Utah Nurse

Utah Nurse: The Official Publication of the Utah Nurses Association. Utah Nurse has been published quarterly since 1946 for the Utah Nurses Association, a constituent member of the American Nurses Association. Sent to RNs and LPNs throughout Utah, Utah Nurse provides a forum for members to express their opinions and become aware of healthcare issues in the state of Utah.

Official Publication of Utah Nurses' Association CONVENTION '74 CONVENTION f74 UNITED FOR ACTION AMERICAN NURSES' ASSOCIATION CONVENTION '74 JUNE 9-14 SAN FRANCISCO UTAH NURSES' ASSOCIATION CONVENTION '74 MAY9,10,11 Tri Arc Travelodge Salt Lake City Winter, 1973-7 4 Vol. 25 No. 1 Editorial - Professional Nursing Today IJtah Nurse Vol. 25 Winter, 1973 -74 No. 1 OFFICIAL PUBLICATION of the UTAH NURSES' ASSOCIATION 1058 E. 9th South Salt Lake City, Utah Phone [phone] Execut ive Ed itor ... CORALLENE McKEAN 1058 East 9th South Salt Lake Ci ty, Utah 84 105 Assistant ANNETTE J. BIGLER 11 " A" Street Apt. 36 Salt Lake City, Utah 841 02 Table of Contents Page Edi to rial 3 .. . Statement on Instit utional Licen sure 4 Massachusetts Nurses' State Board . 5, 6 Challenge Exa mination . . 7 100% Mem be rship Club 7 . 8, 9, 10 School Nurse Pra ct itioner 10 Job Opportunity . . . Mate rn al-Child Nursing Standards .. 11 , 12 From Samoa .......... . . Operating Ro om Standa rds 12 .. 13, 16, 17 UNITED FOR ACTION Convention Prog ram .... ... .. .. 14, 15 Where Are We In 1973? ... 18, 19 Primary Care Statem ent . ..... .... 20 , 21 , 22 , 23 , 24 Primary Care Nurse Practitio ners .. 25 , 26 Psychiatric Workshop . ... . 28 Profession al nursing tod ay is the result of crea tive ideas, corporate en ergy and labor of all those dedica ted and committed nurses of the past. This is an obvious statement yet it is remarkab le how rarely it is recognized and given cred ence by todays contemporary nurse practitioners, directors and edu ca tors. Neverthe-less, is a n essential component of the art and sci_en ce of nu rsin g. Throughout the history of nursing right clown to the present including modern clay times, persons both inside a nd outside the profession have struggled and will probably continue to struggle with the n eed to define nursing in expli cit terms. In our rapidly changing fluid society, the b est a nd most relevant definition would appear to b e "N ursing consists of everything clone by a knowledgeable, compe tent, and qualified r egistered nurse". To some, this definition m ay appear face tious, but to those nurse practitioners who understand their ca pab ilities, a nd who function judiciously according to their knowledge, judgment and skill, it seems a perfectly logical d efinition. Individu als h ave enoneo us ry interpreted the u se of speci fie tools su ch as the stethoscope, otoscop e, ophthalmoscope, and vaginal speculum, as well as, techniqu es of palpation a nd p ercu ss ion as exclusively id entified with the m edi ca l practitioner. It is foolish to think that the use of tools or techniques identifies a competent m edi ca l pra ctitioner; in reality, the a pplicat ion and impl em entation of acquired m edi ca l kn ow)- edge is th e tru e criterion b y whi ch an individual should be d eemed qualified to practi ce med icine. In th e d elivery of h ea lth care to the publi c, n o one p er son or group of persons ca n sta ke out a boundary in this ch angin g society which cl early, spec ifica ll y a nd adequ ately disting ui shes medi ca l science from the science of nursin g. The fields overla p each other, th e bound aries continu all y shift in keeping with th e progress being m ade in each science. Physicia ns and nurses m ay well u se the sa me tools and techniques but each physician a nd nurse does so within the co ntext of hi s own realm of knowledge. T hu s, when a physicia n does a n examination or an eva luation, it is medi ca l prac tice; in essen ce h e is applying and implem enting hi s acquired m ed ica l knowledge. Likewise, when a nurs~ tloes a n examination and evaluation, h ej she is usin g hi sj h er acquired nursing knowl edge, therefore, it is nursing practice. In ac tu ality, th e demands for h ealth care are so great and diversifi ed tha t littl e eHort or concern should be ex pend ed b y either the practicing physician or the m~rs~ pra ctition er to worry ?ver a d ~ h_m­ tion. If each professiOn, m ed1cm e and nursing, were to m aximize its efforts toward s the achievement of its expressed prim ary goal, n amely tha t of providing optimum care to the p atient, not only the publi c but the profession itself would reap great r ewards. HAPPINESS IS ... NURSING AT THE COTTONWOOD LOS HOSPITAL • A 154-bed progressive, dynamic acute hospital • A suburban setting located at 5770 South Third East- Murray, Utah ,l\d~ertiser Am erican Fork Hospital . . . . . . . . . . . . . 17 Coca Cola . . . . . . . . . . . . . . . . . . . . . . . . 2 Cottonwood Hospital . . . . . . . . . . . . . . . . 3 Health Service Corp. 5 Holy Cross Hospital 19 Hyla nd Pharmacy . . . . . . . . . . . . . . . . . 11 Midgley Manor, Inc. . . . . . . . . . . . . . . . . Quality Press . . 8 18 Unive rsity Utah Med. Cent. 6 Vall ey West . . . . . . . . . . . . . . . . . . . . . . 9 Wasatch Vill a Conval . W INTER , 1973-74 • A friendly place to work Rewarding and challenging Opportunities in Medical, Surgical and Obstetrical Nursing including Specialty Units • You'll love belonging to the- HOSPITAL with a . . .. . . . . . .. . 25 PAGE 3 Statement On Institutional Licensure The li censing of health care institutions and individual h ealth practitioners is a function of the state government. ANA recognizes tha t licen sing m easures are n ecessar y to protect the h ealth and welfare of the public. ANA b eli eves that licen sing systems require constant and careful scrutiny in order to maintain a level of sa fety and competen ce in the provision of h ealth services. '\Vithin the last severa l years, pro.p o sals have b een put forth by anumber of individu als a nd agen cies concerning the exten sion of institutional li cen sure to include th e reg ul a tion of heal th practitioners who currentl y hold indi vidu al li cen se to practice 1 ' For an explanation of vanous proposals consult: DHE\1V R eport on L icensure nnd R elated H ealth Personnel Credcntialing, 1971. Nathan H ershey, "An Al ternative to Mandatory L icen sure of H ealth Professionals, Hospi tal Progress, March 1969, pp. 71-74. Natha n Hershey and Walter S. Wheeler, Health Personnel Regulations in the Public Interest, California H ospital Association, 1973. In addition, two proj ects are underway to test the feasibility of institu. twnal licensure. In July 1972 RushPresb yterian-St. Luke Medical Centers, in Chicago initiated a study entitled "Cred enti aling H ealth Personal by Licen sed Hospitals." The purpose of the study is to examine the credentialing m ech anism. A second proj ect started in June 1973 by the Pennsylvania Hospital Association R esearch Foundation is studying roles of variou s h ea lth care personnel. '' The proponents of the exten sion of institutional licensure argue that su ch licensure would : (l ) give institutions more flexibili ty in the utilization of h ealth personr{el, (2) offer increased opportunity for career mobility, (3) give institutions b etter control over the competen ce of h ealth prac tition ers, and (4) reduce the n eed for individ u al licensure of em e rging hea lth ca reeri sts. PAGE 4 N urses, as the largest group of inel i viduall y licen sed h ealth prac titioners in hospitals a nd health r elated agencies would b e cri ti cally affected by these proposals. It is the position of the American Nurses' Association that it is not in the best interest of the public to invest the responsibility for lega l regula tion of competency, utiliza tion of health care personnel, setting of p erformance standards and determination of new categories of workers and their functions with an agency which is also responsible for the fi scal operations of h ealth institution . The American Nurses' Association is fu lly cognizant of the trends in society which ch allenge the traditional conceptualization of the purpose of licen sure and which imply that the current sys tem of licensure is inadequa te to deal with the complex issu e of holding individually licensed health professionals responsible for continued compe tence in practice. However, this enormously difficult task wi ll not be solved b y shifting the b asis of legal accountability from the individual a nd the nursing profession to h ealth care institutions which face the eve n more overwhelming task of providing quali ty h eal th care which is human e, coordinated and compreh en sive at a reasonable cost to all people. In 197 3 ANA's House of D elega tes reaffirmed its support of individual licensure as one means of assuring the public that nursing practitioners possess the basic knowledge and skills to enter the profession of nursing. The fact that all states u se the S.B.T.P. has resul ted in a reasonable degree of uniformity in the prep aration of nurses throughout the n ation. This, in turn, has facilitated intersta te licensure and geographica l mobility of nurses. As a result, access to a pool of nu rses who have b een individu ally licensed as safe practitioners and who are legally respon sible and accountable for the quality of their services has add ed imm ea surably to an institu tion's capability for maintaining h ealth care standards . The present institutional licensu re system is a process b y which a state governm ent regulates health institutions b y requiring the operator of such an institu tion to obtain legal a uthority (a license) to es ta bli sh a health care facility and to compl y with certain standards in order to retain the li cense to operate his institution. The Association believes that a strong system of institutional li censure as it relates to these activities is a vital asp ect of the m aintenan ce of quality care. A system of individual licen sure is an essential adjunct for an effective institutional licensure system . Under the current system of licensure of h ealth care institutions many opportunities exi st for institutions to accomplish much that proponents of the extension of institutiona l licensure h ave identified as advantages of their proposa ls. Many opportumttes now exist for employers to participate in the processes for dealing with incompetent a nd unethical practition ers. The profession encourage vigorous implementation of the existing m echani sms for su ch input. In addition, the nursing profession wou ld welcome an y positive plan that the employers of nursing ca n put forth to d emonstrate their interest in m aintainin g and upgrad ing employee capabiliti es in order to m ain ta in a nd improve the h ealth services the inst itution provides the public. In view of this, the proposa l that institutional li cen sure include the licensure of nurses b y institutions can only be seen as an attempt to seriously distort the concept of institutional licensure and to cripple its effectiveness as a h ealth care m easure. Such a proposal should b e recognized and exposed as a move that would rescind in eli vidual licen ses issued b y the states to nurses. R ecent ANA Guidelines on Continuing Education speak to the responsibility of the employer to encourage and promote opportunities for registered nurses to en gage in continuing edu cation. The profession is advocating appropriate p articipation of public m embers of the regulatory processes, profession al review of p erform an ce by peers a nd certifica ti on for the recogni tion of superior p erforma nce of nurses. W e see these measu res as significant steps in the direc tion of insuring individu al accountability for performance and an appr opriate complem ent to the role o f sta te gover nm ent in the reg ul a tion of health personnel. UTAH NURSE J\1\11\ Staff Testifies on behalf of Massachusetts l\lurses9 J\ssociation EILEEN M. JACOBI, Ed.D., R.N., Executive Director, American Nu rses' Association I o Governor Francis Sargent, Massach1tsetts Ap ril1 3, 1973 It h as com e to th e a ttention of the American Nurses' Association that legisl a tion is being consid ered in yo ur House of R epresenta tives, Committee on Social Welfare, (HR120) to reorganize th e D epartm ent of Hum an Services. The American urses' Association must express grave con ce rn particularly regard ing those aspects of the proposal which relate to the processes of gra nting n ew a nd renewed licen ses of registered professional and licensed prac ti cal nurses. Nursing is th e on ly health profession which h as a system for the development and utilization of a single n ational ex<l min a ti on as a b asis fo r li censure. Poli ci es governing this n ational exam in a tion are establi shed b y a Council of State Boards of ursing, a unit of the Am erica n Nurses' Assoc iation. The nursing profession hils found great benefit to nurses and to the public through the standardization resu l ting from a single national examin ation. Through this mechanism, problems otherwise related to interstate mobility of health personnel are minimized. State Boil rds of Nursing contract with the Na tion al Leagu e for Nursing, according to the sta ndards a nd policies establi sh ed by the Council of State Board s, for use of the exam in a tion. The .State Board of Nursing t hu s fulfills the sta te's responsibility to d etermine the comp etency of individuals for li censure as safe practitioners of nursing. It ap pea rs imminent that if HR120 is pa ssed and impl emented Jul y 1, 197 3, as proposed , the foll owing would result: 1. The Commonwealth of Massachus- care • 1sourgame. put your valuable nursing skills into action with ]n Idaho : CASSIA MEMORIAL HOS PITAL, Burley; FREMONT GENERAL HOSPITAL. SL Anthony; IDAHO FALLS L.D.S. HOSPITAL, Idaho Falls; In Uta h: COTTONWOOD L.D.S. HOSPITAL, Murray; FILLMORE L.D.S. HOSPITAL, Fillmore; LATTER-DAY SAINTS HOS· PITAL, Salt Lake City; LOGAN L.D.S. HOSPITAL, Logan ; McKAY -DEE HOSPITAL CENTER, Ogden ; PANGU ITCH L.D.S. HOSPITAL, Panguitch; PR IMARY CHILDREN 'S HOSPITAL, Salt Lake Cit y; SANPETE L.D.S. HOSPITAL, Mt. Pleasant; SEVIER VALLEY CHURCH HOSPITAL, Ri chfield. UTAH VALLEY L.D.S. HOSPITAL, Provo; In Wyoming: STAR VALL E Y L.D.S. HOS P ITAL. Afton . W INTE R, 1973 · 74 e tts wou ld not be eligibl e to adthe State Board Test Pool Examination to gradu a tes of Massachusetts schools of nursing or to gradu ates from schools of nursing in o ther states or foreign co un tries. mini s t ~ r 2. Gradua tes of sc hools of nursing not licen sed in that state on the basis of passing the State Board Test Pool Examination, would b e d eprived of ga inful e mploym ent as a registered professional or li cen sed practical nurse. 3. Th ere is no eviden ce that provision is m ade to carry out the essenti al functions of renewing li censes of nurses. The process is p articularl y criti ca l as i t appli ed to nurses li ving outside the Commonwea lth of Massachusetts. In 197 J, the Massachusetts Board of ursing renewed over 20,000 li cen ses of nurses li ving Pt~ tsid e of the state. Sin ce renewal of li censes for nursing by the Board of Nursin g in Massachusetts is a monthl y process, sched uled b y d a te of birth, thousands of nurses whose renewal d ate is Jul y, 197 3, or the succeeding m onth s risk ill ega l prac tice unl ess their li censes a re renewed on schedul e. The America n N urses' Association is extremely con ce rned regarding the potentia l impact of h ealth care services of any modifi ca tion of requirem ents p erta ining to li censure of he~ lth profess ionals. Licensing legislat iOn should be d efined and administered in a way to assure th a t all who practice in the parti cul ilr profession, meet minimum stand ards of competency in order th a t the h ea l th of the publi c m a y b e protec ted . Furthennore, li censing legislation should provid e ad equate opportunity for those knowledgeable a nd qualified in the fi eld to supervise the mainten a n ce of stand ards in educationa l progra m s prepa ring for the .. profession . In the interes t of the public and of the students graduating from schools of nursing in the Commonwealth of Massachusetts, the American N urses' Association urges you to prevent passage of a n y legisla tion which does not protect the publi c. HR120 does not appear to contain provision s n ecessary to provide the citizen s of Ma ss<lchu setts assuran ce of safe practitioners of nursing. PAGE 5 ANNA KUBA, R .N. , Co ordinator, Program on St ate Boards of N uning, to th e Secre tary for Con swneT A ffairs, April S, 197 3 Thi s le tter is in response to your requ es t (Author's N ote : Sent March 26, 197 3, six days aft er HN1 20 was fil ed with the L egisl a ture.) for assista nce relative to the admini stration of the State Board T est Pool Ex a mina tions for nursin g li cen sure in view of reorganiza tional and pe rsonnel problems in Ma ssachusetts. The Co uncil of Sta te Boa rd s of Nursing es tab lish ed the poli cies [or the Sta te Board T est Pool Ex a mi na tion. According to these poli cies, th e cont racts for the administration o f the Sta te Boa rd T est Pool Ex aminations must be n egotiated with a Board of N ursing. Furtherm ore, the Exa miner (person having m a jor res pon sibility for the ac tual administration and conduct of the examination) and the Ass istant Exam iner shall b e registe red nurse employees or registe red nurse members of the Boa rd of Nursing. Oth e r members of the exa minin g team shall b e employees of the Boa rd of N ursing or p ersons who are not associa ted with a schoo l preparing registered or practical nurses, unless such a person is also a member of the Boa rd of Nursing. The contract specifies the n ame of the registered nurse, whose positi o n or title in relationship to the Board of N ursing is id entified , that is to have administra tive respon sibil ity o n behalf of the Board for comp liance with th e contrac t. Jf during the term of the contra ct, the des i gn ~ e must b e cha nged, a n am endment to the contra ct must b e filed. Approval of the a mendm ent is d ep endent upon the new designee being a registered nurse employee or registered nurse memb er of the Board. In addition , the ri ght to acquire the new d es ign ee to accept from the N ational Leag ue for Nursing, In c. spec ial consultation at the offi ces of the Boa rcl in connec tion with the assumption of res ponsib iliti es und er the contrac t is reser ved . The poli cies a re stringe nt because the .S tate Board T est P ool Exa mination s for reg istered nurse lice nsure a nd prac ti cal nurse lice nsure a re used by sta te boa rd s of nursin g in a ll juri sdi cti o ns of the U nited Sta tes. 4.