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Wakefield 1 Michael Wakefield A.

Minks Introduction to Healthcare 6/30/08

Career Project Career: Nursing, Registered Nurse Overall Description: Provide care for patients as directed by physicians. Care focuses on the mental, emotional, and physical needs of the patient. Job Roles and responsibilities: Registered nurse (RNs) • Work under the direction of physicians • Provide total care to patients • Observe patients • Assess patients’ needs • Report to other health care personnel • Administer prescribed medications and treatments • Teach healthcare • Supervise other nursing personnel RNs are not limited to employment as bedside nurses. Registered nurses are employed by physicians, attorneys, insurance companies, private industry, school districts, ambulatory surgery centers and fire departments, among others. Some registered nurses are independent consultants who work for themselves, while others work for large manufacturers or chemical companies. Research Nurses conduct or assist in research or evaluation in many areas such as biology, psychology, human development, and health care systems. Occupational Requirements and Recommendations: Requirements: Education • 2-3-year diploma program in hospital school of nursing, or associate’s or bachelor’s degree. Master’s or doctor’s degree for some administrative/educational positions and for some advanced practice nursing positions. Licensure

Wakefield 2 • Licensure is in the state of practice. The scope of practice of registered nurses is the extent to which an RN can practice and the limits of that practice. In the United States, these limits are determined by a set of laws known as the Nurse Practice Act of the state or territory in which an RN is licensed (Wikipedia, 2007).

Recommendations: • Personal Skills and Qualities: i. Intelligence, compassion, leadership, flexibility, empathy, the ability to stay calm in a crisis.

Educational Requirements: Educational Path: • 2-3-year diploma program in hospital school of nursing, or associate’s or bachelor’s degree. Master’s or doctor’s degree for some administrative/educational positions and for some advanced practice nursing positions.

Education Obtained: • Education is obtained from an accredited college, university, hospital school of nursing institution. There are also annual continuing education requirements depending on state of licensure.

Governing Agencies: State: • Each state has its own laws, rules, and regulations governing nursing care. Usually the making of the rules and regulations is delegated to a state board of nursing, which performs the day-to-day administration of these rules, qualifies candidates for licensure, licenses nurses and makes decisions on nursing issues.

Professional: • These depend on your primary specialty as a nurse, as there are different professional organizations that you can join depending on your specialty. Most nurses are members of the American Nurses Association.

Wakefield 3 Licensure, Certification, Registration: Completion of any one of any of the educational routes described previously allows a graduate nurse to take the National Council Licensure EXamination-Registered Nurse (NCLEX-RN), the test for licensure as a registered nurse, and is accepted by every state as adequate preparation so long as the graduate attended an NLNAC-accredited school. Professional nursing organizations, through their certification boards, have voluntary certification exams to demonstrate clinical competency in their particular specialty. Completion of the prerequisite work experience allows an RN to register for an examination, and passage gives an RN permission to use a professional designation after their name. For example, passage of the American Association of Critical-care Nurses specialty exam allows a nurse to use the initials 'CCRN' after his or her name. Other organizations and societies have similar procedures. The American Nurses Credentialing Center, the credentialing arm of the American Nurses Association, is the largest nursing credentialing organization and administers more than 30 specialty examinations (Wikipedia, 2007). Description of Job Outlook and Job Growth Predictions: The job outlook is promising. There are currently more job opportunities than there are nurses to fill their positions. This shortage allows nurses to be more selective in choosing their practice settings. In 1996, 1,971,000 RNs were employed in the United States. By the year 2006 there was a 21% increase (2,382,000) in jobs for RNs. 72% of BSN students and 94% of MSN students had awaiting jobs prior to the completion of their degrees. The unemployment rate for RNs is less than 2% (Good et. all, 2007). Career Path: Entry level RNs start out as ADN (Associate Degree – RN) or BSN (Bachelor Degree – RN). They then have the opportunity to pursue a Master of Science in Nursing (MSN) degree which is for BSN-prepared nurses intending to pursue further studies. MSN programs vary from 12-18 months of full-time study. Examples of advanced nursing practice include: Clinical Nurse Specialist (CNS) Nurse Practitioner (NP) Certified Registered Nurse Anesthetist (CRNA) Certified Nurse-Midwife (CNM) Doctoral degrees for nursing include the doctor of philosophy in nursing (PhD), nursing doctorate (ND or DN), and doctor of science in nursing (DSN). The overall goals of doctoral education are to broaden nursing’s scientific knowledge base through research and other scholarly activities and to prepare nurses to serve in a capacity of leadership roles or as educators (Good et. all, 2007).

