Nursing Study: PNJ

PROFESSIONAL NURSING

PROFESSION is all of the following:
- it requires intensive training and academic preparation to qualify its members to render a particular type of service to the public
- it is service oriented and not profit motivated
- it has its own unique body of knowledge
- it is a means of employment, livelihood and occupation for its members
PROFESSION according to LEXNER REPORT of the Carnegie Foundation in 1910

- activities must be intellectual
- activities can be learned because they are based on knowledge
- activities must be practical rather than academic
- profession must have teachable techniques
- must have strong internal organization of members
- members, called practitioners, must be motivated by altruism


according to BIXLER and BIXLER

- it utilizes a specialized body of knowledge
- enlarges the body of knowledge and improves its techniques of education and service using scientific method
- entrusts the education of its practitioners to institutions of higher education
- applies its body of knowledge in practical services which are vital to human and social welfare
- functions autonomously  in the formulation of professional policy and in the control of professional activity
- attracts individuals of intellectual and personal qualities who exalt service above personal gain and who recognize their chosen occupation as a lifework
- strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth and economic security



according to William Shephard
- must satisfy an indispensable social need and be based upon a well established and socially accepted scientific principle
- must demand adequate pre-professional and cultural training
- must demand the possession of a specialized and synthesized knowledge
- must give evidence of needed skills which the public does not possess
- must have developed a scientific technique which is the result of tested experience
- must require the exercise of discretion and judgment as to time and manner of performance of duty
- must be a type of beneficial work, the result of which is not subject to standardization in terms of unit performance
- it must have sufficient self impelling power to retain its members for life
-
- must not be used as a mere stepping stone to other profession
- must recognize its obligations to society by insisting that its members live up to an established code of ethics
DEFINITION OF NURSING


ICN Definition

Nursing, as Integral part of the health care system, encompasses the promotion of health, the prevention of illness, and care of the physically ill, mentally ill, and disabled people of all ages, in all health care and other disabled people of all ages, in all health care and other community settings.  Within this broad spectrum of health care, the phenomena of particular concern to nurses are individual family and group responses to actual or potential health problems.  These human responses range broadly from health restoring reactions to an individual episode of illness to the development of policy in promoting the long term health of population.


WHO Definition

The mission of nursing in society is to help individuals, families and group to determine and achieve their physical, mental and social potential, and to do so within the challenging context of the environment in which they live and work.  This requires nurses to develop and perform functions that relate to the promotion and maintenance of health as well as to the prevention of ill health.  Nursing also includes the planning and implementation of care during illness and rehabilitation, and encompasses the physical, mental and social aspects of life as they affect health, illness, disability and dying.  Nursing is the provision of care of individuals, families and groups throughout the entire lifespan – from conception to death.  Nursing is both an art and a science that requires the understanding and application of the knowledge  and skills specific to the discipline. It also draws on knowledge and techniques derived from the humanities and the physical, social, medical and biological sciences.




WHO Definition on the Function of the nurse

(1) providing and managing direct practical nursing,
(2) teaching patients, clients and health care personnel,
(3) developing nursing practice based on critical thinking and research




American Nurses Association

Nursing is the diagnosis and treatment of human responses to actual or potential health problems

4 Essential Features of Contemporary Nursing Practice
1. Attention to the full range of human experiences and responses to health and illness without restriction to a problem-focused orientation.
2. Integration of objective data with knowledge gained from understanding of the client or group’s subjective experience.
3. Application of scientific knowledge to the processes of diagnosis and treatment
4. Provision of caring relationship that facilitates health and healing.


Major Nurse Theorist Definition of Nursing

Florence Nightingale (1859)

Mother of Modern Nursing, born in Florence Italy and became a hero because of the Crimean Ware and was referred to as Lady with the Lamp.  She attended the Fliedner School of Nursing in Kaiserswerth Germany, which was the site of the first organized nursing school.  She succeeded in reducing the mortality rate in the hospital during the Crimean War by attending to the environment of the soldier.

