MODERN NURSINGCOLLEGE

ANNANDALE SHIMLA

ASSIGNMENT
ON
EXTENDED AND EXPANDED ROLE OF
NURSE IN EMERGENCY

SUBMITTED TO: SUBMITTEBY:

MISS DEEKSHA SHARMA MISS ANJANA
ASSOCIATE PROFESSOR M.Sc. NURSING 1styear

PEDIATRICS ROLL NO.-02

SUBMITTED ON:

EXTENDED AND EXPANDED ROLE OF NURSE IN

EMERGENCY:
Introduction :
• It is a integral part of an hospital
• Microcosm of the hospital as whole
• Front door of the hospital
• Portal of entry that interacts with the highest volume of patients requiring
critical care.
Emergency: is a situation that poses an immediate risk to health, life, property, or
environment. Most emergencies require urgent intervention to prevent a worsening of the
situation.

Or

Emergency has defined as a condition determined clinically or considered by patient or his

her relatives as requiring urgent medical services, failing which, it could result in loss of life
or limb.

Here are some of the most common medical emergencies that people experience:

• Bleeding.
• Breathing difficulties.
• Someone collapses.
• Fit and/or epileptic seizure.
• Severe pain.
• Heart attack.
• A stroke.

Types of emergency:
• Major emergency and disaster management
• Basic emergency
• Stand by emergency
• Referral emergency Aims of emergency:
• Right treatment
• Right time
• Right place
• Right resources
• Speed
• Sympathy
• Science

Interrelationship:

• OT
• ICU
• Blood bank
• Laboratory
• OPD
• Mortuary
• Radiology
• Endoscopy
• CCU

Five Steps of Emergency Care:

Sudden illness or injury can occur without warning, and while no one typically plans a trip to
the Emergency Department, everyone should know what to expect after they arrive. The
Emergency Department (ED) at St. Mary’s Regional Medical Center provides urgent care
to patients who have traumatic injury, major illnesses or other issues that require immediate
treatment. The staff includes physicians, nurses and other healthcare professionals who
follow specific procedures so that you can get the care you need as quickly as possible.
Following are the five steps to expect when you arrive at the St. Mary's Regional ED.

The Steps of Care:

1. Triage
2. Registration
3. Treatment
4. Reevaluation
5. Discharge

Step 1 – Triage:

Triage is the process of determining the severity of a patient’s condition. Patients with the
most severe emergencies receive immediate treatment. That is why some patients may
receive medical care before you, even if they arrived at the ED after you. When you arrive at
the ED, emergency technicians determine the reason for your visit. A registered nurse will
take your medical history and perform a brief examination of your symptoms. The triage
registered nurse might assign you a priority level based on your medical history and current
condition according to the following scale: Level 1 – Resuscitation (immediate life-saving
intervention); Level 2 – Emergency; Level 3 – Urgent; Level 4 – Semi-urgent; Level 5 –
Non-urgent. In some cases, an emergency registered nurse may start diagnostic testing to
decrease the time spent waiting for medical treatment. Should your symptoms worsen as you
wait, notify the emergency technician or triage nurse immediately. Only one person may
accompany the patient in the triage area.

Step 2 – Registration

The registration process is important for two reasons: it lets the ED staff gather information
for your patient record and we obtain your consent for treatment. Both are necessary to order
diagnostic tests to enable the physician determine the best treatment option for you. Patient
Access Specialists can conduct bedside registration for patients who have been taken directly
to a treatment room.
Step 3 – Treatment

Every patient who comes to the Emergency Department at St. Mary’s Regional receives
treatment from an attending physician or mid-level practitioner. Depending on your
condition, a registered nurse may start an intravenous (IV) line. The IV line will allow the
nursing staff to quickly administer medications or fluids that may be ordered by a physician.
A nurse or technician may also take blood or urine samples, or they may send you for an X-
ray or other imaging test before a physician sees you. Physicians may also order blood tests
on an urgent basis. Test results help emergency medicine physicians assess your condition.
The results could be available within one to two hours, while you are in the ED. However,
some test results may require a longer wait. During your treatment, the staff in the ED will
help make sure you are comfortable and informed. Only two visitors are allowed at one time
in the patient room.

Step 4 – Reevaluation

An ED physician or mid-level practitioner will reevaluate your condition after they receive
your test results because the results may give them additional insight into the type of
treatment you need. You know your body. How you feel can be just as important as your test
results, so be sure to let physicians or nurses know about any pain or discomfort you may
feel. The staff may also contact your personal physician for additional information. If you do
not have a personal physician, we may refer you to an on-call physician. After your
reevaluation, the attending physician determines whether you should be admitted to the
hospital or treated and sent home.