- AN EQUAL OPPO RTUN ITY EMPLOYER "T' CALL COLLECT . . . [phone], EXT. 301 PAGE 6 lt would indeed be unfortuna te i f Massachusetts, which attracts many out-of-state stud ents to their schools of nursing in priva te colleges and universities as well as h a ving a large enrollm ent of nursing students from insta te, were un ab le to m ee t the obligatio n s of the contract for the admini sn·a tion of The Sta te Boa rd Test Pool Examinations a nd have to relinquish its contrac t. N o tes t m a terials rela ting to the Sta te Board Tes t Pool Examinations will be sent to Ma ssachu se tts until we have assuran ce tha t the tenns of the contract can b e fulfilled. There are no alternati ves to offer yo u. *Author 's N ote : Sent M a rch 26, 1973, six cl ays after HN120 was fil ed with the Legislature. Utah NuTse E di tor's N ote : Ma ssach usetts N urses' A ssocia tion was successfu l in de fea tin g the disso lution of the Sta te Board of Nunin g. UNIVERSITY OF UTAH MEDICAL CENTER SALT LAKE CITY, UTAH 84112 UTAH NURSE Weber State College Dept. of Nursing Challenge Exa m ination For ma n y years, the D epa rtment of N urs in g at ·w eb er Sta te Coll ege ha s stron gly end o rsed career mobility in nursin g education . The nursing facu lty b elieves that continuin g education is a li fet im e pursui t a nd th at each p erson shou ld be given the opportunity of b ecoming what he is ca pab le of b eing. The d ecision to gra nt adva n ced placem ent a nd offer credit by exa min ation was b ased on id eas, ph il oso ph y a nd co ncepts towa rd nu rsin g ed uca tion , ra ther than the content of bo th programs and con crete co mpa ri sons. T he followin g sta tem ents re fl ec t the thinking of the nursing faculty toward spec ial ch allenge exa min at io ns. I . Th e essence of educati o n is not takin g co urses, but the lea rn ing th at takes place. 2. T he objecti ves of m a n y co urses ca n be achieved by mea ns o th er than a tten d ing classes. 3. Such achieve m ent ca n be measured b y examinat ion. 4. High scores on exa min :1tio n s, includin g pra cti cum a nd t heory, provid e a n acce ptabl e bas is for granting adva nced pla cement an d credit. 5. No individu al should be req uired to repeat work h e h as alread y m astered. 6. A limit sh ould b e placed on a mount of credit ea rned by chal lenge examinations. In the fall of 1972, th e D epartm ent of N ursing was g ra nted pe rmi ssio n to prep are special challenge examin ations for credit and for adva n ced pl acement to previou s li ce n sed practica l nurse gTaduates or to those whose learnin g h ad tak en place b y m ea n s oth er than a ttendin g an accredited school of nu rsin g. R esid ency req ui remen ts were waived, and cred it wo uld not b e gi ven until the student registe red a t the college. A fee of $ 15. 00 is requi red for eac h course ch all e nged b y special exa mina tion. Successful ach ievement of the examin a tion s is measured b y a pe rfo rm a nce of 70% or above in both practicum a nd theory. Th e w ritten test score mmt be sa tisfactory in order for th e pra cti cum to b e taken . To determin e clini ca l nursin g a biliti es, eva lu a tion sheets for basic skill s are used. Ea ch phase of th e test requ ires ap proxim a tely two hours. The initial W INTE R . 1973 · 74 examina tion is o ffered to receive 10 hours of coll ege credit in li e u of the Fundam en tals of Nurs ing co urse. If the person h as a sa tisfactory performan ce on the first se t of exa min a tions, h e is given the optio n to chall ::n ge o n e o f two su bsequ ent nursin g courses, either the m edical-surgical nursing co u rse o r the ma te rn al child nursing course. Each of th ese courses offers 12 credit h o urs. Hen ce, 22 credit hours can be achi eved b y special chall en ge exa min at ions. If a p erson success full y challenges the first two co urses, in order to articul ate in to the nursin g program, h e mu st have comple ted the ge neral educa tion requirem ents with a C gTad e o r b etter, of the scien ce and fami ly life de p artmen ts, as des ignated in the curri culum pa tte rn of the N ursing D epartment. Advanced pl acem ent is con t in gent o n the ava il abi lity o f cla ss enrollm ent spa ce. Challenge Examinations, Advanced Pl ace ment, Caree r Mobility 1972-73 Durin g the latter p art of the A utumn Quarter, 1972, 35 l ~ tt ers were se nt to lice nsed prac ti ca l nurses a nd med ica ll y train ed ve tera n s who were interested in qualifyin g for advanced pb cement in to the Assoc ia te Degree N ursin g Program . T we nty person s respo nded b y ta king th e writ te n portion of the examination ; 18 were li ce n sed pn tcti ca l nurses and 2 were ve terans. The m ea n score was 83 % . One veteran scored 68 % and failed. Th e other veteran did n o t ch oose to take the practi cum , and of the 18 li cen sed pra ctica l nu rses, all com ple ted the practicum a nd passed su ccessfull y. This sa m e test was give n as th e fi n al exa min at io n to the curr ent freshm en nursing students en rolled in this course. T he mea n score was 89% and there were n o scores less than 70%. T en of the li cen sed practi cal nurses were not rea d y for ad va nced placem ent, since th ey h ad n ot taken an y gen eral edu ca tion cou rses. The rem aining 8 did qu ali fy for advan ced pl acement, W inter Quarter, 1973 . Six were accepted into the WSCj UTC ex tended campus in Salt L ake City, U tah, one was acce pted into the \1\T.SCj USU ex tended ca mpu s 111 Logan , Uta h , a nd o ne entered the A.D . Program a t W eber. After two weeks of \!\Tinter Qu a rter, an opening occ u rred at WSC/ UTC, and the one entering the progra m on Weber ca mpu s tran sferred there. During Spring Qua r ter, 1973, letters were m ailed to interested applica n ts a nnoun cin g the ~ ch edule and informa tion reg~ i-di ng sp ecial ch a llenge exa mination s to be give n At1tumn Quarter, 197 3. If the person successfull y ch all enges the Fu ndam ental s of N ursin g course h ej she wi ll h ave the op tion to ch all enge either one o r the other su cceedi ng nursing co urse . T his choice is ei ther med ica lsurgica l nursin g (12 cred it hours) or m aternal ch ild nursing (12 credit hours). Hence, 22 cred it hours of nursing ca n be achieved b y sp ecial ch all en ge exa mi nations . In order to arti cul a te into t he nursing progra m , the gen eral edu c:1 tion requirements m ust be compl e ted, with a C grade or better, of the sc ien ce and fami ly life d ep:utm ents, as des i g n a te.~ in the cu rricu lum p a ttern of th e \ f>epartm ent of Nursing. A p erson could then be eli gible for adva n ced placem ent in to the A. D . N ursin g Progra m for the winter or spring quarter of the freshman year. Adva nced pl acem ent is contin gent on the availa bility of class enrollment sp ace. At the end of spring qu arte r, over o ne-third of the lice nsed prac tica l nurse students indi cated a desi re to adva n ce in to the A. D . prognm. There were n ine vacancies on the combin ed three camp uses, and these were immediately fill ed . " 100% Membership Club " Davi s Co unty H ea lt h D epart m ent Community Nu rs in g Serv ice Weber Co u nty Schoo l D istrict Westm in ster Co ll ege of N ursing Facu lty Hil lhave n Conva lescent Ce nter lf any other age ncies or institution s have 100 % membership with UNA, notify UNA Headquarte rs so yo ur nam e ca n be added to thi s honor ro ll. PAGE 7 A joint Statement Of the American Nurses' Association and the American School Health Association RECOMMENDATIONS ON EDUCATIONAL PREPARATION AND DEFINITION OF THE EXPANDED ROLE AND FUNCTIONS OF THE SCHOOL NURSE PRACTITIONER The American Nurses' Association and the American School H ealth Association endorse the collaborative efforts of medici ne, nursing, and ed ucatio n to increase the availability and accessibility of h ealth care for children and youth in the United Sta tes. One way to achieve this a im .is to expand the traditional role of school nurses so they may serve as school nurse practitioners. In this expanded role, school nurse practitioners can identify and assess the factors that may operate to produce learning disorders, psycho-educational problems, perceptive-cognitive d iffi cul ties, and behav ior problems, as well as those causing physical d isease. School nurse practitioners, with appropriate consul tation, can assum e a major role in h ealth education and coun seling. They can work coll aboratively with physicians and other health professionals, educators, and parents to provide comprehensive assessment and remedi al ac tion. School nurse practitioners are prepared to assume more initiative and to acce p t increased responsibility and accou ntab ility for their acts. The recognition and acceptance of medical, nursing, and educational collaboration permits the poten tial of each discipline to be u sed more effectively in improving the health care of children and youth. B ecau se ~ the role of th e nurse has expanded and the health needs of school children h ave received increased attention, the Am erican Nurses' Association and the American School H ealth Association recognize a need for professional school nurses to h ave an expanded role in providing health care in the school setting. T hese associa tion s accep t the n ecessity for a reorganization of certai n school health care services, endorse the development of the role of the school nurse practitioner, and join in defining the educational preparation, expanded role, and functions of nurses working in school health programs. I. Functions and Responsibilities O f School Nurses The functions and activities in current nursing prac tice may include: PA CE 8 - Participating in obtaining a health history - Performing a physical appraisal -Evaluating development status -Ad vising and coun seling children, parents, and others - H elping in the management of technologic, economic, and social influences affecting child h ealth - Participating in appropriate routine immunization programs -Assessing and managing certain minor illnesses and accidents of children - Planning to meet the health needs of children in cooperation with physicians and other members of the hea l th team School nurses also may serve as health consul tants to admini strators, teachers, and the community. In association with physician s and others, sch ool nurses may participate in the formulation, implementa tion, and coordination of standards, policies, and procedures for school health services an d health education programs; assist p arents in identifying and utilizing appropri ate p rivate and community resources for h ealth care; provide inservice education for teachers and other school p ersonnel to increase their knowledge and skills in the area of child h ea l th ma intenance ; and engage in defining their role with other members of the school health team. II. School Nurse Practitioner Programs A. GOALS The goals of school nurse practitioner progra ms are to prepare nurses to assume an expanded role in providing impro ved health care. In addition, school nurse practitioners will assu me a more direct and responsible professional role in securing child hea lth care in the school setting through cooperation with all health profession als, educators, :mel others within the health delivery system in the community. The programs should build on previou s nu rsing knowledge and ski Us. On compl etion of a formal course of study, school nurse practitioners should, wi thin the area of their compe tence, be able to perform the following activi ties: -Serve as a heal th advoca te for the child. -Assist p arents in assuming greater respon sibility for health m aintenance of the child, and provide relevant health instruction, counseling, and guidance. -Contribute to the health education of individua ls and groups, and appl y methods designed to increase each person's motivation to assume respon sib ility for his own health care. -Assess and arra nge appropriate management and referrals for children with health problems who require further evalu a tion and care b y their p erson al physicians or others, and collaborate with them in decision making in volving health care and serv ices. - Collaborate with teachers and other school personnel in interpreting pupil h eal th status and provide guidan ce regarding adjustments an d management of educational and health programs fo r students with special needs. - Identify the health statu s of the child by securing and evaluating a thorough health and d evelopmental history, and record the findings succinctly and systematically. - Perform physical examina tion . - Initiate, perform, and assess approp riate preventive an d screening tests, and refer for diagnostic, cin ical, and labo ratory procedures. MID GLEY MANO R , I NC. Convalescent and Long-term care Margaret Mutch, Adm inistrator Myrtle Pavich, Direc tor of N ursing Murray, U tah 85 107 Telephone [phone] UTAH NUR SE School Nurse Practitioner - Perform developmental evalu ations and screening tests; par ticipate with other h ea lth and educa tional professionals in assessi ng normal variations and abnormalities of motor, cognitive, and p erce ptual aspects of child developm ent; and assist in m<~n­ aging health probl ems. - Assist in determining th e presen ce of signifi cant emotional di sturban ces and psychoedu ca tiona I problems in childhood and adolescen ce, and in planning for the referra l <~nd managem ent of these problem s. -Provide appropriate emergen cy hea lth services. -Adv ise and counsel students con cerning acute and chronic h ealth problems, and assurri~ responsibility for appropriate intervention, management, or referral. - Make home visits when indica ted for effective m an agem ent of h ealth problems. -Participate in providing antiCIp a tory guidance and counseling to parents concerning problem s of child rearing, including those related to developm ental crisis, common illn esses, accidents, d ental heal th, and nutrition. - Identify community resources. - Participate in developing and coordinaitng h ea l th car e p lans involving famil y, school, and community to enhance the quality of h ea lth care and to diminish both fragmentation and duplica tion of service. -Assess and evaluate nursin g tice in the school settin g. B. pr <~c­ PLA NNJ.l\,TG Representatives of nursing, . m edicine, the school system, other professional d isciplines, and the community-a t-large must assum e responsibility in p la nning for school nurse practitioner education program s. Participation should be sought from nurses' associa tions, physician s' gro up s , school h eal th and educationa l organizations, nursing and m edical schools, con sumers, a nd other interested groups. The con cepts of the school nurse practit ioner program should b e incorporated i n to b accala urea te nursing curricula as soon as feasible. Opportunities for continuing education in school health should b e encouraged. W INTER , 1973 -74 C. ORG ANIZATIO N AND A DMIN I STR A TIO N Educa tion al program s for the prepara tion of school nurse practitioners should , wherever possible, b e carried out in health centers and under the aegis of accredited b<~ccalaureate nursing progTam s. Programs should be developed jointly b y schools of nursing, p edia tric d epartm ents, and community school system s. School nurse practitioner program s shou ld conform to the exi sting policies and regu lations governin g the conduct of compara b le edu ca tional programs. Adequ ate in stru ction by and consulta tion with physicians should be ava il ab le on a continuing b asis. Funding ma y be provided from a variety of sources. D. SER VI CES AND FACILITIES School nurse practitioner program s should p rovide ad equate clinical faciliti es for demonstra tion, student observa tion, and guided practice in ambulatory <~ nd inpa tient settings. Facilities with sufficient and qualified h ea lth care p ersonnel as well as adequa te numbers of patients to provide a varied lea rn ing experience in schools, m edi cal ce nters, community h ealth centers, a nd private offices shou ld be u