EXPANDED ROLE OF NURSE

EXPANDED ROLE OF NURSE


INTRODUCTION

Nurse fulfils a number of roles on the health care term. They are the most flexible of health professionals and do a number of things well. Contemporary nursing requires that the nurse posses knowledge and skills for a variety of professional roles and responsibilities. In the past, the principle role of nurse was to provide care and comfort as they carried out specific nursing functions. Changes in nursing field have expanded the role to include increased emphasis on health promotion and illness prevention as well as concern for the client as whole.

Nursing is not static, unchanging profession but is continuously growing and evolving as society changes and health care changes. So roles of nurses are changing from time to time. At present nurses have different level of career roles. They are

1.Nurse Practitioner.
2.Clinical nurse specialist.
3.Nurse Anaesthetist.
4.Nurse Midwife.
5.Nurse Researcher.
6.Nurse Administrator.
7.Nurse Educator
8.Care Giver.
9.Nurse Advocate.
10.Nurse Entrepreneur.
11.Nurse Communicator.
12.Nurse Manager.
13.Nurse Counsellor.


NURSE PRACTITIONER

A nurse who has an advanced education and is a graduate of a nurse practitioner programmed. The areas of this role are adult nurse practitioner, paediatric nurse practitioner or gerontology nurse practitioner. They are employed in health care agencies or community based setting. They usually deal with non emergency, acute or chronic illness and provide primary ambulatory care.
British medical journal says that nurse practitioner skills as just as good as that of doctors and patient prefers to receive care from nurse practitioner than from a doctor.
Nurse practitioners provide health care to client usually in an out patient ambulatory care or community based settings. They provide more holistic approach, attending to symptoms of non pathological conditions, comfort and comprehensiveness of care. The nurse practitioner is able to establish a collaborative provider-client relationship. A nurse practitioner may work with a specific group of clients or with clients of all ages and health care needs.





Adult nurse practitioner

They provide primary and ambulatory care to adults with a non emergency acute or chronic illness and in some setting territory care. She work collaborates with one or more primary care physicians.
e.g. in a five physician primary care practice, a nurse practitioner may exclusively manage all diabetic clients who have foot ulcer. In this example nurse practitioner is working collaboratively with all physicians.

Family nurse practitioner

They provide primary ambulatory care for the families usually in collaboration with a family care physician. They meet the family’s general health care needs manage some illness by providing direct care and guides or counsels the family as needed.

Paediatric nurse practitioner

They provide primary ambulatory care to women seeking obstetrical and gynaecological health care.

Acute care nurse practitioner

They function in collaboration with a physician or house staff physicians in acute care settings such as hospital or speciality clinic. Acute care nurse practitioner is usually based on internal medicine, focussing on the care of the hospitalised patient.

Gerontology nurse practitioner

They are specialised in the care of the older client or adult. They are trained in special needs of the aging adult with emphasis on health promotion, health maintenance and functional status. The geriatric nurse practitioners work with the client and family to manage existing health problems so as to promote independence and self care. The client’s population is usually aged 65yrs and older.


CLINICAL NURSE SPECIALIST

The clinical nurse specialist is an advanced nurse practice nurse with nursing expertise in a specialised field of practice and may work in any practice setting. A nurse who has an advanced degree or expertise and is considered to be an expert in a medical surgical setting or concentrate on a specific area of practice such as emergency care or critical care. Many ICU and emergency dept nurses require to have teaching in advanced cardiac life support and certification in critical care emergency nursing or trauma nursing. Hospital based nurse may also choose to practice in speciality areas such as transportation, rehabilitation or oncology. The clinical nurse practitioners may specialise in specific disease such as diabetes mellitus, cancer or cardiac problems or in a specific field such as paediatrics or gerontology. The clinical nurse specialist functions as an expert clinician, educator, case manager, consultant and researcher to plan or improve the quality of care provided to the client and family.

Essential qualities of a clinical nurse practitioner

Clinical knowledge and skill.
Ability to act confidently and quickly.
Sensitivity to patients and relatives.
Action with patience but firm.
Desire to learn more.
Commitment and stamina for long hours of work in critical situation.
A strong belief in the role of a nurse.