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Pay Levels: Financial earnings for nurses vary according to the type of nursing, geographic location, years of experience, and level of education. Beginning salaries for entry-level staff nurses range from $30,000 to $45,000. $60,300-$108,900 with advanced specialties. Here are some examples of nurse specialty salaries: • $51,089 average annual - Clinical Nurse Specialist • $55,014 average annual - Nurse Practitioner/Midwife • $86,310 average annual - Certified Registered Nurse Anesthetist

Additional Items: Job Opening Announcements: 1. Swedish Medical Center Job Title: STAFF REG NURSE, Shift: Evenings, FTE: 1.00, Location: First Hill Campus, Reference: 009285 Position Specifications STAFF REGISTERED NURSE – INPATIENT PACU - First Hill. This is a regular, hourly, 8 hour, Evening shift position, 1.0 FTE, 40 hours per week. This position is eligible for full benefits. SALARY: Placement within the scale is dependent upon years of work experience. The salary scale is reviewed on an annual basis for market comparison and may change with the market. SCHEDULE: Shift starts at 1pm. Schedule may vary according to business needs. Call required on a rotational basis. Responsibilities The Registered Nurse is responsible for providing nursing care adapted to individual patient needs based on the nursing process, which includes assessment, planning, implementation, and evaluation. He or she is also responsible for delegation and supervision of personnel, as states above, that participate in the provision of care to ensure that patient needs and expected outcomes are met. The PACU (/Post Anesthesia Care Unit) Registered Nurse (RN) assumes leadership, responsibility and accountability for designated patients in the Pre-operative, post-operative, and other assigned locations in the peri-operative continuum. The work area consists of separate units in relatively close proximity to each other. This is a combined staff with nurses working between Day Surgery, Pre-Surgical Center, Fiberoptics, PACU, and Medical Treatment Center. Day Surgery provides ambulatory care for the patient undergoing surgical, non-surgical and diagnostic procedures. The PreSurgical Center nurse interviews patients a few days before the procedure, assessing and obtaining history and lab work. Day Surgery provides ambulatory care for the patient undergoing surgical, non-surgical, and diagnostic procedures. The pre-anesthetic phase

Wakefield 5 focuses on preparing patients physically and emotionally for their experience through interview, physical assessment, and education. The Post Anesthesia Phase II, also done in Day Surgery, focuses on preparing patients to care for themselves. PACU RN is responsible for providing triage assessment, nursing diagnosis and evaluating all aspects of nursing care in the PACU, and focuses on providing a transition from a totally anesthetized state to one requiring a less acute intervention. The Fiberoptic nurse admits and discharges patients through Day Surgery. The Fiberoptic nurse assesses and monitors the patient, and assists the physician during endoscopic procedures. The Medical Treatment Center nurse cares for out-patients receiving Chemotherapy and other procedures. Nurses in these clinical departments are cross-trained to work in all areas as needed. Qualifications The minimum qualifications listed below are representative of the knowledge, skill and abilities needed to perform this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job. Education: Graduate of an accredited Registered Nurse Program. Licensures/Certifications: Current license to practice as a Registered Nurse in the State of Washington. Current BLS Certification and ACLS certification. Completion of EKG interpretation and Critical Care course or Critical Care Course equivalent. Experience and Skills: Experience acquired from Accredited Registered School of Nursing. Minimum of 1 year of PACU experience or 2 years of Critical Care or Emergency experience required, including cardiac and hemo-dynamic monitoring. Nurses with acute care setting experience need to complete a critical care course prior to employment in the PACU or completion of an approved training course preferred. Ability to operate, or learn to operate, unit-specific equipment as outlined in defined competencies. Working knowledge of ventilators, cardiac monitors, defibrillators, chesttubes and other related medical devices. Adequate knowledge to perform assessments, plan patient care, provide direct care, and educate and orient families and staff. Skilled to work with a wide range of staff as part of an interdisciplinary team including physicians, nurses, and ancillary staff. Ability to read, write, understand and communicate in English. Ability to complete mathematical calculation (addition, subtraction, multiplication, division, equivalencies). Must have knowledge of human growth and development to modify services to the age and development stage of the patient. Closing Statement As per the 1199NW/SEIU Contract employees in this position are required to become a union member in good standing and successfully complete a 90-day probationary period. Swedish Medical Center has a non-discrimination policy and is an equal opportunity employer. 2. Part Time LPN and Full Time School Nurse (RN with BSN) Highline School District is in need of a part time LPN and a full time School Nurse (RN with BSN). Come join a group of caring professional nurses providing quality care in

