Documente Academic
Documente Profesional
Documente Cultură
Nicky Reed
Abstract
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,
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
Literature Review
Researchers Jeanette Erickson, Marianne Ditomassi, and Jeffery Adams analyzed the
(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
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
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
registered nurse role expansion on care cost or on physician and registered nurse workload was
reported.
Implementation
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
The United States is not the only Nation that has identified the profound importance of
Benefits
(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
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
innovative midwifery service for women who are dependent on drugs and alcohol (Malone,
2002).
Barriers
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
REFLECTION PAPER ATTENDING NURSE 6
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,
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
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
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
REFLECTION PAPER ATTENDING NURSE 7
to assess via email to employees. We will continue to look at some barriers to implementing
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
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,
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
healthcare.
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.
Conclusion
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
REFLECTION PAPER ATTENDING NURSE 8
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.
REFLECTION PAPER ATTENDING NURSE 9
References
Centers for Medicare and Medicaid Services (2014). HCAHPS: Patients' perspectives of care
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
http://www.medscape.com/viewarticle/773245_4
Malone, B. (2002). Expanding nurses’ roles: from vision to reality. Clinical Medicine, 2(4): 292-
Press Ganey (2016). Caregiver engagement a pathway to deliver patient centered care.
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
https://www.surveymonkey.com/mp/take-a-tour/?ut_source=header
Watson, J. & Foster, R. (2003). The attending nurse caring model: Integrating theory, evidence
http://www.watsoncaringscience.org/images/features/library/Attending%20Nurse%20Car
ing%20Model .pdf