This document discusses the extended and expanded roles of nurses beyond traditional nursing roles. It defines the extended role as activities delegated by doctors to nurses, and expanded role as functions not specified in traditional nursing legislation. Some key roles discussed include nurse practitioners who can assess, diagnose and treat patients, nurse specialists with expertise in a clinical area, and nurse clinicians with advanced clinical skills. The document also outlines roles like nurse educators, administrators, entrepreneurs, researchers and other clinical roles.

1. EXTENDED &EXPANDED ROLE
OF NURSE
-Ms. Sucheta Panchal

2. TRADITIONAL
ROLE
EXTENDED
ROLE
ROLE OF
NURSES
EXPANDED
ROLE
concentrating in curative aspect
maximum
nurse assumes by virtue of
education & experiences
Nurses reach out to the
community

3. DEFINITIONS
Extended role of nurse
“Those activities concerned with patients,
either in hospital or the community, that
are appropriate for delegation by doctors
to nurses.”

4. DEFINITIONS
Expanded role of nurse
“The functions of a nurse that are not
specified in the traditional limits of
nursing practice legislation.”

5. ADVANTAGES OF EXTENDED AND
EXPANDED ROLE OF NURSE
• Provides variety of services for patient of all age
groups which may be part of hospital or community.
• Enhances clinical decision skills.
• Provides great challenges & opportunities for nurses.
• Provides expert knowledge and high level of job
satisfaction.

6. IMPORTANCE AND NEEDS OF EXTENDED
AND EXPANDED ROLE OF NURSE
• Provision to broad access to basic health services
• The transition of health care systems from a
disease oriented model to health oriented model

7. IMPORTANCE AND NEEDS OF EXTENDED
AND EXPANDED ROLE OF NURSE
• Out of bedside care
• Lack of experts due to promotional trend
• Improvement in expertise and satisfaction

8. EXTENDED ROLE OF
NURSE

9. EXTENDED ROLE OF NURSE
• Means to reach out.
• Nurse assumes by virtue of education,
type of institution where she is employed
and experienced.

10. 1.NURSE PRACTITIONER (PRIMARY)
According to the international council of
nurses, nurse practitioner means “A
registered nurse who has acquired the
expert knowledge base, complex decision
making skills and clinical competencies for
expanded practice.

11. 1.NURSE PRACTITIONER (PRIMARY)
• History:
• In the 1950-60 due to acute shortage of
primary care physician in US resulted in
the development of nurse practitioner.
• The first formal education program for
nurse practitioner was established in
1965 at the University of Colorado
school of nursing by Loretta Ford and
Henry Silver.

12. 1.NURSE PRACTITIONER (PRIMARY)
Qualification:
• 2 types of course
1. Short term program- certification
2. Long term education programs-
bachelors or masters degree

13. 1.NURSE PRACTITIONER (PRIMARY)
Functions:
• Obtaining history of patient.
• Performing physical assessment and examination
• Order medical and laboratory studies
• Interpret diagnosis / laboratory studies
• Diagnosing and treating acute illness, infections,
injuries & chronic illness
• Prescribe / manage medication therapy.

14. 1.NURSE PRACTITIONER (PRIMARY)
Functions:
• Providing physical therapy, rehabilitation
treatment.
• Counseling and educating patients
• Provide psychological, family planning & diet
counseling.
• Provide continued / follow-up care.
• Collaborating with physicians and health
professionals as needed including referral
services.

15. 1.NURSE PRACTITIONER (PRIMARY)
PRACTICE AREAS:
Community clinics
& health centers
Nurse
management
centers
Home health care
agencies / home
nursing
Hospitals &
hospital clinics
Hospice centers /
Nursing homes.
Accident & injury
or trauma centers
School / College
based health
Geriatric homes
Ambulatory
clinics / mobile
health care units
Midwifery centers
/ woman’s health
clinic
Rehabilitation
centers
Day care dialysis

16. 1.NURSE PRACTITIONER (PRIMARY)
Different category of nurse practitioner
• Adult Nurse
• Family Nurse
• Pediatric Nurse
• Geriatric Nurse
• Rehabilitation Nurse
• Mental Health Nurse

17. 1.NURSE PRACTITIONER (PRIMARY)
• Nurse practitioners in India
• Independent nurse practitioner, 18 months post basic
diploma in midwifery to impart all midwifery skills to
handle obstetrics emergencies.

