EXTENDED &EXPANDED ROLE OF NURSE
During the first five decades the nursing profession made significant progress
towards developing a body of scientific knowledge, nursing practice change a
response to consumer demand and involvement of new technology changes in
health care delivery system and policy .
A Resent debate about nursing is weather the nurses role should be expanded or
extended health care delivery system an policy .
EXTENDED ROLE OF NURSE
Extended care facilities are becoming the nurse popular means managing the
health care needs of the client who require additional care .
Extended care facilities assists client with their daily activities ,provide care
when necessary and co-ordinate rehabilitation service.
Extended role of nurse is a activities concerned with the patient either
in hospital or community that are appropriate for delegation by
doctors to nurses.
EXTENDED ROLE OF NURSE
1 Care giver
3 Advocator &protector
5 Nurse educator
9 School health nurse
10 Occupational health nurse
11 Parish nurse
12 Public health nurse
13 Home care nurse
14 Rehabilitation nurse
15 Office nurse
16 Nurse epidemiologist
17 critical nurse
18 Nurse administrator
19 Nurse practitioner
21 Community health nurse
22Occupational health nurse
24Medical surgical nurse
1. CARE GIVER-
- Care giving role is primary role of nurse.
- The nurse add the holistic care needs of the client, including
measures to restore emotional, spiritual & social well being.
3 PROTECTOR AND ADVOCATOR
- As protector,nurse helps to maintain a safe environment for the client
and take steps to prevent injury and protect client from possible
adverse effects of diagnostic or treatment measures.
- Conforming that a client does not have an allergy to a medication
and providing immunization..
- The role of a counselor, nurse helps to explore feelings and attitude about
wellness &illness with patients and their families.
- It involve providing emotional, intellectual and psychological support.
- Counseling requires therapeutic communication skills.
- The role of communicator is central to all nursing roles and activities.
- Nursing involves communication with client, families, other nurses and
health care professional and he community.
- Quality of communication is critical factor in meeting the needs of
individual, families and communities.
- The nursing interventions planned and implemented for each client and
should document them on client record this type of communication need
to be clear and relevant
- Rehabilitation is the process by which individual returns to maximum
level of functioning after illness ,accidents or other disability events.
- Usually client experiences physical or emotional impairment that
changes their lives and nurse helps them to adapt as fully as possible by
using her knowledge and skills.
- Move towards independence
- Work as part of multidisciplinary team
- Coordinate patient care prevent complication
- Patient education and counseling
- Many professions make up the team involved in the care of each client.
- Besides nurse ,their also can be physical therapist ,occupational
therapist, social workers and nutrionists.
- The nurse collaborates with other team members when providing care
9. SCHOOL HEALTH NURSE-
- School nursing is a specialized practice of professional nursing
that facilitates the well being, academic success and life long
achievement of students.
Direct care giver- The school nurse is expected to give immediate
nursing care to the ill or injured child or the school staff members.
Case finder- the school health nurse identifies as early as possible
children at risk for physical, behavioral, social or academic problems.
Case manager- help to coordinate the health care for children, with any
Consultant- provide professional information about changes in school
environment and their impact on the health of children
Health educator- the nurse provides health education regarding
proper nutrition or safety information ,personal hygiene to children
and also to their parents
10.Occupational health services-
- Occupational and environmental health nursing is the specially
practice that provides for the delivery health and safety programmes
and service to the workers and community group.
- The practice focus on promotion and restoration of health, prevention
of illness and injury and protection from environmental hazards.
Practices focus on…
- Promotion of health
- Restoration of health
- Prevention of illness
- Protection from hazards
Direct nursing care- this care involved primary, secondary and tertiary
prevention with nursing intervention from assessment.
- eg. physical assessment, screening
- Counseling-occupational nurse counsel for issues such as substance
abuse and emotional or family problems
- Health promotion-occupational health teaching skills and developing
health education programmes especially on smoking cessation
exercise, nutrition wait control and chronic illnesses family problems.
- Parish nurse is the most commonly used term for the professional
advanced nurse practice role for the gathering in churches,tempels or
- A parish nurse specialist who encourages physical and spiritual health .
- A parish nurse is a registered nurse with specialized knowledge who is
called to ministry and affirmed by a faith community to promote
health, healing and wholeness
-Provide a spiritual care :- spiritual care is the core of parish
nurse practice and central to the healing process.
- Health counselor :- health counselor explain health risk
apprisal,plan for health their life style, provide support and
guidance related acute and chronic, actual and potential
- Health advocate :- as an advocate, parish nurse guides
persons successfully for problem solving and care options.
- Health educator :- as a educator ,serves to gain knowledge
in order to make best choices for maintaining health,
lowering health risk, preventing illness and managing
diseases' already present.