sed. The program shou ld includ e a combination of a classroom work, clinical pra ctice, and work experience in a school setting. There shou ld be a ppropria te teaching aids; cla ssroom a nd library facili ties; and an ad equate supply of books, periodi cals, a nd other referen ce m a teri als relilted to the curri culum . A h ea lth service for eva lu a tion a nd m aintenance of h ealth of school nurse practitioner students should b e ava ilable. Counseling service shou ld b e provided . Valuable ~ervice to the commumty A ppeciates your evaluations Listens to the patients Listens to the people Employs qualifiedi personnel 1 Your concerns are our responsibilities Works towards improved patient servLces Endorses continuing education for personnel Specialized patient care ::,· E. FACULTY Nursing, m edi cine, and th e school sys tem should collaborate in the imp lementation of the curri cu lum and in ach ieving the goa ls of the progra m . Other members of the h ealth team - includ in g psychologists and oth er m en tal h ealth workers, heal th educa tors, sp eciali sts in grow th and development, individuals skilled in the assessm ent of lea rning a nd p erceptual problem s, nutritionists, a nd socia l workers - should participate Total h_ealth team commitment HOSPITAL 4160 West 3400 South Serves: Granger, Hunter, Magna and Kearns PA GE 9 ' to enrich the ed ucational experience for the stud ents. The facul ties for school nurse practitioner programs and the student - instructor ratio should meet the same requ irements as similar educat iona l programs of the sponsoring in stitutions. Appropriate nursing faculty should have m ajor responsibility in administering the progra m . Joint appointments for fa culty in the departments of pedia trics, schools of nursing, and sch ool sys tem s are recommended . F. COURSE CON TEN T Existing nursing knowledge and skills serve as the b ase for in creasing the nurse's ability to m ake di scrimin ative and acc u ra te assessm ents of the h eal th status of the school child. The fo ll owing gen eral area should b e covered in the curriculum: G R 0 v\T T I-I AND DEVELOPMENT- A comprehensive review of phys ical, p erceptive, cognitive, and psychosocial growth a nd d evelopment and their normal varia tions, including the u se of appro pri ate screen in g instruments. INTERVIE\t\TING AND COUNSELING - The principles of the interviewing process a nd basic approaches to co unseling pupil s a nd their p arents, including utiliza tion of psychotherapeu tic, behavior modificaiton, a nd anticipator y guidance tech niques. FAMILY DYNAMI CS - A study of the attitudes that affect m ember interactions and the cr iti cal p eriods in familyi li fe, includin g the effect of fami ly , dynamics a nd sociocultural p atterns on h ea l th. POS I TIVE HEALTH MAIN TENANCE AND HEALTH EDUCAT I ON(a) The study of the knowledge and techniques necessary for school nurse practitioners to perform adequate physical exa min ation s an d to assess nutritional sta tu s and dental h ealth. (b) The common emo tional adjustm ent probl em s of each age group . (c) P r inciples of h ealth edu cation, including disease and accident prevention. CHILDHOOD ILLNESS - Review of the common p edia tric illnesses, their prevention and managePA CE 10 m ent, and the early recognition of complica tions. courses concurrent with enrollment 'i n school n u rse practitioner program s. LEARN IN G DISABILITIESStudy of physical, emotional, and environmenta l factors which influence a child's ability to learn, with particular attention to the prevention, early identifica tion, and appropria te managem ent of p erceptual handicaps and psychoeducation al difficulties of school chi ldren. l t is recommended tha t applicants have a position with in a school system to wh ich they can return to practice and be allowed to func tion in an expanded capa city. It u su ally will b e n ecessary for them to d elega te tasks not rela ted to d irect ch ild health servi ces. These tasks should b e assumed by trained a uxiliar y personnel. MENTAL HEALTH - R eview of the factors that affect the emotional a nd psychologica l d eve lopment of the child a nd hi s relationship to others. C 0 M M U N IT Y RESOURCES AN D DELIVERY OF C I-I I L D HEALTH CARE SERVICES R eview of community resources, health d elivery sys tem s, a nd the referra l process. FAMILY - NUR SE- PHYSICIANSCHOOL R ELATIONSHIP - Interpreta tion of the goals of the team a nd required role chan ges. R eview of the e lements requ ired to effect chan ge. CLIN I CAL E X PE R I E N C E Plann ed fi eld experiences and practice in schools and other se ttings under the direction of competen t instru ctors a nd pract itioners tha t provide a transition from th eory to clinica l application . G. A DMJSSION OF STUDENTS Gen era ll y, only nurses prep ared at the baccalaurea te level should b e eligible for admission to school nurse ,practitioner programs. P olicies for selection of students should be d eveloped by the faculty of the sponsoring institutions in cooperation with those responsible for co nducting the program. Admission criteria should consider factors of edu ca tion an d exp er ience as well as local needs and reso urces. Applicants lacking prepara tion in areas regarded as essen tial sh o uld be guided to correct deficits b efore entering the program, or should enroll in supplemental H. LENGTH OF PROGRAM Experien ce to d a te has indica ted tha t a minimum of 4 months of educa tional exp erience and 8 months of prac tice with m ed ical b ackup is n eeded to a ttain th e d esired objectives. Candidates su ccessfully comple ting courses of study should receive a certifi ca te of completion from the spon soring educa tion al institution. I. EVA L UA TION All asp ects - including educational, a ttitudinal, compe tency and adequan cy of care, accep ta nce, productiv ity, and cost of effectiven ess of school nurse practitioner p rogra m s and their gradua tes - should b e evalu a ted . The data collec ted from ongoing evalu ation should b e u sed to modify and strengthen existing and develo ping programs in the areas of prereq uisie ti es, cu rriculum, faci l ities, fa culty, and practice. J CERTIFICATION To assure the professional status of the school nurse practitioner, stan darcls fo r certificat ion are b eing developed . Ill. General Information Inquiri es regarding programs a nd careers for school nu rse practition ers should be addressed to Division of Commun ity H ea lth N ursing Pract ice, America n Nurses' Association, 2420 Persh ing R oad, Kansas City, Missouri 64 108; or the American School H ea l th Association, Kent, 0 hi o 44240. JOB OPPORTUNITY ASSOCIATE D IR ECTOR OF NU RSING f o r large progressive hospita l in no rt hern Ca li fo rni a. Cha ll engin g pos it io n avail ab le fo r indi vid ual w it h Maste rs Deg. pl us expe ri ence in nursin g supe rvis io n. Aff ili ated w it h seve ral educatio nal institutio ns, howeve r no teac hing is required . $1,500 per m o nth wit h li be ral f rin ge benefits. Write: Person nel Dept., Sutter Co mmuni ty Hosp ita ls, 2820 " L" Street, Sac ram ento , Ca li f. 95616 UTAH N URSE .. Rationale Utah Nurses' Association Maternal & Child Nursing Standards Rationale PREAMBLE The developm ent a nd implem entation of nursing care involves: present and past h ealth sta tu s and role relationships; a nd grow th a nd developmental potential of the individual and family. Thus nursing intervention is not only directed toward the immedia te or present survival , recovery or growth. Insi ght into the patterns and sequence of d evelopm ent in an individu al' s life a id in d eveloping implem enting, and eva lu a ting present and future plans for nursing care in terms of short-ra n ge and long range goals. Individual s :mel famili es progress through var ious phases of d evelopm ent from birth through the childb earing and childrearing phases. A role played b y one m ember is related directly to the roles played by other m embers of the family. Individu al family roles m ay cha nge with the introduction of a bab y, illness, death, pregnancy out of wedlock, introduction of children into school. Roles assumed are d efined by socia l, cul tural, and fa mily norm s. P arental andj or famil y support play a significa nt role in a ttaining full physiol ogic, psychologic, a nd social development. Maternal and child nursing prilctice is famil y-centered. I NT RODUCTION Standards for mate rn al and child care are available from the American College of Obstetricians and G yn ecologists and the American Academy of Pediatrics. These provide excellent guidelines for planning servi ces. It is expected th a t each agency will provide its own policies and procedures based on these ilnd the following guidelines. STANDARD 1 Maternal and Child Nursing Pra ctices is eviden ced by ilctions whi ch are based upon knowl ed ge of the biophysical and psychosocial development of individu:1ls from con ception through th e ('hild rearin g ph ase of development a nd t;pon knowl ed ge o[ the basic hum a n n e<:ds (or op timUln development. WYNTER , 19i3 . 74 T h e basic component in the nurses' actions which facilitate the growth and d evelopm ent potential of each individual is care - to provide cornfort to reduce tension, to nurture, to support, to minister to p erso ns in rela tion to mutually identified needs. A knowledge 'a nd understanding of the normal ranges in human grow th development il nd behavior are essenti al to su ch action. Concomitant with thi s knowledge is the recog-nition and con sid era tion of the socio-economic, cui tural, nutritional, sp iritual, and educa tional fac tors that enhilnce or deter the biophysical a nd psychologicil l maturation of the individu al. Guidelines Therefore m prac tice, the MCN: I. Observes a nd assesses the d evelopment level ilnd / or n eeds of the individual within the famil y b efore p erforming an y ac tion s. 2. Involves th e individual and family in the assessme nt and action pl a ns. 3. Selects va riou s care action s based on mutuall y identifi ed n eeds and carries them out in direc t contac t with ilnd in behalf of a p erson or gTo up of persons. 4. Continually validates and eva lu - ates all nursing action s to insure achievement of the sp ecifi c goal intended and optimum d evelopment of each individu al in the family unit - directly or indirec tly. 5. ·w orks with individuals and groups considering th e socioeconomi c, cu ltural, nutritional, spirituill, and edu ca tional fa ctors inherent in the fa mil y or group in vironment. STANDARD 2 Maternal Child N ursin g Practi ce recognizes tha t th e fa mil y provides the stru ctural framework in which the indi vic! ual progresses through variou s mil turat ional levels. Indi vidu als do not ex ist as isolates but in a social gro up ; whether a family or another close knit group. Human development progresses only with mature, ca re il nd love from signifi ca nt p erson s. Assessment to plan and implement relevant nu rsing care involves fam il y m embers and other p ersons of significa n ce in the patient's life for prom otion of op tion al heillth. Guidelines Therefore in practi ce, the MCN: I. R ecogni zes and und erstands family piltterns, role relation sh ips a nd attitudes toward childbeari n g, childreilrin g, h eil lth andI Iillness.. 2. U tilizes knowled ge and understanding of the ra n ge of n orma l bod y stru cture a nd function as well ilS psychosocial development sequen ces. 3. Observes a nd assesses the development level of the family and those in supportive roles. HYLAND PHARMACY 3291 Highland Drive 485-9281 or 466-0787 11 The Store With Prescriptionality'' DOUG ROTH Registered Pharmacist PAGE 11 4. Identifi es the individual's a nd family's cop i n g mechanisms which are used to protect and facilitate their capa city f or growth, recove ry a nd surv ival. 5. Enhances those cop ing mechanisms which are beneficial to the individual a nd family a nd works toward acceptance of alte rnatives which have positive effects. 6. Adapts the nursing pl an for intervention b ased on present and future n eeds and changes in the individu al anclj or famil y. 7. Utilizes and seeks assista nce from other reso urces and di sciplines when a ppropriate to accomplish desi reel goa Is. S TA NDARD 3 Maternal a nd Chi ld Nursing Pra ctice is evidenced b y th e provi sion, use and coordination of all services tha t assist in eli viduals to prepare for responsible soc i:.ll a nd sex ual roles. R ationale People are prepared for sexu al roles through a process of socia li zation that takes place from birth to adulthood. This process of socialization, to a large extent, is carried out within the family structure. Social control over child ca re increases in importance as humans b ecome increasingl y dependent on the culture rather than upon instincts and drives. The culture of any society is maintained b y the transmi ~ ions of its specific values, attitudes and behaviors from generation to gen e ra tions. If no famil y structure exists or if it is un sta ble, then the socializa tion of the child is likely to b e inadequ ate an d socie ty, itself, is threatened . Attitudes and values concern ing male and fema le roles d evelop as part of the socialization process. Attitudes toward self, the opposite sex, and towilrd parents will influen ce the roles each ind ividu al assumes in adulthood and the responsibiliti es accepted. Even a ttitudes toward h ea lth in general, its importance, and the abi lity of a n y individu al to influ ence his own health status are sh aped to a large ex tent during childhood. The Maternal Chi ld N urse in coll aborat io n with others involved PAGE 12 in promoting maternal and child h ealth, has the responsibility for counseling in light of all ava ilab le knowledge a nd in proper perspective with value sys tem existing in the environment in whi ch the individual lives. Guidelines Therefore in practice, the MCN : I. Makes use of resources avail able in the social and beh avioral sciences to h elp her understand the attitudes and va lues of individuals and families with whom she is workin g. Z. Promotes those a ttitudes a nd values condu cive to emotion a l and physical health a nd fa mily solidarity without imposin g h e r own valu e systems. 3. Encourages society to provide the reso u rces n eeded to h elp p eople pre pare for responsibile sexu al roles. 4. Works with other h ealth personnel to communicate n eeds and develop services which promote optim al health and fa mily solidarity. ST ANDARD 4 Maternal a nd Ch ild Nursing Practice recognizes d eviations from expected patterns of physiologic, anatomic and p sychosocial development, a nd initi ates therap eutic intervention . R ationale Early detection of d evia tions a nd therapeutic intervention are essential to the prevention of illness, to facilitating gTowth and developmental potential, and to the promotion of optimal health for the individual and the fa mily. The nurse h as a unique opportunity to observe and assess the patient and hi s fam il y in the community se tting. Guidelines Therefore in prac tice, the MCN: l . Demonstra tes a thorough understanding of the range of normal body structure and function by de tec ting sign s and sy mptoms which a re not within norrr¥1 limits. 2. Identifies the variety of coping mechanisms which m ay serve an adaptive function or represent m aladoptive pa ttern s of response. 