The Inpatient Team

Hospital tutorials are an opportunity to learn from different members of your patient’s inpatient team. Their nurse will perform an assessment at least once per shift and will administer all medications. Depending on your patient’s needs, you may also see a dietitian, occupational therapist, pharmacist, physical therapist, social worker or a medical specialist.  Consider asking your patient and the other provider if you can stay to observe their interview – you can learn a lot about another profession’s skills and expertise that way.

Registered nurse

Registered Nurses (RNs) practice in a variety of settings, including homes, schools, community centers, and homeless shelters, but over half of all registered nurses practice in the hospital.

Hospital bedside nurses care for up to 6 patients, depending on their acuity.  For example, intensive care nurses care for one or two patients while nurses on medical-surgical floors care for 3-6 patients.  RNs are assisted with routine tasks, like vital signs and bathroom help, by nursing assistants or nursing techs.

At admission, a patient’s nurse performs their own history, physical exam and safety assessment and then reassess the patient every shift.  A patient’s nurse is usually the first to assess any new concern or complication, and often troubleshoots common issues before or while getting in touch with their physician.  Clinical problem solving is considered a critical nursing skill.

Nurses dress wounds, manage lines and tubes, and reposition patients to maintain comfort and avoid skin breakdown.  They coordinate the timing of tests and administer scheduled medications, often listing drugs and doses as they give them to the patient (this is a good chance to collect an accurate medication list).  Nurses may also administer as needed (PRN) medications for common symptoms.

Your patient’s nurse is typically at the bedside more frequently than their physician, and often provides information, education and emotional support to both the patient and their family. Many nurses pride themselves on being strong patient advocates.

RN Education:

• Basic science courses, including biochemistry, anatomy and physiology, microbiology, nutrition, human development and statistics
• Theory (classroom) and clinical work in medical-surgical, obsetetric, pediatric, psychiatric, and commmunity health nursing
• Courses on professionalism, leadership and ethics

Other Roles Associated with Nursing

Advanced practice registered nurse (APRN) is an umbrella term for those who have gone beyond the basic nursing education, have met advanced educational requirements, and who provide at least some level of direct care. APRNs include:

• Nurse Practitioner (NP):  Provide a wide range of primary and preventive health care services, prescribe medication, and diagnose and treat common minor illnesses and injuries. NPs specialize in a variety of areas including pediatric, adult, family, women’s or psychiatric care and seventy percent deliver primary care.
• Certified nurse‐midwife (CNM): Provide gynecological and low‐risk obstetrical care in hospitals, birth centers, or homes.
• Clinical nurse specialist (CNS):  Handle a wide range of physical and mental health problems, and also work in consultation, research, education, and administration.
• Certified registered nurse anesthetists (CRNA): The oldest of the advanced nursing specialties, CRNAs administer more than 65 percent of anesthetics given to patients each year.

Dietitian

All hospital patients are screened for nutritional disorders by a dietitian, who may perform a chart review and meet with those at greatest nutritional risk.  Poor nutrition and weight loss can benefit the most from in-hospital dietary intervention, such as nutritional supplements, dietary changes or an alternative means of feeding.  Dietitians may also educate patients who are discharging on a new diet, such as a low sodium diet for heart failure or a low potassium diet for kidney disease.  Registered dietitians typically complete an undergraduate degree and a Master’s degree.

Occupational therapist

Occupational therapists (OTs) assess patients’ ability to safely care for themselves at home and provide training and adaptive equipment as needed.  Along with physical therapists, they can recommend an appropriate level of post-discharge care based on a patient’s ability to safely manage their daily activities. Occupational therapists complete a graduate degree after their undergraduate education, and must pass a licensing exam to practice.

Pharmacist

Hospital pharmacists work with patients and medical teams to ensure medications are appropriately prescribed. They may perform medication histories at admission, evaluate for drug related problems and provide medication education at discharge. Hospital pharmacists may also work in the inpatient pharmacy, reviewing medication orders for errors or interactions, monitoring drug levels, and preparing medications for administration.

Like physicians, pharmacists apply to graduate school after completing their undergraduate education. The receive a doctorate of Pharmacy (PharmD) on completion of a four year program. Some PharmDs go on to complete a specialized residency, while others go directly into practice.

Physical therapist

Physical therapists (PTs) focus on patients’ functional mobility, including transfers and ambulation. They recommend assistive devices for mobility, such as a cane or walker, and recommend therapy to improve strength and safety. Along with occupational therapists, they can recommend an appropriate level of post-discharge care.  Physical therapists complete a 3-year doctoral degree after their undergraduate education and may do an optional residency in a specific area of practice, such as neurology and geriatrics. PTs must pass a clinical exam to receive a full license

Respiratory therapist

Respiratory therapists manage oxygen treatment, deliver treatments like bronchodilators and chest physiotherapy, manage ventilator settings, and perform airway suctioning as needed.  They complete either a two-year associate degree or a four-year bachelor’s degree.

Social worker

Hospital social workers help patients and families navigate the healthcare system and access resources. They have a leading role in working with medical teams, patients and families to set up an optimal discharge plan. They can also work with patients and medical teams to find a patient’s legal next of kin, help them choose a durable power of attorney for healthcare, and access services outside the hospital. Hospital palliative care, psychiatry and addiction medicine teams often have social workers who can spend more time counseling patients. Social workers are required to complete a Masters degree, have 4,000 supervised work hours, and pass a clinical examination in order to receive a full license.