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exploring the career or profession of
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nursing
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is a bit like an adventure it's not just
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about the job
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it's not just about caring for patients
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it includes a
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whole aspect of another realm of things
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that nursing students sometimes have
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difficulty wrapping their heads around
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as they enter their career as a new
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registered nurse
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so let's go on this adventure together
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and let's backtrack
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and let's look at the history of nursing
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in its beginnings
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professional nursing holds a unique
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place in the american health care system
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as members of the largest health care
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profession the nation's 3.1 million
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nurses work in diverse settings and
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fields
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and are frontline providers of
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healthcare services
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while most nurses work in acute care
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settings such as hospitals
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nurses expertise and skills extend well
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beyond hospital walls
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working independently and with other
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health care professionals
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nurses promote the health of individuals
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families
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and communities millions of americans
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turn to nurses for delivery of primary
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healthcare services
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healthcare education and health advice
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and counseling
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nurses are critical links in maintaining
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a cutting-edge health care system
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nursing continues to be an indispensable
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service to the american public
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while many may think of a nurse as
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someone who takes care of hospitalized
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patients
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nurses also fill a wide variety of
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positions in health care in many varied
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settings
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working both collaboratively and
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independently with other healthcare
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professionals
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for example most americans are familiar
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with home care nurses
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who provide a plethora of nursing and
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health care services to patients in
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their homes
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school nurses have a long history of
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providing health services to school
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children from kindergarten through high
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school
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nurses play a major role in delivering
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care to those residing in long-term care
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facilities such as nursing homes
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workers with job-related health concerns
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often seek out nurses employed by
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business and industry
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many people visit a nurse practitioner
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as their primary caregiver
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expectant mothers often prefer nurse
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midwives as their health care providers
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during pregnancy
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and childbirth and each day in
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operating rooms across the country nurse
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anesthetists
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ensure that patients undergoing surgery
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receive
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safe anesthesia care today schools of
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nursing compete for the brightest
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applicants
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and nursing is highly regarded as an
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excellent career choice for both women
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and men
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most people think of the nursing
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profession as beginning with the work of
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florence nightingale
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an upper-class british woman who
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captured the public imagination when she
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led a group of female nurses to the
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crimean war
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in october of 1854 to deliver nursing
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service to british soldiers
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upon her return to england nightingale
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successfully established nurse education
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programs in a number of british
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hospitals
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these schools were organized around a
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specific set of ideas about how nurses
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should be educated
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developed by nightingale often referred
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to as the nightingale principles
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actually while nightingale's work was
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groundbreaking and that she confirmed
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that a core of educated women
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informed about health and the ways to
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promote it could improve the care of
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patients based on a set of particular
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principles
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she was not the first to put these
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principles into action
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let's look at nursing and hospital care
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in the united states
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throughout history most sick care took
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place in the home and was the
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responsibility of family friends and
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neighbors with knowledge of healing
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practices
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in the united states family-centered
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sickness care remained traditional until
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the 19th century
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sick care delivered by other than family
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and close acquaintances was generally
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limited to epidemics and plagues that
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periodically swept through towns and
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cities
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by the beginning of the 19th century
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however urbanization and
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industrialization changed the way in
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which and in many cases the place in
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which
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sick individuals received care hospitals
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began to proliferate to serve those who
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were without the resources to provide
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their own care
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and as hospitals increased in numbers so
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did demand for
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caregivers who would be able to deliver
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thoughtful care to the patients in them
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early 19th century hospitals were built
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mainly in more populated sections of the
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country generally in large cities
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nursing care in these institutions
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differed enormously
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in hospitals operated by religious
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nursing orders
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patients received high quality care but
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in other institutions
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nursing care was more variable ranging
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from good in some hospitals to haphazard
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and poor in others
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the beginnings of nurse education
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recognizing the importance of good
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nursing care to a patient's well-being
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some physicians initiated courses for
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those interested in nursing
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in 1798 valentin siemen a new york
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physician
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organized an early course of lectures
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for nurses who cared for maternity
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patients
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an early 19th century program the nurse
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society of philadelphia trained women in
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caring for mothers during childbirth
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and postpartum periods
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its founder dr joseph warrington a
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strong advocate of providing instruction
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for women interested in pursuing nursing
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as an occupation
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authored an 1839 book entitled the
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nurses guide containing a series of
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instruction to females who wish to
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engage in the important business
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of nursing mother and child in the lion
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and chamber
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this publication which each nursing
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society nurse received
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represents an early example of a nursing
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practice text
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between 1839 and 1850 the nurse society
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employed about 50 nurses
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establishing an early practice of
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engaging nurses for care of patients in
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the home
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the outbreak of the civil war created an
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immediate need for capable nurses to
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care for an enormous number of sick and
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wounded
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about 20 000 women and men served as
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nurses in both the north and the south
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the commendable service rendered by
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civil war nurses provided a rationale
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for future experiments in setting up
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training programs for nursing
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one such program was initiated in
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pennsylvania where the women's hospital
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philadelphia
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offered a six-month nurse training
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course which graduated its first class
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in 1869.
