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Attending Registered Nurse Reflection Paper

Nicky Reed

Ferris State University



This paper discovers the expansion of nursing roles and the benefits that is provided to the

patient, staff, and healthcare institutions. The nursing profession has always been an

environment of endless changes that pushes nurses to do better with many stressors. Nurses

promote and provide the highest quality of care for patients while staying on top of new

developments in science that could be beneficial for healthcare. Florence Nightingale, in the

nineteenth century, one woman, because of her religious convictions and profound vision of the

potential of nursing, altered the status of nursing from that of domestic service to that of a

profession (Selanders & Crane, 2012). Florence’s motivation and strength transformed the

nursing profession into a permanent role within healthcare. Involvement and creation of

transformational roles that facilitate a higher quality experience for patients and families. By

designing roles outside of the formal role of nursing will enable relationships with patients and

families in which builds trust and competence of health. This paper explores the newly created

role of an Attending Registered Nurse. Review articles will be analyzed for the benefit,

limitations and success of new founded programs.


Attending Registered Nurse

Healthcare is an ever-changing landscape aiming towards an ideal system with emphasis

on safe, quality, efficient, equitable, and effective care. To meet the expected standards, health

care organizations need to think outside of the box and utilize the highly-qualified nurses within.

Formulating new roles for nurses and tapping into the experienced and nurtured nurses over the

years will aid in creating new innovative ideas for healthcare while reducing costs. The purpose

of this paper is to reflect on the identification of the expansion of nurse’s roles and review the

attending registered nurse role and the impact within healthcare.

Literature Review

Researchers Jeanette Erickson, Marianne Ditomassi, and Jeffery Adams analyzed the

impact of establishing an Attending Registered Nurse into Massachusetts General Hospital

(2012). The researchers identified after the release of the 2001 Institute of Medicine six aims for

quality healthcare report that creation of a new patient care delivery model was at the forefront of

importance. It was found that after implementation of the Attending Registered Nurse role there

was a significant improvement of communication, education, length of stay, satisfaction, and

prevention of readmissions. The only constraint was the oversight of patients being admitted

from surgery.

Other authors such as Jean Watson and Roxie Foster concluded using the Attending

Nurse Care Model. Watson and Foster (2002) founded an increase in nurse caring consciousness

and intentionality to use knowledge and evidence, as well as define clinical problems in pain

management. Parents gave feedback in their confidence in the clinical expertise displayed and

difference in care for their child (Watson & Foster, 2002). Ultimately, a reduction in pain

control for children was noted.


In another study considering expansion of nursing roles, Kovner and Djukic (2010)

analyzed the non-advanced practice nurses ability to fulfill physician roles. It was found that

with appropriate training and education nurses could perform duties of physicians that allowed

better utilization of physician’s time. However, no formal examination of the impact of

registered nurse role expansion on care cost or on physician and registered nurse workload was



Like many healthcare systems across the nation, Massachusetts General Hospital

responded to the Institute of Medicines Report (2001) regarding the six aims of quality

healthcare. A new patient care model was implemented to create a culture that was truly driven

by needs and expectations of patients and families (Erickson, Ditomassi, & Adams, 2012). One

role that transpired to meet the standards Massachusetts Generals initiatives was the Attending

Registered Nurse (ARN). The focus of the role was to aid in delivering more integrated,

patient-centered, evidence based care, while preserving their standards of quality, and enhance

efficiency (Erickson, Ditomassi, & Adams, 2012). The Attending Registered Nurse are senior,

experienced, highly respected, inquisitive nurses who are willing to put themselves forward to

advance the agenda for change. The role is initiated in the Emergency Department upon

admission and continues through discharge. The ARN is present during interdisciplinary rounds

to promote seamless communication between the health care team to identify key next steps in

the patient’s plan of care. Upon discharge the ARN facilitates an action plan that is educated and

understood by the patient and family.

The United States is not the only Nation that has identified the profound importance of

expansion in nursing roles.



The new caring–healing practice environment is increasingly dependent on partnerships,

negotiation, coordination, new forms of communication pattern and authentic relationships

(Watson & Foster, 2003). The Attending Registered Nurse facilitates this movement of patients

and reduction of cost. A reduction of return visits will be evident with implementation of the

ARN role providing an open dialect between healthcare providers and patient after discharge.

The justification for this new evolving role empowers nurses to improve quality care and

supports professional practice. By utilizing nurses to their fullest extent of their experience and

education would assist in aiding future changes within healthcare. The key to a successful

healthcare system across the nation is by redesigning healthcare by ensuring nurses act as full

partners with physicians and other health professionals.

