Nursing Roles Nurses fulfill multiple roles on a daily basis as they care for clients. These roles can have a direct impact on the care of the individ

Nursing Roles

Nurses fulfill multiple roles on a daily basis as they care for clients. These roles can have a direct impact on the care of the individual client, or a group of clients with the same diagnosis who may be receiving similar care. In addition to the direct effect on client care, several of these roles can impact the teamwork demonstrated by the nursing staff, the culture of the work environment, and the advancement of evidence-based nursing practice. This section explores each of these roles and considers how the nurse uses these roles in the best interest of clients’ lives​​​​​​​.

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Roles of the NurseNurses can perform multiple roles in the daily care of the client.

Care Provider

A nurse is most often identified as a care provider. Nurses have been educated to provide knowledgeable, compassionate care to promote health and address illness. Nursing practice is built on shared sciences such as physiology, microbiology, and psychology. Along with the scientific foundation, nurses are taught critical thinking, the value of holistic care, and evidence-based nursing skills so that they can provide direct care to their clients. Nursing focuses on care of the whole person—physical, mental, emotional, and spiritual health—and the nurse has a unique role as an advocate for the client. By understanding the needs of the whole person and demonstrating empathy, a nurse is better able to provide the client with the care needed, and to communicate with the health care team to help meet those needs. An effective care provider communicates and works well with the client and other coworkers and is a strong advocate for the needs of the clients and their families.

Nurses must be able to provide professional empathy to all clients, regardless of their race, illness, socioeconomic status, ethnicity, religion, and level of education. A critical part of caring for the whole person is being sensitive to individual cultural preferences, also referred to as practicing culturally competent care. Providing culturally competent care needs to be taught; it does not come naturally. This complex concept must be taught to nurses as well as health care employees. A nurse learns awareness and appreciation of clients’ personal cultural values and practices, and how they affect clients’ perceptions of their health. Even the most basic communication with a client requires knowledge about that person’s language; preferences for family inclusion/exclusion during health discussions; need for an interpreter; health practices and spiritual care preferred by the client; and level of education, knowledge, or health literacy. Successful client outcomes are more often achieved by nurses who make the effort to educate themselves about their clients’ cultural preferences and needs.

Being a care provider is an essential role for all nurses. Clients’ safety and health outcomes depend on the nurse being a competent care provider. Although nursing tasks are important, the nurse must see the role of the care provider as being much broader than simply completing a task such as medication administration. On a daily basis, the nurse as a care provider is key to the delivery of person-centered care​​​​​​​.

Case Manager

The complexity of the health care delivery system and the increased number of clients who have multiple health problems (also known as comorbidities) have been identified as potential causes that may lead to fragmentation of the care services clients receive. Thus, another role that nurses must incorporate into their nursing practice is that of a nurse case manager. As a case manager, the nurse works with the client, the family, and the health care team to ensure that the client receives needed services. Nurses manage the care of the client by communicating with the appropriate interprofessional team members to create a plan of care that will meet the needs of the whole client, including the need for interdisciplinary services (e.g., physical therapy, occupational therapy, enterostomal therapy, home health nursing, speech therapy), as well as coordinating the client’s educational needs as they relate to the disease process, medications, and discharge instructions. During the nurse’s role as the care provider, the client’s need for additional services, or coordination of those services, and education will become apparent to the competent nurse. The nurse can suggest a consultation for an interdisciplinary service or may coordinate the timing of a physical therapy session and diagnostic testing to avoid the client becoming fatigued, hypoglycemic, or short of breath. These actions as a case manager by nurses have been demonstrated to lead to safer and more effective care of the client.

Although the nurse who is providing care often manages the daily or short-term care of the client, many facilities have established a formal role of case manager, which is often held by a nurse who has clinical experience. In addition, this formal case manager role may require an MSN or certification in case management. Case managers are consulted to assist in coordinating needed services once the client is discharged. They typically do not provide direct care to the client. They need to be knowledgeable about the client’s insurance, and the services covered through that insurance, or they may need to assist the client in obtaining insurance to cover the costs of services being provided or needed upon discharge. They can then facilitate, coordinate, and advocate for services to meet the client’s needs and develop a plan for discharge. The case manager serves to provide a seamless transition to home or a long-term care facility and continuation of the needed services to assist in the care of the client.

Researcher

All nurses have a role in research. As direct care providers, nurses utilize research to provide evidence-based care. Evidence-based practice is the delivery of care (e.g., procedures, assessments, interventions) that is supported by scientific research showing its factual accuracy and effectiveness. The use of such practice helps ensure clients receive the best care. Nurses keep informed on evidence-based practice by reading scholarly resources to find the most valid and current information about new medications, procedures, or technology. Nurses who serve on a quality improvement committee can also use published research to improve the care of clients. In addition, the direct care provider nurse may assist a researcher (nurse, physician, or PhD student) in the collection of data or a clinical trial of a new procedure, medication, or diagnostic test. Some facilities encourage nurses to learn more about research and offer various continuing education opportunities related to this area.

