CAREER OPPORTUNITY

INTRODUCTIONThere is a strong demand for nurses today, career prospectes are good

& possibilities are plentiful. Nurses are needed not only in hospital, but in health agencies, long term care facilities such as nursing home ,managed care centers & in community health . Educating patients & their families in preventing care is highly important. Demands for advance practice nurses are growing in the many areas. Never before has nursing been so axciting; taday new graduates has a variety of job opportunities available. The job opportunity for the LPN have expanded & now extended beyond those in the long term care facility and hospital.

There are many job opportunities for nurses such as- Hospitals Long term care facilities Home health Physicians office or clinic Insurance company

Temporary agencies Travel opportunity Pharmaceutical sales Other medical sales Outpatients hotel Military nursing Adult day care School nurse Public health Out patient surgery Private duty nursing Government nursing Industrial nursing

Rehabilitation nursing Psychiatric nursing Hospice nursing Clinicians Advance practice nurses

Clinical nurse specialist Nurse practitioner Certified nurse midwife Certified registered nurse anesthetist Nurse educator Nursing administrator Nurse researcher Nurse entrepreneur

HOSPITALS:Employment of LPN in hospital setting is a high level, because of health care economics, hospitals are responsible for providing quality care as economically as possible. Under the supervision of an RN the LPN is able to provide most bedside care to patient in the hospital setting. The overall management of unit is the responsibilities of a RN salary in a hospital setting typically include shift differential & extra pay for holidays & perhaps weekends benefits tend to be good in the hospitals. Nurses have the opportunity to function on hospital committies .there may be unique positions such as working in infection control or employee health .there a number of different types of hospitals to be considered, some hospitals are trauma centers, specialized surgery, some hospitals have specialized services with different departments.

LONG TERM CARE FACILITIES:The LPN/LVN is the backbone of long term care facilities, they can advance to change nurse & supervisory capacity with RN supervision. They must be used in staff development , recruitment, & and all types of committee work. The nurse management & leadership skills have ample opportunity for development in the long term care setting. Salary are typically higher in long term care facilities than

in hospitals, but this is not necessary the case in all situation. Typically shift differential pay and scheduling alternative are possible. Benefit packages might also be good in the long-term care setting. The long term care facility is just that a facility for those who require long term care. Hospitals no longer are available to patints past the must acute period. Alternative include rehabilitation hospitals if patints qualification are met, home health or a long term care facility. In rehabilitation canters physical, speech occupation & other therapies are available, many patients receive therapy & are able to retun home.Home healthThe degree to which home health opportunities are available to LPNs/LVNs , varies in different part of the united state. The LPNs is capable of providing much of the care required , but RN supervision must be available . the advance of home health care are a more relaxed atmosphere, decreased patient load and a primarily day time schedule. The nurse may be paid on a per case basis, the travel expenses are reimburse, the salary can be good for individual who put in a lots of hours. Continuity of care and a degree of independence are advantages of this type of position. There is also scheduling flexibility, which is hard to find in other position.

Physicians office or clinic-Many physician’s choose to employ an LPNs/LVNs for their office, they prefer to have some with the educational background available to assist them. Salary in offices tends to be lower than that in hospitals and long term care facilities. The benefits package may not be as complete as in the other settings. However the schedule of primarily days with minimal weekends is a definite advantage. There is an opportunity to focus on prevention in these settings & opportunity for patients teaching are also available . Less manual dexterity is required, which might be advantages for some individuals.

Insurance companies: Many insurance companies employ LPNS/LVNs in their pre admission & claims departments. The position are office position with few manual dexterity requirements. Companies usually require experience in medical- surgical nsg before employment. Salary tends to be lower than in hospitals & long term care facilities. However the schedule is usually days with no holidays or weekend work required.

