Chapter 4: Patient Care: Nursing
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Registered Nurses
• Overview
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Most education & widest scope of practice of nurses
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Largest health care occupation in U.S.
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Large demand
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Diverse work settings
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Flexible working arrangements
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U.S. News & World Report: one of the best careers of 2010
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Registered Nurses (cont’d)
• History of the Profession
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Ancient times: women tending families during sickness
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Early Christian times: deaconesses & religious orders provided
care
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Early 16th century: criminals served as nurses in lieu of jail
time
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18th & 19th centuries: reform in roles
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Florence Nightingale: elevated nursing to respected profession
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After WWII: universities & colleges set up schools of nursing
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States developed & adopted a national licensing exam for nurses
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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)
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Registered Nurses (cont’d)
• Diploma Programs
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Offered by hospitals
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3 years to complete
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Earliest of nursing programs
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Main source of graduates until 1960s
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Decreasing in number in recent years
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Emphasis on clinical experience in direct patient care
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Registered Nurses (cont’d)
• Associate’s Degree Programs
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Associate’s degree in nursing (ADN)
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Offered at community or junior colleges
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Typically 2-3 years
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Prepare nurses for various settings
• Hospitals
• Long-term care facilities
• Home health care
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Provide technical skills
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Prepare students to carry out nursing roles & functions
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Registered Nurses (cont’d)
• Bachelor’s Degree Programs
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Bachelor of science in nursing (BSN)
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4 years to complete
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Accelerated BSN programs for those who already have bachelor’s
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Built on general education base
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Concentration on nursing at upper levels
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Emphasis on working with health care team, research,
foundation for graduate study, variety of practice settings
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Registered Nurses (cont’d)
• Course Work
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Anatomy
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Physiology
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Microbiology
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Chemistry
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Nutrition
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Psychology
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Nursing practice
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Registered Nurses (cont’d)
• Further Education
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Bachelor’s degree
• RN-to-BSN bridge program
• Required for many administrative, managerial, & community
health positions
• Accelerated master’s degree programs (combined BSN &
MSN)
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Master’s degree programs
• Required for all advanced practice nurse specialties
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Doctoral degree programs
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In-service education (on-site training)
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Registered Nurses (cont’d)
• Licensure
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NCLEX-RN: licensing exam for RNs
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Exam & licensure is by states
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Nurse practice acts: regulation of nursing by states
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License renewal required
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Registered Nurses (cont’d)
• Certification
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Specialty certification available
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Leads to higher pay
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American Association of Critical-Care Nurses (AACN)
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American Nurses Association (ANA)
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Requires:
• Licensure
• Bachelor’s degree or graduate degree or work experience
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Must be renewed every 3 (AACN) or 5 (ANA) years
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Registered Nurses (cont’d)
• General Duties
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Care & treatment of patients
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Supervision of other nurses & nursing assistants
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Protection of patient rights
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Advice & emotional support to families of patients
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Communication with other health care professionals
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Patient education
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Registered Nurses (cont’d)
• Specialties
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Emergency or trauma care
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Critical care
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Addiction
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Diabetes
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Specific organs & body systems (e.g., cardiovascular)
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Specific population (neonatal, pediatric, geriatric)
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Advanced practice
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Non-patient (infection control, forensics, informatics, case
management)
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Registered Nurses (cont’d)
• Personal Characteristics
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Desire to help others
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Caring, sympathetic attitude
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Detail-oriented
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Flexible
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Good judgment
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Responsible
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Team work
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Registered Nurses (cont’d)
• Employment Opportunities and Trends
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32% growth from 2008 to 2018
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In demand due to:
• Improvements in medical technology
• Increased emphasis on preventive care
• Growth in number of older adults
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Registered Nurses (cont’d)
• Professional Organization
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ANA
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Formed from state nurses’ associations
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Founded in 1896
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Sets standards of practice
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Encourages research to advance nursing practice
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Advocates on behalf of nursing at state & federal levels
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Benefits: subscription to journals, discounts on certification,
online continuing education, conferences, educational events
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Licensed Practical Nurses
• History of the Profession
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1892: first formal training program in U.S., at YWCA
