ULL Nurs 100 Units 5

Flashcard maker : Lily Taylor
Professional Nurse
Addresses the humanistic and holistic needs of patients, families, and environment and provides responses to patterns and/or needs of patients, families, and communities to actual and potential health problems
Contemporary issues
Problems, changes, and concerns that are current fo the present time
Core competencies
Essential cluster of abilities and skills required for competent nursing practice
Competency outcomes
The results, or end products, of planned study and experience that are focused on specific abilities required for practice
Educational mobility
Progressive movement from one type or level of education to another, often based on flexible, self-directed, or advanced placement options.
RN to BSN or MSN; BSN to doctoral degree, or non-nursing degree to BSN, MSN, or doctoral degree
Educational trends
Shifts in conditions and concerns that emerge from and influence various aspects of society;
broad changes is the United States and the world that influence the education and practice of nurses and other providers.
Performance Examinations
Standardized evaluation based on objective demographics of specific required competencies
Used in conjunction with written tests of knowledge about those abilities
May require performance in actual or simulated situations, related to physical pyschomotor skills or the observable evidence of other skills such as critical thinking, communication, teaching, planning, writing, or analysis and integration of data
Increasing professional and personal responsibility
Certification requirement
Increasing competency assessment in the work place
High stress from competing demands of school, home, meeting competency requirements
Education
Common master’s specialty in the 60’s
Faculty shortage
causes limited access for nursing students
CCNE
Commission on Collegiate Nursing Education
accredits Master’s programs
NLN
National League for Nursing
Accredits Associate degree programs
Safety
concern of consumers and nurses
Disaster preparedness
Increased after 9/11
BSN by 2010
New York seeks to make BSN the standard for entry into nursing practice
Yale
First BSN in 1924
Profession
A type of occupation that meets certain criteria that raise it to a level above that of an occupation.
Professional
A person who belongs to and practices a profession.
Professionalism
The demonstration of high-level personal, ethical, and skill characteristics of a member of a profession
Practice-Based Competency Outcomes
specify expected results, the destination the student needs to reach.
The outcomes approach requires a mental shift from trying to memorize voluminous readings and class notes to actually learning to think like a nurse, to integrate information in problem solving and decision making and providing competent patient care.
Performance-Based Learning & Assessment
practiced based case studies and simulations for students to engage in problem solving, critical thinking, and integration of concepts, knowledge, and evidence-based practice.
Sociodemographics, Cultural Diversity, and Economic and Political Changes
these climates are changing and education must prepare graduates for an ever changing landscape.
People are living longer with more chronic diseases, the cultural mix continues to become more and more diverse, there is a rise in domestic abuse and violence, epidemic of obesity, the traditional family has changed (single parent households, same sex couples, singles living with singles, social disrespect). All of these issues affect health care. Nurses work with those all aspects of society, and thus, course content and interactive practice-based learning that incorporates these issues is essential.
Community-focused Interprofessional Approaches
The push to change “illness care” to “health care” on a large scale involving families and communities, not just individual patients. Our current health care system focuses on illness, we must change our focus to health promotion and disease prevention.
Consumer-Oriented Care – Engagement, Safety, and Privacy
a change of approach from “giving patient care” to “working with” the patient and families. Prevention of medical errors-2000 IOM study that reported the alarming number of serious medical errors and their consequences.