Temporary agencies:There are opportunities available to work for staffing agencies. These agencies provide nurse to meet the staffing needs in a variety of health care facilities. The salary is usually very good but the benefits package may be limited. must be a highly flexible person to be able to adjust to various work settings. Advantages of employment with a temporary agency are the right to refuse and the wealth of variety available. When employed by an temporary agency, have the right to say “no” on a given day when they call and ask you to work. This provides more flexibility in personal schedule.

Travel opportunities:After having some experiences, if interested the nurse can explore opportunity to travel & work for specified period in areas in need of nurses through a type of temporary agency with an expanded area of service. These agencies match employer’s needs with nurses experiences& interest in living in that area for a period of time .Lording is provided in addition to salary. This offers nurses who have the flexibility to travel the chance to visit an area of work for a period of time.

Pharmaceutical sales: Some might be interested in the field of pharmaceutical sales. After having some experience, this might be a field of interest. These companies usually require experience in specific area & an expertise in science & pharmacology. Salary is usually based on sales. There is no direct patient care. Contacts are made

with physicians, pharmacist & nurse in various clinical settings to present the advantages of products & to teach about side effects & precautions.Other medical sales: Opportunities are also available for nurses with companies selling medical supplies. Responsibilities & compensation are similar to those in pharmaceutical sales. Nurses may do in –service programs at facilities to demonstrate product use. Products vary widely, from such items as incontinence products to surgical equipment.

Out patient hotels:In some areas opportunities might be available in hotel settings owned by a hospital. The patient guests stay in type hotel while they undergo testing before surgery. The nurse is available for patient teaching and to assist the guests in any preparation required for the tests. The nurse is also available in case of an emergency. Salary and benefits are the same as those of the hospitals.

Adult day care:Some communities may provide adult day care facilities that require nursing supervision. These facilities are designed for individuals who require medical supervision while their family members work or take a break from the responsibility of care, the place is relaxed & the schedule is excellent the opportunity such a facility affords to the adult requiring the service & their family members can provide a rewarding experience for the nurse.

School nurse: Opportunities may be available in some communities to work as a school health nurse. Health screening, emergency care & health teaching are the major responsibilities. The nurse may function in one school or travel to different schools. Working only during the school year might be an advantages for the nurse who would like to be off summers & can afford to do this.

Public health:

There may be opportunities for nurses in community with the public health department. Responsibilities may include working in clinics & home visits. The nurse may also participate in the health inspections. Teaching is a major area of responsibility. The focus is on prevention. Day schedules are usually available. Salaries tend to be lower than in hospitals & long term care facilities.

Outpatient surgery:A large number of out patient facilities are available especially for out patient surgery. The LPN/LVN may be employed to prepare patient for surgery , as a scrub nurse, or to work in the recovery room under. The supervision of an RN. The facility may be free standing or a part of a hospital complex.

Private duty nursing:The private duty nurse gives total care to one patient. This type of nsg is totally independent nsg care service. Private duty nsg may take place in the hospital, home or other facilities and while travelling abroad or in the united state. When doing private duty nsg, the nurse has to accept not only patient but the family as well . the nurse is paid directly by the patient or responsible person. When the setting for private duty nsg is in a health care facility, the nurse is expected to follow the policies & procedures of that facility. When doing private duty nsg. The nurse are legally responsible for their own actions. The nurse should keep continuous, accurate records of the worked days & payments received. Advantage of private duty nursing is that she may work as many days , she like or may accept a case for as long period of time as she desire

Government nursing: (civil nursing)-The LPNs/LVNs may work in a vitreous administration hospital or other govt. hospitals. Advantages are good salary, good insurance & retirement plans. The disadvantages is that the ratio of nurses is sometime low.

Industrial nursing:

The focus in industrial nursing is on promoting wellness & preventing accidents. Safety is emphasized & usually the nurse is first-aid oriented. The industrial nurse may do physical assessment, health surveys, insurance forms preparation and health education as well as nursing intervention for patients injured in industrial accidents. The LPNs/PVNs will work under the supervision of an RN or a physician dependent on the size of the industrial site, this type of nursing may offer shifts and benefits different from those of other career opportunities. In the field the nurse should have patients, understanding, observational skills and current first aid techniques & principles able to adjust all types of situations.

