EXTENDED AND EXPANDED

ROLES OF NURSE
 INTRODUCTION
• The extended and expanded role of nurse can be
described as a role, which goes beyond the
traditional nursing roles to include
additional responsibilities and a wide range
functions in community and clinical care setting.
In traditional role, qualified nurses were
concentrated in curative sector of health care
system providing general nursing services.
• In expanded role trained nurses are urged to move to
community, institutional setting, research etc. Hence
extending their services to people.
 DEFINITIONS
• NURSING: (ICN Definition of Nursing):
Nursing is a unique function of nurse that is to
assist the individual, sick or well in
performance of those activities contributing to
health, recovery or to a peaceful death, that
he/she would perform unaided if he/she had
the necessary strength, will or knowledge, and
to do this in such a way to help him gain
independence as rapidly as possible.
 According to American Nurses
Association
Nursing is the protection, promotion &
optimization of health & abilities,
prevention of illness and injury,
alleviation of suffering through the
diagnosis & treatment of human
response, and advocacy in the care of
individuals, families, communities &
population.
 NURSE
A professional nurse is a
graduate of a recognized
nursing school, who has
met the requirement for
a registered nurse in a state
in which she is licensed
to practice.
 NURSING AS A PROFESSION
Nursing is not simply collection
of skills and the nurse is not simply
a person trained to perform specific
tasks. Nursing is a profession. In
almost all the countries, nursing
practice is defined and governed
by law, and entrance to profession
is regulated at national or state level.
PROFESSION POSSESS FOLLOWING
PRIMARY CHARACTERISTICS
• A profession requires an extended education of
its members as well as a basic liberal foundation.
• A profession has a theoretical body of
knowledge leading to defined skills, norms
and abilities.
• A profession provides a specific service.
• Members of a profession have autonomy in
decision making and practice.
• The profession as a whole has a code for
practice.
PROFESSIONAL RESPONSIBILTIES
AND ROLES OF THE NURSES
CAREGIVER
/ CARE
PROVIDER

COUNSELOR ADVOCATE

CHANGE
AGENT EDUCATOR
 Cont….
COMMUNICATOR

CLINICAL
RESEARCHER DECISION
MAKER

REHABILITATOR MANAGER
 NEED OF EXPANDED & EXTENDED
ROLES
• Health is now recognized and proclaimed as
fundamental right of citizen.
• The transition of health care system from disease
oriented model to a health oriented model is an
emerging trend.
•Specialization is another development which has
major implication for nursing practice.
•The need of nursing experts to
utilize their expertise
for care of the client.
•The search for increased status for nursing
 THE EXPANDED ROLE OF NURSE
Expanded role of nursing means enlarging the
sphere of nurse’s roles within the boundaries
of nursing or it is the responsibility assumed
by a nurse in the field of practice autonomy
Directions for expanded role of nurses
Outward
•Nurses are moving from the curative
sector into community for supporting primary
health care.
 CONTD…
• School health nursing services.
• Maternal and child health nursing
services.
• Occupational health nursing services etc.
Inward
• Nurses are utilizing their expertise for
direct care of client.
• Client may be individual or the family.
 FACTORS INFLUENSING EXPANDED
ROLE IN NURSING
•Health is now recognized and proclaimed as
fundamental right of citizen.
•The transition of health care system from
disease oriented model to a health oriented
model is an emerging trend.
•Specialization is another development
which has major implication for nursing
practice.
•The need of nursing experts to
 ADVANCED PRACTICE NURSES
• An advance nurse practitioner/independent
nurse practitioner include registered professional
nurses, with a current license to practice, who is
prepared for advance nursing practice by virtue of
knowledge and skills obtained through a post
basic or a advance education program of study
acceptable to the state board of nurse examiners.
• The APN is prepared to practice in an expanded role
to provide health care to individuals, families
and groups in a variety of setting including
homes, hospitals, institutions, office, industry,
schools public and private clinics etc.
 HISTORICAL DEVELOPMENT
• The first successful programme to prepare ANP
was developed at University of Corado in 1965.
• During 1970 – 71, Federal legislation
recommended certificate programme for nurses
to deliver primary health care.
• Gradually certificate programme shifted to
master’s degree.
•In response to health care reform in 1990s
many programmes were developed to
meet the demand of primary care services.