3. Searches for improved mea ns of detecting impairment of physical and emotional function, a nd the environmental situ a tions which may lead to su ch impairment. ·L Invol ves the individual and fam- ily in recognizing and understanding deviations, a nd assists them in planning immedia te il nd long range goals. From Samoa W e arrived here August l , 197 3, a nd I a m teaching in the School of Practi cal Nursing. It is a 2 year (24 months) school. I h a ve a lot to learn about it but so far I have found it a challenge. There are 16 RNs on this island. (13 are working at the LBJ Hospital) . \IVe h ave formed a group called American Samoa Nurses Associat ion. Vve have written to ANA rega rding n a tional m embership . I really didn 't want to b e, but I was elected the first vice president of the gTo up . I am on the By-Laws Committee. There is no R N licen se on Samoa. The hospital il ccepts any valid US or New Zea land licen se now. The elirector of nursing, Dorothy Williams, MSN from Ca tholi c U has asked H awaii to give US li cense to the two m embers from New Zealand. In one week I have seen a case of fi lariasis, lymphatic tuberculosis, and possibly lep rosy. I am teach ing obsetri cal a nd publi c health nursing with a New Zealand ed uca tional nurse midwife from \1\Testern Samoa. Our students are all Samoans and most of the pa tients are Samoans. Samoan is th e language. So Mrs. Briski is teaching m e Samoan . I HAVE to learn to speak it. Our classes are in English a nd our students will take the S.T.B.P. Exam for Prac ti cal Nurses in June, 1974. Thank you for yo ur help. Since re! y, June Bracken If you wish to write to June, h er ad dress is: School of Prac tical N ursing LBJ Tropical M edica l Center R aga'a lu , America n Silmoa 96799 Au gust 25, 1973 UTAH NURSE 1< Standards Of Professional Nursing In The Operating Room INTRODUCTION The chroni c shortage of n urse pra ctitioners in the health ca re facilities throughout th e U nited States is recogni zed by society. However, demands for health care conti nue to in crease. The d em and for adequ ately prepared professional nu rse practition ers will , consequ entl y, continu e to in crease, in all areas of nursing servi ce. 1 N urses in th e operating room share a common con cern regard ing the recruitment of professional nurse pra ctitione rs into this specialized area of nursing servi ce. Ma n y State Board of N urse Examiners do not require clinica l practi ce in th e opera ting room as a curriculum pre-requi site for eligibili ty to take the sta te li cen sure examina tion . As a resu lt, clini ca l practi ce in th e opera tin g room has been d eleted fro m or d e-emphasized in the curr iculum s of m an y schools of nursing p reparing stud ents for b eginning profe ssion al practice. Opera1tin g room nurses b eli eve that a theory-oriented experien ce in the operating room is essential to the und erstanding of the comprehen sive, complex b ody of knowled ge required to m ake critica l, ind ependent judgm ents abo u t patients and their care. 2 T he AOR N Board of Directors ha s adopted the d efinition o f professiona l operatin g room nursi ng and th e objective of clini ca l practi ce of profession al operating room nursing submitted by th e AOR N Sta tement Committee. These statem en ts are intended to serve as th e ultimate aim s and guidelines for nurse practiti oners, both in nursing edu ca tion and nursin g service. "Edu ca tin g nurses and providing pati ents with care ca n on ly be ca rri ed out wh en nurses in education a nd in servi ce recognize their interdepend e nce and actively coll aborative to achieve th e ultimate aim of both - improved ursin g care." 3 ASSUMPTIONS T he ass umption s underl y the developm ent of the statements are: l. Surgery is the direct intervention ancl j or confrontation with di sease. W INT ER , 1973-74 2. N ursing is a h elping profession and, as such, provides services which contribute to the h ea l th and we ll bei n g of p eopl e. -The attitudes and feelings of the patient regarding surgical intervention a nd its ou tcome carry a significant influen ce on the post-perative recovery and social re-adjustm ent to life in the community. • -N u rsing is of vital con sequ ence to the individual receivin g services. Therefore, nursing care in the opera tin g room fill s a n eed wh ich ca nn ot be m et by the indi vidu al, his fa mil y or by other persons in the commun ity.• - The services of profession al practitioners of nursing wi ll continu e to be suppl emented and complem ented by the services of alli ed techni ca l p erso nnel who functio n as ass istan t · to nurses. However, the professional practitioner is res ponsible for the nature and quality of all nu rsing ca re p atients rece ive. 4 -Th e AOR is mu ch concerned wi th the n ature of ope rating room nursing practi ce, the m ea ns for improvin g nursing pra cti ce, the education n ecessa r y for su ch practice a nd the sta nd ards for ad mini strative an d clin ica l pra cti ce in the operating room. In recognition of the n eed for profession al operati ng room practition ers to ma ster a complex body of knowled ge; to make criti ca l, i ncle pendent judgm ents a bout p atients a nd their care; and to co ntinuou sly lea rn an d improve professiona l pra cti ce in th e opera ting room, the AORN Statem ent Committee submitted to th e Bo~r~ . of Directors . the following defm1t10n . of professiOn al operatina 0 room nursing: PROFESSIONAL NU RSI N G I N THE OPERATI NG ROOM IS T H E ID ENTIFICATION OF THE PHYSIOLOGICAL, PSYSHOLOGICAL AND SOCIOLOGI CAL NEEDS OF THE PATI E NT AND THE DEVELOPMENT AND IMPLEMENTAT ION OF AN I N DIVIDUALIZED PROGRAM OF NU R SI NG CAR E THAT COORDI NATES NUR SI NG ACTIONS, BASED 0 T T H E K OWLEDGE OF THE NATU R AL A D BEHAVIORAL SCIENCES, TO RESTORE OR JVJAl NTAl N THE HEALTH AND WELFAR E OF THE PAT IENT BEFORE, DURING AND AFTER SU R GI CAL I NTER VENTI ON. Id entifi cation, development and im p li cation of an individu alized progra m of nursing care im p li es a course of action to be put into cl ini cal practi ce by the professional nurse practitioner. Every actio n mu st h ave a n objec ti ve. The objective of clinical prac ti ce of professional operat in g roo m nursing is: TO PROVIDE A STANDARD OF EXCELLENCE I N T H E CA R E OF THE PATIENT BEFORE, DURI NG, AND AFTER SO R C ICA L I NTER VENTI ON. STATEMENTS New knowled ge of hum an phys iology and technologica l advances in instrum entation acqu ired during the past decades h ave increased the technical compl exiti es of surgi ca l interveniton. However, each pati ent as an indi vidu al continues to bring to the operati ng table physiologica l, psychologica l, and sociological n eed s that must be m et to m aintain hom eosta tic controls over h is or h er body and en vironment. Professional practiti oners of nursing in the operating room assist the p a tient b y recogn izing these individu al needs and taking mea sures to su stain homeostasis until the p a ti ent resumes hi s ind ependent stabi lity (or conclud es a p eaceful death.) ACHIEVEMENT OF THIS OBJECTIVE The ANA position p a per on ours-. ing eel uca tion d efines the essenti al components of profession al nursin g as care, cure, and coord in ation. The care aspect is more than " to take care of"; it is "caring for" and "caring about"; it is d ea lin g with hum an bein gs under stress. 5 Initiall y the nurse mu st make an assessment of the pati ent as an indi vidu al, b ased on the prin ciples of physiologi ca l, psychologica l and sociologica l scientifi c knowledge, to ident ify th e overt and covert n eeds of th e pati ent. T hrough observa ti on of a nd communi cation w ith (Cont inu ed o n page 16) PAGE 13 ANNUAL CONVENTION PROGRAM May 9- 10- 11, 1974 TriArc Travel Lodge, 161 West 6th South Salt Lake City, Utah "UNITED FOR ACTION" May 8, 1974 - Wednesday l 6:30 p.m . ......... Convention Chairman and Board Members Dinner Meeting with Guest, ANA Pres., Rosamond Gabrielsen ~ May 9, 1974 - Thursday 8:00 a.m . to 9:00 a.m .. .. . . . Registration and Visiting Exhibits 9:00 a.m. to 12:00 Noon ...... .. .. . .... OPENING SESSION 9:00 a.m. " Call to Order" ... Dr. Norma Hansen , UNA Pres. Advance of Colors . . . . . . . . . . . . . . . . . . Recruiter Invocation . . .. . ... . . . . . .. . .... Father Dahnken Chaplain of Newman Center, Weber State College Welcome .... Jake Garn , Mayor of Salt Lake City 9:30 to 10:30 a.m. . . . . .. . .. . .. .. .. .. . . . " Unite for Action " Rosamond Gabrielson , ANA President 10:30 to 11 :00 a.m . . ... ..... VISITING EXHIBITS AND BREAK 11:00 a.m . l ' Acknowledgements .......... . ..... Dian Suta Voting Instructions ...... . ...... Bobby Cuburu First Reading of Resolutions ... . .. Bonnie Bullock 12:00 to 1 :30 p.m . .. . .. ... . .. . .... . .. LUNCHEON - GENERAL " Legal Aspects " . .... .. Mrs. Irene Warr, UNA Legal Councilor Nurse Practitioner Panel ..... . . ... Sister Carol ita and others 1:30 to 2:00 p.m ..... . ..... VISITING EXHIBITS AND VOTING l 2:00 to 5:00 p.m .. . ........ . . . . ....... GENERAL SESSION ~ 2:00 to 5:00p .m. " United For Decision Making " . . . . ... Dr. lngaborg Mau ksch 5:00 to 5:30 p.m . .. . . ..... .. . . . . ............... BUS INESS ...... . . Executive Directors Report . ..... . . . . . . . . . . Treasurers Report. ... .. . . . . . . . . . . Committee Reports ....... . 5:30 to 6:30 p.m .... . .... VOTING AND VISITING OF EXHIBITS 7:00p .m .. .... . ... . . . BANQUET - PAGE 14 Members , Guests, Award s and Pro gram UTAH NURSE May 10, 1974 - Friday 7:30 to 9:00a.m .. . .. . ... . . VOTING AND VdiSITING EXHIBITS 8:00 to 9:00 a.m.. . .. ... ... . . . . ...... ..... REGISTRATION 9:00 to 11 :00 a.m . ... .. . . ... .. .. ... ... CLINICAL SESSIONS 11 :00 to 11 :30 a.m . . .... . .... BREAK AND VISITING EXHIBITS r 11 :30 a.m . to 2:00 p.m . " Forum on Issues" . ... ............ . . GENERAL SESSION " Critical Issues from ANA Viewpoint . Rosamond C. Gabrielson " Critical Issues Facing Nursing in Utah " .. Dr. Norma Hansen and Corallene McKean t " Discussion and Voting on Resolutions " .... Bonnie Bullock ........ Dian Suta, Moderator .. . .... . \ I 2:00 to 2:30 p.m.. ..... .. . . . . BREAK AND VISITING EXHIBITS 2:30 to 4:30 p.m . ...... . .... .. .. .... ... CLINICAL SESSION 4:30 to 5:45 p.m ........... VOTING AND VISITING EXHIBITS . . .. .... EVENING FREE .. . . .. . . May 11, 197 4 - Saturday 7:30 to 8:00a.m.. .. . REGISTRATION AND VISITING EXHIBITS 7:30 to 8:00a.m ..... . . ..... FINAL VOTING - POLLS CLOSE 8:00 to 10:00 a.m . .. . . . .. .. . .......... CLINICAL SESSIONS 10:00 to 10:30 a.m .. ..... .. . BREAK AND VISITING EXHIBITS 10:30 a.m . to 12:30 p.m . " Institutional Licensure- Yea or Nea" . GENERAL SESSION * " Institutional Licensure " ............ E. Martin Egelston , Ph .D. Assistant Director Bureau of Health Manpower Rosamond C. Gabrielson , ANA President Nathan Hershey, Professor of Health Law Drew Peterson , M.D., National Delegate of Ame rican Med ical Associatio n r t .. ..... . Marianne Fraser, Moderator .... . . . . 12:30 to 1:00 p.m . . ................. ... CLOSING SESSION ....... . Introduction of New Officers . .. . ... . 1:30 p.m ... . .. Post Convention Board Meeting inc lud ing Lunch * General Session Open To The Public. Non-M ember Fee Will Be Charged. WINTER, 1973 · 74 PAGE 15 Professional Nursing In The Operating Room (Continu ed from page 13) the p a ti ent, th e nurse m akes assessment. this Observa tion of the patient provid es an assessm ent of overt a nd covert manifesta tions of a physiologica l a nd psychological nature. ld entifi ca tion of th e covert sign s of nursin g ca re probl em s is not an easy task . Most adults h ave a wall of d efen ce built around th em , b ehind which they a ttempt to obscure those probl em s th at they consider sociall y un acce ptabl e or tha t they do not wish or kn ow how to ex pose. Psychologica l signs m ay exist that indi ca te the possibility of a covert nursing care p roblem of a soci ological n ature. Identifi ca tion of thi s p roblem requires considerable skill in providin g the patient with an opportunity to express it, and then , interpre ting correctl y what the p atient expressed . An intervi ew with the patient pre- and post-pera tively encourages him to becom e acqu a inted with the operating room nurse and to relate both on a pro fession al and social level. Through interv iewing a nd observing, the nurse id entifi es pati ent n eed s. This process if often referred to as a nursin g hi story or nursing di agnosis prep ara tory to th e development of a pl a n for ca re. Therefore, to achi eve the objective, STEP l is: THE IDENTIFICATIO N OF THE PHYSIOLOGICAL, PSYCHOLOGICAL AND SOCIOLOGICAL NEEDS OF EACH PATIENT. I ' A nursing care plan of action based on th e identified individual p a tient n eed s, must be developed. A nursing ca re pl an is a written report of the patie nt's n eeds and the care actions the nurse will take to meet those n eeds. For exa mple, the patient h as shortn ess of breath clue to a card iac condition . This pati ent is placed in a semi-Fowler's position during transportation to th e operating room suite a nd until h e i s a n esthe ti cal. Every p a tient needs emotional support to allay his or h er fears of pain and impending physical trauma. A word of reassurance and a hand to hold gives the patient the confid ence that someon e cares during thi s p eriod of stress. The p atient with a lan gu age barrier co uld feel sociall y isolated. Man is essen tially a social creature. Non-verba l communi ca tion, su ch as PAGE 16 facial expressions, gestures, body pos~ures and movem ents will convey the message to the patient that h e is not alone. Each patient regard less of hi s medical diagnosis or contemplated surgery, brings to the operating room a uni que p ersonality and indi vidualized needs for nursing care. Although nurses become involved in multiple task-ori ented procedures, one of the unique functions of the professional nurse in the operating room is the development and implem entation of a pl an of nursing care. The professional nurse practitioner of today is primarily people-oriented ra ther than task-oriented. Acting with knowledge and leadership skills, sh e implem ents h er pl an of action to insure a standard of excell ence in the care of the pati ent en trusted to her. Therefore, to achi eve the objective, STEP 2 is: DEVELOPMENT AN D IMPLEMENTATION OF AN INDIVIDUALIZED PLAN OF NURSING CARE THAT MEETS THE NEEDS OF THE PATIENT. N ursing care plans, lik e other corredina ted pl an s in the hospital, must have a goal and th e involvement of p eople interes ted in achieving thi s goal. These pl an s ca n and should _he used to the fulles t extent to d enve compreh en sive and coordin a ted nuning ca re of pati ents. The professional operating room nurse mu st become involved in the pre- and post-op erative care of the p a ti ent, as well as the care during surgica l intervention. Channels of communi cation mu st b::: open between all m embers of th e h ea lth team who parti cipate in th e care of each p a ti ent. Observation s of and information about the pati ent are noted b y each team m ember. This knowledge is tra nsferred in writing via the p a ti ent's chart and j or verba lized to the surgeon, anesthesiologist, nursin g p ersonnel of the p a ti ent's unit or recovery room, as a ppropriate. P ersonnel in the laboratory, pathology, radiology, pharma cy, e tc. departments of the hospital also ha ve need for inform ation in ord er to p ~ r­ form their respective fun ctions in th e total care of the pati ent. " The promotion h ea ling is th e cure 1sion al nursin g. It is to understa nd th eir fo h ealth and asp ect of profesassisting patients h ea lth probl em s and h elpin g them to cope. It is the administration of medica tion s and trea tm ents. lt is the use of clini cal nursin g judgment in dete m1inin g, on th e basis of the patient's reactions, whether the plan for care n eed s to be m aintained or ch an ged. It is knowing when and how to use existing and potential resources to help patients toward recovery a nd ad justment by mobilizing their own resources". Therefore, to achieve the objective STEP 3 is: THE COORDINATION OF THE INDIVIDUALIZED PLAN WITH OTHER MEMBERS OF THE HEALTH TEAM TO PROMOTE C 0 NT I NU IT Y OF NU RSI NG CARE. T h e thera p euti c environm ent is essenti al to the welfare of the pa t· ient. The powers of observation a nd rational judgment are necessary skills and tools for the nurse to process. She mu st observe and control the physica l environment, the nursing care plan in action , a nd the deviations from acceptable technical proced ures. The nurse serves as a consultant to the other team m embers. Sh e carri es out nursing measures a nd ase pti c techniqu e, b ased on scienti fi e principl es a nd kno wledge, with a hi gh degTee of skill and sound judgm ent. Therefore, to achieve the objective, STEP 11 is : APPLICATION OF THE PRINCIPLES OF ASPECTS AN D TECHNICAL KNOWLEDGE TO INSU RE A SAFE ENVIRONMENT FOR THE WELFARE OF THE PATIEN T. Professional nursing practice is "supervising, training and directing those who give nursing care". 