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This is the place to learn about the nursing profession from someone who has been working steadily at it for the last 20 years. I will be exploring nursing as a profession, different types of nursing, specialties in nursing, as well as current trends in nursing as they develop.

What you will find here on this Lens

How do you get to be a nurse? Okay, I got started! Nursing Essentials Are you sure you want to become a nurse? I Got Accepted! Read Blogs from other Nursing Students Current trends in the Nursing Profession Currents trends on nursing specialties Finding Your Niche in Nursing Just a taste of the possibilities! Spotlight on Nursing Areas of Practice What Do Operating Room Nurses Do? Nursing Notes Nursing in the News The Hottest Up and Coming Nursing Specialties More about the future of Forensic nursing Home Health Nursing Dialysis Nursing How do you get to be a nurse?

Where do you start? When a person decides to become a nurse the initial problem is school. School means money and time. I came to nursing late in life, complete with two children that I supported basically on my own. I really worried about how to pay my bills while I was learning how to be a nurse, and I am sure that some of you out there will also have these same worries. So, the first thing you have to do is get your house in order and make applications to schools based on what you need and what will be best for you and yours.

The next problem will be getting accepted into nursing school. I know that doesn't sound much like a problem, but believe me it will be. I know, I know. We have a terrible nursing shortage and so it should be no problem getting in, right? Not necessarily so. First, there are only so many nursing programs around and the number of openings is predetermined by the number of students each professor can take. Unfortunately, there is a shortage of nursing professors just like there is a shortage of staff nurses.

After you look around for nursing programs you would like to be accepted into, then you start the applications process. Each school will have its own standards and prerequisites. You will need to complete this step even before you find out if they will accept you into their program.

So, now you have a plan and a program to follow. Are you a nurse yet? Not by a long shot! Keep reading and I will help you through this maze of challenges. Here is a link to a site you might find interesting while you are making your plans:

Free Money For Nursing School!

Okay, I got started! What comes next? Before we get too much farther along, let me help clarify some of the questions you may have about "What is a nurse?"

Within this profession there is much diversity. You can get to nursing through numerous pathways. So, here, let's explore those pathways.

First, you may decide to start as a LVN or LPN so you can get out of school fast and get working soonest. Good plan, but if you are like most of us, if you take this pathway, you may never do any more. You may stay an LVN or LPN for your entire career. There is nothing wrong with this choice! You will be a nurse, but the state board specifies strict limits to what you can and cannot do on the job.

It has been my experience that life will always intervene in your plans, so you may get sidetracked here if you choose this route. No shame, no problem. You just need to look at your life circumstances realistically before you make a decision.

If you decide that you want to be an RN, there are different pathways here, too. You can go to school for two years and get an associate degree in nursing. When you graduate, you will be able to take the state boards for the RN license. You will be a fully functioning nurse when you get a job.

Another pathway would be to go to the University near you and get your Bachelor's of Science in Nursing. This is a longer process, and will cost you

more money, but you will be a fully functioning nurse upon graduation and be eligible to sit the state board exam. I chose this option because I already had an associate's degree and didn't want to get another. Each of us has to decide what is best for our circumstances. BSN RN's are really no better or worse than ADN RN's. They usually start out at a higher salary and they are better equipped to move into management positions. Not always, though.

Then, if you already have a Bachelor's Degree you could become a nurse by taking a fast-track Master of Science in Nursing. Or, maybe you might want to get into a Nurse Practioner's program.

Any way you go, you can get to be a nurse. It's really up to you and how much time and effort and money you want to invest in yourself and your future. Nursing Essentials Books every nurse has on the shelf As with any profession, it is imperative that you continue to read and learn throughout your entire nursing career. When you are just getting started, you will of course have all your nursing textbooks, but there are reference books you will need to be able to perform your tasks with skill and confidence.

Feel free to visit my storefront, where I have gathered several of the essentials for you. Are you sure you want to become a nurse? Where we have been and where are we going.....

Okay, so now you have done some homework and you have decided to jump into the pool. Good for you! You have done some of the hardest decision making you will ever have to do. Now, let's explore what nursing is all about, just so we are clear about what you will be getting yourself into.

According to the US Dept. of Labor, Bureau of Labor Statistics website at http://www.bls.gov/k12/print/help04.htm:

Nurses, also called registered nurses or RNs, take care of sick and injured people. They give people medicine. They treat wounds. And they give emotional support to patients and their families.

