Copyright © The McGraw-Hill Companies, Inc.Chapter 15 Nursing

Copyright © The McGraw-Hill Companies, Inc.Chapter 15 Nursing


15 Nursing

Explain the roles and responsibilities of unlicensed personnel who perform nursing duties, including certified/certificated nursing assistants, home health aides, dialysis technicians, patient care technicians, and surgical technicians.

Differentiate between the roles and responsibilities of licensed nurses, including licensed practical nurses and licensed vocational nurses, registered nurses, and advanced practice nurses.

Practice 16 nursing procedures.


15.1 Careers in Nursing

Careers in Nursing

Unlicensed Nursing Personnel

Licensed Nursing Personnel



Careers in Nursing

Nursing offers many career opportunities.An aging population, increasing turnover because of age, and people exiting the nursing field have created the need for new trainees.



Careers in Nursing (cont.)

Nursing can be divided into two areas:Unlicensed nursing personnel• Certified or certificated nursing assistant• Home health aide• Dialysis technician• Surgical technician

Licensed nursing personnel• Licensed practical nurse or licensed vocational nurse• Registered nurse• Advanced practice nurse



Unlicensed Nursing Personnel

Need is being generated by the rapidly rising cost of healthcare.

Work under licensed nurses.

Perform nursing tasks that can be safely done by people with specific training.

There are unresolved issues currently being debated about which tasks can safely be delegated to unlicensed personnel.



Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing AssistantRegulated by state law – not federal.

Federal government issued guidelines for training in Omnibus Budget Reconciliation Act (OBRA).




The Certified or Certificated Nursing Assistant (cont.)Nursing assistant is often primary caregiver.

Often involves working evenings, nights, weekends, and holidays.

Typically works in 3 types of facilities:• Acute care.• Long-term care.• Residential care.




The Certified or Certificated Nursing Assistant (cont.)Tasks delegated may include:• Answering patient call signals.• Setting up rooms for new admissions.• Keeping patient rooms neat to ensure safety.• Delivering messages, supplies, and equipment.• Serving and assisting with meals.• Assisting with daily personal care.• Assisting with toileting.




The Certified or Certificated Nursing AssistantTasks delegated may include (cont.):• Making beds.• Providing oral care.• Assisting with oral care.• Assisting with skin care.• Helping with shaving.• Taking and reporting vital signs.• Assisting with bathing and/or showering.• Reporting changes in patient’s condition.• Helping patients transfer and/or ambulate.




The Certified or Certificated Nursing Assistant – Long-Term Care

Perform the same duties as in acute care, but additional duties may include:• Emptying bedpans.• Cleaning incontinent patients.• Reporting significant changes, including

changes in mental status or self-care capabilities.




The Certified or Certificated Nursing Assistant – Residential Care

Perform same duties as in acute care and long-term care, but additional duties may include:• Assisting with medications.• Assisting with taking patients

shopping or other outings.• Providing assistance with

transportation to medical appointments.




The Home Health AideWorks with patients in their homes.• May work in one or multiple homes.• Patients are often elderly, disabled, or ill.

Works independently with occasional supervisory oversight.• Supervisor is home health nurse who writes detailed plan of care.




The Home Health Aide (cont.)Performs same tasks as certified or certificated nursing assistant.

Assists with medications.

Assists with personal care.• Cooks meals.• Assists with eating, bathing, and dressing.• Does light housekeeping and laundry.• Changes bed linens.




The Home Health Aide (cont.)Assists with shopping.

Takes patients to medical appointments.

Provides assistance that allows patient to remain safely in home.




The Dialysis TechnicianAlso known as hemodialysis or renal dialysis technician.

Operate kidney dialysis machines.

May perform maintenance and repairs on dialysis equipment.




The Dialysis Technician (cont.)Must minimize exposure of patient’s blood to minimize spread of disease.

Tasks may include any or all of the following:• Getting machines ready.• Obtaining and recording patient’s weight and vital signs before

procedure.• Administering anesthetics and medications before, during, and

after procedure.• Beginning the procedure.




The Dialysis Technician (cont.)Tasks may include any or all of the following (cont.):• Monitoring the patient and process.• Checking for signs or symptoms of adverse reactions. • Administering emergency care if needed.• Cleaning equipment after procedure.• Training patients on how to perform the procedure at home.




The Surgical TechnicianAlso known as operating room technician.

Assist during surgical procedures.

Work under supervision from surgeons, registered nurses, and others.




The Surgical Technician (cont.)Work in operating or delivery room.

May work in outpatient facility for physicians or dentists.

May set up an operating room before surgery.




The Surgical Technician (cont.)Other duties may include:• Maintaining a sterile environment for surgery.• Learning required surgical tools.• Knowing the order in which surgical tools are required during

surgery.• Setting up and testing non-sterile equipment.• Preparing patient for surgery: shaving, cleaning, and disinfecting.• Taking patient’s vital signs.• Checking medical charts for the surgeon.• Transporting patients to the recovery room.• Cleaning and restocking after surgery.




The Patient Care Technician The patient care technician (PCT), or patient care assistant, is responsible for providing assistance to doctors, nurses, and other support staff while also interacting directly with the patient.

Patient care technicians focus on recording vital health information, collecting samples, and assisting patients. The education and job responsibilities vary between states and healthcare facilities.


