Nursing

1. Nursing

2. In the past, nursing was viewed primarily in terms of direct patient care roles, mainly in hospitals • Now - nearly 50% of nurses work in settings outside of hospitals(hospice care, home care, and nursing home care) • Nurses develop their own group practices • Nurses can build careers in the "business" side of nursing

3. In the first edition of the Random House Dictionary (1966) the verb "to nurse" means to foster or cherish (доглядати, бавити), to treat or handle with adroit care; to bring up, train, or nurture; to handle carefully or fondly; to preserve. "Nurse" suggests attendance and service; its antonym is neglect (зневага).

4. In Random House Collegiate Dictionary (1995), the first meaning of "nurse" is "a person formally educated in the care of the sick or infirm, especially a registered nurse"

5. Legal definitions in nurse practice acts exist to protect the public and to protect the title. • North Carolina was the first state to pass a licensing law (1903), and it was intended to protect the title, not to define the practice. The early statutes were certification laws, permissive rather than mandatory, and in general permitted anyone to perform legally the functions of a nurse, even for compensation, but only those who were licensed could use the RN title (Hadley, 1989).

6. Inclusion ... of the diagnostic function would authorize the nursing practitioner to make nursing diagnoses, not medical diagnoses. Whereas the diagnostic function as an intellectual process is central to the practice of any number of professions, including medicine and nursing, the focus of this function varies among these professions. For example, the focus in medicine is the nature and degree of pathology or deviaion from normality; within nursing the focus is the individal's response to an actual or potential health problem and the nursing needs arising from such responses. [Driscoll, 1976, p. 61; italics in original]

7. "Nursing is the diagnosis and treatment of human responses to actual or potential health problems" (ANA, 1980)

8. Staff Nurses Working in Hospitals • At present, 59.6% of all employed nurses work in hospitals, and this number is projected to decrease to 52.8% by 2008 • In 1992, 84% of all registered nurses 30 years old or younger worked in hospitals, whereas only 50% of nurses over 50 worked in hospitals. • Most hospital nurses work in general medical and surgical units (40%), but many work in acute care units such as critical care (18%), operating rooms (7%), and emergency rooms (8%).

9. The current demographics of RNs in the United States in 1996. • 2,558,874 people were licensed as RNs • 82.7% were currently employed as RNs, and 60% were working in hospitals • The number of male RNs in 1996 was 5.4%, which is a substantial increase from the 3% in 1980. Moreover, in 1996 nearly 12% of newly licensed RNs were men

10. About 10% of RNs come from racial or ethnic minorities: • 4.2% were African American; • 3.4% were Asian or Pacific Islander; • 1.6% were Hispanic; • and 0.5% were Native American. • Again, when we look at the numbers of newly licensed RNs, we see steady change: 5.5% were African American; 6% were Asian or Pacific Islander; 3% were Hispanic; and 0.8% were Native American (NCSBN, 2000).

11. The average salary of a full-time RN in 1996 was $42,000, which was an 11% increase over RN salaries in 1992 • Most employed RNs (58.4%) had less than a baccalaureate degree: 31.8% had a baccalaureate as their highest degree; 9.1% had a masters as their highest de­gree; and 0.6% were doctorally prepared.

12. For nurses working in large hospital centers, increased specialization is common. • In small rural hospitals, however, nurses are often called upon to be generalists, to be competent in caring for an older person with a cardiac condition as well as in emergency room treatment of an injured child.

13. Within hospitals, nurses are caring for sicker patients for shorter periods of time with ever more sophisticated technology. Hospital staff nurses require expert clinical and communication skills to: • 1. Monitor and care for their patients • 2. Counsel their patients' families • 3. Interface and collaborate with other health care providers as part of a health care team • 4. Keep up with rapid technological advances • 5. Effectively use information systems to manage patient care • 6. Participate in clinical research.

14. Today's hospital nurses have to supervise and delegate nursing duties to unlicensed assistive personnel • 1. Staff nurses need to know exactly what is allowed under their state practice acts; for example, they should not delegate nursing assessments and judgment. • 2. Staff nurses need to be the ones who train the unlicensed assistive personnel to perform the tasks or to monitor the patients so that they know exactly what the assistant can do. • 3. Staff nurses need to develop protocols for the unlicensed assistive personnel to work under. • 4. Staff nurses need to supervise the care given (King, 1999).

15. Causes of staff shortage • overwork • work-related stress • mandatory overtime • drops in student enrollment • cost cutting by hospitals • increased job opportunities for women • health risks at the workplace (risk of infection, sensitivity to latex) • workplace violence

16. Hospitals and nursing homes account for 64% of workplace violence, and health care workers have a 16 times greater risk of sustaining a fatal injury on the job than the general population has (ANA, 2000c; Smith-Pittman & McKoy, 1999).