Advanced nursing roles have been adequately explained .

1. Glimpse of Contemporary Nursing Prepared by:-Mr.Kim Monteiro RN.BScN.PGDPC Clinical Nurse Educator, Faculty of Nursing Datta Meghe Institute of Medical Sciences ,India

2. Introduction Diogenes one of the great philosophers , once he has seen the pathetic situation of the people in Athens. He thought how pathetic the situation where there is no knowledge. So He put up a tent at a busy junction at Athens with this inscription On the door, “WISDOM SOLD HERE” .After some time a passer –by read the inscription .He roared with laughter .Calling one of his servants he gave 3 coins and said , “Ask that bragger ,how much wisdom he dispenses for 3 coins”

3. Contd :- Diogenes pocketed the money and said to the servant give this maxim to your master “IN ALL YOUR WORKS FIX YOUR EYES ON FINAL END” . My dear Friends during this journey of study I want to say the same . “SET YOUR GOALS AND AIMS TO BECOME A BETTER PERSON AND A BEST PROFESSIONALIST”

4. As we talk on Modern Nursing ,We the nurses have misunderstood the scope of our profession . As in other professions , Nursing’s Scope –SKY IS THE LIMIT

5. Pioneer of Modern Nursing-Florence Nightingale

6. Definition of Nursing :- Florence Nightingale:-Florence Nightingale defined nursing over 100 years ago as "the act of utilizing the environment of the patient to assist him in his recovery( Nightingale,1860). The American Nurses Association (ANA) uses this definition of nursing. -"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."

7. NURSES –TO THE RESCUE Nurses have always been an integral part in dispensing of Primary Health Care. All over the world there is an acute deficiency of Primary care Physicians leading to inequitable distribution of Health care which is a matter of Social Injustice. Nurses have formally stepped in to fill this gap all over the world, thus Advancing nursing practice and providing efficient independent and collaborative services .

8. So m e Advanced Nursing Roles Nurse Practitioner Clinical Nurse Specialist Nurse Midwifery Practitioner Certified Registered Nurse Anesthetist RN-First Assistant Nurse Case Managers Nurse Entrepreneurs –Nurse Led Clinics Forensic Nurse Nurse Legal Consultant Nurse Educator Nurse Scientist Nurse Administrator

9. Nurse Practitioner "A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Masters degree is recommended for entry level.” (ICN)

10. NATURE OF PRACTICE OF A NURSE PRACTITIONER (I.C.N.) 1.Integrated research, education, practice and management. 2.High degree of professional autonomy and practice 3.Case Management and independent case load. 4.Advanced health assessment skills ,decision making skills and diagnostic reasoning skills . 5.Recognised advanced clinical competencies . 6.Provision of consultant services to the health providers .7.Plans ,implements and evaluates programmes . 8.Recognised first point contact for clients.

11. REGULATORY MEC H ANISMS–Country specific regulations which underpin N.P. practice. 1.Right to diagnose. 2.Authority to prescribe medication. 3.Authority to prescribe treatment. 4.Authorrity to refer clients to other professionals . 5.Authority to admit the patients to hospitals . 6.Legislation to confer and protect the “Nurse Practitioner/Advance Practice Nurse”. 7. Legislation or some form of regulatory mechanism specific to advance practice nurses. 8.Official titles for nurses working in advance practice roles

12. Clinical Nurse Specialist Clinical nurse specialists, who provide care in a range of specialty areas, such as cardiac, oncology, neonatal, pediatric, and obstetric/gynecological nursing

13. Nurse Midwifery Practitioner Independent management of Normal Vaginal deliveries and antenatal and post natal health management and may provide referral services if handling the case needs more medical specialist expertise . It is the first Nurse Practitioner programme to be approved by the Indian Nursing Council, Delhi.

