Digesting the Alphabet Soup of Nursing: Choosing Your Career Path

1. Digesting the Alphabet Soup of Nursing: Choosing Your Career Path Colleen O’Leary MSN, RN, AOCNS® The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

2. Significance • Epidemiology of U.S. Nursing • 2.8 million nurses • 250,000 APN’s • 150,000 graduates each year • 28,000 RN BSN in 2011 • 24,000 Master degrees • 2200 Doctoral degress • Demographics • Average age of 36 in 1980 • Average age of 47 now • 26.6% are under age 40 • 1/3 are over age 50 American Association of Colleges of Nursing, 2014; U.S. Department of Labor, 2014; U.S. Department of Health and Human Services, 2014

3. The Future of Nursing: Leading Change, Advancing Health • Nurses should practice to the full extent of their education and training. • Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. • Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. • Effective workforce planning and policy making require better data collection and information infrastructure. Institutes of Medicine, 2010

4. Roles and Skills Nurse Roles Skills Needed To Advance Leadership Mentorship Critical thinking Clinical decision making • Leader • Negotiator • Facilitator • Change agent • Communicator

5. Advanced Practice Nurses (APN) • Master’s level prepared • Licensure dependent • Require additional board certification • Types • Nurse Practitioner (NP) • Clinical Nurse Specialist (CNS) • Certified Nurse Midwife (CNM) • Certified Registered Nurse Anesthetist (CRNA)

6. Nurse Practitioner (NP) • Must have advanced degree • Master’s or Doctoral • National certification • Periodic peer review • Clinical outcome evaluations • Code of ethics for practice

7. NP • Practice locations • Rural • Urban • Suburban • Clinics • Hospitals • Emergency rooms • Urgent care sites • Private physician practices • Private NP practices • Nursing homes • Schools • Colleges • Public health departments • Pharmaceutical companies • Services provided • Ordering, performing and interpreting diagnostic tests • Diagnosing and treating acute and chronic conditions • Prescribing medications and other treatments • Managing patients’ overall care • Counseling • Educating patients on disease prevention and positive health and lifestyle choices

8. NP • Specialty Areas • Acute care • Adult Health • Family Health • Gerontology Health • Neonatal Health • Oncology • Pediatric/Child Health • Psychiatric/Mental Health • Women’s Health • Sub-specialty areas • Allergy and immunology • Cardiovascular • Dermatology • Emergency • Endocrinology • Gastroenterology • Hematology & Oncology • Neurology • Occupational Health • Orthopedics • Pulmonology & Respiratory • Sports Medicine • Urology • Radiation Oncology

9. NP Core Competencies • Scientific Foundation • Leadership • Quality • Practice • Technology and Information Literacy • Policy • Health Delivery Systems • Ethics • Independent Practice The National Organization of Nurse Practitioner Faculties

10. NP Certifications

11. Why NPs are Important • NP Credibility • Care providers, mentors, educators, researchers, administrators • Ensures that professional standards are maintained • Lower health care costs • Patients who see NPs as primary provider have few ER visits, shorter LOS and lower medication costs • Patient satisfaction • 916 million NP visits each year • Patients report extremely high satisfaction with care • Primary care shortage solution • NPs provide high-quality, cost-effective care American Association of Nurse Practitioners, 2014

12. Clinical Nurse Specialist (CNS) • Must have advanced degree • Masters or Doctorate • National Certification • Periodic peer review

13. CNS • Practice locations • Rural • Urban • Suburban • Clinics • Hospitals • Emergency rooms • Home health care • Long term care • Nursing homes • Public Health centers • Ambulatory care • Pharmaceutical companies • Services provided • Direct patient care • Staff development • Improving healthcare system • Improving patient outcomes • Care coordination • Monitoring quality indicators • Prescriptive authority** • Clinical expert • Researcher • Educator • Consultant • Leader

14. CNS Specialty Areas • Population • Pediatrics • Geriatrics • Women’s health • Setting • Critical care • Emergency room • Disease or medical subspecialty • Diabetes • Oncology • Type of Care • Psychiatric • Rehabilitation • Type of health promotion • Pain • Wounds • stress

15. CNS Practice Roles Spheres of Influence Patient/Family System Staff • Clinical Expert • Researcher • Educator • Consultant • Leader

16. CNS Core Competencies • Direct Care • Consultation • System Leadership • Collaboration • Coaching • Research • Ethical Decision Making, Moral Agency and Advocacy

17. CNS Certifications

18. Types of Midwives • Certified Nurse Midwife (CNM) • Certified Midwife (CM) • Non-nurses • Bachelor’s degree in another field • Graduate level midwife education • National certification • Same scope of practice as CNM • Certified Professional Midwife (CPM) • Either apprenticeship or formal educational program • More narrow scope of practice • Cannot prescribe

19. Certified Nurse Midwife (CNM) • Must have advanced degree • Masters or Doctorate • National Certification • Periodic peer review