Nurses ask patients about their symptoms and keep detailed records. They watch for signs that people are sick. Then, nurses help doctors examine and treat patients.

Some nurses help to give tests to find out why people are sick. Some also do lab work to get test results.

Nurses also teach people how to take care of themselves and their families. Some nurses teach people about diet and exercise and how to follow doctors' instructions. Some nurses run clinics and immunization centers.

Nurses can focus on treating one type of patient, such as babies or children. They can also focus on one type of problem. Some focus on helping doctors during surgery, for example. Others work in emergency rooms or intensive care units.

Many nurses work in doctors' offices. They help with medical tests, give medicines, and dress wounds. Some also do lab and office work.

Home health nurses go to people's homes to help them. Flight nurses fly in helicopters to get to sick people in emergencies.

Some nurses have special training and can do more advanced work. Nurse practitioners can prescribe medicine. Nurse midwives can help women give birth.

Helping sick people and dealing with medical emergencies can be stressful. Nurses in hospitals often have to help many patients at once.

Many nurses spend a lot of time walking and standing. Nurses also need to be careful in order to stay safe. Nurses care for people who have diseases that they can catch too. And nurses can get hurt while helping to move patients. Nurses also need to guard against radiation from x-rays and chemicals in medicine.

Because patients need 24-hour care, hospital nurses often work nights, weekends, and holidays. Office nurses are more likely to work regular hours. Many nurses work part time.

Nurses must graduate from a nursing program. It takes about 2 years of college to finish an associate degree in nursing. It takes about 4 years to finish a bachelor's degree in nursing. And a nursing diploma program usually takes about 3 years.

Deciding what kind of training to get is important. Some career paths are open only to nurses who have a bachelor's degree.

Nursing education includes taking classes and hands-on learning with experienced nurses in hospitals and other places. This is called clinical training.

Nurses study anatomy, chemistry, nutrition, psychology, and nursing theory.

After graduating, nurses need to pass a test to get a nursing license. They have to take classes every few years to keep their skills current.

Nurses need to be caring and kind. They also need to be good at recognizing problems and remembering details.

Nurses need to work well with doctors and patients. Many nurses also supervise assistants and other workers.

Nurses can become head nurses or directors of nursing. Some nurses move into the business side of health care. Some get jobs in big health care firms planning, marketing, and making sure people get good care.

To get ready for this job, students can take biology and other science classes. They also can become good at reading and writing. Math skills are also important for adding doses of medicine and taking measurements.

The middle half of all registered nurses earned between $47,710 and $69,850 in 2006. The lowest-paid 10 percent earned less than $40,250. The highest-paid 10 percent made more than $83,440.

Registered nurses are in the largest health care occupation. They held about 2.5 million jobs in 2006. About 3 out of 5 worked in hospitals. About 1 out of 5 worked part time.

Very good job opportunities are expected for registered nurses. BLS expects jobs for registered nurses to grow much faster than the average for all occupations through 2016. Many new jobs will be available for people who want to be nurses.

New ways of helping people will let nurses treat more problems. And the number of older people, who need more health care, will grow very rapidly. They will need nurses to treat them when they get sick.

Hospitals will need nurses, but many new nurses will also work in home health, clinics, doctors' offices, and nursing homes.

Here is a resource you might be interested in to help you decide if this really is the profession for you: Click below to find out!

Career Guide: Should I Be A Nurse?

I Got Accepted!

Now the fun begins! So, now you are about to start nursing school. There are a few things you need to know from the start.

First, this will be like no other school you have ever attended. The profession of nursing is one that demands the ability to take high levels of stress and to make competent judgments on the fly. You will need to be both flexible and assertive. You need to be able to work well with others, but be able to set good personal boundaries for yourself. You need to know your stuff or if facing a new situation, you need to know where and how to find out what you need to know. You cannot be bashful or timid. You are your patient's advocate in the red tape that has become healthcare.

With all of this in mind, you need to understand that nursing school will be designed to give you a taste of what it will be like in the working world as a nurse. You will be stressed, you will have to make decisions on the fly, you will be held accountable for everything you say and do, you will be expected to be there and to give 100% effort. If you cannot stand it in nursing school, how will you ever stand it at work? Do not take anything personal. The instructors are doing you a favor if they make it hard and stressful. You need to know that you can stand up to the demands of this profession before you get into it.

