Contributor: Dr. Keith Quirolo
Bedside nurses have more contact with patients in the hospital than any other provider. They spend their entire day physically, emotionally, and technically caring for from two to six patients depending on the degree of care needed. Nurses can be the primary nurse provider through an entire hospitalization or on successive hospitalizations. They see their patients on their good days and their bad days. Nurses are there when things go very bad and have the primary responsibility to bring more practitioners to the bedside for critically ill patients who take a turn for the worst. They are responsible to report between shifts of nurses the most important factors and changes in care to provide continuity from shift to shift and day to day. They interact with the patients’ families and explain procedures and care decisions. They can be the patient’s advocate in the confusing and complicated place that is the hospital. They can have bonds with patients that last for years.
Nurses perform functions that are critical for patient care. They are at the bedside and have the responsibility to administer medications and watch for side effects and efficacy once administered. They are responsible for administering blood products and monitoring patients through the transfusion process. They can be responsible for the safe operation of procedures such as exchange transfusions and progenitor cell collection for transplants for gene therapy. Their responsibility for monitoring patients can range from simple observation and vital signs to hospital monitors that include cardiac, oxygen, blood pressure, and other parameters. Intensive care nurses have to be able to interpret these monitors and alert physicians and other providers if there are deviations.
In the emergency room, they can be responsible for assessment of patients who arrive to determine whether they need to be seen immediately or have to wait in the waiting room. They are at the bedside for trauma resuscitation and procedures to record and report laboratory results and document the treatment.
Nurses should be the buffer between their patients and the rest of the providers in the hospital. They may know the patient better than other providers and can interpret the medical jargon in a way that the patient can understand. They can relay their assessment of the patient to other providers in a timely manner to be sure that changes in status are communicated.
There is more than one kind of “nurse” working in a hospital or clinic. Some nurses do not clinically practice nursing.
|Type of Nurse||Education||Function|
|There are two general types:
BSN (Bachelor of Science in Nursing): Four-year degree program with the possibility of continuing to master’s or Ph.D. level nurse. Usually specializes in one type of nursing such as pediatrics, intensive care, and general medical.
ADN: Two to three-year program in nursing generally a community college or private school.
|All Registered Nurses have to pass the same state examination to practice nursing.
BSN RNs generally supervise other nurses and providers and can advance to positions within the hospital with more responsibility.
ADN RNs are generally bedside-only nurses and would have to have more training to advance within a hospital.
These are the people who are generally referred to as “Registered Nurses”.
Licensed Practical Nurse
Licensed Vocational Nurse
|Generally, a one-year program with a licensing examination.||Work with RN supervision with restricted practice. Some LVN’s receive extra training in a hospital to perform other technical positions.|
Certified Nursing Assistant
|Usually, one month of training and further training on the job.||Limited responsibility with very restricted practice. Work under the supervision of RN or LVN.|
|Requires an advanced degree in nursing usually starting at the BSN level and advancing to an MSN master’s level or Ph.D. Six or more years of college.
This is an Advanced Practice Nurse.
|Practice independently with oversight by a physician in the hospital, but there are NP clinics. A wide variety of practices mirrors many of the types of physician practice.|
Advanced Practice Nurse
|Requires an advanced degree and frequently specialized training up to 8 years of school with advanced degrees.||APRNs can be nurse anesthetists who hold additional training CRNA.
DNP’s Doctor of Nursing Practice is an advanced practitioner and a step up from an NP.
|Non-Clinical||Ph.D. Nurses are generally non-clinical nurses and require 8 or more years of education to reach this advanced degree.||PhDs in nursing are frequently college or graduate-level professors who engage in nursing research.|