The goal of nursing is to put the patient in the best condition for nature to act upon him, primarily by altering his environment






The Nightingale Pledge
Written by Lystra Grette, the principal of Farrand Training School for nurses in Detroit in 1893)

I solemnly pledge myself before GOD, and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully.  I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.  I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keepings and all family affairs coming to my knowledge in the practice of my profession.  With loyalty, I will endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Hildegard Peplau (1952)

Nursing is viewed as an interpersonal process  involving interaction between two or more individuals that has its common goal assisting the individual who is sick or in need of health care


Concepts of Interpersonal Relations in Nursing (1952)
4 Sequential Phases (overlap, interrelate and vary in duration)
1. Orientation – indv./family has a “felt need” and seeks professional assistance (the problem identification phase)
2. Indentification – pt. begins to have  a feeling of belonging and a capacity for dealing with the problem, creating an optimistic attitude from which inner strength ensues .  Here happens the selection of appropriate professional assistance.
3. Exploitation – the nurses uses communication tools to offer services to the patient, who is expected to take advantage of all services.
4. Resolution – where patient’s needs have already been met by the collaborative efforts between the patient and the nurse.  Therapeutic relationship is terminated and the links are dissolved, as patient drifts away from identifying with the nurse as the helping person.
Faye Abdellah – (1960)

Nursing is a service to individuals, families and society based on an art and science  that molds the attitudes intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people with their health care needs, and is focused around twenty one nursing problem

21 Nursing Problems
1. To maintain good hygiene
2. To promote optimal activity: exercise, rest, and sleep
3. To promote safety
4. To maintain good body mechanics
5. To facilitate the maintenance of  a supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of fluid and electrolyte balance
9. To recognize the physiologic response of the body to disease condition
10. To facilitate the maintenance of regulatory mechanisms and functions
11. To facilitate the maintenance of sensory function
12. To identify and accept positive and negative expressions, feelings and reactions
13. To identify and accept the interrelatedness of emotions and illness
14. To facilitate the maintenance of effective verbal and non verbal communication
15. To promote the development of productive interpersonal relationship
16. To facilitate progress toward achievement of personal spiritual goals
17. To create and maintain a therapeutic environment
18. To facilitate awareness of self as an individual with varying needs
19. To accept the optimum possible goals
20. To use community resources as an aid in resolving problems from illness
21. To understand the role of social problems as influencing factors



Ernestine Wedenbach (1964)

Nursing is a helping, nurturing, and caring service rendered with compassion, skill and understanding in which sensitivity is the key to assisting the nurse in identifying problems.


Virginia Henderson (1966)

Nursling’s role is to assist the individual (sick or well) to carry out those activities he would perform unaided if he had the necessary strength, will or knowledge

14 Components of Basic Nursing Care
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body wastes
4. Move and maintain desirable postures
5. Sleep and rest
6. Select suitable clothes
7. Maintain body temperature
8. Keep body clean and well groomed
9. Avoid dangers in environment and avoid injuring others
10. Communicate with others
11. Worship according to one’s faith
12. Work in such a way there is a sense of accomplishment
13. Play or participate in recreation
14. Learn discover, or satisfy curiosity that leads to normal development and health

Myra Lavine (1969)

Nursing means the nurse interposes her skill and knowledge into the course of events that affect the patient. When influencing adaptation favorably, the nurse is acting in a therapeutic sense.  When the nursing intervention cannot alter the course of adaptation, the nurse is acting in a supportive sense.


Ida Jean Orlando (1972)

Nursing’s unique and independent role concerns itself with an individual’s need for help in an immediate situation for the purpose of avoiding, relieving, diminishing, or curing that individual’s sense of helplessness


Dorothea Orem (1980)

Nursing is concerned with the individual’s need for self care action, which is the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health and well being


Dorothy E. Johnson (1980)

Nursing is an external category force that acts to preserve the organization and integration of the patient’s behavior with optimal level under those conditions in social health , or in which illness is found


Imogene King (1981)

The focus of nursing is the care of human beings resulting in the health of individuals and health care of groups, who are viewed as open system in constant interaction with their environment.


