“History, despite its wrenching pain, cannot be unlived, but if faced with courage, need not be lived again.”
The history of nursing used to be part and parcel of most nursing programs. However, due to a plethora of changes in health care, nursing, and technology, there is little room to include this important content. Today, many nursing programs provide a brief overview of nursing’s rich history because the curriculum is overladen with content. Most historians concur that learning about one’s past history provides one with a greater understanding and appreciation of the issues that inform their current and future practice and policies. The history of the nursing profession is closely intertwined with health care, medicine, society, and public policy. We can see a reciprocal influential relationship between current events and the role of the nurse. Throughout the years nurses have played a pivotal role in the health and welfare of the population across the lifespan, and around the world. Recognizing the significance of the past on our current and future profession, the American Association for the History of Nursing advocates for the inclusion of nursing history in nursing curricula.
Nursing’s history is replete with stories of healing, nurturing, hardships, heroism, discovery, ingenuity, caring, compassion, education, research, and leadership. Historical records demonstrate that nurses have been in existence since ancient times, and their roles have evolved from one of an informal caregiver to the untrained nurse to the professionally trained nurse of today. Although we have made significant advancements along the way when looking back on our history one can see that in some ways nurses of today are not that different from the nurses of the past.
Key Facts in Nursing and Medicine
- Records from ancient time periods demonstrate that nurses and midwives existed.
- Hippocrates is known as the founder of medicine.
- Galen is considered one of the greatest Greek physicians after Hippocrates.
- Some civilizations used slaves, the poor, or fallen women to serve as nurses.
- From the 1st to 14th centuries nursing care was provided by unskilled men and women.
- From the 14th to 17th centuries times were turbulent with unsafe conditions, quackery, plagues, and construction of hospitals.
- During the 18th century family members cared for most of the infirm.
- In 1732 an almshouse for the poor and infirm was opened in Philadelphia.
- Pennsylvania hospital was opened in 1851.
- 18th century nurses made the following contributions:
- bed warmers
- heating pads
- herbal remedies
- During the Revolutionary War, General Washington ordered many women to serve as nurses to the wounded soldiers.
- The Crimean War took place from 1853 to 1856.
- The American Civil War took place between 1861 and 1865.
- Florence Nightingale, who many consider the “Foundress of Modern Nursing,” made significant contributions during the Crimean War and influenced medicine and nursing.
- During the 20th centuries World War I, World War II, the Korean, and Vietnam Wars nurses served to care for the wounded
- Throughout the 20th century, numerous nursing theorists emerged and made significant contributions in the advancement of nursing science.
- Three notable 20th century pioneers in nursing education were Lavinia Lloyd Dock, Isabel Hampton Robb, and Mary Adelaide Nutting.
- Nurse training schools became more formalized after Nightingale opened her first school of nursing and there was rapid growth of nursing schools throughout the 20th century.
- Beginning in the 1950s, nurses sought to develop their own body of knowledge initially “borrowing theories from other disciplines” and eventually developing and testing their own theories.
- Throughout the 20th century, myriad professional nursing organizations were created.
- The 21st century has been a time of continued growth and development of the nursing profession, which is due in part to advances in technology, evidence-based practice, and reports such as the Institute of Medicine’s Future of Nursing.
“Success is not final, failure is not fatal: it is the courage to continue that counts.” —Winston Churchill
New nurses must achieve myriad milestones. Most new nurses breathe a collective sigh of relief upon passing their licensure exam. However, this period of jubilation leads to the next milestone, which includes securing one’s first position and then embarking on the transition from newly licensed nurse through the transition. This transition—which is somewhat akin to a rite of passage—may be smooth sailing for some, something akin to mountain climbing for others, and somewhere in between these two extremes for the majority. No matter where you fall, there are many strategies that you can undertake to facilitate your transition from novice to experienced nurse.
Securing a position in a supportive workplace will certainly serve you well; however, even if conditions are not optimal, there are certain things you can do to make things better. Follow these strategies to ease your transition into the workplace.
Engage in Self-Care
Nursing is a rewarding profession, yet it can also be quite stressful. Consequently, self-care is extremely beneficial. It’s important to get adequate rest, nutrition, and exercise. Other self-care strategies might include deep breathing and relaxation, yoga, meditation, aromatherapy, or journaling.
