Nursing Roles and Responsibilities

The focus of lecture a will be to identify the different roles and responsibility of the Registered Nurse (RN), and how they function at the different levels of health care and where nurses work.

In order to understand the roles of the nurse, it is important to recognize that nursing is a profession that has strict guidelines before a person can practice as a nurse.  All registered nurses are required to have met an approved educational plan of study and passed a national exam before they can engage in the care and management of patients.  The practice of Nursing is regulated by the state in which the nurse is licensed.  Once licensed as a registered nurse they must continue to participate in educational activities to stay current in their practice and show documentation of this when they apply to renew their license.  Each state has their own “Nurse Practice Act” regulated by the State Board of Nursing of each state.  Nurses are dedicated life-long learners.  They are responsible for their actions and expected to make decisions based on evidence and data.  They are members of the health care team but they are fully accountable for all their actions.  Their scope of practice is highly regulated by their licensing board and if the nurse fails to work within her practice he/she will lose their license and the right to practice nursing.

A nurse is reasonably independent and self-governing in decision making and practice.  They are solely responsible, professionally and legally, for the type and quality of nursing care provided.  Nursing has gained the reputation for being the most trusted and respected profession in the world and nurses work hard to keep this honor.

There are approximately 3 million registered nurses in the US. 83.2 % of these nurses are working either full time or part-time in nursing positions across the country.

Hospitals are the primary practice setting for approximately 1.5 million nurses or 57 percent of all RNs.  10.7 % of all nurses work in public/community health settings, the remaining work in long-term care, private practices, schools, and businesses.

Nurses have a variety of combined responsibilities: they are Caregiver - providing hands on, direct patient care at all level. They manage patient care by coordinating the activities of other health care team members for the benefit of the patient.  They advocate for patients, families, their peers and other members of the team as well as the company they work or the community they serve for by supporting or defending the needs of those they are committed to helping or improving a situation.

The nurse at all levels is engaged in educating.  Every day the nurse is teaching and sharing their knowledge regarding health issues, treatment plans, medication, procedures, home care, etc to patients, family members, peers, students and other members of the health care team.  A large part of their role is educating, with the hopes to keep patients informed of their care, the way things are being done and how the treatment or medication can help them.  Informed patients comply better with treatment plans and medication regimens which results in shorter recovery times.  They are also responsible to help train and educate future members of the health care team especially student nurses.

Nurses must communicate in every role.  They must have excellent verbal and written skills.  Accurate and complete documentation and reporting is essential for a nurse working at every level of health care.  Their patient’s lives depend on their ability to commute.

There are 6 levels of health care and nurse’s work at all levels.

  1. Preventive care – Activities that promote health and wellness, health education and programs focused on prevention of disease and accidents.

  2. Primary - Early detection and routine care (health physicals, Pap smears, immunizations etc).

  3. Secondary- (acute care) – Emergency treatment; diagnosis and treatment of ill patients.

  4. Tertiary - special care – highly technical services.

  5. Restorative care - Intermediate follow-up care (surgical postoperative care, routine medical care), rehabilitation.
  6. Continuing – Long term care; chronic care, personal care, hospice care.

Every level of care creates different requirements and opportunities for the nurse.  It requires the nurse to come with different skills and knowledge and requires that the nurse know his/her responsibility in that area of practice. “Scope of practice” as defined by their licensing board must be adhered to when providing care.

So where will you a find a nurse?  In almost every health care setting, performing a wide variety of nursing skills and responsibilities, while having a common goal: to serve others, to provide care, offer comfort and/or to improve patient outcomes and services. 

Most RNs work directly with patients and their families. They are the primary point of contact between the patient and the world of health care, both at the bedside and in out-patient settings.  RNs perform frequent patient assessment and evaluations, including monitoring and tracking vital signs, performing procedures such as IV placement, phlebotomy, and administering medications. Because the RN has much more regular contact with patients than physicians, the RN is usually first to notice problems or raise concerns about patient progress. 

This slide visually depicts how the different sub-specialties of nursing, Psychiatric-Mental Health nursing, Medical-Surgical nursing, Community health nursing, Parent-Child nursing, Geriatric nursing  and Home Health nursing have different sets of responsibilities and different levels of patient interaction, yet there are many shared and overlapping tasks required of all nurses.  Nurses often move from one sub-specialty to another as job opportunities come available or interest changes.

Preventive and primary care nursing is often performed in an outpatient setting.  Clinics & Physician Offices, Community Health Centers, Health Departments; Schools; Immunization clinics; Telephone Triage & Health Care Advice lines, Corrections, and Industrial Medicine.

These nurses usually work with patients with less acute conditions, and focus on keeping the clients well and safe.  Very often these nurses come with years of work experience in acute care and bring with them to these settings an understanding and appreciation of what a person can do to prevent life-long complications from preventable illnesses or accidents. 

In the hospital you will find nurses filling many areas of service:  Most nurses in the hospital are engaged in direct patient care and are called staff nurses.  Their job is to manage and provide care to patients with a variety of acute care needs.  This is a fast paced and challenging position.  General staff nurses must juggle multiple tasks simultaneously; manage competing patient care priorities, such as quality patient care, cost containment, supervising unlicensed assistive personnel and shared governance responsibilities.  They coordinate getting patients ready for diagnostic test, surgery, or rehabilitative therapy; they soothe and comfort difficult patient’s situations, educate and plan for discharge.  All staff RN’s are required by the hospitals and their licensing boards to take continuing education class in their area of work as well as keeping updated on new treatments, medications and equipment.

Specialty advanced practice nurses are required to have extended studies in a specialist field of patient care. 

Travel nurses are nurses who contract with a for-hire agency to be placed in a variety of hospitals in different setting and states.  They often are hired by hospitals or clinics to cover a shortage in the RN staff or to provide specialized care for a patient.  

You will also find nurses working in staff development, developing training and continued education classes for nurses and other hospital or clinic staff.  They also are usually the ones who participate in Utilization review activities.  Because nurses have the education and experience to understand effective uses of resources they are used to review and track the effectiveness of hospital services, oversee medication compliance, and gather data to support changes in the hospital process and policies.  They may be advocates for the patients for insurance billing, out of hospital placements and listen to customer expectations and complaints.   

Risk management departments also use nurses to track unusual reported incidents, identify potential liability areas and provide staff education on documentation and reporting of incidents and assist staff when legal actions or malpractice suits arise.  They focus on reducing the financial losses of the institution due to errors and accidents.

Nurses work in a variety of out of hospital settings.  Nurses play a key role in managing the care of patients in long term care settings.  Long term care nurses manage nursing care for residents with conditions ranging from a fracture to Alzheimer's disease.  Although they often spend much of their time on administrative and supervisory tasks, RNs also assess the residents' health condition, develop treatment plans, supervise licensed practical nurses and nursing aides, and perform difficult procedures such as starting intravenous fluids.  

Nurses also work in specialty-care departments, such as long-term rehabilitation units for patients with strokes, head-injuries and mental health issues.

Companies that sell products such as pharmaceuticals, IV equipment and monitors often hire nurses as sales representatives.  They provide credibility for product promotion, especially when they have used the product in clinical practice.  Nurses also provide insight into product improvement and future products that may be useful in their area of expertise.

 Many businesses have, occupational health departments for which nurses work at managing work place injuries, preventing work-related illnesses, screening for environmental hazards providing employee educational services and marketing employee health programs.

Nurses also work at legal consultants reviewing health related case materials and acting as case experts.

Nurses also play a significant role in education, research and publishing.

Nursing is a profession that offers many opportunities for persons wanting to have a diverse role in promoting health, providing care and educating others.


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