Another thing to learn right away is how to study for and how to take nursing tests. These are not the same tests you took in high school. These tests are designed to confuse you and make you unsure of your knowledge. Most nursing tests will be multiple choice. You will need to look for the MOST correct answer, not necessarily the right one.

To be able to pass these tests, you may want to go here and check out this resource: Learn the in's and out's of taking nursing tests. Don't let test anxiety sink your dreams!

Pass Nursing School With Ease Read Blogs from other Nursing Students See what they all have to say about nursing school Nursing School Blogs on Wordpress.com Current trends in the Nursing Profession Moving to an all graduate profession is a necessity Controversy continues to rage over nursing as a graduate entry profession, but this move is a necessity to deliver healthcare in the 21st century, says Sue Bernhauser

The demands on the nursing profession in the 21st century are far more complex than those of the past. Historically, nursing has sometimes been viewed as a low status profession, but this must change if we are to embrace the challenges ahead (see this week's In depth article).

Over the next 15 years and even beyond, nurses will meet challenges relating to changes in demography, disease patterns, lifestyle, public expectations and information technology. We will see the greatest demands in healthcare met by nursing or other therapy care. There will also be a growing need for healthcare professionals with advanced practice skills and they will need to develop these from a graduate knowledge base.

The announcement that nursing would become an all degree profession by 2013 was greeted with concern by those whose image of nursing rests in the past rather than in the future. Nursing is not - and should never be simply the carrying out of uncomplicated tasks under the direction of others. Nor is it a vocation for which short term technical training will suffice. It is a profession that requires highly knowledgeable and competent individuals....read more

Sue Bernhauser is dean of the School of Human and Health Sciences, University of Huddersfield

Source: Bernhauser, S (2010) Degrees will equip nurses to meet future challenges in healthcare. Nursing Times; 106: 21, 8. Currents trends on nursing specialties Where do you want to go from here? Once you get your license, you will need to get at least a year of medical/surgical experience. Usually, you will start as a floor nurse on a busy med/surg floor in a hospital near you. Most probably, you won't get the shift you want or the schedule you want, but you will get a job.

While you are racking up the days of experience, you need to be thinking about the future...your future. Nursing as a profession is wide open and filled with possibilities. What area are you interested in? Where are you drawn? What type of patient really speaks to you? Who do you think you are best suited to help?

Some nurses start out as med/surg nurses and never leave it because that is where they feel the calling. Others find themselves gravitating to a particular type of patient or seem to have a knack dealing with a specific problem that patients have. Because of this, they follow their hearts into specialty fields.

As a new nurse, you will need to learn everything you can about the different specialties opening up to you. Make your decision carefully, but realize that during your career as a nurse you may try out two or three different areas until you find the right fit for you. Finding Your Niche in Nursing http://www.nursetogether.com/tabid/102/itemid/1753/Finding-Your-Nichein-Nursing.aspx It is not uncommon for a brand-new graduate to step into his or her first role as a registered nurse, only to state shortly thereafter, "What have I gotten myself into?"

Clinicals are over. Orientation is over. Those seven patients on that medical-surgical ward are yours, all yours. Also yours is the responsibility to give meds within one hour of the assigned time (after knowing the purpose of each drug and potential side effects, of course), to make sure each patient receives abundant personal care, to follow physicians' orders to the tee, to make sure each patient is prepped for surgery, radiology, or lab work, to give your charting exquisite attention to detail, just in case a lawyer will eventually read it, to make sure foley bags are emptied regularly and urine totals are kept up-to-date, to record vital signs every four hours and report significant changes to the physician, to replace outdated IV lines, to replace outdated IV tubing, to answer a multitude of family members' questions with intelligence and grace, and to provide tender loving care with a smile. The funny thing is that I have seen medicalsurgical nurses do this day after day for twenty years in an effort that

appears to be flawless. How on earth do they do it? Why am I not good at this? You see, when I was a medical-surgical nurse, I was anything but flawless%u2026

During nursing school and throughout my nursing career I discovered that I exhibit the very definition of the word klutz. I am the type who will go into a patient's room, trip over the IV pole, grab for something to ease my fall, and yank the oxygen and the call light cord out of the wall. In the meantime, I have pulled the IV cannula out of the patient's arm with accompanying blood everywhere, and have strangled myself with the oxygen tubing and have gracefully landed on top of the patient in their bed! Since the call light has been pulled out of the wall, the emergency light is on and the entire floor comes to see what the problem is. Try explaining that.

