The Health Care Team: Where the Practical/Vocational Nurse Fits In



The Health Care Team


Where the Practical/Vocational Nurse Fits In



Objectives


On completing this chapter, you will be able to do the following:


1. Explain in your own words the goal of the health care team.


2. List 10 members of the health care team. (All levels of nurses count for only one member on your list.)


3. Identify the nursing personnel who are part of the health care team, according to the following criteria:


a. Education


b. Role and responsibilities


c. Licensing


d. Sites of employment


4. Define nursing.


5. Describe in your own words the following methods used to deliver nursing service:


a. Case method


b. Functional method


c. Team method


d. Primary care


e. Case management method


6. Describe the practical/vocational nurse’s role in the methods used to deliver the nursing services listed in objective number 5.


7. Describe how the philosophy of patient-centered care impacts nursing care.


8. Discuss how the hidden nursing shortage impacts jobs for the LPN/LVN.



Key Terms



advanced practice


(ăd-VĂNSD PRĂK-tĭs, p. 183)


associate degree nursing


(ă-SŌ-sē-ăt dĕ-GRE, p. 181)


bachelor’s nursing program


(p. 182)


case management method


(kās MĂN-ăj-mĕnt, p. 188)


case method


(kās, p. 187)


certification


(SŬR-tĭ-fĭ-KĀ-shŭn, p. 183)


clerk receptionist


(rĕ-SĚP-shŭ-nĭst, p. 186)


clinical pathway (care maps)


(KLĬN-ĭ-kăl PĂTH-wāy, p. 188)


diploma program


(dĭ-PLŌ-mă, p. 182)


functional method


(FŬNK-shŭn-ăl, p. 187)


general supervision


(p. 184)


independent


(ĬN-dĕ-PĕN-dĕnt, p. 182)


interdependent


(ĬN-tĕr-dĕ-PĕN-dĕnt, p. 182)


nurse manager


(p. 179)


nursing assistant


(NŬR-sĭng ă-SĬS-tĕnt, p. 186)


nursing case management


(p. 188)


patient-centered care


(PĀ-shĕnt SĚN-tĕrd, p. 190)


practical/vocational nurse


(PRĂK-tĭ-kăl/vo-KĀ-shŭn-ăl, p. 179)


primary care method


(PRĪ-măr-ē, p. 188)


registered nurse


(RĚJ-ĭ-stĕrd, p. 181)


skill mix


(skĭl mĭks, p. 188)


standards of care


(STĂN-dĕrds, p. 182)


student nurse


(STOO-dĕnt, p. 185)


team leader


(p. 179)


team method


(tēm, p. 187)


unit manager


(YOO-nĭt MĂN-ăj-ĕr, p. 187)


unlicensed assistive personnel (UAP)


(ŭn-LĬ-sĕnsd, p. 186)


image http://evolve.elsevier.com/Hill/success



image   Keep in Mind


You can’t tell the players without a program. Chapter 15 is your program to identify players on the health care team.




Who is responsible for Mrs. brown’s discharge?


Mrs. Amelia Brown, age 75, lives with her daughter on a 200-acre farm in rural Wisconsin. While working in the barn, Mrs. Brown fell and broke her right hip. She required surgery to repair the hip. Under general anesthesia during surgery, Mrs. Brown’s blood pressure reached dangerously high levels, but it quickly stabilized under the anesthesiologist’s interventions. Despite this setback, Mrs. Brown was discharged after 3 days in the hospital. She and her family agreed that she was not ready to return home at that point in her recovery, so she was discharged to an extended-care facility, where she was given physical therapy to learn how to function at home with her restrictions in ambulation. Two weeks later, Mrs. Brown was discharged from the extended-care facility to her home.


This sounds like just another success story for nursing, doesn’t it? We will follow Mrs. Brown as she progresses through the health care system and then decide who should get credit for Mrs. Brown’s discharge back to the farm.



