What is Nursing?

21st Century nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual.  

Beyond the time-honored reputation for compassion and dedication lies a highly specialized profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health.

Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient’s needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise.

However, nursing has a unifying ethos:  In assessing a patient, nurses do not just consider test results. Through the critical thinking exemplified in the nursing process (see below), nurses use their judgment to integrate objective data with subjective experience of a patient’s biological, physical and behavioral needs. This ensures that every patient, from city hospital to community health center; state prison to summer camp, receives the best possible care regardless of who they are, or where they may be.

What exactly do nurses do?

In a field as varied as nursing, there is no typical answer. Responsibilities can range from making acute treatment decisions to providing inoculations in schools. The key unifying characteristic in every role is the skill and drive that it takes to be a nurse. Through long-term monitoring of patients’ behavior and knowledge-based expertise, nurses are best placed to take an all-encompassing view of a patient’s wellbeing.

What types of nurses are there?

All nurses complete a rigorous program of extensive education and study, and work directly with patients, families, and communities using the core values of the nursing process. In the United States today, nursing roles can be divided into three categories by the specific responsibilities they undertake.

Registered Nurses

Registered nurses (RN) form the backbone of health care provision in the United States. RNs provide critical health care to the public wherever it is needed.

Key Responsibilities

• Perform physical exams and health histories before making critical decisions
• Provide health promotion, counseling and education
• Administer medications and other personalized interventions
• Coordinate care, in collaboration with a wide array of health care professionals

Advanced Practice Registered Nurses

Advance Practice Registered Nurses (APRN) hold at least a Master’s degree, in addition to the initial nursing education and licensing required for all RNs. The responsibilities of an APRN include, but are not limited to, providing invaluable primary and preventative health care to the public. APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease and engage in continuous education to remain at the very forefront of any technological, methodological, or other developments in the field.

APRNs Practice Specialist Roles

• Nurse Practitioners prescribe medication, diagnose and treat minor illnesses and injuries
• Certified Nurse-Midwives provide gynecological and low-risk obstetrical care
• Clinical Nurse Specialists handle a wide range of physical and mental health problems
• Certified Registered Nurse Anesthetists administer more than 65 percent of all anesthetics

Licensed Practical Nurses

Licensed Practical Nurses (LPN), also known as Licensed Vocational Nurses (LVNs), support the core health care team and work under the supervision of an RN, APRN or MD. By providing basic and routine care, they ensure the wellbeing of patients throughout the whole of the health care journey

Key Responsibilities

• Check vital signs and look for signs that health is deteriorating or improving
• Perform basic nursing functions such as changing bandages and wound dressings
• Ensure patients are comfortable, well-fed and hydrated
• May administer medications in some settings

What is the nursing process?

No matter what their field or specialty, all nurses utilize the same nursing process; a scientific method designed to deliver the very best in patient care, through five simple steps.

• Assessment – Nurses assess patients on an in-depth physiological, economic, social and lifestyle basis.
• Diagnosis – Through careful consideration of both physical symptoms and patient behavior, the nurse forms a diagnosis.
• Outcomes / Planning – The nurse uses their expertise to set realistic goals for the patient’s recovery. These objectives are then closely monitored.
• Implementation – By accurately implementing the care plan, nurses guarantee consistency of care for the patient whilst meticulously documenting their progress.
• Evaluation – By closely analyzing the effectiveness of the care plan and studying patient response, the nurse hones the plan to achieve the very best patient outcomes. 

Nurses are Key to the Health of the Nation

• There are over 4 million registered nurses in the United States today.
• That means that one in every 100 people is a registered nurse.
• Nurses are in every community – large and small – providing expert care from birth to the end of life.
• According to the January 2012 “United States Registered Nurse Workforce Report Card and Shortage Forecast” in the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2009 and 2030. In this state-by-state analysis, the authors forecast the RN shortage to be most intense in the South and the West
• Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.

