The Nursing Profession

Development, Challenges, and Opportunities

Diana J. Mason, Stephen L. Isaacs, David C. Colby, Diana J. Mason, Stephen L. Isaacs, David C. Colby

• Publisher: Jossey-Bass
• Year: 2011
• ISBN:
  9781118122204
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

The Nursing Profession: Development, Challenges, and Opportunities is designed to be a resource for those who are interested in or touched by nursing. This book is designed in part to complement the report by the Institute of Medicine on the future of nursing. Readers—whether researchers or practitioners, foundation or government officials, students, or simply lay people interested in nursing—should use this volume to gain a better understanding of the nursing profession and the issues with which those in the field and related fields are grappling. Major topics include:

• The history of nursing
• The nursing profession
• Current issues and challenges, including the nursing shortage, educating and training nurses, utilizing advanced practice nurses to their fullest, quality and cost, long-term care, community-based care, gender and power, and new areas for nursing
• A vision for the future

The book begins with a comprehensive review of the nursing field by Diana Mason, the Rudin Professor of Nursing at the Hunter-Bellevue School of Nursing, City University of New York, and former Editor-in-Chief of the American Journal of Nursing. Mason's chapter is followed by reprints of twenty-five of the most influential or significant articles on nursing—some of them classic pieces dating back to Florence Nightingale, others presenting more current thinking on critical issues. This kind of source material is rarely found in one place.

REVIEW OF THE NURSING FIELD

An Original Article

Diana J. Mason, “The Nursing Profession: Development, Challenges, and Opportunities”

THE NURSING PROFESSION: DEVELOPMENT, CHALLENGES, AND OPPORTUNITIES

DIANA J. MASON

CHAPTER CONTENTS

• A Brief History of Nursing
  • The Beginnings of Modern Nursing
  • The Professionalization of Nursing
  • War and the Development of Nursing
  • Modern Nursing: Education, Specialization, and Certification
• The Nursing Profession
  • Defining Nursing
  • The Nursing Workforce
  • Nurses’ Employment: Where Nurses Work (and What They Do)
  • Organized Nursing
  • Nursing Research
• Current Issues and Challenges
  • The Nursing Shortage
  • Building an Educated Workforce to Meet Contemporary and Future Needs
  • Full Utilization of Advanced Practice Registered Nurses
  • Quality and Costs in Acute Care
  • Long-Term Care
  • Community-Based Care
  • Gender and Power
• Opportunities: A Vision for the Future
  • Innovative Models of Care
  • Ensuring that the Nation Fully Utilizes Its Nursing Workforce

Nursing has a long and important legacy. Nurses have served as advocates for a better, safer, more humanistic health care system, and for public policies that promote the health of the nation throughout the profession’s history.

• Lillian Wald in 1893 founded the Henry Street Settlement that provided home care to New York City’s poor immigrants on the Lower East Side of Manhattan when no other providers would serve them.1
• Margaret Sanger was a public health nurse whose fight for the reproductive rights of women from 1916, when she established the nation’s first birth control clinic, to her death in 1966 changed the nation’s policies on access to birth control information and services.2
• Ruth Watson Lubic, the first nurse to receive the John A. and Catherine D. MacArthur Foundation’s “Genius Award,” has spent the last half century as a leader in reframing childbearing as a “normal” life experience rather than a disease. She founded one of the first freestanding, nurse-midwife-run childbearing centers in the nation and spread her model to the South Bronx and Washington, D.C., where she has improved outcomes for mothers and babies.
• Connie Hill is a pediatric nurse manager on a respiratory unit at Chicago’s Children’s Hospital, where she refused to accept the notion that her urban community could not muster the resources to support long-term ventilator-dependent children and their families after hospital discharge. She formed a coalition of stakeholders to bring about the policy, system, and financial changes needed to accomplish this.3

The legacy of nurses such as these continues to be enriched by those who follow their example and refuse to be bound by others’ views of their profession or of women’s place in society and the health care system. Nurses are expert clinicians, researcher-scientists, policymakers, chief executive officers of hospitals and their own organizations, primary care providers, independent practitioners, deans of schools of nursing in research-intensive universities, heads of foundations, and leaders in every segment of society. Every day, nurses innovate to keep people alive, prevent pressure ulcers and infections, reduce pain and suffering, and ease the transition from life to death. They screen schoolchildren’s ability to see and hear, teach older adults and their family caregivers how to manage illnesses such as congestive heart failure, provide outreach to the homeless, counsel those with mental illness, and are otherwise present during some of the most intense, joyous, painful, difficult, and profound times of people’s lives.