Betty Neuman (1982)

Nursing respond to individuals, groups and communities who are in constant interaction with the environmental stressors that create disequilibrium.  A critical element id the client’s ability to react to stress and factors that assist with reconstitution or adaptation.


Sister Callista Roy (1984)

The goal of Nursing is the promotion of adaptive response (those things that positively influence health) that are affected by the person’s ability to respond to stimuli.  Nursing involves manipulating stimuli to promote adaptive responses.


Martha E. Rogers (1984)

Nursing is an art and science that is humanistic and humanitarian directed towards the unitary human, and corrected with the nature and direction of human development. (Ellis 2001)


Legal Definition of Nursing Practice

Philippine Nursing Act of 2000 defines nursing practice

Sec 28 Scope of Nursing
• A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infant, childhood, toddler, preschool, school age, adolescence, adulthood and old age.  As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness.  As members of the health team, nurses shall collaborates with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.  It shall be the duty of the nurse to:
- Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral, topical and Parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery.  In case of suturing of perineal laceration, special training shall be provided according to protocol established
- Establish linkages with community resources and coordination with the health team
- Provide health education to individuals, families and communities
- Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied setting such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision making skills of a registered nurse; and
- Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice
• Provided, that this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty. Provided, further, that in the practice of nursing in all settings,
- The nurse is duty bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice
- The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board.


NURSING A PROFESSION

CRITERIA NURSING
There is educational background required to ensure safe and effective practice • Only one way to attain – by entering – Bachelor of Science in Nursing Degree
• The BSN curriculum includes CHN, Maternity nursing, pediatric nursing, medical surgical nursing, psychiatric nursing and fundamental nursing skills that provides a broad spectrum of scientific, critical-thinking, humanistic, communication and leadership skills. It prepares its graduates to provide safe and efficient care, ambulatory care, public health, and mental health
Members of the profession adhere to a code of ethics • Philippine Code of Ethics for nurses
Members participate in professional organizations • The largest and PNRC accredited – PNA
• Others – Maternal and Community Health Nurses Association of the Phil., National League of Government Nurses, Association of Nursing Service Administrators of the Phil., Association of Deans of Colleges of Nursing, Military Nurses Association of the Phil., Catholic Nurses Guild, Private Duty Nurses association of the Philippines, Operating Room Nurses Association of the Phil., Integrated Registered Nurses of the Phil., and Occupational Health Nurses Association of the Phil.






Members are accountable for continuing education and competency.  The nursing professional keeps his or her base current by formal or informal on going education, and can demonstrate that competency when required • After BSN, continuing education can be attained by formal studies at graduate schools that leads to Masteral and Doctoral degrees and by in service program by employing agencies, on the job training, seminars and enroll in distance learning programs
• The law requires nurses to undergo continuing professional education
Professionals publish their knowledge and advances in their profession. – nursing publications, web, one-to-one communication • During conventions they share results of their studies and research, discuss emerging trends, formulate guidelines to maintain and advance nursing standards.  Different nursing works are published  in nursing publications such as the AJN and on various nurse websites such as the ICN website.




Members of the professional are autonomous and self regulating • The BON regulates the practice of Nursing in the Philippines
Professionals are involved in community service.  Nurses formally and informally disseminate health promotion in their communities • The DOH  restructured  health care delivery system, nurses play an integral part of the community health services from providing health education to the more complex task of planning community health development programs

A profession develops, evaluates and uses theory as a basis for practice • Nursing theory has been based on theory since the time of Florence Nightingale.
Members of the profession are involved in research • Individual nurses are integrally involved in research and other activities for eth purpose of expanding the profession’s knowledge base to ensure the most up-to-date, safe and effective practice

BECOMING A NURSE

The Baccalaureate Nurse

- 4 year Bachelor of Science in Nursing since 1983
- the curriculum is a competency based and community oriented which means that it prepares its graduates to become competent nurses




- after graduation, they presumed to posses the following traits and competencies
i. a critical and creative thinking
ii. caring behavior which means that she is compassionate, competent and committed
iii. ability to practice legal, ethico-moral, social responsibilities/accountabilities
iv. SKA (skill, knowledge and attitude) for health promotion, illness prevention, health restoration, suffering alleviation, and providing assistance to dying clients to die with dignity and in peace

Integrated Nurse Licensure Examination

- after the BNS degree, the nurse must pass the licensure examination given the BON and PRC



SCOPE OF NURSING PRACTICE

CAREGIVER

Helping clients promote, restore, and maintain  dignity, health and wellness, within physiologic, spiritual, emotional, developmental, cultural and social needs of a holistic person.