Big emphasis on safety, introduction of QSEN competencies. HIPAA -the 2002 Health Insurance Portability and Accountability act and patient privacy issues.
Ethics and bioethical concerns:
Multicultural, multiethnic populations and patients who have different ways of responding to illness, treatment, and care providers raise ethical issues of who is “right” and who has the “right to decide”.
Many ethical dilemmas require students, nurses, and other providers to accept the value of individual choice regarding abortion, organ transplant, stem-cell research, preference in sexual partners, and the patient’s right to die a dignified death.
Shortage of nurses and faculty:
inadequate clinical staff and use of part-time and agency nurses tend to reduce the quality of overall care and increase stress and burnout.
Students are assigned to multiple and diverse community clinical settings, some of which may be short staffed, making it difficult for them to find qualified preceptors.
An alarming number of qualified applicants to schools of nursing are being denied admission due to the lack of prepared nurse educators, limited space and other administrative constrains.
The number of MSN and doctoral prepared faculty are inadequate to meet current demands.
Disasters, violence and terrorism:
Nurses have always worked in situations emanating from disasters, abuse and violence in families and communities and in military conflicts.
Domestic violence, violence in the workplace and in schools has increased resulting in an increased emphasis in nursing education and in state regulations of reporting and responding to violent incidents.
Criminal acts and substance abuse have become more common in hospitals and other health care agencies and in schools of nursing threatening the safety of patients and staff.
As a consequence, criminal background checks are required for all students and by agencies providing clinical experience.
Increasing professional and personal responsibilities:
Students, teachers and nurses confront increasing life responsibilities and associated stressful demands on time and resources. Issues include expansion of information and technology, changing health care systems, more interactive and out-of-class methods of learning, multiple care settings, higher expectations for competence, shortage of nurse preceptors and teacher, multiple cultural, ethical, and legal aspects of an ever-changing society. Many students are responsible for the care of dependent children and aging parents.
LPN/LVN (licensed nurse)
Licensed Practical Nurse/Licensed Vocational Nurses (California and Texas)
Shortest programs (9 to 18 Months)
Most restricted form of practice
Must work under the supervision of an RN
Cannot perform all skills
Limited work in critical care areas
Practice focuses on technical skills
NCLEX-PN licensing exam [NCLEX=National Council Licensure
These nurses can also work under the supervision of an MD – such as in a physician’s office
Diploma Program (RN)
The oldest, most traditional RN programs
Modeled after Nightingale programs in Europe
Approximately 2-3 years in length
1950-1960 – increase in the number of hospitals led to the increase in the number of diploma programs. More than 1300 programs operational
By 2008, only 75 diploma programs remained
NCLEX-RN licensing exam
Diploma programs now are more similar to associate degree programs. Many have arrangements with colleges so that students can simultaneously earn an associate or baccalaureate degree.
Associate Degree Program (ADN) (RN)
Accounts for largest number of nursing graduates (63% in 2009).
Average about 3 years to complete
Increased demand for nurses.
WWII
Hill Burton Act
Increased demand for college based education (as opposed to diploma)
Intended to be the “technical nurse”
NCLEX-RN licensing exam
Basic Tech care in RN positions, licensure
ADN notes
The Hospital Survey and Construction Act (or the Hill-Burton Act) is a U.S. federal law passed in 1946 which provided monies for construction of hospitals which in turn created an increase need for hospital based nurses.
WWII also created an increase demand for nurses.

