scope of practice and differentiated practice – Flashcards
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ANA standards of practicr
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Standard 1. Assessment Standard 2. Diagnosis Standard 3. Outcomes Identification Standard 4. Planning Standard 5. Implementation Standard 5A. Coordination of Care Standard 5B. Health Teaching and Promotion Standard 5C. Consultation Standard 5D. Prescriptive Authority and Treatment Standard 6. Evaluation
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differentiated practice
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the practice of structuring nursing roles on the basis of education, experience, and competence
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National Advisory Council on Nurse Education and Practice recommends that at least ____ of the nurse workforce hold BS or higher degrees in nursing by 2010.
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2/3
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Currently only ____% of nurses hold degrees at the BS and above.
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43
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Critical Care Nursing - based on a differentiated group professional practice that includes:
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1. Shared Governance Model 2. Differentiated Care Delivery 3. Shared Value, in addition to the multi-cultural and multi-disciplinary building process that values quality of care.
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Shared governance model
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(RNs have a voice and vote in their nursing practice
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Differentiated Care Delivery
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RN practice is recognized as exampled by Advanced Practice Nurses and Clinical Nurse Specialists)
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shared values
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(recognition of excellence in practices for the bedside RN's in Precepting, Charge Roles, Leadership, and Collaboration)
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carnegie foundation advancement of teaching includes:Entry-level registered nurses begin at the ________ level Requiring all RNs to earn a master's degree within ___ years of initial licensure. Authors found that many of today's
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baccalaureate; 10
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task force on differentiated competencies for nursing practice are sponsored by (3)
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1. American Association of Colleges of Nursing 2. American Organization of Nurse Executives 3. National Organization for Associate Degree Nursing
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task force on differentiated competencies for nursing practice are funded by
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robert wood johnson foundation
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what does the differentiated competencies for nursing practice recognize?
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that nurses with differing educational preparation bring different capabilities to the patient care system
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do graduates of bachelors, associates, and diploma programs all take the same licensing exam?
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yes, to assume minimum safe practice
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In the work environment of acute and long term care facilities, alot/ little differentiation exists in beginning staff nurse positions
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little
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Realistic statements about competencies of each level or category of nursing education will facilitate the _____ and _______ use of each category of graduate within the health care delivery system
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effective;efficient
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Validated competencies will provide a basis for the _________________ to ensure adequate preparation of each category of caregiver.
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development of curriculum patterns
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statements of competencies serves as
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a foundation for educational mobility patterns in the profession, job descriptions in the health care system, and responsive reimbursement packages.
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the council of associate degree programs published education outcomes of associate degree nursing programs roles and competencies (3 roles)
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1. provider of care 2. manager of care 3. member within the discipline of nursing
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National Council of State Boards of Nursing (NCSBN) conducted several studies aimed at
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role dilenation and job analysis of entry level rns
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purpose of the national council of state boards of nursing
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to validate the n-flex-rn
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NCSBN Role Delineation Study (1999):
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describes the similarities and differences in the roles of nurse aides, licensed practical/vocational nurses, RNs, and advanced practice nurses.
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Dr. linda aiken study (JAMA 2003)
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identified a clear link between higher levels of nursing education and better patient outcome
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what surgical patients have a substantial survival advantage
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those treated in hospitals with a higher proportion of nurses educated at the BS or higher
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A _____% increase in the proportion of nurses holding BS degrees decreased the risk of patient death and failure to rescue by ____%.
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10; 5
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Data show that health care facilities with higher percentages of BS nurses enjoy ______ patient outcomes and significantly _____ mortality rates.
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better; lower
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Magnet Hospitals are
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model patient care facilities that employ a higher proportion of BS prepared nurses
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true of falsE: they're trying to standardize the degree of taxonomy of the states
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true
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what do they want to adopt
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common nursing course content, sequencing, and number systems
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Frameworks of clinical nursing practice that are defined or differentiated by (5)
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1. level of education 2. expected clinical skills or competencies 3. job descriptions 4. compensation 5. participation in decision making.
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where is differentiated nursing practice implemented
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acute care inpatient settings rural community nursing centers acute care operating rooms
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what supports differentiated nursing practice
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clinical ladder systems
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Clinical Ladder Systems:
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defined steps for advancement within the organization based on experience in nursing, education, certification, or other indicators of professional excellence.
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differentiated nursing practice outcomes
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1. Increased job satisfaction 2. decreased staffing costs 3. decreased nurse turnover rates 4. decrease in adverse events 5. clear nursing roles 6. improved patient interventions and outcomes
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minimum of a BS for employment:
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1. case manager 2. clinical care coordinator 3. nurse manager 4. infection control nurse 5. quality improvement coordinator 6. patient care manager.