Rehabilitation nursing :This field requires responsibility for guiding the patient toward health & independence. Advantages are steady employment ,a less formal environment & an opportunity to provide good care.

Psychiatric nursing:Psychiatric nursing requires a mature person (not in years) to handle the responsibilities of the job. This type of nursing may be done in an open unit in a general hospital, outpatient clinic , mental health agency, psychiatric hospital, or institution, advantages are a good salary & advancement in leadership areas.

Hospice nursing:Hospice nsg offers are to terminally ill patients in either an institution or a home setting, usually under the auspices of home health nsg. The qualifications for a hospice nurse are to have a clear understanding of his or her own feelings concerning death and to understand the philosophy of the hospice setting. The nurse closely supports the patient & family without interfering with family interpersonal relationships. Advantages of hospice nursing are steady employment . less formal environment & opportunity ti provide good bedside

care that is concerned with pain relief & comfort measure. Disadvantages are always caring dying patient and the possibilities of having to travel to more than one home each shift.

Clinician: Most nurses enter the profession with the goal of providing direct care. TheNurse providing direct client care accounts for The majority for of practicing nurse. There are increased opportunity for nurses to provide direct in the clients home. The clinical nurse provides direct care to the client , using the nsg process & critical thinking skills. The clinical nurse provides education to the client & family to promote health maintenance & self care In the hospital nurses choose to practice in hospitals such as transplantation rehabilitation, ontology longer medical centers offer mire opportunity to concentrate practice in a single area.Opportunity in the military nursing;Opportunities are available for LPN/LVN in military service. Use of LPN/LVN is increasing in the military just as it is civilian life . active duty & the reserve are options. Benefits in the military are generous. One major benefits is in the area of educational opportunities. Assistance may be given to healp repay loans & may be eligible for assistance with tuition for additional education.

Advanced practice nurse:The advance practice nurse (APN ) is generally the most independent functioning nurse. An APN has a master’s degree in nursing, Advanced education in pharmacology & physical assessment & certification & expertise in a specialized area of practice. The advanced practical nurse may work in primary, acute restorative care settings. The advanced practical nurse function as a clinician educator, case manager, consultant & researcher within his/ her areas of practice, to plan or improve the quality of nursing care for the client & family.

Clinical nurse specialist: the clinical nurse specialist is an advanced practice nurse with nsg expertise in a specialized area of practice & may work in any practice setting. traditionally The clinical nurse specialist has practical most often in the hospital setting. The clinical nurse specialist may specialized in a specific disease, such as dm cancer cardiac problems or in a specific field, such as pediatric. The clinical nurse specialist function as an expert clinician, educator ,case manager & researcher to plan or improve the quality of care provided to the client & family.

Nurse practitioner:A nurse who has an advanced education & is a graduate of a nurse practitioner program. These nurses are certified by the American nurses credentialing center in area such as adult nurse practitioner, family nurse practitioner, school health nurse practitioner,etc. the y are employed in health care agencies or community base settings . They usually deal with non emergency acute or chronic illness & Provide primacy ambulatory care.

Certified nurse midwife:

clinical nurse specialistnurse practitionercertified nurse midwifecertified registered nurse anesthesistnurse researchernurse adminstratornurse educatornurse entrepreneur

A certified nurse midwife is an RN who is also educated in wildlife and is certified by the American college of nurse midwife. The practical of nurse midwifery involves providing independent care for women durig normal pregnancy, labor & delivery: as well as care for the newborn. It may include some gynecological service such as routine, pap smear, family planning & treatment for minor vaginal infections. A certified nurse midwife practice with a health care agency that provides medical consultation, collaborative management & referral.