Clinical Differences between your BSN and MSN – Guest Post

Let’s start out on a positive note, which is rare for me because my sense of humor is dark and drier than the saltines locked up by Dietary because the nurses were eating too many.  I love nurse practitioners.  They are adaptable, dependable, and their education opens up a world of possibilities and knowledge that doesn’t exist at the BSN level.  Like CRNAs, the skill and finesse they learn in school elevates caring to an art form.  Sometimes it’s a lot of fun! But, on the healthcare hierarchy totem pole, graduate students are still a bug trapped underneath the pole.  Clinical sites evaluate them much more closely and lord more power over them than in nursing school.  When it came to the hands-on, manage-the-patient-as-if-you-were-a-nurse part of nursing clinicals, I was about as skilled as this guy.

It took a long time for anyone to notice because I had a 4.0 and could answer any question thrown at me.  With an MSN, the bar is much higher.  You need to start performing on Day One rather than blunder through a three month orientation trying not to kill anyone at your first job.  The closer scrutiny on clinical results is necessary and rewarding, but there are two major ironies for CRNA and NP students to accept.  There are a lot of fabulous things too, but those aren’t as interesting to write about.  The first irony is that you are paying money to make other people money–sometimes while being treated poorly.  An example is the anesthesiologist resident being supervised remotely while sedating for colonoscopies, except that he makes enough to buy Ramen while the nurse anesthesia student does not.  The second is that although you occasionally generate the same level of notice and respect that Housekeeping does, whether your clinicals are at a small office or a large hospital, some of your preceptors will be intensively interested in your personal life.

Watch out for bullying

Identifying psychotic preceptors is an invaluable tool as a graduate student.  My site on bullying and corporate wellness can help with some of this.  Who can you trust?  Programs with multiple clinical sites have a liaison between the school and the program, although that doesn’t automatically mean anything.  Find out from students who have been to that clinical site before, although they may be more loyal to advance practice nurses at an institution than they will be to you.  Seniors may be after a job or desperately want to please someone at the site with juicy information about a new student.  At this point, you may suspect I’m a suspicious sourpuss.  I’m actually embarrassingly gullible and tend to see the best in people rather than their glaring faults, which is why advice like this was so helpful for me.  And really, you should be treating everyone as well as you can.  Not two-faced or disingenuous, but the way you want to be treated.  The simpler you can keep your clinical relationships, the more you can concentrate on doing well clinically instead of the petty drama that some people live for.  I know it doesn’t sound like it, but I found clinicals tremendously more fun and interesting the second time around.

Trying to understand expectations between preceptors

Once you do find trustworthy preceptors that have your best, long-term interests in mind and really want to help, try new things and work on your clinical weaknesses with them.  As a new student, skills like arterial and central line placement or intubating with a new type of blade or equipment are good examples.  Even discovering your deficits may seem bewildering.  One preceptor will compliment you on your critical thinking and the next may berate you for the exact same thought process.  Understand that many of the brilliant preceptors who ask you highly specialized and difficult questions only have a handful of them that are meant to stump you, unless they’ve been reading textbooks between patients.  Often there’s a strong correlation between a fixation with antibiotics or airway or amiodarone dosing and a terrible mistake they once made.  Even if an outcome is one in a million, if it happens to your patient, you’ll pay special attention to it in every subsequent case until you retire (or receive adequate therapy).

Prioritize your emotional wellbeing

As a last side note, would extensive counseling help you survive and perhaps even thrive in graduate school?  The answer is yes.  Of course, if you had the time and money for counseling during school, you probably wouldn’t really need it.  Similar to training your brain how to study, resilience is one of the most important skills you should master.  This is quite different than stubbornness, which can be evidenced clinically as trying that spinal for a sixth time instead of just changing your inflexible plan.  In the future, we will talk much more about emotional help on FreshNP.com and how to build a healthy, balanced support system that doesn’t suck or suck your loved ones dry.  Although it helps to stay close to home instead of leaving everyone you know for that perfect school hundreds of miles away, I’ve been asked if it’s better to be a nurse at a facility before becoming a nurse practitioner or anesthesia student.  Can you step out of the shadow of your old job?  An incompetent student will still have major problems six months into a program, even if everyone loves her.  

