Chapter 14

Registered nurses assign routine care and the care of stable patients to assistive personnel. This allows RNs to do the following:

1. Plan care. 2. Coordinate all the activities of care, including care trom interdisciplinary health care team members. 3. Provide care that requires more specialize knowledge and judgment. 4. Teach patients, families, and other members of the health care team. 5. Act as a patient advocate.

Which of the following are methods of delivering nursing care in acute care agencies?

A. Primary care B. Case method C. Team method D. Functional method

What are the differences in the different types of RN programs

Amount of time in school 2 years, 3 years, & 4 years

LPNs must be under the general supervision of

An RN, physician, podiatrist, or dentist as determined by the State Nurse Practice Act

Difference between NA & a UAP

• Nursing assistants take a test and their score must meet the Federal Omnibus Budget Reconciliation Act.

The IOM defines patient-centered care as?

"providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions"

Supervisor

BSN preferred; deals with specific problems with nursing personnel; makes rounds to all nursing units on assigned shift to ensure patients' needs are met according to organization's procedures; clinical resource for collaborative decision making

Chief nursing officer (CNO):

Highest-ranking administrative nurse in a health care organization; MSN, Masters in business or health-related field required; doctorate may be required in larger organizations; organizes and coordinates the nursing department responsible for excellence in nursing that is consistent with the mission, vision, and values of the organization.

Which of the following statements differentiates the role of the LPN/LVN from the professional nurse?

The LPN/LVN has a collaborative role in health teaching for patients.

Which of the following statements best describes team nursing as a method of delivering nursing care?

The method is based on the level of staff skill and patient need

According to the Virginia henderson, how do you define nursing?

The unique function of a nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or recovery that he would preform if he had the necessary strength, will, or knowledge

Practice-focused: doctoral nursing education

These evolving programs graduate nurses who are considered nursing's expert clinicians (nurses working in health care agencies) and most effective practice leaders who will promote and facilitate changes in practice that enhance quality care

What is the primary goal of healthcare?

To restore optimal physical, emotional, and spiritual health patients.

medical emergency technicians (EMTs).

• 150-hour course in basic life support skills. • certified after passing a national test. • 18-to 24-month course, preparing them to provide more advanced life support skills. • On the way to the hospital, they monitor blood pressure, pulse, respirations, and level of conscious- ness.

Associate degree nursing progranm

• 2-year educational program (often completed over 3 years) • can be found in community colleges, junior colleges, and technical schools. • The ADN program includes general education courses (e.g., courses the biologic, behavioral, and social sciences), nursing courses, and clinical practice. • On graduation, the graduate receives an associate degree in nursing and is eligible to take the NCLEX-RN examination to become a registered nurse.

Diploma program

• 3-year educational program conducted by a hospital-based school of nursing. • The diploma program comprises the same general education courses as 2-year programs, with nursing courses and clinical practice. Diploma programs traditionally have emphasized clinical experience. • Today, many diploma nursing schools have a University educational partner. • Likely to be dual enrolled

Bachelor's nursing program

• 4-year nursing program that can be found in public and private colleges and universities. • The bachelor's program emphasizes course work in the liberal arts, sciences, and nursing theory, including public health. Clinical practice is included. • On graduation, the nurse receives a BSN and is eligible to take the NCLEX-RN® examination to become a registered nurse.

Standards of care

• Are used instead of care plans in some acute care agencies. • These standards include the priority nursing diagnosis for each patient, with appropriate assessments, nursing interventions, and expected outcomes • standards provide minimum guidelines for a consistent approach to delivering patient care

Role of Licensed Practical Nurses/Licensed Vocational Nurses

• Cares for patients within the scope of the state's NPA while upholding clinical standards • provides care in basic and complex patient situations under the supervision of an RN, physician, podiatrist, or dentist, as determined by the state Nurse Practice Act • Primary responsibility in the care of vulnerable populations with chronic, stable conditions • Provides safe patient care, serves as a patient advocate, teaches patients, and communicates effectively.