Step 5 – Discharge

Part of our job is to keep you healthy long after you’ve left the ED. All patients receive
written home-care instructions to follow when discharged. The instructions describe how you
can safely care for your wound or illness, directions for your prescribed medications and
recommendations for follow-up medical care. It is important to fully understand all
instructions. If you have a question – let us know while you’re here. Or call 580-249-3001
once you return home. Be sure to follow up with your personal or referred physician as well.
One to two weeks after your visit to the Emergency Department at St. Mary’s Regional
Medical Center, you may receive a phone call asking for your opinions about your stay. Your
comments allow us to continually provide outstanding emergency care to all our patients.

EXTENDED ROLES OF THE NURSE IN EMERGENCY:

Extended role of a nurse is the responsibility assumed by a nurse beyond the traditional role.
Nurses in extended care facilities assist clients with their daily activities provide care when
necessary and coordinate rehabilitation and autonomy and they are supposed to provide care
in variety of settings such as hospital, community etc.

1) Care Giver
2) Manager
3) Protector and Advocate
4) Counselor
5) Nurse Educator
6) Communicator
7) Rehabilitator
8) Collaborator
9) School Health Nurse
10) Occupational Health Nurse
11) Parish Nurse
12) Public Health Nurse
13) Private Health Nurse
14) Home Care Nurse
15) Hospice Nurse
16) Rehabilitation Nurse
17) Office Nurse
18) Nurse Epidemiologist
19) Critical Care Nurse
20) Nurse Administrator
21) Nurse practitioner
22) Nurse Midwife
23) Community Health Nurse
24) Occupational Health Nurse
25) Psychiatric Nurse
26) Medical Surgical Nurse

1) CARE GIVER

• Care giving role is a primary role of the nurse. The provision of care to clients
combines both the arts and science of nursing which helps clients regain health to
healing process. Healing is more than just curing a specific disease, although
treatment skills that promote physical health are important to caregivers.
• The nurse aids the holistic health care needs of the client, including measures to
restore emotional, spiritual and social well being. The care giver helps the client and
family set goals and meet those goals with minimal cost of time and energy.

2) MANAGER
• As a manager, the nurse coordinates the activities of the health care team, such as
nutrionists and physical therapists, when managing care for a group of clients.
• The nurse must also manage their own time and resources of the practice setting when
providing care to several clients. As a clinical decision maker, the nurse uses critical
thinking skills throughout the nursing process to provide effective care.
• Before giving care, the nurse should plan the action by deciding the best approach for
each client. The nurse makes these decisions alone or in collaboration and
consultation with other health care professionals.

3) PROTECTOR AND ADVOCATE

• As a protector, the nurse helps to maintain a safe environment for the client and takes
steps to prevent injury and protect client from possible adverse effects of diagnostic
and treatment measures. Confirming that a client does not have an allergy to a
medication and providing immunization.
• As advocate, nurse protects the client human and legal rights and provide assistance in
asserting those rights if the need arises. The task of an advocate is to be a supporter
and source of information for the patients significant others.
Eg;:nurse may provide additional information for client who is trying to decide
whether or not to accept a treatment or nurse may assist with communication within
the family.

4) COUNSELOR
• Nurse helps to explore feelings and attitudes about wellness and illness with patients
and their families. It involves providing emotional, intellectual and
psychologicalsupport. In contrast to psychotherapist, the nurse counsels primary
health individuals with normal adjustments difficulties. The nurse encourages the
client to look at alternative behaviors, recognizes the choices and develop a sense of
control.
• Counseling can be provided on a one – to-one basis or in groups.Counseling requires
therapeutic communication skills. She should be a skilled leader able to analyses a
situation , synthesize information and experiences and evaluate the progress and
productivity of the individual or group. The nurse must also be willing to model and
teach desired behaviors, to be sincere when dealing with people.

5) NURSE EDUCATOR
• The nurse educators are employed in nursing programs at educational institutions and
in hospital staff development department of health care agencies and client education
departments. A nurse educator usually has a baccalaureate degree or more advanced
preparation.
• Faculty members in a school prepares student’s to function as a nurse and are
responsiblefor teaching current nursing practices theory and necessary skills in
laboratories and clinical settings. Nurse educators in staff development department
provide educational programs for nurse within their institute.
• As a nurse educator in client education department he/ she teaches ill or disabled
client and families to provide care in home

6) COMMUNICATOR
• The role of communicator is central to all nursing roles and activities. Nursing
involves communication with clients, families, other nurses and health care
professionals, resource persons and the community, without any clear communication,
it is impossible to give care effectively, make decision with clients and families, and
protect clients from threats to well being, coordinate and manage client care, assist the
client in rehabilitation, offer comfort or teach.
• Quality of communication is critical factor in meeting the needs of individuals,
families and communities. Communication facilitates all nursing actions. The nurse
communicats to other health care personnel’s the nursing interventions planned and
implemented for each client record. This type of communication needs to be concise,
clear and relevant.

