Académique Documents
Professionnel Documents
Culture Documents
Class Objectives
To identify the educational preparation and skills required to work in nursing roles.
Education
Early Education
1860: Florence Nightingale established SON in association with Hospital London, England 1874: First hospital diploma SON in Canada
St. Catharine's General and Marine Hospital Admission standards: Plain English education, good character, and Christian motives nursing considered undesirable vocation refined ladies
What was the 1 acceptable vocation?
University Programs
WWI & 1918 Influenza pandemic led to support for public health programs and new patterns of health care delivery Nurses were seen as central participants who needed university level education Canadian Red Cross: awarded grants to # of universities to develop public health nursing 1919: 1st nursing degree University of British Columbia 1975: proposed by 1995 entry to practice be baccalaureate degree (Alberta Task Force on Nursing Education)
Radical proposal at time / requirement now in most provinces
2006
162,493
Bacc
Masters Doctorate Total RNs
22.7%
1.6% 0.1%
52,927
3,652 186
33%
2.5% 0.15%
83,704
6,354 382
232,566
252,933
each regulatory college to develop, establish and maintain programs to promote continuing competence among members of the profession. College of Nurses of Ontario (CNO)
Every member is responsible for practising in accordance with the standards of the profession, and for keeping current and competent throughout their nursing career.
http://www.cno.org/pubs/compendium.html#intro
legislative requirement. supports nurses s to practise according to standards and continually improve. facilitates practice development in areas that need
members of the public have the opportunity to express concerns about the nursing care they have received. College responds in a number of ways, including disciplinary measures for professional misconduct.
3. Peer Assessment
College-assigned Assessors review Practice Assessment Make recommendations to QA Committee/ may require members to complete additional learning activities.
RNs in health-care
Direct clinical practice Education Administration Research Policy
(CNA, 2007)
Discussion Questions
What brought you into nursing? What characteristics or roles come to mind when you think of a nurse?
Clinical Nurse Specialist (CNS) Nurse Practitioner (NP) Nurse Anaesthetist* Nurse-midwife*
* Roles in USA only Initial work underway to introduce Nurse anaesthetists in Canada
Effectiveness of APNs
Numerous randomized controlled trials (RCTs) and systematic reviews have shown that APNs are effective, safe practitioners who can positively influence patient, provider and health system outcomes:
22
Domains of Practice
Expert clinical practice Consultation Education Research Leadership
24
Nurse Practitioners
Introduced in 1960s
Legislation exists in all Canadian provinces & territories Involved in health promotion, disease prevention & acute and chronic illness management
26
Sudbury, Ontario
first of 25 NP-led clinics is up and running
Cost-Effectiveness of NP Role
(CNA, 2003)
80-90% of visits to primary care physicians can be managed by NPs NPs cost 40% less than physicians NPs are cost-effective in terms of preventive care because of expertise in counselling, patient/client education, and case management
NA NA 52 99
<10
2 5 3 46 29 872
88 663
210 303
98
*
80 49 2 5 4 8
63
115
555
415
RPNs
In Ontario nursing is one profession with two categories:
Registered Nurse (RN) Registered Practical Nurse (RPN)
overlap exists in certain client care tasks critical practice differences exist RPN Education
2 year practical nursing diploma RPNs RNs 3 years
RN versus RPN
RN draws on more in-depth theoretical and clinical knowledge
Have greater range of care delivery options from which to select when adopting a plan of care
RNs / RPNs
Client Risk Category Low risk
RPNs and RNs independently care for clients Predictable
Medium-risk
High-risk
RPNs and RN collaborate RNs care independently; at varying degrees in care RPNs may be involved in limited aspects of care Moderately predictable Unpredictable
Moderately complex More Complex Moderate risk of negative High risk of negative outcomes outcome
Image of Nurses/Nursing
5. 1965- 1982
Sex Object
Nursing Self-Image
(Buresh & Gordon, 2000) Influenced through socialization process (society & profession) Self-image reflected though:
personal appearance interactions with other nurses other health care providers the public
Dear [Nurse],
I wanted to thank you personally for teaching this old dog new tricks. I always thought that nurses were basically the doctor's handmaidens..... that the sexy little stereotype portrayed on television... was correct. I looked upon your profession badly, and I sincerely apologize. What I have found during my stay in your care is a completely different story .... I think each patient should be given a copy of this on admission, and hospitals should be known as nursing care providers, because a patient enters the hospital for nursing care. I found this out during my stay. I had nurses 24 hours a day every day I was hospitalized, I had maybe 10 minutes a day with the doctor. So here goes my opinion of what every patient needs to know.