Certified registered nurse anesthetist:A nurse who has completed advanced education in an accredited program in anesthesiology. The nurse anesthetist carries out proper active visit & assessments & administers general anesthetics for surgery under the super- vision of a physician prepared in anesthesiology. The nurse anesthetist also assess the post operative status of clients.

Nurse researcher:Nurse researcher investigate nursing problems to improve nsg care & to refine & expand nsg knowledge. They are employed in academic institution, teaching hospitals & research centers such as the national institution for nursing research in Bethesda, Maryland. Nurse researchers usually have advanced education with at lest a master’s degree in nsg and at the doctorate level.

Nurse administrator:The nurse administrator manages client care, including the delivery of nsg services. The administrator may have a middle management position, such as head nurse or supervisor or a more senior management position, such as director of nsg services. The functions of nurse administrator include budgeting, staffing & planning programs. The educational preparation for nurse. Administrator position is at least a B.Sc.(N) degree in nsg & freqently a master or doctoral degree.

Nurse entrepreneur:A nurse who usually has as advanced degree and manages a health related business. The nurse may be involved in education consultation or research etc

Professional Advancement The Nursing Professional Advancement System or Clinical Ladder is a 4-tiered performance-based career advancement system that provides a professional framework for developing, evaluating, promoting and rewarding RNs who are in direct patients care.

Purpose

Provide opportunity for nurses have choice to move beyond entry level role based on interest in professional development & increasing responsibility & accountability for leading nursing practice & care delivery.

Objectives

Enhance the professional growth & development. Provide recognition for professional contributions. Encourage involvement of bedside nurse in decisions that support / enhance patient care outcome.Provide motivation for direct care nurses to pursue higher education , certification other professional achievements.

Professional Growth Nursing has programs in place to encourage life-long learning and long-term professional growth.

Nursing Orientation Educational Opportunities Internship Program Shared Leadership Councils Local, Regional and National Conferences National Certification Nursing Grand Rounds Professional Advancement Program (Clinical Ladder) Fellowships Simulation Learning Center

Nursing Orientation Each nurse receives an introduction and overview to the goals, policies, procedures, and traditions of the Department of Nursing. This allows for successful integration into the nursing culture and system of patient care delivery

Educational Opportunities The Department of Nursing offers a broad range of educational activities and events at the hospital to provide research and evidence-based information on relevant patient care and health services-related topics. The department also provides opportunities for nurses to attend educational programs at institutions of higher learning to further their professional goals.

Shared Leadership Councils Shared Leadership Councils within the Department of Nursing and at the unit/department level provide the opportunity for staff nurses to take part in shared decision making. Shared decision making benefits all parties—staff nurses, leadership nurses, physicians, and most importantly our patients.

Local, Regional and National Conferences Nurses at Children’s can apply to attend local, regional and national professional conferences to enhance personal and professional development and to share information with their peers.

National Certification nurses are encouraged to seek national specialty certification from accredited nursing organizations. These certifications validate that an RN is practicing excellent patient care with exceptional patient outcomes.

Nursing Grand Rounds These clinical development programs help registered nurses build clinical knowledge and skills. The programs are targeted toward but not limited to registered nurses who work on inpatient units.

Professional Advancement Program (Clinical Ladder) The professional development clinical ladder allows nurses to advance in their career without leaving the bedside, and therefore is a means by which RNs can continue to advance their clinical skills and be promoted. The program acknowledges the value of the expert nurse at the bedside and how they can

positively affect patient outcomes.. It provides for an additional level of prestige, respect, and job satisfaction for the bedside RN.

Fellowships The Neonatal Critical Care Fellowship Program, Critical Care Nursing Fellowship Program and Perioperative Nursing Fellowship Program are available to those seeking advanced clinical experiences tailored to specific interests and learning needs. The length of the fellowships varies depending on the specialty.