Mrs. Brown’s emergency care


After Mrs. Brown falls, her daughter calls the emergency squad to transport her mother to the nearest hospital. The hospital is located 20 miles away in a city with a population of 98,000. The three people manning the emergency squad are emergency medical technicians (EMTs). Each EMT has taken an approximately 150-hour course in basic life support skills and has been certified as an EMT after passing a national test. The EMTs are currently taking an 18- to 24-month paramedic course, which is preparing them to provide more advanced life support skills. On the way to the hospital, the EMTs monitor Mrs. Brown’s blood pressure, pulse, respirations, and level of consciousness. They keep her right leg immobilized. The EMTs maintain contact with the hospital emergency room by means of a two-way radio.


On arriving at the emergency room (ER), the EMTs provide the registered nurse (RN) with verbal and written reports of Mrs. Brown’s status. The emergency room doctor examines Mrs. Brown and orders an x-ray film of her right hip. The x-ray technician brings the x-ray equipment to the ER and takes an x-ray film of Mrs. Brown’s right hip. This x-ray technician has taken a 2-year program conducted by a hospital or technical college to prepare her to perform diagnostic measures involving radiant energy. The radiologist on duty reads the x-ray film of Mrs. Brown’s right hip. On the basis of the physical examination and the results of the x-ray, the ER physician diagnoses a fracture of Mrs. Brown’s right proximal femur. The ER physician notifies Mrs. Brown’s family physician and contacts the orthopedic surgeon whom Mrs. Brown requests.


The RN receives Mrs. Brown in the ER, assesses her, and provides care until she is admitted to the hospital. The RN is a graduate of a diploma or 3-year program in nursing. This nurse has passed a national examination to become an RN. RNs who work in the ER participate regularly in continuing education courses at the hospital and at seminars given regionally and nationally for ER nurses. Mrs. Brown’s RN prepares her for surgery.


To be qualified to be in charge of the medical care of Mrs. Brown, the family physician has attended 4 years of college, 4 years of medical school, 1 year of internship, and approximately a 3-year residency program. Medical school consists of a program that provides the basic knowledge and skills needed to be a medical doctor. Internship involves a program of clinical experiences designed to complete the requirements for licensure as a practicing physician. The residency program prepares physicians for practice in a specialty. The specialty in this situation is family practice. The ER physician, the radiologist, and the orthopedic surgeon have had the same education as the family physician, up to the residency experience. The ER physician has completed a residency program in emergency or trauma medicine. The radiologist has completed a residency program in the reading and interpretation of x-ray films. The orthopedic surgeon has completed a 3- to 5-year residency in performing surgery for problems of bones and joints. Each of these physicians has passed the board examinations, which licenses them as physicians and allows them to practice under the state medical practice act. Each physician in this scenario is board certified in his or her specialty area.


Laboratory studies are ordered preoperatively. Lab personnel draw blood for these studies. Lab personnel have varied educational backgrounds. Some have on-the-job training to obtain blood samples. A medical lab technician has 2 years of education. A medical technologist (MT) has more than 4 years of education and can be certified by a national examination. Lab personnel are responsible for collecting the specimens needed for lab tests, performing the tests, and reporting the results to physicians and staff.


The family members request that their parish priest be contacted to give Mrs. Brown the sacrament of the sick (see Chapter 17). Because surgery is imminent, the pastoral care department is notified. A Roman Catholic priest, a member of the pastoral care team, anoints Mrs. Brown with holy oils, prays with her, and gives her Holy Communion. To be able to meet Mrs. Brown’s spiritual needs, the priest has had 4 years of college and 4 years of theological school before being ordained.



The surgical experience


In the ER the anesthetist prepares Mrs. Brown and her family for the anesthesia part of the surgical experience. This health care worker is an RN with a bachelor of science in nursing (BSN). This nurse has studied an additional 2 to 3 years in an approved school of anesthesiology after the 4-year BSN program. The anesthetist provides anesthesia to patients undergoing surgery. Mrs. Brown is transferred to the surgical suite, where she undergoes a right hip pinning procedure under general anesthesia. This type of anesthesia will put Mrs. Brown in a state of unconsciousness. During surgery, the anesthetist monitors Mrs. Brown’s vital signs continuously while she is unconscious. The surgical technician assists the orthopedic surgeon. The surgical technician sets up the sterile environment in the operating room. This health care worker makes sure the surgeon’s instruments and supplies are available when he requests them for the pinning of Mrs. Brown’s right hip. The surgical technician is a graduate of a 1-year diploma program at a local technical college. The professional nurse, who has a minimum qualification of a BSN, coordinates the overall functioning of the surgical team.