7) REHABILITATOR
• Rehabilitation is the process by which individuals return to maximum levels of
functioning after illness, accidents or other disability events. Usually, client
experiences physical or emotional impairment that changes their lives, and the nurse
helps them to adapt as fully as possible by using her knowledge and skills of many
concepts when she learned.
• Rehabilitation activities range from teaching client to walk with crutches to helping
clients to cope with life style changes often associated with chronic illness.
8) COLLABORATOR
• Many professions make up the team involved in the care of each client. Besides nurse,
there also can be physical therapists, occupational therapists, medical social workers,
home health aids, recreational therapists, volunteers and nutritionist. The nurse
collaborates with other team members when providing care to a client.
• Quality care is given when and nurse and team members work together in planning for
the patient’s care management. A nurse can be a good collaborator when she is
knowledgeable, a good planner when providing patient care, and a good
communicator of each patient’s assessment and need to work well with patients,
families and health care members.
9) SCHOOL HEALTH NURSE
• School nursing is a specialized practice of professional nursing that facilitates the well
being, academic success and lifelong achievements of students. School health
services have the goal of supporting educational success by enhancing health.
• Effective school health service are comprehensive programmes that integrates health
promotion principles throughout school’s curriculum. A school nurse develops
programmes that foster children’s growth, positive life skills for successful coping and
acquisition of knowledge and skills for self care and thereby reinforce positive health
attitudes.

Functions
Direct caregivers; the school nurse is expected to give immediate nursing care to the all or
injured child or the school staff members.
Case finder: the school health nurse identifies as early as possible children at risk for
physical, behavioral, social or academic problems.
Case manager: helps to coordinate the health care for children with complex health
problems.

Consultant: provides professional information about proposed changes in school

environment and their impact on the health of the children.

Counselor: the school health nurse must be trust worthy person to whom children can go if
they are in trouble or they need someone to talk to.

Researcher: the nurse makes sure that the nursing care is based on evidence based practice.

Health educator: the nurse provides health education regarding proper nutrition or safely
information, personal hygiene o children and also to their parents.

10) OCCUPATIONAL HEALTH NURSE

• Occupational and environmental health nursing is the specialty practice that provides for
and delivers health and safely programmes and service to worker populations and
community groups. The practice focuses on promotion and restoration of health,
prevention of illness and injury and protection from work related and environmental
hazards.

Functions
Direct nursing care: this care encompasses primary, secondary and tertiary prevention with
nursing intervention from assessment to rehabilitation. Eg physical assessment, screening,
emergency care etc.

Case management: occupational health nurse acts as gate keepers for health services,
rehabilitation, return to work and recommending treatment plans that ensure quality and
efficacy while controlling costs and monitor care outcomes.

Counseling and crisis intervention: besides counseling workers about work related illness
and injuries occupational nurse counsels for issues such as substance abuse and emotional or
family problems and work place stressors?

Health promotion:occupational health teaching skills and developing health education

programmes specially on smoking cessation, exercise, nutrition, weight, control, stress
management, control of chronic illnesses etc.

Legal and regulatory compliance:Occupational health nurse provides knowledge regarding

various occupational legislation and she works with employers on compliance with
regulations and laws affecting the work place.

Worker and work place hazard detection:Occupational health nurse monitors the health
status of worker populations by conducting research on the effects on the workplace
exposures, gathering health and hazard data and using the data to prevent the injuries and
illnesses.
According to the study, occupational research is seen as a more complex issue in india, which
include child labor, poor industrial legislation and vast informal sector and balance between
modern industrial exposures and health risk of traditional sectors.

11) PARISH NURSE

• Parish nurse is the most commonly used term for the professional advanced nurse
practice role for gathering in churches, cathedrals, temples or mosques and
acknowledge common faith traditions. Parish nurse in church has been referred to as
congregational health minister, an emergency church nurse, a faith community nurse
or a health minister’s nurse.
• Parish nurse responds to health and wellness need within the context of populations of
faith communities and are partners with the church in fulfilling the mission of health
ministry.

Functions;

Provider of spiritual care: spiritual care is the core of the parish nurse practice and central
to the healing process.

Health counselor: health counselor explains clarifies and interprets for the client the
language of health care. She discusses health risk appraisals, plan for healthier life styles,
provide support and guidance related to numerous acute and chronic, actual and potential
health problems and performs spiritual assessment.

Health advocate: as an advocate, parish nurse guides persons successful for problem solving
and care options.

Health educator: as an educator, serves to gain knowledge in order to make best choices for
maintaining health, lowering health risks, preventing illness and managing disease already
present.

Facilitator of support groups: facilitating the support necessary for those encountering
lossxs or other changes is an important part of whole person health journey. Equipping
congregations with the tools of support i.e. coaching and facilitation, assures sustainability.

Trainer of volunteers: many volunteers need additional preparation in order to be effective.

The parish nurses facilitate varied trainings necessary for a variety of ministries.