NURSE ANAESTHETIST

A certified registered nurse anaesthetist is a registered nurse who has received advanced training in an accredited programme in anaesthesiology. Nurse anaesthetist provides surgical anaesthesia under the guidance and supervision of an anaesthesiologist, who is a physician with advanced knowledge of surgical anaesthesia. The nurse anaesthetist can assess the post operative status of the client.


NURSE MIDWIFE

A nurse midwife is a registered nurse who is educated in midwifery. The practice enables independent care of women during normal pregnancy, labour, and delivery, as well as care of newborn. It may include some gynaecological services like PAP smears, family planning and treatment for minor vaginal infections.


NURSE RESEARCHER

Nurse researcher investigate nursing problem to improve nursing care and to refine and expand nursing knowledge. They are employed in nursing institution, teaching hospitals and research centres. A nurse researcher usually has advanced education at the doctoral level with at least a master’s degree in nursing.
Researcher involves action taken to implement studies to determine the actual effect of nursing care to further the scientific base of nursing, can include all nurses, nurse scientist, graduates and students.
Research is a nurse primary responsibility, and all nurses should be evolved in research. Researcher investigates whether current or potential nursing actions achieve their expected outcome, what options for care may be available and how best to provide care. Nursing research looks at patient outcome, the nursing process and the system that support nursing services participation by all nurses in research is` essential to the growth and development of nursing profession.


NURSE ADMINISTRATOR

The nurse administrator manages client care including the delivery of nursing services. The administrator may have middle management position such as head nurse or supervisor or a more management senior position, such as director of nursing services.
Nurse Manager’s position usually requires at least bachelor degree in nursing, and director and nurse executive positions generally requires a master degree. Chief nursing executive and vice-resident positions in large health care organization often require preparation at the doctorate level. Nurses may have degree such as hospital administration, public health etc.

Functions and responsibilities of nurse administrator

To manage client care.
Directors have more responsibility than nursing personnel it include particular service such as medicine or cardiology, supportive function and personal such as medicine clinics, cardiac diagnostics.
Directors are responsible for auxiliary personnel such as cardiology techniques, respiratory therapist, social workers.
Vice president or chief executive has responsibilities with the hospital.
Administrator should be skilled in business and management as well as understand all aspects of nursing and client care.
Functions include budgeting, strategic plan of programmes and staffing, employee education and development.


NURSE EDUCATOR

Nurse educator teaches patients and families, the community, other health care team member, students, business and government. In hospital setup, nurse provides information about illness, medication and treatment and rehabilitation needs. They help patients understand how to deal with the life changes necessitated by chronic illness. Nurses also teach how to adopt care to the home settings when that require; nurse demonstrate procedures such as self care activities.

In community setting nurses offer classes on injury and illness prevention and health promotion often these classes are jointly taught with other health care team members. E.g. a nutritionist and a nurse may teach a group of expecting mothers how to prepare formula and feed their infants. Nurses also have the responsibility to understand and teach how a healthful or unhealthful environment may affect both short term and long term health of the community.

Nurse educators in the health care team; teach other team members about the patient and family and why different intervention may have varying degrees of success. Nurse helps other team members to find cost effective and quality interventions.

Nurse also serves as teachers of next generation of nurse and staff development department of health care agencies and client education department. Nurse educators need clinical practices. Nurse can teach the students about current nursing practices, trends, theory, and necessary skills in laboratory and clinical settings.

Nurse educators need graduation degree in nursing and additional education in education process. Many hold doctorate and advanced degree in nursing education.

Qualities of a nurse educator

Emphasizes on participative leadership.
Transmit knowledge and experience.
Recognize human values.
Creates a ‘we’ feeling among staffs and students.
Delegates responsibilities with appropriate authority to facility.
Provide direction when needed.
Creates positive attitude.
Posses multidimensional
Role of a friend, philosopher and guide.


CARE GIVER

As a care giver, the nurse helps the client regain health through the healing process. Healing is more than just curing specific diseases, although treatment skills that promote physical healing are important to care givers. A nurse addresses the holistic health cared needs of the client, including measures to restore emotional, spiritual and social well being. The care giver sets goal and meet those goals with a minimal cost of time and energy.