18. 1.NURSE PRACTITIONER (PRIMARY)
Challenges in implementing independent nurse
practitioner.
 Develop nursing standard, nursing practice act.
 Develop law regulation.
 Develop nursing practice model for Indian health settings
 Develop nurse practitioner courses
 Salary structure
 Develop nursing network, online network of nurses, and drug
act policy for nurses.
 Develop evidence based research
 Establishment of nursing bureau

19. 2.NURSE SPECIALIST (SECONDARY)
• An expert practitioner in a specific branch of nursing
with advanced knowledge, high degree of skills and
extensive experience in the care of patients in the
specialty concerned
• Usually practice in secondary or tertiary care settings
• Focus on care of individuals who are experiencing an
acute illness or an exacerbation of a chronic condition.

20. 2.NURSE SPECIALIST (SECONDARY)
• History
• According to Hamric (1989) the role of CNS
originated for the purpose of improving
the quality of nursing care provided to
patients.
• In 1954, Peplau has started the 1st CNS in
psychiatric nursing.

21. 2.NURSE SPECIALIST (SECONDARY)
• Qualification:
• B Sc or M Sc nursing in any specialized area.
• In India following specialization & post basic
diploma’s in nursing are available

22. 2.NURSE SPECIALIST (SECONDARY)
• Role of clinical nurse specialist:
• Change agent
• Collaborator
• Clinical Leader
• Role Model
• Patient Advocate
• Expert practitioner
• Educator
• Researcher
• Consultant

23. 2.NURSE SPECIALIST (SECONDARY)
Responsibilities:
• Active case finding
• Expertise in chronic illness care
• Interpersonal competence
• Skilled clinical documentation
• Ethical decision making

24. 3.NURSE CLINICIAN (TERTIARY)
Nurse clinician is a clinical nursing expert
with a depth understanding of nursing
for her clinical expertise in working
with a defined group of patients.

25. 3.NURSE CLINICIAN (TERTIARY)
• History
• In 1943, Reiter 1st coined the term
nurse clinician to designate a nurse
with advanced clinical competence in
graduate educational program.

26. 3.NURSE CLINICIAN (TERTIARY)
• Qualification
• B.Sc. or M.Sc. nursing with extensive clinical
experience
• Practice areas :
• Hospital
• Community
• Geriatric health
• Mental Health
• Occupational Health

27. 3.NURSE CLINICIAN (TERTIARY)
Role of nurse clinician (tertiary)
• Care :
• basic and technical nursing care based on patient
need which include palliative, physical and
protective care
• Cure:
• medical care, therapeutic regime and overall
nursing management of patients.

28. 3.NURSE CLINICIAN (TERTIARY)
Role of nurse clinician (tertiary)
• Counseling:
• psychological care to patients, families
including guidance related to health and
working with them for restoration &
maintenance of health.

29. 4.NURSE EDUCATOR
• Qualification:
• B. Sc nursing or M. Sc nursing
• Work primarily in three areas
• Schools and colleges of nursing
• staff development departments
• client educational departments

30. 4.NURSE EDUCATOR
Functions:
• Teaching
• Supervision
• Inspection
• Committee member
• Work in staff development programmes

31. 5. NURSE ADMINISTRATOR
• Manages client care and the delivery of specific
nursing services within the health care agency.
• Upper level management position
• assistant or associate and director of nursing services
(M.Sc. Nursing)
• Middle management position
• head nurse or supervisor (B.Sc. Or M.Sc. Nursing)

32. 5. NURSE ADMINISTRATOR
Functions:
• Planning
• Organizing
• Directing
• Co-ordinating
• Implementing
• Budgeting
• Staffing various nursing activities & managing
nursing department

