Chapter 26

Chapter 26
Contemporary Nursing Roles and
Career Opportunities
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Care provider
 Assessing clients, planning therapeutic interventions,
coordinating and evaluating care
 Caring: central to nursing interventions
 Educator and counselor
 Teaching health promotion and health maintenance
 Increasingly important in the changing health care
environment
Professional Nursing Roles
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 Advocate
 Promoting what is best for the client
 Protecting the client’s rights
 Change agent
 Identifying client and health care delivery problems
 Assessing motivation and capacity for change
 Determining and exploring alternatives and assessing
cost-effective resources
 Leading the change process
Professional Nursing Roles (cont'd)

 Leader and manager
 Improving the health status and potential of
individuals, families, and communities
 Enhancing effectiveness and level of satisfaction
among colleagues
 Managing multiple resources in a health care facility
 Raising citizens’ and legislators’ attitudes toward and
expectations of the nursing profession and the health
care system

 Researcher
 Leading nursing research: nurses prepared at the
doctoral and postdoctoral levels
 Participating in research: nurses prepared at the
master’s, baccalaureate, and associate’s degree
levels

 Coordinator of the interprofessional team
 Coordinating practice relationships among several
health care disciplines to bond, interact, and unite
toward common goals of patient care
 Using successful health care team models with
concepts related to interdisciplinary health care such
as pain management, nutritional support, skin care,
rehabilitation, mental health, hospice, discharge
planning, and patient education

• Nurse (RN)
• Chaplain or pastoral representative
• Dietitian (RD or LD)
• Occupational therapist (OT)
• Pharmacist (RPh or PharmD)
• Physical therapist (PT)
• Advanced practice nurse (NP, CNS, CRNA, CNM)
• Physician (MD or DO)
• Physician assistant (PA)
• Respiratory therapist (RT)
• Social worker
• Speech/language pathologist (SLP)
Team Members

 RN demographics as of 2008
 Approximately 3 million RNs in the United States
• Largest occupation in health care specializing in four ways
 Work or treatment setting
 Disease category or condition
 Organ or body system
 Population
 Approximately 60% of RNs employed full time
 Average age: 46.8 years
Nurses Today: Who Are They
and What Are They Doing?

 Number of male RNs increased from 5.4% in 1996 to
6.2% in 2010
 Approximately 83.2% of RNs are white/non-Hispanic
 In 2008, nurses reported their highest degree as:
• 20.4% diploma
• 45.4% associate’s degree
• 34.2% baccalaureate degree or higher
Nurses Today: Who Are They
and What Are They Doing? (cont'd)

 Infection control: assess incidence of infection and
conduct comprehensive review to ensure prompt and
accurate treatment, so that it is not passed to other
patients; determine source and onset of infection
 Quality management: assess compliance of the
institution with established standards; ensure that
patient services are consistent with standards through
chart review and ongoing interaction with staff
Hospital Opportunities

 Specific client services: extensive list of client
services that include intravenous team, ostomy
care, support groups, and health education
 Coordinator positions: various coordinator
positions, which require considerable experience
in the specialty practice area
Hospital Opportunities (cont'd)

 Hospice nurse
 Informatics nurse specialist (NI)
 Occupational health nurse
 Quality manager
 Case manager
 Flight nurse
 Telephone triage nurse
 Forensic nurse
 School nurse
 Travel nurse
 Parish nurse
 Nurse educator
Variations on Traditional Roles in
Nursing

1. An RN enjoys caring for complex patients in
acute care and is interested in returning to school
for a graduate degree as a generalist to gain
greater autonomy over care decisions at the
bedside for those patients with multifaceted
dynamic health status. This nurse should
consider a career opportunity such as:
A. Flight nursing
B. Parish nursing
C. Clinical nurse leader
D. Case manager

2. A nurse establishes a “roadmap” for diagnostic
tests, activities, and treatments that standardize
care and increase safety while promoting
excellence of care in the acute care setting. The
nurse is operating in the role of:
A. Occupational health nurse
B. Informatics nurse specialist
C. Quality manager
D. Community health nurse

 Home care: as patients shift from hospital to
ambulatory care and home care, the role of the
community health nurse has evolved beyond the
traditional public health nurse concept
 Dobutamine administration
 Chemotherapy
 Radiography or telemetry
 Uterine monitoring
Nontraditional Roles in Nursing

 Minimum of master’s degree in the specialty
area in which they teach
 Must be competent in clinical practice at
advanced generalist or specialist level
 Expectations of the role include teaching,
scholarship, and service to the community
Nurse Educator

 New role
 Prepared as a master’s generalist
 Oversees the care of a distinct group of patients
in any setting
 Actively provides direct patient care in complex
situations
 Evaluates patient outcomes
 Puts evidence-based practice into action
Clinical Nurse Leader (CNL)

 Nurse practitioner
 Assesses and manages nursing and medical
problems; emphasis on disease prevention and health
promotion; job responsibilities include taking patient
histories, conducting physical examinations, and
ordering, performing, and interpreting diagnostic
tests; prescribing pharmacologic agents, treatments,
and therapies for the management of patient
conditions
Advanced Practice Nursing

 Clinical nurse specialist
 Possesses clinical expertise in a defined area of
nursing practice for a selected patient population or
clinical setting; functions as an expert clinician,
educator, consultant, researcher, and administrator
Advanced Practice Nursing (cont'd)

 Certified registered nurse anesthetist
 Provides anesthesia and anesthesia-related care on
request, assignment, or referral by a patient’s
physician, most often to facilitate diagnostic,
therapeutic, or surgical procedures

 Certified nurse-midwife
 Manages women’s health care, focusing particularly
on pregnancy, childbirth, postpartum care, care of the
newborn, and the family planning and gynecologic
needs of women

 Unites the leadership perspective of professional
nursing with various aspects of business and
health administration; focuses on administration
of health care systems for purpose of delivering
services to groups of patients
Nurse Administrator/Executive

 Expert in advanced nursing practice who has
earned a clinically focused doctorate in nursing
 In 2004, the American Association of Critical-
Care Nurses (AACN) published a DNP position
statement calling for transformational change in
nursing education, recommending nurses
practicing at the highest level should receive
doctoral degrees
Doctor of Nursing Practice (DNP)

 Diversity
 Challenge
 Unparalleled opportunities for new roles
What About the Future?

Chapter 26

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Editor's Notes