Liaison to community resources and referral agent: knowing community and services
available within the community and establishing relationships is an important aspect of parish
nurse.

12) PUBLIC HEALTH NURSE

• Public health nurse is an registered nurse with special training in community health.
The PHN works special training in a specific geographic area and help the client and
the family with health concerns and parenting and lifestyle issues.
• The PHN should be knowledgeable about the resources in her immunity.
Functions:

▪ Health advocate: as an advocate, public health nurse collects, monitors and analyses
data and discusses with the client which services are needed. She also promotes
healthy behavior, safe, water, air and sanitation. The client can be either an
individuals, a family, a community or a population.
▪ Care manager: public health nurses use the nursing process of assessing, planning,
implementing and evaluating outcomes to meet client’s need at the least cost.
▪ Referral resource: the nurse educates clients to enable them to use the resources and
to learn self- care. Nurses refer to other services in the area and the other services refer
to public health. Nurse for care and follow- up.
▪ Health educator: as an educator, the public health nurse identifies community needs
and develops and implements educational activities aimed at changing behavior.
▪ Direct primary caregivers: public health nurse provides primary care is determined
by community assessment and is usually in response to an identified gap that the
private sector is unable to respond to, coupled with an assessment of the impact of the
gap in services on the health of the population . the direct care services are available in
the community for at risk- populations by working with the community to develop
programs that will meet the needs of that population eg: free or low cost immunization
for target groups.
▪ Communicable disease control: public health nursing skills are necessary for
education, prevention, surveillance and outbreak investigations of communicable
disease in community.
▪ Disaster preparedness: nurse provides education that will prepare communities to
cope with disaster, professional triage for local shelters, conducting communicable
disease surveillance, working with environmental health specialists to ensure safe
food and water for disaster victims and emergency workers and serving on the local
emergency planning community.

13) PRIVATE DUTY NURSE

• Private duty nurse is a registered nurse or a licensed practical nurse that provide
nursing service to patients at home or any other setting in accordance with physician
orders.
• Patients may receive continuous nursing services beyond the scope of care available
from Certified Home care Agencies (CHHAS). Patients may need only intermittent
nursing services which are normally provided with CHHAS which are unavailable at
the time the patients needs them.

14) HOME CARE NURSE

• Home care nurse is a nurse who provides periodic care to patients with in their home
environment as ordered by physician. It includes health maintenance, education,
illness prevention, diagnosis and treatment of disease, palliation and rehabilitation.
• It is component of a continuum of comprehensive health care where by health services
are provided to individuals and families in their home to promote, maintain or restore
health, or to maximize the level of independence while minimizing the effects of
disability and illness.
• Home care can be restorative care or acute care depending upon the client condition.
Home care nurse acts as referral agent for clients who are discharged from acute care
settings such as hospitals or mental health facilities for continued care and follow up.
• In community have care nurse, conducts home visits where nurse can view clientsin
perspective and thus can understand them better, capitalize on their resources and
tailor health services to meet their needs.

15) HOSPICE NURSE

• Hospice nurse is one who provides a family centered care and allows client to live and
remain at home with comfort, independence and dignity, while alleviating the strains
caused by terminal phase.
• The nurse provides care and support for the client and family during the terminal
phase or at the time of death. Hospice care can be given to patients to hospital, nursing
home or private hospital facility.

Functions
Pain and symptoms control: the nurse helps the patient to achieve comfort and allows
remaining in the control in life by managing to ensure that the patient is free of pain and
symptoms as much as possible.

Spiritual care: spiritual care is individualized to meet patients and their families need and to
include helping the patient to look at what death means to them.

Home care and impatient care: the nurse stay involved in treatment of the patient and with
the family, resuming in home care when appropriate.

Family conferences: the nurse provides a chance to share feelings, talk about expectations,
and learn about death and the process of dying. Family members can find great support and
stess relief through family conferences.

Co-ordination of care: there should be coordination and supervision of care 7 days a week,
24 hrs a day between the interdisciplinary team. The interdisciplinary team includes doctor,
nurses, social and emotional support to the client.

Bereavement care: bereavement is the time of mourning following a loss. They provides
support to the family members through visits, phone calls, letter and through support groups.

16) REHABILITATION NURSE

• Rehabilitation nurse is a nurse who specializes in assisting persons with disabilities
and chronic illness to attain optimal function, health and adapt to an altered life style.
• Rehabilitation nurse can practice in hospitals, inpatient rehabilitation centers, long
term care facilities, community and home health settings, insurance companies,
private practice.
Functions:
▪ Assists patients in their move towards independence by setting realistic goals.
▪ They work as a part multidisciplinary team and often coordinate patient care and team
activities.
▪ Rehabilitation nurse provides care that helps to restore and maintain functions and
prevent complications.
▪ Provide patient and family education, counseling and case management.
▪ Serves as a patient and family advocate and participates in social that helps improve
the practice of rehabilitation.

