How does nursing contribute to patient care

In fact, nurses spend a fair amount of time updating records and communicating pertinent information to the larger care team. Reading about the nursing profession, no doubt you have heard that nurses today have a greater degree of autonomy than in the past. What exactly does this mean? Especially in the case of hospital stays, nurses are often the first to uncover a problem, and while notifying the attending physician is standard protocol, there are times when nurses must act immediately to stabilize the patient.

In other cases, as part of the order set, a physician may spell out instances when a nurse can act without seeking permission from the doctor. This autonomy requires nurses to have a thorough understanding of their scope of practice, as well as collaborative, trusting relationships with physicians and other key members of the care team. From increased job prospects, to overall higher pay and career longevity, discover more as we explore the many benefits that come with earning a BSN degree as a nursing student.

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Mercer Georgia Baptist College of Nursing. Start Today Fill out the form or call us at In this Part I education do-over on what nurses really contribute to health care, we will explore their responsibilities as dictated by professional organizations and the roles they play in promoting health and wellbeing for the public at large. Parts 2 and 3 will clarify how the work of nursing impacts you and your family on a personal level and identify the role differences between nurses and other collaborative partners, such as physicians and physician assistants.

Nursing constitutes the largest number of American health care professionals and is the most predominant component of any hospital payroll infrastructure, with the current number of registered nurses being more than four times the number of practicing physicians in the United States. Nurses and their contributions are vital components of any reliable health care organization striving for zero patient harm and quality care. It has been suggested that hospitals promoting better nursing environments with above-average staffing ratios experience lower patient mortality, particularly for patients considered "high-risk.

The truth is very few people understand the myriad roles and responsibilities of nurses until they are in need of nursing care themselves. Hartford Foundation , says, "Whether people know it or not, they come into hospitals for nursing care. Surgery is one thing, but it is the nursing care post-surgery that will determine how quickly patients recover, the success or failure of the intended surgical outcomes, and the quality of life recovered during a tenuous post-operative phase.

Another "for instance" pertains to the extreme health challenges and life-threatening illnesses faced by intensive care unit ICU patients on a daily basis. What patients and families in the ICU quickly learn is that once the physician team rounds in the morning to collaborate with nursing and determine an appropriate plan for the day, it is the nursing care that assumes primary responsibility for delivering interventions in a safe and evidence-based manner, reporting and responding to patient changes in condition, and making the critical minute-to-minute decisions that keep patients alive.

So what do nurses do exactly? While this concise list certainly provides an overview of nursing, it is not exhaustive by any means. Nurses' working conditions and patient safety. Safety and Quality Rating Systems. Related Patient Safety Primers. Culture of Safety.

Disruptive and Unprofessional Behavior. Missed Nursing Care. Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.

March 1, Nurse staffing levels and patient-reported missed nursing care. October 14, Incorporating nursing complexity in reimbursement coding systems: the potential impact on missed care. October 25, Description and factors associated with missed nursing care in an acute care community hospital.

October 17, Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study. December 19, Nurse Managers. Second victims. Interruptions and distractions. Back To Top. Patient Safety Primers Topics Glossary. Improvement Resources Innovations Toolkits. Connect With Us. Sign up for Email Updates To sign up for updates or to access your subscriber preferences, please enter your email address below.

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Get email alerts when new content matching your topics of interest publishes. We have a patient who is very compulsive. We made agreements about how to approach and handle this patient. We continually need to communicate with each other, physicians, psychologists, nurses. Clear communication is so important, and I miss that sometimes. When you have good relationships it is easier to review and discuss the treatment administered.

It will not only increase your knowledge, but also be helpful in the communication with the patient and his family. Respondent 5, mental health care focus group. Participants in all four focus groups stated that the scope of practice for which they are accountable influences patient experiences. The scope of practice, according to them, means that nurses can control their own work related to patient care and can make independent decisions about patient outcomes based on clinical judgements.

Participants therefore believe it is essential to monitor and measure outcomes, as long as the monitoring is directly related to patient care. However, participants indicated that they did not have insight into care results obtained from assessments. We participate in an annual national prevalence survey. We have to fill out a lot of forms. We get a pile of papers, screen patients and register them.

And what does one measurement tell us? I do not believe that. Respondent 12, home care focus group. According to participants, there is no policy to improve patient experiences on the basis of the information derived from assessments. Participants could not indicate whether the interventions deployed are actually leading to desired nursing care results, including patient experiences.

Participants feel they have insufficient autonomy to influence this process. Participants stated that the number of nurses available influences how patients experience the quality of care. Although they could not indicate what number they consider sufficient, they think that a sufficient nurse staffing level is linked to team composition or staff mix.

For instance, participants indicated the proportion of registered nurses to student nurses, or the number of different nurse qualification levels in one team. Participants stated that several tasks and assignments have been transferred to nurses with a lower qualification in order to work as efficiently as possible and to achieve higher productivity. As a result, participants believe that nursing care is, in general, increasingly developing in the direction of task-centred care in which different working methods are applied.