The Simulation Learning Center

Clinical Simulation is a practical and necessary method of teaching/learning and evaluating competence. Simulation allows the adult learner to be self-paced, receive immediate feedback and develop critical thinking skills, and provides for knowledge reinforcement. Simulation facilitates learning through enactment and imitation of a condition or situation using computer driven manikins that mimic human symptoms and provides responses to caregiver actions.

Simulation Technology Instructor Development

Best use of simulation technology is accomplished when educators fully understand the application of the technology as well as the methods for development of clinical ‘scenarios’. The learning site consist of 9 modules: (1) Designing and Developing Simulations, (2) Debriefing and Guided Reflection, (3) Guidelines for Simulation Research, (4) Teaching and Learning Strategies (5) Integrating Concepts into Simulations, (6) Evaluating Simulations, ( 7) Curriculum Integration (8) Programming a High-Fidelity Simulator, (9) Designing a Simulation Center.

Professional advancement model

The Professional Advancement Model is designed to recognize and reward nurses based on their professional contributions to advancing the practice and profession of nursing. The Model focuses on the continuing professional growth and development of the nurse with emphasis on involvement at the unit level and contributions within the medical center and beyond. Advancement requires the nurse to meet defined criteria related to clinical practice/care delivery, professional development, quality/safety, and unit operations.

Model ComponentsThe Professional Advancement Model contains four roles:

1. Clinical Nurse I (CN I);2. Clinical Nurse II (CN II);3. Senior Clinical Nurse I (SCN I), and4. Senior Clinical Nurse II (SCN II).

Professional Advancement Model Roles

ROLES General Description Core Requirements

Clinical Nurse I

This role is reserved for the new grad or nurse with less than 12 months experience. The nurse will utilize this time to learn the institution and nursing practice. It is expected that a nurse in this role successfully pass the probationary period within 6 months (12 months maximum with a defined action plan developed with manager).

New hire/new graduate

Clinical Nurse II

This role is considered the minimum role for all nurses who have greater than 12 months experience. This nurse will be competent in the skills/knowledge required

“Competent” evaluation with successful passing of probation; current on all mandatory classes/training

Member of a professional organization.

Note: For all roles, continuing education can be achieved through

and fully participate in unit governance. He/she will practice and adhere to the guidelines specified in the Professional Nurse Job Charter.

conferences, in-services, formal unit education, Journal Clubs, Nursing Grand Rounds, nursing college classes, etc.

Sr. Clinical Nurse I

This role is aimed for the nurse who is a clinical and professional leader at the unit level. He/she advances evidence based practices, leads unit governance initiatives, and mentors others to achieve and grow in the role of the professional nurse.

Member of a professional organization.

Demonstrated evidence of professional growth and development through:

enrollment in degree program, specialty certification, teaching in formal hospital programs or outside of hospital, board member of professional association, etc.

Senior Clinical Nurse II

This role is designed for the nurse who has achieved expertise and leadership in the clinical and professional role, within the unit and beyond. He/she leads and evaluates evidence based practice, actively participates and/or leads organizational initiatives, mentors and coaches nurses and other disciplines, exemplifies the role of the professional nurses and demonstrates

Member of a professional organization.

Bachelor’s degree required.- must have a Bachelor’s * degree or active enrollment with graduation within 5 years of promotion - External candidates must have BSN.

In addition to Bachelor degree, must have one of the following:

Specialty certification (active) Master’s degree or enrollment in

Master’s Program with graduation

active involvement in clinical and professional nursing beyond the walls of the unit and/or organization.

Roles and Functions of the Nurse

A nurse is a health care professional who is engaged in the practice of nursing. Nurses are responsible—along with other health care professionals—for the treatment, safety, and recovery of acutely or chronically ill or injured people, health maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-clinical functions necessary to the delivery of health care1.

