Bedside Visitor: All the Basics You Need to Know

Your loved one is in the hospital and whether you are visiting them for the first time or for the 10th time, bad visitor etiquette is a little known pet-peeve of nurses. Being a super bedside visitor involves educating and arming yourself with some knowledge about nursing bedside care routines.

The patient bedside can be a busy area for nurses, doctors, and other health care professionals. In older hospitals the beside area was not built to accommodate visitors staying all day or all night. The open door 24 hour visitation policy was an afterthought only put into effect by hospital administrators in the last few years. The thought behind this is if patient relatives are happy, perhaps they may make a financial donation to the hospital in the future.

The official line is however, that family and visitors at the bedside make for better recovery outcomes for patients in the new era of patient-centered care. In reality, only patients who are fully aware of your presence will have better outcomes. Nursing and other medical staff usually talk to sedated or unconscious patients and tell them what is happening as they may be able to hear even if they can’t respond. Regardless, some patients have only vague memories of this during the course of severe illness. They report hearing voices but can’t remember the conversations or who was speaking to them. Many patients do not remember a stay in Intensive Care or their visitors, due to the medications they were given to keep them calm and save their lives.

Nursing in general has become a service and is now tied to customer satisfaction. What would be easier than relatives having 24 hour access to the bedside area? Apparently nothing. This leaves nurses who are are task oriented in a bind. Many nurses like to periodically, but steadily do nursing duties for their patients, not group their tasks together. Grouping tasks together allow relatives to have extended visits before the nurse requests access to care for the patient. However, things may be forgotten or overlooked such as mouth care, eye care, turning the patient, or simply checking the patients skin or private parts to make sure they are not developing a pressure related bedsore. Instead the focus ends up on making sure medications are given on time or visible dressings are changed as needed so as not to disturb the visit.

As well, nurses often get asked a variety of questions many times by different members of the same family:

What are those pills for?

What does that beep mean?

You pushed a button on the monitor, did you change something?

He’s coughing, is something wrong?

His blood pressure was 132/74 and now it’s 115/60, what’s happening?

These questions can indicate genuine curiosity, or may be perceived as not trusting the competency of the nurse. For the nurse, answering numerous visitor’s questions can be exhausting and time-consuming. Instead of bedside teaching, they should be focused on taking care of the patient.

Being a super bedside visitor involves educating and arming yourself with some knowledge about nursing bedside care routines. 