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similar courses such as that offered by
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the new england hospital for women and
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children
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were begun in other locales
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professional nurse education begins
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the year 1873 was a watershed year in
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american professional nursing history
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in that year three nurse educational
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programs the new york training school at
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bellevue hospital the connecticut
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training school at the state hospital
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and the boston training school at
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massachusetts general hospital
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begin operations these three programs
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all based on ideas advanced by florence
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nightingale are generally acknowledged
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to be the forerunners of organized
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professional nurse education in the
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united states
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the success of these first three
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so-called nightingale schools
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led to a proliferation of similar
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nursing schools or as they were most
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commonly called
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nurse training programs by 1900
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somewhere between 400 to 800 schools of
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nursing were in operation in the country
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these programs followed a fairly typical
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pattern
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the school was either affiliated with or
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owned by a hospital that provided the
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students with the clinical experience
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considered necessary for the education
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of the nurse
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students received two to three years of
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training while in the program
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students carried out the majority of
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patient care activities offered in the
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hospital
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receiving only a modicum of classroom
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education in the form of lectures on
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patient care and related subjects
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at the end of the educational program
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students received a diploma and were
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eligible to seek work as a trained nurse
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these early nurse education programs
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were in reality
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little more than apprenticeship programs
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that use student nurses for their labor
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despite their significant shortcomings
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however they proved very popular with
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both hospitals and students
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and created a pattern of hospital-based
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nursing education that persisted until
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the mid-20th century
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and while many disparaged the exploitive
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nature of the nurse education system
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the presence of trained nurses with
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their emphasis on cleanliness
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orderliness and close observation of
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patients
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successfully transformed hospitals into
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scientific institutions of care
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further the popularity of the schools as
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evidenced by their high student
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admission rates and the large numbers of
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nurses they graduated
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testified to the profession's appeal as
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an excellent occupation
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in which to carve out a career schools
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of nursing did improve over time
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better oversight of nursing educational
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programs by state licensing boards
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as well as the increasingly complex
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demands of patient care
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led the schools to increase the amount
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of theoretical instruction
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and decrease the amount of direct work
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performed by the students
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the profession of nursing organizes
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as the number of nurses grew in the late
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19th century
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nursing took on the rudimentary
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characteristics of a profession
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in the 1890s nurses organized
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two major professional associations
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the american society of superintendents
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of training schools for nurses
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later renamed the national league of
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nursing education
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and the associated alumni of the united
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states
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later renamed the american nurses
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association
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other major organizations such as the
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national association of colored graduate
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nurses
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and the national organization for public
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health nursing
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formed in the early 20th century state
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nurses associations
