Chapter 1

Nursing Today

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 Nursing as a Profession

 Patient-centered care
 Professionalism
 Administer quality care
 Be responsible and accountable
 Health care advocacy groups
 Robert Wood Johnson Foundation (RWJF) Future of
Nursing: Campaign for Action
 Institute of Medicine (IOM) publication on The Future
of Nursing

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 Science and Art of Nursing Practice

 Nursing requires
 Current knowledge and practice standards
 Insightful and compassionate approach
 Critical thinking
 Benner’s stages of nursing proficiency:
 Novice
 Advanced beginner
 Competent
 Proficient
 Expert

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 Scope and Standards of Practice

 Nursing definitions
 Nursing: Scope and Standards of Practice
 1960: Documentation began
 Standards of Practice
 Standards of Professional Performance
 Goal
 To improve the health and well-being of all individuals,
communities, and populations through the significant
and visible contributions of registered nursing using
standards-based practice

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 Standards of Practice

 Six standards of practice:

 Assessment
 Diagnosis
 Outcomes identification
 Planning
 Implementation
 Evaluation
 The nursing process is the foundation of clinical
decision making

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 Standards of Professional
Performance
Quality of Practice Professional
Ethics Practice
Evaluation

Education Communication Resources

Evidence-Based
Practice and Leadership Environmental
Health
Research

Collaboration

6
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 Code of Ethics

 A code of ethics is the philosophical ideals of

right and wrong that define principles used to
provide care.
 It is important for you to incorporate your own
values and ethics into your practice.
 Ask yourself: How do your ethics, values, and
practice compare with established standards?

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 Professional Roles

Autonomy and Accountability

Caregiver
Advocate
Educator
Communicator
Manager

8
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 Quick Quiz!

1. Nursing is defined as a profession because

nurses:
A. perform specific skills.
B. practice autonomy.
C. utilize knowledge from the medical discipline.
D. charge a fee for services rendered.

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 Career Development

 Nursing provides an
opportunity for you
to commit to lifelong
learning and career
development.

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 Case Study

 Ming graduated with an associate’s degree in

nursing last year and received his RN credential.
He currently works in a long-term care facility.
Although Ming enjoys his work and has been
promoted to shift supervisor on his unit, he finds
that he’d like to pursue a nursing career that
offers a regular schedule and more autonomy.
 Ming considers returning to school for an
advanced degree.

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 Career Development (Cont.)

 Provider of care
 Advanced practice registered nurses
 Clinical nurse specialist
 Certified nurse practitioner
 Certified nurse midwife
 Certified registered nurse anesthetist
 Nurse educator
 Nurse administrator
 Nurse researcher

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 Case Study (Cont.)

 Ming is particularly drawn to the idea of

becoming an advanced practice registered
nurse (APRN).
 Ming’s career options for becoming an APRN
include which of the following?
(Select all that apply.)
A. Physician assistant (PA)
B. Clinical nurse specialist (CNS)
C. Certified nurse midwife (CNM)
D. Certified RN anesthetist (CRNA)
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 Case Study (Cont.)

If Ming decides to choose a career as a critical

care CNS, then his specialty is identified by
which means?
A. Population
B. Setting
C. Disease specialty
D. Type of care
E. Type of problem

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 Nursing Shortage

 With fewer available nurses, it is important for

you to learn to use your patient contact time
efficiently and professionally.
 Essential skills include:
 Time management
 Therapeutic communication
 Patient education
 Compassionate implementation of bedside skills

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 Historical Influences

 Nurses:
 Respond to needs of patients
 Actively participate in determining best practices
 Knowledge of the history of the nursing
profession increases your ability to understand
the social and intellectual origins of the
discipline.

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 Florence Nightingale

 First practicing epidemiologist

 Organized first school of nursing
 Improved sanitation in battlefield hospitals
 Practices remain a basic part of nursing today

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 Civil War to the Beginning of the
Twentieth Century
 Clara Barton
 Mother Bickerdyke
 Harriet Tubman
 Mary Mahoney
 Lillian Wald and Mary Brewster

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 The Twentieth Century

 Movement toward scientific, research-based

practice and defined body of knowledge
 Nurses assumed expanded and advanced
practice roles
 1906: Mary Adelaide Nutting, first nursing professor at
Columbia Teacher’s College
 Army and Navy Nurse Corps established
 1920s: Nursing specialization began

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 Twenty-First Century

 Changes in curriculum
 Advances in technology and informatics
 New programs address current health concerns
 Leadership role in developing standards and
policies

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 Contemporary Influences

 Importance of nurses’ self-care

 Changes in society lead to changes in nursing:
 Affordable Care Act (ACA)
 Rising health care costs
 Demographic changes
 Medically underserved

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 Trends in Nursing

 Evidence-based practice
 Quality and Safety Education for Nurses (QSEN)
 Impact of emerging technologies
 Genomics
 Public perception of nursing
 Impact of nursing on politics and health policy

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 Professional Registered Nurse
Education
 Registered nurse education
 2-year associate’s degree
 4-year baccalaureate degree
 Graduate education
 Master’s degree, advanced practice RN
 Doctoral degrees
 Continuing and in-service education

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 Nursing Practice

 Nurse Practice Acts (NPAs)

 Overseen by State Boards of Nursing
 Regulate scope of nursing practice
 Protect public health, safety, and welfare
 Licensure and certification
 Licensure: NCLEX-RN® examination
 Certification: requirements vary

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 Professional Nursing Organizations

 Address member concerns

 Present educational programs
 Publish journals
 Student organizations
 National Student Nurses Association (NSNA)
 Canadian Student Nurses Association (CSNA)

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 Quick Quiz!

2. Professional nursing specialty organizations

seek to:
A. improve standards of practice.
B. expand nursing roles.
C. improve the welfare of nurses in specialty
areas.
D. all of the above.

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