3.

4 Roles and
Responsibilities of RNs and
Health Teams
1:00-4:00

Advocate
What are the roles
and
Clinician
responsibilities ofLeader
nurses?
Change Agent
Manager / Coordinator

Counselor
Educator / Teacher

Communicator

Caregiver

Caregiver

Primary role
Helping clients promote,
restore and maintain
dignity, health and
wellness, within
physiologic, spiritual,
emotional, developmental,
cultural and social needs
of a holistic person.

Communicator

Central role
Identifies needs and
problems of the client, and
communicate to other
members of the health
team.

Educator / Teacher

Involve in all nursing

activities
Health promotion is
the primary nursing
concern
The nurse's role in
health promotion is to
work with people, not
for them
Use of communication
skills to assess,
implement, and
evaluate individualized

The nurse can best increase a learner's

motivation by encouraging selfdirection and independence for
learning.
The nurse is responsible for recording
evidence of learning in the patient's
chart such as the learning needs,
objectives, topics discussed, outcomes,
and resources provided.
6

Counselor

Helps client recognize and

cope with stressful
psychological and social
problems, (facilitate the
patient's problem-solving
and decision-making skills )
Develop interpersonal
relationships, and
Promote growth
7

Manager / Coordinator

Directly manages and coordinate care,

delegate nursing activities, supervises
and evaluates performance of other
nurses and support workers.
8

As a nurse manager achieves a

higher management position in
the organization there is need
for conceptual and
interpersonal skills.
Essential competencies for
today's nurse manager is
communication and teamwork.
9

Nurse Researcher

Working with a multidisciplinary health

care team to monitor the outcomes of
individual clients.
Factors related to research utilization by
nurses: Availability of research findings
and nurses' attitudes toward research.
Role of nurses in clinical practice play in
the research process: identify the
problems in need of investigation and
collaborate with nurse researchers.
10

Collaborative Role

Assume accountability and

increased authority in practice
areas.
Nurses need to assume a new
place in health care and work
with other members of the Team
who are not fully accepting of the
restructured health care system
to develop collaboratively.
11

Nurse Practitioner

Has a wide scope of practice and a

more autonomous role, with health
promotion and illness and injury
prevention as important focuses.

12

Clinical Nurse Specialist

Improve client care and nursing

practice by functioning as an
expert nurse in the practice
setting.

13

Change Agent

Assist client to modify

behavior (lifestyle)
Coping with highly
dynamic (changing)
health care system,
health technology, and
human system itself
14

Leader

Influence others to work together

towards a mutually envisioned goal.

15

The characteristics of an
effective nurse leader: Sound
problem-solving skills and
strong people skills.

16

Clinician

Use of technical
expertise to
administer
nursing care and
initiate and
modify care based
on clients needs
17

Advocate

Intercedes for or works on behalf of

the patient: explains, interprets
and defend the patients right

Participation on client in his own care

ensured
Rights on client protected and supported
Autonomy of client is safeguarded
Needs of client communicated
Information r/t care and condition provided
Nurture therapeutic alliance
Given options and choices for decisions

18

Nursing Responsibilities

HEADNURSE
1.

2.

3.
4.

5.

6.
7.
8.

9.
10.

Supervises and evaluates the quality of patient care through

frequent rounds
Oversees the action of assigned staff nurse, medication nurse
and chart nurse.
Familiarized and take care of the emergency cart.
Takes note of the special procedures for the patients within the
unit.
Keep superiors informed regarding the problems and issues in
patient care with the nursing unit.
Participates in the selection of nursing staff for the unit.
Presents changes or innovations to staff in a positive manner.
Provides conducive climate for work and maintains effective
communication within the unit department.
Makes the 24 hrs. Nursing report of the unit.
Checks daily time record of the staff.

19

STAFF NURSE
1.
2.
3.

4.
5.
6.
7.

8.
9.
10.

Should know the patient very well.

Should always establish rapport with the patient.
Assess the patients needs for care based on the patients
history, results of physical examinations, diagnosis, and
laboratory exams.
filling up the request admissions
Oversees the activities of the nursing students.
Make part of the endorsement for the shift.
Proper endorsement (detailed, clear, and updated) of the
patients incoming shift.
demonstrate god nursing in caring of patients
Acts as a role model to fellow students.
Makes a nursing care plan for the patient he/she handled.
20

MEDICATION NURSE

Must know the 10 rights in giving the medication.