COMMUNICATOR

This is the central role of nurses.  As the nurse identifies needs and problems of the client or group, the same is communicated to other members of the health team.
EDUCATOR/TEACHER

This is a role, which is involved in all nursing activities; especially that health promotion is  the primary nursing concern.  Part of this is the assessment of client’s learning needs and readiness to learn setting learning goals, implement and evaluate teaching strategies

COUNSELOR

Assuming role that helps client recognize and cope with stressful  psychological and social problems, develop interpersonal relationships, and promote group.
MANAGER/COORDINATOR

Nurse directly manages and coordinates care, delegates nursing activities , supervises and evaluates performance of other nurses and support workers.

CHANGE AGENT

Nurse assist clients to modify behavior.  Also coping with highly dynamic (changing) health care system, health technology, and human system itself.

LEADER

Nurse influences others to work together towards a mutually envisioned goal

CLINICIAN

Use of technical expertise to administer nursing care and initiate and modify care based on client’s needs.



ADVOCATE

Nurse intercedes for or works on behalf of the patient explains, interprets and defends the patients right.


SCOPE OF NURSING PRACTICE

A. Independent Nursing Functions
a. Licensed to initiate based on knowledge and skills
b. Physical care
c. Gathering health information
d. Support and comfort
e. Teaching, counseling
f. Environmental support
g. Referrals


B. Dependent/Collaborative Nursing Functions
a. Under physician orders
b. Under protocols
c. Decision under parameters
d. Student reports to faculty member



NURSING HISTORY IN THE PHILIPPINES
• Iloilo Mission Hospital Training School for Nurses graduated the first trained nurses in the Phil. In 1909.  Iloilo Mission Hospital (under the Baptist Foreign Mission of America) started its school of nursing in 1906
• The first examination given by the Board of Examiners for Nurses was held in Manila in June 1920, presided by Dr. Juan Cabarrus with Belen del Rosario and Ms. Anastacia Giron
• The first board topnotcher was Anna Dahlgen with 93.5%
• Act 2493 of 1915 “An act to amend Act 310 regulating the practice in the Phil. Isalnd of medicine and Suregry” was the first law affecting the practice of nursing in the Philippines, specifically through Sec 7 and 8
• The first Nursing Law was Act. No. 2808 “act regulating the Practice of Nursing Profession in the Philippine Island, signed on March 1919”
• University of Sto. Tomas College of Nursing is the first college of nursing in the Philippines, with the first Dean, Ricarda Mendoza (UST-CN evolved from School of Male Nurses opened in 1877)
• The first board examination held outside Manila was held in Iloilo in 1946 on the request of Ms. Loreto Tupaz
• Ms. Anastacia Giron initiated and presided over the organizational meeting of Filipino Nurses Association (FNA), now Philippine Nurses Association (PNA), in September 2, 1922, attended by 150 nurses. FNA became incorporated in 1924 and was accepted as member of International Council of Nurses in 1929
• Mrs. Anastacia Giron-Tupas as “dean and Pioneer of Philippine Nursing” and was awarded (post-humous) by PNA in 1981 as the “Founder of PNA and Dean of Philippine Nursing.”
• Ms. Rosario Montenegro was the first President and Ms. Anastacia Giron was the first executive secretary of the FNA
• Every last week of October is the “Nurse’s Week” since President Carlos P. Garcia’s Proclamation 539 in October 17, 1958
• Pres. Fidel V. Ramos declared 1997 as the Nurses Diamond Jubilee Year” under Proclamation No. 1060
Professional Nurse

- a person whose name and registration/professional license number is entered in the Commission’s registry book and computerized data base as legally authorized to practice the nursing profession (BON Resolution 425, s. 2003).  This is the basis of the title RN.





