After studying this chapter, the reader will be able to: 1. Evaluate the effect of the current health care environment on the future role of nurses. 2. Analyze the influence of current demographic characteristics of RNs in the United States on contemporary nursing roles. 3. Differentiate among various innovative nursing practice roles today. 4. Differentiate between the roles of advanced practice nurses and other RNs in various settings. Based on knowledge and skills acquired through basic nursing education, with licensure as a registered nurse (RN) and graduate education and experience that includes advanced nursing theory, physical assessment, psychosocial assessment, and treatment of illness. Includes nurse practitioners (NPs), certified nurse-midwives (CNMs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs). The CNL is a master’s degree–prepared generalist who oversees the care coordination of a distinct group of patients in any setting. The CNL actively provides direct patient care in complex situations, evaluates patient outcomes, and has the decision-making authority to change care plans when necessary. This clinician puts evidence-based practice into action to ensure that patients benefit from the latest innovations in care delivery and is envisioned as a leader in the health care delivery system. Doctor of nursing practice (DNP) The DNP is an expert in advanced nursing practice who has an earned clinically focused doctorate degree in nursing. Health care team composed of professionals from different disciplines including chaplains, nurses, dietitians, pharmacists, physical therapists, physicians, respiratory therapists, social workers, and speech-language pathologists who cooperate, collaborate, communicate, and integrate care to ensure that care is continuous and reliable. (1) Traditional duties and responsibilities of the professional nurse, regardless of practice area or setting, such as the roles of care provider, educator, counselor, client advocate, change agent, leader and manager, researcher, and coordinator of the interprofessional health care team. (2) Duties and responsibilities of the professional nurse that are guided by specific professional standards of practice and usually carried out in a distinct practice area (e.g., flight nurse, forensic nurse, occupational nurse). The health care system continues to change as social and economic factors create a state of constant evolution. Professional nurses respond by creating innovative alternatives to traditional nursing practice to meet these new challenges. As nurses proactively define solutions to today’s health care dilemmas, multiple career opportunities emerge. In the past, describing the role of the RN was simple because there were few opportunities for variation. Today exploring job opportunities for RNs is more complicated because nurses can practice in literally hundreds of diverse settings with a broad variety of clients. The proliferation of career opportunities for nurses is growing. Although nursing roles have expanded, the traditional functions of the nurse remain intact. Box 26-1 summarizes the roles nurses assume in any employment role or setting. • Improving the health status and potential of individuals or families • Ensuring that safe, high-quality care is provided across all health care settings • Increasing the effectiveness and level of satisfaction among professional colleagues providing care • Managing multiple resources in a health care facility • Elevating citizens’ and legislators’ attitudes toward and expectations of the nursing profession and the health care system Box 26-2 lists some common roles of interprofessional health care team members with the website of their associated professional organization. These team members are involved in client care to varying degrees, depending on client needs for the specific talents and knowledge of each team member. This list contains selected professional roles contributing to the interprofessional health care team approach, but there may be more in a given team. Case Study 26-1 provides an excellent example of the role of various members of the interprofessional health care team. Multiple professional caregivers provide health care within the limits of each provider’s expertise. The joint efforts of all professionals provide the opportunity for a better overall outcome. The phrase “a typical nurse” became a misnomer as the profession entered the twenty-first century. Nursing roles are so diverse that no typical role or practice setting exists. Nurses are the largest occupation in health care with a total of more than 3 million, with 62.2% working in a hospital setting. Projections state that nursing will create the largest number of new jobs of all occupations in the future as more specialties and diverse work options emerge. Overall jobs for nurses are projected to expand 22% between 2008 and 2018, with some specialties such as home care services and physician offices growing up to 48%. Nurses can specialize in basically four ways: work or treatment setting, disease category or condition, organ or body system, or population. Some nurses specialize in more than one of these (U.S. Department of Labor, 2011). Although the nursing profession continues to be mostly female, the number of men working as RNs significantly increased in the past decade. The 2004 report indicates that the number of male RNs increased to 6.2% who were licensed prior to 2000 and 9.6% of those licensed in or after that time (Bureau of Health Professions, 2010). Changes in racial or ethnic backgrounds were reported as well. The 2008 survey reports that 83.2% of RNs were white or non-Hispanic, whereas 16.8% reported being from one or more racial and/or ethnic backgrounds. Some did not specify this information on the survey (http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf). Changes also are occurring in the educational preparation of RNs. There has been a substantial increase in the number of nurses graduating from associate degree nursing programs over the past decade. Although not as dramatic an increase, baccalaureate-prepared nurses also are increasing in number. In 2008, nurses reported their highest degree as 20.4% diploma, 45.4% associate degree, and 34.2% baccalaureate degree or higher (Bureau of Health Professions, 2010). In 2008, advanced practice nurses numbered 250,527. NPs lead this group in numbers, followed by CNSs, nurse anesthetists, and nurse-midwives (Bureau of Health Professions, 2010). Acute care hospitals remain the common worksite for RNs, although there has been a trend toward outpatient settings. In 2008, 62.2% of RNs reported working in hospitals, an increase from the 57.4% in 2004. The next largest area of employment was in community, public health settings, and school nursing—a total of 13.4%. About 12.3% work in ambulatory care settings such as physician-based practices, nurse-based practices, surgical centers, or insurance claims organizations. Other worksites include occupational health settings, policy or regulatory agencies, telehealth, pharmaceuticals, adult/senior centers, and flight nurse/medical air transport (Bureau of Health Professions, 2010). The Health Resources and Services Administration (HRSA) is part of the U.S. Department of Health and Human Services. The Bureau of Health Professions, a division of the HRSA, provides national information on the health professions workforce in this country. You can explore demographic changes in nursing online at http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf. Despite enormous changes in hospital care, jobs in the hospital environment will be available for a long time. In the hospital, a nurse provides direct care for people who are ill and unable to care for themselves. Another function of the direct-care role is to help the client and family in managing the illness event. Hospital positions can range from staff nurse to administrator and may entail any of the clinical specialties and most of the target populations identified in Table 26-1. Determining the area of clinical interest depends mainly on personal preferences. TABLE 26-1 TRENDS IN HEALTH CARE DELIVERY SYSTEMS
Contemporary Nursing Roles and Career Opportunities
Chapter Overview
Nursing—Much the Same, but Bigger and Better
Leader and Manager
Coordinator of the Interprofessional Health Care Team
Nurses today: who are they, and what are they doing?
Demographics for Registered Nurses
Hospital Opportunities
FROM
TO
Acute inpatient care
Lifespan care
Focus on the individual
Focus on aggregates or populations
Product of care orientation
Value of care orientation
Number of hospital admissions
Number of lives covered (capitation)
Managing organizations
Managing networks
Managing departments
Managing markets
Coordinating services
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