Must know the drug action, side effects and nursing
consideration of each medications.
Must know the color coding of the medication cards followed
by the institution.
Always bring medication tray with you in giving medication.
Should always establish rapport with the patient.
May give medication only with the supervision of clinical
instructor or staff nurse on duty.
always double check with the doctors order
Make a drug study as a students clinical assignment.
Must know the computation concisely and table of
equivalents
Document all medications given legibly as countersigned by
respective clinical instructor or staff nurse on duty.
21

CHART NURSE

Record all the vital signs taken on the TPR sheet on

the patients chart.
Must know the normal values of BP, PR, RR and
Temperature.
Reports intake and output
Makes a narrative report of the vital signs recording
system for the shift then submit to the assigned
student head nurse.

22

Professional

Boundaries

Are the spaces between the nurses power

and the clients vulnerability.
The power of the nurse comes from the
professional position and the access to private
knowledge about the client.
Establishing boundaries allows the nurse to
control this power differential and allows a
safe connection to meet the clients needs.
23

Differences Between Professional and

Social Relationships
Characteristi Professional Relationship Non-Professional
cs
(nurse-client)
Relationship
Remuneratio Nurses paid to provide
n
care to client

No payment

Length

Time limited

May last a lifetime

Location

Place defined and

limited to where nursing
care is provided

Place unlimited;
undefined

Purpose

Goal-directed to provide
care to the client

Pleasure, interestdirected

Structure

For nurse to provide

care to client

Spontaneous,
unstructured

24

Differences Between Professional and

Social Relationships
Unequal nurse has more
power due to authority,
knowledge, influence and
access to privileged
information about client

Relatively equal

responsibilit
y

Nurse is responsible for

establishing and
maintaining relationship,
not client

Equal responsibility
to establish and
maintain

Preparation

Nurse requires formal

knowledge, preparation,
orientation and training

Does not require

formal knowledge,
preparation,
orientation and
training

Time spent

Nurse employed under

contractual agreement that
outlines hours of work for

Personal choice

Power
balance

25

As a health care professional, a nurse

strives to inspire the confidence of clients,
treat all clients and other health care
providers professionally, and promote the
clients independence.
Clients can expect a nurse to act in their
best interests and to respect their dignity.
This means that a nurse abstains from
obtaining personal gain at the clients
expense and refrains from inappropriate
involvement in the clients personal
relationships.
26

The nurse should promote the

clients independence.
To do these things, the nurse must
understand and apply the concepts
of professional boundaries.

27

A Continuum of
Professional Behavior
ZONE OF HELPFULNESS

UNDERINVOLVE
D

OVERINVOLVE
D

28

A zone of helpfulness is in the

center of this professional behavior
continuum.
This zone is where the majority of
client interactions should occur for
effectiveness and client safety.

29

Over-involvement with a client,

which includes boundary crossings,
boundary violations and professional
sexual misconduct, is on the right side
of the continuum.

30

Under-involvement, which includes

distancing, disinterest and neglect and can
also be detrimental to the client and
nurse, lies on the left side.
There are no definite lines separating
the zone of helpfulness from the
ends of the continuum; instead, it is
a gradual transition or melding.
31

This continuum provides a frame of

reference to assist nurses in
evaluating their own and their
colleagues professional-client
interactions.

32

BOUNDARY CROSSINGS

Are brief excursions across boundaries

that may be inadvertent, thoughtless
or even purposeful if done to meet a
special therapeutic need.
Boundary crossings result in a return to
established boundaries but should be
evaluated by the nurse for potential
client consequences and implications.
33

For a given situation, the facts

should be reviewed to determine
whether or not the nurse was
aware that a boundary crossing
occurred and for what reason.