1. 2.
You have been placed in the hospital for nursing care. The provider of that care is an educated individual who unselfishly dedicates themselves to your health and well-being. And even though you may not like being told what things are good for you and what are not, the nurse telling you does so to give you a chance to redeem your health and well-being. That provider is proud to be a nurse.
3.
4.
That nurse does more than you know. She plans your care around your medical condition, emotional state, abilities to do for yourself (sorry, [nurse], I think you said "self care" in your rant), that nurse provides support to you and your family, she/he is the link between you and the doctor, [and] everything in the facility.
That nurse does your bedside care, she knows what medicine you need when, and how to give it. She knows what all the tubes and stuff are and what they are used for and what to look at them for.
5.
6.
That nurse can hang an IV or hold your hand and reassure you.
7.
That nurse watches over you and reads monitors and knows when [you're] sleeping and when [you're] awake and pulls strings to get you that cup of tea at 3 a.m.
That nurse is your lifeline, she can call a whole team of professionals together with her calm voice and make them work their [butts] off for your life with the flash of her/his eyes. That nurse will wish you luck and give you all the instructions you need when you leave her competent care even if you were the biggest pain in the [butt] she ever met.
8.
9.
10. The nurse is why you are in the hospital and why you will go onward, be it home, perpetual care, or the morgue. She will insure that you do so with your dignity and rights intact. Why? Because it is what a nurse does. signed/ .................
Discussion Question
What is your image of nurses in 2010 Why should nurses be concerned about their public image?
References
Buresh, B., & Gordon, S. (2000). From silence to voice: What nurses know and must communicate to the public. Ottawa: Canadian Nurses Association. Canadian Nurses Association. (2006) 2006 workforce profile of Registered Nurses in Canada. Ottawa: Author. CNA (2002). Fact sheet: Role of the nurse practitioner around the world. Ottawa: Author. CNA (2003). Position Statement: Cost-effectiveness of the nurse practitioner role. Ottawa: Author CNA (2003). Position Statement: Clinical nurse specialist. Ottawa: Author Evans, J. A. (2002). Cautious caregivers: Gender stereotypes and the sexualization of men nurses touch. Journal of Advanced Nursing, 40(4), 441-448.
References
Evans, J. A. (2004). Men nurses: A historical and feminist perspective. Journal of Advanced Nursing, 47(3), 321- 328. Hamric, A. B., Spross, J.A., & Hanson, C. M. (2005). Advanced Practice Nursing. St Louis: Elsevier Saunders. Higuchi, K. S., Hagen, B., Brown, S., & Zeiber, M. P. (2006). Meeting the needs of rural seniors: A new role for advanced practice nurses in Canada. Journal of Gerontological Nursing, 32(7), 49-55. Davies, B. & Hughes, A. M. (2002). Clarification of advanced nursing practice: Characteristics and competencies. Clinical Nurse Specialist, 16 (3), 147-152.
Sutherland, R. (1996). Will nurses call the shots? Ottawa: Canadian Nurses Association.
References
Kalisch, B. & Kalisch, P. (1982) Anatomy of the image of the nurse: Dissonant and ideal models. In C. Williams (Ed.) Image Making in Nursing (pp. 3-23) Kansas City: American Academy of Nursing. Lusk, B. (2000). Pretty and powerless: Nurses in advertisements, 19301950. Research in Nursing and Health, 23, 229-236.
Wood, M. J. & MacPhail, J. (2003). The professional image: Impact and strategies for change. In J. C. Ross-Kerr & M. J. Wood (Eds.),
Canadian Nursing: Issues and Perspectives (4th ed., pp. 65-81). Toronto: Elsevier Science Canada.