Yet nurses face significant barriers to providing the care that people need, and they are often excluded from policymaking in workplaces, boardrooms, and government entities. Legal and regulatory barriers to the full utilization of nurses persist, limiting the nation’s ability to use its health care workforce efficiently and effectively. Other barriers are not specific to nurses but impede them from fully using their expertise. For example, nurses are skilled in managing chronic illness and coordinating care, but most payers do not cover these services.

Most policy discussions about nursing have focused on nursing shortage—a focus that overlooks the innovations and perspectives nurses can offer to improve both the way health care is delivered and the overall well-being of Americans. Certainly, the shortage is a complex problem of supply and demand. With the doubling of the nursing workforce over the past 25 years, it has become clear that the demand is outpacing the nation’s ability to educate and retain enough nurses. In fact, the demand part of the equation speaks to how valuable nurses are to the nation’s health care system. But there are two pitfalls that should be avoided in addressing the shortage. First, much of the focus has been on how to recruit more new nurses, with insufficient regard for how to retain and better utilize qualified nurses and decrease unnecessary demands on their time. Second, although nurses are part of most discussions about the health care workforce, they are often excluded from discussions of how to transform health care. Meeting these challenges requires an understanding of the complex realities of nursing and the important policy issues that confront the nation.

A BRIEF HISTORY OF NURSING

In her insightful discussion of the gradual professionalization of nursing during the nineteenth century and the first half of the twentieth, historian Susan Reverby describes the inherent tension between duties and rights that increased as nursing emerged from traditional “women’s work”:

Nursing was organized under the expectation that its practitioners would accept a duty to care rather than demand a right to determine how they would satisfy this duty. Nurses were expected to act out of an obligation to care, taking on caring more as an identity than as work, and expressing altruism without thought of autonomy either at the bedside or in their profession. Thus, nurses, like others who perform what is defined as “women’s work” in our society, have had to contend with what appears as a dichotomy between the duty to care for others and the right to control their own activities in the name of caring.4

These tensions between rights and duties continue to haunt nursing to this day.

The Beginnings of Modern Nursing

Prior to Florence Nightingale, daughters and wives were expected to care for infirm relatives. It wasn’t until the Crimean War (1853–1856) that Nightingale, regarded by many as the mother of modern nursing, performed the work that indelibly marked the profession and the development of health care delivery, leaving a legacy of data-driven, altruistic practice.

Nightingale violated prevailing tenets of the privileged class of England in the early 1800s to become a nurse. Her work at the British military hospital at Scutari, begun in November 1854, was groundbreaking. She collected data on the causes of death among the soldiers and demonstrated that a significant number were due to poor nutrition and unsanitary, toxic environmental conditions at the hospital. The changes she instigated in the hospital dramatically improved clinical outcomes.5,6

Her treatise, Notes on Nursing: What It Is and What It Is Not,7 defined nursing as creating the conditions for nature to take its course in healing a person—conditions such as a clean and nontoxic environment, fresh air, good nutrition, comfort, rest, and emotional support. While ostensibly deferring to the military surgeons at the hospital in keeping with gendered role expectations of the day, she used her connection with a reporter at the London Times to get front-page coverage of the problems at the hospital. The reports sparked public outrage, and she got the supplies, equipment, and support that she needed. Nightingale went on to transform the British, Indian, and military health services.

Nightingale also upgraded and formalized nursing education and the role of nurses. She transformed the image of the drunken, untrustworthy nurse immortalized as Sarah Gamp in Charles Dickens’s Martin Chuzzlewit, to that of an educated, ethical, caring “lady.” Indeed, Nightingale was referred to as “the lady with the lamp,” because of her habit of making rounds night and day, tending to ill soldiers, and overseeing her nursing staff with a comportment that challenged the Gamp stereotype of nurses. She established the Nightingale School of Nursing at what is now St. Thomas Hospital in England, and replaced physician oversight of nursing services with an independently funded women’s nursing organization. This work coincided with other experiments in modern nursing in Germany and France and became the model for educating nurses in Western countries.8,9

In the United States, the Civil War had demonstrated the need for trained nurses, although both men and women tended to wounded soldiers on both sides of the conflict. Walt Whitman was among these untrained nurses, as were Harriet...

Table of contents

• Cover
• Contents
• Title
• Copyright
• Dedication
• Foreword
• Preface
• Editors’ Introduction
• Acknowledgments
• Review of the Nursing Field
• The History of Nursing and the Role of Nurses
• Nursing Education and Training
• Advanced Practice Nursing
• The Nursing Workforce/Nursing Shortages
• Quality, Safety, and Cost
• Specialty Practice in Nursing
• Afterword
• The Editors