Health care careers

Persons who are trained to do basic nursing tasks but who do not require a license are called

unlicensed nursing personnel.

State laws vary, but the title of Certificated or Certified Nursing Assistant (CNA) is most often used. This does not require a high school diploma, but does require 75 hours of training and passing a competency

evaluation of knowledge and skills testing.

The CNA may work in a hospital, nursing home, or residential care facility. They take orders and are supervised by licensed nurses. They tend to have more personal contact with clients than any other

care provider.Client safety and

confidentiality are primary concerns.

Accurate written and verbal

communication are very

important.

CNAs sometimes work in acute care facilities such as hospitals, where the client’s stay is usually short-term.

They answer call lights; get rooms ready for new

admissions; tidy patient’s rooms and make beds;

deliver messages, supplies, and equipment; serve and

assist with meals; assist with personal care, toileting,

bathing, oral care, skin care, and shaving; take and report

vital signs; and help with patient ambulation.

CNAs sometimes work in long-term care facilities. A nursing home would be an example.

Additional duties in this type of facility

may include emptying bedpans,

cleaning incontinent patients, reporting changes in mental status or self-care

capabilities.

CNAs sometimes work in residential care facilities. The

clients here are able to take care of many of their own needs. An assisted living

facility would be an example.

In this setting, the CNA may be responsible for assisting with medications, assisting with client

outings for shopping or appointments, or providing transportation to appointments.

Home health aides or CNAs sometimes provide home health

care. The client can still live safely in their own homes, with

some assistance.

The home health aide may do all tasks of the CNA, assist with

medications, assist with personal care such as cooking, eating,

bathing, dressing, light housekeeping, laundry, changing

linens, shopping, or driving to appointments.

Technicians work primarily with equipment; technologists work primarily with people.

One example of an technician would be the dialysis technician. This person operates kidney dialysis

machines that artificially filter a client’s blood in the case of kidney failure. They would set up, operate, and

clean the machine, be exposed to blood, work with seriously ill clients, administer local anesthetics, etc.

A surgical technologist may work as part of a team, performing sterilization procedures, setting up

equipment, preparing the surgical site on the patient, handing instruments to the surgeon or their assistant,

transporting patients to recovery, restocking surgical

suites, etc. They would be exposed to unpleasant sights,

odors, and materials during procedures.

Licensed nursing personnel complete post-secondary training and pass a test. They are

licensed through a state agency; they are held accountable through standards; they belong to

professional groups; the more training they have the more duties and higher pay they have.

The Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) completes 1-2 years of

classroom and clinical training. They practice under the supervision of a physician or registered nurse.

An LPN takes vital signs, treats bedsores,

administers injections and medications, gives

enemas, applies dressings, icepacks, and

hot water bottles, and inserts and cares for

urinary catheters.

The LPN also assesses clients for effects of

medications and treatments, assists with meals, records

intake and output, helps with personal needs, helps with

emotional needs of patients, assists with the delivery of infants, cares for and feeds infants, supervises CNAs,

evaluates client needs, makes appointments and keeps

records, and teaches patients how to care for themselves.

Registered nurses (RN) must complete a pathway of study, getting a diploma in 2-3 years, an

Associate degree in 2 years, or a Bachelor of Science degree in 4-5 years.

Each state has its own licensing requirements,

but the RN passes a national licensing

exam. Advancement, management, and

teaching positions may require a Bachelor’s

degree.

RNs work independently or in team settings with

the physicians, therapists, medical

social workers, aides, and dieticians.

RN responsibilities range from basic client care to administrative duties. The RN is always a patient ‘advocate’… meaning they represent the needs of

the client. All communication skills, including speaking, listening, and writing, are critical.

Hospital RNs provide the same patient care as LPNs; provide bedside nursing care; start IV infusions, carry out medical procedures and

regimens as ordered by physicians; and supervise LPNs and unlicensed nursing personnel.

Physician office RNs provide care for clients in an

outpatient setting; prepare clients for examinations;

assist physicians with examinations; administer

injections and IV solutions; perform wound care; assist

with minor surgeries; maintain documentation,

and perform routine specimen collection and lab

work.

