Many states and organizations offer postgraduate courses and certifications. NAPNES offers certification programs in pharmacology, IV therapy, and long-term care (www.napnes.org). NFLPN offers national certifications in IV therapy and gerontology (www.nflpn.org). NFLPN has also partnered with Professional Education, to offer a new Foot Care Certification (www.nflpn.org/cerification.html). The American Board of Managed Care Nursing (www.abmcn.org) offers certification in managed care nursing. Some vocational and technical colleges offer postgraduate courses on being a charge nurse. Some states recognize postgraduate courses and certifications with an increase in salary and permit the LPN/LVN to use the skills they have learned in providing care. A major benefit of postgraduate information is knowledge gained for more effective patient care.

Extended care as an employment option may be available to you if you possess the following characteristics:

• Use solid nursing process skills in gathering data and use the care plan as a guide.

• Use critical thinking throughout the shift.

• Use therapeutic communication skills; differentiate between therapeutic and personal.

• Enjoy longer-term contact with people. (High turnover rates of staff have been associated with lower quality of care in some extended care facilities.)

• Provide excellent nursing care without immediate supervision of an RN or physician.

• Seek assistance or additional instruction as needed.

• Apply information about growth and development changes during illness.

• Willingly seek to learn new skills through continuing education and certification courses needed to take care of a varied population and age group.

• Listen to patients regarding what they see as their needs for care.

• Treat patients of all ages and levels of growth and development with respect.

• Recognize when there is a significant personality clash with a patient to whom you are assigned and ask for a change in assignment. (This statement assumes that you have already tried to talk over differences with the patient and other staffs are available to take over.)

Other special qualities needed include the following:

• Patience

• Ability to see below the surface

• Willingness to listen

• Maturity

• Understand the significance of the work you are doing

• Ability to determine priorities

• Ability to set limits

• Interest in working with people with disabilities

• Willingness to work with other health care givers, significant others, and family members.

• A sense of security in regard to your personal value system

Prior experience on a medical/surgical unit is helpful before working in an extended care facility.

LPNs/LVNs who work in extended care are challenged to assist in providing a homelike atmosphere while dealing with immediate, long-term, and terminal health problems of the residents. The level of responsibility in extended care is great. The LPN/LVN often works in a charge nurse role, and although supervision is available from an RN, during some periods of the day, supervision may be general (i.e., at the other end of a cell phone). Consequently, solid knowledge and skills are essential to understanding when to seek help and from whom. The nursing process and critical thinking provide the basis for skilled, compassionate care.

The charge nurse role also means that the practical/vocational nurse is responsible for managing care given by other LPNs/LVNs, certified nursing assistants, and trained feeding assistants. (Refer to Chapters 20 and 21 for more specific details on leadership and charge nurse skills.)

As the LPN/LVN in an extended care facility, much of your work ultimately relates to assisting the residents to attain or maintain whatever capabilities they have in all areas of health. Through your efforts, residents who are recuperating from surgery or trauma will realize their goal for recovery and discharge. For other residents, your role includes supporting them through the final step of the growth process: a dignified death.

Home health nursing

According to the U.S. Bureau of Labor Statistics, faster-than-average growth is expected in home health services. This is in response to the number of older persons with functional disabilities, preference for home care, and technological advances that make it possible to do more complicated treatments in the home.

Because of shorter hospital stays, patients are receiving an increased amount of care in the home. The actual care given is under the supervision of an RN, who uses nursing process steps as a guideline to finalize a plan of care approved by the patient. Data from the LPN/LVN involved with care are essential to complete the care plan. Postdischarge (subacute) care fits in well with LPN/LVN basic education, thereby making LPNs/LVNs invaluable in implementing the plan of care. LPN/LVNs’ observations of physical and mental changes allow additions to the continuing data collection and evaluation of the plan of care. Because of difficulty in receiving payment from nonprivate sources, some home health agencies use LPNs/LVNs for private-pay patients only. Others employ LPNs/LVNs as home health aides to avoid

Helpful Qualities for Home Health Nurses

• Flexibility: You will have to improvise in the home, yet practice sound nursing principles. For example, this may include using makeshift equipment, determining how to clean the equipment, and using it to attain desired results.

• Communication skills: You are working in the patient’s domain. You have to understand the patient’s expression of needs and also make sure that you express yourself clearly and tactfully. For example, you may find yourself having to use words in the patient’s vocabulary to be understood.

• Self-confidence: An air of insecurity or uncertainty will be picked up by the patient, resulting in lack of confidence in the LPN/LVN. This does not imply that you should fake confidence. Have the knowledge and nursing skills that enable you to perform tasks efficiently. Do not ask for unnecessary reassurance from the patient when performing basic skills. Ask questions away from the patient, unless an emergency exists. For example, you may be tempted to tell the patient, “This is only the second time I have changed a dressing on a foot without contaminating the dressing, and I’m kind of nervous about it.” Do not make a comment like this. It will worry the patient.

• Sensitivity to physical and emotional changes: Once the initial assessment is completed by the RN, it will be up to you to be alert to any changes of which the RN must be made aware. The RN must be able to depend on your observational skills, for safety’s sake. For example, be tuned in to the person’s affective communication as well as the verbal and nonverbal. Perhaps the individual is beginning to show signs of agitation that will need to be diffused before continuing the other work you have been assigned.

• Ability to deal with emergencies: Staying calm and following agency protocol are essential. For example, the patient may start to bleed from the wound you are dressing. Remembering what you learned to do in basic nursing and during first aid class is more effective than screaming that you can’t stand the sight of blood! In an emergency, your motto is “Function now, and shake later.”

• Nonjudgmental attitude: This is a must because you work in the patient’s home. You are providing a service. If you are comfortable with your own values, different values are not personally threatening. For example, the home may not be up to your standards in cleanliness.

restrictions. This is an unfortunate practice because the pay is lower and the LPN/LVN is always held to the standard of his or her highest license in legal situations. Because of the need for the level of LPN/LVN skill, there is some hope the payment plan will be revised.