What do you think? How do your NP clinicals compare to nursing school, or how do you expect them to differ?

To learn more please visit World Nursing Congress 2020

Nursing Congress 2019 | Nursing Education Summit 2019

The Nurse Practitioner Will See You Now

In case you haven’t noticed, health care is changing.

By 2019 will lead to 25 million more primary care visits across the country. That’s nothing compared to the 75 million baby boomers aging into advanced care, and the 50 millionamong them who will need to be treated for multiple chronic conditions.

Altogether, as a nation, we face a seemingly incalculable sum of provider sweat equity hours needed to care for our people, and how we accomplish that depends on how we evolve our health care system. One major shift has been the role of nurse practitioners in the quest for more affordable, high quality, patient-centered care at a time when the nation is searching for an antidote to today’s health care challenges.

Nurse practitioners have been around for more than 50 years, and in that time, their role has evolved tremendously to meet the demands of our fluctuating health care system. Now nurse practitioners are embracing their biggest health care challenge yet. Here’s a look at what’s changing.

1.  The numbers. Yes, there’s a provider shortage, but nurse practitioners are bringing reinforcements. Last year, primary care nurse practitioner graduates outnumbered primary care medical school graduates by more than three times, and projected job growth for nurse practitioners exceeds 30 percent (almost three times the average of other professions). In the next seven years, we will add almost 55,000 providers to an otherwise shrinking health care workforce, and the next generation is more educated, ethnically diverse and younger than ever before.
2. Specialization. Nurse practitioners must have a master’s degree or a doctorate degree, pass a national certification exam and be licensed in their state. In addition to primary care, nurse practitioners are going further in their education to specialize in areas like oncology, gerontology, psychiatry and neonatology.
3. Our purpose. Nurse practitioners are trained to have a holistic, preventative approach to personalized care, which comes in handy when system fragmentation overwhelms patients and providers. One of the biggest challenges to primary care, is the ability to coordinate the care patients receive from specialists, ER teams and follow-up on home health to ensure patients do not fall through the cracks and to avoid duplicative appointments and unnecessary readmissions. From diagnosing critical conditions and prescribing life-saving medicines to teaching patients how to flush a tube or properly dress a wound, nurse practitioners have training that spans the entire care spectrum. Because of this unique skillset, nurse practitioner leadership to help coordinate a seamless continuum of care for better patient outcomes creates improved patient outcomes and cost savings.
4. Autonomy. Nurse practitioners are working at the top of their license in 22 states plus the District of Columbia, practicing independently without the need for costly physician oversight or prescription sign-off. Increased practice rights have created new opportunities in retail clinics, onsite corporate health clinics and in-home health care companies, and they have paved the way for nurse practitioners to open their own independent practices, which is especially important in urban and rural areas where provider shortages are affecting access to care. More states are expected to pass similar legislation in the next few years, filling voids in service and providing an affordable alternative for patients looking for more personalized care
5. Demand. Demand for nurse practitioners increased 320 percent in just three years, and today we are the fifth most sought after medical specialty (for reference, six years ago we didn’t even make the list). U.S. News ranked nurse practitioner second on its list of the 100 best jobs – naming formidable salaries, job security and increased practice rights as enticements for students weighing health care professions. The notoriety is paying off – more people are choosing the nurse practitioner career track and capitalizing on the tremendous job opportunities to jump-start their medical career.

Nurse practitioners today play a very different role than they did in 1965, and we are still in the process of defining our full potential. Trends in job growth and demand reflect what patients, providers and now legislators have been realizing for some time – that nurse practitioners are vital to our health care delivery system and that they must play an integral role in the future of care. As more states pass legislation granting nurse practitioners full practice authority, and as more opportunities emerge to capitalize on our skilled and rapidly growing workforce, look for nurse practitioners to dramatically change our care delivery system for the better in the next 50 years.

Joyce M. Knestrick, PhD, APRN, CFNP, FAANP, is President of the American Association of Nurse Practitioners (AANP).

To learn more please visit Nursing Education Summit 2019
To register please visit World Nursing Congress 2019