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issues with the differentiation of nursing
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consumers find it difficult to understand the various credentials and just care about satisfactory care 2. employes have difficulty differentiating among three major types of rn grads
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5 types of education
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1. diploma program 2. associate degree 3. baccalaureate 4. masters 5. advanced practice
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diploma program is based
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in a hospital
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two other caregivers
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nurisng assistant practial/vocaitonal nurse
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when did the nursing assistant start
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WW1
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nursing assistants provide a majority of the care in the
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nursing home
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Omnibus Budget Reconciliation Act (1987):
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all people working as nursing assistants in nursing homes are required to complete a minimum of 75 hours of theory and practice and pass an examination to be certified
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nursing assistant is reguated
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federally, but jurisdiction is via state
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National Council of State Boards of Nursing developed the ________ 5 words_____ which identifies the minimum skills a nursing assistant must attain.
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Nurse Aide Competency Evaluation Program
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nursing assisstants function under
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the direction of the RN or the licensed practice nurse
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where is training for the nursing assistant
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high schools long term care facilities community colleges
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JCAHO requires what of hospitals
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assure the competence of all employees
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nursing assistant skills
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Changing bed linens. Taking vital signs. Bathing. Personal care. Tube feedings Enemas Ambulation Stable, unchanging clients Feeding and exercising patients. Safety: safe environment and proper use of side rails, restraints, and patient rights. Home health aide assist individuals with basic care in their home (also grocery, cooking, and laundry
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_____(the year) YWCA in Brooklyn, NY established a program in nursing.
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1892
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the year --> 1908
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The American Red Cross began a practical nursing program.
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the year --> 1938
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NYS was first state to require licensure for the practical nurse.
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the year 1941
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Association of Practical Nurse Schools was formed.
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the year 1955
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All states had mandatory licensure.
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the year 1957
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The NLN established the Council on Practical Nursing
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1979
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NLN published a list of competencies of graduates.
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training for practical nurse typical takes how long
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1 year
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for practical nurses, what is stressed?
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clinical expericence
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where can you become a practical nurse
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high shoals trade or tech schools hospitals community colleges
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graduates of the practical nurse take the
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NCLEX-PN exam
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practical nurse Scope of practice focuses
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on meeting the health care needs of clients in hospitals, long term care facilities, and the home.
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who do practical nurses care for?
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patients whose conditions are stable
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true or false: practical nurses give direct patient care
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true
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can a practical nurse administer meds and treatments?
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yes
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do practical nurses assist in rehab?
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yes
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who directs a practical nurse?
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an RN or a licensed physician
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earliest type of nursing education
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diploma education
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in the 1930's approx how many diploma education
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2000
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in 2006, how many diploma education
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62
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diploma education is based on what model
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modified apprenticeship model
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how long is a diploma education
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27 to 36 months
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hospital based post secondary education programs
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diploma education
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diploma education has a strong emphasis on what kind of experiences?
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diploma education
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dimploma education has a foundation in what kind of courses?
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biologic social sciences
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graduates of diploma education work in
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acute, long term and ambulatory health care facilities, fulfilling the responsibilities established by the scope of practice for RNs as defined by the state in which they are licened
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what percentage of all basic RN education programs re diploma education
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10
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what year and where did an associate degree education begin
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1952; cooperative research project in junior and community college education for nursing at teachers college, columbia university
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which form of education prepare more graduates for licensure as RNs than any other program
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associate degree
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The first and only type of nursing education established on the basis of planned research and experimentation.
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associates degree education
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what program demonstrated that qualified students could be educated in less than 3 years.
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Cadet Nurse Program (WWII)
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what followed in the organization and growth of 2 year community colleges
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assoicate degree education
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what program prepared nurses skilled in bedside nursing
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associate degree education
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Characteristics of Associate Degree Education
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1. Encompassing the nursing program as an integral part of the college that controls and finances the program. 2. Ensuring the members of the nursing faculty the same privileges and responsibilities granted to other faculty. 3. Organizing a curriculum with a clearly stated philosophy, rationale, and conceptual framework, designed to be completed in 2 years. 4. Ensuring that nursing students are treated the same as other community college students with regard to admission, progression, and graduation requirements. 5. The programs are designed to award an associate degree on completion. Graduates are eligible to write the state licensing examination for registered nursing.
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in an associates degree education, whats the breakdown of gen eds and nursing courses
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1/2 and 1/2
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issues with associate degree education
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1. pressure to increase credit 2. increased enrollments 3. selective administration process
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baccalaurate education (how many years)
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4
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baccalaureate education in 1909
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university of minnesota as part of their chool of medicine and followed the 3 year diploma program structure
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how many baccalaureate education in 1916
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16
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what school and in what year was the first baccalaureate education to be a separate department
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1924 Yale School of Nursing
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minimum education prep recommended by a 1965 ANA position paper
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baccalaureate education
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center that requires a baccalaureate degree for initial basic certification in any nurse specialty, and requires a master's degree for initial certification as a clinical specialist or nurse practitioner.