 CONTD…
• By 1994, 248 programme centers were
developed for INP in US.
•In 1995, 49,000 nurses were employed
as INPs.
•American Academy Of Nurse Practitioner
in 1993 developed standards and guidelines
for practice of ANPs which are still followed.
• Today 200 universities and colleges are
offering this programme all over the world.
• 70,000 nurses are working as ANP in US.
 BASIC REQUIREMENTS
• Basic nursing education
• Registered nurse
• Advance nursing certification
(Master degree in any specialization)
• Collaboration with any hospital for
referral and reimbursement
 AREA OF PRACTICE
• Community clinics and health
centres
• Nurse – managed centres
• Home Health Care Agencies
Home Nursing
• Hospital and hospital clinics
• Hospice centres
• Nursing home
• Accident and injury/ trauma
centres
 CONTD…
• School or college based
health clinics
• Geriatric Homes
• Ambulatory Clinics
• Midwifery Centres
• Rehabilitation Centres
• Day care dialysis unit
• First referral units
 CHALLENGES OF INDIAN NURSES
IN IMPLEMENTING ANP
• Develop nursing practice act.
• Develop nursing standards
• Develop law regulation
• Develop nursing practice model for Indian health
setting
• Develop nurse practitioner courses
• Clarity of role requirement agencies
• Establish recruitment agencies
 CONTD…
• Salary structure
• Develop nursing network
• Develop online network of nurses
• Develop drug act policy for nurses
• Educational challenges
• Develop evidence based research
NURSE PRACTITIONER PROGRAMME
IN INDIA
•Indian nursing council has
developed a new nursing course
Independent Nurse Practitioner
•18 month post basic diploma in
midwifery to impart all midwifery skills to
handle obstetric emergencies
CONTD…
•INP will be authorized
to establish
her own independent
practice
•Course has been
piloted in West Bengal
and 2 of 4 trainees have
been assigned to a CHC
 DIFFERENT CATEGORIES OF ADVANCE
NURSE ARE DEFINED FOR THE EXPANDED
ROLE
• Certified registered nurse • Adult nurse practitioner
anesthetist • Women health practitioner
• The certified registered nurse • Geriatric nurse practitioner
midwife
• Nurse informatics specialist
• Nurse practitioner
• Community nurse
• Clinical nurse specialist
practitioner
• The acute care nurse
practitioner • Home health nurse
• Family nurse practitioner • Oncology nurse
• Psychiatric nurse practitioner • Clinical nurse leaders
• Pediatric nurse practitioner • Public health nurse
CERTIFIED REGISTERED
NURSE ANESTHETIST
 CONTD…
• A Certified Registered Nurse
Anesthetist, or CRNA, is an
Advanced Practice Registered Nurse
(APRN) who has acquired graduate level
education and who specializes in the
• administration of anesthesia.
The nurse anesthetist carries out pre-
operative visits and assessments, and
administers general anesthetics for surgery
under the supervision of a physician prepared
in anesthesiology.
 CONTD…
• The nurse anesthetist also assesses the postoperative of
clients
• Educational qualification: Nurse Anesthetists must
first complete a four-year baccalaureate degree
in nursing or a science related subject. They must
be a licensed registered nurse.
• Then, she requires a minimum of one year of full-time
nursing experience in an acute care setting, such
as medical intensive care unit or surgical intensive
care
unit. Following appropriate experience, applicants
enroll in an accredited program of anesthesia
education for an additional two to three years.
THE CERTIFIED NURSE
MIDWIFE
 CONTD…
• A Certified Nurse-Midwife ("CNM") is an
Advanced Practice Nurse who has
specialized education and training in both
Nursing and Midwifery.
• CNM's function as primary healthcare
providers for women and most often provide
medical care for relatively healthy
women, whose birth is considered
uncomplicated and not "high risk," as well
as their neonate.
EDUCATIONAL QUALIFICATION
• Certified Nurse-Midwives, in most states, are
required to possess a minimum of a graduate
degree such as the Master of Science
in Nursing, or Post-Master's Certificate.
• The first Doctor of Nursing Practice
(DNP) program graduated its first class in
May 2010.
• Additionally, Certified Nurse Midwives must
also hold an active Registered Nurse
license in the state in which they practice.
