervisory
duties.
Assessing client’s medical conditions.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Home Health Nurse
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Job responsibilities may include:
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Providing periodic care to clients in their
homes.
Assessing the home environment for safety.
Teaching clients and their family members
how to care for themselves.
Supervising the home health aide, possibly an
LPN/LVN, to assist with cases.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Public Health Nurse
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Job responsibilities may include:
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34
Working in the community setting.
Working with the selected populations to
improve the health of the community at large.
Educating community members in health
maintenance, disease prevention, nutrition, and
child care.
Providing health screenings.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Occupational or
Industrial Nurse
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Job responsibilities may include:
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35
Providing workplace care to employees and
customers.
Assessing and educating on health hazards
found in the workplace.
Assisting with health examinations.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

The Registered Head or Supervisory
Nurse
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Job responsibilities may include:
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36
Managing the department.
Planning work schedules and assigning
duties.
Planning and monitoring the budget.
Supervising all personnel.
Maintaining all required records.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

Advanced Practice Nurse
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Takes advanced training to obtain advanced
practice certificate or degree.
Nurse practitioner is allowed to write
prescriptions with physician’s approval.
There are four specialties:
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37
Clinical nurse specialist.
Certified registered nurse anesthetist.
Certified nurse-midwive.
Certified registered nurse practitioner.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

Advanced Practice Nurse
(cont.)
–
The Clinical Nurse Specialist is
a registered nurse who
specializes in a specific
nursing area such as:
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38
Gerontology (care of older
clients).
Neonatology (care of
prematurely born infants).
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

Advanced Practice Nurse (cont.)
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39
The certified registered nurse
anesthetist has additional training in
the use of anesthesia.
 Works in surgical suites.
 Works under the supervision of
an anesthesiologist or a
physician who specializes in
anesthesiology.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

Advanced Practice Nurse (cont.)
–
The certified nurse-midwife assists with the
delivery of infants.
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40
Has training and expertise in the delivery process.
May assist with birth in home of client.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Licensed Nursing Personnel (cont.)

Advanced Practice Nurse (cont.)
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Duties depend on setting in which they work.
Many work in rural areas where access to
traditional care is scarce.
May work in:
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41
Physician’s office.
Hospital outpatient area.
Surgical area.
Acute care, clinics, or in client’s home.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Section 14-1
Apply Your Knowledge #1
What are the three training paths
for a registered nurse?
Answer:
1. Hospital diploma.
2. Associate’s degree.
42
3. Bachelor of science in
nursing degree.
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Section 14-1
Apply Your Knowledge #2
One area that a clinical nurse
specialist works in is
gerontology. What group of
people does this term reference?
Answer:
Clients over the age of 65.
43
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Procedures in Student Text
14A
14B
14C
14D1
14D2
14E1
14E2
14F
44
Admitting a Client
Transferring a Client
Discharging a Client
Making an Open or Closed Bed
Making an Occupied Bed
Measuring Oral Fluid Intake
Measuring Urinary Fluid Output
Positioning Clients
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Procedures in Student Text (cont.)
14G1
14G2
14H1
14H2
14H3
14H4
45
Moving a Client Up in Bed with the
Client’s Assistance
Moving a Client Up in Bed Using a
Turn or Lift Sheet
Transferring a Client Using a
Mechanical Lift
Transferring a Client into a Wheelchair
Transferring a Conscious Client from
the Bed to a Stretcher
Transferring an Unconscious Client
from the Bed to a Stretcher
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Procedures in Student Text (cont.)
14I1
14I2
14I3
14J1
14J2
14J3
14K
46
Assisting with a Bath or Shower
Performing a Partial Bed Bath
Performing a Complete Bed Bath
Providing Denture Care
Assisting with Oral Care
Performing Oral Care for a Helpless
Client
Nail Care
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Procedures in Student Text (cont.)
14L1
14L2
14M
14N1
14N2
14O1
14O2
47
Shampooing a Bed-Bound Client’s
Hair
Brushing or Combing a Client’s Hair
Shaving
Providing Female Perineal Care
Providing Male Perineal Care
Changing a Client’s Gown
Undressing and Dressing a Client Who
Has Limited Use of Limbs
Copyright © The McGraw-Hill Companies, Inc.
Chapter 14
Procedures in Student Text (cont.)
14P
14Q1
14Q2
14Q3
14Q4
14Q5
14Q6
14Q7
48
Applying Elastic Stockings
Providing a Bedpan
Removing a Bedpan
Providing a Urinal
Removing a Urinal
Indwelling Catheter Care
Emptying a Catheter Drainage Bag
Assisting with the Bedside
Commode
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Chapter 14
Chapter 14 Credits
Slide 11
Slide 12
Slide 13
Slide 14
Slide 30
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Chapter 14