NURS 2210-Roles II

Unit 1: Role of the RN in the Health Care System

Nancy Pares, RN, MSN

Levels of education

• Cert. Nurse Assistant, Med Aide• LPN; LPN-C• ASN• BSN• MSN; APRN• PhD• Specialists: Wound Care, Ostomy, Care

Management, Diabetes,

Roles/Functions

• Direct care provider• Communicator• Educator• Advocate• Counselor• Change agent• Leader• Manager/case manager• Research consumer

Roles/functions

• Administrator• Researcher• Clinic setting• Hospice• Clinical Nurse Specialist

• 1. decision making• 2. relating• 3. influencing• 4. facilitating

Scope of Practice

• Nebr Statute 38-2212• Practice of nursing defined:– The practice of nursing by a registered nurse

means assuming responsibility and accountability for nursing actions

• Nursing actions include, but are not limited to– Assessing human responses to actual or potential health conditions– Establishing nursing diagnosis– Establishing goals and outcomes to meet identified health care needs– Establishing and maintaining a plan of care– Prescribing nursing interventions to implement the plan of care– Teaching health care practices– Delegating, directing, or assigning nursing interventions that may be

performed by others and that do not conflict with the Nurse Practice Act

– Maintaining safe and effective nursing care rendered directly or indirectly

– Evaluating responses to interventions, including, but not limited to, performing physical and psycholological assessments of patients under restraint and seclusion as required by federal law, if the registered nurse has been trained in the use of emergency intervention

– Teaching theory and practice of nursing– Conducting, evaluating and utilizing nursing research– Administering, managing and supervising the practice of nursing– Collaborating with other health professionals in the management of

health care

• Visit NHHS web site• http://dhhs.ne.gov/crl/nursing/rn-lpn/apps.ht

m

Compact stateshttps://www.ncsbn.org/nlc.htm

• Advisory Opinions– Pronouncement of death– Meds when pharm closed– PICC lines– Arterial lines– IV sedation– Casting– CPR– cardioversion

Benner’s stages of nursing expertise

• Stage I Novice– Nursing student

• Stage II, Advanced Beginner – Demonstrates marginal performance

• Stage III, Competent– Licensure, 2-3 years experience

• Stage IV, Proficient– Licensure, 3-5 years experience

• Stage V, Expert– Highly skilled, fluid, intuitive, analytical

Evidenced based practice• The integration of best research with clinical

expertise and patient values• Levels– 1 : evidence obtained of all randomized control

trials (RCT)– 2: properly designed study-non RCT– 3:A: controlled trials/non randomized• B: case controlled analysis/ > one center/group• C: multiple time series with dramatic results

– 4: opinions, clinical expertise reports

Research Designs• Quantitative– Conclusions that produce new knowledge• Descriptive*• Retrospective• Prospective• Correlational*• Experimental*• Quasi experimental

Steps in Quantitative • Phase I--conceptual

• Phase 2-design/planning

• Phase 3-empirical

• Phase 4-analysis

• Phase 5-dissemination

Qualitative designs

• Subjective, small sample, events as they occur; often biased-– Biographical– Case Study– Ethnography– Phenomenology– Literature Review

Elements of Research Proposal

• Sampling• Measurement techniques• Data collection and analysis• Results• Implications for nursing

Implementation into practice

• Research utilization• Changing of nursing practice• Application of legal/ethical principles• Role of ADN– Identify what needs to be changed– Assist in data collection– Put findings into practice

Examples of change

• Heart failure centers• Saline vs heparin lock• Vent tube changes• Music in the hospitals• Fall risk assessment

Critical Thinking

• Multi dimensional skill, involves reasoning, systematic, reflective, rational, outcome directed thinking based on knowledge and available information.

Components of Critical thinking• Ask questions• Gather information to consider all factors• Validate the information• Analyze the information• Draw on past experiences; acknowledge personal bias• Maintain flexible attitude• Consider options related to advantages and

disadvantages• Formulate decisions that reflect creativity and

independent decision making

The inquiring mind

• What does this tell me?• What is the most

important?• Is anything missing?• Do I need more help?• What are the risks?• What are the

complications?• What do I want to

happen?

• What should I do first?• Do family dynamics

have affect?• Is culture an issue?• Are my ethics in line?• What does nursing

research support?

Characteristics of Nurses with critical thinking skills

• Creative• Logical, rational• Prudent, inquisitive• Self regulating

judgment• Intellectual humility• Independent thinking• Willing to take risks

• Action oriented• Recognizes patterns in

phenomenon• Focused thoughts• Blends logic and

intuition• Anticipates events• Works collaboratively

and respects perspectives of others

Barriers to critical thinking

• Physical/emotional states• Personal characteristics• Agency policy• Intellectual courage (or lack of)

Skillful critical thinking

• Interpretation– Catagorize,clarify

• Analyze• Infer• Explain• evaluate