33. EXPANDED ROLE OF
NURSE

34. EXPANDED ROLE OF NURSE
• means enlargement of nurse role within the
boundaries of nurse
• It goes beyond the traditional role and ads
maximum responsibility with wide range of
functions in community and clinical care settings

35. EXPANDED ROLE OF NURSE
Nurse
entrepreneur
Nurse
researcher
Nurse
rehabilitator
Palliative care
nurse
Nurse
oncologist
Gerontological
nurse
Nurse
consultant
Nurse
prescriber
Nurse
endoscopist
Enterostomal
nurse
Infection
control nurse
In-flight nurse
Trauma nurse
specialist

36. 1.NURSE ENTREPRENEUR
• The nurse entrepreneurs are those who use their
skills and ability to create a successful business
while assuming total responsibility and risk.
• organize, manages and assumes the risk of
business or the enterprise

37. 1.NURSE ENTREPRENEUR
• Qualifications
• Master’s degree in nursing with 3-5
years of experience.
• competent in communication,
marketing, time management,
public relations, skills and
knowledge in legal maters

38. 1.NURSE ENTREPRENEUR
Functions:
• Provide multiple services
direct care
Consultancy
ambulance services
home health care
supplies for hospitals
child and geriatric care
emergency management.

39. 2.NURSE RESEARCHER
Qualification:
• M.Sc. Nursing or PhD in nursing.
• employed in an academic setting or hospital

40. 2.NURSE RESEARCHER
Functions:
• Investigate nursing problems and conduct
research
• Refine and expand nursing knowledge
• Work as independent research coordinator
for particular project.
• Involve in nongovernmental organization
as a nurse researcher

41. 3.REHABILITATION NURSE
• Nurse as rehabilitator
• Functions:
• Develop a therapeutic and supportive
relationship with the patient and family.
• Work with patient to gain his previous strengths
and provide necessary training.
• Make a plan program to restore disabled person
to their greatest physical, psychological, social
and economical potential.

42. 4. NURSE INFORMATICS
A specialist in managing health care
information and science technology in
identifying, collecting, processing, managing
data including nursing practices.
Qualification
Masters degree in nursing with clinical
experience.

43. 5. PALLIATIVE / HOSPICE CARE NURSE
Qualification
• Diploma or degree in nursing with 2-3 years of
clinical experience.
Functions
• Provide care and support to the patient and
family during the terminal phase.
• Provide pain control and comfort measures.

44. 6. NURSE ONCOLOGISTS
• An expert, competent and leader in the
provision of care to the individual with
an actual or potential diagnosis of cancer
• The oncology nursing society developed
in 1990.

45. 6. NURSE ONCOLOGISTS
Qualifications:
• Diploma or degree in nursing with
advanced diploma in oncology
• Master’s degree in oncology
•

46. 7. GERONTOLOGICAL NURSE
Functions:
• Provide guidance and care to the older adult
• Assist the old persons to function at their highest
level and minimize health risks.
• Contribute to society’s perception on aging with
optimistic view towards them
• Provide information and resources to older adults in
terms of their health (Physical, psychological)

47. 8. NURSE CONSULTANCY
• As nurses develop specialized areas of
expertise
• A consultant draws from personal
expertise to
• advice others
• validate current practices
• provide specialized knowledge.

48. 8. NURSE CONSULTANCY
FUNCTIONS:
• Research
• evaluating new health care products
• advising health care professionals
• designing and evaluating new programs
• developing circulars for nursing education etc.

49. 9. ENTEROSTOMAL NURSE
Qualification:
• Specialized diploma in entero-
stomal therapy after diploma or
degree in nursing.

