Outline

I. Emerging Opportunities Fields of specialization According to setting or treatment According to health condition According to population According to organ or system Expanded roles of nurses Nurse Practitioner (NP) Clinical Nurse Specialist (CNS) Advanced Practice Nurse (APN) Certified Registered Nurse Anesthetist (CRNA) Certified Nurse Midwife (CNM) Balancing personal and professional needs

II. Issues and Trends in Nursing Practice/Education Technological Advances Migration Cultural Diversity Living with Chronic Disease Changing Patterns of Disease

III. Nursing Associations Accredited professional organizations Specialty organizations Other professional organizations

I. Emerging Opportunities

1. Field of Specialization Besides being an in- demand career today, a career in nursing also has practically limitless opportunities. Nurses can choose from various specializations as well as career paths, from traditional to the emerging ones. Let us go take a closer look on some alternative specializations in the nursing field 1. Ambulatory Care- providing care within doctors offices and clinics. Ambulatory care nursing is characterized by rapid, focused assessments of patients, long-term nurse/patient/family relationships and teaching and translating prescriptions for care into doable activities for patients and their caregivers. Ambulatory care nurses work in outpatient settings,

Field of specialization by setting or treatment

responding to high volumes of patients in short term spans while dealing with issues that are not always predictable.

2. Critical Care- providing care in intensive care units primarily. Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency departments and the intensive care units. 3. Emergency or trauma care- providing care in emergency rooms. Emergency Nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury. While this is common to many nursing specialties, the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known.

4. Hospice care- providing care in the patients home or in hospice care settings. Hospice and palliative care nurses provide care for, and help ease the pain of, terminally ill patients outside of hospitals.

5. Holistic care- providing care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients mental and spiritual health in addition to their physical health.

6. Perioperative/Perianaesthesia care- Perianaesthesia nurses provide preoperative and postoperative care to patients undergoing anaesthesia during surgery. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery.

Field of specialization by health conditions

1. Oncology- providing care to cancer patients. Oncology nurses care for patients with various types of cancer and may administer radiation and chemotherapies. Oncology nurses need to identify their own reactions to cancer and set realistic goals to meet the challenges inherent in caring for patients with cancer for many people associate cancer with pain and death. In addition, oncology nurses must be prepared to support patients and families through wide range of physical, emotional, social, cultural, and spiritual crises.

2. Genetics- providing care to those with genetic conditions. Genetic nurses provide care for patients with genetic diseases. These nurses are involved in various levels of genetic treatment, from explaining treatment and conditions to patients, to risk identification, and screening. Genetic nurses are also involved in genetic counselling and clinical trials.

3. Diabetes Management- providing care to those with diabetes. Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections.

4. Addictions- providing care to those with alcohol, drug, and other addictions. Nurses help addicted patients in rehabilitation.

5. Psychiatric- providing care to patients with mental illness. Nurses in this area receive more training in psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and the

administration of psychiatric medication. Psychiatric mental health nursing works within nursing models, utilizing nursing care plans, and seeks to care for the whole person. The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. Mental health nurses seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.

Field of specialization by population 1. Neonatology- providing care to neonates or newborns. Neonatal nursing is the provision of nursing care for newborn infants up to 28 days after birth. Neonatal nurses are a vital part of the neonatal care team. In this, neonatal nurses work in three levels; level I consist of caring for healthy newborns, level II provides intermediate or special care for premature or ill newborns and at this level, infants may need special therapy provided by nursing staff, or may simply need more time before being discharged, and level III treats newborns who cannot be treated in the other levels and are in need of high technology to survive, the neonatal nurse works in the NICU.

2. Pediatrics- providing care to children and adolescents. Pediatric nurses cares and meets the needs of youngsters.

3. Gerontology or geriatric- providing care to adults or elderly or the aged. Geriatric nurses provides comprehensive nursing care to older people by combining the basic nursing process of assessment, diagnosis, planning, implementation, and evaluation with specialized knowledge of aging. Geriatric nursing care includes promoting and maintaining functional status and helping older adults identify and use their strengths to achieve optimal independence.

