In this world of interdisciplinary healthcare, it is important that we understand who we work with and trust as our clinician partners. The role of the nurse has expanded over the decades and we should not assume understanding of this role simply when hearing, "I’m a Nurse".
Nurses are differentiated primarily by education, licensure, and specialty. From entry level to terminal degree, the following will provide an overview of the variety of nurses we may encounter.
Licensed Vocational | Practical Nurses (LVN or LPN)
These nurses are often educated in 3 semesters at adult schools or community colleges. They are prepared to delivery quality patient care and some medication management. Activities of the LVN or LPN may require oversight by a Registered Nurse.
Registered Nurse (RN)
Associate Degree Nurse (ADN)/Diploma-This RN is educated in approximately 3 years, typically at a community college and has a technical focus. Proficiencies include patient care at all levels, development of a nursing plan of care, and can lead a team of nursing staff (e.g., charge nurse).
Bachelor of Science, Nursing (BSN): This RN is educated in approximately 4 years, typically at a college or university. Preparation includes introduction to research concepts, leadership, and theory. This degree is often considered the first level of the "Professional Nurse". Many healthcare facilities will now only accept BSN level or higher for their nursing leadership positions.
Master of Science, Nursing (MSN): This degree confers a wide range of different career paths for the RN. The following are some of the more common designations for these specialized nurses:
- Nurse Practitioner (NP)– A R)-Aegistered Nurse who has a clinical license to diagnose and prescribe. They will often work under the direction and supervision of a physician or surgeon. Nurse Practitioners can further specialize, as in Pediatric Nurse Practitioners (PNP) or Family Nurse Practitioners (FNP).
- Clinical Nurse Specialist (CNS) – A Registered Nurse who has acquired advanced training in a specific area of healthcare. Several years of work experience is usually required before being accepted into a CNS program. Clinical Nurse Specialists will often assess and treat a single type of patient, provide patient and staff education, and develop nursing policies.
- Certified Registered Nurse Anesthetist (CRNA) – A Registered Nurse who supports the Anesthesiologist. The CRNA may perform pre-surgical patient assessments, deliver anesthesia under the supervision of an Anesthesiologist, and round on patients post-operatively.
- Nurse Administration and Nurse Education – These are other professional options for the MSN prepared Registered Nurse. The Administrator role focuses on nursing leadership, healthcare structure, regulations, and reimbursement. The Educator role prepares the Registered Nurse to teach in Schools of Nursing and develop training curricula and programs.
There are many other certifications and professional nursing roles that can be acquired at the BSN and MSN levels. Furthermore, many nurses have found benefit in obtaining complementary education with degrees in Law, Business, Public Health, etc.
Terminal Nursing Degrees
Currently the most accepted Doctorate level of Nursing education would be the Ph.D in Nursing and the Doctor of Nursing Practice (DNP). Nurses with Ph.D’s typically focus on nursing theory, research, and education. Nurses who acquire the DNP tend to influence how patient care is delivered and seek to improve patient outcomes.
The American Medical Association has formally expressed their concerns regarding possible misrepresentation of Nurse Doctoral Programs offering the DNP. These concerns include confusion among patients when non-physician staff refer to themselves as "Doctor" as well as standardizing education requirements for the DNP.
Nurses represent a significant segment of healthcare professionals, and continue to take on more advanced roles. Understanding their background: education, licensure, and specialty, will improve our ability to develop a collegial, professional relationship.
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