17) OFFICE NURSE

• Office nurse is also called as clinic nurse. Office nurse provides patient care along with
physician offices, surgi centers and medical office buildings.
• The main focus is on diagnosis and treatment of specific illness rather than health
promotion. But now the patient enrole to have regular physical examination.
Functions
▪ Identifies trends in the types of problem client present and treating them.
▪ Provides health promotion activities by health education and health counseling
▪ Acts as problem solver who helps with referral questions
▪ Performs clerical duties like managing the flow of clients though the office and
dealings with physician concerned.
▪ It is an important bridge between physician and problems of clients.
▪ Supervision of secretarial and medical assistance staff and medical record personnel.
▪ Nurse epidemiologist
▪ Nurse epidemiologist searches for new diseases and its reporting and taking part in
health programmes.

18) NURSE EPIDEMIOLOGIST

❖ Nurse epidemiologist searches for new diseases and its reporting and taking part in
health programs
FUNCTIONS
▪ Conducts epidemiologic investigation.
▪ Provides education.
▪ Provides on-going in-service training.
▪ Conduct study to determine risk factors leading to infections.
▪ Conduct surveillance of infection out breaks.

19) CRITICAL CARE NURSE

• Critical care has progressed from a “do the best you can “ approach into a speciality
based on a solid body of scientific knowledge and intricate skills.
• The critical nurses uses primary nursing delivery system which allows a certain
degree of independence and also serves as a full fledged team member in patient
management. Qualification of critical care nurses are basic BSc degree or diploma in
nursing and advanced preparation in critical care nursing.

Functions
▪ Monitoring balloon angioplasty, pacemaker, hemodynamics, intra aortic balloon
pumping, bedside hemodialysis, advanced neurological and surgical procedures
▪ .Teaching physicians, primarily interns and residents in teaching hospitals about
caring for critically ill patient.
▪ Help design products and techniques for practice.
▪ Manages patient’s total care. ▪ Performs defibrillation ▪ Interprets diagnostic tests.

20) NURSE ADMINISTRATOR

• The nurse administrator manages client care, including delivery of nursing service.
The functions of nursing administrator include budgeting, staffing and planning
programs.
• The educational preparation for the nurse administrator is at least a baccalaureate
degree in nursing and and frequently a masters or doctoral degree.

21) NURSE PRACTITIONER

Nurse practitioner are currently recognized as a critical component of health care reform.
They are employed in health care agencies or community based settings. They usually
deal with non emergency, acute or chronic illness and provide primary ambulatory care.

22) NURSE MIDWIFE

A RN who has completed a course in midwifery and is certified by the corresponding

national council can be a nurse midwife. The nurse midwife gives perinatal care for the
mothers. They also conduct routine pap smear, family planning and routine breast
examinations.

23) COMMUNITY HEALTH NURSE

Community health nurse functions within the communal framework and serves the health
needs of the portion of public assigned and delivers care to the community as a whole. The
goal of the community health nurse is to improve health of the community as a whole.

24) OCCUPATIONAL HEALTH NURSE

It is branch of public health nursing. The occupational health nurse work in traditional
manufacturing, industry service, construction sites and government settings. The roles
include: worker/ workplace assessment and surveillance, primary care, case management,
counseling, health promoting and protection, research, administration and management,
community orientation, legal and ethical monitoring.

25) PSYCHIATRIC NURSE

It is a branch of nursing that deals with mentally challenged and mentally disturbed clients
and their needs, in daily life as well as in the social life. The role includes educator, surrogate,
counseling, psychotherapist and advocate.

26) MEDICAL SURGICAL NURSE

It is a branch of medicine that deals with the overall medical and surgical needs of the client
and the functions include assessment of the problem help in diagnosis, treatment,
administration of medication, assistance in ADL (Activities of daily living) and so on.

EXPANDED ROLE OF NURSE IN EMERGECY:

Enlargement of role of nurse within the boundaries of nurse (within the field of practice)
called as expanded role of nurse.

Because of increasing educational opportunities for nurses, the growth of nursing as a

profession and a greater concern for job enrichment, the nursing profession offers expanded
role and different kinds of career opportunities.

The expanded roles include the following:

1) Advanced Nurse Practitioner

2) Clinical nurse specialist
3) Nurse anesthetist
4) Nurse researcher
5) Advanced Nurse educator
6) Acute care nurse practitioner
7) Nurse entrepreneur
8) Operating home nurse
9) Professional nurse case manager
10) Rehabilitation nurse
11) Travel nurse
12) Nurse oncologist
13) Nurse analyst
14) Sport nursing
15) Hospice Nurse
16) Nurse liaison
17) Space nursing
18) Tele nursing
19) School health nurse
20) Cruise ship/ resort nurse
21) Attorney
22) Disaster/bioterrorism nurse
23) Nurse as author
24) Epidemiology nurse
25) Ethicist

1)ADVANCED NURSE PRACTITIONER

A nurse who has an advanced education and is a graduate of a nurse practitioner program is
employed in health care agencies or in community settings and deals with non emergency
acute or chronic illness and provide primary ambulatory care.