During surgery, the anesthetist notes that Mrs. Brown’s blood pressure is rising to a dangerous level. She contacts the anesthesiologist STAT (i.e., immediately!). The anesthesiologist, a medical doctor with a residency in anesthesiology, orders antihypertensive drugs (i.e., drugs that lower the blood pressure). The situation is quickly brought under control. Surgery is completed, and Mrs. Brown is sent to the postanesthesia care unit (PACU).




Intensive care: a time for close observation


The ICU is staffed by RNs who went to school for 2 years (associate degree nurses), 3 years (diploma nurses), or 4 years (bachelor’s degree nurses). Each nurse has taken the same national examination to become an RN. None of these nurses are qualified to work in the ICU immediately after graduation from their nursing programs. Most institutions prepare a nurse for the responsibilities of this unit through in-service classes after a minimum amount of experience or through a postgraduate or continuing education course. Mrs. Brown’s nurse, a 2-year graduate, is responsible for the care and observation of two patients.


The family is unable to answer some additional questions about Mrs. Brown’s medical history. The family physician asks the clerk receptionist (ward clerk) to obtain Mrs. Brown’s medical records from the medical records department. The clerk receptionist assumes the responsibility for many of the clerical duties that are a necessary part of any patient care area. The clerk receptionist learns these skills by taking a course that varies in length, depending on the area of the country. The course averages approximately one semester of theory and clinical experience. The medical records department is staffed by personnel who have gone to school for 2 to 6 years to learn the skills required for indexing, recording, and storing patient records, which are legal documents. Thanks to Mrs. Brown’s old records, which are sent to the ICU, the family physician receives answers to his medical questions.


The surgeon writes postoperative orders for Mrs. Brown, including an order for patient-controlled analgesia (PCA) to control postoperative pain. The hospital pharmacist has studied for a minimum of 8 years to become licensed to prepare, compound, and dispense drugs prescribed by a physician or dentist. The pharmacist fills the order for Mrs. Brown’s drugs and intravenous solutions.


The respiratory therapy department is contacted to evaluate Mrs. Brown’s respiratory status and suggest treatment to prevent respiratory problems. Certified respiratory therapists (CRTs) are graduates of 2-year programs in respiratory therapy and have passed a certifying examination. Registered respiratory therapists (RRTs) are graduates of associate degree or 4-year college programs in respiratory therapy and have taken three examinations to register. Within 24 hours of admission to the ICU, Mrs. Brown is judged to be in stable condition. A transport aide and an ICU staff member transfer her to the surgical floor.



Surgical floor: an eye to discharge


The nurse manager on the surgical floor at this hospital is an RN who has graduated from a 4-year nursing program. As manager of the unit, this nurse is responsible for all the care given to patients. Mrs. Brown’s team leader is an RN from a 2-year nursing program. This nurse is responsible for formulating a plan of care for each of the assigned patients and modifying these plans as needed.


The team leader receives a verbal report and the current care plan for Mrs. Brown from the ICU personnel. The team leader begins assessment of her new admission. The practical/vocational nurse (LPN/LVN) helps put Mrs. Brown to bed and immediately takes her vital signs. The LPN/LVN is a graduate of a 1-year vocational program in nursing. The LPN/LVN has taken a national examination to become licensed as a practical/vocational nurse. The practical/vocational nurse is assigned to give Mrs. Brown bedside care.


A referral is sent to the physical therapy department. The physical therapist (PT) assesses the strength of Mrs. Brown’s unaffected extremities. The PT sets up a program of exercises and ambulation with no weight bearing on the right extremity. The goal of treatment is to restore function and prevent the development of complications. Physical therapy keeps up the strength of Mrs. Brown’s unaffected extremity until she is able to bear weight fully on the right side. The PT has been educated in a 4- or 5-year college program. Some PTs have a master’s degree in physical therapy. The physical therapy assistant (PTA) has been educated in a 2-year community college or technical school setting. The PTA carries out the plan of care developed by the PT.