CLINICAL NURSE SPECIALIST
 CLINICAL NURSE SPECIALIST
Within the three domains of CNS practice,
Sparacinio (2005) identified seven core
competencies which are:
• Direct clinical Practice
• Expert coaching and guidance
• Collaboration
• Consultation
• Research
• Clinical and professional leadership
• Ethical decision-making
NURSE PRACTITIONER
 NURSE PRACTITIONER
The nurse practitioner can be authorized to perform the
following expanded role-related functions:
•Make health assessment
•Order laboratory tests
•Identify health problems
•Diagnose minor ailments and common diseases of a
recurrent type
•Initiate, continue or discontinue treatments or refer clients
of a secondary level of health care
•Prescribe medicines(within approval of higher authorities)
•Manage the care of patients
•Maintain appropriate record
THE ACUTE CARE NURSE
PRACTITIONER
THE ACUTE CARE NURSE PRACTITIONER
• These practitioners are specially educated to deal with
advance level of nursing care for patient suffering from
critical, acute as well as chronic nature of ailments.
•It is developed in 1995 to meet the increasing need for
an APN to function in the absence of a physician or house
staff physician.
Primary responsibilities:
•The acute care nurse practitioner primarily takes care
of patients who have chronic, acute and critical illness.
•Typical environment where such nurses operate include sub
acute and acute hospital departments such as burn unit,
intensive care unit, emergency department, dialysis,
trauma units etc.
FAMILY NURSE PRACTITIONER
FAMILY NURSE PRACTITIONER
A family nurse practitioner's job may include the
following:
• Diagnosing, treating, evaluating and managing
non-life-threatening acute and chronic illness and
disease
• Obtaining medical histories and conducting
physical examinations
• Ordering, performing, and interpreting diagnostic
studies
• Prescribing physical therapy and other
rehabilitation treatments
 CONTD…
• Providing prenatal care and family planning
services
• Providing well-child care, including screening and
immunizations
• Providing primary and specialty care services,
health-maintenance care for adults, including
annual physicals
• Providing care for patients in acute and critical care
settings
• Counselling and educating patients on health
behaviours, self-care skills, and treatment options.
PSYCHIATRIC NURSE PRACTITIONER
 PSYCHIATRIC NURSE PRACTITIONER
• Psychiatric nurses must be registered nurses (RNs).
• Also need specific additional training in
psychological therapies, building a therapeutic
alliance, dealing with challenging behavior and the
administration of psychiatric medication. This may
be achieved through elective classes, continuing
education and/or clinical study.
• To become a psychiatric nurse practitioner
or clinical nurse specialist, person will need
additional education at the graduate level,
usually two-year Master of Science in Nursing
 CONTD…
• Then need to complete a period of supervised
clinical practice before you are eligible for
certification as a specialist in adult or child and
adolescent psychiatric-mental health nursing.
• Certification for psychiatric nurses and
psychiatric nurse practitioners is available
from the American Nurses Credentialing
Center (ANCC). Certified nurse’s earn
significantly more than those without such
credentials.
 ADULT NURSE PRACTITIONER
Areas of Study to Be an Adult Nurse Practitioner:
• Primary Care for Adults
• Advanced Health Assessment
• Theory and Research Applications
• Advanced Physiology/Pathophysiology
• Acute Illness in Adults
• Advanced Pharmacology
• Legal Leadership Issues
• Genetics and Advanced Nursing
• Health Policy and Finance
Often, adult nurse practitioner programs are considered
advanced programs equivalent to a master's degree program.
 PEDIATRIC NURSE PRACTITIONER
• The pediatric nurses perform physical exams,
diagnose injuries and many common
illnesses and have the training to provide the
treatment procedures, therapies and
medication necessary for the child.
• They order specific lab tests and diagnostic
testing, such as x-rays, blood tests
and laboratory tests when needed. Trained to
give immunizations, they also manage their
patient's problems, such as juvenile diabetes
and other conditions.
 CONTD…
• They provide education, support and
health care counselling to the families
of their patients and answer any questions or
address any concerns the family has
regarding the child.
• A pediatric nurse practitioner must be
a problem solver and critical thinker
with decision-making skills and able to work
well under pressure. They work in
many healthcare settings.
