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Health Professionals - The People in Health Care - Lecture 2_slides
- 2. The Culture of Health Care Health ProfessionalsāThe People in Health Care Lecture b This material (Comp2 Unit 2) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
- 3. Health Professionals ā The People in Health Care Learning Objectives ā¢ Define terms used in health care and in health professionalsā education and training, including clinician, patient/consumer, disease, and syndrome. (Lecture a) ā¢ Describe the education, training, certification, licensure, and roles of physicians, including those in primary care and other specialties. (Lecture a) ā¢ Describe the education, training, certification, licensure, and roles of nurses, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides. (Lecture b) ā¢ Describe the education, training, certification, licensure, and roles of physician assistants, pharmacists, therapists, and allied health professionals. (Lecture c) ā¢ Describe the education, training, certification, licensure, and roles of paramedics, emergency medical technicians, dental professionals, mental health professionals, and social workers. (Lecture c) 3
- 4. Nurses ā¢ Education ā Diploma ā Associateās degree ā Bachelor of science ā Bridge programs for RN to BSN ā¢ Clinical training ā Part of the education process ā¢ Additional training programs 4
- 5. Nurses Continued ā¢ Certification ā Certification is not required for licensure, but nurse licensure is required for nurse certification programs ā Many specialty certification programs are available ā¢ Licensure ā Requires successful completion of a accredited nursing school program ā NCLEX-RN 5
- 6. Nursing Roles ā¢ Provide direct patient care and coordinate care activities with other ancillary/allied health professionals based on physician orders and the patientās plan of care ā¢ Continuous patient assessment, monitoring, and planning of care ā¢ Diagnostic tests and treatments ā¢ Medication administration ā¢ Patient and family education ā¢ Emotional support 6
- 7. Specific Nursing Roles in a Hospital Setting ā¢ Hospital medical-surgical nurse ā Care for patients with medical and surgical problems ā May obtain certification but not always required ā¢ Specialized nursing roles ā Specific disease or specialty o Diabetic nursing o Emergency nursing o Rehabilitation nursing o Neurosurgery nursing 7
- 8. Specific Nursing Roles in Other Provider Settings ā¢ Ambulatory care facilities ā Similar to hospital-based units ā¢ Home health, hospice, patientās medical home ā Medication administration, wound care, postoperative care, physical therapy ā¢ Long-term care, nursing homes ā Provides constant care and assistance with activities of daily living ā¢ Public health clinics ā Focus on population health with health promotion and disease prevention 8
- 9. Advanced Practice Nursing ā¢ Nurse practitioner ā Education: Usually requires a masterās degree in nursing with specific clinical and diagnostic training ā Training: Programs include clinical training in physical diagnosis, managing acute and chronic disease, wellness care, and prescribing medication 9
- 10. Advanced Practice Nursing Continued ā¢ Nurse practitioner ā Certification: Most states require certification in their area of specialty o Examples: Family nurse practitioner (FNP), pediatric nurse practitioner (PNP), geriatric nurse practitioner (GNP) ā Licensure o States vary on the roles allowed to nurse practitioners, including prescription privileges and whether they may practice independently ā Roles o Nurse practitioners function most often as primary care providers, including preventive, acute, and chronic care 10
- 11. Nurse Midwives ā¢ Education ā Postgraduate or graduate program ā Must have a BSN to become a certified nurse midwife ā¢ Training ā Most include courses in advanced practice nursing (physical diagnosis, pharmacology, pathophysiology) ā Clinical course and practice in ante-, intra-, and postpartum care and care of the newborn 11
- 12. Nurse Midwives Continued ā¢ Certification ā Only a few of the nurse midwife programs are post-baccalaureate programs ā¢ Licensure ā Licensed in all 50 states and the District of Columbia ā¢ Role ā Provide routine gynecology services and prenatal, delivery, and postnatal care 12
- 13. Nurse Anesthetist ā¢ Education ā Must have a BSN ā Certified registered nurse anesthetist (CRNA) programs are masterās degree programs ā¢ Training ā Most include courses in advanced practice nursing (physical diagnosis, pharmacology, pathophysiology) ā Clinical course in anesthesia simulation labs and practicums in clinical anesthesia 13
- 14. Nurse Anesthetist Continued ā¢ Certification ā National certification exam ā Must have 40 hours of continuing education every two years to renew ā¢ Licensure ā Most are licensed by the state board of nursing ā¢ Roles ā Provide a significant amount of anesthesia care in the United States and usually practice with physicians but are relatively autonomous 14
- 15. Nonclinical Roles of Nursing ā¢ Administration ā¢ Research ā¢ Education ā Nursing school ā Continuing nursing education ā¢ Case management ā¢ Nursing/clinical informatics 15