20. CNM • Practice locations • Rural • Urban • Suburban • Private practice • Hospitals • Birth centers • Health clinics • Home birth services • Services provided • Attending birth • Reproductive health visits • Regular gynecologic care • Peri-/post-menopausal care • Primary preventative care • Family planning needs • Treatment of sexually transmitted diseases

21. CNM Specialty Areas • Clinical practice • Education • Administration • Research • Health policy • Legislative affairs

22. CNM Core Competencies • Hallmarks of Midwifery • Professional Responsibilities • Midwifery Management Process • Fundamentals • Care of Women • Care of Newborn

23. Midwife Certifications

24. Certified Registered Nurse Anesthetist (CRNA) • Must have advanced degree • Masters or Doctorate • National Certification • Periodic peer review

25. CRNA • Practice locations • Hospital surgical suites • Obstetrical delivery rooms • Critical access hospitals • Ambulatory surgical centers • Offices of • Dentist • Podiatrist • Ophthalmologist • Plastic surgeon • Pain management specialists • Military healthcare facilities • Public health services • Veteran’s Affairs • Services provided • Administration of every type of anesthesia for every type of procedure

26. CRNA Specialty Areas • Clinical practice • Administration/Management • Quality assessment • Education • Research • Clinical/administrative oversight of other departments

27. CRNA Core Competencies • Preanesthetic preparation and evaluation of patients • Intraoperative care • Postanesthesia care • Special requests

28. CRNA Certifications

29. Other Advanced Degree Titles • Clinical Nurse Leader • Nurse Educator • Nurse Researcher • Doctor of Philosophy • Doctorate of Nursing Practice

30. Clinical Nurse Leader (CNL) • Master’s or post master’s prepared • Certified by the Commission on Nurse Certification • An arm of ANCC • http://www.aacn.nche.edu/cnl/cnc • Oversees the care coordination and integration of care for a distinct group of patients

31. CNL Role • Provides and manages care at the point of care to individuals, clinical populations and communities • Responsibilities: • Clinical management • Planning of client’s contacts within the healthcare system • Coordination and planning of team activities and functions • Supervise and evaluate delegatees • Design and implement care • Improve individual care outcomes • Maintain quality and cost effectiveness • Use of up to date technology to deliver care • Critically evaluate and anticipate risks to client safety • Profile patterns of need and tailor interventions within a population • Client advocacy

32. CNL Competencies • Background for practice from sciences and humanities • Organizational and systems leadership • Quality improvement and safety • Translating and integrating scholarship into practice • Informatics and healthcare technologies • Health policy and advocacy • Interprofessional collaboration for improving patient and population health outcomes • Clinical preventions and population health for improving health • Master’s level nursing practice

33. Nurse Educator • Registered nurses with advanced degree who are also teachers • Faculty members in nursing schools and teaching hospitals • Typically work in academic settings at nursing schools, community colleges and technical schools • Certified through the National League for Nursing • www.nln.org/Certification/ • CNE

34. CNE Roles/Responsibilities • Develop lesson plans • Teach courses • Evaluate educational programs • Oversee student’s clinical practice • Manage nurse education programs • Writing or reviewing textbooks • Developing continuing education programs for working nurses

35. CNE Competencies • Facilitate learning • Facilitate learner development and socialization • Use assessment and evaluation strategies • Participate in curriculum design and evaluation of program outcomes • Function as a change agent and leader • Pursue continuous quality improvement in the nurse educator role • Engage in scholarship • Function within the educational environment

36. Nurse Researcher • Scientist who study various aspects of health, illness and health care • Work in a variety of healthcare settings including • Universities, research organizations, laboratories, private organizations • Skilled writers • Competitive grant writing • Report study results • Prepare journal articles

37. Role of the Nurse Researcher • Principle Investigator on studies • Coordinate day-to-day management of study • Preparing trial protocols • Submitting proposals for regulatory approval • Ensuring informed consent • Randomization and collection of data • Reporting of adverse events • Patient advocacy and assuring patient protection • Build knowledge base to provide evidence to guide interventions by other nurses

38. Scope of Nursing Research • Clinical research • Acute, chronic care experiences, promotion, prevention and end of life care • Health system and outcomes research • How do organization and delivery of care influence quality, cost and patient/family experience • Nursing education research • Developing and testing more efficient educational processes • Identifying ways to incorporate technology in order to enhance learning • Discovering more effective approaches to promoting life-long learning AACN, 2014

39. Key points for Nurse Researcher • Clinical research is vital for finding new treatments and improving patient care • Research nurses need a thorough understanding of the research process and terminology • The nurses act as patient advocates, ensuring they are protected and supported • Research nurses need a wide range of skills including management and organization, teaching and monitoring, communication and IT • Working with other researches and the multidisciplinary team is crucial for successful research Pick, A., et al. (2011)