ADN Programs emerged in the 1950’s
At the time of development of the ADN program BSN programs graduated only 15% of graduates. There was a push to increase the number of college based graduates. The increase demand for nurses increased the need to graduate nurses in a shorter time period than the traditional 4 year degree. At inception, ADN programs took only 2 years to complete. Today, most ADN programs take about 3 years to complete.

The intention was that the ADN would be the technical nurse and BSN would assume the charge nurse and leadership roles. Because of the shortage of BSN graduates and the competence of the ADN graduates, ADNs were quickly put into leadership roles.

Because of the periodic nursing shortages, the shortage of BSN graduates, and the fact that they all take the same licensing exam make the expectation of differentiation of roles (ADN vs BSN) unrealistic.

Currently, salary for bedside nursing is the same for a BSN or an ADN Graduate

There is an ongoing 50 year debate about the entry level for the professional nurse.

“With inception of ADN education, nursing took control of nursing curriculum and assumed full responsibility in shaping nurses for a more professional level of practice””Before ADN programs more then 85% of graduating nurses’ curriculum was controlled by hospitals and physicians” Orsolini-Hain and Waters, 2009.

With the demand for more leadership skills from nurses, ADN programs have added courses and now most programs take a minimum of 3 years to complete.

BSN Program (RN)
4 year degree program
Intended to be the “professional nurse”
More emphasis on leadership and management than ADN Programs
First BSN program at Yale University in 1924
BSN degree usually required for admission to graduate programs.
NCLEX-RN
community course is essential
BSN notes
Nurse leaders from those early years until today believe that nurses provide more comprehensive and competent care when they get a solid foundation in the arts and sciences, in addition to nursing content.

As stated in the previous slide, with inception of the Associate degree programs, the ADN was intended to be the “technical” nurse and the BSN was intended to be the “professional” nurse. Because of social and political forces the distinction has never materialized.

More hospitals who are seeking “Magnet” status are requiring nurses in management and leadership to have a minimum of a BSN or an MSN.

With the increasing demand for APRNs it is advantageous for students to have a BSN as entry level into practice.

Masters degree Program (RN)
Master’s degree in nursing
Different areas of specialty
Nursing education
Schools of nursing, staff development, industry for clinical support.
Health Care Administration
Health care management positions
Some choose to also get MBA, or business administration graduate degree concurrently
Clinical Nurse Leader (CNL)
Clinical Nurse Leader/CNL
Prepared as a master’s generalist clinician (not APRN)
Master’s degree RN who assumes resposibility for client care outcomes through assimilation and application of research based info to design, implement, and evaluate client plans of care

Oversees the care coordination of a distinct group of patients, evaluates outcomes, and has the decision – making authority to change care plans when necessary

Relatively new specialty, promoted by AACN and other nurse leaders.

Expertise in quality improvement and cost-effective resource utilization

Master of Science in Nursing degree that prepares students to sit for the certification exam as Clinical Nurse Leaders (CNL).

APRN- Advanced Practice RN
Master’s Prepared
Doctoral Prepared
Clinical Nurse Specialist
Nurse Anesthetist
Nurse Mid-Wife
Nurse Practitioner
Family
Adult
Pediatric
Psychiatric/mental health
Women’s health
Emergency
ARPN notes
not an all inclusive list of nurse practitioners. Currently the entry into practice for APRN is a master’s degree. In the year 2015, APRN will be required to have doctoral degree for entry into practice (2015 is the planned year but there is still much discussion and deliberation about this issue). This will not be required for current APRNs.

Requires certification for practice.

Clinical Nurse Specialist/CNS
An advanced practice nurse who possesses expertise in a efined area of nursing practice for a selected client population or clinical setting
Traditional roles
Expert practitioner
Educator
Consultant
Manager
Researcher
Hospital-based CNSs have faced fewer opportunities due to hospital downsizing
Nurse Anesthetist (CRNA)
Anesthesia specialists
Administer many types of anesthesia
Anesthesia -related care
Preanesthetic preparations
Anesthesia induction, maintenance, emergence
Certification Exam required
40% of CRNAs are men
Nurse – Midwife
Management of women’s health care
Primarily:
Pregnancy
Childbirth
Postpartum period
Care of the newborn
Family planning
Gynecological needs

Master’s level not yet required for nurse-midwifery students. In 5 states, midwifery may be practiced by care givers who are not registered nurses.

Nurse Practitioner
Assesses patients and uses independent decision -making skills at an advanced level
Has prescriptive authority
Functions in collaborative agreement with a physician or dentist
http://www.lsbn.state.la.us/documents/scope/apscope.pdf
Master’s Programs
Master’s programs typically take approximately 2 years to complete when attending full time.
Many flexible options now available
Part-time
Distance learning
APRNs are required to obtain certification for practice
Doctoral degree in Nursing Program
PhD, DNS, DNP,ND
Varies for education program completion
Advanced nursing for research, clinical practice, education, and leadership positions

Some think introducing another level of education will further the nursing shortage.