16 Super Bedside Visitor Tips:

  1. Be aware that nurses must turn patients who cannot turn themselves – every 2 hours as per hospital policy. Sometimes, this may extend to 3 hours if they are critical, or perhaps not at all if it is going to jeopardize the patient’s life. However, there is no harm in asking if it is time to turn your loved one yet, and stepping out of the room or unit so that care can be given.
  2. Eye care (eye drops to keep eyes from sticking together) and mouth care is also given as per hospital policy every 4 hours to patients who are unconscious. Unless, the patient has a breathing tube or some contraindication on the frequency of mouth care you can ask the nurse if they can show you how to give mouth care. Mouth care is essential in helping prevent the over-proliferation of mouth bacteria that can lead to certain types of pneumonias.
  3. Ask your nurse if it is okay to stimulate your loved one. By this we mean, touching or massaging their hand or stroking their arm, and verbal cues. In some very sick patients, this can be perceived as negative feedback and cause undue neurological stress on the patient. In others, stimulation can be reassuring especially when they are coming around and not as seriously ill. You can tell them where they are and why, and that they are being taken care of.
  4. If you meet your neurologically impaired relative with their wrist’s restrained don’t be alarmed. The wrist restraints serve as reminders for the patient not to pull out their feeding tube, breathing tube, intravenous lines, or any other devices they may have attached to their bodies. Unfortunately, if these devices get pulled out, they usually have to go right back in and cause undue discomfort to the patient. Ask your nurse if you can remove the restraints, but you will be responsible for making sure they don’t pull anything out.
  5. Do not administer anything to the patient’s skin or down the feeding tube without first asking your nurse. Also do not touch the buttons on the IV pumps, ventilators, or other machines unless the nurse gave you instructions on which ones to press. Do not overly concern yourself with alarms, and beeping noises, as nurses know what they represent. As well, do not change the position of the hospital bed without asking.
  6. Do ask if you can shave your male relative (if that’s their preference) with the razor you brought in, or comb their hair with their favorite comb. Do bring in their favorite body wash, deodorant, toothbrush, and toothpaste. Ask your nurse if you can wash your loved one’s hands and feet (body parts that are frequently overlooked by inexperienced or busy nurses). Also, most hospitals will allow you to bring in their favorite music through earphones or a TV if there is a cable outlet. Here are some tips on what else you should bring.
  7. Bring pictures from home and make a poster board for your critically ill relative. As they recover they will enjoy being reminded of the people they love. Perhaps keep an ICU diary as they start to become more aware of their ICU surroundings. Read up on Post Intensive Care Syndrome (PICS) and the sources to seek help from if it occurs.
  8. Give your nurse not only the physical space to do their work, but also the mental space to think and do his/her assessments. It is very difficult to be a chatty nurse when the patient is very sick. Such a patient requires a nurse’s full attention, and it can be difficult to focus properly if a visitor needs attention as well. If you need support have another family member or friend at the hospital that you can talk to. Also, you can ask to speak to the hospital Chaplin for spiritual counsel.
  9. There are no more than two visitors allowed at the bedside at any one time. One is actually a preference of nurses, however for short visits two people can be accommodated. Please do not crowd the room with more than two visitors, because it is against hospital policy, and most nurses are not comfortable going near the bedside with a multitude of visitors.
  10. Please do not bring food to eat in the room of the very critically ill. Not only may the smell trigger nausea and vomiting in the patient or other patients, but it is impolite to be eating at the bedside when in most cases a mess will be left behind for the nurse to clean up. A non- alcoholic beverage is acceptable.
  11. Please do not sleep in the bed with the patient. Nurses cannot care for your loved one while you are in bed with them. Also, visitors sleeping on the floor of the patient’s room is not advised. Both scenarios are not only inappropriate, but patients who are critically ill have difficulty fighting infections from any source including yourself. You may also pick up germs from the patient or the hospital floor. Hospital beds and the room are unsuitable for this type of sleeping arrangement and will not result in the best outcomes for your loved one.
  12. When a patient who has been stressed and in pain is finally sleeping do not wake them up with touching or speaking out loud! Visiting quietly will be valued, whereas making your presence known, may lead to further stress for the patient and the nurse who now has to give additional medications to keep them calm. Talk to you nurse to find out if your visit should be at another time.
  13. If you need an update on tests and procedures you will have to ask your nurse if you can speak to a doctor. Nurses can give you a general update on how the patient’s day or night is going (or has gone) only. Nursing as a profession cannot divulge the outcomes of tests and procedures. Occasionally, a family meeting will be put together by the doctor for the substitute decision maker and other family members to discuss the course of events and the prognosis for the patient. Please make sure to have all relevant parties present at the appointed time and date. Also, if a translator is needed let the nurse know in advance of the meeting.
  14. Please leave the hospital periodically not only for your own well-being, but to get some rest away from a difficult situation. Your psychological and emotional health is also important and you can’t be at your best for your relative when they start getting better if you are sleep deprived or emotionally drained. Continued sleeping in the hospital crisis room or common areas is not endorsed. If you need to stay close to the hospital ask your nurse for the names of lodging places that have discounted rates. Also, limit your visitors in the visitor’s lounge. Most visitor lounges cannot accommodate extended family and friends. The noise level almost always gets out of control and people end up mingling in the hallways due to the lack of space in the room. This situation will result in Security coming up and asking you to either keep the noise level down, and/or asking those who are not immediate family to leave.
  15. Immediate family can call in 24 hours a day for a telephone update. Just make sure to tell whoever answers the phone – your name, the reason for your call, the name of the patient, your role, and the room number. For example “hello my name is Michael Flynn, I’m calling about Ryan Flynn’s in bed two, I’m his father and I’d like to get a telephone update from his nurse please”. If the nurse is unavailable to speak with you, ask for their name and when you should call back.
  16. Not every nurse is going to be your favorite. and it’s certainly not going to help to be critical and suspicious of the people who are helping your loved ones heal. Your primary nurse for the shift will be there for 12 hours. Unless, there is serious discord between you and the nurse, you should try to get along with him or her and reserve judgement. If there’s an issue you can ask to speak to the “Charge Nurse”, however nursing assignments once made are very difficult to change. Usually, a personality conflict with a nurse can be resolved fairly easily. A personality conflict is not a sign of their professional knowledge or competence.

