A U.S. Navy recruiting poster from World War II, showing a Naval nurse with a hospital ship. Prior to the foundation of modern nursing, nuns and the military often provided nursing-like services. The religious and military roots of modern nursing remain in evidence today in many countries. For example: in Britain, senior female nurses are known as ‘‘sisters’’. It was during time of war that a significant development in nursing history arose when Florence Nightingale, working to improve conditions of soldiers in the Crimean War, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing. Other important nurses in the development of the profession include: Mary Seacole, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones and Linda Richards, who established quality nursing schools in the USA and Japan, and Linda Richards who was officially America’s first trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston.
New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12th of September, 1901. Ellen Dougherty was the first registered nurse. North Carolina was the first state in the United States to pass a nursing licensure law in 1903.
Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses primary purpose is to follow the direction of medics. This tendency is certainly not observed in Nightingale’s Notes on Nursing, where the doctors are mentioned relatively infrequently and often in critical tones, particularly relating to bedside manner.
The modern era has seen the development of nursing degrees and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.
Nursing as a profession
The aim of the nursing community worldwide is standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice and training in clinical skills.
In order to work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. A Licensed practical nurse(LPN) (also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works under a Registered nurse. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. ($30,000-$50,000/yr base). Registered nurses may also earn additional credentials or degrees enabling them to work under different titles.
The high demand for nurses in the US
The demand for nurses has been increasing for several years, spurred by various economic and demographic factors. According to the US Department of Labor, demand for nurses is projected to increase by 23% between 2006 and 2016. Nursing jobs that are in highest demand include registered nurses, licensed practical nurses, certified nurse assistants, and certified medical assistants.
The Department of Labor’s estimated increase percentage per nurse employer type is:
25% – Offices of physicians
23% – Home health care services
34% – Outpatient care centers, except mental health and substance abuse
33% – Employment services
23% – General medical and surgical hospitals, public and private
23% – Nursing care facilities
Nursing practice is primarily the caring relationship between the nurse and the person in their care. In providing nursing care, nurses are implementing the nursing care plan, which is based on a nursing assessment.
Although nursing practice varies both through its various specialities and countries,is the International Council of Nurses offers the following definition:
‘ Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. ‘
The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.[Royal College of Nursing]
Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.
Nursing theory and process
In general terms, the nursing process is the method used to assess and diagnose needs, plan and implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals. Currently, two paradigms exist in nursing, the totality paradigm and the simultaneity paradigm.
Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-run clinics, long-term care facilities and camps. They also work on cruise ships and in military service. Nurses act as advisers and consultants to the healthcare and insurance industries. Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing.
Internationally, there is a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. DeLucia, Ott, & Palmieri (2009) concluded, “the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that underloads also can be detrimental to performance (Mackworth, 1948). Considering both overloads and underloads are important to consider for improving performance.”
Nursing is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.
The major divisions are:
- the nursing of people with mental health problems – Psychiatric and mental health nursing
- the nursing of people with learning or developmental disabilities – Learning disability nursing (UK)
- the nursing of children – Pediatric nursing.
- the nursing of older adults – Geriatric nursing
- the nursing of people in acute care and long term care institutional settings.
- the nursing of people in their own homes – Home health nursing (US), District nursing and Health visiting (UK).
- ‘Nurse’. The Oxford English Dictionary 2nd editionOxford University Press. 1989. pp. p603-604. ISBN 0198611862.
- Florence Nightingale (1820 — 1910)
- Radcliffe, Mark (2000). ‘Doctors and nurses: new game, same result‘. British Medical Journal 320 (1085): 1085. doi:10.1136/bmj.320.7241.1085. http://www.bmj.com/cgi/content/full/320/7241/1085. Retrieved on 2007-08-14.
- Nightingale, Florence (1860) Notes on Nursing Full text online Accessed 14 August 2007
- International Council of Nurses Accessed August 2007
- US Department of Labor, Bureau of Labor Statistics, Health Care.]
- DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (in press). “Performance in nursing”. Reviews in Human Factors and Ergonomics (Human Factors and Ergonomics Society)