 WOMEN’S HEALTH NURSE
PRACTITIONER
• A WHNP is a registered nurse who has advanced
education and clinical experience in women's
health care.
• As a specialist, the WHNP delivers comprehensive
health care to women throughout the lifespan, with an
emphasis on reproductive and gynecologic
health needs.
• The WHNP is well-qualified to provide well-
woman care, prenatal and postpartum care, care for
women experiencing episodic acute or chronic
illnesses, as well as care to men who have
selected reproductive health needs or problems.
•GERIATRIC NURSE
PRACTITIONER
GNP is an ANP with specialization in care of the
older adult .GNP’s are trained in the special needs of
the aging adult, with emphasis on health
•promotion
The GNPstatus.
works with the client and family to
promote independence and self care. The client
population is usually age 65 or older.
•A geriatric nurse practitioner provides expert care,
treatment, and counseling for elderly patients. A
professional conducts diagnostic tests, checks vital
signs, and assists doctors in treatment
procedures for a variety of medical conditions.
 CONTD…
• In addition, a geriatric nurse practitioner
might help a patient engage in physical
therapy exercises and educate family
members about their loved one's situation.
Most
employednurses
by are
general hospitals and nursing
homes, though some professionals work in
specialty clinics, private doctor's offices, and
home health care companies.
•A geriatric nurse practitioner understands
the problems faced by older patients and
tailors treatment to their specific needs.
 CONTD…
• A geriatric nurse practitioner who works in a
hospital or clinic is often responsible for
performing initial patient evaluations, aiding
in diagnostic tests, and helping doctors determine
the best treatment options.
•A master's degree in nursing is required to become
a geriatric nurse practitioner in most regions
and countries. In addition to a earning degree,
a new nurse usually needs to complete a
practical internship program and pass a series
of licensing examinations before working
independently.
NURSE INFORMATICS SPECIALIST
 NURSE INFORMATICS SPECIALIST
• Nursing informatics are specialists within the
nursing profession that combine their nursing skills
with their knowledge of computer science.
• They work with data, collecting, organizing,
and interpreting it in order to make patient care more
efficient and higher quality.
• They work in a range of settings, such as insurance
companies, hospitals, and consulting firms.
• They may write programs that will be used by nurses.
They may train nurses and other healthcare workers in the
proper use of computer systems.
• They may interview workers and identify their
technological needs.
 JOB SKILLS
• Nursing informatics need to be
technologically inclined. They need to
have well-developed critical thinking and
problem- solving skills.
• They should have well-developed
communication skills, and the ability to
observe accurately and make
decisions accordingly. They must be
willing to work with a team, as well as
supervise others.
 TRAINING AND EDUCATION
• Nursing informatics must first become registered nurses
(RNs) by earning their nursing license. Candidates have
three different options for educational paths leading
to certification as a registered nurse.
• The first option is obtaining a bachelor's of science
degree in nursing (BSN). BSN programs are offered
through colleges and universities and take 4 years to
complete.
• The second option is an associate degree in nursing
(ADN), offered through junior and community colleges,
which takes 2 to 3 years to complete. The third option is
a 3-year diploma program administered by hospitals.
 CONTD…
•All three types of programs qualify students
to be hired as a registered nurse, but BSNs
are becoming more of a requirement for
nursing informatics.
• Many nursing informatics receive additional
graduate-level training in computer science,
either within a nursing program or through
strictly computer-based programs. Nursing
informatics can become certified by the
American Nursing Informatics Association.
 A FAITH COMMUNITY NURSE / PARISH
NURSING
• ANA defines FCN as "the specialized
practice of professional nursing that
focuses on the intentional care of the spirit as
part of the process of promoting holistic
health and preventing or minimizing illness
in a faith community.“
•Rather than dealing primarily with sickness
in a faith community, parish nurses focus
on wellness, disease prevention and
health promotion.
 RESPONSIBILITIES INCLUDE
• Health education and teaching
• Personal health counselling for faith community
members
• Coordinating with community health resources and
acting as a church liaison
•Training and coordinating volunteers in support services
•Organizing health support groups
•Assessing congregational and community health needs
•Responding to health-related issues such as
substance abuse, addictions and violence within
congregational families or the surrounding community
 TELEPHONE NURSING
CONSULTATION SERVICES
Telehealth refers to providing health
administration, patient and professional
education, or even long-distance clinical
health care through
telecommunication technology. Technologies
are improving and expanding at great
speeds and are offering healthcare providers
economical and efficient ways of delivering
timely medical education and support to
clients at home.
