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Modern Day Nightingales

Generations of children have grown up inspired by nursing role models such as Clara Barton, Florence Nightingale, and modern day nurses of both sexes, including those featured on the small and large screen.

And it’s no wonder. According to the American Nurses Association, for the ninth consecutive year, nursing has been found by the Gallup Poll to be the most trusted profession in America, based on voter opinions of honesty and ethical standards.

The profession earned its reputation during a colorful history of dedication to service: The earliest roots of nursing may be traced either to Hippocrates, the Greek father of medicine, to various 17th century religious orders, or even military brotherhoods in times of war. Encyclopedia Britannica notes that “from the time of Phoebe (A.D. 60), nursing has been recognized as one of the works of mercy of the Christian church.”

Phoebe, a deaconess and a friend of St. Paul, became the first parish worker who called upon and ministered to the sick—the mother of visiting nursing.

Various monastic orders such as St. Benedict’s sixth century communities also embraced the care of the sick, while some of the earliest nursing records were maintained by Augustinian sisters. The Knights Hospitaller of St. John of Jerusalem and other military nursing orders contributed a tradition of rigorous discipline to nursing, fostering the dedication of orders such as the Sisters of Charity, established in 1634.

During the 19th century, as public nursing schools were established, nursing became more secular in nature. Recent landmarks in nurse education have occurred in our own backyard: As the nurse practitioner programs of the early 1970’s emerged, the UT Health Science Center College of Nursing was among the lead­ers of the movement. The practice doctorate inaugurated there in 1998 served as a foundation for Doctor of Nursing Practice degrees now proliferating across the country.

Wars have dramatically expedited the evolution of nursing. As a result of her work during the American Civil War, Clara Barton created the American Red Cross. Florence Nightingale’s service during the Crimean War in 1854 allowed her to make use of her considerable talents—not only as epidemiologist, but as organizer, strategist, researcher, and statistician—to implement reforms in nursing while introducing new concepts in hygiene that reduced the death rate of the wounded from 40 percent to 2 percent. (Unconfirmed Internet sources also credit Nightingale, a formidable data analyst, with inventing the pie chart.)

Donna Hathaway, PhD, FAAN, Professor and Dean of the UTHSC College of Nursing, notes that today’s nursing role models demonstrate a much greater diversity in terms not only of gender and age, but also of the variety of roles that nurses play, the different worksites they occupy, the tasks they undertake, and the responsibilities they assume.

Opportunities for appropriately educated nurses are amazingly diverse. Hathaway lists community health nurses, nurses in hospital ICUs, ambulance/trauma nurses, flight nurses, military nurses, nurses who conduct research, educators, nurse informaticists, nurses who deal with policy issues on Capitol Hill, and nurse attorneys, as well as nurse commissioners of health and nurses who work in leadership roles as administrators.

“Healthcare today is very complex,” said Hathaway. “Patients are living longer in combination with many chronic conditions. Gall bladder surgery patients may also have a heart condition, diabetes, some type of emotional problem—or all of the above.”

Complex treatments and technology advances continue to outpace textbooks, so that “there is no way we can teach people everything they need to know about each condition, all the therapies and all the interactions; so today we’re really teaching all healthcare providers how to find answers, how to think, how to problem-solve, how to access the expertise of other healthcare professionals in different ways. It’s a whole different way of thinking and working and viewing the world.”

Is there a shortage of nurses?

The pre-recession projected shortage of nurses wasn’t as great as anticipated. However, warns Hathaway, as the recession slowly turns around, those part-time or semi-retired nurses who responded to fill the shortage are already starting to leave. Although Tennessee schools doubled enrollment of nurses in the years prior to the recession, the shortage threatens again, and as Hathaway notes, “the need is going to do nothing but increase, due to the continued entrance of Baby Boomers into the healthcare arena, and the huge new numbers of people requiring additional healthcare as a result of healthcare reform.”

Further exacerbating the problem is the shortage of nursing educators.

“Nursing schools are still turning away qualified applicants, because the shortage of nurses is dwarfed by the shortage of nursing faculty. If you don’t have the faculty, you are limited in the number of students you can admit,” said Hathaway.

Where is nursing headed?

“I feel extraordinarily privileged to be in this profession at this point in history,” said Hathaway, “when nursing is at a real pivotal juncture. New things are opening up: master’s degrees for graduates of our RN professional entry program, and advanced practice nurses will be awarded doctoral degrees—reflecting the additional knowledge, skills, and problem-solving abilities nurses need for today’s challenges.”

She cites an October 2010 consensus report published by the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The two-year initiative was launched to assess and transform the nursing profession, empowering it to overcome existing barriers that prevent nurses from “being able to respond effectively to rapidly changing health care settings and an evolving health care system.”

With more than three million members, the report explains, the nursing profession is the largest segment of the nation’s healthcare workforce, and could play a vital role in helping to realize the objectives of the recent legislation. Consequently, the study enumerates and defines four key recommendations, along with the means to achieve them:

-Nurses should practice to the full extent of their education and training.

-Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

-Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.

-Effective workforce planning and policy making require better data collection and information infrastructure.

The study urges government, businesses, healthcare organizations and others to use their powers to improve regulatory, business, and organizational conditions, creating a climate in which nursing can progress, unimpeded by obstacles that limit scope of practice.

These are exciting times indeed, as nursing prepares to spread its wings and lead the way into a future filled with achievements unimagined.



See the complete report at www.iom.edu under “Reports”

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College of Nursing, Dean and Professor, Donna Hathaway, FAAN, PhD, Ruth Neil Murry Endowed Chair in Nursing, University of Tennessee Health Science Center

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