Nursing and Nursing Education Public Policies and Private Actions (1983) / Chapter Skim
Currently Skimming:
CHAPTER I NURSING SERVICES AND NURSING EDUCATION: AN OVERVIEW
CHAPTER I NURSING SERVICES AND NURSING EDUCATION: AN OVERVIEW
Pages 24-50
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 24... ...
The chapter concludes with a historical review of the respective roles of federal and state governments and private sources in the financing of nursing education. The Diversity of Registered Nurses' Responsibilities Nursing education must supply the nation with RNs prepared for a wide range of roles and responsibilities: providing direct care to patients in hospitals, nursing homes, and patients' homes; helping to safeguard the health of community and school populations; assisting with ambulatory care of individuals and families; performing clinical nurse specialist services; administering nursing services at both middle and top management levels; conducting nursing research; and providing professional and educational leadership to the profession.
|
From page 25... ...
As in-service instructors, they manage and conduct orientation, staff development, and continuing education for RNs and all other nursing staff personnel; KNs with advanced clinical training provide consultation and patient care in clinical nursing specialities, such as coronary care or renal dialysis. At the staff nurse level, where most direct patient care is handled, a large proportion of the RN staff may be monitoring patients on complex life support systems in various types of intensive care units, while others will be at the bedside caring for patients with widely differing physical and emotional needs in medical, surgical, pediatric, obstetrical, and psychiatric units of the institution.
|
From page 26... ...
In hospitals, these directors of nursing services and their assistants typically manage nursing services with hundreds of staff personnel whose education and skills range through those of specialist and generalist RNs, and those of LPNs, to simple staff support by such ancillary personnel as aides and orderlies.+ Registered nurses are the single largest component of health care personnel in the United States. There are also very large numbers of LPNs and aides.
|
From page 27... ...
Of these, more than 735,000 were in staff or head nurse positions in hospitals and nursing homes. In these roles they were expected not only to have high level technical nursing skills and to work closely with physicians, but also, as we have seen, to assess patients' nursing needs on a 24-hour basis and to plan, coordinate, and document the nursing care given by other nursing and non-nursing personnel.
|
From page 28... ...
The Licensed Practical Nurse State boards license practical or vocational nurses to provide nursing services under the supervision of RNs and/or physicians. In 1980 approximately 300,000 LPNs were employed in hospitals, where they performed routine nursing tasks, largely under supervision.8 In 1977, the National Nursing Home Survey estimated that 97,500 LPNs were employed in nursing homes.9 In these settings they have greater responsibilities than they do in hospitals, because, as is described in Chapter VI, they often are the only licensed nurses on the premises.
|
From page 29... ...
Approximately 386,000 aides were employed in the nation's hospitals in 1980 and 463,000 in nursing homes in 1977.13,14 In hospitals, they carry out routine patient care tasks such as assisting in personal hygiene under the direction of either RNs or LPNs. In nursing homes, they often carry out a much wider variety of direct patient care tasks and functions.
|
From page 30... ...
Evaluate changes indicated on patient care plan 3. Establish priorities as demanded by a situtation 4.
|
From page 31... ...
Direct Patient Care: Provide direct care to patient including personal hygiene needs, i.e., bedbath, backrubs, mouth care, changing bed, assistance with bedpan and voiding. Also includes transfer of patients from bed to chair and patient positioning 1.
|
From page 32... ...
,* in contrast to only 15 percent in nursing homes certified as skilled nursing tithe American Hospital Association membership includes approximately 6,000 hospitals and other patient care organizations in the United States and Canada and 24 hospital schools of nursing.
|
From page 33... ...
In 1980, in small hospitals (50-99 beds) , only 39 percent of the nursing service staff were FTE RNs compared with 53 percent in hospitals of 500 beds and more.25 Conversely, the proportion of FTE LPN s decreased with increasing hospital size, dropping from 23 percent of the nursing personnel of small hospitals to 15 percent in the largest hospitals.
|
From page 34... ...
This means that in hospitals that have fewer total RNs to begin with, an even smaller number of KNs at the staff and head nurse level are available to deliver patient care. For example, when, for purposes of analysis, the advanced nurse positions are removed from the overall nursing personnel staff mix, RNs constitute only 15 percent of the nursing personnel in chronic hospitals compared with 42 percent in general hospitals, and RNs are only 32 percent of the nursing personnel in small hospitals compared with 44 percent in hospitals of 500 beds or more.
|
From page 35... ...
Although each of the 1,422 nurse education programs probably lists its curriculum requirements in catalogues, there are no compendiums of the information in a form that permits comparative analysis. Nor does the National League for Nursing (NLN)
|
From page 36... ...
Most are given in schools of nursing that also offer 4-year generic baccalaureate degree programs; others are separately organized. Graduations from such post-RN programs almost quadrupled between 1972 and 1981.29 In another even more recent development in nurse education, hospital schools of nursing have been reaching out to combine in various ways with either AD or baccalaureate programs.
|
From page 37... ...
Relation of Type of Generalist Nurse Education to Licensure and Practice Graduates of all three types of nurse education programs that prepare for RN kc ensure take the same standard national examination to obtain licensure in their respective states. According to annual surveys by the NLN of all newly licensed nurses 6-8 months after graduation, each of which usually elicits about 55,000 responses, more than 90 percent of the graduates from each of the three types of programs take positions in hospitals.32 There, after an orientation period, all are customarily assigned to carry out the same kinds of direct patient care activities.
|
From page 38... ...