THREE CRITICAL ELEMENTS IN TNCS
• Co-ordinates with relevant healthcare
stakeholders
• Utilizes protocols to guide nurses’ clinical
decisions
• Utilizes IT support
• Links with the Clinical Management System
(CMS)
• Utilizes ‘High Risk Elderly Database & Alert
System’
 HOME HEALTH NURSE
• Home health nurses provide care in the
homes of their patients.
• The following tasks are some of the
common daily activities of a home health
nurse:
•Administering medications
•Cleaning and dressing wounds
•Monitoring patient health and needs
•Documenting symptoms and vital signs
 CONTD…
• Instructing patients and their families
on proper home care.
• Supervising home health aides.
• Providing encouragement and
support.
• Education: Home health nurses
must be registered nurses (RNs).
 ONCOLOGY NURSE
• Oncology nurses provide and supervise care for
cancer patients who are either chronically or
critically ill. Oncology nurse practitioners monitor
their patients' physical conditions, prescribe
medication and formulate symptom management
strategies.
• These caring individuals often witness suffering
and death, but many thrive on the deep, ongoing
relationships they develop with patients
• Oncology nurse practitioners are advanced practice
registered nurses (APRNs) who have master's
degrees.
 CONTD…
• With their additional knowledge and qualifications,
these nurses can work in many roles, including direct
caregiver, coordinator, consultant, educator,
researcher and administrator. Oncology nurse
practitioners provide, guide and evaluate nursing
care for individuals with cancer, as well as for their
families and communities.
•Oncology nurses must be registered nurses
(RNs).To become an oncology nurse practitioner,
person will also need to complete a Master of
Science in Nursing (MSN) degree, typically
obtained through a 2-year program of graduate
 CLINICAL NURSE LEADERS
• The Clinical Nurse Leader (CNL) is an advanced generalist
who focuses on the improvement of quality and
safety outcomes for patients or patient populations.
• The role differs from that of a Clinical Nurse Specialist (CNS)
in that the CNL is a masters prepared registered nurse with a
focus on clinical and leadership skills and training in
health care systems management at the clinical unit level
while the CNS has master's-level preparation in an
advanced practice specialty.
• The CNL is a registered nurse, with a Master's Degree in the
Science of Nursing. Required core advanced nursing
courses in pathophysiology, clinical assessment and
pharmacology. The Commission on Nurse Certification
(CNC) provides certification for the Clinical Nurse Leader,
in addition to the required board certification for RN licensure.
 CNL ROLES
• Client and Community advocate
• Clinical management of client care
• Designs and provides health promotion
• Practices evidence based nursing
• Collaborates with other health care
professionals
• Manages and uses client care information
technology.
• CNLs work in a variety of health care
 PUBLIC HEALTH NURSE
• Public health nurse
strives to promote
prevention over
treatment.
• By correcting poor health
practices and maintaining
a safe home or work
environment,
patients lower risks to
their health and require
fewer visits to health
care facilities
 ENTEROSTOMAL THERAPIST
• Specializes in the prevention of pressure
ulcers and management and
rehabilitation of patients with wounds,
ostomies, and incontinence
• Diagnoses: Stomas, including colostomy,
ileostomy, urostomy; wounds such as
surgical, pressure ulcers, fistulas, and
venous/arterial ulcers; incontinence
(urinary, fecal).
EXTENDED
ROLE
OF
NURSE
 EXTENDED ROLE OF NURSE
It was the social security administration, which
used the term “Extended Care” to designate a
period of reimbursement for post
restorative service in a nursing hospital home
institution. type of
Extended care is potentially of great importance to
patients because of the emphasis placed
upon restorative services whereby it is hoped,
that they will be able to return to their homes
in relatively brief time after having benefited from
treatment to the maximum degree possible. An
extended role is a lengthened in a unilateral
 DEFINITION
Extended role in nursing is
one in which a
nurse assumes
responsibility outside the
usual practice area (in
hospital) with autonomy.