Job responsibility include:-

• Taking client history

• Conducting physical examinations
• Ordering performing and interpreting diagnostic tests
• Prescribing pharmacologic agents
• Treatment therapies for the management of client’s condition.
• Providing primary care
• Consultant for individuals, families and communities
The major nurse practitioner categories are:-

• Adult nurse practitioners are those who provide primary ambulatory care to adults
with a non emergency, acute or chronic illness and some setting tertiary care.
• Family nurse practitioners provide primary ambulatory care for families usually in
collaboration with family care physician.
• Pediatric nurse practitioner provides care to infants and children.
• An obstetrics and gynecology nurse practitioner provides care to women seeking
obstetrical and gynecological health care and conducts delivery independently.
• Geriatric nurse practitioner provides ambulatory or in patient care to older adults.
Their activities include interventions for health maintenance , illness prevention or
health restoration.

2) NURSE CLINICIAN / CLINICAL NURSE SPECIALIST

The clinical nurse specialist has a master’s degree in nursing and expertise in a specialized
area of practice. The CNS may work in primary care, acute care, restorative care and
community based settings. The CNS function as client care provider, educator and consultant
and researcher, manager, to plan and improve the quality of care provided to the client and
family.

3)NURSE ANESTHETIST

A nurse anesthetist is an RN who received advanced training in an accelerated program of

anesthesiology.

Functions
• Carries preoperative visits and assessments
• Administration of general anesthetic agent for surgery and supervision of anesthetist.
• Assessment of post operative status of client.
4) NURSE RESEARCHER

Minimum educational qualification is a doctorate, with at least a masters degree in nursing.

The nurse researcher investigates problems to improve nursing care and to further define and
expand the scope of nursing. They may be employed in an academic setting, hospital or
independent professional or community service agencies.

5ADVANCED NURSE EDUCATOR

The nurse educator is usually holder a baccalaureate degree holder or more advanced and
frequently an expert in particular area of practice.

6 ACUTE CARE NURSE PRACTITIONER

An acute care nurse practitioner functions in settings where critically ill patients reside, this
type of nurses provide special expertise. The certification includes physiology, advanced
assessment, advanced pathophysiology, pharmacology and advanced therapeutics.

7. NURSE ENTREPRENEUR

An entrepreneur is an individual who organize operates and assumes the risk for business
ventures. Such business includes independent nursing practice, consultant services etc. The
nurse may be involved in education consultation research etc.

8 OPERATING ROOM NURSE

When patients are admitted before or after surgery, the operating room nurse monitors the
patient’s progress from the time he/ she enters the operating room until he/ she is dismissed
to the attending staff nurse. She also performs preoperative assessment prepares the patient
for surgery, set up for surgery, assists the surgeon during the procedure and manages patient
recovery.

9 PROFESSIONAL NURSE CARE MANAGER

The nurse case manager assesses the patient and develops care according to expected
outcomes in terms of cost and quality.

10 REHABILITATION NURSE

The most important role of rehabilitation nurse is education. She teaches the client to perform
self assessment, make decisions about beginning continuing self care measures. Perform
everyday activities and evaluate the progress and recovery.
11 TRAVEL NURSING

Travel nursing and the Travel Nursing Industry developed in response to the nursing shortage
in which nurses are relocated for short- term nursing positions. Most nurse enjoy travel
nursing for 3 reasons:-

• Visiting many different locations

• Free benefits
• Higher salary with bonuses.
12 NURSE ONCOLOGIST

Advance oncology nursing practice is defined as the practice of expert competency and
leadership in the provisional care to individuals with an actual or potential diagnosis to
cancer.

13 NURSE INFORMATICS/ NURSING ANALYST

• The nursing analyst works within the management team to ensure high quality of
performance, compliance and technical support to both the management and nursing
staff the nursing analyst is involved in data analysis and interpretation with regards to
effectiveness and efficiency of data collection, entry and use within the various areas
of hospital or health care facility.
• A nursing analyst must have a strong statistical background and be able to interpret
data in in a logical and organized manner. The nursing analyst must be able to work
on multiple projects at one time, focus on details as well as the overall project, as well
as stay on deadlines and timelines for preparing and presenting information to
management sources or shakeholders.
• The nursing analyst may be required to actually present the material orally or in
written form or may be required to create Power Point or other presentations to
display the required information. Excellent computer skills and a good working
knowledge of data analysis and display are critical. Some of the programs that the
nursing analyst may use include Crystal Report, Oracle, SQL, Power Point or Desktop
Publisher. In addition, the nursing analyst should be able to complete public speaking
activities as required.
• The nursing analyst may also be required to assist in setting benchmarks and standards
for the various projects based on actual data and healthcare regulations and
requirements. An ability to analyze data is critical to effectively make
recommendations for standards and policy and procedural changes. Understanding the
realities of the job is very important for the nursing analyst.