UL College of Nursing just recently had their DNP program approved!!

Doctor of Nursing Practice/DNP
A clinical practice focused doctoral degree in Nursing
– advanced nurse practitioners – will be entry level in 2015
PHD
Research focused
DNS
doctor of nursing science – advance clinical nursing practice
ND
ND – doctor of nursing – BS or higher degree in non-nursing field who want to pursue a career in nursing leadership
Certification
Specialty certifications are certifications obtained from a certifying board other than the state board of nursing
Specialty certifications can further validate a nurse’s skill, knowledge and abilities
Not required by state boards to practice as a registered nurse
Required for APRN
Some employers or specialty areas may require certifications.
Education Today
Flexibility
LPN to BSN
RN to BSN
RN to MSN
Accelerated Programs
Baccalaureate to Doctoral
Career ladder programs
1+1
2+2
Distance Learning
Documented needs of students, the nursing shortage, and the expansion and acceptance of electronic learning technology has led to variety of much more flexible education options.

UL College of Nursing now has the RN to BSN program all online!!

Excelsior
Classroom without walls.
Innovative distance mobility program
Developed under New York Board of Regents
Provides degree programs for adult learners underserved by traditional programs
The nursing programs enroll thousands
Other Educational Trends
Accelerated, fast- track, or second degree programs designed for non-nurses with other degrees – most rapidly growing programs
Some programs reaching out to underrepresented groups such as men and minorities
Noteworthy
The American Association of Colleges of Nursing [AACN] & other organizations strongly support
the BSN as the ”entry into practice” & the professionalism of nursing.
Lifelong Learning
“The illiterate of the 21st century will not be those who cannot read and write but those who cannot learn, unlearn and relearn”

To practice as a nurse requires continuing education. The rate of change in the health care field is rapid and the recognition of the need for continuing education and the willingness to do so is crucial.