In the formal role of nurse researcher, the nurse develops nursing knowledge by conducting research and publishing the results. A nurse researcher can be hired to work in a laboratory at a pharmaceutical company or in the field (oncology, neurology), in a variety of settings (inpatient or outpatient clinics), or in a university’s school of nursing. Nurse researchers or nurse scientists should be PhD prepared and have experience with research and evidence-based practice. They are responsible for designing scientific research to answer pertinent questions about an intervention or the client’s feelings or experience with a disease process. Such research is designed to provide a base of knowledge to the nursing profession through a systematic inquiry design, and by proving hypotheses to be true or not true. Overall, ongoing research aims to improve nursing practice by generating evidence for nurses to use in the care of their clients.

Educator

Another role that the nurse assumes in the care of clients is that of an educator. Client education is a critical intervention that nurses implement daily. Educating clients serves to increase their knowledge, which empowers them to employ appropriate self-care management skills and to make informed care decisions, and can improve the client’s quality of life. In addition to client education, nurses are responsible for helping to teach student nurses and serving as preceptors for newly hired nurses. Student nurses’ clinical experiences foster their competency as care providers as well as their development of a professional identity as a nurse. The interaction between the student nurse and the nurse can influence whether the student continues to pursue nursing. Therefore, it is of the utmost importance that nurses assist student nurses in their learning during clinical experiences. Nurses who serve as preceptors to newly hired nurses are experienced staff members. The preceptor helps the newly hired nurse transition to a new role (from student nurse to staff nurse, or from staff nurse at another facility/unit to the current position). The preceptor provides clinically appropriate experiences, assists with the development of new nursing skills and knowledge, is readily available as a resource for the new staff member, acts as a role model, and gives the new nurse feedback on his or her progress.

There are several formal nursing education roles within clinical facilities as clinical nurse educators and within schools of nursing as faculty members. Nurses who enjoy teaching may be interested in moving into these roles. However, they will need to have or be in pursuit of a graduate degree (MSN, DNP, PhD). In addition to formal education, these nurses need to have years of clinical experience with expertise in a clinical area. With the shortage of nursing faculty in the United States, faculty may teach in both the classroom and clinical areas, including simulation and skill laboratory settings​​​​​​​. The National League of Nurses has recognized the importance of preparing new educators through faculty development resources. Its website provides an online toolkit and recommendations for mentorship to allow educators to be fully prepared for the teaching experience.

Clinical nurse educators (CNEs) are primarily responsible for providing education to the nurses who work in the facility. CNEs may be called upon to develop an orientation program for newly hired staff, assess the competency of staff nurses, introduce new technology (e.g., computerized documentation, IV infusion pumps, cardiac monitors), and provide continuing education opportunities. They can also be responsible for writing or revising facility policies and procedures based on evidence-based research.

Leader

Leadership is the process of using social influence to inspire and empower individuals to work together toward shared objectives. The power of effective leadership is seen in the way a team works with seemingly effortless coordination. Strong leadership encourages effective communication, relationship building, and communicating and working together to create clear plans and achieve goals. Optimal client outcomes occur when nurse leaders foster interdisciplinary teamwork​​​​​​​.

Two types of leadership are distinguished: assigned leadership and emergent leadership. Assigned leadership is associated with a position within the organizational structure such as a nurse manager, nursing director, or chief nurse officer (CNO). These are formal positions of power and influence. However, not all nurses need to be in an assigned leadership role to influence others and to achieve common goals. Informal leaders often include staff nurses who provide direct care to the clients. These nurses exhibit strong influence due to their expertise and knowledge, relationships with others, and willingness to be seen as innovative, outspoken, and ethical. Emergent leaders are necessary for improving both the quality of care and the work environment. Preparing new clinical nurse leaders with quality training that enhances personal trust, communication, and decision-making processes makes for a more effective and confident leader​​​​​​​. Opportunities also exist for nurses who have strong leadership skills to progress into an assigned leadership role such as a nurse manager.

Match each nursing role with its correct description or responsibility.

Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right).

Coordinates interdisciplinary services, discharge planning, and insurance coverage for clients

Case manager 

Provides education to staff nurses, develops orientation programs, and introduces new technology

CNE

Conducts scientific studies to generate evidence for nursing practice and publishes findings

Nurse researcher 

Teaches students and mentors new nurses

Nurse educator

Well done!