7 It is "constant eva luation of the practi ce itself. " ' T h e nurse assumes th e role of lea d er and teacher on nursing ca r etea m s. She not onl y plans the nursing care of the p atient, but supervises other p ersonnel in carrying out the technical aspects of care. Technical p ersonnel aug·m ent the effo rts of the professional nurse practitioner. These persons mu st acquire a high degree of techni ca l skill b ased on the application of principles. Their direction comes from the professional nurse who teach es, supervises, and evaluates perfom1 an ce of technica l skills and effectiven ess of nursing care. The patient can best eva luate the effectiven ess of nursin g practi ce, UTAH NURSE through a post-operative VISit to the patient. The nurse determines whether or not her nursing plan met the needs of the patient and how effectively the plan was carried out. If the patient, for example, h as numbness in an extremity, he may have been incorrectly positioned on the table. ' t\Thoever positioned this patient needs closer supervision ;md instruction. Operating Room nurses share a responsibility to assist beginning professional nurse practitioners to continuously master theoreti cal knowledge and develop opera ting room skills through an orientation program and inservice education. Therefore, to achieve the obj ective STEP 5 IS: GUIDANCE OF OTHER PROFESSIONAL A D ALLIED TECHNICAL PERSONNEL IN THE NURSING CARE OF THE PATIENT BY TEACHING, SUPERVISING, A D EVALUATING PERFORMANCE. Professional nursing practice is "asking questions and seeking an swers - the research that adds to the body of theoretical knowledge. It is u sing this knowledge, as well as other r esearch findings, to improve services to patients and service program s to people. It is collaborating with those in other disciplines in research , in planning, a nd in implementing car e." 8 Only through research into the n ature of professional practice will operatin g room nurses exp and their body of scientific knowledge based upon sound judgments rela tive to the nursing care of patients in the opera ting room. Theerfore, to achieve the objective, STEP 6 is: INITIATION OR ASSISTANCE WITH RESEARCH PROJECTS DESIGNED TO DEVELOP A BODY OF SCIENTIFIC KNOWLEDGE RELATIVE TO THE CARE, CURE, AND COORDINATION COMPONE TS 0 F PROFESSIONAL OPERATI G ROOM NURSING. IMPLICATIONS If nu rses accept the assumptions underl ying the development of hte sta tement of definition of professiona l operating room nursing and the objectives for clinical practice of professional operating room nursing, it WINTER , 1973 -74 is obvious that nursing in the operating room is patient-oriented. Further, if nurses accept the three essential components of professional nursing practice as stated in the ANA position paper on nursing education, it is obvious tha t all these comments are incorporated into the clinical practice of professional nursing in the operating room. The in creased util ization of operating room techni cians has b een forced upon nursing service by the ever-increas ing shortage of profession al nurses prepared to funct ion in the operating room . As allied technica l personnel have assum ed th e tec hnical duti es once per form ed b y nurses, nursing educators have deemphasized the contributions of nurses during surgical intervention in rendering to patients the ca re, cure and coordination compon ents of the profess ion al nursing practice. At this critical phase in the life of the patient, a person prep ared and authorized by law to practice nursing and , therefore, deemed competent to render sa fe nursing care (the definition of registered nurse practitioner) should plan, implement and direct nursin g care. Many of the physiological, p sychologica l and sociological outcomes of surgical interve ntion are influenced b y the level of competency of the persons providing services to the patient. The pa ti ent will b e deprived of a service which contribu te to his health and welfare, at a time when he criticall y needs and is entitled to nursing car e, unless professional nurses fill the vo id in the continu ity of nursing care. CON CLUSION The definition of professional operat ing room nursing gives guidance to nursing service and nursing edu cation. The obj ective for clinical practice of professional operating room nursing and the steps toward the achi evement of this objective should provide d irection to present and future prac titioners of profess ion al operating room nursing. These sta tements are intended to assist opera ting room nurses in developing their professiona l role in providing nursing service to the pa tient before, during, and after surgical intervention. Hopefull y these sta tements will also encourage nuring service admi ni strators and nursing educators to recognize the role of th e profess ional operating room nurse and the patient's need for nursing ca re in the operating room . Explanatory paper prepared by the AORN Statemen t Committee UNA Operating Room Conference Croup Chairman, Mary Alice Jones. REFERENCES The de finition of te rms u sed in this paper a re synon ymous with those adop ted . by th e ANA in the Position P a pe r o n N urs•n g Educat ion . 1 Nurse practitione,·: a ny person p repared a nd a uth o rized by law to practice nursin g a nd , th ere fore, dee med compete nt to re nder safe nursin g care. Nu1"Sing service: th e syste.m thro ug h whi c.h the se rvices of nurse pract itiOners a nd the1r assistants a re m ade a va ila ble to those in need. H ealth fa cilities: A spec ially designed place wh ere people rece ive health instruction a nd ca r. 2 A Positi o n pape r " Education al Prepara· t ion fo r N urse Pract iti one rs a nd Ass ista nts to N urses", Am erican N urse's Association, 1965, p. 5. 3 IBID , p. 15. \ I " Quoted or ad apted from the assum ption s of: t he ANA positio n paper, IBID , p. 4. 5 IBID , p. 5. 6 IBID , p. 6 P rofessional nursing p ractice is also " coordin at in g a nd sy nchroni zin <>" m edical a nd oth e r profess io nal a nd tech ni~a l serv ices as these a ffect pat ients." ; IBID , p. 6. s IBID , p. 6. W elcome to AMERICAN FORK HOSPITAL E xpert nursing care C oncern for patients J\ware of individual needs R ehabilitate to patient's potential E ndorses continuing education for staff _t, Irene B. Evans , R.N . Director of Nursing AMERICAN FORK HOSPITAL 350 East Third North American Fork, Utah 84003 PAGE 17 · Panel Discussion: Where J\re We In 1973? First, let me express my pleasure at being asked to participate on thi s panel. The subj ect, "W h ere Are ·w e in 1973?" seemed a bit puzzling at first. T hen I realized that we are a year b eyond wh ere we were at this same tim e in 1972, a nd seven years beyond where we were in 1966. I b elieve that the past seven years h ave witnessed nursing pass through a state of ferment, a seemingly n eces~a ry period of great agitation , from wh ich we have emerged with grea ter insights, hopefull y more wisdom , and with en o ugh m ental health to stagger onward. The move to \ Vestmin ster Coll ege Campu s in 1968 with the ch arge to establi sh a four-yea r nursin g program on that College Ca mpu s was for m e the beg innin g of a giganti c task which seemed overwhelming, but ch allen ging. In the process of program development, I learned what m yths to discard , what rea lity to incorporate, and h ow to shr ug m y should ers and say simpl y "I don ' t know." There were guid elines. In fact. perhaps, too many guid elin es. I had arrived on th e College Campus a t a time when hi gher educa tion wa s und ergoing grea t turmoil a nd un certainty. It beca m e obvious by the hour that ch ange was the order of the clay for higher education. College m ea nt cha nge! New programs would b e establi sh ed. New poli cies woul d b e inst igated. Trad ition would be di scarded. L ittle did I realize at the time that the k erta inty that seem in gly guided my action s would soon collapse. I kn ew what ba cca laurea te nursin g ed uca tion was all about. After all , I was a m ember of the Bacca laurea te Seminar of the Western Interstate Commission for Hi gh er Education in Nursing. I had gu idelines from the National League for Nursing describing the behaviors implicit in baccala urea te nursing edu ca tion , and I h ad all kinds of information from th e Uta h Board of N ursing. In ad diti on, I h ad read Martha Roger's publi ca tion , REVEILLE I N NURSING, 1964, I was and still am an admirer of Marth a R ogers. I remember over and over h er commen t, "Society h as criti ca l need of far larger numbers of coll ege gra duates equipped to cop e with multiple dim ens io ns of man 's world. " The way to dea l with probPAGE 18 !ems was through college edu ca tion . Dr. Rogers stated further that Colleges and U ni versities provide a road to self-fulfillm ent for those whose cap acities and goals are con sistent with wh a t high er ed ucation h as to offer. I just knew that Nursin g's problems would be solved if onl y we could get N ursin g within the m;:;instream of higher eel uca ti on ! Pl acing N ursing within the framework of the hi gher educational institution wou ld on ly partially solve N ursing's prob lem s, I was to lea rn later on. For aga in , I h ad misjudged th e situation surroun d ing me. First, admission poli cies were b eing scr u tini zed with a view toward adm itting the disadvantaged ~ tudent. Second , a m yriad of regi stered nurses seeking the bacca la ureate nursin g d egree b egan pounding on the R egistrar's Office door. Sudd enl y, the nursin g program at ' Vestminst er had breathed in sta nt life into the Coll ege commun ity. I was b usil y in volved in the process of tailoring a nu rsing program to prescription, a nd I wa s not prepared for the kind s of d emands now facing the n ewly created D ep artm ent of N ursing. I kn ew enou gh about education to kn ow th a t recruitment of the bright stud ent would m ea n success. Therefore, only well-prepared high sch ool gra dua tes with respectable grade p oint averages would be ad mitted. Thus, both faculty and College would look grea t. I d idn' t want hi gh-ri sk st ud ents I had a program to sell to th e right stude nt, a nd I didn't wa nt State Board failures! I was protecing m yself a nd the nu rsin g faculty from any and alJ crit icism . That see med important. After havin g b ee n on \ 1\Testmin ster Coll ege Campus for abollt one year, I was invited to attend a special hum an relations semin a r in an adjoining sta te. I accepted. The ex p erien ce shattered many more m yths for m e. Although semi nar di scussiom centered around the need for New Careerists in the profession s and the explora tion of avenu es through which disadvantaged groups co uld fe ed into the larger sys tem s of socie ty, the phychological fall out from tha t conference wilted m a ny participants. I sh all n ever forge t h earin g a black lady fro m th e gh etto respond to a Ph .D. professor. H e sat as thou~;h paral yzed for th e remaind er of th e conferen ce. She stru ck forth with such undeni able truth tha t no on e seemingly ca red to comment. She asked su ch qu es tions as, "\ !\Th at does education m ea n ? vVhy is it that you hold hi gh-powered d egrees, ye t you reall y don't unders tand me nor my people ?" I am gratef ul to that woman. La ter, I found myself asking the sa m e qu estion . Ju st what does education mea n ? T h en, I reali zed tha t I h ad been exposed to a sli ce of reality from whi ch there was no retreat. I had stepped to the summi t where so man y others already stood, holding o n to a bag of traditional myths which h ad b een pou red into our heads by on e speci fic segment of socie ty. I h ad glimpsed a t the path of education al uncertainty. I discovered that I co ul d n o longer d efine eel uca tiona} term s whi ch h ad been unqu es tioned on ly a few m onths previou sly. ' Vell , how does thi s help d efine WHERE ARE WE I N 1973? For me, 197 3 is a summit year. In creased awaren ess makes for increa sed res ponsibilities. I now refuse to be wrapped in the cloak of profession al ill usion . I recognize th e world as a very real world with very real people as its occ upan ts. I b elieve tha t nursing is n ow standing on a bridge connecting the old a nd th e n ew. The task of highe r edu ca tion now see ms to center a round the n eed to teach for selfdevelopm ent. It h as b een said that socio-cu ltu ra l chan ge is now occuring with such rapidity tha t we ll-in~;ra in­ ed rol es a nd va lu es are b lurred. Indeed the basic charac ter of the human self m ay b e cha nging. H ow does nursing fit into the ed ucational picture? N ursing in the State of Uta h fits squarely within the stru ctu re of hi gher ed uca tion. T he stresses a nd strain s of hi gher ed u ca tion will in p a rt b e the stresses a nd strain s of nursing. Many coll eges tod ay are ad vocat in g a n open admi ssion policy, PRINTING TYPOGRAPHY LITHOGRAPHY RULING Quality Press 52 EXCHANGE PLACE SALT LAKE CITY 363-5751 UTAH NURSE with a n open c urri culum to a n y and all who feel that they ca n in some way be helped to live more produ ctive lives b y exposure to college. Many, man y students are seek ing exposure to coll ege, and we don' t know if we can help them . One thing rings clear, the coll ege population of the 1970's and 1980 's will p roba bl y not be m ade of the sa me type of student as the 1950's and 1960's. A different kind of learner is now seeking admittan ce. In response to the n ew seeke r, the Dep artm ent of N ursin g is work ing on an Open C urr iculum Con ce pt. I m ay be biased , but I b elieve that it may work well for the intellectuall y aware, self-directed student. For the student ~ nte ring college with no concept of md epend ent stu dy a nd without a sen se of respo nsibility, the open curriculum ma y n ot mee t hi s n eeds. Once aga in, a m yth h as b een exploded: I u sed to think t ha t all ba ccalaureate nu rsi ng stud ents sho uld become leade rs. Indeed , if they did not possess th e potential for b ecoming lea de rs, then they d id not b ~ l ong in a baccalaureate nursing program. I now know tha t just as ma n y followers as lea ders are grad u a ted , a nd that we ju st do n 't know wha t makes a lea d er! As for nursing co nten t. It is h ard to know wh at is n ursing co nten t. Im agine m y surpri se at learnin g tha t one of m y stucl_ents in p sychi atric nursin g was pursumg an indep end en t stu dy in sociol ogy. Sh e was u si ng h er exposure to a social institution as a studen t nurse Lo fulfil l cou rse re9u irements in sociol ogy. 1 lot a b ad rdea. Bu t somehow, I fe lt a bit uncomfortable about it a II. On e ca nnot build curriculum without first stud ying the n eed s of the lear ner. 1t rem ains to b e seen what the study o f the lea rner will revea l. Life styles <~re cha ngi ng very rapidly. Old values are dying. N ew valu es are no t well d efined . The adolescent of today is having; co n sid e r<~ bl e cliffic ~dty es tablishing hi s identity. Suiode ra tes are high. Yet, despite these blea_k . facts, m<~ny adolescents possess a w 1~lm gn ess to deal with highl y cli stu rbmg probl ems su ch as social ills, inequiti es, eco logica l probl em s, and promotion of q u ali ty life. The n eeds of Nurs in g in 1973 m ay we ll parallel the d eveloping adolesce nt's edu ca ti on demand . R esh aping of structures m ay be n ecessary in order to rem ain res ponsive to NursW INT ER , 1973 · 74 ing's educa tion al d em ands. Meaningfulness a nd releva nce a re two guiding principles for cu rriculum development. Each facu l ty m ember is h eld responsible for kee ping the content taught releva nt to the r ea l world. Most fac ulty m embers rea lize that the st udent of toda y needs h elp in sorting out m od ules whi ch wi II ass ist the student to achieve goa ls in a se lf-directeel m <~ nn e r. Other pla ns consist of new method s of inst ru cti on emphasizing more student indep enden ce. There is the need to shift more emphasis to the student who lea rn s ind epend e n tly a nd a t his own pace. Some progTess has bee n mad e in thi s area thro ugh an ind epend ent study laboratory with <1 numb er of pro· gra mmed ma t er i <~ l s . Students of tocla y are unusu all y bri gh t, but man y are co nfu sed about the fu ture a nd the prioriti es of contro llin g officials. R egul ar College admi ssion poli cies apply to the D epartment of N ursing. Special scree n ing tests have not b ee n utilized. Stud en ts a re inte rviewed re lative to th ~ ir interest in nursin g, wh a t they hope to ach ieve as nurses, a nd what motiva ted th em to see k admi ssion to the nursin g progra m. 'i'\'e have. however, adm itted some st ud ents who have been sc ree ned out of o ther nursing program s. \!Ve a re watching ver y closely th e progress of th ese students. W e are look in g at curriculum very carefully with a view towa rd a concept-centered curriculum incorporating n ecessa ry nursing skill s a nd understa nd ings in such a wa y :-ts to a llow th e st ud en t to see th e relationship b etween theor y a nd practi ce. Vl!e are di scardin g obsole te materia ls. N u rsing's n eed for teaching specifi c sk ills a nd co mpete ncies ma y no longe r jib e with th e philosoph y of highe r edu cation . I a m pa rti cu la rl y concerned a bout thi s wh en I look a t teaching load detennin ;ttion within th e College fram ework. In summ a r y, the re is no <~ lt e rn at i v e to co nsta nt stru ggle wi th rega rd to curri culum d evelopmen t. I do no t a nti cipa te b eli ev in g tha t I ca n ever again co ntrol the education al situ ation that con sumes so m uttl¥ of m y tim e. R ath er, I ex pect to engage in the e"' pl orat ion of edu cat ion al uncert:-t in ty. L. Fe lkn er, Associ:-tte D irector D c p<~rtm c nt o[ l'\ urs in g vVes tm i nster College Play as hard as you work. FrU your life with the things you care about in a city that will about you. Our town is enough friendly; enough opolitan. Our hospital is one of the best anywhere. Call us collect if you want to know about the p lace to be, professionally and personally! HOLY CROSS HOSPITAL 1045 East First S01.1th, Salt Lake City, Utah 84102 (801) 328-917 1 PAGE 19 nurses' association to en sure continuance of th e U tah Certification Program. In the practice settin gs, nurses must be allowed to fun cti on in accordance with th eir knowled ge and expertise. Primary Care - Position Paper Su bmitted /o Greater Salt Lake H r>r1 l!h P lanning Coun cil. AUTHORS: J oyceen Boyle Lori H ammond J ean O sborne Ginette Pepper Abstract D istrict One- Utah Nurses' Assoc. Introduction District One of th e Utah Nurses' Assoication is acutely awar~ that on e of th e greatest failures of th e present h ealth care system in th e Great Salt L iik e area is in th e delivery of primary h ealth care. District On~ b elieves th at the role of nurses in m eetin g increased d emands for care can n ot r em ain stat ic - it must ch a n ge alon g with tha t of all oth er h ealth p rofessionals. The practicing nurses in District One sta nd r eady to assum~ a greate r responsibility and accountability t o augm ent th e t raditional coordinatin g role within a t rue multi-discipl ina r y ap p r oach in m eetin g th e n eeds of a rapidly ch a n ging, but sound h ealth ca re system. State licen sure law affectin g nursing practice present no barriers to professional nurses assumin g th e role of a primary care provider . - Exe rti on of th e scope of nursing practice in primary h ealth car e will h ave a profound impact on h eal th providers a nd consume rs. Recommendations - Professional nurses wh o h a ve been identified as qua lified primary h ealth care providers will be utili zed to th eir maximum