According to them, this affects patient experiences of the quality and effectiveness of nursing care. Nurses provide care within certain theoretical frameworks that are designed to increase the self-reliance and self-management of the patient. Nurse assistants have a more practical focus and take over patient care at a point when they should not.

These two ways of working are confusing for patients. And we think 'How come the patient is made to feel so nervous? Respondent 3, mental health care focus group. As stated by participants, a sufficient nurse staffing level determines whether patient wishes and needs are met. According to participants, an insufficient deployment of nursing staff has a direct negative impact on patient experience. I work alone in a group. So I have to keep my eyes and ears open and must respond to what occurs.

And that is not always easy. I constantly think: I must check if everything is all right. I always leave the bathroom door partly open, so I can see and listen to what is going on in the living room. I provide patient care too hastily.

My patients obviously feel that. Respondent 17, nursing home focus group. The participants stated that control over nursing practice means that nurses are involved in nursing policy or nursing issues.

In their view, nurses are not always in charge and cannot always make their own decisions about nursing issues. Participants feel that this affects the quality of nursing care. In the past, I always made my own schedule. Efficient planning is more important than patient-centred planning. The patient should be scheduled later if it fits better in the planned route. Respondent 9, home care focus group.

The participants stated that if nurses were more involved in the development of nursing policies, this would have a positive influence on patient care.

According to them, they would be able to reflect upon and discuss nursing issues related to the quality of patient care, which would improve the quality of care.

Participants indicated that a manager should pay attention to the team spirit and unity. In their view, a manager must be able to handle conflicts, and also be visible and approachable.

Participants said that they believe that a manager should ask the opinion of nurses; therefore, in their opinion, regular contact is important. A manager, according to the participants, must be able to create the right conditions and have the logistical ability to ensure continuity of care.

In their view, this means arranging sufficient personnel, replacement staff and succession planning. Participants find that managers critically examine the deployment of personnel.

According to them, the nursing staff mix has drifted towards a model whereby higher-educated nurses are replaced with lower-educated ones. They noted that management is tied to a system that is dominated by controlling costs. Thus in their view, nurses may want to provide a patient with a specific form of care, while management limits care to a maximum number of minutes based on budgetary considerations.

According to participants, nurses regularly experience a tension with management in shaping care that meets patient expectations. For instance, we plan 30 minutes for patient care. When a patient wants to go outside for a walk, this will cost him 10 minutes of this total time.

So we really have to negotiate with the patient or his family. This leads, of course, to lots of misunderstandings. I understand that feeling. Respondent 13, nursing home focus group. According to participants, the focus of nurses is the provision of patient-centred care. They define this as nursing care that is focussed on patient needs and preferences and is intended to increase patient self-management and encourage improved health and recovery.

As participants stated, nurses are the first points of contact for patients. They think that direct contact with patients is crucial to building and maintaining a relationship of trust. The participants believe that high quality nursing care is achieved when patients feel heard and understood, consider themselves to be in safe hands and know that their care problems have been noticed.

This, according to the participants, results in positive patient experiences. We listen to the patient and talk to him. We immerse ourselves in his background. What is important, how he copes and handles care problems. Based on this knowledge, we present the patient with a number of options so that he can decide upon a solution for his care problems.

Respondent 8, home care focus group. Participants stated that organisation policy is focused on the efficient and effective deployment of people and resources. They mentioned the transfer of tasks to less well qualified nurses in order to work as efficiently as possible and to achieve higher productivity. In their view, care is more and more standardised.

At the same time, they noted that care has become increasingly complex. According to them, patients are generally older and have multiple age-related comorbidities. The participants experience an increasing workload and work-associated pressure. In recent years, patient turnover has increased. It means that patients are discharged quicker. However, patients sometimes also have chronic disorders. I sometimes think it is irresponsible [to send these patients home so quickly].

Patients get less attention because the work pressure is high. Respondent 22, hospital focus group. Participants reported an increasing administrative workload to account for the quality and costs of care. So many forms. Entering the data means a double administrative workload.

We use different programs. We first have to register in program X. Then we have to register our measurements and enter all kinds of codes in another program. Log in and log out. The registrations and coding are needed for the government and health insurers. It is not always patient related and does not inform us about the health status of patients. Respondent 23, hospital focus group.

The administrative workload is, according to participants, out of balance. They said that this means that monitoring and registration is aimed not at improving nursing care, but at serving an external accountability goal to inform health insurers and the government. The participants stated that they have little autonomy to change this policy.

According to them, monitoring care results should help nurses to improve their own practice. For them, it means that nurses can reflect upon and discuss nursing issues related to quality of patient care, including the results of patient experiences.

We interviewed 26 nurses working in various Dutch healthcare settings in order to ascertain their views on how their work and their work environment contribute to positive patient experiences. Using an open approach, we obtained insights into their perceptions and noted what they said.

Participants stated that a diverse range of elements are essential to providing high-quality nursing care. When these elements are incorporated into daily nursing practice, the participants expect it will result in more positive patient experiences of nursing care.