Objective

Roles, Functions, and Scope of Practice in Professional Nursing

  • Roles of Professional Nurses

    • Health promotion: Engaging in activities that improve the well-being of individuals and communities.

    • Health restoration: Focusing on the recovery of patients to their previous level of health.

    • End of life care: Providing specialized support and comfort to patients and families during the transition to death.

    • Advocate: Acting as a voice for patients, especially those unable to speak for themselves.

    • Change Agent: Working to improve nursing culture and clinical environments.

    • The collaborative team: Working alongside other professionals to provide comprehensive care.

    • Ancillary staff: Directing and working with support personnel in the healthcare setting.

  • Scope of Practice Settings

    • Acute care: Short-term, intensive care for urgent medical conditions.

    • Extended care: Long-term care facilities, such as nursing homes.

    • Specialized clinics: Facilities focused on specific medical expertise or patient populations.

  • Functions of Nursing

    • Protection and promotion of health and human functioning.

    • Prevention of illness and injury.

    • Facilitation of healing.

    • Alleviation of suffering.

    • Advocacy in the care of individuals, families, groups, and communities.

Historical Figures and Contributions to Nursing

  • Florence Nightingale

    • Introduced foundational hygiene practices into the medical field.

    • Emphasized the importance of bathing patients and providing proper nutrition (food and water).

    • Improved laundry services and prioritized the presence of sunshine and fresh air in treatment areas.

    • Established systematic documentation and connected findings between unclean conditions and patient outcomes.

  • Linda Richards

    • Recognized as the first trained nurse in the United States.

    • Introduced the practice of maintaining doctor’s and nurse’s notes for patient records.

    • Established standard requirements for nursing uniforms.

    • Founded the first nursing school located in Japan.

  • Mary Mahoney

    • The first African American registered nurse in the United States.

    • Co-founded the National Association of Colored Graduate Nurses (NAGCN).

  • Clara Barton

    • A former schoolteacher who organized and distributed medical supplies during the American Civil War.

    • Organized meetings in her New York apartment that ultimately led to the founding of the American Red Cross.

  • Dorothea Dix

    • Served as the Superintendent of Army Nurses.

    • Advocated for formal nursing training and significant reforms in mental health care.

  • Lillian Wald

    • Provided essential healthcare services to the impoverished populations of New York City.

    • Played an instrumental role in the established Henry Street Settlement.

    • Actively involved with several major organizations, including the NAACP, the Women’s Trade Union, and the ACLU.

  • Lavinia Dock

    • Founder of the National League for Nursing (NLN).

    • A prominent activist for women’s suffrage.

    • Contributed significantly to the passage of the 19th19^{th} Amendment.

  • Margaret Sanger

    • Advocated for birth control rights and women’s bodily autonomy.

    • Founded Planned Parenthood.

  • Mary Breckinridge

    • Established the Frontier Nursing Service in Kentucky.

    • Created a system to make midwives accessible to rural populations.

    • Founded the first midwifery school in the United States.

The Public Image and Representation of Nursing

  • General Perception

    • Nursing is consistently ranked among the most trusted professions globally.

  • Media Representations

    • Nurse Jackie: Depicted the professional struggles and personal experiences of nurses.

    • Carla from Scrubs: Illustrates how fictional portrayals can shape audience perceptions regarding nursing professionalism.

  • Significant Public Events and Figures

    • Miss Colorado: Used her platform to highlight her impact on a patient, which sparked national discourse regarding the public image and potential misrepresentation of the nursing profession.

    • Alex Wubbles: A significant figure in patient advocacy who was forcefully arrested and handcuffed in the middle of an Emergency Room (ER) before being dragged out of the building. She remained a fierce advocate for patient rights despite the trauma.

    • Redonda Vaught: A nurse involved in a fatal medication error. She bypassed medication system safeguards and administered the incorrect drug to a patient who was scheduled for a CT scan. Despite self-reporting the error, she was fired, lost her nursing license, and faced a high-profile criminal court case.

Nursing Education Levels and Licensure Requirements

  • Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN)

    • In the state of Texas, the role is referred to as a Licensed Vocational Nurse (LVN).