potential in th e followin g primary care settings. (a) Specia lly trained Nurse Practi tioners in Outreach Clinics urban a nd rural. (b ) Specia lly trained Nurse Practit ioners in Ambulato ry Car e Cen te rs, Community H ealth Agencies, HMO's, Ex tend ed Care F acilities a nd Ph ysician Officers. (c) Specially trained h ospital nurses in Eme rgen cy D ep a rtments and Out-patient Clinics. C ritical evalua tion be m ad e of existing h ealth m a npowe r t o d etermin e numbe rs, ty pes, and distribution . Con sideration sh ould th en be given to wh e th er th ese p erson s have been producing a t th eir maximum p otential befor e cos tl y n ew programs a r e initia ted and producing a n oth e r h ealth care worker into th e la bor m a rk et. District One Position s Profession al nurses b e identified and utilized as prima ry h ealth care providers in th e Grea t Salt L a ke a rea . - All existing h ealth m a n power in the Great Salt Lake a r ea be identified and utilized befor e d~vel o pin g " n ew" ty pes of h ealth care workers. - Knowled ge, skills and exercise of profession al nu rses b e broaden ed so th a t they may assume exte nd ed resp on sibilities in providing prima ry h ealth car e. - The delivery of primary h ealth care be a multidisciplinary approach . I - Education a l cen ters sh o uld undert a ke curri cular innova t ion s th a t dem on strate n ew concepts in th e delive ry of care in a va rie ty of settings und e r condition s tha t provide optimum opp ortuniti es for nurses to achieve th e high est levels of competence. Continuin g education programs for nurses should be coo rdinated by the educational centers a nd th e p rofessional Compreh en sive h ealth services must involve integration of the skills and r esources of many professions, th e m embers of ea ch which sh a re and seek th e sam e goal. As th e con sume r of h ealth services may b e dep endent on h ealth pe rsonnel fr om a va riety of disciplines, so t oo th e providers of h ealth services a re d ep endent on one a noth er to e xercise lead ership when n ecessary; t o occupy supportin g rol es wh en a ppropria t e, and at a ll times to colla borate toward th e objective o f providing th e mos t effective ca re in th e m ost effi cient manne r . - Nursing Practice Acts like M edical Practical Acts set forth educational and exa mination r equirem ents, provide for r egistration of th e profess ional, a nd describe th e practic~ of th e profession in broad gen e ra l terms. An orderl y t ra n sfer of resp on sibilities between m edicine a nd nursing h as proceeded over many yea rs and must continue to d o so. Nurses functions will change primarily because nurses a re dem onstrating th eir compe tence to p erform a gr eater variety of fun ction s. In this p eriod of rapid t ransit ion, the initia l service p erformed for a pat ien t may be th e practice of m edi cine wh en ca rri ed out by a ph ysician or the prac tice of profession a l nursing wh en carri ed out by a nurse. Cost-ben efit a nalyses a nd similar econ omic studies sh ould be under ta ken in a va riety of geographic and institutiona l settin gs to assess th e impact on th e h ealth ca re d elivery system of ex tendin g nursing practice in prima ry car e. Attitudinal surveys of h ealth car e providers a nd consumers sh ould be conducted to assess th e significance of factors tha t migh t affect th e acceptance o.f nurses in primary h ea lth care roles. ~ Primary Care - Position Paper In Detail District No . 1 - Utah Nurses' Assoc. Since th e F lexn e r R ep ort in 1910 stimulated a r~volution in m edical education , resultin g in radical chan ges in th e educa tion of ph ysicia n s and the reby establishin g a major d et erminan t of the m odern h ealth care system , man y ch a n ges have occurred n ot only historicall y and socially but also in sc i en c~ and technology. R ecently it h as been r ecogni zed that this h ealth care sys tem has serious defi ciencies. " Ther e is a crisis in Ameri can h ealth ca r~. The intutition of th e ave rage cit izen has foundation in fact. H e sen ses th e contradiction of increa sing employmen t of h ealth man power with d ecr easing p e rson al a ttentio n to pa ti~nts and incr easing costs." The Great Salt Lake H ealth Plannin g Council, as is the rest of the n a tion , is becoming acutely aware that one o.f th e greatest failures of th e present Ame rican h ealth care sys tem s is in th e PAGE 20 - delivery of primary h ealth care. The term primary ca r e a s used in this pape:r is d efin ed in Extending the Scope of N u rsin g P r actice - A Report of th e Secretary's Committee to Study Extended Roles for Nurses. Prima ry care is: (a ) a p erson 's first contact in an y given episode of illness with th e h ealth care syst em that leads to d ecision of what must be d on e to h~ lp r esolve his probblem ; and (b) th e r esp on sibility for th e continuum of car e, i.e., m a inten a nce of h ealth , eva lua ti on of mana gem ent of symptoms, and a pprop riate referrals. F or th e last decade th er e h as been much discu ssion a nd evaluation of " th e ph ysician shortage," " th e nurse shor ta ge," " the sh ortage of h ealth care workers," etc. resultin g in larger enrollmen ts in education al institutions a nd th e prolific development of a va riety of n ew h ealth worke rs. H oweve r , this approach has not noticeably alter ed th e p erceived shorta g~s, or even wh eth er th is a pproach is th e answe r to th e larger problem s in th e h ealth care system . The crisis is n ot on e simpl y of numbers. It is tru e that substantia lly incr eased numbers of h ealth m a npower will be n eeded , over time. But if addit ional p ersonn el continue to be employed in th e presen t manne r and wi thin th e present patte rn s and 'system s' of care, th ey will n ot a ve rt, or even perhaps a llevia te, th e crisis. Unless we improve th e sys tem through which h ealth care is provided , ca re will continue t o become less satisfa ctory , eve n th ou gh th er e are m assive increases in cost and in numbers of h ealth pe rsonnel. H ealth ca re has becom e recognized as a ri ght ra th er th a n a privilege, a nd h ealth is becom in g in c reasingly va lued . Consum ers a re no lon ger content to be passive recipients of m edical car e. They have becom e activated and knowled geable, r ecogniz in g tha t h ealth care a nd m ed ical car e are not syn on om ous. Consum ers a re a lso becoming more vocal, expressing their dissa tisfa cti on with th e " back sea t" patient care has often taken to m edical e duca ti on a nd to research. UTAH NURSE One of the most evident contributin g factors to the h ealth care c risis has been a lack of physician manpowt;r t_o delive r primary care. Many pediatr~­ cians, obstetricians, and gen eral practition ers in Salt Lake County who deliver the major portion of primary care have closed their practices and are n o lon ger taking n ew patients. The most recent Utah H ealth Profile r eveals that Tooele County h as 0.18 primary care physicians p e r 1,000 population adve rtised as available in the November 1971 phone listings. This is the lowes t rate in Utah (with the exclusion of three counties which have no physicians at a ll). The ave rage fo r Utah is 0.42 per 1,000 population, and while Salt L ake County r eportedly boasts 0.45 primary care physicians per 1,000 population, this does n ot represent th e number wh o a re actuall y taking patients. N ewcom e rs to the Salt Lake City area, eve n those n ot encumbe red by econ om ic, socia l, or la n guage limitations, r eport they oft en find it very difficult to ge t physicians' services. po rt and trust that are bas ic to primary ca re . District No. 1 -Utah Nurses' Association questions if there is a sh orta ge of health manpower but rather a ttributes the h ealth crisis to the inadequate uti lization and distribution o.f ave rage h ea lth talent. This ex planation of our h ealth dilemma has not been faced squarely by h ealth lead ers. Instead the y tend to focus on pre paring with n ew labels n ew role descriptions that are n ot en ti rely n ew or highl y innovative. Services co ns umers receive are n ot hi gh qua lity ca re and are seen to be due to too m a n y patients, too little t ime, and limited peer control. Interre lationship Between Prima ry Care and O ther Problems Differen t Health Problems The focus of m edicine has ch a n ged radicall y over the yea rs with today's specia list-oriented m edicine h oldin_g that medical care with the m ost extensive r esources is the best; that first -level m edi cal ca re is give n best by specialists in a health cente r or in a h osp ital ambulatory car e center. The truth is that th e great major ity of ailm ents for which p erson s seek m edical ca re can be d iagnosed a nd t reated better in a simple than in a complex setting. On e of the reason s be ing that the m ore complex and sophisticated the system, th e less p ersonal ide ntity is maintained by the patient. The focus of m edicine h as chan ged to th e chronic conditions a nd illnesses which a re often more important in lost productivity rath er than lost life. A survey of Utah medical _se rvices. revealed a hi gh u sage of m edical serv 1 ce~ _for preven tative a nd / or J:ealth superv1s_wn purposes. R espiratory Ill!lesses we re. fi_rst on the list for consultmg a ph ySIC ian with gen eral m edical examinations, innocula tions well-baby care, pre-natal and post-p~rtum care ranking second . In summary, many prima~y care contacts are r elated to uncomplicated . acute, e pisodic illnesses and to stable chroni c illn esses. Major n eeds in primary car e a re for understanding causes of a particular patient's problem and m otivatin g and educating the patient to relieve these. Continuity and p ersonalization of the patient-health professional relationship are n ecessary for th e understandin g, s up WINTER, 1973 -74 Accessibility Although diffic ulty in obtaining primary care affects all ~merican citizens. it is enco unte red most m Salt La~e a nd Tooele Counties by th e low mcome g roups, the m edicall y in(!i ge~t, th e sen ior citizens, and the mmonty g rouJ~S . Some of the problem s encounte red m obtaining prima ry car e are : Entry points unknown o r barrie rs c reated to entry points. Compreh e ns ive available. se rvices are n ot Se rvices are fra gm ented , provided at differe nt a gencies a nd at diffe ren t times. Consume rs are not aware that th ey can exercise th eir right of fre e ch oice in selecting a practition er or a diffe ren t sys tem in obtaining h ealth ca re services. Limited access ibility du e to : Lack of t ra nsportation Distance Time Babysitting Language barrie rs Cultura l factors Eligibility proced u res Payment of fees Ove rcrowd ed a nd inadequate facilities. T he Cost Cr isis From the consumers' poin~-<:>f-view th ere has been a h ealth care c n s1s eve r since American m edical car e gr ew ';>Ut of drugstore elixirs and hard - h o.Jd~n g into a streamlin ed s pace-age commodity. Frequently ca re has ~ften been of low quality, u sually unavailable whe n needed most and always too expensiVe. Until recentl y this crisis seemed to go on year after year ~nnotic ed except for occasional complamts from con sum ers. In 1969 som e thin g happe ne d to ~a~ e the health ca re cris is a matte r of official national concern : th e m ed ical costs rose so hi gh and so fast that it began to look as if h ealth would soo n be beyond th e m eans of th e rich est na t ion on earth. The majo rity of the large inc reases in h ealth ca re costs have been in hospita lization costs. H ence, a system of compreh e nsive primary, preventive, and maintenance ca re which is economically and conveniently avai labl e to a ll consumers, aimed at decreasing hospitalization s should resu lt in decreas ed co nsume r costs . Some pe rsons have expressed th e idea that a noth e r way to reduce medica l costs and to improve accessibi li ty is to shorten m edical education. Othe rs believe that a g reat deal of h ea lth care rendered is in the primary care catego ry a nd could be provided by a Nurs_e Practitione r. However , no cost-ben efit studies of the u se of the primary care nurse practitione r have been reported . It is unlike ly that even primary care costs can be curtailed if all the practitioners, for routine as well as complex m edical problems, have an average of seventeen yea rs of secondl:l~Y a nd posto-raduate education. In add ition th e pres~nt c risis makes it evident_ that m er_e len o-th of education has n ot m sured um for~ly high-quality of ca re. However , me rely to shorten m edical edu cation would not n ecessarily m ean that h ea ~th care services were improved . One maJor problem in h ealth care is an infori?ation gap between research a nd a pplication to patient care. One m ethod of solving th e cost crisis is th e H ealth Maintenance Organi zation (HMO ) . This is an organized system of h ealth care providing compreh ensive services to a vo luntarily enrolled populat ion for a p er capita prepaid fee. Compreh en sive ser vices includes th e provis io n of primary care, em ergen cy care, acute in-patient hospital care, in-patie n t a nd out-patient care, and r ehabili tatio n for chroni c and disa bling condition s. Nursin g is an integral part of th e HMO. In order for th e HMO to provide compreh en sive h ealth ca re se rvices, it is impe rative th at nurses participate in th e planning, operation a nd !'! valuation of th e h ealth care program 1 Nurses in a n HMO must be prepared to function in an ex te nded role a nd accept accountabi lity to th e consume r fo r th e ir nursing practice. Compreh ensive Services Anoth er impedimen t to compreh ensive se rv ices is the existence of sep a ra te uncoo rdin a ted subsystem s for the compon ents of health care: m edical, m enta l, and de ntal se rvices. In addition , th e trends toward inc reasing sp ecializatio n h ave complicated ent ry into the health care sys tem . It is at th e point where th e individual decision rega rdin g th e n eed for treatment must be d ete rmine d an d assessed that one of th e most important h ealth ca re decisions is made. Th e nurse is the pe rson best-qualified to function e ffectively at this importan t leve l, as sh e has the required knowledge, as well as th e n ecessa ry capacity for makin g inde pend ent judgments. In situations wh ere th e s ubsys te ms r emain separate, the primary ca re nurse can serve as a n advocate, as well as r esource p erso n , for the patient seekin g car e in the complex maze of agencies a nd specialties. Problems of Specific Groups in the Great Salt Lake Area A dichotomy of h ealth n eeds exists in the Great Salt Lake area due to the urba n versus rural settin gs. In addition , Salt Lake City is th e h ealth ca re cente r fo r the inte rmountain region. The variety of primary and secondary h ealth care problem s which the Salt Lake area h ealth services must m eet multiplies the n eed for individualized planning and se rvic es. A variety of "m edically indigent" h ave been c r·e ated by th ese di ve rse co nditions. R ural Tooele Co un ty has six practicing phys icia ns all located in the c ity of Tooele, o ne of 'whom has reach ed retirem ent age. The total county population is a pproximate ly 22,000, or one physician pe r 3,700 pe rso ns. Tooele City has the largest con PAGE 21 centration of population 12,539, leav in g 9,461 p ersons in th e County w ith out immediate access to an y ty pe of h ealth ca re deli very se rvices. A m a jor freewa y c rosses Tooele County acco untin g fo r nume rous tra u matic hi ghway accide nts. with facilities and m edi cal care p er sonn el located onl y at T ooele, n ecessitating transpor tin g c ri ticall y injured pe rsons up to dista nces of llO miles. Urban A r ecent stud y in Salt L a ke County sh owed 1,000 p r acticing ph ysicia ns fo r a tota l coun ty p opulation of 480,000, or on e ph ysicia n per 480 pe rson s. Additiona l d a ta sh owed th a t th e distribution of S alt La ke Coun ty ph ysicia n s lea ves as m a n y as 44,000 pe rsons with ou t access to a prima ry care ph ys icia n within a .reason a bl e distance. It furth er sh owed that num erou s special ists a nd th o£e with cl.osed p ractices, p rovid e p rima ry care to select groups of p a tients. M ode rn techn ology a nd th e crowd ed living conditions have cr eated h ealth problem s uni que to th e urba n settin gs, pa r ticula rl y in a ir, wa t er. a nd noise p ollution. H ealth pla nning must in clude psych o-socia l a nd recr eationa l, as we ll as poli t ical d eterm ina n ts. Migrants Mi gran t worke rs wh o com e to U tah for th e summ er a nd fall m on th s each yea r offer a ch allen ge to th e esta blish ed h ealth ca re system . The inad equ a te and often unsanita ry living con d itions m a ke this group high ri s ks for illness and acciden ts. Th e lack of h ealth h ist ory a nd con tinui ty of m edi cal record s a nd lan gu age a nd cultural ba rri ers complicate th e p icture. While Salt Lake City is m os t often involved with migra n t workers in second a ry care, it h as becom e recog ni zed th at this p roblem should be sh a red by th e en tire r egion ra th er th a n ass ign it to th ose coun t ies a nd cities in wh ich perm a n en t popul ation s a re often in adequa tely cove red m edicall y . As th e r ecogni zed center of m edi cal ca re of th e state, th e Grea ter S