Lecture 7 objective
CNL
Clinical experts who are involved in the care of a distinct group of patients and who may, on occasion, actively provide direct patient care themselves; Coordinate the direct care activities of other nursing staff and health care professionals, gather and evaluate patient outcomes, and have the authority to change plans of care when necessary
What document reminds practitioners and the public that they serve of specific responsibilities and obligations accepted by the profession's practitioners?
Code of Ethics for Nurses
Sallie Thompkins
Commissioned a "Captain of the Calvary, unassigned"; Established a hospital in Richmond; Only woman in the Confederacy to hold a military raking
Who founded the ANA?
Isabel Hampton
What was the Position Statement on Nursing Roles: Scope and Preparations?
It affirmed the nursing baccalaureate degree as the minimum education level for professional nursing practice and associate program as the entry level for technical nursing
What board consists of nurses, faculty members, health care agencies, and all types of nursing and nonnursing programs who support nursing?
National League for Nursing
Who assumes the responsibility for all NLN national program accreditation activity?
National League for Nursing Accreditation Commission (NLNAC)
Florence Nightingale
Nursing's most notable early figure; Wanted to be a nurse but parents did not want her to; Cleaned and took care of patients in a British war hospital; Gathered statistics on morbidity and mortality of soldiers; Introduced sanitization as an important aspect to hospitals; Founded the first training school for nurses
What document outlines the expectations of the professional role within which all registered nurses must practice and delineates the standards of care and associated competencies for professional nursing?
Nursing: Scope and Standards of Practice
office based nursing
Supervise other office workers, such as practical nurses, nurse aides, scheduling clerks, and record clerks
Community Health nursing
Work in ambulatory clinics, health departments, hospice, and a variety of other community-based settings including homes where they provide nursing care to home bound patients
What are external degree programs?
different from traditional basic nursing education in that students attend no classes; Learning is independent and is assessed through highly standardized and validated competency-based outcomes assessments, leading to the description, "virtual university"
Certified nurses may have greater _______ potential than those without certifications.
earning
What degree program does not require students to attend classes and the learning is highly independent?
external degree programs
What are articulated programs?
facilitate opportunities for nurses to move up the educational ladder; Students spend their first year preparing to be an LPN and the second year preparing to be an AND. They can then decide to stop or move on to a bachelor's degree and master's degree.
Who is credited with founding modern nursing and creating the first educational system for nurses?
florence Nightingale
What is a certification?
goes beyond licensure by validating a high level of knowledge and proficiency in a particular area; It is voluntarily pursued by individual nurses; Awarded by a certifying body as validation of specific qualifications demonstrated by an RN in a defined area of practice;
Why was the Henry Street Settlement created?
in response to the health conditions related to the influx of immigrants who came seeking work in the factories and found themselves poverty-stricken and over crowded
Why did accreditation become such a need/want in the nursing world?
it grew out of concerns expressed in reports and by leaders of the profession about the lack of quality and standards for nursing education
What two things help nurses earn credentials?
licensure and certification
What is an occupational group with a set of attitudes or behaviors or both; a calling vocation, or form of employment that provides a needed service to society and possesses characteristics of expertise, autonomy, long academic preparations, commitment, and responsibility?
profession
What is collegiality?
the promotion of a supportive and healthy work environment, cooperation, and recognition of interdependence among members of the nursing profession
How were the standards of nursing regulated before the ICN was created?
they weren't--each school had their own standards and requirements
What does it mean to "continue education" in the nursing field?
used to describe non-degree-seeking ways in which nurses maintain expertise during their professional careers
nurse entrepreneurs
Identifies a need and creates a service to meet the identified need; Enjoy autonomy
What is a diploma program?