 REASONS FOR DEVELOPMENT
OF NURSES EXTENDED ROLES
• The incorporation of medical tasks in development
of extended role is fuelled by two factors i.e.,
the search for increased status for nursing &
economic expediency.
• The committee to study extended role for
nurses recommended that “collaborative efforts
evolving
schools of medicine & nursing should be
encouraged to undertake programme to of
demonstrate effective functional interaction
physicians and nurses in the provision of health
services”-1972 .
 EXTENDED CARE AS A SPECTRUM
OF SERVICES
• Intermediate care: A service provided within a
hospital for patients who not only require
nursing care, but continuing medical attention,
laboratory and x-ray services.
•Domiciliary care: For patients, who are
ambulatory, need only intermittent medical
attention, but need supervision of their daily
activities.
•Home care nursing: Provides physician directed
nursing, medical, social and rehabilitative services to
selected patients in their home environment.
 SCHOOL NURSING
• School nursing is a specialized practice of professional nursing
that advances the well being, academic success, and life-long
achievement of students.
• The practice of school nursing began in the United States on October
1, 1902 when the initial role of the school nurse was to reduce
absenteeism by intervening with students and families regarding
health care needs related to communicable diseases. While the nurse’s
role has expanded greatly from its original focus, the essence of the
practice remains the same. The school nurse supports student success
by providing health care assessment, intervention, and follow-up for
all children within the school setting.
 ROLE OF THE SCHOOL NURSE
1. The school nurse provides direct health care to students
and staff.
2. The school nurse provides leadership for the provision of
health services.
3. The school nurse provides screening and referral for
health conditions.
4. The school nurse promotes a healthy school environment.
5. The school nurse promotes health.
6. The school nurse serves in a leadership role for health
policies and programs.
7. The school nurse serves as a liaison between school
personnel, family, community, and health care providers.
 CAMP NURSING
Camps are temporary small
communities and provide basic
services for their members.
Camp nurses work towards
attaining a healthy camp
community.
Provides emergency care for
accidents and acute care for
minor illness and injuries. Plans
to avoid spread of contagious
illnesses. Screen and eliminates
health hazards from the camp
environment. Supervise that
persons abide by health
related rules.
VOLUNTEER NURSING
• Nurse volunteer to provide nursing
services in community settings.
Provide volunteer service for episodic
events such as health fairs,
•
camps, church activities, community
events and community services
projects.
Volunteer nurse have an obligation to
have adequate knowledge about actual
and potential situations that may arise.
Assumes responsibility for providing
accurate health information and
assures that those served receive
the care they require. Maintains
records to make additional inquiries
OCCUPATIONAL HEALTH NURSING
• The occupational health nurse is a Registered
Nurse with a great deal of clinical experience and
expertise in dealing with sick or injured people.
• The occupational health nurse is skilled in
primary prevention of injury or disease. The
nurse may identify the need for, assess and plan
interventions to, for example modify working
environments, systems of work or change working
practices in order to reduce the risk of hazardous
• exposure.
Assures employee safety by collaborating with
agencies that set standards for safe ,healthy working
environments
 CONTD…
• Assess the health status of clients ,workforce
and work environment using a systematic
approach
• Provide primary, secondary and tertiary
care
• Implements
to persons in thethe
work setting
plan of care to promote
health, prevent illness and injury and
facilitate rehabilitation of injured or disabled
workers.
 DISASTER NURSING
DEFINITION
Disaster Nursing means
involves response to (and
preparedness for) natural or
man-made events that affect
an entire community
or communities.
(Usually) involve massive
numbers of casualties and
extensive property damage.
 FUNCTIONS
• Disaster nurse should have detailed
knowledge of first aid principles , helping
victims of physical and mental trauma
• Should have experience in therapeutic
communication skills to provide psychological
and spiritual skill during times of uncertainty
• Provide care during the time of disaster
• Take measures to prevent contagious illnesses
during and after disaster
 REGISTERED NURSE LAWYER
A legal nurse consultant is a licensed, registered nurse
who performs a critical analysis of clinical and administrative
nursing practice, healthcare facts and issues and their outcomes for
the legal profession, healthcare professions, consumers of healthcare
and legal services, and others as appropriate.
FUNCTIONS
•Assists in obtaining medical records and identifying missing records
•Identifies standards of care, causation and
damage issues. Helps determine the merits of a case.