    • This path involves a 1010 to 1111 month certificate program.

    • LPNs/LVNs practice under the direct supervision of a Registered Nurse (RN), typically in settings such as clinics or nursing homes.

    • Licensure candidate must pass the NCLEX-PN exam.

  • Registered Nurse (RN)

    • Associate Degree in Nursing (ADN): A 22 year academic program.

    • Bachelor of Science in Nursing (BSN): A 44 year traditional program, or a bridge program specifically designed for those who already hold an ADN.

    • Both ADN and BSN graduates are required to take the exact same licensure exam: the NCLEX-RN.

    • The NCLEX exams are administered by the National Council of State Boards of Nursing.

  • Advanced Nursing Degrees

    • Master of Science in Nursing (MSN): Required for roles such as Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), or Nurse Midwife.

    • Doctorate: Required for Certified Registered Nurse Anesthetists (CRNA) in the state of Arkansas.

    • Advanced practice nurses (NPs, CRNAs) often require additional specialized certifications.

  • Maintenance of Licensure

    • Continuing education is often mandated to maintain a license to practice, ensuring that skills and knowledge remain current across all nursing levels.

Delegation and the Five Rights

  • Definition and Responsibility

    • Delegation involves assigning tasks to others. The Registered Nurse is always legally responsible for the final outcome of any delegated task.

  • The Five Rights of Delegation (Arkansas Nurse Rules and Regulations)

    • Right Task: Determining if the task is appropriate for the individual's level of training (e.g., a Certified Nursing Assistant (CNA) should not be asked to start an IV).

    • Right Circumstance: Assessing if the patient is stable enough for the specific task to be delegated.

    • Right Person: Verifying if the specific individual is qualified for the role.

    • Right Direction: Ensuring instructions are clear and fully understood by the person receiving the task.

    • Right Supervision: Monitoring the outcome of the task and providing appropriate oversight.

Definition of a Profession

  • Requirement 1: Body of Knowledge

    • A profession must possess a foundational theoretical and skill-based body of knowledge. In nursing, this includes scientific knowledge and the use of evidence-based practice.

  • Requirement 2: Code of Ethics and Standards

    • Peer-established guidelines must be in place to ensure safe and ethical practice.

  • Requirement 3: Service Provision

    • The field must provide a specific and necessary service to society.

  • Comparison

    • Other fields that meet these requirements include teaching and law, as both have specialized knowledge, ethical codes, and goals oriented toward service.

Evidence-Based Practice (EBP)

  • Definition

    • Evidence-based practice is the integration of the best available research with clinical expertise and individual patient values.

  • Application

    • EBP allows nurses to solve clinical problems using a formal scientific approach.

    • It shifts practice away from relying on luck or traditional "we've always done it this way" methods.

Specific Clinical Roles in the Healthcare Setting

  • Health Promotion

    • Nurses provide education and preventative services, such as flu vaccines, to help prevent illness before it occurs.

  • Health Restoration

    • Nurses help patients return to their baseline health status. This is vital because one full day of bed rest can require 33 days of rehabilitation to recover the lost physical function.

  • End-of-Life Care

    • This requires a specific skill set to support the physiological and emotional transitions of both the patient and their family.

  • Advocate

    • Nurses speak for patients who are unable to speak for themselves. This includes questioning physician orders if an assessment indicates an adverse reaction. For example, a nurse should question orders if they detect signs of a dopamine overdose in a patient with Parkinson's disease.

  • Change Agent

    • Nurses work to improve the culture of the profession. This includes ending toxic practices like "nurses eating their young" (hazing or bullying new staff) and instead fostering a culture of mentorship.

Professional Identity in Nursing

  • The Four Pillars of Professional Identity

    • Values and Ethics: Maintaining integrity, caring deeply for patients, and exhibiting empathy.

    • Knowledge: Maintaining the ability to analyze complex data, evaluate scientific evidence, and recognize patterns or clinical cues.

    • Nurse as a Leader: Taking on the role of patient advocate, successfully negotiating conflict, and always striving for clinical excellence.

    • Professional Comportment: Ensuring that one's presence, actions, and spoken words consistently signal respect and active engagement.