50. 9. ENTEROSTOMAL NURSE
Functions:
• Teach irrigation of stoma and care of the
skin
• Discus diet and relaxation techniques
• Refer patient to the health care agency
• Select appropriate appliances and teach
the technique to the patient and
relatives

51. 10.NURSE ENDOSCOPIST
Qualification
• Graduate nurse with additional qualification in colorectal
endoscopy course
Functions
• Reassure the patient undergoing endoscopy
• Application of bandages in case of hemorrhoids
• Involvement in health promotional activities of this patient
by giving dietary advice

52. 11.INFECTION CONTROL NURSE
Functions:
• Monitoring hospital environment
for existing and potential infections
• Do regular survey throughout
hospital and report findings to
infection control committees for
further actions
• Plan and teach isolation techniques
to the staff and attempt to prevent
and control infection.

53. 12. IN FLIGHT NURSE
• 1st started by Princes Mary Royal air force
nursing service in Scotland.
• Nurses are trained to nurse in-flight.
• knowledge of aircraft safety including
medical conditions.
• undergoes short training program of 9
months.
• team of 2 nurses, 1 supervisor and other
staff nurse to provide services in flight.

54. 13.TRAUMA NURSE SPECIALIST
• A vital member of emergency services.
• Functions:
• Initiation and participation in emergency management of
patient.
• Evaluate the injured system and provide basic care to prevent
complications
• Perform advance nursing skills.
• Observe and maintain patient on ventilator and monitoring
devices.
• Record and interpret ECG findings and report it to the physician

55. EXPANDED ROLE OF NURSE
IN COMMUNITY

56. 1.COMMUNITY NURSE PRACTITIONER
Functions:
• Provide health care services to the neglected, remote
or under served areas.
• Does diagnosis, provide treatment of minor ailments
through standing orders
• Provide a package of preventive, curative and
rehabilitative services for promotion, maintenance
and restoration of community health.
• Perform certain laboratory tests e.g. HB estimation
• Maintain appropriate records.

57. 3. OCCUPATIONAL NURSE
FUNCTIONS
• Participate in pre employment, periodic and special
examination of the employees
• Rendering emergency care
• Conduct classes for training first aid to the workers
to assist in emergencies.
• Conduct classes for training first aid to the workers
to assist in emergencies.

58. 3. OCCUPATIONAL NURSE
FUNCTIONS
• Provide counseling and referral services
• Maintenance of records.
• Participate in health education programs and
research project for desired change

59. 3. OCCUPATIONAL NURSE
FUNCTIONS
• Provide counseling and referral services
• Maintenance of records.
• Participate in health education programs and
research project for desired change

60. 4. NURSES UNDER NHP
Nurse
Administrator
at state level
Nurse Manager at
district level
Nurse Supervisor at PHC
level
Health worker at grass root level

61. 4. NURSES UNDER NHP
1.Nurse Administrator at state level
• Does high level planning, organizing, coordinating,
budgeting and controlling of all activities of
national health programs along with other
members.
• Communicates National Health Program to al
district health nurses
• Conduct training programs for district health
nurses.

62. 4. NURSES UNDER NHP
2.Nurse Manager at district level
• Implement NHP through supervisor at PHC
level
• Arrange training programs for PHC staff
Nurses Role in NHP at various

63. 4. NURSES UNDER NHP
3.Nurse Supervisor at PHC level
• Delegation of work among health workers
related to implementation of NHP
• Supervision to multi-purpose health worker
• Conduct training programs for MPW
community leaders like Anganwadi teachers
and local leaders

64. 4. NURSES UNDER NHP
4. Health worker at grass root level
• Conduct survey.
• Actual implementation of al NHP’s in
community.
• Provide comprehensive care to community
and maintain records.

65. 5. FAMILY NURSE
Functions:
• Assist the past and present physical and psychosocial
health status of individual.
• Provide health promotion, education, care including
referral services for complicated cases and the
management of certain conditions.
• Provide family health counseling e.g. family planning,
anti-natal care, child development and interpersonal
relationship.

66. 5. FAMILY NURSE
Functions:
• Conduct and use research to extend nursing
theory and to improve health practices among
the community.
• Manages the cases of upper respiratory tract
infections, urinary tract infections, gastric upset,
hypertension and crisis situation at home

67. “Have a heart that never
hardens, a temper that
never tires, a touch that
never hurts”
- Charles Dickens