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1930: 11 practical nursing schools were operating
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Late 1930s: process of state licensure begun
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Expansion after WWII due to shortage of RNs & other factors
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1941: Association of Practical Nurse Schools founded
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Renamed National Association for Practical Nurse Education and
Service (NAPNES)
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1955: All states had licensure laws
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1966: Accreditation of schools by National League for Nursing
begun
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Licensed Practical Nurses (cont’d)
• Education
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Training in bedside nursing care
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Programs offered by:
• Technical & vocational schools
• Community/junior colleges
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Programs require HS diploma or equivalent
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Last about 1 year
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Classroom study & supervised clinical practice
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Licensed Practical Nurses (cont’d)
• Course Work
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Basic nursing concepts
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Anatomy & physiology
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Medical-surgical nursing
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Pediatric nursing
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Obstetric nursing
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Pharmacology
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Nutrition
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First aid
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Licensed Practical Nurses (cont’d)
• Professional Certification
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Licensure required in all states
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Requires:
• Graduation from state-approved program
• Passing the NCLEX-PN
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Licensed Practical Nurses (cont’d)
• Work Responsibilities
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Hands-on tasks
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Basic nursing care
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Collect lab samples
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Perform routine tests
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Assist physicians & RNs in administering tests
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Monitoring
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Cleaning medical equipment
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Licensed Practical Nurses (cont’d)
• Personal Characteristics
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Empathetic
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Emotionally steady
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Observant
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Good communication skills
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Patient
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Able to follow orders & work under supervision
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Licensed Practical Nurses (cont’d)
• Employment Opportunities and Trends
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Growing occupation: 21% between 2008 & 2018
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Best opportunities in:
• Home health care
• Nursing care facilities
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Licensed Practical Nurses (cont’d)
• Professional Organization
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NAPNES
• Founded by LPNs
• Develops practice & education standards for LPNs
• Represents LPNs in national meetings
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National Federation of Licensed Practical Nurses (NFLPN)
• Governed completely by LPNs
• Promotes high standards of education & practice
• Monitors legislation
• Represents LPNs before Congress
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Certified Nursing Assistants
• Overview
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Perform simple, basic nursing functions
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Provide care of patients’ personal needs
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Are under direction of LPN or RN
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Certified Nursing Assistants (cont’d)
• History of the Profession
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Delegation of nursing tasks to auxiliary personnel after WWII
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Assistants began to take over tasks of student nurses
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Assistants began working in long-term care facilities & hospitals
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1980s: U.S. Institute of Medicine recommended formal training
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1987: Law passed requiring all states to set up training
programs
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Certified Nursing Assistants (cont’d)
• Education
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Required for certification:
• Completion of state-approved training program
• Passing a competency test
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Training programs
• Minimum of 75 hours
• Available at vocational schools, community colleges, Red
cross, health care facilities
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Recertification requires at least 12 hours of in-service education
each year
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Certified Nursing Assistants (cont’d)
• Course Work
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Documentation skills
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Anatomy & physiology
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Infection control
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Bathing, dressing, & other
personal care skills
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Patient room upkeep
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Patient/resident rights
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Nutrition
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Safety & emergency
procedures
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Communication skills
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Certified Nursing Assistants (cont’d)
• Work Responsibilities
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Hands-on, personal patient care
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Assist with personal hygiene
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Serve meals
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Help patients eat & dress
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Transport patients
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Answer patient calls
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Take vital signs
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Assist other medical staff
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Certified Nursing Assistants (cont’d)
• Personal Characteristics
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Empathy
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Patience
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Emotional strength
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Cooperation
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Respect
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Professionalism
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Responsibility
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Certified Nursing Assistants (cont’d)
• Employment Opportunities and Trends
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Part of a category called nursing aides, orderlies, & attendants
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19% growth between 2008 & 2018
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Growth is due to:
• Aging of population & need for long-term care
• Early discharges of patients from hospitals
• Life-extending technologies
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Certified Nursing Assistants (cont’d)
• Professional Organization
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National Association of Health Care Assistants
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Provides development training & mentoring programs
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Advocates on issues related to caregivers & long-term care
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Membership benefits
• Educational opportunities
• A news magazine
• A national convention
• A national awards program
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