expanded and extended role of nurse is going beyond the traditional nursing role

1. EXPANDED AND EXTENDED ROLE
OF NURSE
SUBMITTED BY
PUNAM BISWAS
M.SC NURSING 1ST YEAR

2. INTRODUCTION:
• The extended and expanded role of nurse can
be described as a role, which goes beyond the
traditional nursing roles to include additional
responsibilities and a wide range functions in
community and clinical care setting.

3. DEFINITIONS:
(ICN Definition of Nursing)
• Nursing is defined as assisting the individual, sick or well in
performance of those activities contributing to health or to
a peaceful death, that he would perform unaided if he had
the necessary strength, will or knowledge, and to do this in
such a way to help him gain independence as rapidly as
possible.
 Nurse
• A professional nurse is a graduate of a recognized nursing
school, who has met the requirement for a registered nurse
in a state in which she is licensed to practice.

4. DICTIONARY MEANING ROLE:
A ROLE IS “ THE SUM TOTAL OF EXPECTED
BEHAVIOUR AND THE BEHAVIOUR EXPECTED
FROM A PERSON WHO OCCUPIES A
PARTICULAR POSITION AND STATUS IN A
SOCIAL PATTERN.”

5. ROLES OF THE NURSES
• Caregiver/Care Provider
• Advocate
• Educator
• Change Agent
• Counselor
• Communicator
• Clinical Decision Maker
• Manager
• Rehabilitator
• Researcher

6. THE EXPANDED ROLE OF A
NURSE:
• Expanded role of nursing means enlarging
the sphere of nurse’s roles within the
boundaries of nursing or it is the
responsibility assumed by a nurse in the field
of practice autonomy.

7. EXTENDED ROLES OF A NURSE:
• Extended role in nursing is one in which a
nurse assumes responsibility outside the
usual practice area (in hospital) with
autonomy.

8. Need of Expanded and Extended
Roles:
• Health is now recognized and proclaimed as fundamental
right of citizen.
• The transition of health care system from disease oriented
to health oriented model is an emerging trend.
• Specialization is another development which has major
implication for nursing practice.
• The need of nursing experts to utilize their expertise for
care of the client.
• Economic upgradation
• Increase status for nursing.

9. Direction for expanded role
Outward:
Community
School health nursing service
Maternal and child nursing service
Occupational health nursing services
Inward
Direct care of client

10. Expanded Roles of a Nurse:
• Clinical Nurse Specialist (CNS)
• A Faith Community Nurse / Parish Nursing
• Nurse Epidemiologist
• School Nursing
• Camp Nursing
• Disaster Nursing
• Volunteer Nursing
• Occupational Health Nursing
• Army Nursing
• Home Health Nurse
• Telephone Nursing Consultation Services.

11. 1)Clinical Nurse Specialist
• Experts with approproate nursing educational preparation and
experience who could deliver high quality nursing care .
• Graduate nurse + M.Sc + Doctorate
• Functions
• Advanced assessment, implementing nursing care, and evaluating
outcomes.
• Providing education or teaching skills to patients and family.
• Collaboration focuses on multidisciplinary team building.
• Consultation with alternative approach.
• Research involves interpreting and using research, evaluating
practice, and collaborating in research.
• Ethical decision making regarding allocating resources , directing
patient care and access to care.

12. 2)A Faith Community Nurse/Parish
Nursing
• It is also known as congregational nursing or church nursing.
• Intentional care of the spirit as part of the process of promoting
holistic health and preventing or minimizing illness in a faith
community.
• Introduced by : Granger Westberg.
• must have a minimum of 2 years experience, must have a
current license in the state where the faith community is
located, and have completed a parish nurse foundations course
for the specialty practice as recognized by the American
Nurses Association.
• RN specialist + spiritual + physical health
• Parish nursing is rooted in the Judeo-Christian tradition

13. Cont
• Responsibilities:
• Health education and teaching.
• Post hospitalization adverse events can be decreased with
the use of faith community nurses
• Personal health counseling for faith community members.
• Coordinating with community health resources and acting
as a church liaison.
• Training and coordinating volunteers in support services.
• Organizing health support groups.
• Assessing congregational and community health needs.
• Responding to health-related issues.

