10/29/2013

Disclosures

 I have no financial or other relationship to disclose

Kori Dewing, DNP, ARNP

Virginia Mason Medical Center
October 29, 2013
koridewing@hotmail.com

References
 
 American Nurses Association and Rheumatology
Nurses Society (2013). Rheumatology Nursing: Scope
and Standards of Practice. Silver Spring, MD:
Nursebooks.org.
 Kozier B, Erb G, Blais K, & Wilkinson JM. (1998).
Fundamentals of Nursing: Concepts, Process, and
Practice. 5th ed. Menlo Park, CA: Addison Wesley
Longman, Inc.
Objectives
 Review the history of nursing
 Describe the various roles of the rheumatology nurse
in the US
 Describe the scope and standards of practice for
rheumatology nursing in the US

What is Nursing? Nursing History

  Ancient civilization – midwives 
The ANA definition:
Nursing is the protection, promotion, and optimization
of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and
treatment of human response, and advocacy in the care
of individuals, families, communities, and populations.
http://nursingworld.org/
 Middle Ages – male and female religious, military and secular
orders
 18th and 19th centuries – nursing within religious order provided as
part of Christian charity
 Florence Nightingale 1820-1910
 Born into wealthy and intellectual family
 Nursing training Kaiserswerth, Germany
 Developed corps of nurses to provide care of wounded and sick
during Crimea War, transformed military hospitals into places of
healing
 Developed nursing school and changed status of nursing to a
respectable profession for women
 In US, nursing and health services established during the American
Revolution
 Hospital programs transitioned to training in colleges and
universities in the 1920’s Kozier et al. 1998

1
 10/29/2013

Rheumatology Nursing
Recent History
  1980’s and 1990’s
 Rheumatology nursing
primarily inpatient
nursing
 The Beverly Hillbillies
“rheumatism medicine”
Scientific Discoveries

 Advancements in immunology
 New therapies developed
 Rheumatology became much more
advanced
 Nurses need help understanding
immune system function, the
complexity of the rheumatic diseases,
and the treatments available

The Rheumatology Nurse Educational Preparation

Today for Rheumatology Nursing

 Understands the complex medications and protocols used to

treat autoimmune diseases  Registered Nurses have initial education preparation
 Familiar with the use of multiple drug combinations and at the diploma, associate degree or baccalaureate
protocols to treat rheumatic diseases, the expected outcomes, level
the side effect profiles and monitoring measures, and the
interactions with other prescribed medications and  APRNs have graduate education. Most are Master’s
nutraceuticals prepared. DNP required for practice entry starting
 Educates the healthcare consumer about the safe use of these 2015.
agents, the need for monitoring and observation, and the  On the job training
need for regimen modification
 Administration of infusible medications requires the  CNE
expertise of a rheumatology RN with competencies in IV  Texts
infusion technique, specific drug infusion criteria and
management of adverse and serious infusion reactions, as  Journal articles and newsletters
well as to identify insufficient therapeutic effects
Rheum Nursing Scope and Standards of Practice 2013

I AM A Scope of Rheumatology
RHEUMATOLOGY NURSE Nursing Practice

 November 2012, American Nurses

Association Board of Directors recognized  Outpatient setting-RN
rheumatology nursing as a nursing  Physical assessment
specialty and approved the rheumatology  Patient education, injection teaching
nursing scope of practice statement  Medication monitoring
 Rheumatology nursing is the specialty  Insurance
practice devoted to the comprehensive care  Coordination of care
of children and adults with rheumatic
conditions  Psychosocial support and assistance
 Authoritative statements of the duties that  APRN
all rheumatology registered nurses are  Scope of practice varies state to state
expect to perform competently  Most NPs have some level of practice
autonomy and prescriptive authority

2
 10/29/2013

Scope of Rheumatology Scope of Rheumatology

Nursing Practice Nursing Practice
 
 Infusion Suite  Research Facilities
 Prepare medication for IV infusion  Trial coordinator
 Access IV site  Principal or sub investigator role
 Assess patients prior to infusion  Maintain records
(infection, vitals, labs)  Administer medications, obtain blood tests or other
 Manage infusion site reactions measurements according to study protocols
 Patient education  Study recruitment
 Manage inventory  Assist in providing consent and educating study
 Develop infusion suite protocols participants

Scope of Rheumatology Scope of Rheumatology

Nursing Practice Nursing Practice
 
 Acute Care Setting  Other
 Consultant to other nurses and healthcare  Rehabilitation
professionals regarding underlying rheumatic  Long term care
condition  Home health
 Assist in clinical decisions regarding use of  Hospice
medications, addressing concerns about exacerbation
of rheumatic conditions and its impact on the acute  Palliative care
problem  Faith community
 Identifying strategies that will benefit a patient in  School nurse
rehab and post hospital care

Rheumatology Nursing The Future: Nursing Core

Standards of Practice Curriculum
 
 Core knowledge that must be in a
nurse’s armamentarium in order to
practice in a specialty
 Submitted, not yet available
 Basis on which certification exam
will be written
 Expected to be available summer
2015
 Initially one test, but will eventually
separate into two tracks (RNs and
APNs)