- 16. Licensed Practical Nurse ā¢ Education ā 12 to 18 months of training postāhigh school ā¢ Training ā Includes training in medical terminology, introduction to anatomy and physiology, introduction to pharmacology, and practical nursing clinical course ā¢ Certification ā Usually results in a certificate of attendance 16
- 17. Licensed Practical Nurse Continued ā¢ Licensing ā All states and the District of Columbia require a licensing exam ā Licensed by the state board of nursing ā¢ Role ā Provide more direct care ā Work under supervision of registered nurse or physician ā State laws vary but most allow LPNs to start and administer IV therapy, and many allow LPNs to administer IV medications except IV push 17
- 18. Medical Assistants ā¢ Variable education: One year (certificate) to two years (associateās degree) ā¢ Most receive training in medical terminology, office administration, coding and reimbursement, laboratory procedures, office patient care, medications ā¢ Not licensed ā¢ Role includes routine administrative and clinical duties 18
- 19. Medication Aides ā¢ Extremely variable education/training ranging from 15 to 70 contact hours ā¢ Most states require an exam and supervised administration for some period of time ā¢ Some states specify training as a certified nursing assistant as a prerequisite ā¢ Most states license medication aides ā¢ Roles are variable but usually include the administration oral, topical, and nebulized or metered inhaled medication. Many states restrict medication aides to long-term care or assisted living facilities 19
- 20. Nursing in 2025 ā¢ Nursing supply could exceed demand, but availability will be uneven, and several factors could cause a shortfall ā¢ The need for nurses (RNs) and advanced nurse practitioners will increase with the anticipated physician shortage ā¢ Colleges and universities are not able to keep up with demand due to lack of qualified faculty American Association of Colleges of Nursing, 2014 20
- 21. Nursing in 2025 Continued ā¢ Solving the potential shortage requires a multipronged approach that involves: ā Innovation in care delivery ā Effective use of technology ā Efficient use of all health professionals on the care team 21
- 22. Health ProfessionalsāThe People in Health Care Summary ā Lecture b ā¢ In this lecture, we ā Described the education, training, certification, licensure, and roles of o Nurses o Advance practice nurse o Licensed practical nurse o Medical assistants o Medication assistants ā Discussed some specific type of nurses and nursing setting ā Described nonclinical roles of nurses 22
- 23. Health ProfessionalsāThe People in Health Care References ā Lecture b References American Association of Colleges of Nursing (AACN). (2014). Nursing shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage American Board of Medical Specialties. (2016). Board certification and maintenance of certification. Retrieved from http://www.abms.org/board-certification American Medical Association. (2016). Obtaining a medical license. Retrieved from http://www.ama- assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page American Medical Association. (2016). Becoming a physician. Retrieved from http://www.ama- assn.org/ama/pub/education-careers/becoming-physician.page American Nurses Association. (2016). American Nurses Credentialing Center. Retrieved from http://www.nursecredentialing.org/Certification Explore Health careers.org. (2016). Career explorer. Retrieved from http://explorehealthcareers.org/en/home HRSA (Health Resources and Services Administration Health Workforce). (2016). Health workforce research. Retrieved from https://bhw.hrsa.gov/health-workforce-analysis/research MedlinePlus. (2014). Health occupations. Retrieved from https://www.nlm.nih.gov/medlineplus/healthoccupations.html MedlinePlus. (2012). Medical dictionary. Retrieved from http://www.nlm.nih.gov/medlineplus/mplusdictionary.html 23
- 24. Health ProfessionalsāThe People in Health Care References ā Lecture b Continued National Association of Advisors for the Health Professions. (2013). Health professions links. Retrieved from http://www.naahp.org/PublicResources/HealthProfessionsLinks.aspx NIH MedlinePlus. (2011). Life works: Explore health and medical science careers. NIH MedlinePlus. Summer. Retrieved from https://medlineplus.gov/magazine/issues/summer11/articles/summer11pg24-25.html U.S. News and World Report. (2016). Best health care jobs. Retrieved from http://money.usnews.com/careers/best-jobs/rankings/best-healthcare-jobs 24
- 25. The Culture of Health Care Health ProfessionalsāThe People in Health Care Lecture b This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. 25
Editor's Notes
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- Welcome to The Culture of Health Care: Health ProfessionalsāThe People in Health Care. This is Lecture b. The component, The Culture of Health Care, addresses job expectations in health care settings, the organization of patient care within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.