40. DNP vs. PhD

41. Indirect Care Roles • Public Health Nurse • Graduate level education traditionally • Moving towards DNP • Competencies available • Much attention to clinical prevention and population health • Informaticist • Technology Informatics Guiding Education Reform (TIGER) • Clinical Research Coordinator • Works with doctorally prepared nurse or health professional researcher • Nurse Administrator or Manager • AACN recommends master’s or doctorate • AONE developed competencies • Two certifications • Certified in Executive Nursing Practice (CENP) • Certified Nurse Manager and Leader (CNML

42. The Ohio State University CCC: James Cancer Hospital, 2013 Used with permission

44. Education Pathway James nurses recognize that lifelong learning is a professional imperative for members of a nursing specialty that is ever changing. Educators promote professional development as an ongoing process by which knowledge and skills are attained to enhance clinical competence, comply with professional and regulatory standards, integrate research findings, and incorporate new technology. Workforce development strategies support staff as their professional interests change and our organizational needs evolve. Educators also prepare other nurses to provide comprehensive teaching to the patients, families, colleagues, and communities we serve. ROLES • Preceptor • Patient • Education Liaison • Course Instructor • RN Continuing • Education Planner • Staff Development • Coordinator • Nurse Educator • Clinical Faculty

45. Professional Development: Education Pathway Developing Self Preceptor Course BLS/ACLS/PALS Instructor Course OSU Leadership Academy Emotional Intelligence Series Nursing Leadership Development Series DMAIC Training OSU Learning Technologies Workshops OSU College of Nursing Center for Transdisciplinary Evidence-based Practice (CTEP) Academic Course Work Collaborating With Colleagues Unit Council Unit Collaboration Council RN Continuing Education Planner Professional Development Council Nursing Excellence Fair Connecting With Community Oncology Nursing Society (ONS) Speaker Training Web Course Association of Nursing Professional Development (ANPD) ANPD Getting Started as a Staff Educator Columbus Chapter ONS (CCONS) Oncology Nursing Society (ONS)

46. Research Pathway James nurses promote discovery and learning through a rich culture of inquiry. By asking questions and challenging clinical practices that lack supporting empirical evidence, nursing research studies are developed, new knowledge is generated, and oncology nursing practice is advanced. By taking bench research findings to bedside practice, groundbreaking cancer research is translated to innovative patient care. James nurses consistently integrate research findings into clinical practice to ensure quality outcomes and enhance performance improvement. ROLES • Evidence-Based Practice Mentor • Clinical Trials Nurse • Nurse Researcher • Research Faculty

47. Professional Development: Research Pathway Developing Self DMAIC Training Collaborative Institutional Training Initiative (CITI) Nursing Leadership Development Series Contents of a Research Proposal OSU College of Nursing Center for Transdisciplinary Evidence-based Practice (CTEP) Nursing Research Fellowship Academic Course Work Collaborating With Colleagues Research Council Annual Nursing Research Day Nursing Excellence Fair Oncology Nursing Society (ONS) Columbus Chapter Oncology Nursing Society (CCONS) Clinical Scientific Review Committee (CSRC) Internal Review Board (IRB) Connecting With Community ONS: Developing Skills for Evidence-Based Practice American Organization of Nurse Executives (AONE) OSU College of Nursing

48. Clinical Care Pathway James nurses practice to the fullest extent of their education and licensure in unique clinical roles and diverse settings by accepting responsibility, accountability, and authority for providing exquisite relationship-based care. Our exemplary professional practice is autonomous and collaborative, safe and ethical; it is supported by professional standards, research evidence, and quality measures. James nurses consistently demonstrate clinical expertise, critical thinking skills, disease-specific knowledge, interpersonal effectiveness, and holistic care of mind, body, and spirit. ROLES Staff Nurse III Staff Nurse IV Quality Nurse Patient Care Resource Manager Clinical Nurse Specialist Nurse Practitioner

49. Professional Development: Clinical Care Pathway Developing Self End of Life Nursing EducationConsortium (ELNEC) Expert Symptom Management Failure to Rescue: When It’s Time to Worry Oncology Certified Nurse (OCN) Review Conflict Management for Team Members Culture Shaping and Life Effectiveness Annual Advanced Practice Nurse Conference CREW Resource Management Primary Nurse Practicum Clinical Ladder Program Collaborating With Colleagues Unit Council Unit Collaboration Council Magnet Council Clinical Practice Council Midlevel Provider Council Super User for New Technology Connecting With Community Professional Organization Online Learning Programs Professional Organization Continuing Education Programs Professional Organization – Local Chapter Meetings and Programs OSU College of Nursing

50. Leadership Pathway James nurses demonstrate leadership by developing and sustaining caring relationships with the staff they support to ensure quality care for patients and families. Each transformational leader embraces a commitment to shared decision-making aligned with the James nursing vision, mission, philosophy, and values. This ensures that James nurses have a strong voice in decision-making and control over nursing practice. Communication is transparent and feedback is encouraged. James nursing leaders consistently model accessibility and advocacy so that colleagues are heard, valued, and supported. ROLES Charge Nurse Clinical Nurse Leader Administrative Nursing Supervisor Assistant Nurse Manager Nurse Manager Director Chief Nursing Officer