Changes occurring within the nursing profession during the past three or four years have been dramatic and exciting. Demonstrations of the extension of nursing functions in clinical practice have grown and spread rapidly. The role of the nurse in providing primary patient care, in initiating treatment, and in making independent decisions as to prevention and rehabilitation is becoming more generally accepted. The expansion of nursing functions is found in all parts of the country, in urban, suburban, and rural health centers.
It is seen in the establishment of nursing clinics, in new collaborative arrangements in doctors’ offices, in group practice, and in health maintenance organizations. And it is evident in pediatrics, psychiatry, obstetrics, geriatrics, and family health care as well as in many other health fields. These increasing responsibilities have heightened the nurse’s expectation of self and of the profession. Not only is she able to apply basic knowledge of nursing to patient care, but is stimulated to think more freely and more critically about the contribution of nursing in the health care system.
Simultaneously she is encouraged to continue to broaden her scope of practice and to look for objective measures to evaluate quality of care. In an effort to strengthen the
In addition to contributing to improvements in health service for the community, the registered nurse role provides an exciting and new clinical career pathway for nurses. The registered nurse is an advanced practice nurse with extensive experience in a specialty field, postgraduate education and increasingly required to hold a registered nurse masters degree (Atkins S, Ersser S, 2000; Reveley S, 2001). The registered nurse works within a defined scope of practice and model of service and is a member of a multidisciplinary team.
The structure and proximity of the team is dependent upon the specific registered nurse model. Some examples of registered nurse models piloted, currently in development or currently practicing in Australia include wound care, neonatal intensive care, rural and remote practice, mental health liaison, pediatric renal, neuroscience, primary health, diabetes, gerontology, child health, cardiac rehabilitation and sexual health. In relation to cancer services, the scope for the registered nurse role is open and responsive to development of new and emerging clinical services.
Accordingly, health service planners looking to streamline cancer services, improve access to comprehensive palliative care and/or improve case management for patients with co-morbid chronic illness are increasingly building the registered nurse role into the health care teams in these areas (McKenna et al, 2004; Sharp & Oldham, 2004). In designing a registered nurse role there are factors that need to be considered to enhance the efficacy and sustainability of a new service.
First the registered nurse is not a medical substitute. The registered nurse model needs to conform to a collaborative/team approach to health care that is complementary to other professional roles and central to better organization of the clinical service. The team may look different depending on the service provided, but the registered nurse, like all other health care providers, operates most effectively in an overtly collaborative model. Second the role needs to be sustainable in that it does not replicate existing services.
The registered nurse level of care is most effective when the service fills a gap in access, efficiency or quality of service for the patient population in a specific field of health care. Finally the candidate for the registered nurse role needs to have extensive experience in the specialty field and appropriate educational preparation. Classification of Functions The making of a nursing diagnosis is an independent function of the professional nurse. Further clarification of functions of nursing has been made by Mulholland (2001).
If nurses are to be prepared as generalists, this immediately presents several problems. Studies show that professional nurses have decided preferences for one unit or service over another. Some nurses like solutions in which their hands or feet are busy, whereas others prefer units where they have an opportunity to teach and rehabilitate patients (Gardner et al, 2004). The Cancer Nurse, the Tuberculosis Nurse, the Medical Nurse, the Surgical Nurse, the Communicable Disease Nurse, the Neurosurgical Nurse, the psychiatric Nurse, etc, are examples of how far nursing has succeeded in fractionizing itself.
A recent study by Lentz and Michaels shows that training may make a difference in the attitude a nurse brings to her work. Factors Affecting Nursing Some of the factors affecting the mounting demands and the consequent trends in the field of nursing are firstly the population pressure and increase in birth rates which had affect on increase in hospital admissions, and the relief in hospitals has been the source for the growing confidence in them by all countries.
Thus new medical techniques and drugs needed skilled nursing care to shorten the average patients’ stay in the hospital. Secondly the extension of public health services in all communities thus industrial nursing, school nursing, bedside nursing in the home have increased rapidly with the availability of trained personnel and institutions. Lastly changes in the health picture as far as the incidence of disease and cause of death are concerned means that to-day the nurse needs a different type of preparation then fifty years ago.
Nurse Vs Physician With the changes taking place in the science of medicine, in world events, in the standards evolved by nurse educators and in social conditions affected by present economic and political trends, the relationship between nurse and physician undergoes corresponding change and readjustment. The early nurse neither expected nor received recognition from the doctor, who considered her as undesirable member of society a low creature, tolerated in the presence of so called “decent” persons only because her services were so greatly needed.
To-day various members of the medical profession when think of specialization in one field of work they do give consideration to nursing service procedures as one topic for specialization in that field of work. In practice a doctor, chiefly concerned with treatment of medical patients, would have the nurse responsible for assisting in a large number of complicated diagnostic procedures leading to crystoscopy, electrocardiography and kidney function tests.
The other procedures with which they are supposed to be familiar are gastric analysis, diagnostic or therapeutic use of x-rays plus a host of other specialized forms of treatment. Similarly a medical specialist, say, a surgeon expects a nurse to be proficient in performing procedures like blood transfusion, inducing intravenous injections, administering of plasma or of recently discovered drugs, recognizing immediately any symptom that might indicate surgical complications, and to be thoroughly versed in oxygen therapy and in the use of suction or other apparatus used extensively in case of post-operative
Research Nurses are now engaged in research in a wide variety of nursing and multidisciplinary projects, they are identifying a body of nursing knowledge and principles needed to build firmer foundations on which to base nursing practice. Concurrently education for nursing, as for medicine and related disciplines is changing and new patterns and programs are being developed to prepare personnel to meet the challenges and problems of modern nursing.
Psychosomatic aspects of nursing, newly discovered drugs and treatments, new medicines in all fields of medical practice have necessitated programs of continuing education for all workers in medical and health fields. In order to utilize to a better extent all professional personnel studies are being made to find out more effective ways of using all personnel to meet health needs.
Practical nurses, hospital aids, clerical works, other professional workers, such as dietitians, social workers, occupational therapists can often, on a team basis, work together with the professional nurse and the doctor to provide better care than we have been accustomed to in the traditional pattern. Conclusion This paper has attempted to clarify some of the issues related to the development of the registered role of nurse.
The registered nurse has been described as an advanced practice nurse who bridges that grey area between nursing and medicine and is emerging as a new type and level of health care clinician. They represent a new breed of health care professional in that they are not limited by traditional health discipline boundaries, their practice includes what has traditionally been viewed as medical activities within a nursing model of care and they expand clinical practice in both medical and nursing specialty areas.