• First practicing nurse epidemiologist whose statistical analyses connected poor sanitation with incidence of cholera & dysentery.

• Volunteered with British during Crimean War; “lady with the lamp”; worked to improve battlefield hospital santiation and nutritional practices; reduced mortality rate from ~43% to ~2% in 6 months. 

• Formed 1st school of nursing at St. Thomas Hospital in London. 

Diploma Programs:

• Non-Degree programs offered by hospitals systems; eligible for NCLEX & licensure; rare

Associate Degree (ADN):

• Offered by accredited community colleges; eligible for NCLEX & RN license; common

Baccalaureate Degree (BSN):

• Offered by colleges & universities; 4 years or 14 mo. for accelerated; becoming more in-demand by hospitals seeking magnate status; eligible for NCLEX & RN licensure

Graduate Degree Entry (MSN):

• non-nursing BSN; eligible for NCLEX & RN licensure

ADVANCED PRACTICE:

Graduate Degree (MSN,PhD, DNP):

• Advanced clinical specialty; education; or specialization.

• NP, CNS, Nurse educator or administrator

• American Nurses Association (ANA)

• Texas Nurses Association (TNA)

EDUCATION & STANDARDS:

• National League for Nursing (NLN)

• National Student Nurses Association (NSNA)

LICENSURE:

• Texas Board of Nursing (TX BON)

• Passed by legislature and enforced by board of nursing

• Defines scope of practice + minimum standards for education, training, and qualifications.

Scope of Practice:

• legally defines what professional nurses are licensed to do

Delegation:

• Process of assigning another competent member of the health care team to be responsible for aspects of patient care (e.g., assigning nurse assistants to bathe a patient).

• Nurse from Jamaica (African/Scottish descent); active in Jamaica & Panama where she was known for “cure for cholera”; practiced traditional herbalism; 

• Also volunteered in Crimean War despite being rejected from Army Hospitals; ran an informal but well respected battlefield hospital for troops; Sidelined from noted history for many decades. 

• Founded American Red Cross; cared for soldiers during American Civil War in battlefield hospitals

• Organized hospitals and ambulances, appointed nurses, cared for wounded soldiers; oversaw and regulated supplies to troops.

• Active in the underground railroad movement; assisted in leading more than 300 slaves to freedom; practicing nurse caring for Union soldiers in wartime. 

• First professionally trained African-American nurse in the U.S.; brought forth an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion.

• Founded Nurses Associated Alumnae of US & Canada in 1896 - which became ANA in 1911; wrote nursing textbooks; one of original founders of American Journal of Nursing.

• Opened Henry Street Settlement in NYC; community nursing focusing on providing care to the poor/disenfranchised; focused on community health model

Assessment:

• RN collects pertinent data and information relative to the healthcare consumer’s health or the situation.

Diagnosis:

• RN analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues.

• Outcomes Identification: RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

Planning:

• RN develops a plan encompassing strategies to achieve expected outcomes.

Implementation:

• RN implements the identified plan.

  • Coordination of Care: RN coordinates care delivery.

  • Health Teaching and Health Promotion: RN employs strategies to teach and promote health and wellness.

Evaluation:

• The registered nurse evaluates progress toward attainment of goals and outcomes.

• Acute Care, Skilled Nursing Facility, Rehabilitation Center, Long Term Care (Nursing Home), Psychiatric Hospital

Outpatient or Ambulatory Care: patient receives care at facility and goes home

• Clinic, Physician’s Office, Urgent Care Center, Surgical Center, Home Health Care, Mental Health Center, Community Health Center, School Health Clinic, Occupational Health Service

Community: provides non-medical services integral to patient care & QOL

• Adult Day Care, Respite Care, Meals On Wheels, Transport Services, Case Management

• The major accrediting body for health care institutions/ orgs funded by Medicare and Medicaid. 

• Accreditation is prestigious & necessary to receive reimbursement for care. 

• Agencies are evaluated every 3 years

What does TJC Do?

• Evaluates care in an organization and determines if overall care meets quality standards

• Requires hospitals to submit error reports & identify key sentinel events

  • Sentinel Events: An event that has the potential for great harm; involving death or loss of limb or function

•  Issues the National Patient Safety Goals (NPSGs).

1. Transferring authority to a competent individual for completing selected nursing tasks in a selected situation.

2. Usually an RN > LPN or CNA

3. Delegated assignment must be in the person's scope of practice

When Delegating:

• Be clear, concise, correct & complete

• Know what needs to be done and how

• Know skills/competency/scope of person doing task

• Follow-up with person doing task

B - Background - PT MedHx and info as it pertains to the situation

A - Assessment - What have you checked? Should be relevant to the situation.

R - Recommendation - What are you recommending? What recommendation does the HCP have?