14. 3)School Nursing
• Reduce absenteeism
Health care assessment , intervention & follow up
• Role of the School Nurse
• The school nurse provides direct health care to students and staff:
• The school nurse provides leadership for the provision of health services
• The school nurse provides screening and referral for health conditions:
• The school nurse promotes health:
• The school nurse serves in a leadership role for health policies and
programs
• The school nurse serves as a liaison between school personnel, family,
community, and health care providers

15. 4)Nurse Epidemiologist (Infection
control )
• Must have an experinece as a
• They monitor standards and procedures for the control and
prevention of infectious diseases and other conditions of public
health.
• Function
• Conducts epidemiologic investigations
• Provides education (communicable diseases)
• Recommendations on infection control
• Establishing quarantine protocols upon the discovery of potential
infection to reduce the spread to additional staff and patients
• Provides ongoing in service training
• Recommendations on infection control
• Conducts study to determine risk factors leading to infection.

16. 5)Camp Nursing
• Camps are temporary small communities and provide basic services
for their members.
• Include summer camps or other camps that last from days to weeks
to even months at a time, but are usually temporary.
• some distance from a hospital or health clinic
• The nurse needs a desire to work with young people( children) as
they navigate developmental milestones.
QUALIFICATION
• Registered nurses who hold an Associate's Degree or Bachelor's
Degree in Nursing are eligible to become camp nurses as long as
they have passed the NCLEX-RN exam and hold an active RN
license. Most camps want RNs who have some clinical
experience. While not required, prior experience in pediatrics .

17. Cont
TRAINING
• Current adult and pediatric CPR training is
recommended and often required.
• First aid procedures must also be brushed up.
Role:
• Provides emergency care for accidents and acute care
for minor illness and injuries.
• Avoid spread of contagious illness.
• Supervise the person abide by health related rules such
as lost campers, weather events, loss of electricity,
remote living, and other significant situations.

18. 6)Volunteer Nursing
• Nurse volunteer to provide nursing services in
community settings.
• Provides volunteer service for episodic events such as
health fairs, camps, church activities, community
events and community services projects.
• Volunteer nurses have an obligation to have adequate
knowledge about actual and potential situations that
may arise.
• Maintain records to make additional inquiries
regarding results of advice given.

19. 7)Occupational Health Nursing
• Acts as client’s
• The occupational health nurse is a Registered Nurse with a
great deal of clinical experience and expertise in dealing
with sick or injured people.
• They need to have certification in occupational health
nursing, industrial hygiene, occupation medicine and safety
• Responsibility
• Assess employee safety
• Provide primary, secondary, tertiary care
• Implement plan of care
• Collaboration

20. 8)Disaster Nursing
• Disaster Nursing means involves response to natural or
man-made events that affect an entire community or
communities.
• It involves massive numbers of casualties and extensive
property damage.
• Responsibility :
• Disaster nurse should have detailed knowledge of first-aid
principles
• Should have experience in therapeutic communication.
• Provide care during time of disaster.
• Takes measure to prevent contagious illness

21. 9)Army Nursing
They are called ARMED FORCE NURSING OFFICER.
 Should have passed MSc (Nursing) /PB B Sc
(Nursing)/B Sc(Nursing) from INC recognized
University and be a registered Nurse and Midwife
from a State Nursing Council .
 Works in ambulatory clinics, community
hospitals, large medical centers, hospital ships,
field hospitals and aircraft.
 It serves the military .

22. 10) Home health nurse
• Home health nurses provide care in the homes of their patients.
• Must be RN
• Focus on - elderly or disabled.
• They do this by continually keeping up to date on the latest
research and Evidence-Based Practice.
 Care :
Basic needs:
 Bathing
 Dressing
Specialized care:
 Wound care
 Medication management
 IV therapy

23. 11)Telephone Nursing Consultation
Services
• Telehealth refers to providing health
administration, patient and professional
education, or even long-distance clinical health
care through telecommunication technology.
• Connect several different client populations with
healthcare services.
• Video conferencing – patient with chronic illness.
• Home monitoring systems – BP & blood sugar.

24. • PALLIATIVE /HOSPIECE CARE NURSE: Palliative
means an agent which relieves but doesn’t
care disease. A hospiece is a system of family
centered care designed to make the terminally
ill patient comfortable and to ensure
satisfactory lifestyle through the terminal
phase of illness.
•

25. EXTENDED ROLES:
• Certified Registered Nurse Anesthetist (CRNA)
• Nurse practitioner
• Nurse informatics specialist
• Registered nurse
• Forensic nursing
• Nurse entreprenuers.

