Contemporary
Nursing

Roles and Career
Opportunities
NURSING . . . MUCH THE SAME,
BUT BIGGER AND BETTER
The proliferation
of career opportunities for
nurses is growing.
Professional Nursing Roles
 Care provider
 Educator and counselor
 Client advocate
 Change agent
 Leader and manager
 Researcher
 Coordinator of the transdisciplinary
health care team
Change Agent
 When nurses first adopted the role of "change
agent," few individuals visualized to what extent
 nurses would fulfill this role.
 nurses have expanded their role as change agents
in many ways.
 The profession continues to identify client and
health care delivery problems, assess their
motivation and capacity for change, determine
alternatives, explore possible outcomes of the
alternatives, and assess cost-effective resources in
infinite health-related situations.
Leader and Manager
The leadership role of the professional nurse is
paramount to the health care system.
 Nursing leadership varies according to the level of
application and includes:
• Improving the health status and potential of individuals
or families.

• Increasing the effectiveness and level of satisfaction
among professional colleagues providing care.

• Managing multiple resources in a health care facility.

• Raising citizens' and legislators' attitudes toward and
expectations of the nursing profession and the health care
system.

Leader and Manager
 There is little doubt that the
management role of the nurse has
become more important.
 Nursing management includes
planning; giving direction; and
monitoring and evaluating.
 Nursing care of individuals, groups,
families, and communities.
Researcher
 The majority of researchers in nursing
are prepared at the doctoral and
postdoctoral levels, an increasing
number of clinicians with master's
degrees are beginning to participate
in research as part of their advanced
practice role.
Researcher
 Nurses prepared at the baccalaureate and
associate degree levels are also participating in
research.
 These nurses may be assisting with data
collection, critiquing research findings, and using
these findings in practice.
 More nursing interventions are based on nursing
research than in the past.
Coordinator of the Transdisciplinary
Health Care Team
 Transdisciplinary teams consist of
collaborative practice relationships among
several disciplines of health care
professionals.
 The disciplines include nursing, medicine,
pharmacy, nutrition, social work, and other
allied health professionals such as physical
therapists, respiratory therapists,occupational
therapists, and speech therapists.
Coordinator of
theTransdisciplinary
Health CareTeam
 Transdisciplinary teams are valuable because
professional members bring their in-depth and
specialized knowledge and skills to the interaction
process.
 A plan of care developed by the transdisciplinary
team is usually considered a valuable health
management tool (Van Ess Coeling and Cukr,
1998).
Transdisciplinary health
care team
 The term transdisciplinary health care team may
not be as familiar as the term multidisciplinary or
interdisciplinary team.
 Multidisciplinary health care teams consist of many
disciplines involved in meeting client care needs.
 Interdisciplinary teams refer to coordination
between and among disciplines involved in
providing client care.
Transdisciplinary health care
team
 The more global and inclusive term transdisciplinary
health care teams can be described as including
multiple disciplines bonding, interacting, and uniting
toward common goals of client care.
 The collaborative process involved in
transdisciplinary health care incorporates the
definitions of multidisciplinary and interdisciplinary
health care and, in fact, transcends a single health
profession to create comprehensive work outcomes.
Transdisciplinary health care
team
 Studies that investigate the process of
transdisciplinary health care teams in action
report improved quality of care, increased client
satisfaction, increased nursing satisfaction, and
reduced hospital cost by decreasing hospital
length of stay and increasing nursing retention
(Wasserman, 1997; Baggs, 1989; Baggs et al.,
1992; Knaus et al., 1986).
Transdisciplinary health
care team
 Successful health care team models that use
concepts related to transdisciplinary health
care include pain management, nutritional
support, skin care, rehabilitation, mental
health, and hospice.
Transdisciplinary health
care team
 Client education is another area in which
collaboration and disciplines working together
 are absolutely essential.
 Health care professionals must understand one
another's contributions to client education and
ensure that the information clients and families
receive is consistent and complete.
 This will lead to the best possible health outcomes
for clients and families.
NURSES TODAY: WHO ARE THEY
AND WHAT ARE THEY DOING?
 The phrase "a typical nurse" has become a
misnomer as the profession enters the
twenty-first century.
 Nursing roles are so diverse that there
literally is no typical role or practice setting.
Registered Nurse Demographics
Eighty-one percent of these
RNs hold active licenses and
are employed in nursing.
Approximately 58.5% of this
group are employed full time in
the profession, with 23.3% of
nurses working part time.
Registered Nurse Demographics
 In 2000 the average age of the RN
population was 45.2 years.
 In 2000 31.7% are under 40 years of age,
18.3% under 35 years, and 9.1% under 30
years.
 Some speculate that the increase in the
average age of RNs may represent the aging
society or "second-career" nurses, with
younger persons may be choosing other
professions.
Registered Nurse Demographics
 Although the profession continues to be
predominantly female, the number of men
working as RNs significantly increased.
 The 2000 report indicates that the number
of male RNs increased to 5.9%, up from
5.4% in 1996 data (Division of NursingBureau of Health Professions, National
Sample Survey, 2001).
Registered Nurse Demographics
 Changes also are occurring in the educational
preparation of RNs:
 increasing in the number of nurses graduating from
associate degree nursing programs and
baccalaureate-prepared nurses.
 In 2000 graduates from basic nursing programs were
40.3% associate degree, 29.6% baccalaureate
degree, and 29.3% diploma graduates.
 In 2000 nurses reported their highest degree as 22.3%
diploma, 34.3% associate degree, 7% baccalaureate
degree, and 10.2% master's or doctoral degree
(Division of Nursing-Bureau of Health Professions,
National Sample Survey, 2001).
Registered Nurse Demographics
 Advanced practice nurses now comprise 7.3% of
the RN population, up from 6.3% in 1996.
 Nurse practitioners lead this group in numbers,
followed by clinical nurse specialists (CNSs), nurse
anesthetists, and nurse midwives.
 Nurse practitioners and CNSs make up 80% of the
advance practice group. (Division of NursingBureau of Health Professions, National Sample
Survey,2001).
Hospital Opportunities
 In the hospital the nurse in a direct-care role
provides care for people who are ill and
unable to provide for themselves.
 Hospital positions can range from staff nurse
to administrator and, in a general hospital,
entail any of the clinical specialties and most
of the target populations.
Trends in Health Care Delivery
Systems
From
 Acute inpatient care  Treating illness  Focus on the individual 
To
»
»
»
Lifespan care
Maintaining health
Focus on
aggregates/populations
 Product of care orientation »
 Number of hospital admissions - »