The Roles and Functions of a Nurse

Extended role of a nurse• Care Provider• Communicator• Teacher• Counselor• Client Advocate• Change Agent• Leader• Manager

• Researcher• Case Manager• Collaborator

Caregiver/ Care provider –

the traditional and most essential role

functions as nurturer, comforter, provider “mothering actions” of the nurse provides direct care and promotes comfort of client activities involves knowledge and sensitivity to what matters and what is

important to clients shows concern for client welfare and acceptance of the client as a person

.Communicator/Helper

The nurse communicates with clients, support persons and colleagues to facilitate all nursing actions.

Teacher –

provides information and helps the client to learn or acquire new knowledge and technical skills

encourages compliance with prescribed therapy. promotes healthy lifestyle interprets information to the client

Counselor-

helps client to recognize and cope with stressful psychologic or social problems; to develop an improve interpersonal relationships and to promote personal growth

provides emotional, intellectual to and psychologic support focuses on helping a client to develop new attitudes, feelings and behaviors

rather than promoting intellectual growth. encourages the client to look at alternative behaviors recognize the choices

and develop a sense of control.

Change agent-

initiate changes or assist clients to make modifications in themselves or in the system of care.

Leader

The nurse through the process of interpersonal influence helps the client make decisions in establishing and achieving goals to improve his well-being.

Client advocate-

involves concern for and actions in behalf of the client to bring about a change.

promotes what is best for the client, ensuring that the client’s needs are met and protecting the client’s right.

provides explanation in clients language and support clients decisions.

Manager –

makes decisions, coordinates activities of others, allocate resources, evaluate care and personnel

plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed .

Researcher –

participates in identifying significant researchable problems

participates in scientific investigation and must be a consumer of research findings

must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects.

Communicator/Helper

The nurse communicates with clients, support persons and colleagues to facilitate all nursing actions.

Case Manager

The nurse coordinates the activities of other members of health care team, Such as nutritionists and physical therapist, when managing a group of client’s care.

Collaborator

The nurse works in a combined effort with all those involved in delivery, for

a mutually acceptable plan to be obtained that will achieve common goals.

The nursing initiates nursing actions within the health team.

Expanded role of the nurse

1 Clinical Specialist

2. Nurse Practitioner-

3. Nurse-midwife

4. Nurse anesthetist

5. Nurse Educator-

6. Nurse Entrepreneur-

7. Nurse administrator

8. nurse researcher

1 Clinical Specialists-

is a nurse who has completed a master’s degree in specialty and has considerable clinical expertise in that specialty. She provides expert care to individuals, participates in educating health care professionals and ancillary, acts as a clinical consultant and participates in research.2. Nurse Practitioner-

is a nurse who has completed either as certificate program or a master’s degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P. E., counseling, teaching and treating minor and self- limiting illness.

3. Nurse-midwife-

a nurse who has completed a program in midwifery; provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies.

4. Nurse anesthetist-

a nurse who completed the course of study in an anesthesia school and carries out pre-operative status of clients.

5. Nurse Educator-

A nurse usually with advanced degree, who beaches in clinical or educational settings, teaches theoretical knowledge, clinical skills and conduct research.

6. Nurse Entrepreneur-

a nurse who has an advanced degree, and manages health-related business.

7. Nurse administrator- a nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care

CAREER OPPORTUNITIES Content

Career opportunity

Introduction There are many job opportunities for nurses such as-

Hospitals Long term care facilities Home health Physicians office or clinic Insurance company Temporary agencies Travel opportunity Pharmaceutical sales Other medical sales Outpatients hotel Military nursing Adult day care School health nurse Public health Out patient surgery Private duty nursing Government nursing Industrial nursing Rehabilitation nursing Psychiatric nursing Hospice nursing Clinicians Advance practice nurses

Clinical nurse specialistNurse practitionerCertified nurse midwifeCertified registered nurse anesthetistNurse educatorNursing administratorNurse researcherNurse entrepreneur

Professional advancement Introduction Purpose Objectives Professional growth Professional advancement model

Model component Role & scope of nursing education

Extended nursing role Expanded nursing role Summary Bibliography