- A professional nurse is one who meets all the following criteria
i. Completed the required nursing education
ii. Passed the Nurse Licensure Examination
iii. Has her name included in the registry book of and computer data base of registered nurses of the PRC





Practicing Professional Nurse

- a person engaged in the practice of the nursing profession or is performing acts or activities, whether regularly or occasionally, including one who is employed in a government office or in a private corporation who duties require knowledge and application of the nursing profession (BON Res. 425, s. 2003)



Foreign Professional Nurse

- a foreign national, being license professional nurse in her own country is authorized by existing laws to practice her own profession either as a holder of a certificate of registration and a professional identification card or a special/temporary permit in the Philippines, subject to the provision of subsections (j) and (l) of Section 7 of RA 8981 and other pertinent provision of said RA 8981 and RA 9173 (BON Res. 425, s 2003)

Sec 12 of RA 9173
- Licensure Examination – All applicants for license to practice nursing shall be required to pass a written examination, which shall be given by the Board in such places and dates as may be designed by the Commission; Provided, that it shall be in accordance with Republic Act No. 8981, otherwise known as “PRC Modernization Act”




Sec 13 of RA 9173
- Qualifications for Admission to the Licensure Examination – In order to be admitted to the Examination for nurses, an applicant must, at the time of filling his/her application, establish to the satisfaction of the Board that:






o He/She is a citizen of the Philippines, or a citizen or subject of a country which permits Filipino nurses to practice within its territorial limits on the same basis as the subject or citizen of such country; Provided, That the requirements for the registration or licensing of nurses in said country are substantially the same as those prescribed in this Act;
o He/she is of good moral character; and
o He/she is a holder of a Bachelor’s Degree in Nursing from a College or University that complies with the standards of nursing education duly recognized by the proper government agency.

Sec 14 of RA 9173
- Scope of Examination – The scope of the examination for the practice of nursing in the Philippines shall be determined by the Board.  The Board shall take into consideration the objectives of the nursing curriculum, the broad areas of nursing, and other related disciplines and competencies in determining the subjects of examinations.



Sec 15 of RA 9173
- Ratings – In order to pass the examination, the examinee must obtain a general average of at least 75% with a rating of not below 60% in any subject.  As examinee who obtain an average rating of 75% or higher but gets a rating below 60% in any subject must take the examination again but only in the subject or subjects where he/she is rated below 60%.  In order to pass the succeeding examination, an examinee must obtain a rating of at least 75% in the subjects or subjects repeated.

Sec 16 of RA 9173
- Oath – All successful candidates in the examination shall be required to take an oath of profession before the Board or any government official authorized to administer oaths prior to entering upon the nursing practice

Sec 17 of RA 9173
- Issuance of Certificate of Registration/Professional License and Professional Identification Card – A certificate of registration/professional license as a nurse shall be issued to an applicant who passes the examination upon payment of the prescribed fees.  Every certificate of registration/professional license shall show the full name of the registrant, the serial number, the signature of eth Chairperson of the Commission and of the Members of the Board, and the official seal of the Commission
- A professional identification card duly signed by the Chairperson of eth Commission, bearing the date of registration, license number, and the date of issuance and expiration thereof shall likewise be issued to every registrant upon payment of the required fees.

Sec 19 of RA 9173
- Automatic Registration of nurses – All nurses whose name appears at the roster of nurses shall be automatically or ipso facto registered nurses under this Act upon its effectivity

Sec 20 of RA 9173
- Registration by Reciprocity – A certificate of registration/professional license may be issued without examination to nurses registered under the law of foreign  state or country: Provided, that the requirements for registration  or licensing of nurses in said country are substantially the same as those prescribed under this Act: Provided further, That the laws of such sate or country grant the same privileges to registered nurses of the Philippines on the same basis as the subjects or citizens of such foreign state or country.