In conclusion, if you’ve been an observant bedside visitor you would know that nurses absolutely love treats. Whether, it’s Tim Horton’s Timbits for the whole unit, or a coffee or tea for the nurse taking care of your relative, they appreciate the thoughtfulness of the gesture. So, in order to become a super bedside visitor you’ll need to follow the above 16 tips, obey other visitor hospital policy and procedures, and get your nurse or nurses a treat once in a while.

Improve Your Day – Daily in Just 5 Minutes!

Try these 10 simple ways to lower stress and boost your mood and energy levels. They may just help you find the extra spark you need to meet the challenges of the day.

mindfulness

1. Make your bed. Starting off each day with this small ritual can help create a calm environment for you in your bedroom. Gretchen Rubin, the author of The Happiness Project, writes that many people benefit from making this modest step part of their routines. By checking it off your to-do list first thing, you’ve got one less thing to worry about for the rest of the day.

2. Pack a snack. Before you head out the door in the morning, go into the kitchen and grab a fruit (like a banana, apple or grapes) or a healthy snack (like unsalted nuts or low-fat cheese). This way, when a case of the munchies strikes later in the afternoon, you won’t be reaching for a bag of chips or a candy bar from the vending machine out of convenience. Besides, you know what they say about an apple a day.

3. Clear your desk. You may not be able to overhaul your closet in five minutes, but you can manage to tidy your desk at work. From stray papers to scattered coffee mugs, clutter can make you lose focus and curb productivity. Declutter your outer environment and you may feel lighter on the inside and more motivated to concentrate on the task at hand.

4. Pump up the music. Several studies have found that listening to music can help lower blood pressure, reduce stress, and boost mood. The right music has the power to change your attitude. So load up your MP3 player and create a special playlist that will make you smile — whether you’re working or working out.

5. Sniff a lemon. For a quick de-stressing trick, turn to an underrated sense — your sense of smell. Japanese researchers found that linalool; a substance found in lemons, has anti-inflammatory properties and may reduce the flight-or-fight stress response. Other scents like basil, juniper, and lavender have also been found to lower stress.

6. Stretch. You don’t have to be a yogi to benefit from light stretching. Lift your arms above your head at your desk. Or better yet, stretch your legs by walking outside. Stretching can help improve your circulation and flexibility and may help ease the tight muscles that accompany stress.

7. Meditate or Hypnosis. Try meditation and deep breathing to relax and turn your mind off. You don’t need any special equipment to practice meditation. Find a comfortable position in a chair or on the floor. Meditating or listening to hypnosis tapes on a daily basis, even just for a few minutes, has been shown to fight depression and ease stress.

8. Keep a gratitude diary. Take a minute every day to write down several things you’re thankful for, whether they’re big or small things. It’s easy to vent about weather, traffic, or job woes, but complaining brings negative energy along with it. Being thankful for what you have can make you appreciate all the positives in your life.