Field of specialization by organ or system

1. Gastroenterology- providing care to those with digestive or intestinal ailments. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also specialize in endoscopic procedures, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. 2. Cardiovascular- providing cardiac care treatments. Nurses help in the treatment of cardiac patients. Cardiac nurses help treat conditions such as unstable angina, cardiomyopathy, coronary artery disease, congestive heart failure, myocardial infarction and cardiac dysrhythmia under the direction of a cardiologist. Cardiac nurses perform postoperative care on a surgical unit, stress test evaluations, cardiac monitoring, and others.

3. Orthopaedics- providing care to those with muscular and skeletal problems. Orthopaedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy.

4. Respiratory- providing care to those with respiratory ailments. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis.

5. Urology- providing care for patients with disorders of the kidneys, urinary tract, and male reproductive organs. Nurse helps in procedures like cystoscopy, biopsy and fulguration of bladder lesions and

transurethral resection of the prostate or localized bladder tumors, retrograde exam of the ureters, placement of ureteral stents, and various laser procedures are also performed in conjunction with cystoscopic procedures and also transurethral needle ablation therapy used to treat benign prostatic hypertrophy.

6. Gynecology- providing care to female patients with reproductive problems. Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer, and sexually transmitted diseases.

7. Neurology- providing care to for patients with kidney disease caused by diabetes, hypertension, or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures.

2. Expanded Roles of Nurses Professional nursing is adapting to meet the changing health needs and expectations. The role of the nurse has expanded to improve the distribution of health care services and to decrease the cost of health care.

Nurse Practitioner (NP) - are prepared as specialists. They define their role in terms of direct provision of a broad range of health care services to

patients and families. The focus is on providing direct health care to patients and collaborating with other health professionals. NP is a nurse who has education beyond the bachelors degree in a clinical specialty area strongly focused on primary care, and some subspecialties are hospital-based. Clinical Nurse Specialist (CNS) are prepared as specialists who practice within a circumscribed area of care. They define their role as having five major components: clinical practice, education, management, consultation, and research. CNSs often focus on their education and counselling of patients and families, as well as education, counselling and consultation with nursing staff. CNSs are ideal case managers because they have the educational background and the clinical expertise to organize and coordinate services and resources to meet the patients health care needs in a cost-effective and efficient manner. A CNS is a registered nurse with an advanced nursing degree, masters degree, or doctorate who is an expert in a specialized area of clinical practice. Advanced Practice Nurse (APN) encompasses both NPs and CNSs roles. Certified Registered Nurse Anesthetist (CRNA) - takes care of the patients anesthesia needs before, during, and after surgery and other procedures, either alone or in conjunction with other health care professionals.

Certified Nurse Midwife (CNM) - delivers newborns and also provides health education, including teaching of self-care skills and preparation for childbirth and childrearing.

3. Balancing Personal and Professional Needs

A nurse has full of work in the hospitals. And proper balancing of personal and professional life is a great deal for nurses. Proper time management, stress reduction, and setting priorities are the top ways in balancing personal and professional life. II. Issues and Trends in Nursing Practice/Education The healthcare field is a dynamic profession. Issues and trends that emerge make a great impact to the healthcare profession specifically the nursing profession. These occurrences have brought about changes to the health care delivery.

Minimize distractions. Know when to stop working. Don't eat lunch at your desk. Schedule regular "dates" with your spouse and children. Take at least one weekday off per month to play. Make a list of fun things you've always wanted to do, and then start doing them. Use your office for business-related activities only. Don't use other parts of your home for business on a regular basis. Include your spouse in your business. If you and your spouse work together, avoid talking about business after hours.