Career requirements: The minimum requirement for a nursing analyst is a Bachelor in

Nursing. Many hospital or healthcare facilities require a Master level training in medical
informatics, healthcare management or quality management. In addition the nursing analyst
will have experience working in the same type of hospital or healthcare facility that they are
apply for a nursing analyst position in. experience with statistic analysis and data
management is considered beneficial as is a strong computer background and a familiarity
with various medical and data programs.

14 SPORT NURSING

• Helping humans stay healthy and prevent disease is one of the main thrusts behind an
emerging trend that combines nursing with some aspect of fitness or sports. Although
the nursing profession has yet to officially develop a speciality in ‘fitness nursing’ or
‘sports nursing’ on either the professional or academic level, a growing number of
nurses are becoming involved in these areas.
• The connection between physical fitness, wellness and disease prevention is well
documented. As a result, hospitals and HMOs around the country have begun opening
fitness centers and offering wellness programs with information on nutrition, stress
management and exercise. Many corporate employers, meanwhile, have begun
offering on-site fitness programs and wellness centers for their employees.
• In addition to these practice settings, nurses can also find job opportunities working
for professional sports teams, college and university athletic departments and
hospitals, clinics and orthopedic practices that have sports medicine or sports
medicine on a full- time basis while others work on a part- time, contract basis for
sports teams

15 HOSPICE NURSE/ PALLIATIVE NURSE

The focus of hospice care is a comprehensive physical, psychosocial, emotional, and spiritual
care to terminally ill persons and their families. Hospice providers promote quality of life by
protecting patients from burdensome interventions and providing care at home, whenever
possibly, instead of the hospital.

Roles

• Hospice and palliative care nurses work in collaboration with other health providers
within the context of an interdisciplinary team. Composed of highly qualified,
specially trained professionals and volunteers, the team blends their strengths together
to anticipate and meet the needs of the patients and family facing terminal illness and
bereavement. Hospice and palliative nurses distinguish themselves from their
colleagues in other nursing speciality practices by their unwavering focus on end-
oflife care.
• Hospice and palliative care includes 24 hour nursing availability, management of pain
and other symptoms, and family support. By providing expert management of pain
and other symptoms combined with compassionate listening and counseling skills,
hospice and palliative nurse promote the highest quality of life for the patient and
family.
• Regardless of the setting, hospice and palliative nurses strive to achieve an
understanding of specific end-of-life issues from the perspective of each patient and
his or her family. To accomplish this, nurses collaborate in cultural assessment of the
patient and family and provide culturally sensitive care.
• Hospice and palliative nursing is not only practiced at the bedside. Nurse, consistent
with their individual educational preparation, experience and roles, promote the
highest standard of end-of-life care through community and professional education,
participation in demonstration grants, and in end-of-life research. As society’s needs
change and awareness of the issues surrounding the end of life increases, nurses are
called to advocate for the terminally ill and their families through public policy
forums, including the legislative process.

Education: hospice and palliative nurses are registered nurses prepared at the associate-
degree, baccalaureate- degree and/ or master degree level. There are currently two master’s
degree programs that focus on hospice/ palliative care- New York University and Ursuline
College. A small percentage of hospice and palliative nurses hold a doctoral degree.

16 NURSE LIAISON

• The nurse liaison role is multifaceted. They are vital link between the potential patient
and the rehabilitation facility. In this capacity, the transition between an acute
hospitalization and rehabilitation is made as smooth as possible for the patient. The
nurse liaison explains to the potential patient and his/her family members what to
expect during the rehabilitation stay. This explanation is usually given during the
assessment of the potential patient,
• The Nurse Liaison performs the assessment at the request of the attending physician.
This information, once obtained, is then submitted to the physician and the admission
staff for review. The major role in liaison nursing is enhancement of delivery of
psychological nursing care and effective management. Also serves as a catalyst in
negotiations with staff and clients. The Nurse Liaison is an RN/LPN currently
licensed in the state of Tennessee. He/ she has 3 or more years of diverse clinical
judgment, and excellent assessment skills.

