HealthMay 12, 2020

We Shape the Future of Nursing

By: Pam Embler

Happy Nurses Week!  Nursing is not a profession of mediocrity. There is no such thing as a minor or meaningless skill. In fundamentals, we teach future nurses the important, but often overlooked, skill of bedmaking. It cannot be overemphasized that a poorly made bed can contribute to skin breakdown.

As we journey alongside our students we watch as content meets practice, as knowledge meets application. By their senior year they are ready to titrate vasopressor medications according to heart rate and blood pressure, interpret blood gases and manage ventilator settings, and anticipate intravenous fluid changes based off the most recent lab results. We stand alongside them as they contribute inpatient rounds and we support them as they experience their first patient death.

What we impart serves as a foundation for lifelong learning and professional growth. My fellow nurse educators, during this Nurse’s Week I feel compelled to take a look back in order to motivate us forward.

The profession of nursing is not one with a glamorous beginning. In the mid-1800's nurses served physicians and performed menial tasks. We were not called upon to think or add to a conversation about the course of illness, treatment, or care plan. During this time, Florence Nightingale contributed her evidence-based research outcomes. The statistics she provided could not be refuted; nursing actions improve patient outcomes and influence morbidity and mortality rates.  Her infamous Notes on Nursing served as the first instruction manual for nurses. The Nightingale Training School opened in England in 1860.  From that point on, the profession of nursing based on formal education was born.

Between 1873 and 1889 schools of nursing in the United States were established. The Bellevue Hospital in New York City was the first, offering a one-year program duplicating the philosophy of the Nightingale Training School. Shortly thereafter, the New England Hospital for Women (Connecticut) and Massachusetts General Hospital (Boston) opened nurse training programs.

The remainder of the nineteenth century saw an explosion in hospital-based nursing programs. However, among the over 400 programs there was no standardization in curriculum, program length or graduation requirements. In essence, these schools existed to staff the hospitals that manage them.

The progression of nursing education then moves at a record pace with the University of Minnesota offering the first university-based nursing program to award a baccalaureate degree upon completion of the three-year program.

Between 1923 and 1948 studies of nurse education conclude and formally recommend that nurses should be educated in academic settings as opposed to hospital settings. The hospital-based diploma programs continue to produce the majority of nurses. The introduction of associates degree programs grows in the mid-1950’s producing a steady decline of diploma based programs through to the mid-1970’s. 

In 1982, the National League of Nursing releases the position statement that would challenge the course of nurse education stating that the Baccalaureate of Nursing (BSN) degree be the minimum education of entry-level nurses. Since that time, research continues to support that patient outcomes improve when a higher percentage of nurses on staff hold a BSN.

The Institute of Medicine issued the landmark report The Future of Nursing in 2010 providing momentum for the profession to differentiate itself from medicine and position itself as a distinct contributor to patient outcomes and health care processes. The report calls for nurses to obtain advanced degrees, with a goal of 80% of the nursing workforce to hold a BSN degree.

Looking forward, we see that hospital hiring preferences for BSN prepared nurses or providing incentives for nurses to obtain their BSN once hired, is providing for more registered nurses to seek RN-BSN completion programs.

We serve to educate the mid-level providers who will contribute to the Triple Aim of health care by improving population health, patient experience of care and ultimately, by reducing the per capita costs of health care. We will mold the minds who will shift the focus of health care to prevention, health promotion, and coordinated care.  

Ultimately, we contribute to health care by educating the nurses who are full partners, working with physicians and all health professionals. We will educate the nurses who will be integral players in redesigning health care in the United States.