Soon after the patient is transferred to the surgical floor, the social worker visits Mrs. Brown and her family to discuss discharge plans. The social worker suggests that Mrs. Brown stay in an extended-care facility for 2 weeks to participate in extensive physical therapy before returning to the farm. Social workers help patients and families solve problems with the financial concerns of hospitalization. They arrange for community agencies to provide appropriate care and services needed by patients after discharge from the hospital. Social workers also help the family communicate their health care needs more clearly. Social workers obtain a bachelor’s degree in social work in 4 years and a master’s degree in 1 additional year of college. Mrs. Brown’s social worker talks to the PT and the family. All agree that with exercise and skills teaching, the family eventually will be able to care for Mrs. Brown at home.


As the time for discharge to the extended-care facility gets closer, a patient care technologist (PCT) is assigned to take Mrs. Brown’s vital signs. PCTs perform treatments and skills assigned to them by the RN or the LPN/LVN. PCTs are trained by the hospital for the specific duties they are to perform. Training involves classes (sometimes autotutorial or self-study classes) and a clinical component. The training a PCT gets is short and varies among facilities. The job titles unlicensed assistive personnel (UAP), nurse’s aide, nursing assistant, and patient care assistant are used in some facilities. The responsibilities of the LPN/LVN in relation to PCTs are discussed in Chapters 20 and 21.


Because Mrs. Brown is 50 pounds overweight, her physician orders a weight-reduction diet. The dietitian teaches Mrs. Brown and her daughter the elements of weight reduction that will be carried out when Mrs. Brown returns to the farm. A hospital’s dietitian is responsible for planning the meals and supplementary feedings for patients and the cafeteria meals for staff. The dietitian also supervises the preparation of food and counsels patients and their families about nutritional problems and therapeutic diets. This health professional is educated in a 4- to 5-year college program, followed by a year of internship in a health care agency.


The housekeeper cleans Mrs. Brown’s room and bathroom every day of her stay. Maintaining cleanliness is an effort to maintain medical asepsis (absence of germs) and to provide a pleasant environment. The housekeeper receives training in the needed skills by the employing institution or through a short course in a technical school.


Finally, Mrs. Brown is discharged from the hospital. She leaves by Medi-Van and is transported to the extended-care facility.



Extended-care unit: on the road to rehabilitation


Mrs. Brown’s roommate in the extended-care facility is an 80-year-old woman who has had a stroke. The roommate is also preparing to go home after additional physical therapy. The PT conducts an initial assessment of Mrs. Brown and incorporates the hospital physical therapy plan of care with her findings. The PTA helps Mrs. Brown daily with exercises and ambulation, using a walker, and minimum weight bearing on her right leg. A nursing assistant (NA) is assigned to assist Mrs. Brown with her personal care. NAs are educated to give bedside care through courses of a minimum of 75 hours. Successful completion of this course of study makes the NA eligible to be placed on the state registry as a certified nursing assistant (CNA).


A referral is sent to the occupational therapy department. The occupational therapist (OT) completes an assessment of Mrs. Brown. The occupational therapy assistant (OTA) carries out the plan of care. The goal for Mrs. Brown is to be as independent as possible when she returns to the farm, despite her physical limitations. Occupational therapy helps patients restore body function through specific tasks and skills. Educational requirements include a 4-year occupational therapy program. Some 4-year graduates pursue a master’s degree in their field. A 2-year program prepares OTAs for their roles.


Mrs. Brown receives her newly prescribed blood pressure medication from the practical/vocational nurse, who also is functioning in her expanded role as charge nurse in this facility. The day supervisor, an RN with a BSN, checks Mrs. Brown daily to monitor her progress. Ten days later, Mrs. Brown excitedly waits for her family to take her back to the farm. She is pleased with her progress and is confident about going back to her home. She knows that at this time she is unable to gather the eggs each day, but she is anxious to get back in the kitchen.



image   Critical Thinking


Who Is Responsible for Mrs. Brown’s Recovery?


Who is responsible for Mrs. Brown’s return to the farm?