9. Turn off your electronics. Just because we live in a wired world doesn’t mean you need to stay connected every minute of every single day. Staring at computer screens and electronics all day long can zap your energy and encourage inactivity. So log off your email, phones, and the Internet (yes, social networking websites count, too). This is especially important to allow you to unwind and relax before bed.

10. Prioritize. It’s easy to feel overwhelmed when you have multiple tasks crowding your mind. Make a list and finish your most dreaded duties first to avoid the anxiety caused by procrastination. Make a list and check off each task as you complete it. At the end of the day, a list of accomplishments is a great visual reminder of how productive you were.

The Best Way to Overcome the English Language Barrier in Hospital

If you’re ill and need to access the healthcare system you need somebody with you who can speak English. This is especially important when you first come into the hospital.  In many North American communities there are people who have been a resident for 20 years or more who don’t speak conversational English.  This is fine if you work with others who speak your language and if you’re going to be doing your banking, and shopping in your community that supports your cultural heritage.  However, when you leave your community it becomes a hindrance.

We see it time and time again when someone from a non-English speaking culture becomes a patient and is either alone or the family member also does not speak English.  Staff has to find someone from somewhere in the hospital who speaks their language. The problem with this is they may not be a registered nurse or a doctor.  If they don’t have a medical background the information the English-speaking nurse or doctor is telling the patient and their families may not be translated correctly.  Sometimes as a last resort we may have to ask housekeeping or the kitchen staff to do the translation, but their availability is limited.  Even the “Google Translate “ app, as good as it is, only has basic utility. 

So it’s very important that non-English speaking patients have somebody readily available who will advocate for them in English. It’s also better if they have more than one person who would be available. The English speaking person has to be willing to stay in the hospital for the first 24 hours that the patient is hospitalized, and depending on the gravity of the situation they may have to stay for a longer time.

For example:

A non-English speaking patient with a brain injury or who’s had an operation on any part of their brain would find it very difficult to communicate how much pain they are in or if they feel their symptoms are getting worse.  A nurse would be assessing the patient hourly to see if their level of consciousness is appropriate.  The nurse may have been given basic words on how to ask the patient to show their thumb or wiggle their toes in their language.  However, after many hours of this, patient’s simply become exhausted and could be drowsy for the current assessment.  The nurse may opt to only look into the patient’s pupils and if they haven’t changed in size, wait for another hour in which to make sure the patient shows their thumb or wiggles their toes. However, within that time frame the patient could go sour. 

If the patient had spoken English the nurse could have asked them why they’re not wiggling their toes or showing a thumb or encouraged them to obey another command. But because of the language barrier, it could take longer to realize if the patient was just very sleepy or going into a dangerous coma.   If a family member who spoke English was accessible either at the bedside or nearby, it would’ve been much easier for them to ask the patient to obey and to notice a change in their behaviour and tell the nurse or doctor of their concerns. This is a great help if it is a new staff member taking care of the patient and the patient is still very sick. 

Your advocacy for your relative will help overcome the language barrier if they become hospitalized. Plan for the future, sign up on our home page and get your free “Hospital Handbook”. Have a discussion with your family member about it now, not later. It would be the best thing you could do for them.

Promising Cancer Cure Hits the Market

This video will focus specifically on CAR T-cell therapy as an immunotherapy for the treatment of leukemia, cancer of the blood… just one of 100 identified cancers.

Immunotherapy is relatively new compared to the three primary pillars of cancer treatment: surgery, chemotherapy, and radiation.

Significant leaps in molecular biology techniques, in particular, have advanced the understanding on how the immune system works, in addition to how it can be modulated.

This has lead the scientific community to identify the chimeric antigen receptor (CAR) as a potential target for molecular genetics to insert new epitopes on the receptor region, allowing a degree of control of the immune system.