Case managers ensure clients receive needed services, coordinate care, and manage insurance issues for smooth transitions. Nurse educators teach students and mentor new nurses to develop skills and professional identity. CNEs focus on staff education, competency assessment, and policy updates. Nurse researchers design and conduct studies to advance nursing knowledge and evidence-based practice.      

Manager

The nurse manager is an assigned leadership role. This role has evolved to meet the needs of the ever-changing health care delivery system. Nurse managers are formally responsible for a team of nurses and have a significant impact on their team’s job satisfaction. A nurse manager has overall responsibilities for the assigned clinical area(s), including managing the staff and ensuring the quality of care being delivered. Specific responsibilities include hiring, orienting, scheduling, and evaluating the nurses. Nurse managers help problem-solve for staff, clients, and agencies. Managing supply and equipment availability, maintaining budgets, and creating goals and objectives for the unit are among the daily duties of the nurse manager. This role is vital to the cohesion of the team and the ultimate health of the client. Nurse managers strive to achieve a balance so that the workplace is focused on safety, health, and satisfaction for both clients and staff. Support and education for this role are critical to prevent manager turnover.

Another management role for nurses is as an executive nurse leader. Nurse leaders at the executive level are responsible for seeing that the Nurse Practice Act and the Standards of Care are being followed in the clinical setting, thereby enforcing safety for all clients and staff. CNOs are tasked with managing the bigger picture of the regulation of nursing. They work with those at the state and national levels tasked with improving procedures or practices to avoid safety issues. This consideration is especially important if an error or unwanted outcome occurs and reporting the adverse incident becomes necessary. Nurse leaders in policy-making positions are instrumental in effecting changes for nursing as a whole, such as staffing policies. Regulations that affect safety influence staffing and are addressed through nursing leaders at the facility, local, state, and national policy-making levels.

Which of the following are the responsibilities of a nurse manager? (Select all that apply.)

a

Budgeting

b

Scheduling

c

Resolving conflicts

d

Client safety

Well done!

You answered correctly. Nurse managers are responsible for their staff and unit functioning well. Their responsibilities include hiring, orienting, scheduling, evaluating, problem-solving, managing budget needs such as supplies and staffing, ensuring workplace staff and client satisfaction, and providing oversight of the safety, care, and positive outcomes of the clients on the unit.

Change Agent

All nurses can serve in the role of a change agent. Nurse change agents recognize the need for and take steps to make a change; to do so, they are required to be both credible and reliable. Nurses must embrace change, working creatively with others based on a shared understanding of the need for change. A nurse who is a change agent has the power to facilitate change and the responsibility to assist others in making the transition. This can involve planning and initiating changes that can improve client outcomes and then evaluating the progress toward safer client care. For example, a change agent is needed when a new infusion device is introduced to replace the old one. Because most nurses will be comfortable with the old device, it is important for them to understand the reason why the change is necessary, the advantages of the change, and when implementation will occur after education is provided. Change agents know that change typically triggers stress and resistance, so they help other nurses see that the change is for the better and is based on research. The change agent’s goal is to change attitudes, values, or norms related to the relationship between the nurse, client, and organizational system.

change agent

Which of the following ways could a nurse act as a change agent? (Select all that apply.)

a

Maintain the client's privacy

b

Serve on the quality improvement committee

c

Provide the nurse manager with information on a more efficient cardiac monitor

d

Provide care for the client

e

Introduce a new process to discharge clients

Match the following nursing roles with the appropriate description. (Match the option from the left column with the description in the right column.)

Inspires and motivates a group toward achieving a common goal or cause

Seeks factual evidence-based information for nursing practice

Communicates and coordinates care for the client with all team members

Teaches nursing students

Nursing Competencies

Nursing competencies are the knowledge, attitudes, values, and skills that nurses are expected to know to provide safe care. These competencies have different levels of attainment, such as novice, proficient, or mastery levels, or are based upon performance or standards achieved. In this lesson, the competencies of advocacy, counseling, change management, communication, and collaboration are discussed. The ways in which nurses use these tools to address the needs of their clients are also explored.

Advocacy

The ANA’s definition of nursing includes advocacy as one of the pillars of nursing in the provision of care to individuals, families, and communities. As client advocates, nurses support, protect, and promote the rights, health, and safety of the client​​​​​​​. A client can voice to the nurse who is preparing the client for a surgical procedure that they do not want to have the surgery. The nurse needs to act as the client’s advocate by immediately contacting the surgeon, so the client, surgeon, and nurse can discuss the client’s concerns. Another example of client advocacy can be seen when a nurse becomes aware of a potential safety or privacy issue, such as malfunctioning equipment or a peer who is talking about a client in the elevator, and corrects or reports this concern.

advocacy

Advocacy also applies to championing nursing interests directly with decision and policy makers. Nurses can be involved in this process by becoming active in facility committees (e.g., staffing, quality improvement); local, state, or national nursing associations; or other nonprofit organizations that impact the health of clients who have an illness (e.g., mental health, cancer, substance use disorder, Crohn’s disease). An example of advocacy at a local level might be the nurse who is a member of a local nonprofit organization focusing on suicide prevention. This nurse could assist the nonprofit organization in obtaining funding by writing a government grant application or by lobbying the local school district to have educational programming about suicide prevention for grades 6 to 12. Such forums connect nurses, provide platforms to share their perspectives on current issues, and support nurses' efforts to implement policy and build and improve programs to promote health​​​​​​​.