the earliest form of nursing education in the United States
Explain differences between licensure and certification
+ Licensure - state regulation of the practice of nursing + Certification - beyond licensure Benefits of being a certified nurse - Greater earning potential - Wider employment opportunities - Broader scope of practice - Validation of SKA (skills, knowledge, abilities) - Possibly public recognition - Sense of personal satisfaction - Prestige that sets certified nurses apart from noncertified nurses Professional but not legal status
Describe traditional and alternative ways of becoming a registered nurse
++Diploma Programs: hospital-based nursing education. Mid 1960s - dramatic decline caused by: - Growth of ADN and BSN programs - Hospitals unable to continue to finance - Difficulty for diploma programs to attract qualified faculty - Increasing complexity of health - need more nurses with better academic preparation. (1800-early 1900s - Diploma programs provided formal education and jobs to women. Modified apprenticeship model Demanding schedule Duration: 3 years (now ~24 months) Not originally recognized by colleges, universities Current diplomas programs establish agreements with colleges and universities for college credits "Hands-on" skill and service orientation - hallmark of hospital-based diploma education) ++ Baccalaureate Programs: BSN needed - To qualify nursing as a recognized profession. To provide leadership in administration, teaching, and public health - 1909: First BSN program in University of Minnesota Slow growth because: - Theoretical, scientific orientation Different from "hands-on" skill and service orientation that was the hallmark of hospital-based diploma education. (1980: National Commission on Nursing Problem with advancement of nursing was conflict about nursing's educational preparation. Recommendation: -Establish a clear system of nursing education including pathways for educational mobility and development of additional graduate education programs 1982: National League for Nursing Position Statement on Nursing Roles: Scope and Preparation BSN as minimum educational for professional nursing practice and ADN or diploma as the preparation for technical nursing practice. 1996: AACN Position Statement. The Baccalaureate Degree in Nursing as the Minimal Preparation for Professional Practice It supports programs for ADN to BSN.) ++ Associate Degree Programs: 1952 as result of post-WWII nursing shortage Most common type of basic nursing education program in US and graduate most RN candidates Popular because: - Accessibility of community colleges - Low tuition costs - Part-time and evening study opportunities - Shorter duration of programs - Graduates' eligibility to take the RN licensure exam ALTERNATIVE WAYS +++ External Degree Programs: No classes - "virtual university" Excelsior College Does not offer clinical experiences to those seeking a basic nursing education Encouraged to seek basic education that includes clinical instruction. +++ Articulated Programs: Articulation = mobility between programs in order to facilitate opportunities to move up the educational ladder Multiple-entry and multiple exit programs LPN/LVN/AND/BSN/MSN
Differentiate between licensed practical/vocational nurses and registered nurses
- Licensed practical/vocational nurse (LPN/LVN): short 9-12 month program, most restricted form of practice, have to work under supervision of an RN or physician, limited work in critical care areas, technical skills. - Registered nurses (RN): 2-3 year program.
Discuss recommendations of the Institute of Medicine (IOM) and major nursing organizations regarding transforming nursing education
- Nurses must practice to the fullest extent of their education and training. - Nurses should attain higher education levels through a system of improved education with seamless progression across degrees. - As health care in the United States is being transformed, nurses should be full partners with other health care professionals in this effort. - Improved data collection and information infrastructure can result in more effective workforce planning and policy development.
Trace the development of basic and graduate education in nursing
--- Sentimental Women Need Not Apply: A History of the American Nurse Documentary portraying nursing shaping and shaped by sociocultural and historical contexts Nursing education exploitative - did not serve nursing or society interests --- 2009: Patricia Benner and Carnegie Foundation for Advancement of Teaching - Educating Nurses: A Call for Radical Transformation BSN as entry level MSN within 10 years Nurses are undereducated 2010 IOM Published The Future of Nursing: Leading Change, Advancing Health - Nurses must practice to the fullest extent of their education and training. - Nurses should attain higher education levels through a system of improved education with seamless progression across degrees. - As health care in the United States is being transformed, nurses should be full partners with other health care professionals in this effort. - Improved data collection and information infrastructure can result in more effective workforce planning and policy development Call for increased federal support for the preparation of nurses at the BSN level and higher Policy changes needed to address the growing need for nursing faculty and in the preparation of advanced practice nurses (APNs) to serve in primary care Tri-Council of Nursing (many associations working together) Policy Statement calling for increased education to strengthen nursing workforce Title VIII Nursing Workforce Development Programs part of Public Health Service Act overseen by Health Resources and Services Administration (HRSA) Advanced Education Nursing - grants to schools Workforce Diversity Grants - opportunities for students from disadvantaged backgrounds
What are the different types of nursing educational preparation opportunities
1. Diploma nurse 2. LPN 3. ADN 4. BSN 5. MSN 6. DPN
What two documents shape professionalism for nursing?
1. Nursing: Scope and Standards of practice 2. Code of Ethics for Nurses
What kinds of doctoral programs are available to nurses?