(Okay, now don't you pretend this has never happened to you...)

The multitasking ability and managerial expertise that is required for a medical-surgical nurse just was not in my skill set. How could I multitask when I was concentrating on putting one foot in front of the other and not injuring someone? Did I make a mistake by going into nursing in the first place? Was there a better "fit" out there for me?

Ahh, but this is the beauty of nursing! There is a place for everyone, even the more klutzy among us!

After my stint in medical-surgical nursing (casualty free, thank God), I ventured into the area of critical care. This was a little bit better fit, but it was not for me either. I am a very slow methodical thinker, and I found that in critical care you need to be a little quicker in the old noggin. My next

move was to home health. Again, this was an even better fit. I loved the independence of setting my own schedule, writing my own care plans, and spending individual time with each patient (although I cringed when I walked into the home of an elderly lady that was filled with a multitude of tiny, fragile glass knick-knacks that were just daring me to do one of my klutzy pirouettes that would send them crashing to the ground). However, as good as a fit this seemed to be, it just wasn't for me.

What on earth in the field of nursing WAS for me?

The answer came during a flashback from nursing school. I remembered studying nursing theorist Virginia Henderson, and I recalled her saying that an effective nurse was a combination of heart (caring), head (intellect), and hands (clinical skill). It seemed to me that not every nurse was going to be equally blessed in all three areas. Wouldn't every nurse be a little more skilled in one area over the others? Was one area necessarily better or more essential than the others?

This became the key for me in finding my niche in nursing.

I began to examine my nursing practice in light of Virginia's theory. My greatest skill was obviously not my hands (see embarrassing revelations above). I was definitely strong in the area of caring, but I found through close examination that my greatest strength lay in my head, my intellect. I remembered the enjoyment of trying to figure out complex medical issues on a medical-surgical ward where there just was no time for that. I recalled loving to orient new nurses and to teach them the finer points of nursing practice. Especially, I loved sitting at the computer and devising comprehensive care plans for my home health patients. Maybe my place,

my greatest contribution to nursing as a whole, was not at the bedside, but at the computer.

Thus began my journey into the realm of nursing education. It started with continuing education and a BSN and an MSN degree. This was followed by a several-year stint teaching clinical rotations at our local community college (the very one where I graduated). Finally, my dream came true when Kaplan University took a chance on me and gave me a fulltime, online teaching position as a member of their wonderful faculty.

At this writing, I have worked with hundreds of online students and now work to orient and train new faculty members at Kaplan. I can still be involved in nursing practice because I am working with nursing faculty who, in turn, train their students to become better nurses! Indirectly, I work with hundreds of patients each day throughout the country without the risk of my hurting anybody! (When I went into nursing education, I just knew that I heard the nationwide patient population give a collective sigh of relief.)

Take heart, my nursing colleagues. If your current position is not a good fit for you, just know that there is something out there that will be, no matter if your greatest strength lies in your heart, your head, or your hands. When in doubt, just remember that Virginia knew best.

Nurses, please leave a comment below sharing your thoughts on this article!

About the Author: Susan Kieffer, RN, MSN/Ed., is a fulltime faculty member with the Kaplan University School of Nursing online. Her current position involves orienting and training new faculty members in their transition to

online education. She is a busy pastor's wife, worship leader, a mother of two, a grandmother of six, and pet owner of a Great Dane, Pomeranian, a Himalayan cat, a snake, and other multiple critters. She is currently pursuing her Ph.D. in E-Commerce. Just a taste of the possibilities! A list of places for nursing Last Updated Feb 2010 List of Nursing Specialties

* Ambulatory care nursing * Advanced practice nursing * Behavioral health nursing * Burn nursing * Camp nursing * Cardiac nursing * Cardiac catheter laboratory nursing * Case management * Clinical nurse specialist * Clinical research nurse * Community health nursing * Correctional nursing * Critical care nursing * Developmental disabilities nursing * District nursing

* Emergency nursing * Environmental Health nursing * Flight nursing * Forensic nursing * Gastroenterology nursing * Genetics nursing * Geriatric nursing * Health visiting * Hematology oncology nursing * HIV/AIDS nursing * Home health nursing * Hospice nursing * Hyperbaric Oxygen Therapy Nursing * Intavenous therapy nursing * Infectious disease nursing * Legal nursing * Legal Nurse Investigator * Maternal-child nursing * Matron * Medical-surgical nursing * Military and uniformed services nursing * Neonatal nursing * Neuro-surgical nursing