TABLE 2 Percent Distribution of Registered Nurses Aged 35-39 Years in Selected Types of Employment According to Their Highest Levels of Educational Preparation, November 1980 Associate Bacca Type of Employment Diploma Degree laureate Hospital 47.5 67.4 45.4 Nursing homes 7.3 6.7 3.9 Public and community health, student and occupational health 9.0 6.1 15.4 Nursing education 1.2 0.6 4.3 All others 10.0 7.5 6.4 Not employed in nursing 25.0 11.7 24.6 TOTAL 100.0 100.0 100.0 SOURCE: Study analysis of data from National Sample Survey of Registered Nurses, November 1980. Hospital and nursing home employers of RNs find other aspects of the findings reported in Table 2 to be of particular interest.
|
From page 39... ...
Almost twice as high a proportion of baccalaureate nurses were in teaching or administrative positions or held expanded nurse jobs such as nurse practitioner.35 Analysis of the National Sample Survey of Registered Nurses, November 1980, shows that among employed RNs with 11 to 15 years of experience, 65 percent of diploma, 53 percent of AD, and 52 percent of baccalaureate graduates still held direct patient care staff level positions. However, as in the NLN study, a considerably higher proportion of baccalaureate RNs with these years of experience held administrative positions (8.5 percent)
|
From page 40... ...
Performing some proportion of examinations Instructing patients in management of defined illness 67 Instructing patients in health maintenance Primary responsibility for follow through on care Assisting activities 65 71 63 17 43 Assisting during patient exams 70 Administering medications 78 Sustaining and supporting persons during diagnosis or therapy Implementing therapy 18 47 70 63 50 62 57 75 81 72 59 67 67 48 56 71 57 59 SOURCE: Study analysis of data from National Sample Survey of Registered Nurses, November 1980. nurse, those with baccalaureate and diploma preparation were more apt to be occupied in record keeping and other kinds of responsibilities that drew them away from direct patient care.
|
From page 41... ...
Although the ANA is silent on diploma programs currently preparing for RN kc ensure and on programs currently preparing for LPN licensure, by implication there would be no future place for either. The ANA position derives from a statement of principles developed in 1965 that "the education for all who are licensed to practice nursing should take place in institutions of higher learning," and that "minimum preparation for technical nursing practice at the present time should be an AD education in nursing."38 In 1978, the ANA House of Delegates adopted the following formal resolutions to advance its position:39 · that the ANA ensure that two categories of nursing practice be clearly identified and titled by 1980; ~ that by 1985 the minimum preparation for entry into professional nursing practice be the baccalaureate in nursing; and · that the ANA, through appropriate structural units, work closely with state nursing associations and other nursing organizations to identify and define the two categories of nursing practice.
|
From page 42... ...
Some nursing organizations take somewhat intermediate positions. In February 1982, the Board of Directors of the NAN, which accredits practical, diploma, AD, and baccalaureate nursing education programs, adopted a statement that explicitly supports the retention of all current types of nurse education programs and the current system of state licensure but nevertheless recognizes the goal of baccalaureate preparation for entry into professional practice.41 The controversy over the education to be required for entry into professional practice has divided nursing, particularly in its influence at the state level, where legislation to change current nurse practice acts would usually be required to implement a position limiting entry into professional practice.
|
From page 43... ...
The National Sample Survey of Registered Nurses, November 1980 estimated that hospitals employed 23,100 nurses in top administrative positions and an additional 48,600 in middle management supervisory positions, while nursing homes employed more than 19,700 nursing service administrators and 14,400 nurse supervisors.43 The count of nurses who have had advanced training and who practice in one or more clinical specialties is made difficult by the variety of position titles they hold. According to the same National Sample Survey of Registered Nurses, November 1980, about 24,000 such nurses, including 5,700 nurse practitioners, provided specialized clinical support to hospital nursing services.
|
From page 44... ...
Many large hospitals also offer institutional certif ication to successful graduates of their various stat f development programs in some spec ial nursing f ield, such as coronary care or trauma care. Table 4 shows the highest nursing-related educational preparation TABLE 4 Di s tribut ion of Reg i st ered Nurse s Among Po s it ions in Nursing Service Management, Nurse Education, and Clinical Specialties by Highest Educational Preparation, November 1980 Associate Bacca- Doctor Title Total Degree Diploma laureate Masters ate Administrator or assistant 100.0 9.7 46.7 Consultant 100.0 8.8 39.3 Supervisor or assistant 100.0 17.4 59.8 Instructor (all nurse educators)
|
From page 45... ...
Even in the field of nursing education, as will be documented in Chapter V, there is an appreciable deficit. The relatively low average level of formal educational attainment of nurses in management positions may be explained in part by larger proportions of diploma nurses being employed in small hospitals and in nursing homes.
|
From page 46... ...
Nurse education took place almost entirely in hospitals, often in an apprentice-type mode where formal and informal instruction of students was exchanged for the students' services in patient care. At the same time, however, schools of nursing in a few universities were establishing the models that education for RNs would follow in the postwar period, when it largely moved out of hospitals and into institutions of higher learning.
|
From page 47... ...
However, in 1981 about three out of five entering college freshmen who expected to enter nursing reported that they expected to receive some form of federal student aid. Finally, although most formal nurse education is no longer located in hospitals, according to an estimate by the Health Care Financing Administration, in 1979, hospitals were reimbursed approximately $350 million for nursing education under the Medicare program.51 Private sources, including students and their families, and local government funds are other major sources of nurse education financing.
|
From page 48... ...
. Nursing home utilization in California, Illinois, Massachusetts, New York, and Texas: 1977 national nursing home survey (DHHS Publication No.
|
From page 49... ...
DHHS, NCHS. The national nursing home survey: 1977 sublunary for the United States, Op.
|
From page 50... ...
Philosophical foundations of baccalaureate nursing education. Nursing Outlook, 1981, 29~4)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.