5 Things You Probably Didnât Know About Nurses and the Nursing Profession
[I put Claire Temple there because she is the only nurse on TV that Iâve seen that actually acts like a nurse. Like, she breaks scope of practice all the freaking time, and there was that little incident where she abandoned her patients without telling anyone, but in Daredevil S1E2, I was thoroughly convinced of Rosario Dawsonâs nurse status. And thatâs saying something, cause you all know Iâm picky.]
Nursing publicity actually sucks (see chapter 21 of this textbook), so here are some fun facts to get you thinking in the right direction when youâre writing, reading, or otherwise applying your knowledge of the nursing profession in a creative way:
1. Nurses treat reaction to disease. Literally our job is to assess and treat the reaction a person has to a disease process, or what impact a disease has on a person physically (are they in pain? having trouble breathing? canât walk?), mentally (does a disease process alter how they think, their quality of life?), emotionally (are they devastated by a prognosis? depressed by their inability to act as they used to?) and spiritually (what is their relationship with their belief system? has it changed in response to disease? how do they feel about that?). In contrast, a physician treats the disease itself.Â
2. Nurses have a system of diagnosis and care planning that is unique from that of a physician. Medical diagnosis of course is taken into consideration when treating a patient and planning care, but remember that we are treating a reaction to a disease process, and so our diagnoses are those reactions. Some examples include:
Impaired gas exchange (difficulty breathing)
Decreased cardiac output (less (or too little) blood getting out of the heart)
These are usually written as part of a larger âDiagnosis Statementâ which goes something like this: âImpaired gas exchange related to bronchospasm as evidenced by expiratory wheezing, abnormal blood gases, patient statement of âI canât breatheâ and medical diagnosis of acute asthma exacerbation.â Nurses then plan and carry out interventions to improve the patientâs condition. Often, this goal coincides with the physicianâs plan of care, and a nurse can ask a physician for orders if they feel the patient needs something that requires such an order.
3. There are different âlevelsâ of nursing. These are:
Nurse Aide (NA or UAP): 2 weeks-3 months of training. Nurse Aides carry out patient care activities such as bathing and dressing, they can measure patient intake and output, take vital signs (depending on facility), take blood sugars (depending on facility), remove IVs and Foley Catheters and do other duties as assigned by the Registered Nurse or Licensed Practical Nurse they work under. Must have passed either   State Licensure or a facility-based training program.
Licensed Practical Nurse (LPN): 1-1.5 years of training. These are starting to go out of style and mainly found either âgrandfathered inâ in hospital settings or working as supervisors in nursing homes. In addition to all things listed above, they can do a full assessment and basic nursing interventions, including placement of IVs an Foleys, pass (most) medication, collect samples for testing, take health histories, supervise Nurse Aides, and other duties as assigned by a Registered Nurse. LPNs must have taken and passed national licensure (NCLEX-PN in the USA).
Registered Nurse (RN): 2-4 years of training, usually with an accompanying associatesâ or bachelorsâ degree. Registered Nurses can do all of the above, as well as administer all medications, do full range of IV therapy, write and make plan of care for nursing diagnoses, follow ACLS protocol (without deviation), do nursing research and supervise LPNs and NAs. Training for RNs focuses a lot more on critical thinking and research skills. RNs must have taken and passed national   licensure (the NCLEX-RN in the USA). This is generally what people think of when they think of a nurse.
Clinical Nurse Specialist (CNS): 6-8 years of training. CNSs are mastersâ or doctoral prepared nurses who specialize in one area or population, usually in the inpatient hospital setting (though some specialties practice in community or mental health settings). They provide higher-level care in their specialty and are able to perform procedures outside an RNâs scope of practice. CNSs also teach, supervise and conduct nursing and medical research within their specialty. Â CNSs have either extremely limited or no prescriptive privilege (they canât prescribe medication).
Nurse Practitioner (NP): 6-8 years of training (minimum Doctor of Nursing Practice (DNP) degree by 2030). NPs can often practice independently in a primary care capacity (varies by location), and have a broader scope of practice than a CNS. In a primary care capacity, they can prescribe medication, do office-level medical procedures and refer to specialists. NPs also do research, teach and supervise nurses in hospital and long-term acute care facilities.
4. Nurses are expected to question orders and advocate for their patients. We are the end-point of all orders and the last line of defense before an order hits a patient in a hospital setting. In the USA, a nurse is legally responsible for questioning orders and may choose to hold an ordered medication or intervention if they think it will harm the patient (we do have to immediately call the physician and ask for another order, but we can do it).
5. Nursing is applicable in extremely diverse fields that have nothing to do with clinical nursing care. For example, there are:
Forensic Nurses, who collect evidence from victims of crime
Nurse Advocates, who are practicing lawyers who also hold degrees in nursing
Nursing Informatics Specialists, who design computer systems and technology applicable to nurses and healthcare
Insurance Nurses, who work as liaisons between the insurance industries and patients
Nurse Administrators, who work the business end of healthcare
Nurse Case Managers, who work as social workers
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