The Attending Registered Nurse

INSPIRATION | INNOVATION | TRANSFORMATION

THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT

The Attending Registered Nurse

R. Gino Chisari, RN, DNPDirector

Norman Knight Nursing Center for Clinical & Professional Development



The ARN Defined

The Attending RN (ARN)• Ensures collaboration • Is a consistent presence throughout and

following the patient’s hospitalization • Core competencies allow the ARN to

serve as a clinical coordinator, facilitator and mentor in order to cultivate a safe, efficient and effective environment of care



Theoretical Basis

Presence through Attunement• It is what happens when connection is made

and each person experiences the other as present

• It is through attuning that we form relationships and our experiences becomes aligned

• The capacity to attune to our patients and families is a prerequisite for therapeutic care

• It’s not a task; it’s an intentional use of self and the container for the therapeutic practices of wondering, following and holding

“See me as a Person: Creating Therapeutic Relationships with Patients and Families”, Mary Koloroutis and Michael Trout, 2012



Theoretical Basis

Wondering A practice of discovery grounded in curiosity and

genuine interest in othersFollowing

The practice of listening, respecting and acting on what we learn from our patients and families

HoldingCreating a safe haven for healing in which

people feel accepted and held with dignity and respect

“See me as a Person: Creating Therapeutic Relationships with Patients and Families”, Mary Koloroutis and Michael Trout, 2012



The ARN Selection Criteria

A staff nurse who has:• Strong interpersonal relationship skills• Emotional intelligence• Resiliency• A sense of humor• Credibility with all members of the team• A sense of joy



The ARN Selection Criteria

A staff nurse who has (continued):• Clinical expertise• The ability to be flexible, creative,

innovative• The ability to act calm under pressure• Passion• A bit of risk taking behavior• Commitment to the power of the role



The ARN Competencies

Core Competencies:• Communication • Organization and priority setting • Interpersonal relationships• Patient-centered/relationship-based care• Teamwork and collaboration with other

disciplines, patient and family



Actualizing the ARN Role

• Identifies and uses best practices to promote patient- and family-centered care

• Identifies and resolves barriers to promote safe hand-offs, interdisciplinary collaboration and efficient throughput of patients

• Ensures, with Attending MD, that patient care meets the unit’s clinical standards

• Develops and revises the patient care goals with the clinical care team daily




• Coordinates meetings with clinicians for timely decision-making and optimizes handoffs across the continuum

• Communicates with the patient and family, discusses plan of the day, etc

• Serves as a role model for interdisciplinary problem-solving

• Transmits all key information to covering clinician(s) in an efficient, comprehensive manner when handoffs are required




• Organizes twice daily care team huddles

• Meets with family on a continuous basis regarding plan of care, disposition, goals of treatment, palliative care, end of life issues

• Meets weekly with all members of the healthcare team to design, coordinate and evaluate the plan of care



The ARN Scope of Practice

Massachusetts General Laws, Chapter 112, section 80B defines the legal practice of nursing in the Commonwealth as,

“Those services which assist individuals or groups to maintain or attain optimal health. Nursing practice requires substantial specialized knowledge of nursing theory and related scientific, behavioral and humanistic disciplines…

…Nursing practice involves clinical decision making leading to the development and implementation of a strategy of care to accomplish defined goals…

…shall include, but not be limited to the performance of services which promote and support optimal functioning across the life span; the collaboration with other members of the health team to achieve defined goals; health counseling and teaching; the provision of comfort measures; teaching and supervising others; and participation in research which contributes to the expansion of nursing knowledge.”




Massachusetts Board of Registration in Nursing regulations at 244 CMR 3.01

interprets the law as,

• systematically assess health status• analyze and interpret data; and make informed

judgments• plan and implement nursing interventions• provides and coordinates health teaching• evaluates outcomes• collaborates, communicates and cooperates• serve as patient advocate




The ANA Code of Ethics for Nurses at Provision 7 states, “The nurse participates in the advancement of the profession through contributions to practice, education, administration and knowledge development.”

7.1: Advancing the profession through active involvement in nursing and in healthcare policy.

7.2: Advancing the profession by developing, maintaining, and implementing professional standards in clinical, administrative, and educational practice.

7.3: Advancing the profession through knowledge development, dissemination, and application to practice.



The ARN Development

Dreyfus Model of Skill Acquisitionas applied by Benner to Nurses



The ARN Development

Stage 1: Novice • The nurse at this stage has no experience • Their practice is rule governed• They must learn the rules to guide their

actions- following the rules is good practice• They cannot yet grasp context-specific

meanings • Their practice is limited and inflexible

because they do not yet have the experience to draw on



The ARN Development

Stage 2: Advanced Beginner • Feels secure with practice directed by orders, rules and

procedures or “common practices.” Feels they can rely on protocols

• Multiple & competing tasks show up as an overwhelming list of things that must be done

• They feel responsible for completing the tasks- engagement is with the tasks

• Good day is defined as getting everything done• Delegate up• Focus on the immediate present• In rapidly changing situations - misses subtle cues of

problems



The ARN Development

Stage 3: Competent • Characterized by increased organization

and efficiency• Mastery of technical skills• Conscious deliberate planning• Shift from managing the task to managing

the patient



The ARN Development

Stage 4: Proficient • Stage of rapid learning - the patient

and their needs are the focus• Skill of seeing - narratives reflect

overturned expectations and seeing contextual and situational changes that require actions other than those planned or anticipated

• Recognize patterns of signs and symptoms and their meanings

• Numbers gain meaning or salience



The ARN Development

Stage 5: The Expert • Attention and actions are guided by the

patient’s needs and changing responses, and demands

• Fusion of thought and action• Clinical forethought• Fluid, skillful maneuvering in very complex

and difficult situations• Intuition - direct understanding of the

particulars of a situation without conscious deliberation, awareness or articulation



The ARN Future

The Future of Nursing: Leading Change, Advancing Health1. Nurses should practice to the full extent of their

education and training. 3. Nurses should be full partners, with physicians and

other health care professionals, in redesigning health care in the United States.

Conclusion“The United States has the opportunity to transform its

health care system, and nurses can and should play a fundamental role in this transformation.”

Ref: IOM, October 2010

The Attending Registered Nurse

Health & Medicine

Transcript of The Attending Registered Nurse