- The objectives for Health ProfessionalsāThe People in Health Care are to: Define terms used in health care and in health professionalsā education and training, including clinician, patient/consumer, disease, and syndrome. Describe the education, training, certification, licensure, and roles of physicians, including those in primary care and other specialties. Describe the education, training, certification, licensure, and roles of nurses, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides. Describe the education, training, certification, licensure, and roles of physician assistants, pharmacists, therapists, and allied health professionals. Describe the education, training, certification, licensure, and roles of paramedics, emergency medical technicians, dental professionals, mental health professionals, and social workers.
- This lecture describes the education, training, certification, licensure, and roles of nurses. There are several ways to become a registered nurse, or RN. Diploma programs were more common in the past and were usually two- to three-year programs that focused mostly on clinical skills. An associateās degree in nursing is a two-year program with a similar clinical focus. The BSN, or bachelor of science degree in nursing, is the preferred degree program. It includes general study requirements (math, science, social sciences, and humanities) along with preclinical and clinical course work. Nurses with a diploma or an associateās degree may be able to attain a BSN using a bridge program that allows them to apply credit for courses already taken. Advance nurse practitioner opportunities require a BSN along with additional study in the area of specialization. Also, most nursing administration positions require a BSN and may require a graduate-level degree such as a masterās degree in nursing. Clinical training is a part of all three types of training programs. It includes coursework to gain an understanding of clinical principles and clinical work in hospitals and other health care provider settings under direct supervision. New graduate entry-level nurses must work under the supervision of a licensed, experienced nurse until they obtain their state nursing license, which is achieved by passing an exam. Also, nurses may elect to specialize in their area of clinical practice, which is achieved through additional training programs provided by hospitals and other organizations.
- Formal certification is not required for most nurses at the RN or BSN level. However, many nursing certifications are offered in a variety of clinical specialty areas, such as cardiac medicine, emergency nursing, medical-surgical nursing, and pediatric nursing. Specialty certification may be obtained for work settings other than the hospital environment. For example, a hospice nurse often works in patientsā homes and may earn a certified hospice and palliative nurse (CHPN) certification through the hospice and palliative credentialing center. (Hospice nurses provide care for patients and their families with life-limiting illness or injury.) Specialty certification may also be obtained for nonclinical nursing roles. For example, the American Nurses Association offers certification in nursing informatics. Certification programs generally have prerequisites for eligibility and require participants to pass an exam. Licensure requires completion of an accredited program and passing the National Council Licensure ExamāRegistered Nurse (NCLEX-RN [en-klecks-R-N]). The NCLEX-RN is a nationally administered test required by all states and the District of Columbia. It is administered by the National Council of State Boards of Nursing. Like physician licensure, specific requirements are determined by the states, and there is some opportunity for obtaining reciprocal licenses in other states.
