So What Do Nurses Do, Anyway?

1. So What Do Nurses Do, Anyway? Sean Clarke, N., PhD, FAAN Professor, Susan E. French Chair in Nursing Research and Director, McGill Nursing Collaborative Ingram School of Nursing, Faculty of Medicine McGill University

2. My Purposes Tonight

3. What I will try to avoid

4. … or a slick sales presentation …

5. … or an extended discussion of media images of nurses …

6. A few caveats • A presentation for you, not a presentation for nurses (I don’t necessarily speak for all 300K members of our profession) • I’m not going to mention every single kind of nurse out in the world and might make some broad statements • I’m going to mention nurses’ work with other disciplines/professions, but this is not about other disciplines

7. I’m not implying that nurses are the only health care workers to: • Interact with patients • Provide hands-on care • Teach patients and families • Coordinate care • Advocate on behalf of their patients’ wishes and the “big picture”

8. Nurses • Largest group of health care workers in most industrialized countries • First point of contact for most consumers of health care services • Pretty much anywhere health care is delivered, you will find nurses

10. We could spend the whole hour just listing nursing’s different specialties and practice areas

11. Bevel Up, National Film Board--2008

12. What do nurses do? A first answer … • Providing support and information for patients and their families • That they probably would do for themselves if they had the knowledge, skill and opportunity/circumstances • Often around physical and mental health crises, life transitions, and attempts to stay healthy • Making sure the environment around clients is physically, psychologically and clinically safe • Carrying out treatment plans • Monitoring/observing unfolding situations

13. Protection and Rescue • Nurses protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living -- ordinary acts like breathing, turning, going to the toilet, coughing, or swallowing. Suzanne Gordon, 2006

14. Suzanne Gordon, 2006 • “Even the most emotional work nurses do is a form of rescue. When nurses construct a relationship with patients or their families, they are rescuing patients from social isolation, terror, or the stigma of illness or helping family members cope with their loved ones' illnesses.” • “What do nurses do? They save lives, prevent complications, prevent suffering, and save money.”

15. Nurses work everywhere in health care • Clients from birth to old age and all ages in between • In settings where treatment is for a short-term illness and in places where care is provided over the longer term • Working with individuals, families, groups, and even communities

16. The profession is 150 years old. The work has been done since the beginning of time and will always be needed.

17. What is regulation? • Regulation (of a profession) is a set of limitations on who is allowed to do certain kinds of work and under what circumstances • Self-regulation: occupational group entering into an agreement with government to formally regulate the activities of its members • When is regulation needed? • When public would be endangered by unqualified people performing services

18. Some Distinctions NOT ALWAYS/USUALLY REGULATED • Nursing work • Paid personal care • Practical/vocational nursing • Professional nursing • Advanced practice nursing (specialized/high stakes—nurse practitioners/clinical specialists) REGULATED

19. 332 794 Regulated Nursing Workers in Canada in 2011

20. Fast Facts: Canadian RNs in 2011 (N=291,008) • 93% were practicing nursing • And of these … • Mean age 45.3 yrs (12% under 30, 40% 50 and over) • 6.6% male (10% in Québec) • 8.6% internationally educated • 59% full-time • 61% hospital employed • 86% in direct care • 43% held baccalaureate or higher degrees Source : CNA, 2013

21. High school CEGEP Health sciences DEC CEGEP Nursing DEC CEGEP Any DEC Non-nursing bachelor’s degree Post-diploma bachelor’s completion program Bachelor of Science (Nursing) Master’s entry nursing programs Master’s in nursing PhD education

22. My personal career path • Undergraduate education • Clinical training and experience • Research training • Becoming an educator • Advanced clinical training • Advanced research training—health outcomes and policy research • Leading programs and research groups • Today …

23. There is less and less such a thing as a “typical nurse.”

26. What is nursing? A loose description … • Nursing is the health care discipline concerned with the practicalities of delivering services. • Nurses often work with clients over extended periods of time or on a more continuous basis relative to the involvement of other workers/professionals.

27. And nursing science/research? • Nursing science is the study of responses of individuals, families and communities to health related situations as well as their responses to interventions made on their behalf, especially in relation to assessments and interventions made by nurses (independently or in collaboration with other health professionals) and the organization of nursing care

28. The “Nursing Process” AKA the problem solving cycle, the scientific method etc. etc. • Gathering data • Identifying problems and issues (potential ones, actual ones) • Planning and sequencing treatments • Executing treatments • Evaluating responses of patients and families to care • Revising plans of care

29. “Traditional” illness-oriented nursing tasks • Administering medications • Interviewing and examining patients • Taking vital signs • Looking after tubes, “lines” and drains • Feeding and things connected with feeding • Toileting

31. The “thinking work” of nursing—as important … • Knowing the health status of each patient assigned • Identifying complications as early as possible • Teaching patients and families how to care for themselves • Referring patients to various services • Overseeing nursing care provided by others (volunteers, family members etc.)

32. Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous. Sir Cyril Chantler Dean, London Guy’s Hospital Lancet 355(1999), 1178-81. In Wachter & Shojania, 2004

33. A 68-year-old woman is diagnosed with thrombocytopenia due to acute lymphocytic leukemia. She is admitted to the hospital. Where should the patient be placed? In a … • A) private room so she won’t infect other patients and health care workers • B) private room so she will not be infected by other patients/health care workers • C) semiprivate room so she will have stimulation during her hospitalization • D) semiprivate room so she will have the opportunity to express her feelings about her illness

34. Nursing and Biological/Clinical/Social Science • Nurses’ work is based on a scientific foundation, but are educated in a different combination of sciences and in different depths than other health professions • Understanding normal physical, psychological, and family functioning, how the body responds to disease • Understanding therapies in terms of expected responses and risks

35. Science and nursing … • The science foundation tends to focus on common conditions, risk factors and presentations (not necessarily the simple) • Details that help implement safe care • A basis for understanding what treatments may become common in the future • Once specialized, nurses often gain very sophisticated understandings of conditions and treatments

36. In disease-oriented settings … in collaboration with physicians, pharmacists, rehab professionals etc. • Implementing and adapting treatment plans • Managing symptoms (pain, shortness of breath, anxiety etc.) • Managing emergencies (medical, behavioral) • Helping patients recover function safely • Helping patients and families live as well as possible in the long term …

37. “Classic” Approach to Types of Work

38. Why might nursing not be a “classic” profession? • Practical orientation of the work • Varied educational backgrounds of members • Mixed group involvement in activities, some of which are highly skilled, other activities not necessarily as skilled in an obvious way

39. Another approach to thinking about work • Social needs and technologies create markets for different kind of workers • These needs and technologies change over time • Different groups “claim” areas of work—”entrepreneurs” (branching out) and defense of territory by the traditional holders …

40. Originally part of medical practice • Taking blood pressures • Use of the stethoscope • Drawing blood

41. Originally part of nursing • Respiratory therapy • Dietetics/nutritional therapy • Physical therapy • Occupational therapy • Hospital-based social work

42. Back to what nurses do … • Using a scientific background … • In collaboration with other professionals/workers … • Building a relationship of some variety with the patient/family and/or working from one … • Helping patients make the most of their potential for being healthy—including finding health within illness …

43. … In the critical care unit …

44. The medical-surgical floor …

45. … The Emergency Department …

46. On the street … Bevel Up (NFB, 2008)

47. In the home …

48. A concrete example of nursing practice around a specific practice area • Pressure ulcers (also known as bedsores) • Protecting patients from the hazards of health care • Assessment • Implementing treatment • Support of patients through long and unpredictable courses