14. Certified Registered Nurse Anesthetist CRNAs take their patients through the entire operative process - inducing sleep, monitoring vital signs, adjusting anesthesia levels, and waking the patient after surgery. Nurse anesthetists were the first anesthesia providers and CRNAs practice in every part of the country, deliver every type of anesthetic, and work in every setting in which anesthesia care is delivered.

15. Nurse Case Managers Nurses in this field coordinate care for patients receiving long-term therapy, providing for optimal timing in all aspects of treatment. For cancer patients, for example, they coordinate primary care visits, surgery, radiation, and chemotherapy. A Nurse Case Manager usually specializes in one specific area such as AIDS, geriatrics, or children.

16. Nurse Entrepreneurs –Nurse Led Clinics A broad definition of a nurse-led clinic defines these clinics based on what nursing activities are performed at the site. Nurses within a nurse-led clinic assume their own patient case-loads, provide an educative role to patients to promote health, provide psychological support, monitor the patient's condition and perform nursing interventions. Nurse-led clinics typically focus on chronic disease management: conditions where regular follow-up and expertise is required, but also where a patient may not necessarily need to see a physician at every visit. Most nurse-led clinics use nursing theory and knowledge to educate patients and form care plans to manage their conditions.

17. Forensic Nurse A forensic nurse is first a trained nurse, with typically an R.N. degree, who has chosen to take additional training either post graduate certificate, or masters or doctorate level work in forensics. These extra studies train the nurse to not only deliver healthcare, but also to investigate the potential of someone having been injured through criminal behavior or by lack of appropriate care that could constitute hazardous circumstances or criminal negligence. There are a number of fields in which the forensic nurse may work and many areas in which these specialists find employment.( Sexual assault nurse examiners , examine the dead, as employees in coroner’s offices, treat include gun shot victims, those suspected of having been abused, victims of rape, and others)

18. Legal nurse consultant (LNC) A legal nurse consultant (LNC) is a registered nurse who uses expertise as a health care provider and specialized training to consult on medical-related legal cases. LNCs assist attorneys in reading medical records and understanding medical terminology and healthcare issues to achieve the best results for their clients. Legal nurse consulting is defined as a specialty practice of nursing noting that the professional foundation is first and foremost, nursing.

19. Registered Nurse First Assistant "The RN First Assistant at surgery collaborates with the surgeon and the health care team in performing a safe operation with optimal outcomes for the patient. The RN First Assistant practices perioperative nursing and must have acquired the necessary knowledge, skills and judgement specific to clinical practice. The RN First Assistant practices in collaboration with and at the direction of the surgeon during the intraoperative phase of the perioperative experience. The RN First Assistant does not concurrently function as a scrub nurse”

20. Nurse Educator A nurse educator is a nurse who teaches and prepares licensed practical nurses (LPN) and registered nurses (RN) for entry into practice positions. They can also teach in various patient care settings to provide continuing education to licensed nursing staff. Nurse Educators teach in graduate programs at Master’s and doctoral level which prepare advanced practice nurses, nurse educators, nurse administrators, nurse researchers, and leaders in complex healthcare and educational organizations.

21. Nurse Scientist/Researcher Development of body of nursing knowledge through leadership and collaborative research roles with nurses , other Health care professionals and members of the community. Development of Nursing models and theories .

22. Nurse Administrators President ,Indian Nursing Council/State Council. President ,Voluntary Nursing Associations Director of Health Services (Nursing) Deputy Director Health Services (Nursing ) Addl. D.D.H.S (Nursing) State Nursing Superintendent Hospital Nursing Director/Modern Matron Dean /Principal Nurse Managers Head Nurses Incharge Nurses

23. Then where is the PROBLEM The problem comes from within us .We all have the thought of little imagination and little outcome . Let us also think as our Former President A.P.J.Abdul Kalam said “PROBLEM SHOULD NOT BECOME YOUR CAPTAIN ,YOU BECOME THE CAPTAIN OF THE PROBLEM”. YES- THEN THE ULTIMATUM WILL BE REACHING THE GOAL.