Wakefield 6 the school setting. Enjoy the peer support and excellent orientation. If you are a School Nurse ( RN) candidate you will need to obtain a temporary ESA certificate. The information about that certificate is available at our Health Services office. 206433-2413, FAX 206-433-2110 or denverat@hsd401.org. Call or send a resume today.

Wakefield 7 Personal Interview: David Bork is an RN at Puget Sound VA Hospital on Beacon Hill in Seattle, WA. David has worked for the VA for over 18 years. 12 years at American Lake VA Hospital in Tacoma, WA and almost 6 years at Puget Sound VA Hospital in Seattle. A typical day for David starts at 9:30am when he starts his shift at the Same Day Unit on the 2nd Floor of Building 100. The SDU is the outpatient surgery clinic at the VA Hospital in Seattle. David performs Diagnostics: this includes blood draws, EKG’s, urine samples. He also completes a Valuables Inventory. This is an inventory of patients’ valuables that are kept under lock and key until the patient is discharged. After these tasks are completed, David helps out in the OEC office. This is the Outpatient Education Clinic. This is where patient education about upcoming outpatient surgery is completed. These are typically for either scheduled patient admissions or patient admissions for surgery that day (unscheduled outpatient surgery overflow on space available basis). Any patient medications are also inventoried at this time and then delivered to the Pharmacy in Building 1. Chain of Custody for Schedule Drugs must be maintained as well. Schedule drugs are highly addictive drugs that a patient might be prescribed. Other duties might include: Patient teaching (scrub body parts for surgery, stop taking meds, fasting, bowl prep, what time to be here etc.) is discussed. Lodging and a ride home is also squared away at this time. Then, patient charts are broken down. All paper is destroyed by a shredding company and transferred to microfilche or computer records for electronic retrieval. At the end of the day (around 4pm or so), David might float to Recovery depending on the census and number of nurses available. Secondary recovery (vital signs taken 3 times at 15 minute intervals) is done here after surgery. A wait for x-rays, or setting up slings for orthopedic surgeries, if applicable. They might have to wait for a patient to urinate unless they had GI surgery. Also, follow-up appointments and discharge appointments with doctors

Wakefield 8 are scheduled during this time as well. Discharge orders are also reviewed with the patient. David typically ends his day around 6pm and closes up the unit along with the rest of the nurses that remain in SDU. This includes general cleanup and sanitation of rooms.

Wakefield 9 Bibliography

Good, Holly, Meghan McGonigal, Casandra Moyer, Jill Muller, and Pernell Peppers. "What is Nursing?" University of Iowa. May 2000. University of Iowa. 28 Nov. 2007 <http://www.nursing.uiowa.edu/sites/users/hgood/>. "Registered Nurse." Wikipedia, the Free Encyclopedia. 28 Nov. 2007. Wikimedia Project. 28 Nov. 2007 < http://en.wikipedia.org/wiki/Registered_nurse>. "Registered Nurses." Occupational Outlook Handbook. 4 Aug. 2006. U.S. Department of Labor. 28 Nov. 2007 <http://stats.bls.gov/oco/ocos083.htm>. Simmers, Louise. Health Science Career Exploration. Clifton Park: Thompson Delmar Learning, 2007. 94-98.