1. Technological Advances The health care setting had its biggest transition through technological advances. Emerging of new equipments and devices made health care professionals do task easily and safely. Computerized physician order entry and barcode medication management system are one of those newly designed devices that aims to improve efficiency and reduce medication errors in the clinical setting. The EHR or Electronic Health Record made nurses do charting in

a more fashioned, organized way plus less effort exerted. Also, through technology a wider spectrum of communication is possible. Through the World Wide Web (WWW), a nurse via chat rooms or any e-mailing sites can communicate with other nurses anywhere across the globe. They can share ideas and experiences with other nurses throughout the world. Cell phones and PDAs are also used for the same purpose. Another is that, through internet connections, information are easily accessible and are ensured to be up-to-date. A nurse as well as nursing students can use any search engines to browse a particular matter regarding any concerns or health subjects like nursing care about a specific disease or nursing responsibilities of a particular operation. There are many other advantages of technology in the nursing profession which aims in rendering nursing care appropriately and effectively. However, these advances made in healthcare are hard to implement to a third world country like the Philippines for greater funds are needed to fully implement these. Another factor is that, with the fast advances made in healthcare, some nurses will have a hard time coping up with these changes, especially with the older nurses.

2. Migration There is growing number of migrating nurses to developed counties for higher job opportunities. Many registered nurses left for abroad for better and higher paying jobs. With this, it will greatly affect the contributing country for they will lose knowledgeable and skilled registered nurses which will lead to inability to deliver effective health care services of health care systems. This is true in the Philippines where more and more skilled and experienced registered nurses migrate for better opportunities.

3. Cultural Diversity As cultural composition of the population changes, it is increasingly important to address cultural considerations in the delivery of health care. Patients from diverse sociocultural groups not only bring various health care

setting, but also have a variety of risk factors for some disease conditions and unique reactions to treatment. These factors significantly affect a persons responses to health care problems or illnesses, to caregivers specially nurses, and to the care itself. In relation to this, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Knowing the cultural and social situations have for each patient helps the nurse avoid imposing a personal value system when the patient has a different point of view. Thus, nurses, including student nurses should take responsibility to know cultural differences and to respect it.

4. Living with Chronic Disease The prevalence of chronic conditions is increasing and because of this heath care broadens from a focus on cure and eradication of disease to include the prevention or rapid treatment of exacerbations of chronic conditions. In relation to this, nurses must act as advocates and have a stress on young and old clients to avoid known risk factors such as alcohol and tobacco and encourage to adopt healthy diets, exercise and stress managements.

5. Changing Patterns of Disease We have witnessed some arrivals of new kinds of viruses, continuous mutations, and multiple drug resistance. There is an increase in communicable disease cases which includes AIDS/HIV, other sexually-transmitted diseases, tuberculosis and others. Government agencies are keenly aware of these problems, but the solutions, such as newer antibiotics, antiviral, and vaccine programs, are unlikely to be ready in time of combat pathogens as fast as they appear on the scene. Thus, nurses and other health care providers must be prepared to contain and prevent the spread on these diseases. They must increase their awareness of the threat of these diseases and their role in preventing and managing the bona fide public health crises they represent.

III. Nursing Associations The growth of nursing profession leads to the developments of organizations and groups that assists and helps nurses. With the dynamic roles of nurses and the expanding responsibilities, the establishment of organizations arises to improve the nursing profession and also to standardize.

1. Accredited Professional Organizations

American Nurses Association A full- service professional organization that advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911. It is based in Silver Spring, Maryland and Karen Daley, PhD, MPH, RN, FAAN, is the current President. ANA also has three subsidiary organizations: (1) American Academy of Nursing that serves the public and nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge, (2) American Nurses

Foundation, the charitable and philanthropic arm, and (3) American Nurses Credentialing Center, which credentials nurses in their specialty and credentials facilities that exhibit nursing excellence. For more than 100 years ANA is the voice of nursing through policy development, lobbying, publications/newsletters, involvement and

partnerships with other organizations, and presence on the Internet. Policy development and lobbying efforts of ANA ensure the rightful place of nurses in all healthcare settings. ANA gets the message to the members and other nurses through their Web site NursingWorld.org and two

publications The American Nurse and the official journal American Nurse Today. These publications, along with conferences, provide an important opportunity for dialogue amongst nurses on the important issues of the day. Strategic partnerships and collaboration with other organizations strengthens the voice of nursing and expands the influence of professional nursing in all settings as the role of nurses develops to meet ever changing needs of patients and consumers.

