History lesson: Nursing education has evolved over the a long time

The 1893 Chicago World’s Fair introduced Americans to hamburgers, the Ferris wheel, the Pledge of Allegiance, and the concept of ​​higher education for nurses.

This exhibition featured “the first truly global gathering of nurses,” said nursing historian Louise C. Selanders, RN, EdD, FAAN, professor of nursing at Michigan State University and co-author of Florence Nightingale in Absentia: Nursing and the 1893 Columbian Exposition. published within the Journal of Holistic Nursing in 2010. Nurse leaders of the time – including Nightingale, who was not present on the conference but delivered her last major paper at it – advocated for an informed workforce adhering to standards of practice, as opposed to 1 during which nurses interned in hospitals, which was customary on the time, Selanders said.

From the World’s Fair to the Institute of Medicine’s 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” which calls for increasing the variety of baccalaureate-prepared nurses to 80% and doubling the variety of nurses with doctoral skilled degrees by 2020, nurse leaders and educators have been pushing for a highly educated and trained nursing workforce. Reports on nursing over the past 120 years recommend higher education and greater responsibilities for nurses, but progress is usually hindered by gender and sophistication barriers, in addition to the short-term economic demands of the health care industry, nursing historians say.

“Nursing education has developed very chaotically,” said Julie Fairman, MD, FAAN, Nightingale Professor of Nursing and director of the Center for the Study of the History of Nursing. Barbara Bates and a Robert Wood Johnson Foundation researcher engaged in health policy research on the University of Pennsylvania in Philadelphia.

Most American nurses received on-the-job training at hospital graduate schools. Nursing students weren’t paid, which provided hospitals with a source of free labor. This has created what many nursing historians and policy analysts see as a system that continues to undervalue the nurse’s contribution to acute care.

“Students worked 12-hour shifts with little or no clinical supervision,” wrote nurse historian Karen J. Egenes, RN, EdD, associate professor of nursing at Loyola University Chicago, in a chapter on the history of nursing within the book “Problems” and Trends in Nursing: Essential Knowledge for Today and Tomorrow,” published by Jones and Bartlett. “Classes were held irregularly and were often canceled when students were needed to fill the units.”

Despite reports in the primary half of the twentieth century advocating moving nursing schools to universities, hospitals resisted until the Fifties, when advances in science and technology transformed health care, Fairman said. She said hospital nurses suddenly stopped supporting people after easy surgeries and providing comfortable look after individuals with “incurable” conditions, and now cared for patients undergoing very complex procedures.

Hospitals moved their schools to universities, but four-year baccalaureate programs couldn’t produce nurses fast enough to fulfill the large shortages. In the early Fifties, nurse educator and founder and director of the Adelphi College School of Nursing in Garden City, New York, Mildred Montag, RN, proposed and created a two-year associate degree nursing program to supply qualified nurses to fulfill immediate requirements until sufficient numbers of nurses might be trained in bachelor’s degree. ADN programs “were designed to address the immediate shortage of nurses and then disappear,” Selanders said. Instead, they stayed and there have been 3 ways to turn out to be an RN: through a two-year associate’s degree, a three-year diploma program, or a four-year baccalaureate program. Earning a BSN was essentially the most time-consuming for college students and the most costly to rent for employers.

“This report was never implemented the way Mildred Montag wanted it to be,” said Geraldine “Polly” Bednash, M.D., FAAN, executive director of the American Association of Colleges of Nursing. The ADN program has turn out to be popular with each nursing students and hospitals, but has created confusion and “unfortunate tensions around physicians’ ability to provide care,” she said. The American Nurses Association, searching for to advertise educational standards that they believed would best serve patients, stated in 1964 that nurses must be educated only in four-year programs.

“The nurses took this statement very personally,” Selanders said. Those who had bachelor’s degrees generally agreed with the ANA. People with ADNs or diplomas felt let down by their skilled organization and denigrated as not being good nurses, she added.

The federal Nurse Education Act of 1964 pumped enormous funds into collegiate nursing education, spurring the expansion of baccalaureate, advanced and doctoral programs, Fairman said, but a significant movement of nursing students into universities didn’t occur until the Nineteen Eighties. That’s when the Institute of Medicine issued a report in 1983 calling for the creation of a national center for nursing research (the National Institute of Nursing Research, a part of the National Institutes of Health, opened in 1985) and recommending the education of more nurses in colleges. graduate level, Bednash said. Advanced nursing practice and nursing research “would not exist without this report,” she said.

The 2010 IOM report used extensive data and research to support its recommendations for nurses, including calls for a smooth academic transition to higher education and full partnership with physicians and others to revamp U.S. health care. Historians and nurse educators said that is what we hope will stimulate change greater than previous reports.

For the primary time, universities and community colleges are working together to enroll nurses in four-year or higher degree programs that emphasize critical considering, leadership, systems evaluation and teamwork, while also searching for to incorporate students with limited resources who cannot afford a standard four-year degree . annual programs, said Beverly Malone, RN, PhD, FAAN, CEO of the National League for Nursing. “Everyone agrees that we need the most educated, prepared and diverse nursing workforce,” Malone said. “There will be many roads to get to this place, but this is where we will end up.”

The report is vital not only since it advocates for higher levels of education for nurses, she said, but in addition since it calls for eliminating barriers to using this advanced education, akin to state laws prohibiting nurses from prescribing medications with out a doctor’s approval. “There is something about the legitimacy of the IOM report” and the campaign by the Robert Wood Johnson Foundation to implement its recommendations, Malone said. “Foundations have bought into it and are willing to make grants to make it happen.”

At the identical time, she added that the IOM report wouldn’t have been produced without previous reports and suggestions regarding nursing education. “In their time, each of them was extremely important. Everyone relied on the others. [The IOM report] it was the right thing at the right time, just as each of these reports was the right thing at the right time.”

Bednash taught within the diploma program within the Sixties. “We were about to get up when the doctor came to the ward,” she recalls. Nurses have made significant progress since those days, she said, but they need to remember their past as they appear forward to latest, exciting and difficult roles – as care coordinators, primary care providers and health decision-makers. “We must maintain our core values ​​of nursing. We are a caring profession, providing science-based care that works collaboratively with others and the patient to achieve health goals.” •