Advanced Nursing Role

Advanced Nursing Role

The advanced nursing option I have chosen is nurse executive. This has been a difficult decision for me to make but I feel it is the right one. I have been working in the administrative field of nursing for five years now and feel this is the path my career is taking.

Description of Role

Decision

The decision to choose the nurse executive option was a difficult one to make. There are so many different options in nursing and the decision didn't come without careful thought. I first started out wanting to be a Psychiatric Mental Health Nurse Practitioner but later decided that it wasn't the right option of me. I was the Chief Operating Officer of a psychiatric residential treatment center for children and felt the role of a PMHNP was what I wanted. I later resigned from that position and accepted the role as a Clinic Manager of a urgent care center. In making this change it was apparent to me that my goal wasn't to be a PMHNP but to be a nurse executive. I came to terms with the fact that it takes many people to provide good quality care to patients and I didn't have to be a nurse practitioner in order to achieve this.

Description Responsibilities

The nurse executive plays an important role in providing care to patients. They provide professional leadership to nursing and contribute more broadly to the leadership of all services (Kirk, 2009). The responsibilities of the nurse executive cover a broad spectrum of duties related to health care. He/she is a leader and actually facilitates the design of how patient care is delivered. They maintain relationships with staff and colleagues and act as mentors to those under their supervision. They also serve as a communicator, making sure staff receives information needed in a timely matter. They are highly involved in the budgeting aspect of the facility and are held accountable for budgeting functions. The nurse executive also supervises nurses, creates work schedules, and assigns responsibilities to staff.

Educational Requirements

In order to be credentialed through the ANCC as a nurse executive the nurse must hold a RN license in the United States or legally recognized equivalent in another country, hold a bachelor's degree or higher in nursing, held a mid-level administrative position or higher position, a faculty position teaching graduate students nursing administration, or a nursing management or executive consultation position, for at least 24 months full time equivalent in the last five years. They must have also completed 30 hours of continuing education in nursing administration within the last three years. This requirement is waived is you have a master's degree in nursing administration from a U.S. program (ANCC, 2011). Most employers require the nurse executive to have a master's degree in nursing.

Certification

The American Nurses Credentialing Center offer a nurse executive certification, however, there is certain criteria that must be met. The individual must have a current, active RN license within a state or territory of the United States or the professional, legally recognized equivalent in another country, have a bachelor's degree or higher degree in nursing, having held a mid-level administrative or higher position or a faculty position teaching graduate students nursing administration, or a nursing management or executive consultation position, for at least 24 months full time in the last five years, and must have completed 30 hours of continuing education in nursing administration within the last three years. This requirement is waived if you have a master's degree in nursing administration (ANCC, 2011).

Scope of Practice

The Arkansas State Board of Nursing does not define the scope of practice for a nurse executive due to the administrative role. The nurse executive is accountable for ensuring positive patient outcomes, productivity goals, financial targets, retention quotas, customer and provider satisfaction goals, and other performance metrics demands that nurse executive possess, and demonstrate well-developed leadership skills and organizational management competencies (Stichler, 2006).

Typical Day

A typical day in the position of a nurse executive would consist of a broad spectrum of duties. It would include creating and distributing schedules, budgets, and handling problems consistent with human resources. A large portion of the day would include assigning responsibilities and supervising staff.

Theoretical Background

Patient Exemplar

One night was a 18 month old baby boy, who we will call Garret, I met one night working my assigned pediatric floor. I worked twelve hour shifts and was hoping for a nice quiet night to finish off a five day stretch I had worked. Garrett was admitted by his pediatrician who was worried he might have a bowel obstruction. The pediatrician stayed that night and took little Garrett down to x-ray and performed UGI with small bowel follow through himself to rule out any bowel obstruction. The pediatrician came back to the floor with great news for the family. The tests results were normal and it was probably a mild case of dehydration. He told the family he would keep Garrett overnight and administer intravenous fluids to correct the dehydration. The pediatrician then called his partner on call and explained the situation to him. I followed the orders left for Garrett but noticed a couple of hours later that something wasn't right. Garrett had turned a ash gray color and this worried me. I immediately ordered a pulse ox which was 99% and took his vital signs which were completely normal. Needless to say I was puzzled by this result. I couldn't figure out why his color was changing but everything appeared normal. My instincts were telling me that something was wrong and I had to figure out what it was. I called the pediatrician on call and he stated that Garrett was dehydrated and gave orders to bolus him with fluids. I performed the task but Garrett continued to turn more ash colored. I couldn't figure out what was going on but I knew it wasn't right. Garrett's mother buzzed the nursing station and stated that he had urinated and had a diaper to be weighed. I went to his room and obtained the wet diaper, opened it and to my surprise his urine was solid brown. I placed a wee bag on him and waited in anticipation for him to urinate again so I could order a urinalysis.