Screens for record tampering
•Prepares chronologies of medical events and correlates them to the
allegations
•Conducts research and summarizes medical literature
•Educates attorneys regarding medical facts and
issues relating to case or claim
 CONTD…
• Assists with depositions and trials, including
developing exhibits
• Organizes medical records and other medically-
related litigation materials
•Conducts client interviews
•Locates and procures demonstrative evidence
•Researches and identifies expert witnesses
•Acts as a liaison with attorneys,
physicians and
clients
•Works in various legal settings including law firms,
 ARMY NURSING
• Works in ambulatory clinics,
community hospitals, large
medical centers, hospitals, field
hospitals and aircraft.
•Serve the military by enlisting
for active duty ,reserve status
or in the national guard
•Promote health and meet
the health care needs of
military personnel and their
dependence during war time
and in time of peace.
•Armed force nursing
offers
 FORENSIC NURSING
• Forensic means having to do with the law
• Forensic nursing is Application of the nursing process to public or
legal proceedings
• Application of the forensic aspects of health care to the scientific
investigation of trauma and/or death related to medico legal issues
• One of the most important duties in forensic nursing is assisting in
the physical and emotional recovery of patients while
protecting their rights. Forensic nurses help victims and
contribute their expertise to solve crime.
• Forensic nurses are trained to recognize, collect and preserve
evidence while treating patient wounds—something that's
crucial in a fast-paced crime scene environment. A
forensic nurse examiner also works beside hospital staff
collecting and documenting evidence while treating patients.
 ROLES OF FORENSIC NURSE
• Clinical Forensic Nurse
• Sexual Assault Nurse Examiner (SANE)
• Pediatric Forensic Nurse
• Forensic Psychiatric Nurse
• Nurse Death Investigator/Coroner
• Correctional Nurse
• Legal Nurse Consultant
• Nurse Attorney
• Promotes health and safety through community
education.
• Applies the nursing process to death investigation
across the life span
• Collaborates with interdisciplinary agencies
• Identifies trends
• Conducts and/or participates in research
 NURSE ENTERPREUNERS
“One who creates innovation within the healthcare
organization through the introduction of a new product, a different
service, or simply a new way of doing something” Manion
(1990) . These men and women apply their skills and
training toward establishing, promoting, or consulting in
business ventures in the health care industry. They can build on
their nursing knowledge to develop medical devices or
computerized systems for delivering healthcare, freeing staff
nurses to spend more time caring for patients.
•FUNCTIONS
•Leadership
•Networking
•Marketing
•Business skills
NURSE MANAGERS
• The Nurse Manager plays an essential
role in healthcare. She sets the tone
of any Healthcare System. The Manager
is the backbone of the organization.
The quality of patient care, as well as
staff recruitment and retention success,
rests with this key role.
• And yet it is rare that nurse managers are
given the opportunity to acquire
the operational, financial, and
management skills essential to their
success – and the success of their
organization.
• The Healthcare Performance Institute
is committed to the development of
the Nurse Manager, so that each patient
care area is managed to assure
 GUIDELINES TO AVOID LEGAL
IMPLICATIONS WHILE
PERFORMING ADVANCED ROLES
•As a registered nurse, midwife or specialist
community public health nurse, must maintain
their professional knowledge and competence
•Take part regularly in learning activities that
develop their competence and performance.
•They have a duty to facilitate students of
nursing, midwifery and specialist community
public health nursing and others to develop their
competence.
 CONTD…
• To practice competently, they must possess the knowledge,
skills and abilities required for lawful, safe and effective
practice without direct supervision. They must acknowledge
the limits of their professional competence and only
undertake practice and accept responsibilities for those
activities in which they are competent.
• If an aspect of practice is beyond their level of competence
or outside their area of registration, they must obtain help
and supervision from a competent practitioner until they and
their employer consider that they have acquired the requisite
knowledge and skill.
• They have a responsibility to deliver care based on current
evidence, best practice and, where applicable, validated
research when it is available.
CHALLENGES IN IMPLEMENTING ANP
IN INDIA
• Develop law regulation & nursing practice act.
• Develop nursing standards
• Develop nursing practice model for Indian health
setting.
• Clarity of role requirement agencies
• Establish recruitment agencies.