34

The nurse would be asked: What was

the intent of the boundary crossing?
Was it for a therapeutic purpose? Was
it in the clients best interest? Did it
optimize or detract from the nursing
care? Did the nurse consult with a
supervisor or colleague? Was the
incident appropriately documented?
35

Guiding principles to determining

professional boundaries and the
continuum of professional behavior:

The nurse is responsible to delineate

and maintain boundaries.
The nurse should work within the
zone of helpfulness.
The nurse should examine any
boundary crossing, be aware of its
potential implications and avoid
repeated crossings.
36

Variables such as the care setting,

community influences, client needs
and the nature of therapy affect
the delineation of boundaries.
Actions that overstep established
boundaries to meet the needs of
the nurse are boundary violations.
37

The nurse should avoid dual

relationships where the nurse has a
personal or business relationship, as
well as the professional one.
Post-termination relationships are
complex because the client may need
additional services, and it may be
difficult to determine when the nurseclient relationship is truly terminated.
38

What if a nurse lives in a small

community? Does this mean that he or
she cannot interact with neighbors and
friends?

A professional living and working in a

remote community will, out of necessity,
have business and social relationship with
clients. Setting appropriate standards is
very difficult. If they do not relate to real
life, these standards may be ignored by the
nurse or simply not work.
However, the absence of consideration of
professional boundaries places the client
and nurse at risk.
39

What if a nurse wants to date or

even marry a former patient? Is that
considered sexual misconduct?

The key word here is former.

The important factors to be considered when
making this determination are:

What is the length of time between the nurse-client

relationship and the dating? What kind of therapy
did the client receive? (Assisting a client with a shortterm problem, such as a broken limb, is different
than providing long-term care for a chronic
condition,)
What is the nature of the knowledge the nurse has
had access to, and how will that affect the future
relationship? Will the client need therapy in the
future? Is there risk to the client?
40

Do boundary violations always

precede professional sexual
misconduct?
Boundary violations are extremely
complex. Most are ambiguous and
difficult to evaluate. Boundary
violations may lead to sexual
misconduct, or may not.
41

BOUNDARY VIOLATIONS

Can result when there is a confusion

between the needs of the nurse and
those of the client. Such violations are
characterized by excessive personal disclosure
by the nurse, secrecy or even a reversal of roles.

Boundary violations can cause delayed

distress for the client, which may not be
recognized or felt by the client until
harmful consequences occur.
42

PROFESSIONAL SEXUAL
MISCONDUCT

Is an extreme form of boundary

violation and includes any behavior that
is seductive, sexually demeaning, harassing or
reasonably interpreted as sexual by the client.
Professional sexual misconduct is an
extremely serious violation of the
nurses professional responsibility to the
client.
IT IS A BREACH OF TRUST!
43

In some cases, extreme sexual

misconduct, such as assault or rape,
may be habitual behavior, while at
other times, it is a crime of opportunity.

Regardless of the motive, extreme

sexual misconduct is not only a
boundary violation, it is criminal
behavior.
44

Does client consent make a

sexual relationship acceptable?

If the client consents, even if the

client initiates the sexual contact,
a sexual relationship is still
considered sexual misconduct for
the health care professional.

45

It is an abuse of the nurse-client

relationship that puts the nurses
needs first.
It is always the responsibility of the
health care professional to
establish appropriate boundaries
with present and former clients.
46

How can a nurse identify a

potential boundary violation in
the making?

Some behavioral indicators can alert

nurses to potential boundary issues,
for which there may be reasonable
explanations. However, nurses who
display one or more of the following
behaviors should examine their
client relationships for possible
boundary crossings or violations.
47

EXCESSIVE SELF-DISCLOSURE

The nurse discusses personal

problems or aspects of his or her
intimate life with the client, or
discusses feelings of sexual
attraction.

48

SECRETIVE BEHAVIOR

The nurse keeps secrets with the

client and/or becomes guarded or
defensive when someone questions
their interaction.

49

SUPER NURSE BEHAVIOR

The nurse believes that he or she is

immune from fostering a
nontherapeutic relationship and that
only he or she understands and can
meet the clients needs.

50

SINGLED OUT CLIENT TREATMENT OR

CLIENT ATTENTION TO THE NURSE.

The nurse spends inappropriate amounts

of time with a particular client, visits the
client when off duty or trades
assignments to be with the client.
This form of treatment may also be
reversed, with the client paying special
attention to the nurse, e.g., giving gifts
to the nurse.
51

SELECTIVE COMMUNICATIONS

The nurse fails to explain actions and

aspects of care, reports only some
aspects of the clients behavior or
gives double messages. In the
reverse, the client returns repeatedly
to the nurse because other staff
members are too busy.
52

FLIRTATIONS.