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also organized and were instrumental in
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passing state nurse registration acts
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which regulated and provided a licensing
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system for nursing practice
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the successful passage of nurse
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registration acts considered a
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significant legislative accomplishment
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at the time when women held little
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political power
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also provided nurses with their modern
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legal title
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registered professional nurse these
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changes improved and reformed many
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aspects of the nurse training system but
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problems remained
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reflecting the social and legal status
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of african americans at the time
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american professional nursing maintained
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strict racial segregation until the
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mid-20th century
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african-american individuals wanting to
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become nurses had to train in a separate
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educational system and faced a divided
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employment field
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in which white and black nurses did not
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participate equally
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nursing also remained a predominantly
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female profession
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while a few schools admitted men most
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schools refused them admission
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challenges for nursing employment
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conditions for nurses
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also presented challenges in the early
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part of the 20th century
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hospitals employed only a few graduate
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nurses
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mainly in supervisory positions they
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relied instead on student nurses for the
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majority of the bedside care provided to
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patients
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most nurses once they graduated from
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their educational program
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entered the field of private duty
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nursing
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nursing diversifies despite the many
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difficulties within the profession
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nursing continued to grow as an
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occupational field and became recognized
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as an essential healthcare service by
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the early 20th century
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nurses fanned out into diverse fields
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delivering services to many people
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outside of hospitals
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for example lillian wald founded the
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henry street settlement house in 1893
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which provided nursing and other social
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services to impoverished populations on
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the lower east side of new york city
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replication of wald's work in other
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parts of the country led to the growth
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of the field of public health nursing
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opening up new employment opportunities
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for nurses and
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expanding the type of services provided
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by nurses
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the onset of world war one created a
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critical demand for the special skills
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of nurses
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about 23 000 american nurses served in
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the military delivering care to the
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armed forces both in the united states
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and at the war front the success of
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military nurses in providing essential
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care during the war
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ensured their participation in
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succeeding conflicts
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at home nurses continued to provide
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essential service to the civilian
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population
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the special skills possessed by nurses
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were easily transferred to different
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fields of health care for example
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nurses were educated to administer
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anesthesia during surgery
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leading to the specialty field of nurse
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anesthetists
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by the early 20th century it was quite
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common to find nurse anesthetists
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delivering anesthesia
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in many of the nation's hospitals by the
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1920s
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in some parts of the country nurse
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midwives delivered babies
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in many cases to the most impoverished
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populations
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during the 1920s and 1930s hospitals
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continued to expand
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adding more and more patient beds and
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delivering care that was rapidly
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becoming more complex
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nurses were the most essential
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ingredient in ensuring that patients