17 SPACE NURSING

• Space nurses provide on the ground monitoring and a full range of health services to
astronauts, who are screened to determine if they meet the NASA health requirements
and in some cases, military stipulations. It is very crucial for mission safety and
service eligibility.
• A dispensary staffed by nurses is included in NASA’s long term plan s which call for
larger space stations and a permanent lunar base. Flight medicine nurses also
coordinate dietary and fitness services; clinic nurse staff a sick call service for
astronauts to use before or after flight.
• Space nurse society members now meet yearly at conferences to exchange ideas share
research findings, and application of nursing methods used on earth in space settings.
The members are with a basic nursing degree and a doctorate or masters in any
discipline of nursing.
• The skills needed are excellent communication skills;interest and knowledge of
aerospace industry and challenges, mental health skills, innovation and creativity,
knowledge of physics and engineering.
18 TELE NURSING

• This refers to the use of telecommunications and information technology for providing
nursing services in health care. Whenever a large physical distance exists between
patient and nurse, or between any number of nurses.
• As a field it is part of telehealth and has many points of contracts with other medical
and non-medical applications, such as tele-diagnosis, tele- consultation, tele-
monitoring etc. telenursing is achieving a large rate of growth in many countries, due
to several factors: the preoccupation in driving down the cost of health care, an
increase in number of ageing and chronically ill population, and increase in coverage
of health care to distant, rural, small or sparsely populated region.
• Among its many benefits, telenursing may help solve increasing shortages of nurses;
to reduce distances and save travel time, and to keep patients out of hospital. A
greater degree of job satisfaction has been registered among telenurse.

19 SCHOOL HEALTH NURSE

The role of the nurse is to support the educational process by helping students keep healthy
and by teaching students and teacher’s preventive practices. The responsibilities include first
aid, screening follow up, control of communicable diseases, immunization, teaching health
classes, transmitting knowledge regarding healthy behaviors, conducted health related
studies, referral services.

20 CRUISE SHIP/ RESORT NURSE

• These nurses work on ships or resorts to provide emergency or general care to

passengers/ vacationers, should it be required. These nurses also serve as part of the
occupational health team of the crew who live in the ship for 6 to 8 months of time, or
the staff at resorts. Responsibilities include providing patient care in the health centre
and dealing with onsite emergencies.
• The requirements are a registration with a minimum of 2 years pf experience in recent
hospital required. Experience with cardiac care, trauma and internal medicine is
desirable. They must possess excellent interpersonal skills, enjoy traveling and be
very flexible with time, strong health assessment skills, possess a valid passport and
able to tackle minor illnesses.

21 ATTORNEY

• Nurse attorneys engage in a range of legal activities include the following , providing
legal consult, prosecute, defend cases, may represent individuals patients, hospitals
health professionals or institutions, provide depositions and court testimony, engage in
legal research, define standards of care, serve as quality of care experts for hospital
and other health care institutions, review cases, define applicable standard of care,
organize records, research the literature, provide behind the screen or up front
consultations, interview clients and witnesses, prepare exhibits, prepare questions for
depositions and court. A register nurse with a law degree fulfills the criteria.

22 DISASTER / BIOTERRORISM NURSE

These nurse works in disaster areas that are the result of bioterrorist attack or in situation
caused by natural disaster, war or property, Red Cross nurses are often part of this wing of
nurses. A basic degree in nursing is needed and should be the member of society like Red
Cross. The skills include: emergency room and critical care experience, experience with local
disaster action teams, management skills, ability to meet the needs of the people in high crisis
situation. Knowledge of disaster preparedness and basic first aid.

23 NURSE AS AUTHORS

A RN who works in any area of writing, this written material may be used in research
education, training, sales and marketing and other mediums and communication forum.
Nursing knowledge must be disseminated as widely as possible to nursing practice and keep
pace with the health needs of the community. The quality of journals which publish,
materials concerning nursing issues depends on quality of material submitted. It’s the
responsibility of nurses to attempt to publish any new knowledge they gain.

21 EPIDEMIOLOGY NURSE

A nurse epidemiologist investigates trends in groups or aggregates and studies the occurrence
of diseases and injuries. The information is gathered from census data and statistics and
reportable disease records. They identify population at risk monitor the progress of disease,
specify areas of health care need, determine priorities and size and scope of programs and
evaluate their impact. They don’t provide direct nursing care, but they do research and
publish the latest trends in health care. Master’s degree in community health or PhD
preferred.

22 ETHICIST

A nurse who knows about legal/ moral/ ethical issues and provides services for patients and
families is called nurse ethicist. The nurse may work with an ethicist team to develop a
detailed investigative plan to answer question raised by an ethics violation allegation or
resolve clinical dilemmas the criteria is a master’s degree in bioethics or related field along
with a registered nurse certificate.
BIBLIOGRAPHY
Books :
• Basheer Shebeer P. & Khan S. Yaseen. A Concise Text Book of Advanced
Nursing Practice, 1st ed, EMMESS Medical Publishers 2012.
• Rawat HC and Brar Navdeep. Text book of advance nursing practice1st ed,
Jaypee Brothers Medical Publishers 2015.

Internet:

• www.google.com
• www.pubmed.com
• www.sciencedirect.com
• https://www.slideshare,net/mobile/jisaanna/emergency-services-64631597