The Culture of Health Care

2. The Culture of Health Care Nursing Care Processes Lecture a This material (Comp 2 Unit 6) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

3. Nursing Care ProcessesLearning Objectives • Describe what nurses do and how they are trained (Lecture a). • Discuss the role of certified nursing assistants (Lecture a). • Describe how nurses make clinical decisions and assess patients (Lecture b). • Identify the settings where nurses work (Lectures a, c). • Discuss the procedures that nurses perform (Lecture c). • Identify nursing career opportunities, including those not involved with direct patient care (Lectures a, b, c).

4. What Do Nurses Do? • Provide direct and indirect patient care: • Deliver direct, hands-on patient care • Screen, assess, and monitor patients • Perform or assist physicians with procedures • Administer medication • Write prescriptions (if licensed) • Coordinate care activities with other caregivers • RNs supervise LPNs, CNAs, and potentially other caregivers

5. What Do Nurses Do? Continued • Educate patients and families on disease management, care activities, and health issues • Educate public on health issues • Advise organizations on health issues • Conduct research on health care topics

6. Nursing Specialties • Several ways to specialize in nursing: • By body system (e.g., circulatory system) • By health problem (e.g., cancer) • By patient population (e.g., older people) • By location (e.g., schools) • Some specialties do not involve direct patient care (e.g., nursing informatics)

7. Types of Nurses • Three general categories of nurses based on education levels: • Licensed practical nurses (LPNs) • Registered nurses (RNs) (most common) • Advanced practice nurses (APNs) (most advanced level of responsibility)

8. What LPNs Do • Licensed practical nurses (LPNs): • Provide patient care and help with self-care • Document in the patient’s medical record • Teach family members how to care for the patient • Some states call LPNs licensed vocational nurses • Licensed professional by state but must practiced under another professional

9. Education and Licensing of LPNs • Becoming an LPN is a three-step process: • Complete a state-approved training program that lasts about 1 year • Pass a national licensing exam for LPNs • Meet all state requirements for licensure to work, such as passing a background check

10. What RNs Do • Registered nurses (RNs) are a large part of the health care workforce. They might • Plan patient care • Give medications and perform procedures • Manage and document in patient records • Teach patients, their families, and the public • Consult with doctors • Manage LPNs, CNAs, and other caregivers

11. Where RNs Work • Many RNs work in hospitals • They also work in • Doctor’s offices, ambulatory care • Home health care services, hospice • Nursing care facilities • Workplaces and employer services • Schools • Military

12. Expanded Roles and Settingsfor Nurses • Administration/management • Leadership • Public health • Insurance companies • Health IT/informatics

13. Education and Licensing of RNs • Three steps to becoming an RN: • Earn a nursing diploma, an associate’s degree in nursing, or a bachelor’s of science in nursing over 2 to 4 years • Pass a national licensing exam for RNs • Meet all state requirements for state licensure

14. What APNs Do • RNs with extra training can become advanced practice nurses (APNs) • Depending on their training, APNs can • Give patients anesthesia (certified registered nurse anesthetist) • Provide gynecological and obstetrical care (certified nurse-midwife) • Provide primary care (nurse practitioner, NP) • Treat patients and conduct research (clinical nurse specialist, CNS)

15. Education and Licensing of APNs • Three steps to becoming an APN: • Earn an RN license and work as an RN • Earn a master’s degree or higher in nursing • Meet state requirements to work as an APN • APNs are also called advanced practice registered nurses

16. Continuing Educationand Credentialing • All nurses pursue continuing education to meet various requirements • All nurses can become certified in a specialty by taking an exam from an approved organization

17. ANCC Nurse Practitioner Certifications • Acute care • Adult nurse • Gerontology: Acute/primary care • Psychiatric-mental health • Family • Gerontology • Pediatric primary rare • Diabetes management—advanced • Emergency American Nurses Credentialing Center (ANCC), 2016.

18. ANCC Clinical Nurse Certifications • Adult health • Gerontology: Acute/primary care • Home health • Psychiatric-mental health: Adult/child/adolescent • Pediatric • Public/community health American Nurses Credentialing Center (ANCC), 2016

19. Examples of Other Nursing Specialties • Cardiac rehabilitation • Case management • College health • Genetics • Informatics • Medical-surgical • Nurse executive • Pain management • Perinatal (newborns) American Nurses Credentialing Center (ANCC), 2016

20. Advanced Degrees for Nurses • Nurses can pursue advanced degrees for career growth: • A master’s degree lets an RN become an APN if he or she meets the other requirements • Doctoral degrees • PhD: Prepares nurses for research and teaching • DNP: Degree names and programs vary, but they always emphasize advanced nursing practice and usually also leadership and management

21. Nursing Care ProcessesSummary – Lecture a • Nursing roles include patient care, teaching, research, and administration • Specialization lets nurses gain expertise in certain areas of medicine • All nurses must have formal training, pass a national exam, and meet state requirements • Nurses stay licensed and build their careers by pursuing continuing medical education, certification, and advanced degrees

22. Nursing Care ProcessesReferences – Lecture a References American Association of Nurse Practitioners. (2015). Quality of nurse practitioner practice. Retrieved from http://www.aanp.org/images/documents/publications/qualityofpractice.pdf  American Medical Informatics Association. (2016). Nursing informatics. Retrieved from http://www.amia.org/programs/working-groups/nursing-informatics American Nurses Association. (2016). How to become a nurse. Retrieved from http://nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/RegisteredNurseLicensing.html American Nurses Association, Center for Continuing Education and Professional Development. (2016). Nursing Knowledge Center. Retrieved from http://ananursece.healthstream.com/Pages/Category.aspx?category=Subject&cat=ANA&orderby=DisplayName&dir=ASC American Nurses Credentialing Center. (2016). ANCC Certification Center. Retrieved from http://www.nursecredentialing.org/Certification Gordon, Suzanne. (2006). What do nurses really do? Topics in Advanced Practice Nursing eJournal, 6(1). Retrieved from http://www.medscape.com/viewarticle/520714_2 Stinson, S. (2014). Roles outside the hospital. Advance Healthcare Network for Nurses. Retrieved from http://nursing.advanceweb.com/Archives/Article-Archives/Roles-Outside-the-Hospital.aspx

23. Nursing Care ProcessesReferences – Lecture a Continued References U.S. Department of Labor, Bureau of Labor Statistics. (2015). Licensed practical and licensed vocational nurses. In Occupational Outlook Handbook, 2014–15 ed. Retrieved from http://www.bls.gov/ooh/healthcare/licensed-practical-and-licensed-vocational-nurses.htm U.S. Department of Labor, Bureau of Labor Statistics. (2015). Registered nurses. In Occupational Outlook Handbook, 2014–15 ed. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm U.S. Department of Labor, Bureau of Labor Statistics. (2015, Aug. 19). Registered nurses employment and wages by state and metropolitan area. Retrieved from http://www.bls.gov/opub/ted/2015/registered-nurses-employment-and-wages-by-state-and-metropolitan-area.htm

24. The Culture of Health CareNursing Care ProcessesLecture a This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002.