* Nurse anesthetist * Nurse-midwife * Nurse practitioner * Nursing educator * Nursing informatics * Nursing management * Obstetrics gynecology nursing * Occupational health nursing * Oncology nursing * Operating room nursing * Orthopaedic nursing * Ostomy nursing * Pain management and palliative care nursing * Pediatric nursing * Perianesthesia nursing * Perioperative nursing * Plastic and reconstructive surgical nursing * Private duty nursing * Psychiatric or mental health nursing * Public health * Pulmonary nursing * Quality improvement * Radiology nursing

* Rehabilitation nursing * Renal dialysis nursing * Renal nursing * Research * School nursing * Sub-acute nursing * Substance abuse nursing * Surgical Nursing * Telenursing * Telemetry nursing * Telephone triage nursing * Transplantation nursing * Travel nursing * Urology nursing * Utilization management * Wound care

Source: Wikipedia www.wikipedia.com Spotlight on Nursing Areas of Practice Forensic Nursing What is Forensic Nursing

Forensic Nursing is one of the newest specialty areas recognized by the American Nurses Association. It involves working with law enforcement officials to aid in the investigation of crimes such as abuse, accidental death and assault.

They also collect evidence from the survivors of the violent crime as well as the suspect so a case can be can be made and justice can be served.

Since crimes happen almost everyday even when the suspect is already in prison, forensic nursing requires a lot of manpower. Just to give you an idea, there is a Correctional Nursing Specialist, Forensic Clinical Nurse Specialist, Forensic Gerontology Specialist, Forensic Nurse Investigator, Forensic Psychiatric Nurse, Legal Nurse Consultant, Nurse Coroner/Death Investigator and Sexual Assault Nurse Examiner.

The largest subspecialty of forensic nursing is sexual assault, closely followed by death investigation, forensic psychiatric nursing and medicallegal consulting.

When sexual assault or rape occurs, it is the job of the forensic nurse to collect evidence and take pictures so whoever is responsible can be caught. This is done by cross referencing the DNA sample into the criminal database system assuming that the one who did it has a criminal record. If the victim knows who did it, a DNA sample can be collected from the suspect and if it is match, then an arrest is made.

In terms of death investigation, the forensic nurse assists the pathologist in determining the cause of death of a victim. In some areas, this person is already the coroner.

Forensic psychiatric nursing is all about giving a convict or a suspect a psychiatric evaluation. This will determine if he or she is fit for trial. Inmates who have been released who have been pardoned and released from prison may also have to do the same test so they can find work.

In order for you to become a forensic nurse, you have to enroll in a program offered by a university which focuses on the criminal justice system, forensic mental health, interpersonal violence, perpetrator theory and victimology.

You will also need practice experience under the auspices of a trained forensic doctor or nurse. Since there are improvements in forensic science, you must also enroll in continuing education courses. If you want to move forward in your career, take a formal graduate study program so you have a master's degree.

Once you have your degree, you can already apply for work without having the need to get a certificate which is required in other nursing professions.

Can you shift to forensic nursing after working for some time as a registered nurse? The answer is yes. You should just pass the exam that is given by the International Association of Forensic Nurses.

Aside from helping law enforcement officials solve a crime or help a victim, forensic nursing is also useful in other fields. These include tissue and organ donation, pediatrics and in a correctional institution.

In tissue and organ donation, the forensic nurse will talk to the family of the potential donor. When they agree, he or she will fill up the legal paperwork so everything is properly documented.

In pediatrics, forensic nurses are present to assist and give comfort who have been victims of abuse and neglect. What Do Operating Room Nurses Do? by BethCNOR for allnurses: A Nursing Community for Nurses Sep 24, 2009 08:09 PM - The RN specializing in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patients' surgical experience. Based on the Standards and Recommended Practices for Perioperative Nursing-A.O.R.N., the operating room nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the eventual goal of meeting the individual needs of the patient undergoing surgical intervention. This process is dynamic and continuous, and requires constant reevaluation of individual nursing practice in the operating room.