Licensed Nursing Personnel

Attend postsecondary education courses and pass a test.

Obtain a license through a state agency.Licensed nurses include:• Licensed practical or vocational nurse.• Registered nurse.• Advanced practice nurse.




Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational NursePerform care under supervision of physician or registered nurse.

Typically receives training from vocational or technical school.

Are required by all states to pass a licensing examination.




The Licensed Practical or Vocational Nurse Job Responsibilities:

Taking vital signs.

Treating bedsores.

Administering injections.

Giving enemas.

Administering medications.

Applying dressings.

Applying ice packs and hot water bottles.




The Licensed Practical or Vocational Nurse Job Responsibilities (cont.):

Inserting and caring for urinary catheters.

Assessing patients for effects of medication and treatments.

Assisting with meals.

Recording intake and output.

Helping with personal needs of patients.

Helping with emotional needs of patients.




The Licensed Practical or Vocational Nurse Job Responsibilities (cont.):

Assisting with the delivery of infants.

Caring for and feeding infants.

Supervising nursing assistants.

Helping evaluate patient needs and developing care plans.

Making appointments and keeping records in physicians’ offices.

Teaching patients how to care for themselves.




The Registered NurseTypes of registered nurses:• Hospital nurse.• Office nurse.• Nursing home nurse. • Home health nurse.• Public health nurse.• Occupational or industrial nurse.• Head or supervisory nurse.




The Registered Nurse (cont.)Must pass national licensing exam and be licensed in state where they work.

Three training paths:• Hospital training program.• Associate degree from community college.• Bachelor of science in nursing.




The Registered Hospital NurseJob responsibilities may include:• Providing all care given by LPN/LVNs.• Providing bedside nursing care.• Starting IVs.• Carrying out medical regimes as ordered by physicians.• Supervising LPN/LVNs and unlicensed assisting personnel.




The Registered Office NurseJob responsibilities may include:• Providing care for outpatient patients.• Preparing patients for examinations.• Assisting physicians with examinations.• Administering injections and IV solutions.• Performing wound care.• Assisting with minor surgeries.• Maintaining documentation.• Performing routine specimen collection and lab work.




The Registered Nursing Home NurseJob responsibilities may include:• Managing the nursing care for patients.• Filling management positions.• Participating in staff education.• Handling administrative and supervisory duties.• Assessing patient’s medical conditions.




The Registered Home Health NurseJob responsibilities may include:• Providing periodic care to patients in their homes.• Assessing the home environment for safety.• Teaching patients and their family members how to care for

themselves.• Supervising the home health aide, possibly an LPN/LVN, to assist

with cases.




The Registered Public Health NurseJob responsibilities may include:• Working in the community setting.• Working with the selected populations to improve the health of the

community at large.• Educating community members in health maintenance, disease

prevention, nutrition, and child care.• Providing health screenings.




The Registered Occupational or Industrial NurseJob responsibilities may include:• Providing workplace care to employees and customers.• Assessing and educating on health hazards found in the

workplace.• Assisting with health examinations.




The Registered Head or Supervisory NurseJob responsibilities may include:• Managing the department.• Planning work schedules and assigning duties.• Planning and monitoring the budget.• Supervising all personnel.• Maintaining all required records.




Advanced Practice NurseTakes advanced training to obtain advanced practice certificate or degree.

Nurse practitioner is allowed to write prescriptions with physician’s approval.

There are four specialties:• Clinical nurse specialist.• Certified registered nurse anesthetist.• Certified nurse-midwife.• Certified registered nurse practitioner.




Advanced Practice Nurse (cont.)The Clinical Nurse Specialist is a registered nurse who specializes in a specific nursing area such as:• Gerontology (care of older patients).• Neonatology (care of prematurely born infants).




Advanced Practice Nurse (cont.)The certified registered nurse anesthetist has additional training in the use of anesthesia.• Works in surgical suites.• Works under the supervision of an anesthesiologist or a physician

who specializes in anesthesiology.




Advanced Practice Nurse (cont.)The certified nurse-midwife assists with the delivery of infants.• Has training and expertise in the delivery process.• May assist with birth in home of patient.




Advanced Practice Nurse (cont.)Duties depend on setting in which they work.

Many work in rural areas where access to traditional care is scarce.

May work in: • Physician’s office.• Hospital outpatient area.• Surgical area.• Acute care, clinics, or in patient’s home.



What are the three training paths for a registered nurse?



1. Hospital diploma

2. Associate’s degree

3. Bachelor of science in nursing degree

What are the three training paths for a registered nurse?



One area that a clinical nurse specialist works in is gerontology. What group of people does this term reference?



Patients over the age of 65

One area that a clinical nurse specialist works in is gerontology. What group of people does this term reference?


15.2 Basic NursingProcedures

Basic Nursing Procedures

Hand Hygiene

Making an open or closed bedA fold in a sheet can cause a decubitus ulcer.

Preventing bedsores

Transporting patients



What is the difference between open beds and closed beds?



Open beds are beds that are used by a patient but are unoccupied when made.

Closed beds are those that are in readiness for the next patient.

What is the difference between open beds and closed beds?


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Copyright © The McGraw-Hill Companies, Inc.Chapter 15 Nursing