Health care team


A primary goal of health care is to restore optimal physical, emotional, and spiritual health to patients. This goal is accomplished by promoting health, preventing further illness, and restoring health when illness or accident has occurred. Health care includes a large number of specialized services. It is necessary for these health care workers to work together to integrate care that will provide patients with all the services they need to maintain safe, quality, comprehensive health care. These groups of health care workers are called the health care team.


For Mrs. Brown to be rehabilitated after her fall, it took a minimum of 127 years of education for all the health care workers in this scenario to learn how to perform their respective jobs. The x-ray technician’s x-ray film confirmed the presence of a hip fracture. The pharmacist supplied the narcotic pain reliever that relieved pain after the surgical procedure, allowing Mrs. Brown to move more freely and avoid complications. The treatment by the RRT helped prevent pneumonia. The PTs, OTs, and nursing staff all helped restore Mrs. Brown’s health and prevent further illness by avoiding complications. The dietitian’s expertise allowed Mrs. Brown to receive the basic nutrients she needed to maintain her health, heal her fracture, and lose weight. Teaching about weight-reduction diets promoted health by pointing out the importance of keeping Mrs. Brown’s weight within acceptable limits.


As you can see from Mrs. Brown’s case, each member of the health care team, because of his or her specific preparation in a field of study, can increase the quality of health care for a patient. It is impossible for one person to provide the knowledge, expertise, and skills that the health care team as a whole can provide. Everyone needs to work together. It is a team effort.


The members of the health care team are generally on duty in acute or residential health care organizations 24 hours a day, 7 days a week. Some members of the health care team may not be scheduled at night or on weekends or holidays, and some of these persons are available on an on-call basis. In the community, health care workers’ hours vary depending on the site of employment. Some sites are open Monday through Friday, during day hours only, whereas others also offer services in the evening. Other sites are open 7 days a week and sometimes 24 hours a day.


Each member of the health care team needs to have good communication skills. Good communication ensures that care is coordinated for the patient’s benefit (see Chapter 13). Fragmentation of care can be avoided. Each health care team member has to be able to anticipate problems and avoid them when possible. This is accomplished by using critical-thinking skills. When problems do occur, the health care team needs to use problem-solving skills to find solutions in the process of delivering care. In this way the quality of patient care is continuously improved. The team must strive continually to keep its care patient-centered. The team needs to realize that a cooperative effort is needed to reach patient goals.



What is nursing?


Virginia Henderson (1966), a nursing theorist, stated, “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform if he had the necessary strength, will, or knowledge.” Henderson refers to nursing’s interest in illness and wellness. The direction of practical/vocational nursing has been channeled by this definition. For a definition of nursing Google Nursing’s Social Policy Statement of the American Nurses Association @ ANA.org.


It is necessary for practical/vocational nurses to understand their role in Mrs. Brown’s care. An understanding of the education, licensure, roles, and responsibilities of the varied members of the health care team is also necessary



Nursing’s place on the health care team


Nursing staff on the health care team includes unit managers, RNs, LPNs/LVNs, student nurses, NAs, and cross-trained staff. UAPs assist the nursing staff. Clerk receptionists, although not nurses, are an important part of the unit staff. Most people are unaware of the different types of nurses on the health care team. Sadly, some RNs do not know the educational requirements for LPNs/LVNs, and some LPNs/LVNs do not know what education professional nursing entails. A common question from the public is “What is the difference between a registered nurse and a licensed practical/vocational nurse?” Members of the health care team generally, and nursing specifically, need to know about one another. For this reason, general information about the education for and the many roles of registered nursing is provided in this section, which describes the members of the nursing team.

Related posts:

  1. Critical Thinking: A Lifelong Journey
  2. Time Management: Making Time Work for You
  3. How Practical/Vocational Nursing Evolved: 1836 to the Present
  4. Assertiveness: Your Responsibility

Stay updated, free articles. Join our Telegram channel
Tags:
Mar 1, 2017 | Posted by in NURSING | Comments Off on The Health Care Team: Where the Practical/Vocational Nurse Fits In

Full access? Get Clinical Tree
Get Clinical Tree app for offline access