Nursing concepts and applications

Nursing

Nurses' risk for occupational exposure to bloodborne pathogens

It is imperative that nurses and other healthcare workers follow safety protocol in order to protect themselves from infection by bloodborne pathogens such as HIV and hepatitis B or C. Since 1991, the Occupational Safety and Health Administration of the U.S. Department of Labor (OSHA), has published formal requirements for "annual bloodborne pathogen training" (OSHA, 2011). On state and local levels, these requirements need to be taken seriously in order to prevent the spread of HIV or hepatitis from patients to nurses.

Studies indicate that the risk of HIV infection for nurses is low, possibly only 1 in 200 incidents, "even after mucous membrane exposure or parenteral inoculation of infected blood, fluids, or secretions" (Allen, 1988). Yet one case of infection with the virus that causes AIDS is too many for a fatal disease that still has no cure. The fact remains that: "By December 2002, occupational exposure to HIV had resulted in 57 documented cases of positive HIV tests among healthcare personnel in the United States" (OSHA, 2011). As a result, the Centers for Disease Control (CDC) recommends a month-long plan for postexposure prophylaxis (OSHA, 2011).

As for hepatitis B, a virus that weakens the liver and can also lead to death, the risk of infection among nurses is higher (Allen, 1988). This is probably due to the ability of the HBV virus to survive outside the body (even in dried blood) for "up to 7 days" (OSHA, 2011), unlike HIV, which is very weak outside the body. As opposed to the .5% risk of contracting HIV, health care workers are at a 6 to 30% risk of contracting hepatitis B (HBV) "after parenteral exposure to the blood of HBV patients" (Allen, 1988). Fortunately, there is a vaccine available that is effective against HBV. Hepatitis C also damages the liver but is more dangerous than HBV because 80% of carriers do not show symptoms, and there is no vaccine (OSHA, 2011). As a result, hepatitis C is becoming a more serious problem than HBV.

OSHA has comprehensive directives for employers and employees to follow in order to prevent infection with bloodborne pathogens. Some of the protective measures include: mandatory implementation of an exposure control plan (ECP) for all employers, HBV vaccinations, use of protective gloves and other "personal protective equipment," treatment of all blood as if it is infected blood (universal precautions), a plan for postexposure treatment, and proper decontamination and hand washing practices (OSHA, 2011). In addition, OSHA employees perform regular compliance checks in healthcare facilities to ensure all requirements are taken seriously (OSHA, 2011).

Future roles for nurses with master's versus baccalaureate degrees

The demand for nurses is growing every year, and experts predict this trend will continue. While the current shortage of nurses is being filled with many health care workers who have only completed a three-year diploma or associate degree, nurses with bachelor and master's degrees have greater and more lucrative opportunities available to them. This trend will likely continue into the future, as highly-educated nurses are being afforded more and more responsibilities akin to those of a medical doctor. Moreover, recent legislation such as the Affordable Care Act is expected to create an even greater need for nurses who can take on more advanced responsibilities. As one nurse stated on National Public Radio: "…with the passage of the Affordable Care Act, which was passed in March, we're going to see 32 million new patients accessing the health care delivery system which previously weren't accessing this system. And currently, we don't have the capacity to provide high-quality, patient-centered care for this new expanded population" (NPR, 2010)

Careers in nursing have become vast and varied, particularly for the highly educated, and pay for many of these careers is above $60,000 annually. While a nurse with a BSN who becomes an RN can still advance in her career, enter management, or become a nursing professor, an MSN is necessary for nurses to enter one of the more prestigious and specialized subfields (Sacks, 2003). In addition, nurses who wish to conduct research, earn their doctorate, and possibly become a tenured nursing professor must first earn their master's degree (Sacks, 2003).

Nurses who have earned their MSN have many exciting and challenging opportunities open to them, now and in the future. Some of these specialized careers include: nurse practitioners (who can order tests and write prescriptions), nursing directors, nursing executives and executive management, senior nursing technical writers, clinical nurse specialists, and specialized nursing consultants. Positions that may be open to RNs holding a BSN, but which are most often awarded to nurses who have earned their MSN include: case managers, nursing medical authors, diabetes educators, medical technical editors, and epidemiology nurses (Sacks, 2003).