Utilize Crucial Conversations
As nurses we have no problem advocating for our patients, but it’s much harder advocating for one’s self. According to a 2009 study published in Critical Care Nursing Quarterly, 77% of nurses experienced disrespectful conversations but only 7% confronted the individual. Following the eight steps of Crucial Conversations: Tools for Talking When Stakes Are High can be quite helpful when dealing with challenging situations such as bullying or confronting a preceptor who is not being very helpful. These include:
- Get unstuck (assess the problem).
- Start with heart (identify what is holding you back).
- Learn to look (observe behaviors; identify stressors).
- Make it safe (respect personal space, use effective communication).
- Master my stories (stick to the facts; see both sides of issue).
- State my path (tell your story; be persuasive not abrasive).
- Explore others’ paths (compromise if possible).
- Move to action (develop a positive action plan).
Following these steps may not solve all problems, but they do offer a systematic, practical way to address difficult situations.
Use Effective Written and Verbal Communication Skills
You learned about therapeutic communication in your nursing programs, so be sure to utilize effective and professional verbal, non-verbal, and written communications. Oftentimes, misunderstandings occur because of miscommunication. Social media policies should also be followed. Other communication strategies include:
- Be a good listener;
- Avoid jargon;
- Speak clearly;
- Be aware of tone, rate, and cadence;
- Clarify and restate;
- Always reread your messages before sending;
- Pay attention to grammar and spelling.
Seek Out a Mentor
Mentors play a vital role in an individual’s professional and personal life. According to Fast Facts for Career Success in Nursing: Making the Most of Mentoring in a Nutshell, a mentor is someone who connects with and develops a reciprocal relationship with a protege and offers support and guidance. Finding a mentor can be challenging and requires one to be proactive and consider what one hopes to find in a mentor. You should approach the particular person with a formal request and a clear set of expectations.
Be an Advocate for Yourself and Your Patients
Patient advocacy comes natural to most of us; however, self-advocacy can be difficult. As a new nurse you will face some challenges and will need to learn self-efficacy, self-advocacy, empowerment, and resiliency. You can complete a resiliency quiz at www.resiliencyquiz.com. Learning the eight steps of “crucial conversations” can also be helpful to utilize when advocating for yourself and addressing issues such as bullying, workload, preceptors, and work environment. Your mentor can also offer guidance.
Improve Your Time Management and Organizational Skills
Perhaps one of the biggest challenges new nurses face is learning how to improve time management and organizational skills. As a new nurse it can be very easy to become overwhelmed as you leave the safety net of your instructors and are expected to manage more patients. Being punctual and setting the tone for the day will help keep you on track. Donna M. White, LMHC, CACP, recommends the following strategies to help you improve your time management skills:
- Create a “to do” list;
- Establish deadlines;
- Avoid multitasking;
- Reward yourself.
Develop Goals and Objectives
Developing daily, weekly, and even monthly goals is a great way to help you transition into your professional practice role. These goals can include a variety of topics. For example, you may include goals for improving time management, self-care, self-advocacy or clinical skills, critical thinking, and problem solving. A template for developing weekly transition goals can be found in my book, The Nurse Professional: Leveraging Your Education for Transition into Practice. When developing goals, you should also develop a five-year plan to help guide you through your transition and beyond.
In summary, the transition into professional practice can be challenging; however, there are strategies you can employ to help ease your transition.
This is such an exciting time for the nursing profession. Because of our past and present influential nurse leaders, educators, and the organizations that value and support us, we are poised to bring the profession of nursing to new heights. Nurses play an integral role in health care, and there is a significant need for greater involvement on all levels. Now more than ever with the Institute of Medicine’s The Future of Nursing report and the Affordable Care Act, nurses must be prepared to assume leadership positions in organizations as well as within the political arena to affect the changes that are vital to the future health care of all populations on a local, national, and global scale.
In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. A committee was formed and a blueprint for the future of nursing was created. The report, titled The Future of Nursing: Leading Change, Advancing Health, was published in 2010. The report includes four key messages and eight recommendations. The four key messages of the report are:
- 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 health professionals, in redesigning health care in the United States; and
- Effective workforce planning and policy making require better data collection and an improved information infrastructure.
In response to the report, the American Association of Retired Persons and the RWJF launched the Future of Nursing Campaign for Action to facilitate implementation of these key messages and recommendations. There is an action coalition in every state and they all have the same goals; however, they do have autonomy to address the issues in relation to the specific needs of their individual states. Progress has been made in all areas, but there is much more to do, and it is vital for all nurses, future nurses, and other stakeholders to be involved in this initiative. The focus of the action coalitions is to address the following pillars that relate to The Future of Nursing report:
- advancing education transformation;
- leveraging nursing leadership;
- removing barriers to practice and care;
- fostering interprofessional collaboration;
- promoting diversity; and
- bolstering workforce data.