1. Research-based degree (PhD) 2. Practice-focused degree (DNP)
List Quality and Safety Education in nursing (QSEN) competencies
1. Students are not being educated to care for the increasingly diverse, elderly, and chronically ill patient populations.(not being educated to care for the increasingly diverse, elderly, and chronically ill) 2. Students are not being prepared to work in teams, but once in practice, they are usually expected to work in interdisciplinary teams. (are not being prepared to work in teams) 3. Students are not consistently educated in how to find, evaluate, and use the rapidly expanding scientific evidence on which practice should be based. ( not educated on how to find, evaluate, and use the rapidly expanding scientific evidence) 4. There is little opportunity to learn how to identify, analyze, and eliminate the root causes of errors and other quality problems in health care delivery systems. (little opportunity to learn how to identify, analyze, and eliminate the root causes of errors) 5. Students often are not provided basic informatics training to enable them to access information and use computerized order entry systems. (not provided basic informatics training)
What are some barriers to professionalism in nursing?
1. variability in educational preparation 2. Gender 3. historical issues 4. external and internal conflicts
How long are most diploma programs?
24 months
school nursing
A specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students
Differentiate between associate degree and bachelor's degree education
ADN: 1952 as result of post-WWII nursing shortage - Most common type of basic nursing education program in US and graduate most RN candidates Popular because: - Accessibility of community colleges - Low tuition costs - Part-time and evening study opportunities - Shorter duration of programs - Graduates' eligibility to take the RN licensure exam BSN: 4 years = general education + nursing courses - Faculty qualifications Prepared - for NCLEX - to move into graduate programs and advanced practice certification programs
Who wrote the Nursing's social policy statement?
ANA
Define accreditation and analyze its influence on the quality and effectiveness of nursing education programs
Accreditation: refers to a voluntary review process of educational programs by the US Department of Education - Protect the quality of education, safety, and the profession itself. Two agencies: - Accreditation Commission for Education in Nursing (ACEN) - Commission on Collegiate Nursing Education (CCNE)
CRNA
Administer anesthetics; Collaborate with a physician or work independently
Dorthea L. Dix
Appointed superintendent of Women Nurses of the Union Army; Created a month-long training program for nurses
CNS
Are experts in a particular field of clinical practice such as mental health, gerontology, cardiac care, cancer care, community health, or neonatal health, and they perform health assessments, make diagnoses, deliver treatment, and develop quality control methods
Which program has the purpose of facilitating opportunities for nurses to move up the educational ladder?
Articulated program
Which APN is an expert in a particular field of clinical practice?
Clinical Nurse Specialist (CNS)
What program is the most costly of the basic nursing programs in terms of time and money?
BSN
Discuss program options for registered nurses and students with non-nursing bachelors degrees
Baccalaureate Programs for Registered Nurses: - - RN to BSN - Programs are offered online Programs for Second-Degree Students - Second-Degree accelerated (or fast track) for students with bachelor's degrees in other fields - can recieve another baccalaureate degree or masters degree. If masters, it is called generic master's degree (usually take 3 years to complete) Online and Distance Learning Programs (DL): students take courses online. Distance learning (DL) is when courses are online. Originally created for rural areas, but now used by many people Some are fraudulent
What are programs for second-degree students?
Baccalaureate programs offer these students an accelerated or fast tract sequence, awarding either a second baccalaureate degree or, in some cases, master's degree in nursing
Clara Barton
Began an independent campaign to provide relief for the soldiers; Set up a makeshift field hospital and cared for the wounded and dying; Revolutionized how to sort and care for soldiers; Received the title "Angel of the Battlefield"; Founded the American Red Cross
Mary Ann Bickerdyke
Brought order out of chaos and created clean conditions in a western from hospital camp; Not a formally trained nurse
NP
Can perform physical examinations, take medical histories, diagnose and treat common acute and chronic illnesses and injuries, order and interpret laboratory tests and X-ray films, and counsel and educate clients
What is a non-degree-seeking way in which nurses maintain expertise during their professional careers?
Continuing their education
hospice and palliative care nursing.
Dedicated to improving the experience of seriously ill and dying patients and their families
What were the four BSN recommendations made by the ANA.
Education for all those who are licensed to practice nursing should take place in institutions of higher learning. Minimum preparation for beginning professional nursing practice should be the baccalaureate degree in nursing. Minimum preparation for beginning technical nursing practice should be the associate degree in nursing. Education for assistants in the health service occupations should consist of short, intensive preservice programs in vocational education institutions rather than on-the-job training programs
What are some qualities of a profession?