alt Lake a rea m ay n eed to assum e a leadersh ip role in h ealth care se rvices to th e mi gra n t worker . / ~ Aged In 1900 onl y four p ercent o f th e U ni ted States po pulation was 65 yea rs of age or old er , while this age group n ow con t ribu tes te n p ercen t of th e p opu la ti on . Simila r trends a r e seen in U tah dem ograph ic figures. The elderl y ty pi call y h a ve greate r h ealth care n eeds th an th e youn ger p atients. The Na ti ona l Health Survey reveals th at four ou t of five person s ove r 65 yea rs of a ge h ave on e or m ore ch ronic diseases. M oreove r , in this t ime of increased m edical exp enses th e eld erl y face a dec reased or fi xed incom e. The ave rage y ea rl y ou tlay for m edical car e of th e elde r p erson h as increased $42 as compa r ed to th e yea r before M edi ca re bega n . Tra nspo rtat ion to me dical ca re faci li ties is diffi cult as th e elderly pe rson must often give u p his priva te au tom obile fo r ph ys ical or fina n cial reasons. Often th e fa m ily ph ysicia n d ies at a t ime wh en th e elderl y person h as h is gr eatest n eed for con tinui ty and h ealth services. The inte raction of ph ysical a nd social loss m a ke -; th is a compl ex developm enta l s tage in PAGE 22 which adjustm en t to radical life ch a n ges a nd impendin g death must occur. The varie ty of subgroups in th e Great S alt Lake dis tri ct with a multitude of h ealth ca re n eeds p oints up th e n eed fo r a gen e ralistic a pproach . The nu rses i n D ist rict One stand read y to asm m e a greater responsibili ty a nd accoun ta bility in its prac tice a nd to a u gm en t its tradition al coordina tin g role within a t rue mul ti-disciplina ry system to m eet th e needs of a h ealth care system in c risis and in n eed of rapi d bu t sound ch a n ge. N urses in th e G rea t S ale L a ke ar·ea ca n fun ction in followin g prim a ry ca re roles: N urse Practitione rs in Out reach Clin ics, (urba n a nd rural) N eighborh ood H ealth Cen ters, Pub lic H ealth Agen cies, a nd in p racticing ph ysic ia ns' offi ces. H ospital em ergency depa rtm en ts, ou t-pa t ient clinics, a nd a mbul atory car e cente rs. Community agen cies f o r disch a r ge planning a nd follow-u p for con tinuity of patien t car e. H ealth tion s M a in ten a n ce Organiza- Ex ten ded ca re facilities As we look to a fu ture goal of d eveloping a nd implem en tin g multi-disciplina ry h ealth care d e live ry m odes a nd bridging th e gap between research devele pom e nts and actu a l de livery of ser vice, each discipline will n eed to extend its r ole to m aximum p otential. T his includes a ll p ro fession s: nursing, socia l work, h ealth administrat ion , clinical pha rmacy, a nd physical th era py, as well as m edi cine. It is th e p osition of D ist ri ct One of th e U tah Nurses' Assoc iation th at on e la rge step towa rd m ee tin g th e challe nges of th e h ealth ca re cri sis in Sa lt L a ke a nd T ooele Coun ties would be accomplish ed throu gh th e extens ion of th e nursing rol e within a tru e multi disciplina ry a tm os ph ere to include th e full scope of r espon sibili t:es a nd fun ct ion s correspond en t with th e capabili ties, t ra ining a nd education of m a ny nurses in th e Grea t Salt La ke a rea. It is the p osition of District N o. 1 Utah Nurses' Associat ion , th a t th e r ole of th e nurse in m eeting inc reased dem a nds fo r ca re must n ot r em a in s tatic it must chan ge alon g with that of a ll oth er h ealth professiona ls, which m eans that th e kn owled ge, skills a nd exper tise of th e nurse n eeds to be broaden ed . The assump tion by nurses of extend ed respon sibilities for pa ti ent ca re m a kes possible a wider professional opp ortunity for profession al nurses a nd implies in cr eased effectiven ess and efficien cy in th e delivery of primary h ealth se rvices. One of th e m ost impor tan t opportuni t ies for ch a n ge in th e curren t system of h ealth care in volves alterin g th e practice of nurses an d ph ysicia n s so th at nurses assum e con side ra bl y greater resoo nsib il ity for delivering prima ry h ealth ca re services. In exammm g th e poten tial for extendin g th e role of t he nurse in p rim a ry ca re, we believe th at su ch care sh ould r efl ect patien ts' n eeds rath er th a n p ro- fession al prerogatives, and that th ose wh o provide primary h ealth care should work as a t eam wh en ever th e needs of the pat ien t and his family wa rrant. W e believe th a t th e present gap b etween ideal h ealth care and wha t actua lly exists could be closed within a r eason able fra m ework of tim e by extending th e role of th e nurse in primary care. Th er e is a great n eed t o assure every person access to health services wh en a nd wh ere th ey are n eed ed at a cost society can a fford. In present practi ce m a ny nurses a re not being u tilized to th eir m aximum potential. N urses in p ubli c health agen cies h ave t raditi on all y fun cti on ed r ela tively ind ep end en tly , bu t w ith ph ysicia n coll a bor ation , in patients' h om es, in r em ote, isolated rura l a nd gh etto a reas, a nd m ore r ecentl y in clinics, h ospitals, and community care centers where th ey h a ve : Assessed problems of individuals and families; treated minor illnesses ; referred patients for differential medical d iagnos is ; arranged for r eferrals to social service agencies and organizations ; given advice and counsel to promote health and prevent illness; supervised health r egimens of normal pregnant women and of children; and worked with health-related community action programs. As h ealth car e b ecom es inc reasingly valued in our society, nurses will be expected to ta ke m ore r esponsibility for th e d eli ver y of prim a ry h ealth a nd nursing ca re, for coo rd ina tin g preven t ive ser vices, for ini tia tin g or p a rti cipating in di agn osti c scr eenin g, a nd fo r r e fer ring patients wh o r equire diffe ren tia l m edical diagn osises and m edi cal th erap:es. It is th e position of D istrict One th at de lineation of th e bound a ries of n ursing prac ti ce r equi res th a t nurses continue to examine th e n ature of nursing, th e n eeds of society, a nd th e part nurses play in th e d elivery of h ealth se rvices today a nd in th e futur e. Once th e profession h as accepted a fun c t ;on as fallin g within th e sphe re of nursing, th en each nu rse wh o ca rries ou t tha t fu nction must obta in th e system a tic instru c tion need ed t o acquire th e n ece~sa ry kn owled ge a nd skill to sup po rt h e r practi ce. Primary Care Functions for Which Nurses Are Now Generally Responsible Case Finding and M edical R eferral These activities u su all y a r e carri ed out by nurses who fun ction in p atien ts' h om es, in community clinics, in sch ools, and in indust rial settin gs, alth ou gh identificat ion of ills, actua l and impendin g, is exp ected of all nurses. Case Finding and Social Agency R efe rral Gen erally this f unction is carri ed ou t in patients' h om es, in com muni ty clinics, in sch ools, a n d in indus try, althou gh h ospi tal nurses inc reasingly assess socia l a n d economic circumsta n ces of pa tie n ts a nd seek to p reven t p roblem s a n d complications th at a re r elated t o social a nd econ omi c facto rs. Primary Care Functions for Which Nurses and Physicians Share R esponsibility U TAH N U RSE H ealth surveillance of pregn a n t and p ost -partum women , well ba bies and children , patients discharged from therap eutic regiments, homebound invalids, a nd p erso ns in r est and nursing homes . Identification of the n eed for. and assisti ng in the planning a nd implem entation of n eeded ch a n ges in living arrangements affecting the h ealth of individua ls. Evaluation of deviations from "normal" in patients who presen t them selves for treatm ent. Assessment of the responses of patients to illness and of th eir compliance with a nd r es ponse to presc ribed tr-e atm ent. P erforma nce of selected diagnos ti c and th erape utic procedures, e.g., laborato ry tests, wound ca re. Prescription of modifications needed by patients coping with illness or maintaining h ealth, su ch as in di et, r·e lief from pain, and adaptation to handicaps or impairments . M a kin g referrals to appropriate agencies. Primary Care Functions for Which Many Nurses Are Now Prepared and Others Could be Prepared Routine assessment of th e h ealth statu s of individuals a nd families. Institution of ca re during normal P!«:gnancies a!ld normal d elive ries, proViSiOn _of fam1ly planning se rvices, and superviSiOn of h ealth-care of normal children . Managem ent of care for selected patients w i t h in protocols mutua ll y agreed upon by nursing and m edical personnel, including prescribing and providing care a nd making referrals as a ppropriate. Screening patients having problem s r equirin g differential medical diagnosis a nd m edical th erapy. The r ecomm endation res ultin g from s uch sc reening activities is based on data gath ered a nd evaluated jointly by ph ysicians and nurses. Consultation a nd collaboratio n with ph ys ic ians, other h ealth professiona ls, and the public in planning a nd instituting h ealth care programs. Assumption of these respon sibilities requires that nurses so en gaged h ave knowledge a nd requisite skills for: Eliciting a nd recordin g a h ealth history. Making physical and psychosocial assessm ents, recognizin g the range of " normal" and the manifestations of common a bnormalities. Assessing the environmen t (family relat ion ships, h om e, school, and work environments) . Interpreting findin gs. selected laborato ry Making nursing diag nos is, choosing, initiating, and m odifyin g selected th e rapi es. Assessing community and n eeds for health care. WINTER , 1973 · 74 resources Providing em er gen cy treatme nt as appropriate, such as in cardiac arrest, shock, or h emorrhage. ple treatment or in executin g a procedure as complex as attempting to defibrillate a h ea rt. Providing appropriate information to th e patient and his fa mily a bout the m edical diagnosis or pla n of th erapy. Legal Considerations The nursing profession must turn to two legal sources - statutory. law. and common law - if th e professw~ IS. ~o move with social n eeds a nd sc1enbhc chan ge in ex tendin g the scope a nd sphe r e of nurs ing practice. Implem entation of extended roles for nurses r equires careful legal evaluation . R easonable conduct is u sed to refer to th e s tandard of care that the law imposes on individuals. The standard for nurses a nd ph ysicians is reasonable care unde r the circumstan ces. R easona ble care req uires the exercise of that degree of skill and care that other individua ls of comparable training and experience exercise unde r comparable circumstances. The standard of r easona bl e conduct for nurses d oes n ot shift even though th e circumstances may diffe r from cases to case. Th e permissible scope of activity for nurses d oes inc rease as the ed ucation and training of nurses becom es more so phisti cated . Concomita nt with inc reasingly complex nursing p ractice is the continua l realignment of th e fun ctions of the professional nurse and phys ician. The bounda ries of r esponsibili!Y for: nurses are n ot shifting more ra pidly Simply beca use of inc reased demands for h ealth se rvices. The functions of nurses are chan gin g pri marily because nurses have d emonstrated their competence to pe rform a o-reater variety of fun ctions and have bee~ will ing to di scontinue performin .,. less important functions that were "'once perform ed only by nurses. In this period of rapid transition , the identical procedure performed on a patient m ay be th e practice of m edicine when carri ed out b_y a physic!an or the practice of profesSiOnal nurs m g when carri ed out by a nurse. Nursing Practice Acts Nursing Prac tice Acts like Medical Practice Acts set forth edu cational a nd examination requirements, provide for registration of the professional. and desc ribe the practice of the profession in broad gene ra l terms. There appears to be g reat difficulty in defining professional practice in gen e ra l langu age with sp ecific application in mind and yet still providing th e necessa ry freedom for interpre tation of th e law required to cover n ew a nd innovative techniques and future conditions of such practice. Specific definitions r estrict th e permissible scope of practice to those functions specified a nd make change impossible in th e absence of legislative action . Nursing Practice Acts in th e m a jority of states have n ever been construed by the State Supreme Courts. Therefore , there a re few definitive judic ial decisions as to what co nstitu tes prescription by a licensed physician or what constitutes an act of diagnosis or a prescription of th erapeutic or corrective measures within the m eaning of th e M edi cal o r Nurs ing Practice Acts. The nurse's legal liability is not n ew. In fact, th e fundamental legal doctrines of negligence and malpractice are applicable whether one is assessing the conduct of th e nurse in carrying out a sim- · Statutory Law In every American jur~sdiction, ~he statu te gover nin_g th e pract!ce o~ nursm g defin es professwnal nursmg m broad gen e ral terms. It permits th e l?rofession to advance into broader practice areas , provided it ca n dem o nstrate the a bility to draw upon knowled ge o f physical, biological, and social scien ces. Th~s_, _although the gen e ral statu to ry dehmt10n permits a n ex panding role fo r th e nurse, it allows the practice of a skill onl y when it is suppo rted by th e n ecessary knowledge of the underlying scien ce. The interpretation of language in a statute will depend upon the circum sta n ces at the tim e of the interpretat ion . If it we re cu stomary practice for a nurse to perform certain acts, r ecogni zed by the m edical a nd nurs ipg professions , it is d oubtful that th e \:ourt would rul e the performance of s uch acts to be in violation of the statute. The reverse would be true. If the nurse is performing acts which are n ot accepted as within the normal scope of nursing activi ty, a Your Membership CardIs it ca rrying a current date? Is it in yo ur \ 1\!a lle t? Now that a ll membership ca rds are issued o u t of the America n Nurses' Assoc iation in Kansas C ity, M issouri, the U tah Nurses' Assoc iation is unable to issue a ny dupli ca te membersh ip cards. vVe ca n not impress upon a ll UNA members en o ug h to check yo u r card N OvV to b e sure the expiration date will b e past May II , 1974 . A membership card is a necess ity to a ttend the UNA May co nvention . \1\!as yo ur ca rd in yo ur wa llet with a current date? PAGE 23 prohibitor y inte rpretation would likely r esult. On th e other hand, if b e for e a legal in terpretation is r equired , th e role of th e nurse is expanded b y mutual con sent of th e m edical and nursin g p rofessions, a nd h as becom e an establish ed part of th e pattern of activity. th e re is less likelihood th e statu te would be inte rpreted by th e courts to prohibit su ch es tablish ed and accepted acts. Common Law Common law is essentially jud gemade Jaw. The nurse practitioner is h eld today to an incr easingly hi gh level of r es ponsibility. Through d ecisions handed down by th e courts, the nursing profession can exam ine sta ndards d erived fr om s tatute. At tim es, common law d ecisions a re th e first to interpret nursin g prac tice in a reas not s pecifically de fin ed by statu tory law. It th en becomes th e res po ns ibility of th e profession to examin e th ese d ecisions in terms of the expectations of society and th e goals of the profession. If th e profession d ecides that a particular d ecision poin ts th e way to nursing practice for th e futur e, it m ay m ean that th e s tatute r egulatin g the practice of nursing should be r econ sider-ed . Survey of State Constitu ents of ANA and State Boards of Nursing Since each of the states has legal r e sponsibility for control of nursing practice within its borders, several of th e item s listed a s " Functions for Which the Nurse is Now Prepa red or Could be Prepared to Assume Further R esponsibilities" we re excerpted and distributed to state con stituents of the American Nurses' Association and State Boa rds of Nursin g in 53 states and territories. Although r e turns wer e not complete, th e comments of th e several respondents indica ted that th e re ar e no legal barriers r elated to th e functions presented and that these are expected activities al though specific a uthority is lackin g. Some of th e r espondents indicated that assessment of pa tients carrie d out b y nurses is gen erally re ferred to a s " nursing dia gn osis" or " nursing assessm ent" . It was indicated that the barriers are more tra<\itjonal than legal. Comments indicated that in w m e ad vanced h ealth care settin gs, a h ealth history is a common nursin g practice. Also, if the nurse does not initiate laboratory tests essential to establish lifesavin g m easures, e.g., blood and urine samples in diabetic a cidosis, this could be con stru ed a s n egligen ce. It is of importance that liability has been imposed when injuries have r esulted by n egligent omissions in life-saving situations. H ere again, the standard of care is the r easonable conduct test discu ssed earli Pr, and no gr eater risk o