I have been an Operating Room Nurse since 1995. Previously, I worked in the Operating Room as a LPN/Surgical Technician from 1980-1994. I love working there. I do tire of hearing comments from other nurses that OR nurses don't really do nursing duties. I'm here to set the record straight. I am as much a RN as the next nurse and I do patient care. Operating Room Nurses assess, diagnose, plan, intervene, and evaluate their patients just like every other nurse. Let me tell you how.

Assessment

The patient enters the preoperative area and is assessed by the preoperative RN. The perioperative RN (Circulating Nurse), then interviews the patient with particular emphasis on ensuring the patient has informed consent, has been NPO for at least 6 hrs. prior to surgery, and current medical history to determine any special needs for the care plan. The perioperative nurse explains to the patient what will happen during the operative phase and tries to alleviate any anxieties the patient and their family may have. The nurse develops a rapport with the patient that enhances the operative experience for the patient by building trust and assuring the patient and the family of the best care possible.

The assessment includes, but is not limited to:

* Skin color, temperature, and integrity * Respiratory status * History of conditions that could affect surgical outcomes (i.e. diabetes) * Knowledge base related to the planned surgery and complications that could arise * NPO status * What medications were taken the morning of surgery and the time taken * Allergies and what reactions the patient experiences * Placement of any metal implants, especially AICD's and pacemakers * Time of last chemotherapy or radiation therapies * Verification of patient's name and date of birth * Checking to verify all medical record numbers match the patient's name band and paperwork

This information is then used to develop the perioperative nursing care plan.

Diagnosis

The nursing diagnosis is written in a manner that helps determine outcomes. Some nursing diagnoses for surgical patients are:

* Impaired gas exchange related to anesthesia, pain, and surgical procedure * Potential for infection related to indwelling catheter and surgical procedure * Activity intolerance related to pain * Anxiety related to anesthesia, pain, disease, surgical procedure * Alteration in nutrition less than body requirements related to NPO status.

Planning

Planning the patient's care in the operating room is focused on patient safety. The nurse gathers supplies needed for the procedure according to the surgeon's preference card, positioning equipment, and any special supplies needed as determined by the nurse's assessment and the patient's history. Preparation assures that the nurse will be able to remain in the surgical suite as much as possible to provide care for the patient. The nurse leaving the room is avoided as much as possible, but unforeseen circumstances may require the nurse to leave to obtain equipment or supplies. When the patient is brought to the operating room

and transferred to operating table, patient comfort and safety are the priority. The nurse provides warmed blankets for the patient and applies the safety strap across the patient. The surgeon is called to the OR suite and the "time out" is performed with the patient participating. Items verified in the time out are the patient's name, date of birth, allergies, procedure to be performed, correctness of consent, site marking, if applicable, and any antibiotics to be given within one hour prior to incision. The patient is instructed to take deep breaths before and after anesthesia to maintain oxygen saturation above 95%. Strict aseptic and sterile technique are maintained throughout the surgical procedure to reduce the risk for postoperative infection. The nurse remains at the bedside during the induction phase and holds the patient's hand to help reduce anxiety. The patient is reassured as needed.

Nursing Intervention

The circulating nurse and the scrub nurse/technician work as a team to protect the sterility of the operative field by maintaining constant surveillance. Any breaks in sterile technique, such as a tear in the surgeon's glove, are remedied immediately.

The nurse provides for patient comfort by placing warm blankets, remaining at the patient's side until anesthesia has been successfully induced and the anesthesia provider releases the care of the patient to the surgical team. At this time a foley catheter will be placed, if indicated, using aseptic technique. The patient will be positioned and all pressure points will be padded to prevent altered skin integrity. The surgical skin prep is then performed aseptically and allowed to dry before placement of the surgical drapes. Fumes from a wet surgical prep can form pockets of gas that have the potential to be ignited by a spark from the electrocautery used in surgery.

Prior to the surgical incision, the anesthesia provider initiates the infusion of the antibiotic ordered by the surgeon. A preincision verification performed by the circulating nurse rechecks the patient's name, the surgical procedure, the site/side of the procedure, the antibiotic infusion has started, and the prep is dry.

Evaluation

The circulating nurse monitors the patient vigilantly during the course of the perioperative phase which includes preoperative, operative, and postoperative stages of surgery. He/she is responsible for the smooth transition for the patient between these phases. Evaluation of the patient's response to the surgical intervention is ongoing and continuous. Have the surgical outcomes been met? If not, reassessment takes place to plan further.