The United States is not the only Nation that has identified the profound importance of

expansion in nursing roles. Nurses around the United Kingdom are beginning to take on these

new roles and responsibilities. There are now several hundred consultant nurses in post around

the UK, both in acute and primary care. In Rotherham, the first nurse consultant for intravenous

therapy is focusing on training, reviewing and auditing procedures as well as building a vascular

access team (Malone, 2002). A consultant midwife in north-west England is developing an

innovative midwifery service for women who are dependent on drugs and alcohol (Malone,



The barriers that were encountered with previous implementation of newer roles was the

education for newly pioneered programs, buy-in from other interdisciplinary team members

including administration, and the support from clinical staff. Administrative leadership is the

driver for organizational change. To create a culture that embraces change and excellence, a

leader must build relationships, encourage new knowledge, innovations, & improvements.

Leaders pave pathways that focus on education, inspiring thoughts and ideas for improvement,

and facilitates a bridge of professional growth.

Another barrier would be the healthcare organizations buy-in to new developing roles.

The ultimate goal is the reduction of cost within the organization but the initial cost will increase

to create these new-found roles. Elevating the experience nurses into new innovative roles will

demand fulfillment of the roles previously attended.

Evaluation, Measurement, & Maintenance

An evaluation plan will consist of qualitative and quantitative review. To evaluate this

role a production of surveys will be utilized to determine program success. One survey

employed in the evaluation process is the Press Ganey (2016). This survey is randomly sent via

email and/or mail to customers for review. The population focus is the outpatient setting but

data is extracted to assess the length of time from emergency room to admission. Another

survey addressing patient satisfaction and overall knowledge of the registered nurse is the

Hospital Consumer Assessments of Healthcare Providers and Systems also known as HCAHPS

(2014). Significant data is reviewed in regards to provider and nurse knowledge. The course of

action and education process is also evaluated by the consumers. The Press Ganey and

HCAHPS are conducted monthly.

Also, another way to evaluate the effectiveness of Attending Registered Nurse function

would be to conduct one-on-one inquiries during interdisciplinary rounds. And a final evaluation

would be to assess the satisfaction level of staff. Utilizing Survey Monkey would be a great way

to assess via email to employees. We will continue to look at some barriers to implementing

expanding roles such as the attending registered nurse.

The findings from the surveys and the inquiries are continuously monitored and evaluated

to consider adopting, adapting, amending or abandoning any of the current methods. On-going

maintenance of the role will be evaluated on a six-month basis.

Outcome Success and Overcoming Limitations

To have the trifecta within healthcare, patient, staff, and organizational satisfaction must

be achieved. Nursing leaders play a pivotal in achieving this success. A leadership that

promotes interprofessional collaboration, transforms the team, inspires others to achieve success,

and supports innovative ideas is the way to over any limitations.

Another component to success of role expansion is collaboration from physicians.

Support from all disciplines is key but physician support is monumental in not only the

educational sense but the trust patients and families see while interacting. The physician-nurse

relationship is the first impression of patients and that is the foundation of high quality


Ultimately, the support from all healthcare institutions in the defining component to the

success of any new idea no matter how grandiose the idea may be. Formulating a team that

drives down costs, delivers safe and high quality, and provides satisfied patient care will be the

optimal factor to the success of healthcare and newly evolving roles within nursing.


The expansion of nursing roles is significant to the future of healthcare. New roles such

as the Attending Registered Nurse will be epic to the transformation of healthcare connecting the

healthcare community with patients and families. While building trusting relationships with

people within our community this will afford healthcare an opportunity to educate and decrease

the cost of healthcare across the nation. Utilizing the expert nurses and nurturing creative

thinking will continue to inspire new role formation and build a culture of excellence.


Centers for Medicare and Medicaid Services (2014). HCAHPS: Patients' perspectives of care

survey. Retrieved from

Assessment- Instruments/HospitalQualityInits/HospitalHCAHPS.html

Djukic, M. & Kovner, C. T. (2010). Overlap of registered nurse and physician practice:

Implications for U. S. health care reform. Policy, Politics, & Nursing Practice, 11:13-22

doi: 10.1177/1527154410365564

Erickson, J. I., Ditomassi, M., & Adams, J. M. (2012). Attending registered nurse. Nursing

Economics 30(5): 282-287. Retrieved from

Malone, B. (2002). Expanding nurses’ roles: from vision to reality. Clinical Medicine, 2(4): 292-

293. doi: 10.7861/clinmedicine.2-4-292

Press Ganey (2016). Caregiver engagement a pathway to deliver patient centered care.

Retrieved from

pathway-to-deliver-patient- centered-care

Selander, L. C. & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. OJIN,

17(1):1. doi:10.3912/OJIN.Vol17No01Man01

Survey Monkey (2016). Get answers with the world’s leading survey platform. Retrieved from

Watson, J. & Foster, R. (2003). The attending nurse caring model: Integrating theory, evidence

and advanced caring-healing therapeutics for transforming professional practice. Journal

of Clinical Nursing, 12: 360-365. Retrieved from


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