f liability exists m erely because em e rgen cy circumstances prevail. There was gen eral consensus that ther e are no legal barriers to nurses a ssumin g tJ: e r esponsibility for acquiring ~h e ~el e<: tiv e pati~nt and his family with Imphca twns of diagnosis, prognosis, and progress wh en mutually agreed upon by m edical and nursing staffs. The majority of th e r esponde nts stated that fun_ctions r elating to th e physical and envuonm ental care of the patient PAGE 24 including r espiratory n eeds , nutritional nee ds , and m eas ures relatin g to security are all ordinary nursing activities. Liability has been imposed for a nurse's failur e to provide for patient safety, such as applying r estrain ts or providing side rails, or failure to evaluate a patient's capacity for safeguardin g himself. In conclusion , nursin g will continue to chan ge and it is a n tici pated that both nursi ng and law will evaluate th ese chan ges and make any n ecessary adaptions to m eet society 's chan ging n eed s. Recommenda tions H ealth care in its entirety , from the po int of vi ew of providers and consume rs alike, is th e sum total of care ren d e red by all disciples. It compr ises more than diagnosis , treatm ent of rehabilitation associated with a cu te a nd chronic illness; it includes h ealth education , giving the public a voice in the voice and d esign and operation of he alth system s and th e allocation of h ealth resources to m eet the chan gi n g needs. It requires fl exibility, creativity a nd th e u se of imagination on th e part of all h ealth car e professionals to m eet th e changing needs of our society. A s such , h ealth care cannot be th e provice of any one profession , nor does it lend itself to delive ry through a ri gid professional hi er archy. Compreh en sive h ealth services must involve integration of the skills and resources of all h ealth car e professions , the membe r of each o f which share th e same goal. Ther efore , as the consumer of h ealth services may be d epend ent on h ealth p e rsonn el from a variety of dis ciplines, so for th e providers of health servi ces are d epend ent on one another to exercise lead ership wh en n ecessary, to occupy supportin g rol es when appropriate and at all tim es to collaborate to ward th e objective of providin g th e most e ffec tive care in the most effi cient man n er . Expanded roles for nurses will require major adjustments in the orientation and practice of both professions. A r ed efinition of th e fun ctional interaction of m edicine and nursing is essen tial: it must be cou ch ed in terms of their resp ective rol es in th e provisiOn of h ealth se rvices rath e r than in te rms of professional boundaries and ri gid lines of r espon sibility. While th e formal educational process wil l n ecessarily be a prime vehicle for formulating and inc ulcating a n ew d efiniti on of the interaction of medicine and nursing, the critical test of any such concept will come in its practical application. Interprofessional Relations Nurses that are motivated and prepared must be encouraged to move vertically in practicing th eir profession and not expect to stay a ll at the sam e level of a ssumed equal competence. Collaborative efforts involving medi cine and nurs ing should be encouraged to undertake programs to d emonstrate e ffective functional inte raction of physicians a nd nurses in th e provision of h ealth services a nd th e extension of those se rvices to th e wid est possible range of th e population. Examples of such collaboration could be the Northw est Multipurpose Clinic in Salt Lake City and a d emonstration project in Wendove r , Utah , utilizing Family Nurse Practitioners in a primary care role. The transfer of fun ctions and r esponsibilities between physicians and nurses should be sou ght through an orderly process recognizing th e capacity and desire of both professions to participate in additional trainin g activities in tend ed to augment th e potential scope of h ealth ca re d elive ry services. A d etermin ed a nd continuing effort sh ould be m ade to attain a hi gh d egree of fl exibility in th e inte rprofession a l relationships of physicians and nurses. Jurisdiction a l concerns per se should not be p ermi t ted to inte rfer e with e fforts to m ee t pati e nt n eed s. BIBLIOG RAPHY I. Ameri ca n College of Obstetricians and Gy necologists and th e Ameri can Col· lege of Nurse-Midwives. "J oint State· ment on Maternity Care. " T he Assoc iation. Ch icago, J anu ary 14, 197 1. 2. Ameri can N urses' Association and the Ameri can Academy of Pedi atri cs, "A Joint Statement of th e ANA , Division of Matern al and Child Health Nursi ng Pract ice and th e Ameri ca n Academy of Pedi atrics." T he Assoc iation . Ne w York - Chi cago, J anu ary 1971. 3. Andrews, Priscilla M. and Alfred , Yan- kauer. "The Pediatri c Nurse Practiti oner." Pa rts I and IT. A meTican ] ow·na / of NuTsing, March 197 1. 4. Bates, B. "Nursin g in a health ma in - tenance orga ni zation: report on th e Ha rvard communit y health pl an," AmeTican .Joumal of Public H ealt h, Vol. 72, p. 991-994 , Jul y 1972. 5. Ehrenreich, B. and Ehrenreich, B. The Ameri ca n Hea lth Empire: PoweT, Pro fit s and Polit irs. (New York : \ ' intage Books) , 1971. 6. Exte ndin g th e Scope of Nu rs ing Prac- ti ce. Report to the Secretary of Hea lth , Educa tion and Welfare, 197 1. 7. Fink , D., Mallory, M. ]. and Co hen, M., et al. "Effective pati ent ca re in th e pediatric ambul atory setting," Pedia trics, No. 43, p. 297-335, 1969. 8. Flex ner, Abraham. Medi cal Education in th e United States and Ca nada, A Report to th e Ca rn egie Foundation for th e Advancement of Teaching, 1910. 9. Ford, L. C. and Sil ve r, H . "Expand ed rol e of th e nurse in chi ld ca re," Nur:sing Outlook, Vol. 15, September 1967, p . 23-25. I 0. Ka ise r Founda tion Medi cal Care Pro- gram, 1967. II. Leininge r, M. "This I believe .. . about interdiscriplin ary hea lth edu ca ti on for th e future," Nw·sing Outlook, Vol. 12, Dece mber 197 1. p. 19. 12. Lewis, C. E., Resnik, B. A. and Schmidt, G. et al. "Activiti es, events, and outcomes in ambulator y pati en t ca re," N ew England ) oum al of Medicine, No. 280. p. 645-649, 1969. 13. Lysa ught, Jerome P. An Abstract for Actions Appendices. National Commi ssion for the Stud y of Nursing and N ursUTAH NURSE ing Edu ca tion. New Yo rk , McG ra w-Hill Book Compan y, 197 1. 14. N a ti o nal Council on Aging R ep ort: Old e r Am e rican s - Special H andlin g R equired . Washingto n , D. C., 1971. 15. N a ti ona l Leagu e for N u rs in g. R ePoTt of the N L N Committee on R esolutions, 197 1 N LN Convention. T he League, New YorkY ork , M ay 12, 197 1. 16. Olsen , ]. a nd Brockett, J . E. Utah H ealth PTofile, Jul y 1972. 17. R epo rt of th e Nat io na l Advisory Comm •ss•on of Hea lth Ma npower, ovember 1967. 18. Sheedy, S. G. " Medi cal nurse practi · tion er in a neighbo rhood ce nter," AmeTi can ] oumal of Nursing, Vo l. 72, 1972, p . 1416-1419. 19. Stearl y, S., Noord ebos, A. a nd Cro uch , V. " Pedi a tr ic nurse pract iti oner." In B. Bull o ugh a nd Y. Bulloug h , Eels.) Ne w Di,·ectors fo!· Nurses (New York: Sprin ger) , 1971 , p . 70-76. 20. Survey of U tah Medica l Se rvices Provided b y U ta h Ph ysicia ns a nd H osp itals, sponsored by Uta h Blue Cross-Blue Shield Pl ans, condu cted b y th e Bureau of Economic A nd Business R esea rch , U n ive rsi ty of Utah , 1959. 21. Th e Season is Now, R epo rt of Utah Migra nt Worke rs H ea lth Confe rence, Weber State Coll ege, 197 1. 22. "Th e weak link in th e hea lth ca re system ," Canadian N urse, No. 68, p . 21-25, J a nu a r y, 1972. 23. Towa rds a Compre hensive Hea lth P olicy for th e 1970 's, A White Ho use P aper. H ealth , Edu ca ti on a nd Welfare Office, Washin gton, D.C., M a y 197 1. -1 I 24. U.S. Depa rtm ent of H ealth , Education , a nd Welfa re. " R eport of Task Force on the Ph a rm acist's Clinical Role," in H SRD Briefs, Nation al Center for H ealth Se rv ices R esearch and Development, No. 4. The Depa rtment, W ashington , D .C., Sprin g, 197 1. 25. U.S. Departm ent of H ealth , Education and W elfa re. Towards a Comprehensive H ealth Policy for the 1970 's. A White Paper. The Departm ent, Washington, D .C., Ma y 197 1. Primary Care by Nurse Practitioners In Western Region " Nursing Is . . ." (from the W ash ington Nurses' Assn.) "N u rsing is wha tever nurses do. It's that simple." And wha t are nurses doing in the State of Washington? Even a quick and admittedl y superficial su rvey of the state of nursing leaves no room for doubt that in addition to providing highl y skill ed a nd complex care in t he ac ute h ospital sett ing, nurses a re moving ou t a nd doing more in providing primary health care. This is particular! y true in those areas and for those of ou r citizens who find it difficult, if not impossible, to b e serviced b y our tradi tion a! h ealth d eli very syste m . The rural nurse clinic that open ed last April in the sm all Snohomi sh timber town of D arrington ca me into existe n ce in response to a community's criti cal need for h ealth care. When Gretch en Schodde and L ynn Vigesaa open ed the cl inic for business last spring, n early eight years h ad passed since there h ad been a resident phys ician in the town . In the first five months of operation some 600 to 700 patients h ave utilized the eli nic servi ces in a total of more tha n 2,000 clinic visits. While there has been the occasional emergen cy - su ch as the logger with a crush ed chest for the most part, Gretchen and Lynn are providing routin e hea l th exams, screening and counseling. Dr. Ben Burgoyne of Arlington - some 30 n:iles away - acts as back-up physiCian. These pioneering nurse practiti oners h ad nine weeks of intensive tra ining to prepare them for their n ew role . This included working in the emergency room at Children 's Orthopedi c H ospital, assisting obstetricians a t Virgini a Mason Hospital - all in Sea ttle - and h elping physician s in Arlington . Orio·inally funded b y 'N j A RMP for th~ee m onths, the clinic is closing the gap b etween expen ses a nd income from fees for ser vice. T he differen ce is cu rrently b eing underwritten b y small voluntar y donations from individuals and local busin e . es. A uniqu e feature of th is fa cility is that it is co n trolled community. A 12-m em b er board is the nurses' employer also sets the clinic fees. hea lth b y the citizen an d it Both practitioners believe t~at nurses "could and should be d om g more in their present employment settings. " l'or insta n ce, they point out that " nurses h a nds which are u sed to comfort ca n also b e used to palp ate ." It wa s not withou t a touch of irony, therefore, that they told of b eing bound b y traditional gu id elines when practicing as school nurses for the community one-half clay a week (an arran ge ment worked out to h elp defray clinic costs) . Yet, if a student injured on the ball fi eld should pre- 26. Ame rica n Nu rses Associa tion (Memo) " N ursin g in H ea lth M a intena nce Organiza ti ons", Jun e 18, 1973. WASATCH VILLA CONVALESCENT NURSING HOME 2200 EAST 33rd SOUTH SALT LAKE CITY, UTAH 486-2096 W INTE R, I973 · 74 RESTORAT I VE CARE FOR THE CONVALESCING and CHRON I CALLY ILL MRS. HARR IET PETERSEN , R.N. ADMI NI STRATOR PAGE 25 sent himself for em ergen cy treatment at the clini c, th e nurses would take imm edi ate and appropriate action . Asked about th:e future of the clinic, Gretchen and Lynn speak as one of their conviction that they are "not so unique" - that hi storicall y many nurses have b een functioning at a similar level. They contend that nurses, given the sa m e brief addi tional training, ca n easily step into the rural clinic si tu ation . Other communities like D arrington with n eed for 24-hour emergen cy -m edical care and an easin g of a health manpower shortage are turning to the all-nurse clinic. Merrilyn Allen and Mary Clark are staffing the Vashon Isla nd H ea lth Center that op en ed thi s past July to provid e health services to the 6,000 island residents. Again, like the D arrington clinic, the H ealth Center is a community-based effort th a t grew out of a house-to-hou se h ealth survey con ducted last year. A third all-nurse clinic is in the pl a nnin g stages in th e <~rea south of Gig Harbor. Another emerging clinic speciali st role that ha s made its ap peara nce beca u se of an unm e t p a ti ent n eed is that of the stroke nurse clinician. This n ew nursing role is the " brain child" of Dr. D avid Frye r, neurologist at the Mason C lini c in Se<~ttl e . The too-ofte n repeated ex p eri en ce of seeing a strok e p atient months later on follow-up who h ad contractures, was in ,a, depenclent state <~ nd whose family was not ad justecl , prompted D r. Fryer to en vision a nurse with specialized training who would provide continuity of care with the goal of reducing th e compli ca tion s th<~t often accompa n y strok es. J an e Jon es, the first nurse selected for trainin g, helped d evelop th e stroke nurse role cl uri ng a two-year pilot stud y. The stroke nurse sees p a tients in the hospital during the ac ute phase of th eir illn ess. Early re habilita tion is begun during the acute phase and th e nurse sp eciali st writes nursing orders on th e p a tient's progress sh eet. U ninterrupted the rap y and education of the pati ent and hi s fam ily from th e acute phase, through conval esce nt and re turn to th e hom e environm ent is stressed . T h e goal for each p atient is th<~t he return to livPAGE 26 in g as indep end entl y as possible. An essenti al part of the progra m involves edu ca tion of th e famil y in assisting with rehabilitative thera p y a nd in understa nding th e ph ysica l <~nd emotional problems of stroke. Services to clients include p ap smears, p elvi c exams, pregnancy testing and family pl anning counseling. In Spokane, in order to provide better service, th e program is d esign ed as a wa lk-in clini c. In April of this year RMP funded a project und er which four nurses are lea rning the spec ial skill s of <~ stroke nurse clini cian . The Pioneer Square Neighborhood H ea lth Station in downtown Seattle h as two nurse prac titioners, Pri scill a D a nn and A rlen Johnson , h elpin g to provid e care to the resiclen ts of the city's intern at ion al di stri ct <~nd Skid Road. Durin g the first year of th e program it is hoped th e tea m will b e able to build th e servi ce to aid nearly 300 famili es. ln the following ye<~ r wh en six nurses are added to the progra m it is ex pected to in crease service to anoth er 600 fa mili es. Tamara Cyr of Yakima has practiced as a li censed nurse-midwife in both Ohio a nd Kentu cky, and is one of some 500 registered nu rses who hoI d nation al ce rtifi ca tion through the American College of Nurse Midwives. The li ce n sed nurse-midwife always functions under an OB-GYN speciali st and is ta ught to deal within the realm of normal obstetrics a nd to be aware of abnormal signs and symptoms for imm edi ate ph ys ician referral. Her respon si biliti es include the complete scope of m a t e rn<~l care - pren ata l, labor, d elivery, fam il y pl an nin g and post-partal care. In areas with wide-spread popul ation of 100,000 served by only four full-time obs tetri cian s, the nursemidwife ca n free up an obste tri cian's time to deal with th e more complex probl em s. The nurse providin g primary care is b eing see n in m a n y places and in m an y settings. In Chelan , Douglas, Okanogan and Grant countri es, publi c health nurses are assessing the health problems of migrant workers and are either providing h ealth services or referring for hea lth care. Currently, one out of every two pa ti ents is seen only by the nurse. Because peopl e's h ea lth n eeds are con sta ntl y chan gin g to keep pace with the rap id growth of medical technology, the li st of n ew a nd exp anelin g roles for nurses will also b e in a state of change and ::tdaptation. This is also true for the traditional role of th e nu rse in the ac ute m edica l ce nter. As one nurse recently sta ted at a mee tin g in Spokane of eme rgency room nurses, "w ith more a nd more traum a a nd coron ary units b ~in g in stall ed in hosp ital s, nurses are being forced to think and act on their own." In an emergen cy situ ation, she explained , " even if a d octor is present, th ere m ay not be tim e for him to write down o rders or even to give them orally. A nurse h as to judge, evalu ate, a nd determine what is n eedeel. Five minutes could mean th e patient's life." But eve n as we report on nurses ex panding a nd enlargi n g their respon sibiliti es th ere are those who are not fun ctionin g to their optimal level b ecau se of practice barriers. Pati ent care is mu ch more complex toda v than ever b efore a nd as th e mass' of m edi ca l knowledge multipli es th ere is an in creasin g d emand for nursin g's unique contributions in all h ea lth ca re settings. The skills of the p edi a tric nurse practition er are being utilized in the pediatri cia n 's office and th e clini cs of a pre-paid health plan . The offering of the pediatric nurse practitioner course a t th e University of Washington indi ca tes there will b e more of these speciali sts in practi ce before the end of the year. Publi c h ea lth nurses at several hea lth districts in the state are cond uctin g famil y pl annin g program s. UTAH NURSE