Canadian Nurses Association In 1908, representatives from nurses associations around Canada were invited to meet by the Canadian Society of Superintendents of Training Schools for Nurses. At this meeting the Provisional Society of the Canadian National Association of Trained Nurses was formed. Mary Agnes Snively was named founding president. The CNATN took its members from societies such as graduate nurse and alumni associations. In 1924, the CNATN changed its name to the Canadian Nurses Association. The Canadian Nurses Association is a federation of 11 provincial and territorial registered nurses associations representing more than 139,893 Canadian registered nurses and nurse practitioners. Currently Judith Shamian is the president of the CNA. It contributes to the health of Canadians and the advancement of nursing and its focus is to act as an advocate and serves as a public voice, an educator and a network that links nurses.

Japan Nursing Association The Japan Nursing Association is an organization that is made up of

nurses and midwives in Japan and governs each of the 47 prefectures' individual nursing groups. It is a governing body that aims in the improvement of nursing.

Nursing Association of Nepal The Nursing Association of Nepal is the national governing body of

nurses in Nepal. The central office is located in Kathmandu.

Nursing Council of New Zealand The Nursing Council of New Zealand (NCNZ) is the professional body

responsible for the registration of nurses in New Zealand, setting standards for nursing education and practice. The council was established in 1902. New Zealand was the first country to legally require nurses to be registered.

Philippine Nurses Association PNA was founded on September 2, 1922 as Filipino Nurses

Association (FNA) in a meeting of 150 nurses presided by Anastacia Giron Tupas, the FNA was incorporated in 1924. The International Council of Nurses accepted the FNA as one of the member organizations during the Congress held in Montreal, Canada on July 8-13, 1929. The FNA became the PNA (Philippine Nurses Association) in 1966, which was the same year that the office at 1663 F.T. Benitez Street, Malate, Manila was inaugurated. The PNA was awarded the Most Outstanding Accredited Professional

Organization by the Professional Regulation Commission in 2003 besting 40 other professional associations and was five-time nominee for the same award. It aims in uplifting the standards of nursing in the country. It aims in providing strategic directions and programs that enhance the competencies of nurses to be globally competitive, passionately sustain the quality work life and collegial interactions with and among nurses, continuously strengthen the internal capacity and capabilities for quality care and services of the nurses and enthusiastically explore possibilities of collaboration towards unification of nurses.

Nursing and Midwifery Council

Established in 2002, the Nursing and Midwifery Council (NMC) is a statutory body set up by the Parliament of the United Kingdom through the Nursing and Midwifery Order 2001. The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public. The NMC maintains a register of all nurses, midwives and specialist community public health nurses eligible to practice within the UK and by setting and reviewing standards for their education, training, conduct and performance. The NMC also investigates allegations of impaired fitness to practice.

International Council of Nurses International Council of Nurses acts as the governing body of all

registered associations of nurses throughout the world. ICN Code for Nurses is the foundation for ethical nursing practice throughout the world. The ICN standards, guidelines, and policies for nursing practice, education, management, research, and socio-economic welfare are globally accepted as the basis for nursing policy.

2. Specialty Groups

Oncology Nursing Certification Council The Oncology Nursing Certification Corporation (ONCC) was

established for the development, administration, and evaluation of a program for certification in oncology nursing. Incorporated in 1984 and governed by a board of directors, ONCC is the certifying body for oncology nursing and meets standards established by the Accreditation Board for Specialty Nursing Certification and the National Commission for Certifying Agencies. ONCC aims to promote excellence in patient care and professional practice by validating specialized knowledge in oncology nursing and related specialties. ONCC envisions that oncology care across the continuum will be provided by oncology certified professionals.

Academy of Neonatal Nursing The Academy of Neonatal Nursing (ANN) is a professional

organization for neonatal nurses. It was established on February 6, 2001. It aims to provide quality neonatal education and programs at a reasonable cost to all health care professionals. This mission is achieved through professional, peer-reviewed publications, Neonatal Network: The Journal of Neonatal Nursing, educational conferences, and offering books and other materials to neonatal health care professionals.