12 .PUBLIC HEALTH NURSE
It is a registered nurse specially trained in community
Public health nurses work within the communities and
focus on different areas to improve the overall health of the
people within that community.
Health advocate-as an advocate, public health nurse
collects, monitors & analyze data and discuss with the
client which services are needed..
Care manager-public health nurses uses the nursing
process of assessing, planning, implementing, & evaluating
outcome to meet clients needs .
Health educator-as an educator the public health nurse
identifies community needs & develop an implement
activities aimed at changing behavior.
Communicable disease control-public health nursing skills
are necessary for education, prevention, survivelence
&investigation of communicable diseases on community.
14 REHABILITATION NURSE-
- Rehabilitation nurse as a nurse who specializes in assisting with
disabilities and chronic illness to attain optimal function, health, and
to adapt to an altered life style.
- They work as a part of multidisciplinary team and often
coordinate patient care and team activities.
- Rehabilitation nurse provides care that helps to restore and
maintain function and prevent complication
- Provide patient and family education,counselling and case
15 OFFICE NURSE-
- office nurse is called as clinic nurse.
- Office nurse provide patient care along with physician in setting such as
physician office ,medical office.
- The main focus is on diagnosis and treatment of specific illness rather than
- identifies trends in the type of problems client present and treating
_ provides health promotion activities by health education and health
- Acts as problem solver who helps with referral questions
16 NURSE EPIDEMIOLOGIST-
- Nurse epidemiologist searches for new diseases and its reporting and
taking part in health programs.
17 CRITICAL CARE NURSE-
- Qualification of critical care nurses are basic b sc ,degree or diploma
in nursing and advanced preparation in critical care nursing .
Monitoring balloon angioplasty, pacemaker, hemodynamic ,bedside
hemodialysis and surgical procedures.
Manages patients total care.
18 NURSE ADMINISTRATOR-
- The nurse administrator manages client care, including delivery of
- the function of nursing administrator include budgeting, staffing and
19. NURSE PRACTITIONER
A nurse who is qualified to treat certain medical condition without the
direct supervision of doctors
Nurse practitioner who are educated and trained to provide health
promotion and maintenance through the diagnosis and treatment of
acute illness and chronic condition
20 NURSE MIDWIFE-
- the nurse midwifes gives perinatal care for the mothers.
- They also conduct pap smear, family planning and routine
21 COMMUNITY HEALTH NURSE-
- The goal of community health nurse is to improve health of
community as a whole.
- Community health nurse function within the community
framework and serves the health needs of public and deliver
care to the community.
- Functions of community health nurse
Assisting in ANC and PNC
Collection of information and data collecting
Conduct school health services
22 OCCUPATIONAL HEALTH NURSE-
- It is a branch of public health nursing.
- The occupational health nurse work in traditional manufacturing,
industry services, construction sites and government setting
- The role includes: assessment, primary health care ,case management
counseling, health promoting and protection, research,
administration and management
23 PSYCHIATRIC NURSE-
- it is a branch of nursing that deals with mentally challenged and
mentally disturbed clients and their needs.
- The role includes educator, surrogate, councelling,psychotherapist
24 MEDICAL SURGICAL NURSE-
- It is a branch of medicine that deals with the overall medical and
surgical needs of the client and the functions include assessment of
problem help in diagnosis, treatment, administration of medication
EXPANDED ROLE OF NURSE
- Expanded role of nurse is the responsibility assumed by the nurse
within the field of practice .
- Increasing educational opportunities for nurses, the growth of
nursing as a profession and a greater concern for job .
- the nursing profession offers expanded role and different kind of career
- expanded role of nurse means enlargement of nursing within the
boundaries of nursing.
The expanded role of nurse includes the following
1. Advanced nurse practitioner
2. Clinical nurse specialist
3. Nurse anesthetist
4. Nurse researcher
5. Nurse educator
6. Acute care nurse practitioner
7. Nurse entrepreneur
8. Operating home nurse
9. Travel nurse
10. Nurse oncologist
11. Nurse informatics
12. Sport nurse
13. hospice nurse
1 ADVANCED NURSE PRACTITIONER- a nurse who has an advanced
education and is a graduate of nurse practitioner program is
employed in health care agencies.
Job responsibility includes- - taking client history
- -- Conducting physical examination
-- ordering performing diagnostic test
- providing primary care
- consultant for individual, families
2 NURSE CLINICIAN/CLINICAL NURSE SPECIALIST-
- The clinical nurse specialist has a master degree in nursing
and expertise in a specialized area of practice
- the main function as client care provider, educator, and
consultant researcher, manager and improve the quality of
care provided to the client and family members.
3 NURSE ANESHETIST-
- A nurse anesthetist is an registered nurse who received
advanced training in an accelerated program of
- carries visit and assessment
- Administration of general anesthetic agent for surgery .
