Nursing WORLD BD

 Nursing and nursing education have undergone striking changes over the centuries. This history reveals a constant struggle for autonomy and professionalism. There have been many influences on nursing practice in the past, including women's struggle for professional acceptance and status, religion, war, technology, and societal attitudes. These factors still influence nursing today. During the past decades, the profession worked to improve its image.

Nursing education in the United States had its beginnings in Europe. In 1836, in Kaiserwerth, Germany, Theodor Fliedner opened a small hospital and training school called the Order of Deaconesses. Florence Nightingale, the founder of modern nursing, received her formal training at this school. In 1859, she published Notes on Nursing: What It Is and What It Is Not in London. This was not intended as a text for nurses but for the ordinary woman who was the nurse for her family. In 1869, voting rights for women were promoted with the organization of the National Women's Suffrage Association and Lavinia Dock, a nurse, used the organization to promote and expand nurses' rights.

The first training schools in the United States were opened in 1872 in Philadelphia at the Women's Hospital, and in Boston at the New England Hospital for Women and Children. Linda Richards, American's first trained nurse, graduated from the latter in 1873. The American National Red Cross was organized by Clara Barton in 1882, and in 1885 Clara Weeks Shaw published the first textbook written by an American nurse: Textbook of Nursing for the Use of Training Schools, Families, and Private Students. The first home visiting nursing organization in the United States, the Henry Street Settlement in New York, was founded by Lillian Wald and Mary Brewster in 1893. In that same year, the American Society of Superintendents of Training Schools for Nurses (renamed the National League of Nursing Education in 1912) was established.

The Nurses' Associated Alumnae of United States and Canada was established in 1897 and renamed the American Nurses Association in 1911. North Carolina, New Jersey, Virginia, and New York established the first Nurse Practice Acts in 1903. In a study funded by the Rockefeller Foundation in 1920, the Goldmark Report recommended that nursing schools become independent of hospitals, and that students should not be a source of cheap labor. It also advocated financial support of university-based nursing schools.

During the Great Depression, many nurses were unemployed and the number of schools declined, but the outbreak of World War II brought a huge increase in nursing demand. During the war years, new students were still taught by experienced nurses in hospital-based programs called diploma schools of nursing.

In 1948 the Brown Report recommended that education for nursing take place in colleges and universities, not hospitals. In the same year, the National League of Nursing Education established the National Nursing Accrediting Service for nursing educational programs. In 1951, Dr. Mildred Montag suggested that one way to increase the number of nurses was to shorten their education period. She also recommended that they be trained in colleges and universities instead of diploma schools. In her dissertation. "The Education of Nursing Technicians," she proposed a two-tiered system in which "technical" nurses, who would be trained for two years, largely in community colleges, would assist "professional" nurses, who would receive four-year degrees. Although the model was not adopted at that time, Dr. Montag's paper is credited with creating the associate degree in nursing.

In 1965, the American Nurses Association (ANA) published a position paper urging that all nursing education should take place in institutions of higher learning. As a result, many diploma schools closed and nursing education began its move to collegiate programs. At this time, the ANA also echoed Dr. Montag's proposal that nursing practice consist of two levels: a professional nurse, who would hold a baccalaureate or higher degree, and a technical nurse, who would have an associate degree and would work under the direct supervision of the professional nurse. Since then, as medical knowledge advanced, nurses have had to keep up with new medications, technology, and a rapidly changing health care system as well as appropriate nursing care.

NURSING EDUCATION

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To place nursing education into perspective, it is helpful to reflect on the health care environment and the role of the nurse in that environment. The health care landscape in the United States has been changing at an unprecedented rate. Nursing education also has undergone changes to keep pace and to prepare leaders who are highly educated and technically sharp decision-makers and clinicians. What is most noteworthy, however, is not that change has occurred but rather that the rate of change since 1980 has been greater than during similar periods. Factors driving the transformations include new medical and technological advances, new health care delivery systems, and expanded roles for nurses.

Nurses are the largest single group of health care professionals but they do not practice in isolation. Rather they are an integral part of health care teams, institutions, and systems. As health care continues to move outside the hospital, the demand for nurses who can function across systems and direct a continuum of care is rising. The changing health care environment has not only changed the role of the nurse, it has also affected the supply–demand ratio. Hospitalized patients have multiple health problems, are more acutely ill, and are discharged sooner. This has increased the demand for nurses in acute care institutions at the same time that more nurses are needed in home and community settings. Given trends that emphasize health promotion and disease prevention, the need for acute and chronic care is skyrocketing.

The Federal Division of Nursing predicts that by 2010, the growing demand for nurses with bachelor of science in nursing (B.S.N.) and master of science in nursing (M.S.N.) degrees will outstrip the supply and that by 2020, the demand for B.S.N. and M.S.N. graduates will grow nearly twice as fast as the expected increase in the workforce. The predicted need for nurses is sobering, yet it is important to acknowledge that the impending crisis is not solely numbers based. The question is not only how many nurses will be available, but more importantly, will their educational preparation be appropriate to meet future health care needs. Based on the Federal Nursing Division's data, the answer is to increase the number of bachelor's, master's, and doctorate-level nurses.