Nursing Home RNs manage the nursing care for the patients; fill management positions,

participate in staff education; handle administrative and supervisory duties, and

assess clients’ medical conditions.

Home Health Care RNs provide periodic care to clients in their

home; assess the home environment for safety, teach clients

and their family members how to care for themselves; supervise the

home health aide or LPN.

Public Health RNs work in a community

setting; they work with selected populations to improve the health of the community at large, educate family members in health

maintenance, disease prevention, nutrition, and child care; and

provide health screenings.

Occupational or Industrial RNs provide workplace care to employees and customers; assess and

educate workers and management on health hazards found in the workplace; and assist with

health examinations for employees.

Head nurses or supervisory RNs manage nursing departments; plan work schedules and assign

duties; plan and monitor the budget; supervise all personnel; maintain all required records.

Registered nurses who successfully complete additional training may obtain an advanced

practice certificate or degree. They provide basic medical care, diagnosing and treating common

ailments.

Nurse practitioners are

allowed to prescribe

medications with the

approval of a physician.

Clinical nurse specialists are RNs who specialize in a specific nursing area such as

gerontology or neonatology.

Certified RN anesthetists have additional training in

the use of anesthesia. They work in surgical settings

under the supervision of an anesthesiologist or

physician.

Certified nurse midwives are RNs who assist with the delivery of infants,

having training and expertise in the delivery

process.

The patient comes first. Willingness to be a lifelong learner. Compassion for others. Nurturing.

Empathetic. Able to observe confidentiality. Skillful. Confident. Does not judge people with different

lifestyles, income levels, and beliefs. Professional demeanor. Excellent personal hygiene.

Ability to work with people who are not at

their best, because they are afraid, ill, or injured.

High tolerance for unpleasant bodily sights,

odors, and functions. Able to follow directives.

Communication is the exchange of information, ideas, feelings, and thoughts.

Communication helps us know what the needs of others are and how to meet those needs.

Healthcare workers must be able to communicate with patients, families, co-workers, other

professionals, and supervisors.

Nonverbal communication is important:Eye Contact – lets others know you’re listeningFacial Expressions – match your facial expression to the verbal messageGestures – shrugging your shoulders, turning your back, or leaving the room while someone is talking all convey lack of interest.Touch – conveys great caring or rejection

Reflect on what the sender is trying to say – think about the message, and avoid thinking about your response.Restate (paraphrase) back to the sender to let them know they are being heard and understood.Ask for clarification if you do not understand part of the message.

Prejudices - biasesFrustrations - Impatience, annoyance, anger, irritation.Attitudes - Disinterest, bored, bad moods.Your own Life Experiences Labeling people – lazy, stupid, complainer, etc.Sensory Impairment – deaf, blind, speech impairedTalking Too Fast

1. Acknowledge (greetings, eye contact, smile)2. Introduce (give your name and role)3. Duration (inform patient of anticipated wait times)4. Explanation (what can patient expect)5. Thank You

Use your senses to make observations.Sense of sight: color, swelling, a rash or sore, amount of food eatenSense of smell: body odor, unusual breath, wound, urine, or stool odorsSense of touch: pulse, dryness or temperature of the skin, perspiration, swellingSense of hearing: listen to respirations, abnormal body sounds, coughs, and speech.

Subjective Observations are those that cannot be seen or felt. They are ideas, thought, or opinions. They are commonly called symptoms, and are usually statements or complaints made by the patient. (report them in the exact words used by the patient).

Objective Observations can be measured, seen, felt, heard, or smelled. They are commonly called signs.

Documentation must be accurate, concise, complete. Writing should be neat and legible.

Spelling and grammar should be correct. All documentation must be signed with the name and title of the person recording the information.Errors should be crossed out neatly with a straight line, have “error” recorded by them, and show the initials of the person making the error.Patient documentation is a legal record, admissible in a court of law. If you do not write it down, it did not happen!Use ink for all documentation.Entries should be in short phrases. No need for complete sentences. Use technical writing.Time should be recorded in military (24 hour) time.Complete an entry by drawing a line to the end.

Client complained of slight headache at 2 p.m.

Client complained of slight headache at 2 p.m

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Robert L. Kramer, RN

Robert L. Kramer, RN