26. 1)Certified Registered Nurse
Anesthetist (CRNA)
• The nurse anesthetist carries out pre-operative visits and
assessments, and administers general anesthetia for
surgery under the supervision of a physician.
• The nurse anesthetist also assesses the postoperative
clients.
• Works hand in hand with anesthesiologist.
• Educational Qualification
Licensed registered nurse + minimum of one year of full-
time nursing experience in an acute care setting = enroll in
an

27. 2)NURSE PRACTITIONER
• The nurse practitioner is a primary health care provider who assumes
responsibilities of the extended role to meet the health care needs of
a group in a community.
• She is meant to provide first contact primary care to the patient.
• All registered nurses are authorized to practice nursing. In this sense,
all registered nurses can be called nurse practitioner, but currently the
term ‘Nurse Practitioner’ is used for those assuming responsibilities
of extended role of a nurse.
• Under the extended role, the nurse practitioner–
 Assumes delegated medical responsibilities and treatment of minor
ailments .
 Her clients are generally in ambulatory care.
 Acquires additional skills and professional expertise to make a health
assessment . (
 Establish a collaborative provider.

28. The Acute Care Nurse Practitioner
• These practitioners are specially educated to
deal with advance level of nursing care for
patient suffering from critical, acute as well as
chronic nature of ailments.
• They are also worked in typical environment
such as burn unit, intensive care unit,
emergency department, dialysis, trauma
units, etc.

29. Family Nurse Practitioner
• A family nurse practitioner (FNP) is a
registered nurse who has completed specific
advanced nursing education—generally a
master’s degree.
• Work in community based nurse managed
health center.
• Provide wide range of care to a diverse group
of patients beginning in childhood and
continuing throughout the aging process.

30. Psychiatric Nurse Practitioner
• Psychiatric nurses must be registered nurses (RNs).
• To become a psychiatric nurse practitioner or clinical
nurse specialist, person will need additional education
at the graduate level, usually two-year Master of
Science in Nursing (MSN) degree.
• They need to complete a period of supervised clinical
practice before they are eligible for certification as a
specialist in adult or child and adolescent psychiatric-
mental health nursing.

31. Adult Nurse Practitioner
• An Adult Nurse Practitioner is a nurse practitioner that specializes in
diagnosing and treating afflictions specific to adults such as AIDS
assessment, pulmonary and vascular care or other health-related fields
• Areas of Study to be an Adult Nurse Practitioner
• Primary care for adults
• Advanced health assessment
• Theory and research applications
• Advanced physiology/pathophysiology
• Acute illness in adults
• Advanced pharmacology
• Legal leadership issues
• Genetics and advanced nursing
• Health policy and finance

32. Pediatric Nurse Practitioner
• A pediatric nurse practitioner is a registered nurse and nurse practitioner
with advanced training in pediatrics and can provide nursing care to
infants, children and adolescents.
• Functions
• The pediatric nurses perform physical exams, diagnose injuries and many
common illnesses and have the training to provide the treatment
procedures, therapies and medication necessary for the child.
• They order specific lab tests and diagnostic testing, such as X-rays, blood
tests and laboratory tests when needed.
• Trained to give immunizations, they also manage their patient’s problems,
such as juvenile diabetes and other conditions.
• They provide education, support and health care counseling to the
families of their patients and answer any questions or address any
concerns the family has regarding the child.

33. Nurse Midwife Practitioner
• A NMP is a registered nurse who has advanced education and clinical
experience in midwifery.
• She does independent management of normal vaginal deliveries.
• A pilot study project was started in W.B in 2006 to provide better medical
services in rural areas .
• INC along with TNAI in 2009 n independent NP programme on midwifery
in Maharashtra , Gujarat, along with A.P , Tamil Nadu , West Bengal.
• She does antenatal and postnatal management.
• May provide referral services if handling the case needs more medial
specialist expertise.
• It is the Ist NP program approved by INC, India.
• These practitioners will provide quality maternal and newborn services in
hospitals and also be clinical instructors for students pursuing midwifery
thus contributing to the quality of pre-service education.

34. Geriatric Nurse Practitioner
• Geriatric Nurse Practitioner GNP is an ANP with specialization in care of
the older adult( The client population is usually of age 65)
• A master’s degree in nursing + complete practical internship programme +
pass a series of licensing examination.
• Responsibility :
• A geriatric nurse practitioner provides expert care, treatment, and
counseling for elderly patients.
• A professional conducts diagnostic tests, checks vital signs, and assists
doctors in treatment procedures for a variety of medical conditions.
• In addition a geriatric nurse practitioner might help a patient engage in
physical therapy exercises .
• Most nurses are employed by general hospitals , nursing homes, though
some professionals work in speciality clinics , private doctor’s office and
home health care companies.