• Salary structure
• Develop nursing network
• Develop online network of nurse
• Develop evidence based research
 1. RESEARCH INPUT
Developing an advanced nurse practitioner service in emergency
care: attitudes of nurses and doctors.
Griffin M, Melby V BACKGROUND:
The role of advanced nurse practitioner in emergency care has
emerged in a number of countries, and has brought with it confusion
about titles, role boundaries, clinical accountability and
educational requirements. Initially, the role resulted from a need
for healthcare professionals to provide a service to the increased
numbers of patients presenting to hospital with less urgent
problems. Since then, the service has evolved to one where nurse
practitioners provide high- quality and cost-effective care to
persons who seek help for non- urgent, urgent or emergent
conditions in a variety of emergency care settings. However, little
research could be identified on the attitudes of relevant nursing and
medical staff towards the development of this role.
 METHODS
A questionnaire survey was carried out, and a 29-item
Likert rating scale was developed to measure attitudes.
Along with some demographic variables, two open-
ended questions were added to allow respondents to
elaborate on what they perceived as benefits and
difficulties associated with an
advanced nurse practitioner service. All general
practitioners, emergency nurses and emergency doctors
in one health board in the Republic of Ireland
were targeted, and 25 emergency nurses, 13
emergency doctors and 69 general practitioners were
approached to take part. Data were collected in
February 2004.
 FINDINGS
An overall response rate of 74.8%
was achieved. All respondents were
positive towards the development
of an advanced nurse practitioner
service, with general practitioners being
less positive. The principal
differences appeared between
general practitioners and hospital
emergency care staff.
 2. RESEARCH INPUT
The clinical nurse specialist as change agent:
reducing employee injury and related costs.
Sedlak CA, Doheny MO, Jones SL, Lavelle C.
PURPOSE:
The purpose of this study was, first, to examine
the role of the clinical nurse specialist (CNS) as it
relates to the implementation of a CNS-initiated
Safe Movement Program and, second, to report
findings from a CNS-initiated safe movement
program (SMP) in reducing healthcare workers'
injuries and related costs.
• DESIGN:
• A longitudinal preimplementation and post-
implementation study design was used.
• SAMPLE:
• Participants at the onset of the study included 52
healthcare workers who participated in the study
preimplementation and postimplementation of the SMP.
Attrition resulted in a final sample of 46.
•METHODS:
•Data were collected on healthcare workers' perceptions
of injuries as well as existing incident reports and
workers' compensation records preimplementation
and postimplementation of the study.
• FINDINGS:
• Outcomes included major reduction in healthcare
worker injuries and related workers' compensation
cost savings. The number of healthcare workers who
thought an injury occurred as a result of lifting
or transferring a resident was reduced by 75%,
and perceptions of lifting and transfer injuries
resulting in a back strain were reduced by 80%. The
number of times in a month healthcare workers felt
lifting or transferring a resident was "too much" for
them was reduced by 73%. Workers'
compensation insurance was reduced by 93%.
 CONCLUSION
• We have covered much ground in the area of nursing roles.
We can see that nursing has become…"bigger, fuller, more
elaborate or systematic, and more mature in current times.
By expanding the nurse’s roles help them taking their own
initiative, doing their own thinking and making their
own decisions based on their own experience and
education, to improve practice for the benefit of patients
and clients.
• However If nurses continue to accept additional roles that
are more to enable management to comply with
then that or
directives stretching or testing
meet targets rather endurance may result
than enhancing in
the care
damage to individual nurses through "burnout", and
of patients,
ultimately damage the profession and the patients for whom
we care.
 SUMMARIZATION
• Definitions
• Professional Responsibilities and Roles of The Nurses
• Need for expanded and extended roles
• Expanded role of nurse
• Factors influencing expanded role in nursing
• Extended role of nurse
• Extended care as spectrum of services
• Guidelines to avoid legal implications while performing
advanced roles
• Challenges in implementing ANP in India
• Conclusion
Thank You…
 BIBLIOGRAPHY
• Potter Patricia A. Perry Anne G.”Fundamentals of nursing”
Edition-6th, Published by- Elsevier publishers. Page no. – 20
– 26
• Taylor C. Lillis C. Lemone P. “Fundamentals of nursing – The
art and science of nursing care”.Edition-4th,published by-
Lippincott publishers, Page no.- 26 – 30
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