The nurse communicates in a

flirtatious manner, perhaps employing
sexual innuendo, off-color jokes or
offensive language.

53

YOU AND ME AGAINST THE

WORLD BEHAVIOR.

The nurse views the client in a

protective manner as his or her client,
tends not to accept the client as
merely a client or sides with the
clients position regardless of the
situation.
54

FAILURE TO PROTECT CLIENT.

The nurse fails to recognize feelings

of sexual attraction to the client,
consult with supervisor or colleague,
or transfer care of the client when
needed to support boundaries.

55

THE NURSES CHALLENGE

BE AWARE
BE COGNIZANT OF FEELINGS AND
BEHAVIOR
BE OBSERVANT OF THE BEHAVIOR
OF OTHER PROFESSIONALS
ALWAYS ACT IN THE BEST
INTEREST OF THE CLIENT
56

What are some nursing practice

implications of professional
boundaries?

Nurses need to practice in a manner

consistent with professional standards.
Nurses should be knowledgeable regarding
professional boundaries and work to
establish and maintain those boundaries.
Nurses should examine any boundary
crossing behavior and seek assistance and
counsel from their colleagues and
supervisor when crossings occur.
57

What should a nurse do if confronted

with possible boundary violations or
sexual misconduct?

The nurse needs to be prepared to deal

with violations by any member of the
health care team.
Client safety must be the first priority. If
a health care providers behavior is
ambiguous, or if the nurse is unsure
how to interpret a situation, the nurse
should consult with a trusted supervisor
or colleague.
58

Incidents should be documented in a

thorough and timely manner. Nurses
should be familiar with reporting
requirements, as well as the grounds
for discipline, in their respective
jurisdictions, and they are expected
to comply with these legal and
ethical mandates for reporting.
59

Standards of nursing
practice

Provide guidelines for nursing performance.

They are the rules or definition of what
it means to provide competent care.
The registered professional nurse is
required by law to carry out care in
accordance with what other reasonably
prudent nurses would do in the same or
similar circumstances.
60

standards of nursing
practice consist of three
components:
Professional standards of care define

diagnostic, intervention, and evaluation

competencies.
Professional performance standards
identify role functions in direct care,
consultation, and quality assurance.
Specialty practice guidelines are
protocols of care for specific
populations.
61

Standards of Nursing
Practice

Assessment:

Diagnosis:

Planning:

Implementation:

Evaluation:

The nurse collects comprehensive data pertinent

to the patient's health or the situation.
The nurse analyzes the assessment data to
determine the diagnoses or issues.
The nurse develops a plan that prescribes strategies
and alternatives to attain expected outcomes.
The nurse implements the identified plan,
coordinates care delivery, employs strategies to promote health and a
safe environment.
The nurse evaluates progress toward attainment of

outcomes.

62

Health Care Team

Members

Attending Physicians: one who admits, responsible for

directing care while a patient is in the hospital. Should be consulted
for questions about illness and for any special concerns.
Residents: A graduate physician completing advanced medical
training who works under the supervision of the attending physician.
Clinical Manager: A registered nurse, responsible for the overall
management of the nursing unit.
Clinical Nurse Specialist/Care Coordinators: RN that
provide clinical leadership and expertise through specialized direct
patient care, consultation and patient education.
Nursing Professionals: RN coordinate, manage and provide
patient care. Licensed practical nurses (LPNs) provide direct care and
work under the direction of the registered nurse. Nurses are dressed in
white uniforms outside the specialty units.
Patient Care Assistants/Nurse Technicians: Provide
basic patient care under the direction of the registered nurse.
63

Health Care Team

Members

Unit Secretaries: Working in the main reception area on each

floor and in the nursing stations; the central resource for information
and perform clerical functions for the nursing unit.
Registered Dieticians: Licensed and trained to complete a
thorough assessment of nutritional needs while in the hospital and after
your discharge, if necessary.
Therapists and Technicians: Staff trained in providing
specialized services in areas including the laboratory, respiratory
therapy, physical and occupational therapy and radiology.
Students: healthcare workers in training that may assist with your
care under the strict supervision of professional staff.
Environmental Services Staff: Provides daily cleaning of
patient care areas.
Volunteers: Contribute many hours of service to patients and
financial support to the hospital.
64