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Hospital and Community-Based Nursing

Providing nursing care in a patient’s home is different from providing care in a hospital. Patients must sign a release form to stay and receive treatment in a hospital. They have little control over what happens to them, and they are expected to comply with the hospital’s rules, regulations, and schedule of activities. They sleep in the hospital’s beds and often wear hospital gowns or clothes. They are given care, treatments, baths, and medications at times that are usually determined by institutional schedules rather than convenience for the patient. Although hospitalized patients may select meals from a daily menu, there is a limited choice in the type of food they are offered. Family members and friends visit during the hospital’s visiting hours. By contrast, the home care nurse is considered a guest in the patient’s home and needs permission to visit and give care. The
nurse has minimal control over the lifestyle, living situation, and health practices of the patients he or she visits. This lack of full decision-making authority can create a conflict for the nurse and lead to problems in the nurse–patient relationship. To work successfully
with patients, no matter what the setting, it is important for the nurse to be nonjudgmental and to convey respect for the patient’s beliefs, even if they differ sharply from the nurse’s. This can be difficult when a patient’s lifestyle involves activities that the nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The cleanliness of a patient’s home may not meet the standards of a hospital. Although the nurse can provide teaching points about maintaining clean surroundings, the patient and family determine whether they will implement the nurse’s suggestions. The nurse must accept the reality of the situation and deliver the care required regardless of the sanitary conditions of the surroundings. The kind of equipment and the supplies or resources that usually are available in acute care settings are often unavailable in the patient’s home. The nurse has to learn to improvise when providing care, such as when changing a dressing or catheterizing a patient in a regular bed that is not adjustable and lacks a bedside table ( Johnson, Smith-Temple, & Carr, 1998).
Infection control is as important in the home as it is in the hospital, but it can be more challenging and requires creative approaches. As in any situation, it is important to cleanse one’s hands before and after giving direct patient care, even in a home that does not have running water. If aseptic technique is required, the nurse must have a plan for implementing this technique before going to the home. This applies also to standard precautions, transmission-based precautions, and disposal of bodily secretions and excretions.
If injections are given, the nurse should use a closed container to dispose of syringes. Injectable and other medications must be kept out of the reach of children during visits and must be stored in a safe place if they are to remain in the house. Nurses who perform
invasive procedures need to be up-to-date with their immunizations, including hepatitis B and tetanus. The home environment often has more distractions than a hospital. The home can be filled with background noise and crowded with people and objects. A nurse may have to request that the television be turned down during the visit or that the patient
move to a more private place to be interviewed. Friends, neighbors, or family members may ask the nurse about the patient’s condition. A patient has a right to confidentiality, and information should be shared only with the patient’s permission. If the nurse carries the patient’s medical record into the house, it must be put in a secure

Nurse Salaries For Different Nursing Fields

by: Robyn Knapp
Many new graduate nurses are readily offered jobs prior to graduation. The positions that they are offered are usually those with the title graduate nurse or GN. For the most part, new graduates are looking for employment near their home. Since the general nursing student is now in their early to late thirties, they have already established a secure family base. While jobs for graduate nurses are plentiful it helps to have some idea of how many jobs are actually offered throughout the United States. The wonderful fact of being a nurse is that they can work just about anywhere.

The following information should be helpful in getting some idea of the pay for different nursing fields. Hospital Nurse Recruiters will inform the new graduate nurse that obtaining a bachelor degree in nursing is favored. Many hospitals will offer some form of tuition reimbursement for those nurses who seek to obtain a BSN degree. Tuition reimbursement can go as high as one hundred percent to fifty percent. For nurses who work in hospitals, there is a world of opportunity to move into many different nursing specialties. As the nurse gains more experience in their field, their salary will also increase. The salaries listed below are not all inclusive, but merely present to the reader a general idea of the salary range that exists. The reader should keep in mind that each hospital will be unique in what type of salary is offered depending on the nurses qualifications and prior work experience.

Just as you might think, large cities like New York, Los Angeles, and Chicago hold the top spots for the number of nursing jobs available. The larger cities also have higher salaries and better benefits for their nurses. The tradeoff is longer hours and more stress in large city nursing jobs versus the small community jobs where hours are usually better and the number of patients to serve is lower.

The median expected salary for a typical Staff Nurse – RN in Detroit**, MI, is $65,817. This basic market pricing report was prepared using our Certified Compensation Professionals’ analysis of survey data collected from thousands of HR departments at employers of all sizes, industries and geographies.

Job Description

Staff Nurse – RN:

Evaluates, plans, implements, and documents nursing care for an assigned patient population. Assists physician during examinations and procedures. Performs various patient tests and administers medications within the scope of practice of the registered nurse. Promotes patient’s independence by establishing patient care goals and teaching patient and family to understand condition, medications, and self-care skills. Requires an associate’s degree and is certified as a registered nurse. Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. A wide degree of creativity and latitude is expected. Typically reports to a manager or head of a unit/department.

Registered Nurse Salaries

Staff RNs working in the United States average a median base salary of $41,642. Half of all US RN’s are expected to earn between $38,792 and $44,869. Nearly 67% of nurses are employed in hospital inpatient and outpatient settings. 32% of all nurses are employed in medical offices and clinics, home healthcare agencies, nursing homes, temporary help agencies, academia, and government agencies.

Learn more about nursing education at The NET Study Guide.


APHA Public Health Fellowship

APHA announces the search for the APHA Public Health Fellowship in Government for 2009. APHA is looking for candidates with strong public health credentials who wish to spend one year in Washington, D.C. working in a congressional office on legislative and policy issues related to health, the environment or other critical public health issues.

The fellowship will begin in January 2009 and continue through December 2009. The fellowship is designed to provide a unique public policy learning experience, to demonstrate the value of science-government interaction, and to make practical contributions to enhancing public health science and practical knowledge in government.

Applications and additional information are available through the links below. The application, including CV and three letters of recommendation, are due to APHA by May 30, 2008. APHA leaders, former fellows and policy experts will review the applications and select the finalists. All candidates must be APHA members, have five years of experience in a public health position and a graduate degree in a public health discipline.
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