Tip: What patients should bring to the hospital

When first hospitalized, you or your relative should bring:

All of your medications you are currently on.  Bring the bottles, or at least bring a list on paper of all the medications you are currently taking.  The list should include the doses, the time taken, and the manner in which the medication is taken.  It’s a good idea to always walk with the list of medications in your purse or wallet and to have another person be aware of where the list is.

If you are allergic to latex, or have any other allergies, please inform your nurse or doctor.

If you have a history of constipation, or haven’t had a bowel movement in a few days, let your nurse know.

If you have any special dietary needs let your nurse know.  As well, arrange to have your loved one bring in certain foods, because hospital diets usually cannot accommodate special diets in a palatable way.

Also important for a more comfortable stay:

  1. A toothbrush
  2. Your favourite body wash
  3. A razor/electric razor and the charger (if you use one)
  4. Your mobile phone and/or ipad (or other tablet) and the chargers
  5. A small radio or other device if you like to listen to the news, sports, music, or prayer songs
  6. A comb or brush
  7. A small note pad to take down important information the doctors and nurses will be telling you

This is not a complete list by any means.  If anyone has any other suggestions on what to bring, leave them in the comments section.

About Physician-Assisted Death and The Responsibility of Nurses

The Supreme Court of Canada says a law that makes it illegal for anyone to help people end their own lives should be amended to allow doctors to help in specific situations.

The ruling only applies to competent adults with enduring, intolerable suffering who clearly consent to ending their lives.

The court has given federal and provincial governments 12 months to craft legislation to respond to the ruling; the ban on doctor-assisted suicide stands until then. If the government doesn’t write a new law, the court’s exemption for physicians will stand.

These Guidelines are applicable to Nurses working in Ontario.  Check your provincial or state licensing board for guidelines applicable to you.

physician-assisted-death

What are your opinions on doctor-assisted death? Do you think it’s sanctioned murder/suicide?  Or do you believe it should be allowed in terminal cases.  What about the role of the nurse?  How comfortable are you with this new legislation in your daily practice?

 

 

 

 

Infographic: A crash course on LinkedIn to help just about everyone who is Linked-less

Image

Courtesy of mindflash.com

LinkedIn is the the world’s largest professional network with 161 million members worldwide.  Mashable has a recent guide (May 2012) to getting started on LinkedIn if you don’t have a profile, and especially if you are a recent college grad here.

About Registered Nurses… in Detail

Registered nurses (RNs), regardless of specialty or work setting, treat patients, educate patients and the public about various medical conditions, and provide advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

RNs teach patients and their families how to manage their illnesses or injuries, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy. Some RNs may work to promote general health by educating the public on warning signs and symptoms of disease. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions.

When caring for patients, RNs establish a care plan or contribute to an existing plan. Plans may include numerous activities, such as administering medication, including careful checking of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treatments; observing the patient and recording those observations; and consulting with physicians and other healthcare clinicians. Some RNs provide direction to licensed practical nurses and nursing aides regarding patient care. (See the statements on licensed practical and licensed vocational nurses; nursing and psychiatric aides; and home health aides elsewhere in the Handbook). RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority.

Specific work responsibilities will vary from one RN to the next. An RN’s duties and title are often determined by their work setting or patient population served. RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs may work a particular setting or type of treatment, such as perioperative nurses, who work in operating rooms and assist surgeons. RNs may specialize in specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs may also specialize with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer. The opportunities for specialization in registered nursing are extensive and are often determined on the job.

There are many options for RNs who specialize in a work setting or type of treatment. Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing, the Internet, or by telephone. Critical care nurses provide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units. Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients’ mental and spiritual health in addition to their physical health. Home healthcare nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long- term care nurses provide healthcare services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities. Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses. Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety standards. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery. Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses. Rehabilitation nurses care for patients with temporary and permanent disabilities. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.

RNs specializing in a particular disease, ailment, or healthcare condition are employed in virtually all work settings, including physicians’ offices, outpatient treatment facilities, home healthcare agencies, and hospitals. Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions. Intellectual and developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speaking or other communication. Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections. Genetics nurses provide early detection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington’s disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring. Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence.

RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics, and outpatient care facilities. Cardiovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer, and sexually transmitted diseases. Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures. Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery. Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy. Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis. Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers.

RNs who specialize by population provide preventive and acute care in all healthcare settings to the segment of the population in which they specialize, including newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). RNs also may provide basic healthcare to patients outside of healthcare settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and throughout the world providing care to patients in areas with shortages of healthcare workers.

Most RNs work as staff nurses as members of a team providing critical healthcare. However, some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on the provision of primary care services. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and healthcare services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.

Some nurses have jobs that require little or no direct patient care, but still require an active RN license. Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident. Infection control nurses identify, track, and control infectious outbreaks in healthcare facilities and develop programs for outbreak prevention and response to biological terrorism. Nurse educators plan, develop, implement, and evaluate educational programs and curricula for the professional development of student nurses and RNs. Nurse informaticists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses, and other healthcare providers. RNs also may work as healthcare consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors.

Work environment. Most RNs work in well-lit, comfortable healthcare facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. RNs may spend considerable time walking, bending, stretching, and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Nurses who work in offices, schools, and other settings that do not provide 24-hour care are more likely to work regular business hours. About 20 percent of RNs worked part time in 2008.

RNs may be in close contact with individuals who have infectious diseases and with toxic, harmful, or potentially hazardous compounds, solutions, and medications. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients.

Registered nurses teach patients and their families how to manage their illness or injury.
Registered nurses teach patients and their families how to manage their illness or injury.

Training, Other Qualifications, and Advancement

The three typical educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s degree program. Individuals then must complete a national licensing examination in order to obtain a nursing license. Advanced practice nurses—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners—need a master’s degree.

Education and training. There are three typical educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. Diploma programs, administered in hospitals, last about 3 years. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions as a staff nurse. There are hundreds of registered nursing programs that result in an ADN or BSN; however, there are relatively few diploma programs.

Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher. Individuals who complete a bachelor’s degree receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing practice becomes more complex. Additionally, bachelor’s degree programs offer more clinical experience in nonhospital settings. A bachelor’s or higher degree is often necessary for administrative positions, research, consulting, and teaching

Many RNs with an ADN or diploma later enter bachelor’s degree programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. Accelerated master’s degree in nursing (MSN) programs also are available. They typically take 3-4 years to complete full time and result in the award of both the BSN and MSN.

There are education programs available for people interested in switching to a career in nursing as well. Individuals who already hold a bachelor’s degree in another field may enroll in an accelerated BSN program. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor’s or higher degree in another field; master’s degree programs usually last 2 years.

All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other healthcare facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.

Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the National Council Licensure Examination, or NCLEX-RN, in order to obtain a nursing license. Other eligibility requirements for licensure vary by State. Contact your State’s board of nursing for details.

Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.

RNs should enjoy learning because continuing education credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for RNs.

Some nurses may become credentialed in specialties such as ambulatory care, gerontology, informatics, pediatrics, and many others. Credentialing for RNs is available from the American Nursing Credentialing Center, the National League for Nursing, and many others. Although credentialing is usually voluntary, it demonstrates adherence to a higher standard and some employers may require it.

Advancement. Most RNs begin as staff nurses in hospitals and, with experience and good performance, often move to other settings or are promoted to positions with more responsibility. In management, nurses can advance from assistant unit manager or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief of nursing. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.

Some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on providing primary care services. There are four types of advanced practice nurses: clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic, and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and healthcare services to patients and families.

All four types of advanced practice nurses require at least a master’s degree. In addition, all States specifically define requirements for registered nurses in advanced practice roles. Advanced practice nurses may prescribe medicine, but the authority to prescribe varies by State. Contact your State’s board of nursing for specific regulations regarding advanced practice nurses.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.

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