Association of Perioperative Nurses The Association of PeriOperative Registered Nurses (AORN)

represents more than 41,000 registered nurses in the United States and abroad who facilitate the management, teaching and practice of perioperative nursing, or who are enrolled in nursing education or engaged in perioperative research. Its members also include perioperative nurses who work in related business and industry sectors. The AORN aims to support perioperative nurses in achieving optimal outcomes for patients undergoing operative and other invasive procedures. AORN promotes quality patient care by providing its members with education, standards, services and representation. Association of Womens Health, Obstetric and Neonatal Nurses AWHONN was created in 1969. At that time, it was called the Nurses Association of the American College of Obstetricians and Gynecologists (NAACOG). AWHONN became a separate and independent organization in 1993. AWHONN publishes Standards for Professional Nursing Practice in the Care of Women and Newborns. These standards define the roles, functions and competencies of nurses caring for women and newborns and delineate the various roles and behaviors for which the professional nurse is

accountable. AWHONN also publishes multiple evidence-based nursing guidelines for use by nurses caring for women and newborns. These evidence-based guidelines cover topics like fetal heart rate monitoring, labor induction, neonatal skin care, care of the late preterm infant, breastfeeding, HPV counseling, neonatal hyperbilirubinemia, nursing staffing, and care of the patient in the second stage of labor. The AWHONN aims to promote the health of women and newborns.

National Association of Orthopedic Nurses The National Association of Orthopaedic Nurses (NAON) is a non-

profit, volunteer-run professional organization that exists to advance the lives and careers of orthopaedic nurses. Formed in 1980, NAON was designed to promote the highest standards of nursing practice by educating its practitioners, promoting research, and encouraging effective communication between orthopaedic nurses and other groups with similar interests. NAON membership consists of more than 7,000 RNs, LPNs, LVNs, student nurses, and associate members from across the country and around the world who share an interest in musculoskeletal health care.

Oncology Nursing Society The Oncology Nursing Society (ONS) is a nonprofit membership

organization of more than 37,000 registered nurses and other healthcare providers dedicated to excellence in patient care, education, research, and administration in oncology nursing. Its official incorporation was on 1975, since then ONS has become a leader in cancer care. It has grown to include 231 chapters and 27 special interest groups. It provides information and education to nurses around the world. In addition, the society plays an active role in advocacy activities at the local, state, national, and international levels. The society offers information and

resources for nurses at all levels, in all practice settings, and in all subspecialties.

3. Other Professional Organizations

Muslim Nurses Association The goal of the North American Muslim Nurses Association is to create a venue for Muslim nurses to gather, network and to discuss relevant topics.

National

Alaska

Native

American

Indian

Nurses

Association

(NANAINA) NANAINA strives to serve the professional needs of Alaska Native and American Indian nurses.

National Black Nurses Association The NBNA's mission is to provide a forum for collective action by black nurses to investigate, define and advocate for the health care needs of African Americans and to implement strategies that ensure access to health care, equal to, or above health care standards of the larger society.

Nurses Christian Fellowship This group looks to establish and advance a community of Christian nurses and nursing students within the nursing profession.

National Association of Hispanic Nurses NAHN is committed to the recruitment and retention of Hispanic men and women into nursing and the professional development of Hispanic nurses.

Other professional organization of nursing in the Philippines

YNAP Young Nurses Association of the Philippines Inc SCVNPP Society of Cardiovascular Nurse Practitioners of the Philippines RENAP Renal Nurses Association of the Philippines PSECN Philippine Society of Emergency Care Nurses PONA Philippine Oncology Nurses Association PHICNA Philippine Infection Control Nurses Association ORNAP Operating-Room Nurses of the Philippines OHNAP Occupational Health Nurses Association of the Philippines NLGNP National League of Government Nurses of the Philippines NICUNAP NICU Nurses Association of the Philippines NARS Nagkakaisang Narses sa Adhikaing Reporma sa Kalusugan ng Sambayanan MNAP Military Nurses Association of the Philippines MCNAP Maternal and Child Nurses Association of the Philippines IAAPI INFJ Alumni Association of the Philippines Inc GNCF Graduate Nurses Christian Fellowship GNAP Gerontology Nurses Association of the Philippines CNGP Catholic Nurses Guild of the Philippines CCNAPI Critical Care Nurses Association of the Philippines Inc APDNPP Association of Private Duty Nurse Practitioners of the Philippines ANSAP Association of Nursing Service Administrators of the Philippines