- Assessment of post operative status of client.
4 NURSE RESEARCHER-
- Nurse researcher may be employed in an academic setting, hospital,
or community service agencies
- The nurse researcher investigates problems to improve nursing care
and to further define and expand the scope of nursing.
5 ADVANCED NURSE EDUCATOR-
- The nurse educator is usually degree holder or more advanced or
more advanced and frequently an expert in particular area of practice
6 ACUTE CARE NURSE PRACTITIONER-
- An acute acre nurse practitioner function in setting where critically ill
patient reside this type of nurse provide special expertise.
7 NURSE ENTERPRENEUR-
- An entrepreneur is an individual who organize operates and assumes
business. Such as independent nursing practice, consultants service
etc. the nurse may be involved in education consultation research etc
8 OPERATING ROOM NURSE-
- When patient are admitted before and after surgery, the operating
room nurse monitors the patients progress.
- She also performs preoperative assessment, prepare the patient for
surgery, assist the surgeon during procedure and manage patient
9 TRAVEL NURSING-
- Travel nursing and the travel nursing industry developed in response to the
nursing shortage in which nurses are relocated for short term nursing
10 NURSE ONCOLOGIST-
- Advance oncology nursing practice it means practice of expert and
leadership in the provisional care to individual with an acute and
potential diagnosis of cancer.
11) NURSE INFORMATICS/NURSE ANALYST-
- The nursing analyst work within the management team to ensure high
quality of performance and technical support to both the management and
the nursing staff .
- A nursing analyst must have a strong statistical background and be able to
interpret data in a logical manner.
- The nursing analyst must be able to work on multiple project at one time,
focus on details.
12 SPORT NURSE-
- The nursing profession has yet to officially develop a specialty in fitness
nursing or sport nursing on either the professional or academic level, a
growing numbers of nurses become involved in these areas.
- The connection between physical fitness, wellness and disease prevention is
- Some nurses are involved in sport medicine on a full time basis while others
work on a full time, contract basis for sport time.e.
s13 HOSPICE NURSE-
- The focus of hospice care is a comprehensive physical, psychosocial,
emotional, and spiritual care to terminally ill person and their
- Hosp[ice and palliative care includes 2 hours nursing availability,
management of pain and other symptoms and family support.
- Hospice providers promote quality of life by protecting patient from
burden some intervention and providing care at home.
14 SPACE NURSE-
- Space nurse provides a on the ground monitoring and a full range of
health services to astronauts, who are screened to determine if they
meet the NASA health requirement.
--Flight medicine nurse also coordinate dietary and fitness services ;
clinical nurse staff a sick call service for astronauts to use before and
15 TELE NURSE
It carries out telephonic communication with patients thus providing response
to medical care/treatment
Among its many benefits telenursing may help solve increasing shortage of
nurses, to reduce distances and save travel time, and to keep patient out of
16 .CRUISE NURSE-
- These nurses work on ships or resort to provide emergency and general
care to passengers /vacationers, should it be required.
- Responsibility includes providing patient care in the health centre and
dealing with onsite emergencies.
- The requirements are registration with a minimum 2 years of
experience in a recent Shospital required. experience with cardiac
care,trauma,and internal medicine etc.
- They must have excellent interpersonal skills, strong health assessment
17 DISASTER NURSE/BIOTERRORISM NURSE-
- these nurses works in disaster areas that are the result of bioterrorist attack or
a situation caused by natural disaster,war,or poverty, red cross nurse are often
part of wing of nurses.
- The skills include: emergency room and critical care experience,
management skill, ability to meet the needs of the people in high crisis
18 NURSE AS AUTHOR-
- An registered nurse who works in area of writing this written materials
may be used in research education,training,sales and marketing, and
other mediums and communication forums.
- The quality of journals which publish to nursing practice, material
concerning nursing issues depend on quality of material submitted.
19 EPIDEMILOGY NURSE-
- A nurse epidemiologist investigates trends in groups or aggregates and studies
the occurrence of diseases and injuries.
- The information is gathered from census data and statistics and reportable
- They identify population at risk monitor the progress of disease, specify areas
of health care needs.
- They don’t provide direct nursing care, but they do research and publish the
latest trends in health care.
Administration of general and specific health surveys
Participation in early diagnosis and treatment
Identification and treatment of certain specific diseases
- A nurse who knows about legal/moral/ethical issues and
provides services for patient and families is called nurse
- The nurse may work with an ethicist team to develop a detailed
investigative plan .
- The criteria is a master degrees in bioethics or related field
along with a registered nurse certificate.
SR NO. Text book Author PAGE NO
1 Advanced nursing practice Shebeer bsaheer 681-686
2 Fundamental of nursing Sr.nacy 94-96
3 Management and nursing