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American Nurse's Credentialing
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what does baccalaureate education provide?
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the background need for public health positions including school nursing and the education base for entry into graduate education in nursing
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american association of colleges of nursing is related to what education
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baccalaureate education
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three ways to describe a baccalaureate prepared nurse
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1. provider 2. designer 3. manager
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characteristics of baccalaureate education:
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upper division nursing major that is built onto 2 years of liberal arts and science courses; basic nursing skills; health maintenance and promotion; disease prevention; supervisory and leadership techniques and practice; intro to research; Experience in public health nursing, community health setting, and leadership responsibility in acute care; Emphasis on critical decision making skills, and exercising independent nursing judgments in complex situations; Collaboration with other members of the health care team; Supervision of others with less preparation; Work with groups as well as individuals.
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changes within the scope of nursing
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increased emphasis and desire of students for specialization
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Yale model:
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students are admitted with a baccalaureate degree in another area were granted a master's degree in nursing after completing a 2 year program that prepares them for RN licensure.
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Case Western Reserve University initiated the first program in which the student earns
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a doctorate in nursing (ND) before being eligible to sit for the NCLEX.
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true or false: All graduates write the NCLEX for licensure in their state.
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true
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true or falsE: All schools preparing graduates for RN licensure must meet the criteria established for state board approval.
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true
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True or false: Most schools preparing for RN licensure have a very similiar number of credits of basic nursing education. BS programs add credits for research, community health nursing, and leadership.
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true
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since faculty are pushed to develop curricula that is up to date, what is required?
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1. greater efficiency 2. the ability to work in a highly technical environment 3. knowledge of new protocols 4. community experiences 5. greater responsibility and accountability
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what do all programs place a greater emphasis on
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critical thinking skills (especially related to decision making)
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what do we want our faculty to posesse
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masters and doctoral
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Members of the faculty are pushed to meet the increasing demands of (4)
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education, clinical excellence, tenure, and vocational certification or research
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in all the education programs out there, what are some administrative similaries
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: 1inadequate financial support 2. finding appropriate learning experiences 3. maintaining programs that prepare graduates for current practice 4. issues recording national accreditation
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in all the education programs out there, what are some student similaries
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1. recruitment and selection of students 2. legal concerns are demanding more time and attention 3. greater diversity in the student bod
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Registered Nurse Baccalaureate Programs is designed for
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Designed for the RN, with either a diploma or an associate degree, who wishes to return to school to complete a baccalaureate degree in nursing.
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purpose of the master's
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to prepare persons with advanced nursing knowledge and clinical practice skills in a specialized area of practice.
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who began graduate education in nursing
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teacher's college, columbia university
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ave program length of master
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18 to 24 months
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entrance requirements of a masters
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bs, rn liscence, gap of 3.0, GRE exams, 1 year of experience
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examples of masters
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Nurse practitioner, nurse educator, nurse anesthetist, nurse administrator, clinical nurse specialist, nurse midwifery, etc
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why doctoral?
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need for advanced study for academic advancement or tenure in the educational setting, and reflects the need in nursing research for the advancement of the profession as a whole.
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doctoral program titles?
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doctor of nursing science (DNS) doctor of philosophy (PhD)
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Because there was a limited number of nursing doctoral programs, most nurses in the 1950's and 1960's earned doctorates in _______ fields.
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nonnursing
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how many doctoral programs by 1996
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66
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do you have legal status if you're certified
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no
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certification program is a program with
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a concentrated study in a specific area
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what is required in a certification program?
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1. comprehensive examination documentation of experience letters of reference
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what three things do certification programs lead to
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greater earning potential increased employment opportunities insurance reimbursement
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what provides certification
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american nurses credentialing center
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Advanced Practice Nurses (APN's) certified by the ANCC must have (WHAT TO THINGS )based on nationally recognized standards of nursing practice and designed to test their special knowledge and skills.
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masters degrees and demonstrate successful completion of certification examination
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how long is a certification program usually good for
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3 to 5 years
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AD-PIE
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assess diagnose plan implement evaluate
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who is benner
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nursing theorist, she looked at how we are educating nursesshe found many are undereducatedand you're not seeing what we should see across all environments
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what was the initial theory of benner
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novice -> expert
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what does the council of associate degree program go through?
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national league of nursing
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can nurse assistants flush tubing?
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no, but they can hang them
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whats in greater focus in a bs as opposed to associates
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focusmore on chn, research, leadership and management