Education takes place in a college or university; Education is prolonged; Work involves mental creativity; Decision making is based largely on science or theoretical constructs (evidence-based practice); Values, beliefs, and ethics are integral part of preparation; Commitment and personal identification are strong; Workers are autonomous; People are unlikely to change professions; Commitment transcends material reward; Accountability rests with individual
Mary Eliza Mahoney
First African American professionally educated nurse
travel nurse
Fixed-term, temporary nurses who usually work at the same hospital for 13 weeks and are scheduled at least 2 months in advance.
Discuss the influences of early nursing studies nursing education
Florence Nightingale Belief that schools should be financially and administratively separate from hospitals - not the case in beginning in U.S. 6 Principles about funding, curriculum, selection related to nursing schools 1872: Establishment of 1st US training schools - "famous trio" 1900 - 432 hospital-owned and hospital-operated nursing programs - length ranged from 6mo- 2 yr Diploma programs - hospital based where primary concern was staffing the hospital, not high-quality education 1860: Nightingale opened a school of nursing at St. Thomas' Hospital in London and established the following principles 1. The nurse should be trained in an educational institution supported by public funds and associated with a medical school. 2. The nursing school should be affiliated with a teaching hospital but also should be independent of it. 3. The curriculum should include both theory and practical experience. 4. Professional nurses should be in charge of administration and instruction and should be paid for their instruction. 5. Students should be carefully selected and should reside in "nurses' houses" that form discipline and character. (Nightingale envisioned nursing as a profession only for women.) 6. Students should be required to attend lectures, take quizzes, write papers, and keep diaries. Student records should be maintained (Notter and Spalding, 1976). POOR QUALITY OF EARLY TRAINING 1899: American Society of Superintendents of Training Schools chose Isabel Hampton Robb to investigate ways to prepare nurses for leadership Teachers College chosen as location for leadership training Mary Adelaide Nutting - 1st nursing professor in History and pioneer in nursing education School at Teachers College became known as "Mother House" of collegiate education - initiated movement towards undergrad/graduate degrees for nurses "The Educational Status of Nursing" study on students' living conditions, nursing education curricula, and teaching methods. EARLY STUDIES ON NURSING EDUCATION 1923: The Study of Nursing and Nursing Education in the United States (Goldmark Report) focused on: - Clinical learning experiences of students, - Hospital control of the schools, - Desirability of establishing university schools of nursing, - Lack of funds specifically for nursing education - Lack of prepared teachers 1924: Yale University opened their school of nursing as a separate university with its own budget and dean 1934: Nursing Schools Today and Tomorrow - description of schools and their curriculum - Recommendations for professional collegiate education 1937: A Curriculum Guide for Schools of Nursing - outlined 3-year curriculum influencing diploma programs EARLY STUDIES=SIMILAR FINDINGS - Nursing education programs should be established within the system of higher education. - Nurses should be highly educated. - Students should not be used to staff hospitals. - Standards should be established for nursing practice. - All students should meet certain minimum qualifications on graduation.
case management nursing
Growing field in nursing developed as a way of managing health care costs and patient length of stay; Involves systematic collaboration with patients, their significant others, and their health care providers to coordinate high-quality health care services in a cost effective manner with positive patient outcomes
Chicago's World Fair
Hampton presented lack of uniformity across nursing schools; Paper by Florence Nightingale was presented; Set the stage for formalized nurse training
nursing informatics
Help bridge the gap between information technology and nursing practice; Combines the nursing science with information management science and computer science to manage information nurses need and to make that information accessible
In articulated programs, students spend their first year preparing to be a ____, and then preparing to be a _____ their second year.
LPN, AND
Who founded the Henry Street Settlement?
Lillian Wald
Who came to Teachers College in 1907 and was the first nursing professor ever?
Mary Adelaide Nutting
military nursing
Practice in peacetime and wartime settings in the army, navy, and air force.
What are the 8 core competencies of AND educations?
Professional behaviors Communication Assessment Clinical decision making Caring interventions Teaching and learning Collaboration Managing care
Certified Nurse Midwife (CNM)
Provide well-woman care and attend to or assist in child birth in various settings, including hospitals, birthing centers, private practice, and home birthing services
occupational and environmental health nursing
Provides basic health care services, health education, screenings, and emergency treatment to company employees at the workplace
Which nurses were impactful during the civil war?