Sec 21 of RA 9173
- Practice Through Special/Temporary Permit – A special/temporary permit may be issued by the Board to the following persons subject to the approval of the Commission and upon payment of the prescribed fees:
o Licensed nurses from foreign countries/state whose service are either for a fee or free if they are internationally well known specialist or outstanding experts in any branch or specialty of nursing;
o Licensed nurses from foreign countries/states on medical mission whose services shall be free in a particular hospital, center or clinic; and
o Licensed nurses from foreign countries/states employed by schools/colleges of nursing as exchange professors in a branch or specialty of nursing
- Provided however, that the special/temporary permit shall be effective only for the duration of eth project, medical mission or employment contract

Sec 22 of RA 9173
- Non registration and Non-issuance of Certificate of Registration/Professional License or Special/Temporary Permit – No person convicted by final judgment of any criminal offense involving moral turpitude or any person guilty of immoral or dishonorable conduct or any person declared by the court to be of unsound mind shall be registered and be issued a certificate of registration/professional license or a special/temporary permit.
- The Board shall furnish the applicant a written statement setting forth the reasons for its actions, which shall be incorporated in the records of the Board.

Sec 23 of RA 9173
- Revocation and Suspension of Certificate of Registration/Professional License and Cancellation of Special/Temporary Permit – The Board shall have the power to revoke or suspend the certificate of registration/professional license or cancel the special/temporary permit of a nurse upon any of the following grounds
o For any of the causes mentioned in the preceding section
o For unprofessional and unethical conduct
o For gross incompetence or serious ignorance
o For malpractice or negligence in the practice of nursing
o For the use of fraud, deceit or false statements  in obtaining a certificate of registration/professional license or a temporary/special permit
o For violation of this Act, the rules and regulation, Code of Ethics for nurses and technical standards for nursing  practice, policies of the Board and the Commission, or the conditions and limitations for the issuance of the temporary/special permit or
o For practicing his/her profession during his/her suspension from such practice
- Provided however, That the suspension of the certificate of registration/professional license shall be for a period not to exceed four years

Sec 24 of RA 9173
- Re-issuance of Revoked Certificates and Replacement of Lost Certificates – The Board may, after the expiration of a maximum of four (4) years from the date of revocation of  certificate, for reasons of equity and justice and when the cause for revocation has disappeared or has been cured and corrected, upon proper application thereof and the payment of the required fees, issue another copy of the certificate of registration/professional license.
- A new certificate of registration/professional license to replace the certificate that has been lost, destroyed or mutilated may be issued, subject to the rules of the Board.
AREAS OF NURSING PRACTICE

A. Nursing Education
B. Nursing Services
C. Community Health Nursing


LEVELS OF NURSING PRACTICE

A. Novice

this stage is attributed to nursing students who have no background knowledge and therefore, needs rules, facts and direct instruction to guide their actions and to perform nursing safely




B. Advanced Beginner

this stage is attributed to a new graduate who ahs developed a greater self awareness as a nurse and has become less reliant on rules, facts and direct instruction and is more contexts free in her practice.  A practitioner at this level begins to grasp situations, has marginally acceptable performance, has previous experience but still cannot recognize situations based on those experiences.  They are aware of there limitations and seek the assistance and guidance of a mentor such as her supervisor.

C. Competent

a practitioner at this level of practice is characterized by a sense of role mastery. Practice at this level is planned and evolves on the basis of long term goals and prioritization.  This nurse has wider knowledge base, plans and anticipates, functions by relying on previous experiences, and therefore works with increases level of efficiency.




D. Proficient

a nurse at this level based on holistic and deep understanding of the situation, which means that she sees the total picture of  a situation and understands it.  The nurse functions with an intuitive grasp, a skill that can be attained only by seeing and comparing many similar and distinct clinical situations that she has been exposed to over time.  Therefore, this nurse has many meaningful clinical experiences that have provided her with valuable lessons and insights on how to act on a particular situation she encounters in her present practice.  The hallmarks of proficient practice are increased perceptual acuity and responsiveness to particular situations.