Value of care orientation
Number of lives covered
(capitation)
 Managing organizations  Managing departments  Coordinating services -
Managing networks
Managing markets
Documenting quality and
outcomes
»
»
»
Trends in Health Care Delivery
Systems
 The clinical setting has been based on
experiences as a student, the new graduate
needs to be prepared to have different
perceptions in a new role.
 At a minimum, experiences that are highly
enjoyable on the limited-time basis of a student
schedule may feel different when the new
graduate functions in that role full time.
 It also is good to have a mix of experiences and
learning opportunities before making a definitive
decision.
Trends in Health Care Delivery
Systems
 Nursing within hospitals offers almost endless
opportunities for diversity.
 Staff level positions in a hospital can be on many
different units, and working different shifts on those
units presents different work environments,
approaches to work, and priorities of client care.
Quality Management
 The parameters of a position in quality management or
quality control vary from institution to institution, the
basic premise is to ensure that outcomes in client care
services are consistent with established standards.
 Quality management nurses assess the compliance of
the institution with established standards and explore
variations from established standards.
 Chart reviews and ongoing interaction with the staff of
the agency are integral components of a quality
management position.
Quality Manager
 The health care providers to assess opportunities
for process improvement, implement changes,
measure outcomes, and then start the
improvement process over again.
 Quality management nurses research and
describe findings and look for opportunities to
improve care.
Quality Manager
 Quality studies produce critical pathways or
algorithms defining care and expected client
outcomes.
 Basic and advanced knowledge of quality
management tools is essential, although
practice may vary from setting to setting.
 In the inpatient setting the quality management
nurse needs strong clinical skills as might be
acquired in medical surgical practice, intensive
care units, or the operating room.
Quality Manager
 Experience in home care would be an advantage for
a quality management nurse in that setting.
 Interpersonal skills are important because to be
successful this role requires building relationships
and rapport.
 The role of quality manager is one that promotes
improved care for health care recipients in a variety
of settings.
Case Manager
 This role has had a rich tradition in community and public
health nursing, and in acute care.
 Case managers coordinate resources to achieve health care
outcomes based on quality, access, and cost.
 The complexity of case management practice is obvious in
the era of chaotic systems caused in which providers,
services, and coverage details are constantly changing.
 Case managers identify the best resources at the lowest cost
to achieve the optimum health outcome for the client
(Stanhope and Lancaster, 2000).
WHAT ABOUT THE FUTURE
OF NURSING?
 Growth of the nursing profession be prompted by
technologic advances in client care, which allow an
increased number of health problems to be detected early
and managed quickly.
 Health maintenance organizations, ambulatory surgicenters,
and church health centers are only a few of the places where
the public will receive their health care.
 Nursing can be a vital component of the "alternative setting"
movement that is on the forefront of health care reform.
WHAT ABOUT THE FUTURE
OF NURSING?
 Professional nursing services should be viewed as a
cost-effective way to provide disease prevention
and health-promotion activities in multiple areas of
the community, including industry, business, and
commerce.
 Wellness and disease prevention, historically
fundamental to the nursing profession, are now
becoming more meaningful and revitalized concepts
within the larger health care system.
WHAT ABOUT THE FUTURE
OF NURSING?
 The nursing profession historically has requested
a chance to prove its worth in producing costeffective, quality health care.
 Encouragement for nurses who are interested in
developing new roles is provided by examples of
nurses who envisioned and created new roles.
 Traditional, nontraditional, and advanced practice
nursing roles offer many exciting opportunities for
professional growth and satisfaction.