clerk receptionist

• Clerk receptionists are trained on the job or in programs of several months in technical schools or community colleges. • Clerks prepare, compile, and maintain patient electronic records on a nursing unit. • Duties include transcribing physicians' orders; scheduling lab tests, x-ray procedures, and surgeries; scheduling other appointments for services; routing charts on patient transfers or discharges; compiling the patient census; answering the telephone; maintaining established inventories of supplies; distributing mail to patients; and generally ensuring that the unit functions smoothly.

functional method

• During World War II, was a popular method • Task-oriented. • The tasks that have to be done for patients are divided among the staff • Ex: one person might measure all vital signs, another might do all treatments, and still another might make all the beds. • This method's emphasis on efficiency and division of labor is based on the assembly-line-production concept found in industry

Director

• Entry level of executive role; MSN or Masters degree in business or health-related field required; coordinates the development and implementation of strategies to initiate new programs and improve current services of several departments.

case management method

• Focuses on delivering cost-effective, quality care to patients with complex needs. • focuses on achieving patient outcomes with a specified timeframe • clinical pathways or critical pathways are used as a tool

What is the major difference between the role of the practical/vocational nurse & the registered nurse?

• LPNs cant work independently

Research-focused: doctoral nursing education

• Lead to an academic doctorate (PhD) or professional doctorate (DNS or DNSc). • Most DNS or DNSc programs have transitioned to PhD programs to better meet the needs of the nursing industry. • Graduates are prepared as a scientist and do rigorous investigation into, for example, clinical or educational issues, to help build the science of nursing

Nurse manager

• Middle management position; MSN preferred; leader of a specific clinical department • responsible for personnel, quality of care, safety, and cost of running department.

total patient care or case method of

• One-to-one relationship with patients • one nurse is assigned to one or two patients and is responsible for planning, organizing, and carrying out the care for these patients. Today, total care nursing occurs in intensive care or special care units • Nursing instructors frequently use the total patient care method when assigning beginning students to the acute care clinical area.

nurse manager

• RN who has graduated from a baccalaureate nursing program (4-year) and is enrolled in a Master of Science this in Nursing (MSN) program. • this nurse is responsible for all the care given to patients and the overall functioning of the nursing unit, including budgetary responsibilities.

Primary care method

• RNs individualize patient care and except responsibility and accountability for total patient care generally eliminating the need to delegate to other licensed staff persons • staffing for this method requires a nursing staff composed entirely of RNs • The major characteristic of this method is the responsibility and accountability of the primary nurse

emergency nurse practitioner (ENP-BC).

• RNs participate regularly in continuing education courses at the hospital and at seminars to be certified as an ENP

unit managers

• Some large health care organizations have unit managers to supervise and coordinate management functions for patient units. • A college background and supervisory experience are desirable for this position. This job is combined with on-the-job training for specific duties. • Responsibilities include budgeting, supervision, assignment, and evaluation of all staff on the unit; coordination with all members of the interdisciplinary health care team; responsibility for patient and unit outcomes, including satisfaction and quality ratings; and clarification of hospital compliance with Medicare requirements. If a health care organization does not have unit managers, the clerk receptionist and the nurse manager assume these duties.

Nurse executive/Certified Nurse Educator (CNE).

• The American Association of Colleges of Nursing (AACN) offers several types of certifications including a nurse executive certification. In addition, • National League for Nursing (NLN) offers a certification for educators called the CNE

team method

• The patients on the unit are divided into small groups. Small teams are assigned to care for the patients in each group. • Assignments are based on the needs of each patient in the skills of the team members. • The team leader Is the RN

Major characteristic of the primary care method

• The responsibility and accountability of the primary nurse • The primary nurse is assigned to a patient on admission, develops the nursing diagnosis after the admission interview, develops a plan of care, and is responsible for the care of that patient 24 hours a day until he or she is discharged.

postanesthesia care unit (PACU)

• They monitor the patient's vital signs, level of consciousness, movement, and any special equipment required by patients after surgery. • Registered nurse

Nurse practitioner (NP).

• This registered nurse has a minimum of an MSN and certification by a national body. • areas of specialization for nurse practitioners, such as acute adult, gerotological, pediatric, and psychiatric/ mental health. • Some provide primary care in the community in physicians' clinics or in their own offices. Others provide acute care services hospitals and long-term care settings. • They order and interpret lab and diagnostic tests, develop diagnoses, and prescribe treatments, including drugs, for acute and chronic diseases. Their care differs from medical care because of their interest in and awareness of psychosocial aspects of illness.