E. Expert

the nurse at this level is characterized by an intuitive grasp of the most salient aspect of each situation with the minimum number of cues.  Unlike the proficient level, there is no detached decision making, hesitation , deliberation or consideration of  a wide range of possibilities instead she instantaneously  zeros in on the problem and takes action.  Clinical grasp is inextricably linked with clinical response.  This ability requires an enormous background and vast experiences.  Expert practice represents the essence of clinical judgment and is the pinnacle of clinical performance from the most knowledgeable members of the profession

Expert Has intuitive grasp of nursing situation
Proficiency Perceives situation as whole rather than parts
Competent Consciously plans nursing care
Advanced Beginner Demonstrates acceptable performance
Novice Governed by rules, limited and inflexible


NURSES WITH POST GRADUATE EDUCATION AND SPECIALIZATION

A. Master’s Degree – MAN, MSN
B. Doctoral Degree – PhD
C. Post Doctoral Programs


Careers in Nursing
Hospital Setting

Critical Care/ICU
Emergency Nurse
Maternal/Child Care
Medical: Cardiology, Diabetes
Gastroenterology, Gerontology
Nephrology, Neurology, Oncology
Pulmonary, Rehabilitation, Renal
Rheumatology, Urology
Operating Room/Recovery Room
Pediatrics
Psychiatric/Mental Health
Surgical: Burn, Cardiovascular
Ear/Nose/Throat, Gastroenterology
Orthopedics, Plastic Reconstructive
Transplant


Non Hospital Setting

Public/Community Health
Mental Health Agencies
Home Health Care/Private Duty
Health Maintenance Organization and
Managed Care Companies
Occupational Health
Research Centers
Extended Care Facilities
Clinics
Rehabilitation Centers
Hospices/Nursing Homes
School Nursing
Day Care Centers
Military Branches

A. Institutional Nursing practice – refers to nursing employment in a health care setting, whether in an in-patient or out-patient setting and providing nursing care to the individual, the family or the community.  This includes nurses working as staff nurse, occupational nurses, clinic nurses, school nurses, nurses in nursing homes, rehabilitation centers and other extended health care facilities.

B. Public Health Nurse/Community Health Nurse – synthesis of nursing theory and public health practice applied to promoting and preserving the health of the populations, This includes the ambulatory health clinics, home health care, industrial sites, nursing centers, outpatient surgery centers (derma clinics), prenatal and well baby clinics, school, rural health nurse and city health offices.

C. Occupational Health Nurse – concerned with the health and safety of  people at work, their families and the general community.  The nurse is responsible in the promotion and preservation of the health of the working population.
D. School Nurse – working in the school setting whose focus is to strengthen and facilitate the educational process by promoting normal development; promoting health  and safety and interfering with actual and potential health problems  of the students.

E. Hospital staff Nurse – provides direct care to patients with a wide variety of conditions and at different ages; teaches patients and families regarding self care, administer medications, IV therapy, and treatments; performs assessment; plans, implements, evaluates and documents care; serves as advocates of the patient and the family and supervises nursing aids.
F. Private Duty Nurse – who contracts independently to render full time comprehensive nursing care to patients on a one to one ratio in the hospital or in the patient’s home environment.
G. Nurse Midwife – is nurse who is both a registered nurse and a registered midwife.  Provides care for women during pregnancy and childbirth which includes services to women and their babies in the areas of prenatal care, labor and delivery management, post partum care, normal newborn care, well women gynecology and family planning.
H. Military Nurse – provides all aspects of traditional nursing care and practice both peace and war time settings through various branches of military service to military personnel and their dependents.
I. Office/Clinic Nurse – facilitates delivery of primary care to patients in settings such as physicians, offices, surgicenters, and medical office buildings.
J. Flight Nurse – provide continuous and often intensive nursing care while transporting critical patients by helicopter, airplane or ambulance from one medical facility to another and from emergency or trauma scenes and brief medical providers at the receiving medical facility  on the patient’s status.

K. Nursing homes – capable of caring for individuals with a wide range of medical conditions, not only the elderly.
L. Nurse Educators – responsible for providing quality educational experiences that prepare future generation of nurses to provide quality patient care, at the same time ensuring competence and advancement of practicing nurse.



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