Change Management

Nursing managers are the leaders on their units, which means they are also responsible for change management in their areas. Improvements in client care, staff processes, and the coordination of the teams on the unit are in constant flux, due to the evolving updates in health care and the increasing acuity of clients. Nurse managers can adapt by being effective change managers with a goal of continually improving the staff workflow and the client outcomes. Effective change managers are characterized by a strong client safety culture with organizational learning, skill improvement, nonpunitive response to errors, with open communication and feedback from nursing staff and clients​​​​​​​.

change management

The Institute of Medicine has identified what constitutes an effective workplace for nurses—enough staff and resources, managers who are approachable and offer support, teamwork and collaboration with staff, a voice for change, and the ability to advance in their career. Change managers are challenged to listen to the needs of the staff and address their concerns, while working with the administration and executive leaders to enact that change. Nurses’ satisfaction in their work and their ability to safely care for their clients are directly influenced by the workplace environment. Change managers can be effective leaders by promoting positive changes within their units or facilities.

Communication

Communication in nursing is the one truly personal way that nurses can convey trust, empathy, understanding, cultural consideration, and interest—all without even speaking a word. Nurses can achieve effective communication by beginning with intentional listening, showing compassion, and demonstrating respect for the individual client. The nurse offers a calm, nonverbal presence through listening and presenting a physical posture of openness and calmness. Verbal communication is addressed through acknowledging cultural considerations; displaying awareness of any difficulties of speech, hearing, or language; and recognizing the need for a translator. Respectful assessment of the client’s communication needs, followed by adaptation or provision of necessary resources to accommodate those needs, is the beginning of effective communication with the client.

Effective communication between the client and the nurse is based on understanding of the client’s needs, and the nurse’s response to those needs through effective communication with the client and the health care team. Effective communication is based on understanding the culture, belief system, and personal practices of each client. This attention to a client’s values, beliefs, practices, and worldview is referred to as being culturally congruent or providing culturally competent care. In this way, trust and communication are established as a foundation for safe and effective care. For example, a client who speaks a language different from the nurse may require a translator to interpret the medical information. Clients who have a hearing or visual deficit may require technology or adaptive devices to assist them in receiving necessary information successfully. Learning about a client’s personal and cultural preferences is an important step in establishing trust and is a part of effective communication for that client. Culturally congruent practice is the eighth standard in the Standards of Professional Performance.

Communication with colleagues is critical to effective client care. Nurses communicate and collaborate with the health care team verbally, as well as through written and electronic documentation. Communication is multifaceted, including listening and observing nonverbal cues, with awareness of professional roles and cultural and personal preferences. Effective communication among health care professionals is called interprofessional communication. Client outcomes improve when an interprofessional team communicates effectively about the plan of care, implements the plan, problem solves, evaluates the care, and makes necessary adjustments as a team.

Collaboration

Collaboration in health care refers to the respectful communication and sharing of ideas, policy, practices, and research with peers and interprofessional team members so as to provide quality professional care. The team members must be knowledgeable about how each member’s role contributes to the care of the client. Most clients have needs that involve more than one area of health care. These needs are best served by collaboration among all the health care professionals who are providing care. For example, a client who reports difficulty walking will need nurses, a physical therapist, and perhaps an occupational therapist to successfully plan and manage his or her care. If interprofessional collaboration is lacking, care may become fragmented and may even lead to untoward client outcomes. To ensure effective collaboration, the ANA recommends recognizing the strengths and expertise of each team member, identifying the resources available to the nurse and the client, respecting the input of each team member, identifying clear roles and responsibilities of the nurse, and involving the client as appropriate to establish cooperation and success in achieving goals.

collaboration

Drag the nursing competencies in the left column to their correct definitions in the right column.  

The process of working jointly with other health care professionals to provide comprehensive care to clients

The ability to support and represent clients' interests, ensuring their wishes and concerns are heard in the decision-making process

The skill of effectively introducing and managing change within a health care setting to improve client care and staff processes

The practice of exchanging information with clients and colleagues in a way that fosters understanding, safety, and trust

Nursing Roles

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