Clinical nurse specialist (CNS).

• This registered nurse has a minimum of an MSN in a specialty area • serves as a mentor, role model, and for staff by setting standards for resource person nursing care. • provides direct care in challenging patient situations and shares knowledge, experiences, and resources with staff. • can serve as an educator, consultant, researcher, and administrator.

When do RNs fuction in an interdependent role?

• When they carry out the legal orders of another health professional • When carrying out decisions about patient care that are made jointly by members of the interprofessional healthcare team

nurse practitioners (NP)

• advanced practice registered nurse. • These nurses have a minimum of a Master of Science degree in Nursing (MSN) obtained in a 1- to 2-year program of study at the graduate level.

With an additional degree, RNs can pursue expanded roles, called

• advanced practice. • These nurses acquire specialized nursing knowledge and skills, and demonstrate a greater depth and breadth of nursing knowledge and an increased complexity of skills and interventions.

How is the primary goal of healthcare accomplished?

• by promoting health, preventing further illness, and restoring health

physician assistants (PA).

• has a minimum of a baccalaureate degree and health care experience. • nationally certified and state licensed as a health care provider.

The term advanced practice registered nurse(APRN) identifies the advanced practice of what specific roles?

• nurse practitioner, a nurse anesthetist, and a certified nurse-midwife. • Each of these nurses has a minimum of a Master's of Science degree in Nursing (MSN), obtained in a 1- to 2-year program of study. • Additional studies can include the Doctor of Nursing Practice (DNP), preparing the APRN for the highest level of clinical practice.

Unlicensed assistive personnel (UAP)

• personnel trained by health care organizations to function in an assistive role to RNs and LPNs/LVNs. • Some health care organizations require applicants for UAP positions to be registered as NAs. • These workers learn selected skills, sometimes by the autotutorial method or module method, combined with some clinical teaching. • Actual skills learned depend which skills are needed in specific patient care units. UAPs are also known by the terms patient care technician, patient care associate, care pair, nurse extender, and multiskilled worker.

Certified nurse-midwife (CNM).

• provides holistic maternal/family-centered health care in the area of prenatal low-risk pregnancy, childbirth, the postpartum period, care of the newborn, and family planning at home, in hospitals, and birthing centers and in the gynecologic care of women. They diagnose and treat illness, including prescribing drugs.

Skill mix

• refers to the different levels of educational preparation of members used to staff the nursing team • Some hospitals are converting to all-RN staffs, and in some regions all baccalaureate-prepared RNs. Some hospitals use LPNs/LVNs and direct care workers to deliver patient care.

Registered nurses (RNs)

• the largest group of health care workers in the United States. • Approximately 2.9 million RNs were active in the workforce in 2012 • 2 year, 3 year, & 4 year programs are avalible • Must pass NCLEX-RN to hold the title

Nursing assistants (NAs)

• trained for their positions by combining federally mandated classroom instruction with close supervision by RNs while in the clinical area. • These programs combine classroom or autotutorial instruction with clinical practice. • At the completion of the course, testing for competence occurs to meet federal Omnibus Budget Reconciliation Act (OBRA) requirements. When test results are satisfactory, the names of NAs are placed in a registry • NAs function under the direction of RNs or LPNs/LVNs. • NAs who work in hospitals, specialty hospitals, sub-acute units and long-term care settings assist in providing personal and comfort needs for stable patients. They are assigned routine tasks, sometimes in volving housekeeping chores.

Clinical pathways

• used as a tool by all health care workers involved with the patient's care to identify incidents that must occur at specific times to achieve patient outcomes within an appropriate length of stay. • These pathways provide a blueprint for care that includes a time frame of significant events that are expected to occur each day a patient with a specific diagnosis is in the hospital

Certified registered nurse anesthetist (CRNA).

• work in every setting where anesthesia is given: operating rooms, clinics, and outpatient surgical centers. • They prepare patients for anesthesia; induce and maintain local, regional, and general anesthesia; provide postanesthesia care, including pain management; and provide emergency resuscitation.