Median Annual Wages for RN
Employment services $68,160
General medical and surgical hospitals $63,880
Offices of physicians $59,210
Home health care services $58,740
Nursing care facilities $57,060
Today’s Nurse
40% of all health care professionals
Mean age of 46.8
5.7% are males
49% of CRNAs are men
56% practice in hospitals,
8.6% are APRNs
51% NPs
24% CNSs
13% CRNAs
6% NP-CNS
4% Nurse-midwives
What are the various levels of nursing education?
LPN, Diploma, BSN, MSN, CNL, DNP, PhD
What feasible opportunities exist to advance education beyond the current degree students are seeking?
Residencies, traineeships, employer reimbursement, scholarships, loan forgiveness and repayment programs, online opportunities
What barriers exist that may interfere with education endeavors?
Personal and professional responsibilities, cost, lack of access, lack of technology skills
AAN (American Academy of Nursing)
The organization of leaders in all facets of nursing: practice, education administration, research, organizations, and government; the think tank of the profession; promotes advancement of all aspects of nursing’ publishes papers , conference proceedings and documents to advance nursing.
AACN (American Association of Colleges of Nursing)
The organization of deans and directors of baccalurate and higher-degree nursing programs’
ANA (American Nurse Association)
The major national nursing organization concerned with borad scope of practice issues’ standard of practice, scope of practice, ethics, legal, employment; a federation of state nurses associations; publications related to array of practice issues and standards
CCNE (Commission on Collegiate Nursing)
A subsidiary of AACN with responsibility for establishing and implementing standards and criteria and for accreditation of baccalaureate and graduate degree programs in nursing.
NCSBN (National Council of State Boards of Nursing)
Organization of all state boards; coordinates licensure activities on national level; creates and administers licensure examinations (NCLEX); developed computerized licensure examinations; works with other organizaitons to promote nursing standards and regulation and establish interstate licensure protocols
NLN (National Leage for Nursing)
The national organization of nurse educators, with long-standing commitment to four types of basic programs (LPN, diploma, ADN, and BSN); includes lay citizens concerned with nursing and health care on its board. NLN also has councils for nursing informatics, research in nursing education, wellness centers, and multiple types of print publications. Initiated certification program and examination to certify excellence of nursing educators; also estalished Centers for Excellence for nursign programs that meet designated standards
NLNAC (NLN Accreditation Commission)
Formed in 1997 as a subsidiary of NLN with responsibility for establishing and implementing standards and criteria and for accrediting all types of schools of nursing.
NONPF (National Organization of Nurse Practictioner Faculty)
Organization of nurse practitioners in multiple specialties; sets national standards and criteria for programs and certification.
NSNA (National Student Nurses Association)
National organization of statewide student nurse associations; concerned with education and career issues; provides student perspectives to other national nursing organizations.
Performance Exams
Standardized evaluation based on objective demorgraphics of specific required competencies
Informatics
a broad academic field encompassing human-computer interaction
Trends and Issues influencing nursing education
Rapid Knowledge Expansion;increasing use of technology, informatics in education and practice
Practice-based competency: outcomes and evidence-based content
Performance-based competency: learning and objective assessment methods
Sociodemographics, cultural, diversity, economic, political changes, and global issues
Community-focused interdisciplinary approaches
Consumer-oriented care: engagement, safety, and privacy
Ethics and Bioethical concerns
Increasing shortage of nurses and faculty
Disasters, violence, and terrorism
Increasing professional and personal responsibility
Performance Exams
Standardized evaluation based on objective demorgraphics of specific required competencies
Rapid Knowledge Expansion;increasing use of technology, informatics in education and practice
Choosing most effective electronic and technology options
Information overload; virtually unlimited global research opportunities, issues
Identifying current and accurate information; material rapidly outdated
Expanded expectations, limited time, rapid response expected; little time for reflection
Informatics
a broad academic field encompassing human-computer interaction
Practice-based competency outcomes
Learning focused on core practice competencey outcomes, professional skills beyond psychomotor skills
Integration of evidence-based standards
Emphasis on critical thinking and problem solving
Performance-based learning & assessment
Multiple teaching-learning methods
Problem-based learning
Accountability for learning and competence
Interprofessional learning
Sociodemographics, cultural, diversity, economic, political changes, and global issues
Increased aging population
Global nursing networks
Consequences for access and health care
Community-focused interdisciplinary approaches
Diverse alternative health practices, influence of cultures
Broad scope of nursing
Clincial approach
Requires more planning, travel time, expenses, and arrangements
Time Constraints
Consumer-oriented care: engagement, safety, and privacy
Privacy issues
Consumer intiatives for involvement and protection
Balance standards and preferences
Focused on safe, competent patient care
Ethics and Bioethical concerns
Alternative solutions to ethical dilemas
Standards of quality care
Patients rights issues
Respect, tolerance for patients decisions, ethical competencies for students
Increasing shortage of nurses and faculty
Shortage of staff esults in limitations in clinical learning
Heavy work load
Student need more clinical learning
Disasters, violence, and terrorism
New learning skills required for major natural disaster events
Preparedness for terroism
Increasing professional and personal responsibility
Certification requirement
Increasing competency assessment in the work place
High stress from competing demands of school, meeting competency requirements
LPN/LVN
Licensed Practical Nurse/Licensed Vocational Nurce
Must work under the supervision of a RN or physician
Technical nursing procedure focus
Hospital Diploma Program
2-3 yrs
Most traditional type of program for RN license
Associate Degree Program
2yrs
Basic Tech care in RN positions, licensure
BSN Program
2-4yrs
Basic professional practice as RN
Masters degree Program
1-2 yrs
Advanced clinical practice, management, education, and leadership positions
Doctoral degree in Nursing Program
PhD, DSN, DNP,DNSc
Varies for education program completion
Advancef nursing for research, clinical practice, education, and leadership positions

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