Sallie Thompkins, Clara Barton, Mary Ann Bickerdyke, Dorthea L. Dix,
What is the NCLEX-RN?
The exam that graduates of basic nursing programs must take to become licensed to practice as a registered nurse
What is the NCLEX-PN?
The examination that graduates of practical nursing programs must take to become licensed practical nurses or licensed vocational nurses
Why has there been a decline in diploma programs?
The growth of the associate degree and the baccalaureate degree programs in nursing which moved the education of nurses into the mainstream of higher education; The inability of hospitals to continue to finance nursing education; Accreditation standards that have made it difficult for diploma programs to attract qualified faculty; The increasing complexity of health care which has required nurses to have greater academic preparation
What gender issues arise in professional nursing?
The number of males is increasing, still female dominate profession
What are the principles for nursing schools?
The nurse should be trained in an educational institution supported by public funds and associated with a medical school; The nursing school should be affiliated with a teaching hospital but also independent of it; The curriculum should include both theory and practical experience; Professional nurses should be in charge of administration and instruction and should be paid for their instruction; Students should be carefully selected and should reside in "nurses houses" that form discipline and character; Students should be required to attend lectures, take quizzes, write papers, and keep diaries. Student records should be maintained
APN
The umbrella term applied to an RN who has met advanced educational and clinical practice requirements beyond the 2 to 4 years of basic nursing education demanded of all RNs; The four categories include: nurse practitioner, clinical nurse specialist, certified nurse midwife, and certified registered nurse anesthetist.
Hospital-based nursing.
They provide direct patient care, serve as educators, managers, and administrators who teach or supervise others and establish the direction of nursing hospital wide.
What are some qualities of an occupation?
Training may occur on the job; Length of training varies; Work is largely manual; Decision making is guided largely by experience or trial and error; Values, beliefs, and ethics are not prominent features of preparation; Commitment and personal identification vary; Workers are supervised; People often change jobs; Material rewards is main motivation; Accountability rests primarily with employer
Evidence based practice
basing one's practice and decisions about patient care on research findings rather than tradition
What does accreditation do for a nurse's education?
makes sure that the educational program is accountable for offering quality education
Nurse educators must hold a minimum of what degree?
masters degree
Before the influence of Florence Nightingale, who was the role of the caretaker left to?
monks and prostitutes
What is a clinical ladder?
multi-step process that begins with entry-level staff nurse positions
Are certifications required by law?
no--they are voluntary
What branch of nursing enjoys the use of autonomy?
nurse entrepreneurs
What external conflicts arise in professional nursing?
nurses must strive for collaboration, not competition, with physicians and other health care personnel with whom they work
What historical issues arise in professional nursing?
nurses unquestioning obedience in the past to physicians
Discuss baccalaureate essentials and the role they have in nursing education
nurses who graduate from BSN programs are prepared "to practice within complex health care systems and assume the [following] roles: - provider of care -designer/manager/coordinator of care - and member of a profession AACN also stress - concept of patient-centered care - interprofessional teams - evidence-based practice - quality improvement - patient safety - informatics - clinical reasoning/critical thinking - genetics and genomics - cultural sensitivity - professionalism - practice across the life span in an ever-changing and complex health care environment role they have in nursing education - prepared to take the NCLEX-RN - prepared to move on to graduate programs if desired
What are clinical nurse specialists?
nurses with a masters' degree in specialized areas of nursing such as oncology
What occupies, or engages one's time; business; employment?
occupation
Why did ADN programs begin?
post-world war II nursing shortage
What were the shorter ADN programs designed for?
prepare nurse technicians who would function under the supervision of professional nurses
What is a licensure?
refers to state regulation of the practice of nursing; Licensure is required of individuals at the entry point to practice and must be renewed periodically; It is a legal designation that assures public safety by assessing basic and continuing competence
What internal conflicts arise in professional nursing?
rivalry among diploma-educated, associate degree-educated, and baccalaureate-educated nurses saps the vitality of the profession
What does the NLN support most?
standardization of nursing
What stressed the concepts of patient-centered car, inter-professional teams, evidence-based practice, quality improvement, patient safety, and much more?
the AACN document by the NLN
Who wrote "Nursing: Scope and Standards of Practice"?
the ANA