Levels of Nursing (page 4)
When it comes to planning a nursing career, few factors are more confusing than the different levels of nursing: practical nursing, registered nursing, and advanced practice nursing.
Licensed practical nurses (LPN), also called licensed vocational nurses (LVN) in some states, care for patients under the direction of physicians and registered nurses. Most are generalists, working in all areas of healthcare, but some work in specialized settings. According to the Bureau of Labor Statistics, LPNs held about 749,000 jobs in 2006, with about 26% of LPNs working in hospitals, 26% in nursing care facilities, and 12% in physician offices. Others worked for home healthcare services; employment services; residential care facilities; community care facilities for the elderly; outpatient care centers; and federal, state, and local government agencies. About 19% of LPNs worked part-time.
LPNs in the workforce tend to fit in one of three categories: (1) those who had no formal education and who completed state-approved courses that qualified them to become licensed; (2) those who were licensed through "grandfathering" (exempt from new licensure rules); and (3) those who graduated from approved schools and have passed a licensure examination. In most states, those wishing to become LPNs today must graduate from an approved practical nurse program and successfully pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN) examination. However, there are exceptions. In California, you can become an LVN by completion of equivalent education and experience: 54 hours of pharmacology, 51 months of paid bedside nursing experience and verification of skill proficiency, or completion of education and experience as a corpsman in the U.S. military—12 months of active duty rendering direct bedside patient care, completion of the basic course in nursing in a branch of the armed forces, and general honorable discharge from the military. Those seeking to become LVNs via these alternatives must still take and pass the NCLEX exam.
LPNs often provide basic bedside care. They gather information from clients, including their health history and present state of health, sometimes using this information to complete medical charts, insurance forms, preauthorizations, and referrals, and they share this information with registered nurses and physicians to help determine the best plan of care for the client. LPNs measure and record clients' height, weight, temperature, blood pressure, pulse, and respiration. They assist clients with bathing, eating, dressing, personal hygiene, and mobility. LPNs collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. Some LPNs help to deliver, care for, and feed newborns; some care for children; others care for the elderly. In physicians' offices and clinics, LPNs may be responsible for making appointments, keeping records, and performing other clerical duties. Those who work in home healthcare may prepare meals and teach family members how to perform simple nursing tasks. In some states, LPNs are permitted to administer prescribed medicines, start and monitor intravenous (IV) fluids, and provide care to ventilator-dependent patients.
With numbers around 2.5 million, registered nurses (RNs) constitute the largest healthcare occupation. Men and women become registered nurses by completing a diploma, associate degree, or baccalaureate degree program and taking the National Council Licensure Examination for Registered Nurses (NCLEX-RN). RNs treat individuals, families, and groups, educate them about various medical conditions, and provide counseling and emotional support. RNs establish or contribute to a plan of care for each client. Care plans may include activities such as administering medication and assessing for effectiveness and reaction; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treatments; observing the patient and recording client care and interactions; and collaborating or consulting with other members of the healthcare team. RNs provide supervision to licensed practical nurses and nursing aides regarding patient care. RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority.
RNs can specialize in one or more areas of patient care. They can choose a particular work setting, such as the operating room, emergency center, or even a prison, or they can choose to work with clients who have a specific problem, as do diabetic nurse clinicians or wound care nurses. Some nurses focus on specific body systems, such as cardiac care or head trauma, while still others work with specific populations, including children (pediatric nursing), the elderly (gerontological, or geriatric, nursing) or women's health. Many RNs combine two of these areas, working in specialties such as pediatric oncology (children with cancer) or geropsychiatric nursing (elders with psychiatric problems including Alzheimer's disease). Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer.
Advanced Practice Nurses
Advanced practice nurses (APNs) are registered nurses with additional education, skills, and scope of practice. They deliver high-quality, cost-effective care, particularly to underserved populations, often performing physical examinations, ordering tests, making diagnoses, and prescribing medications. Most APNs possess a master's degree; however, the American Association of Colleges of Nursing (AACN) member institutions voted to change the current level of preparation for advanced nursing practice from the master's degree to the doctorate level by the year 2015.
APN is an umbrella category that includes nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists:
- Nurse practitioners deliver primary or acute care in clinics, private offices, hospitals, schools, workplaces, and other settings. They perform activities such as conducting physical exams, providing immunizations, diagnosing and treating common illnesses and injuries, and managing common chronic illnesses.
- Clinical nurse specialists provide direct and indirect specialty nurse care to specific patient populations.
- Nurse midwives provide prenatal and gynecological care to healthy women and deliver newborns in hospitals, homes, and birthing centers. They also provide care to the mothers and babies after birth.
- Nurse anesthetists administer more than 65% of anesthetics given to clients each year and are the sole providers of anesthesia in approximately one-third of U.S. hospitals.
Most advanced practice nurses can prescribe medications in all states and the District of Columbia, and many can practice independently without physician collaboration or supervision in several states. Several studies have shown that APNs provide care that is equal to or better than comparable care given by physicians, and they do so at lower cost.
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