1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 27 Emerging Opportunities

3. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Discuss the many nursing opportunities available upon graduation. Discuss advanced nursing practice and other nontraditional nursing roles. Identify various opportunities for certification. Review hospital and nonhospital based nursing practice. Identify directions for the future.

4. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company4 Nontraditional Emerging Opportunities  For nurses who remain in traditional settings, opportunities exist to receive certification in specialized areas.  Certification is the process by which a nongovernmental agency or association certifies that an individual licensed to practice a profession has met certain predetermined standards specified by that profession for practice.

5. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company5 Sample List of Certifying Organizations  ANCC American Nurses Association Credentialing Center  NAPNAP National Association of Pediatric Nurse Associates and Practitioners  ACCN Association of Critical Care Nurses  AWONN Association of Women's Health Obstetrics and Neonatal Nurse

6. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company6 Sample List of Certifying Organizations  NANN National Association of Neonatal Nurses  WOCN Wound, Ostomy, and Continence Nurses Society  AANA American Association of Nurse Anesthetists

7. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company7 Possible Areas of Specialization  Neonatal  Pediatric  Adult medical/surgical  Women's health  Obstetrics/gynecology  Psychiatry  Dermatology  Case management  Renal  Critical care  Emergency room  Clinical nurse specialist  Nurse practitioner  Nurse anesthetist  Nurse midwife  Nursing informatics

8. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company8 Traveling Nurse  Travels to various locations throughout the United States  Usually works in 3-month assignments on the same unit  May receive a similar or higher salary compared to salaries of fellow employees  Needs to be aware of differing nursing methodologies and licensure requirements from state to state

9. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company9 Traveling Nurse  Requires a license for each state in which he or she will practice  Should ensure that contract says exactly what the assignment will be regarding expectations of the institution and agency

10. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company10 Representative for Pharmaceutical Company, Home Care, or Nursing Agency  Affords the nurse a perspective on corporate America and the workings of the business world  Often involves salary enhancements or perks  Allows for a certain level of independence  May present difficulties in meeting sales quotas, providing for customers, or surviving the ups and downs of the business world

11. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company11 Case Manager  This new delivery of care method includes providing and coordinating care across the continuum of prevention, wellness, acute care, rehabilitation, long- term, hospice, and respite care.  The nurse case manager should have at least a baccalaureate degree and expert clinical skills; should possess knowledge of the health care system, health care finances, and legal issues; and should be an effective communicator.

12. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company12 Nurse Entrepreneur  Many nurses are becoming entrepreneurs in a variety of consultative, educational, and technical areas.  Advantages: Independence Job satisfaction Flexibility Choice

13. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company13 Nurse Entrepreneur  Disadvantages: Competition Volatility Lack of provided benefits Must learn to develop and follow a business plan

14. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company14 Advanced Practice/Expanded Role Emerging Opportunities  Advanced practice nursing builds on the foundation of professional nursing practice and responds to the developing health care needs of the United States.  In advanced practice nursing, the nurse may: Assess patients, synthesize and analyze data, and understand and apply nursing principles at an advanced level Provide expert guidance and teaching Work effectively with patients, families, and other members of the health care team Manage patient's physical and psychosocial health-illness status

15. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company15 Advanced Practice/Expanded Role Emerging Opportunities Use research skills Analyze multiple sources of data, identify alternative possibilities as to the nature of a health care problem, and select appropriate treatment Make independent decisions in solving complex patient care problems Perform acts of diagnosis and prescribe therapeutic measures consistent with the area of practice Recognize limits of knowledge and experience, plan for situations beyond expertise, and consult with or refer patients to other health care providers as appropriate

16. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company16 Advanced Practice Nursing: Types of Expanded Roles  Wound, ostomy, continence nurse specialist Clinical expert in managing patients with ostomies, alterations in skin integrity, and wounds  Flight nurse Provides care to infants, children, and adult patients while performing a variety of therapeutic interventions requiring independent decisions; also provides education to outlying communities and serves as a volunteer in emergency situations

17. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company17 Advanced Practice Nursing: Types of Expanded Roles  Nurse anesthetist: certified registered nurse anesthetist (CRNA) Takes care of the patient’s anesthesia needs before, during, and after surgery and other procedures, either alone or in conjunction with other health care professionals  Certified nurse midwife (CNM) Delivers newborns; also provides health education, including teaching of self-care skills and preparation for childbirth and childrearing

18. Chapter 27Copyright © 2003 Delmar Learning, a Thomson Learning company18 Advanced Practice Nursing: Types of Expanded Roles  Clinical nurse specialist (CNS) A registered nurse with an advanced nursing degree, master’s degree, or doctorate who is an expert in a specialized area of clinical practice  Nurse practitioner (NP) An advanced practice nurse who has education beyond the bachelor’s degree in a clinical specialty area strongly focused on primary care, though some subspecialties are hospital-based  Clinical nurse specialist/nurse practitioner (CNS/NP) Combines qualities of both specialties