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received competent care delivered in a
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safe manner
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hospitals continued to rely heavily on
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student nurses for patient care
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but a trend emerged in which hospitals
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hired more nurses who had completed
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their education and graduated
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these nurses initially called general
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duty nurses but later referred to as
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staff nurses
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assumed greater and greater importance
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in ensuring that the nation's hospitals
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operated efficiently by the 1950s
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staff nursing was the nursing's main
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occupational field
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mid 20th century nursing
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when the united states entered world war
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ii
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nurses duplicated the excellent work
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they had performed in world war 1
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taking critical positions in the armed
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services and ensuring that the military
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received appropriate care
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about 78 000 nurses served in world war
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ii
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their contributions acknowledged as
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essential to victory
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the post-world war ii era posed new
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challenges for the profession
00:14:22
while the modern intensive health care
00:14:24
system that emerged after the war
00:14:25
demanded larger number of nurses to
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handle the increasingly complex and
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technical needs of patients
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there seemed to be fewer young women the
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major population from which nursing drew
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its recruits
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willing to choose nursing as a career
00:14:39
nursing's image took on a heroic cast
00:14:41
during the war
00:14:42
but the reality for most nurses was that
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the work was incredibly demanding
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with few financial rewards and poor
00:14:49
working conditions
00:14:50
nursing failed to keep up economically
00:14:52
with other occupations
00:14:54
severe shortages of nurses characterized
00:14:56
the immediate post-war
00:14:58
period threatening the delivery of
00:15:00
health care services to the entire
00:15:02
public
00:15:03
at the same time internal debates within
00:15:06
the profession
00:15:07
over the type of work in which nurses
00:15:09
should engage and the proper way to
00:15:11
educate
00:15:12
a nurse divided nurses into different
00:15:14
camps
00:15:16
some educators and other health care
00:15:18
analysts
00:15:19
promoted removing nursing education from
00:15:21
its base within hospital training
00:15:22
schools
00:15:23
and placing it in institutions of higher
00:15:25
education
00:15:26
by 1960 approximately 172 college-based
00:15:30
nursing education programs
00:15:32
awarded bachelors of science and nursing
00:15:34
degrees
00:15:35
these experts believed baccalaureate
00:15:37
educated nurses
00:15:38
would be better prepared to care for the
00:15:40
complex needs of late 20th century
00:15:42
patients
00:15:43
and would be able to take on more
00:15:44
advanced roles in the delivery of health
00:15:46
care
00:15:48
proponents of the traditional
00:15:49
hospital-based diploma programs
00:15:51
disagreed
00:15:52
arguing that nurses trained in hospital
00:15:54
programs excelled at delivering bedside
00:15:56
care
00:15:57
the major area in which nurses worked
00:16:00
well before the debate was settled one
00:16:02
way or the other
00:16:03
a new nurse educational program centered
00:16:05
in two-year community colleges
00:16:07
community college-based programs also
00:16:09
known as associate degree programs
00:16:11
seem to offer the best of both worlds
00:16:13
education
00:16:14
could take place in institutions of
00:16:16
higher education and the demands of
00:16:18
patient care did not intrude on the
00:16:19
learning process as often occurred in
00:16:21
diploma programs
00:16:23
graduates of community college program
00:16:24
seemed well suited to assume employment
00:16:26
as hospital bedside nurses
00:16:28
further the ability of community college
00:16:31
programs to graduate large number of
00:16:32
nurses
00:16:33
offered potential respite from repeated
00:16:35
nurse shortages
00:16:39
the community college movement achieved
00:16:41
only partial success
00:16:43
community college programs did graduate
00:16:45
many new nurses and often at a lower
00:16:47
cost than traditional diploma programs
00:16:49
but as the needs of late 20th century
00:16:51
patients became increasingly more
00:16:53
complex
00:16:54
research studies indicated that being
00:16:56
treated by nurses prepared at the
00:16:57
baccalaureate level
00:16:58
improved patient outcomes the modern
00:17:02
practice of nursing
00:17:04
despite disagreement among nurses about
00:17:06
the appropriate type and place of
00:17:08
nursing educational programs
00:17:10
the profession itself flourished in the
00:17:11
late 20th century
00:17:13
in the mid-20th century nursing
00:17:15
abandoned its objectional
00:17:17
system of racial and gender segregation
00:17:19
opening up equal educational
00:17:21
professional and employment
00:17:22
opportunities to all nurses
00:17:25
today nurse practitioners clinical nurse
00:17:28
specialists
00:17:29
and other specialty area nurses are well
00:17:31
established and carry out a significant
00:17:33
portion of health care activities
00:17:36
nursing education also thrived in the
00:17:38
latter half of the 20th century
00:17:41
significant federal financial support
00:17:43
for educating nurses which became
00:17:44
available beginning in the 1960s
00:17:47
permitted the revamping and modernizing
00:17:50
of many nursing educational programs
00:17:52
significantly increased funding for
00:17:54
nursing research permitted nursing to
00:17:56
develop a sound or scientific basis for
00:17:58
its practice
00:18:00
as the 21st century continues the
00:18:02
profession of nursing faces many
00:18:04
challenges
00:18:05
periodic shortages of nurses continue to
00:18:07
occur
00:18:08
and a lasting solution to maintaining an
00:18:10
adequate supply of nurses remains
00:18:12
elusive
00:18:13
as the baby boom generation ages larger
00:18:16
numbers of older americans may strain
00:18:18
the health care system and require
00:18:19
increased amounts of nursing care
00:18:21
the demands of 21st century healthcare
00:18:24
services
00:18:25
will continue to test the nursing's
00:18:26
profession's ability to maintain
00:18:28
high caliber care that meets
00:18:30
contemporary societal needs
00:18:32
historically the nursing profession has
00:18:35
consistently demonstrated its ability to
00:18:37
adapt
00:18:38
to changing and varied healthcare needs
00:18:40
it remains an exceedingly popular and
00:18:42
highly respected profession
00:18:44
that attracts large numbers of new
00:18:46
recruits to its ranks
00:18:47
there is little doubt that nursing will
00:18:49
continue to maintain its status as an
00:18:51
extremely important profession
00:18:53
serving the health needs of the nation