They take an active role in illness prevention, health promotion and maintenance; nurse with advanced nursing degree is increasingly providing care at all levels of health care system.


NURSE ADVOCATE

In the role of client advocate, the nurse protects the clients human and legal rights and provides assistance in asserting those rights if need arises. The nurse advocates for the client, keeping in mind the client’s religion and culture. For example the nurse may provide additional information for a client who is trying to decide whether or not to accept a treatment. The health care system is a complex and need a nurse advocate to cut through the layers of bureaucracy and help them get what they require. Today clients are seeking more self determination and control over their own bodies when they are ill.


Values basic to client advocacy

The client is a holistic, autonomous being who has right to make choices and decisions.
Clients have the right to expect a nurse client relationship that is based on shared responses, trust, collaboration in solving problems related to health and health care needs and consideration of thoughts and feelings.
It is the nurse responsibility to ensure the client has access to health care services that meet the health needs.


NURSE ENTREPRENEUR

Nurse entrepreneurs becoming more common. Nurses now has business of their own that provides direct patient services in hospitals, community setting, Business, schools homes, and many other settings. They provide service to business by conducting worksite wellness programmes and by advising human resources staff on how to provide high quality health benefits to employees while reducing their cost.
The nurse should have advanced degree and manages health related business. The nurse may be involved in education, consultation and research.

Entrepreneur should,

Have passion about developing an area of interest.
Be willing to take risk.
Be willing to take commitment.
Believe in themselves.
Have a self image and confidence.
Have a desire to achieve.
Have strong customer orientation.
Have a sense of enthusiasm.


NURSE COMMUNICATOR

The role of communicator is central of all nursing roles and activities. Nursing involve communication with clients and families other nurse and health care professional’s resource persons and the community. Without clear communication it is impossible to give care effectively, make decisions with clients and families, protects clients from threats to well being, coordinate and manage client care, assist the client in rehabilitation, offer comfort. The quality of communication is a critical factor in meeting the needs of individuals, families and communities.

In the role of communicator nurse identifies client problems and then communicate these verbally or in writing to other members of the health team.




NURSE MANAGER

As a manager the nurse coordinates the activities of other members of the health care team such as nutritionist and physical therapists, when managing care for a group of clients. To effectively manage a single client or group of clients the nurse implements solid clinical decision making skills. As a clinical decision and decision maker, the nurse uses critical thinking skills throughout the nursing process to provide effective care. Before undertaking any nursing action, the nurse plans the action by deciding the best approach for each client. The nurse makes these decisions alone or in collaboration with the client and family. In each of these situations the nurse collaborates and consults with other health care professionals.

The nurse managers are responsible for managing clients care and some nurses to assume a management position within the organization as nurse manager, supervisor and executive. All nurses are managers; the bedside staff nurse must manage the care of a group of patients and decide what priorities are, which staff members to assign to patient and how to accomplish all activities during 8-12 hrs periods.

Responsibilities of nurse managers

Efficiently accomplishes the goals of organization
Efficiently using the organization resources
Ensuring effective client care
Ensuring compliance with institutional professional regulatory and governmental standards of care.


NURSE COUNSELLOR

Counselling is the process of helping the client to recognize and cope with stressful psychological or social problems to develop improved interpersonal relationship and to promote personal growth. It involves providing emotional intellectual and psychological support. The nurse counsel’s primarily healthy individuals with normal adjustment difficulties and focuses on helping the person develop new attitudes, feelings and behaviours by encouraging the client to look at alternative behaviours, recognise the choices and develop a sense of control.

For example a community based nurse may work in employee assistance programme or women’s shelter. In this setting major amount of nurse-client interaction is through counselling. A counsellor is responsible for providing information, listening objectively, and being supportive, caring and trustworthy. Counsellors do not make decisions instead help client to reach decision.






CONCLUSION

Nursing profession has changed a lot from ancient period to the present period. And the role of nurse has been expanded to different levels to ensure perfect care to the society. Nurses with extra educational degree helps to enter into different level.