These pillars relate to the recommendations contained in the report. The latest report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, highlights the progress made in health care delivery and the scope of practice; collaboration; leadership; education; diversity in the nursing profession; and workforce data.
The recommendation related to health care delivery and scope of practice posits that all advanced practice nurses be able to practice to the full extent of their education and training. Although progress has been made, barriers still exist. To date, 19 states allow for full practice, 18 states have reduced practice, and 13 states have restricted practice, according to the American Association of Nurse Practitioners. According to the Assessing Progress on the Institute of Medicine Report The Future of Nursing, policymakers, nursing, and health professions groups must collaborate to increase interprofessional collaboration and remove scope of practice barriers.
There are two recommendations that address leadership with the premise being that nurses must be prepared to serve as leaders within organizations and on the executive and policy levels. According to a 2014 survey conducted by the American Hospital Association’s Center for Healthcare Governance, there are approximately 6% of nurses serving on a board. There have been several initiatives developed, such as the American Nurses Advocacy Institute (ANAI), which the American Nurses Association launched in 2009. ANAI is a program designed to increase the political competence of nurses, thus promoting stronger advocacy on nursing related issues at the state and federal levels. In addition, the American Association of Colleges of Nurses (AACN) offers a Faculty Policy Intensive, a four-day immersion program designed to prepare faculty interested in taking an active role in health care policy; the RWJF has programs such as Nurse Executive Fellowships to develop new leaders, and the Nurses on Boards Coalition is focused on improving the health of communities and the nation by placing 10,000 nurses on boards by the year 2020.
Transforming nursing education encompasses four recommendations from The Future of Nursing report—increasing the number of baccalaureate prepared nurses to 80% by 2020, doubling the number of doctorally prepared nurses, increasing transition into practice residency programs, and promoting professional development and lifelong learning. According to the AACN, there are 187 practice sites in 32 states that offer the year-long residency, and more than 40,000 nurses have completed the program. A formal curriculum serves as the framework for the residency, and the faculty and staff of the University Healthsystem Consortium institutions who developed the curriculum review it annually for updates and revisions. The statistics on the number of BSN-prepared nurses vary. There are reports that currently 51% of the 3 million nurse in the U.S. hold a BSN, and there has been an increase in enrollment in generic BSN programs and RN-to-BSN programs. Many programs also have articulation agreements with the Associate Degree programs for seamless transition, and there are also some dual degree programs. The number of doctorally-prepared nurses, which was only 1% in 2010 with enrollment in DNP programs doubled, and there was a 15% increase in PhD programs.
The Campaign has made diversity one of its pillars, and there are many organizations that are focused on a more diverse workforce that is representative of the populations we serve. For example, the New York State Action Coalition developed a Diversity Toolkit that provides resources for organizations to utilize to develop and sustain a diverse workforce.
Statistics on workforce data have improved; however, there remains a need to have an improved structure for data collection on a local and national level to understand resources and needs for continued growth and development of our workforce.
Northern Metropolitan Region Action Coalition
The Northern Metropolitan Region (NorMet) Action Coalition works under the umbrella of the New York State Action Coalition (NYSAC) and was developed in 2011. The organizational structure includes nurse co-leads and committee chairs. This region includes seven counties: Westchester, Putnam, Duchess, Rockland, Orange, Sullivan, and Ulster. The priority recommendation for the NorMet Region is to increase the number of BSN-prepared nurses to 80% by 2020. To address this, the BSN 80-20 Committee developed an Aspiring Protégé Toolkit, which is a mentor program geared to improve retention of nurses in BSN programs. Another priority is to prepare nurses to lead to advance health. This committee includes two Jonas Scholars who completed a leadership video project, Calling All Nurses: Step Up and Lead, and continues to address this recommendation. There is also an Outreach Committee that is focused on networking, public speaking, and increasing membership. Another priority is to promote diversity. The NYSAC also developed a Diversity Toolkit to facilitate the expansion of a more diverse workforce. The action coalition continues to address the key recommendations in accordance with the NYSAC.
In summary, these initiatives are helping to change and redefine the profession of nursing, and we all have a role to play in our future. Learning about the key initiatives, recommendations, and pillars are essential. Everyone should consider volunteering for their state’s action coalitions. There is much work to be done and everyone’s voice is vital.