35. Oncology Nurse Practitioners
• Chronically ill / critically ill.
• Oncology nurse practitioners monitor their
patients’ physical conditions, prescribe
medication and formulate symptom
management strategies.
• Oncology nurse practitioners are advanced
practice registered nurses (APRNs) who have
master’s degrees.

36. 3)Nursing Informatics Specialist
• Nursing informatics specialist = nursing skill + knowledge of
computer science.
• They work with data collecting, organizing, and interpreting it in
order to make patient care more efficient and of higher quality.
• Work – insurance companies, hospital, consulting firms.
• Training and Education
( additional) [either within
nursing programme / through strictly computer based programme]
RESPONSIBILITY :
 Train nurses and HCW for proper use of computer
 Interview workers and identify their technology.

37. 4)Registered Nurse Lawyer
• Performs a critical analysis of clinical and administrative nursing
practice.
• Functions
• Assists in obtaining medical records and identifying missing
records.
• Identifies standards of care, causation and damage issues.
• Screen for record tampering.
• Conducts client interviews.
• Locates and procures evidence.
• Researches and identifies expert witnesses.
• Educate hospital staff on the implications of malpractice law.
• Acts as a liaison with attorneys, physicians and clients.

38. 5)Forensic Nursing
• Forensic means having to do with law
• Forensic nursing is application of the nursing process to
public or legal proceedings.
• Application of the forensic aspects of health care to the
scientific investigation of trauma and/or death related to
medicolegal issues.
• Roles of Forensic Nurse
• Clinical Forensic Nurse
• Sexual Assault Nurse Examiner (SANE)
• Pediatric Forensic Nurse
• Forensic Psychiatric Nurse
• Nurse Death Investigator

39. 6)Nurse Entrepreneurs
• These men and women apply their skills and training toward
establishing, promoting, or consulting in business ventures in
the healthcare industry.
• They can build on their nursing knowledge to develop
medical devices or computerized systems for delivering
healthcare, freeing staff nurses to spend more time caring for
patients.
• Entrepreneurial skill:
 Leadership
 Networking
 Marketting
 Buisness skill

40. • Taken by GOVT. for starting training courses for superspeciality
nurses:
 Diploma in nursing education and administration
 CCN
 Cardiothoracic nursing
 Neuro nursing
 Neonatal nursing
 Operation room nursing
 NP in midwifery
 Oncology nursing
 Emergency and disaster nursing
 Psychiatry nursing
 Orthopedic and rehabilitative nursing

41. • Taken up in future is given by CNO , UK
 HIV
 Pain management
 Dermatology
 Coloproctology
 Cardioversion
 Osteoporesis
 Epilepsy
 Dementia
 BM transplant
 DM

42. • Physician Shortages
• Gaps in Services
• Welcoming gvt attitude
• Recognition by Public

43. Guidelines to Avoid Legal Implications while
Performing Advanced Roles
• Must maintain their professional knowledge and
competence.
• Must keep knowledge and skills up-to-date
throughout their working life.
• Have a responsibility to deliver care based.
• To practice competently
• To facilitate student to develop their competence

44. Conclusion:
We have covered much ground in the area of
nursing roles. We can see that nursing has
become… bigger, fuller, more elaborate or
systematic, and more mature in current times. By
expanding the nurses’ roles, help them taking
their own initiative, doing their own thinking and
making their own decisions based on their own
experience and education, to improve practice
for the benefit of patients and clients.

45. Bibliography
• Journal :
• S E Ormond-Walshe ; The role of the infection control
nurse as a clinical nurse specialist or advanced nurse
practitioner ; 2001 Jul;9(4):209-12. doi: 10.1046/j.1365-
2834.2001.00227.x.
The specialty of infection control is examined regarding the
role of the infection control nurse and the educational
requirements for practitioners in this field in relation to
post titles of clinical nurse specialist and advanced nurse
practitioner. Whilst not fulfilling all the role constituents of
a clinical nurse specialist, the infection control nurse is seen
as more akin to a clinical nurse specialist than an advanced
nurse practitioner.

46. Bibliography:
• BOOKS
Brar Kaur Navdeep ;” advanced nursing
practice “ 1st edition ; 2015; Jaypee; page no
945-960
Behrmann ”A textbook of paediatrics” 1st
edition ; 2000; Harcourt

47. BIBLIOGRAPHY
• ELECTRONIC SEARCH:
https://www.slideshare.net/napnap19/exp
anded-role-of-nurses
https://www.slideshare.net/vijayvandali/ext
ended-and-expanded-role-of-nurse-
238903953