"The best type of nursing girl is one who is tall, strong, and has a suppleness of movement. " If she can dance, it is a great advantage. " If she is favoured [sic] with good looks, it is all[the better] " ." So claimed a 19th century British medical manual. The Journal of the American Medical Association added its two cents in 1902: "Nurses are often conceited and too unconscious of the due subordination [they] owe to the medical profession, of which she is sort of a useful parasite."
Thankfully, nursing has come a long way since then. But even in the days when disrespect was the norm nurses were making a difference in health care delivery, policy, ethics, and more. Florence Nightingale, for example, redesigned health care during the Crimean War so that mortality declined dramatically. Margaret Sanger worked with poor women in New York tenements who died from self-induced abortions, leading her to launch what is now Planned Parenthood. Mary Breckenridge started Kentucky's Frontier Nursing Service in 1925 to serve women and children in rural areas.
More recently Cicely Saunders founded the first modern Hospice in London in 1967, fostering the culture of palliative care. And in our own time Mary Naylor's research helped lead to the design of a Transitional Care Model that addresses "common breakdowns in care when older adults with complex needs transition from acute care settings to other care settings or their homes," while Linda Aikens' work addressed patient safety and its relation to nursing care. She is credited with the term "failure to rescue," defined as the "inability to save a hospitalized patient's life when he experiences a complication."
Today "there has never been a more exciting time to be a nurse," says Pat Donehower, a lecturer at the University of Vermont (UVM) College of Nursing and Health Sciences. "There are fabulous job opportunities in administration, research or practice settings."
Mari Cordes, Vice President for Health Care with the American Federation of Teachers/Vermont, agrees. "I'm so proud of my profession," she says. Specializing in vascular nursing she has seen major changes in her profession over the past 25 years. "I've witnessed many of us stepping forward to demand our rightful place in health care," the labor activist says. "That was our responsibility. No one was going to hand it to us. And the more we demanded the more respect we received. Now most physicians want nurses' distinct input."
Some of the new respect for nurses may be in place because increasingly, nurses are getting advance degrees enabling them to take on leadership roles in research, on hospital boards, and in continuing dialogues around such issues as cost containment, ethics, and training. Dr. Linda Aiken's research demonstrated that hospital nurses with a bachelor's degree or higher gave patients a "substantial survival advantage." She found that a 10 percent increase in the proportion of nurses with a BSN in hospitals decreased the risk of patient death and failure to rescue by five percent. If the proportion of BSN nurses in all hospitals was 60 rather than 20 percent, 18 fewer deaths per 1,000 surgical patients would be expected.
This kind of finding is supported by a 2010 report, The Future of Nursing, by the Institute of Medicine (IOM) that called for increasing the number of baccalaureate-prepared nurses in the workforce to 80 percent and doubling the population of nurses with doctorates in order to respond "to the demands of an evolving health care system and meet the changing needs of patients""
Nurses are also taking their rightful place when the high cost of health care is addressed. While traditionally nurses have been viewed as a labor cost whereas physicians are seen as revenue generators, studies show that while improved nurse-to-patient ratios do increase cost they don't impact overall profitability.
Cost-related issues are often connected to ethical dimensions of health care policy and practice. As Betty Rambur, professor of nursing at UVM puts it, "Nurses go beyond the biomedical. We're holistic in our approach. That impacts the ethics of health economics. It's opened the door to exciting models that include thinking about broader systems of care."
Another challenge with ethical implications is keeping up with necessary technology while not losing sight of important interpersonal contact and communication. "The advent of the computer has helped in many ways," says Felicia Robinson, a labor and delivery nurse at Brattleboro Memorial Hospital's birthing center. "It's easier to assess someone's medical record or to see labs. But the computer can be a barrier between the clinician and the patient. I review the medical record before entering the room. I sit facing the patient and make eye contact. When I turn to the computer I read her what I've written. So my patient is involved in the process. She feels confident I have 'heard' her."
Ever evolving policies, practice norms and financing mechanisms coupled with institutional systems changes mean new opportunities as well as challenges for the country's nearly 3 million registered nurses. Clearly it's an awesome time to be a nurse.
Excerpted from an article that appeared in Vermont Woman, April/May, 2015. Cross posted with Daily Kos.