Nursing

1
Nursing
2

• In the past, nursing was viewed primarily in
  terms of direct patient care roles, mainly in
  hospitals
• Now - nearly 50 of nurses work in settings
  outside of hospitals (hospice care, home care,
  and nursing home care)
• Nurses develop their own group practices
• Nurses can build careers in the "business" side
  of nursing

3

• In the first edition of the Random House
  Dictionary (1966) the verb "to nurse" means to
  foster or cherish (?????????, ??????), to treat
  or handle with adroit care to bring up, train,
  or nurture to handle carefully or fondly to
  preserve. "Nurse" suggests attendance and
  service its antonym is neglect (???????).

4

• In Random House Collegiate Dictionary (1995),
  the first meaning of "nurse" is "a person
  formally educated in the care of the sick or
  infirm, especially a registered nurse"

5

• Legal definitions in nurse practice acts exist to
  protect the public and to protect the title.
• North Carolina was the first state to pass a
  licensing law (1903), and it was intended to
  protect the title, not to define the practice.
  The early statutes were certification laws,
  permissive rather than mandatory, and in general
  permitted anyone to perform legally the functions
  of a nurse, even for compensation, but only those
  who were licensed could use the RN title (Hadley,
  1989).

6

• Inclusion ... of the diagnostic function would
  authorize the nursing practitioner to make
  nursing diagnoses, not medical diagnoses. Whereas
  the diagnostic function as an intellectual
  process is central to the practice of any number
  of professions, including medicine and nursing,
  the focus of this function varies among these
  professions. For example, the focus in medicine
  is the nature and degree of pathology or deviaion
  from normality within nursing the focus is the
  individal's response to an actual or potential
  health problem and the nursing needs arising from
  such responses. Driscoll, 1976, p. 61 italics
  in original

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• "Nursing is the diagnosis and treatment of human
  responses to actual or potential health problems"
  (ANA, 1980)

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Staff Nurses Working in Hospitals

• At present, 59.6 of all employed nurses work in
  hospitals, and this number is projected to
  decrease to 52.8 by 2008
• In 1992, 84 of all registered nurses 30 years
  old or younger worked in hospitals, whereas only
  50 of nurses over 50 worked in hospitals.
• Most hospital nurses work in general medical and
  surgical units (40), but many work in acute care
  units such as critical care (18), operating
  rooms (7), and emergency rooms (8).

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The current demographics of RNs in the United
States in 1996.

• 2,558,874 people were licensed as RNs
• 82.7 were currently employed as RNs, and 60
  were working in hospitals
• The number of male RNs in 1996 was 5.4, which is
  a substantial increase from the 3 in 1980.
  Moreover, in 1996 nearly 12 of newly licensed
  RNs were men

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• About 10 of RNs come from racial or ethnic
  minorities
• 4.2 were African American
• 3.4 were Asian or Pacific Islander
• 1.6 were Hispanic
• and 0.5 were Native American.
• Again, when we look at the numbers of newly
  licensed RNs, we see steady change 5.5 were
  African American 6 were Asian or Pacific
  Islander 3 were Hispanic and 0.8 were Native
  American (NCSBN, 2000).

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• The average salary of a full-time RN in 1996 was
  42,000, which was an 11 increase over RN
  salaries in 1992
• Most employed RNs (58.4) had less than a
  baccalaureate degree 31.8 had a baccalaureate
  as their highest degree 9.1 had a masters as
  their highest degree and 0.6 were doctorally
  prepared.

12

• For nurses working in large hospital centers,
  increased specialization is common.
• In small rural hospitals, however, nurses are
  often called upon to be generalists, to be
  competent in caring for an older person with a
  cardiac condition as well as in emergency room
  treatment of an injured child.

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Within hospitals, nurses are caring for sicker
patients for shorter periods of time with ever
more sophisticated technology. Hospital staff
nurses require expert clinical and communication
skills to

• 1. Monitor and care for their patients
• 2. Counsel their patients' families
• 3. Interface and collaborate with other health
  care providers as part of a health care team
• 4. Keep up with rapid technological advances
• 5. Effectively use information systems to manage
  patient care
• 6. Participate in clinical research.

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Today's hospital nurses have to supervise and
delegate nursing duties to unlicensed assistive
personnel

• 1. Staff nurses need to know exactly what is
  allowed under their state practice acts for
  example, they should not delegate nursing
  assessments and judgment.
• 2. Staff nurses need to be the ones who train the
  unlicensed assistive personnel to perform the
  tasks or to monitor the patients so that they
  know exactly what the assistant can do.
• 3. Staff nurses need to develop protocols for the
  unlicensed assistive personnel to work under.
• 4. Staff nurses need to supervise the care given
  (King, 1999).

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Causes of staff shortage

• overwork
• work-related stress
• mandatory overtime
• drops in student enrollment
• cost cutting by hospitals
• increased job opportunities for women
• health risks at the workplace (risk of infection,
  sensitivity to latex)
• workplace violence

16

• Hospitals and nursing homes account for 64 of
  workplace violence, and health care workers have
  a 16 times greater risk of sustaining a fatal
  injury on the job than the general population has
  (ANA, 2000c Smith-Pittman McKoy, 1999).