Conclusion

The patient under anesthesia is totally dependent on the surgical team for their well-being. The perioperative nurse advocates for the patient. He/she is their voice during the surgical intervention. Whether scrubbing, circulating, or supervising other team members, the perioperative nurse is always aware of the total environment, as well as the patient's reaction to the environment and the care given during all three phases of surgical intervention. The perioperative nurse is knowledgeable about aseptic technique, patient safety, legal aspects of nursing, and management of nursing activities associated with the specific surgical procedure being performed. OR nursing is unique: it provides a specialty service during the perioperative period that stresses the need for continuity of care and respect for the individuality of the patient's needs.

Beth, RN, CNOR ASN Degree with Honors from St. Petersburg College, St. Petersburg, FL Stafff

In the interest of providing cost-effective and high-quality care, a growing number of health care organizations are enhancing their pediatric critical care nursing staff, by hiring nurses with an even higher professional scope of practice. Two such examples include; the pediatric clinical nurse specialists (CNS) who tends to work within the hospital setting and the pediatric nurse practitioner (NP), who often works in outpatient clinics.

The need for more specialized pediatric critical care nursing stems from changes in health care delivery systems and the fact that patients are having more dynamic and complex health care needs. In an effort to create a more seamless, synchronized and effective method of care delivery, some health care professionals are advocating that these two roles, the CNS and NP, be merged into one advanced nursing role.

Pediatric critical care nursing is specialized, in that it focuses on the pediatric patient. However an advanced practice nurse, such as the NP, has further training and the knowledge required for taking histories, performing physical exams, making a diagnoses, and prescribing medications. The CNS focuses more on patient and staff education; they

are valued for their unique contributions to case management, care coordination, and patient teaching.

he exact scope of the CNS and NP roles can be governed by the policies and procedures of their employer, as well as their state licensing board. Advocates for merging these roles, suggest that an advanced pediatric critical care nurse should be able to perform both of these roles, of CNS and NP.

Health care organizations are concerned about containing costs, ensuring patient and family satisfaction and improving quality of care. Pediatric critical care nursing benefits by having access to these higher level specializations. Some specialty physicians, such as pediatric cardiologists, recognize that employing a pediatric NP may support the expansion of his/her current practice. However, not all professions will necessarily be supportive of a merger between the CNS and the NP roles; some Physician Assistance may perceive the new Advanced Practitioner role as a threat to their current positions.

Moving forward with this proposed merger will require restructuring at the academic and institutional levels. Educational administrators will be required to find innovative ways of facilitating the enrollment process for nurses who wish to progress from pediatric critical care nursing, toward advance practice nursing. Offering these courses via distance education or through evening courses, may facilitate the nurse's ability to pursue professional development and career advancement, while at the same time balancing work, family and school.

Beyond physiology, pathophysiology, pharmacology and diagnostics, the APN is expected to be knowledgeable in the areas of health promotion,

counseling, and management of common pediatric conditions from birth through adolescences. The APN is also expected to support the administration team.

Therefore, the course curriculum is expected to cover management principles such as budgeting, creating and developing corporate policies and procedures and managing human resources; each of these issues affects the APN's role.

A health care provider orders an IV aminophylline infusion at 30 mg/hr. The pharmacy sends a 1,000 mL bag of D5W containing 500 mg of aminophylline. In order to administer 30 mg per hour, a nurse should set the infusion rate at how many mL per hour? 20 mL/hr 60 mL/hrthis is the correct response 30 mL/hr 50 mL/hr Using the ratio method to calculate infusion rate: mg to be given (30) : mL to be infused (X) :: mg available (500) : mL of solution (1,000). Solve for X by cross-multiplying: 30 x 1,000 = 500 x X (or cancel), 30,000 = 500 X, X = 30,000/500, X = 60 mL per hour.

The parents of a seven year-old tell a nurse that their child has started to "tattle" on siblings. In interpreting this new behavior, how should the nurse explain the child's actions to the parents? Insecurity and attention getting are common motives Complex thought processes help to resolve conflicts

The ethical sense and feelings of justice are developing Correct response This is the correct response Attempts to control the family use new coping styles The child is developing a sense of justice and a desire to do what is right. At seven, the child is increasingly aware of family roles and responsibilities. They also do what is right because of parental direction or to avoid punishment. This age group, six to twelve years of age, is called the school-aged group.