- Nurses provide direct patient care and are responsible for coordinating patient care activities with other ancillary or allied health professionals based on physician orders and the patientās plan of care. In the last decade, nursing assistants, medical assistants, or patient care associates have assumed much of the direct bedside patient care, such as obtaining vital signs and assisting patients with activities of daily living, such as eating, sleeping, and hygiene. These positions work under the supervision of nursing staff, freeing nurses to provide highly skilled care to more patients. Nursing duties include taking a medical history, starting and maintaining intravenous fluids, bedside laboratory testing, medication administration, wound care, and ongoing assessment and patient monitoring of physiological [fiz-ee-uh-loj-i-kuhl] parameters. Also, nurses have a prominent role in providing education and emotional support to patients and their families.
- A significant amount of nursing care in hospitals occurs on medical-surgical units. In some hospitals, both medical and surgical patients are cared for in a single unit; other hospitals have separate units for these patients. Medical-surgical nurses may be certified, but certification is not required by most hospitals. There is an increased need for specialized nursing units or departments in larger and tertiary care hospitals. Nurses may elect to obtain additional training and education when working in these areas. Examples of specialized nursing roles include the following: Diabetic nursing plays a prominent role in the education of clients newly diagnosed with diabetes. Emergency nursing provides highly skilled care in emergency departments and trauma centers. Rehabilitation nursing focuses on patients recovering from serious injuries or illnesses that require specialized care in recovering activities of daily living. Neurosurgery nursing provides care to patients who have brain and/or spinal cord injury or disease. Many hospitals have evolved to become integrated delivery networks or systems with separate physical buildings on one campus or many buildings across a geographic location. This organizational arrangement enables the hospital to provide more services to a larger number of patients. The more common type of patient care services that are located in a separate building at a single location or across multiple locations include pediatric care, cardiac care, rehabilitation, and cancer care.
- Nurses serve a critical role in providing patient care not only in hospital settings but also in many other types of provider settings, such as physician offices, outpatient clinics, clientsā homes, and more. Nurses may choose to further their education with specialized training and/or certification for working in a non-hospital setting. A few examples of these other setting types include the following: Ambulatory care facilities such as walk-in (general care) clinics, outpatient surgery clinics, urgent care centers: Nursing roles are similar to those of their hospital counterparts. The main difference is that the patient is at the facility for a very short duration and will not stay overnight. Home health, hospice, patientās medical home: Nurses provide care through daily or frequent visits to the patientās home. Activities include medication administration, wound care, postoperative care, and physical therapy. Long-term care, nursing homes: Nurses provide care and/or assist the patient with routine activities of daily living. Public health clinics, community health facilities: The public health nurse provides screenings, disease surveillance, health promotion, and education.
- Nurse practitioners are usually required to earn a masterās degree in nursing with specific clinical and diagnostic training. This includes training in physical diagnosis, managing acute and chronic disease, wellness care, and prescribing medication.
- Most states require certification for a nurse practitioner regardless of the specialty. Most practitioner specialties focus on a specific population. A few example are family nurse practitioner, pediatric nurse practitioner, and geriatric nurse practitioner. All states license nurse practitioners, but states vary on the role of the nurse practitioner. About half of the states allow nurses to practice independently, and some states allow nurse practitioners to prescribe medication without physician oversight. Nurse practitioners typically provide primary care services, including preventive, acute, and chronic care.
- A BSN is required to become a certified nurse midwife, and most complete a masterās degree in nursing. Training entails courses in advanced practice nursing, including pharmacology, pathophysiology [path-oh-fiz-ee-ol-uh-jee], and physical diagnosis. Nurse midwife certification requires course work in antepartum [an-tee-pahr-tuhm] care (prenatal or before delivery), intrapartum [in-truh-pahr-tuhm] care (during delivery), and postpartum [post-pahr-tuhm] care (after delivery). It also involves clinical course work and training in the routine care of womenās health.
