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Journal of Nursing

Change for the Best 

by Anne Bartlett RN [email protected]


 John F. Kennedy said, “Change is the law of life” (Best Quotes Poems, 2007). Nursing has changed. Change is inevitable but generally it is viewed with suspicion and negativity. There have been many changes in nursing even in the almost thirty years since I graduated. Appearances have changed; we no longer dress in the white uniform and hat. Education has changed; graduates are from university based rather then hospital based programs, with opportunities to move on to Masters or Doctorate levels. Attitudes have changed; we don’t see our role as subservient to the medical staff but as vital members of the health care team.


Have all these changes advanced the profession?  Were things better in the “good old days”?  These questions have been the cause of some heated debate between all interested parties such as patients, medical staff, and nurses themselves. The present climate of economic, resource, and technological challenges really left the profession with little choice; change was necessary. But as a result, I feel nursing has evolved with more autonomy, and increased career options for modern nurses.


Appearances


Uniforms are often an issue with patients; most find the array of fashions worn in today’s healthcare confusing. The traditionally the white uniforms and hats were to identify and set apart the nurses from the general staff of the hospitals. Over the years the white hat and uniform were shed for articles that were more practical and comfortable. Also, as educated individuals, nurses felt they had the right to make decisions about their apparel and needed to be recognized for their abilities rather then their apparel. Current infection control issues, such as MRSA and VRE, ensure that starched uniforms and hats will continue to be replaced with items that are both durable and washable. However the issue of patient confusion remains and some facilities are attempting to resolve this with some form of mandatory identification ie., wrist bands, color coded scrubs, or badges (University of Saskatchewan, 2009; R. Byrd, 2008 ).


Education


Nurses traditionally were women and were educated in hospital settings. The programs were based on the needs of the hospitals with the students utilized as unpaid labour. There were efforts even in the 1920’s to move nursing education out of the hospitals and into the universities but there was opposition to women receiving a university education in preparation for a career. Many saw nursing as a “calling” that only required good character and the ability to take direction from a doctor. There was resistance to recognizing nursing as a profession. It was considered a subservient role with no expectations that the nursing staff could perform without the explicit direction of the medical staff (N.Aranda, 2007; Ministry of Health and Long-Term Care [MOHLTC], 2006).


Times have changed. Good character is always important but nurses have established themselves as valued and vital members of the health care team with much to contribute.  Their education now requires a broad base of knowledge to prepare them for the demands of critical thinking, clinical judgment and decision-making that they will face in their practice. Learning doesn’t stop with graduation; continuing education and re-certification are expectations for modern nurses, especially for those in specialized areas. Demands on the skills of modern nurses include an aging population living with chronic illnesses, complex medications, and evolving technology. As well, there are clinical skills performed by today’s nurses that less then twenty years ago were only performed by doctors. Nurses are inserting and accessing invasive lines, prescribing medications, and initiating treatments.


Attitudes


Modern career opportunities are not limited solely to a hospital-based practice. For example, advanced practice nurses have an independent role in the diagnosis and management of acute and chronic illnesses, either collaboratively with a physician or as part of a health care team. They practice in anesthesia, health maintenance, counseling, and patient education (The North Carolina Centre for Nursing, 2004). Today’s nurses also have careers in education, public health, and industry. Nurses hold positions in management and are involved in policy decisions. Times have certainly changed.


Conclusion


Nursing has clearly risen to a level of professional autonomy. The modern nurse has evolved to meet the demands of her peers and of a changing health care system. There can be no returning to the “good old days”.  But even with all the changes the focus of the profession remains the same. Nursing from the time of Florence Nightingale has focused on the patients, their needs, and how they could be met. Just like nurses from the “good old days”, modern day nurses strive to ensure that their patients receive the best care that they can provide. The tools and the delivery have changed dramatically but the focus of the profession will always be on the patient.   


References


  Aranda, N. 2007. A brief history of nursing education. Retrieved March 23, 2009 fromhttp://ezinearticles.com/?A-Brief-History-of-Nursing-Education&id=476012


  Best Quotes Poems. 2007. Retrieved March 23, 2009 from http://www.best-quotes-poems.com/change-quotes.html 


  Byrd R., 2008. A history of nursing uniforms. Retrieved March 23, 2009 fromhttp://www.buzzle.com/articles/a-history-of-nursing-uniforms.html


  Ministery of Health and Long-term Care. 2006. A history of nursing in Ontario. Retrieved March 23, 2009 fromhttp://www.health.gov.on.ca/english/public/program/hhr/nurses/history.html 


  The North Carolina Centre for Nursing. 2004. Nurse practitioner. Retrieved March 23, 2009 fromhttp://nccn.northcarolina.edu/recruitmentandretention/youth/roles/nursepractitioner.htm 


  University of Saskatchewan. 2009. Healthcare uniforms: Who’s who. Retrieved March 23, 2009 fromhttps://wiki.usask.ca/nursing/index.php/Healthcare_Uniforms:_Who%27s_who%3F 



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