- Only a few nurse midwife programs are post-baccalaureate certificate programs. Licensure is required in all fifty states and the District of Columbia. Nurse midwives provide routine gynecology services, prenatal, delivery and postnatal care.
- Nurse anesthetists [ah-nes-thi-tists] must have a BSN degree. A masterās degree is required to be eligible for a certified registered nurse anesthetist (CRNA). Training courses in advanced practice nursing include pharmacology, pathophysiology, and physical diagnosis. Clinical courses include training in anesthesia [an-uhs-thee-zhuh] simulation labs and supervised training in clinical anesthesia.
- Certification as a CRNA requires graduation from an accredited masterās degree program and passing the National Certification Exam administered by the Council on Certification of Nurse Anesthetists. Although there is no recertification exam, there is a requirement of forty hours of continuing education every two years. CRNAās are licensed in every state; however, there is some variation in whether they are able to practice independently.
- As with any health care profession, there are opportunities for nonclinical roles. They sometimes require additional nursing or other graduate degrees. Nurse administrators are common in both hospitals and ambulatory settings. Nurses can serve an active role in both basic and clinical research. They provide clinical and nonclinical teaching in nursing schools and in continuing nursing education. There is also a need for nurses to be involved in case management and quality improvement. As it is for physicians, informatics is a relatively new role for nurses. Informatics focuses on the effective use of information systems in providing patient care services.
- A licensed practical nurse (LPN) has a shorter period of training, usually twelve-to-eighteen months after high school graduation. Preclinical training includes basic sciences such as pharmacology, anatomy, and physiology and preclinical nursing courses such as medical terminology. Clinical courses include practical nursing studies with patient care under supervision, including infusing IV fluids and administration of oral and some IV medications. LPNs often receive a certificate of completion.
- All states and the District of Columbia require the National Council Licensure ExamāPractical Nurse (NCLEX-PN [en-klecks-P-N]) administered by the National Council of State Boards of Nursing (NCSBN). LPNs provide direct patient care and must be under the supervision of an RN or physician. State laws vary on whether LPNs may start and monitor IV fluids and administer IV medications. Most states that allow IV medication administration do not allow LPNs to āpushā or rapidly infuse medications.
- Medical assistants usually complete a one-year certificate or a two-year associateās degree. The training involves both medical and office administration courses, which often include medical terminology, coding and reimbursement, laboratory procedures, office patient care, and medications. Medical assistants are not licensed, and roles include administrative and clinical duties.
- The education and training of medication aides ranges widely from fifteen to seventy contact hours. The training is predominantly on the administration of non-intravenous medications. Most states require an exam and a period of supervised medication administration. Some states require training as a certified nursing assistant as a prerequisite. In most states, medication aides can administer oral, topical, and nebulized or metered inhaled medication. Many states restrict medication aides to long-term care or assisted living facilities. Certification may be obtained for successful completion of the educational course.
- Employment projections released in December 2013 anticipated a shortage of nurses by 2025. In contrast, a 2014 HRSA study projected that nursing supply could outpace demand by 2025. The contrasting studies reflect the changing employment environment for clinical workers. The HRSA study, for instance, further stated that uneven distribution of nurses will result in shortfalls in several states and noted that retirements and other factors could shift projections. One factor that could limit the expansion of nursing supply is a shortage of nursing faculty. In addition to the current shortage, existing faculty are aging and retiring, and there are not enough qualified applicants available to replace them. In addition, the need for advanced nurse practitioners is anticipated to increase to supplement the physicianās role in providing direct patient care. This is due in part to the anticipated physician shortage along with the need of skilled clinicians in the ambulatory setting as patient care shifts from the inpatient setting to the outpatient and home settings.
- As with the physician shortage, offsetting a potential nursing shortage will require a multipronged approach with industrywide collaborators.
- This concludes Lecture b of Health ProfessionalsāThe People in Health Care. In summary, this lecture described the education, training, certification, licensure, and roles of nursing personnel, including nurses with RN and BSN degrees, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides. Roles are also described for nurses in specific work settings, specialty areas, and nonclinical positions.
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