Nursing is a dynamic and evolving profession that has grown from its historical roots to become an indispensable and diverse healthcare service, continuously adapting to meet societal needs.
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exploring the career or profession of nursing
nursing
is a bit like an adventure it's not just
about the job
it's not just about caring for patients
it includes a
whole aspect of another realm of things
that nursing students sometimes have
difficulty wrapping their heads around
as they enter their career as a new
registered nurse
so let's go on this adventure together
and let's backtrack
and let's look at the history of nursing
professional nursing holds a unique
place in the american health care system
as members of the largest health care
profession the nation's 3.1 million
nurses work in diverse settings and fields
fields
and are frontline providers of
healthcare services
while most nurses work in acute care
settings such as hospitals
nurses expertise and skills extend well
beyond hospital walls
working independently and with other
health care professionals
nurses promote the health of individuals families
families
and communities millions of americans
turn to nurses for delivery of primary
healthcare services
healthcare education and health advice
and counseling
nurses are critical links in maintaining
a cutting-edge health care system
nursing continues to be an indispensable
service to the american public
while many may think of a nurse as
someone who takes care of hospitalized patients
patients
nurses also fill a wide variety of
positions in health care in many varied settings
settings
working both collaboratively and
independently with other healthcare professionals
professionals
for example most americans are familiar
with home care nurses
who provide a plethora of nursing and
health care services to patients in
their homes
school nurses have a long history of
providing health services to school
children from kindergarten through high school
school
nurses play a major role in delivering
care to those residing in long-term care
facilities such as nursing homes
workers with job-related health concerns
often seek out nurses employed by
business and industry
many people visit a nurse practitioner
as their primary caregiver
expectant mothers often prefer nurse
midwives as their health care providers
during pregnancy
and childbirth and each day in
operating rooms across the country nurse anesthetists
anesthetists
ensure that patients undergoing surgery receive
receive
safe anesthesia care today schools of
nursing compete for the brightest applicants
applicants
and nursing is highly regarded as an
excellent career choice for both women
and men
most people think of the nursing
profession as beginning with the work of
florence nightingale
an upper-class british woman who
captured the public imagination when she
led a group of female nurses to the
crimean war
in october of 1854 to deliver nursing
service to british soldiers
upon her return to england nightingale
successfully established nurse education
programs in a number of british hospitals
hospitals
these schools were organized around a
specific set of ideas about how nurses
should be educated
developed by nightingale often referred
to as the nightingale principles
actually while nightingale's work was
groundbreaking and that she confirmed
that a core of educated women
informed about health and the ways to
promote it could improve the care of
patients based on a set of particular principles
principles
she was not the first to put these
principles into action
let's look at nursing and hospital care
in the united states
throughout history most sick care took
place in the home and was the
responsibility of family friends and
neighbors with knowledge of healing practices
practices
in the united states family-centered
sickness care remained traditional until
the 19th century
sick care delivered by other than family
and close acquaintances was generally
limited to epidemics and plagues that
periodically swept through towns and cities
cities
by the beginning of the 19th century
however urbanization and
industrialization changed the way in
which and in many cases the place in which
which
sick individuals received care hospitals
began to proliferate to serve those who
were without the resources to provide
their own care
and as hospitals increased in numbers so
did demand for
caregivers who would be able to deliver
thoughtful care to the patients in them
early 19th century hospitals were built
mainly in more populated sections of the
country generally in large cities
nursing care in these institutions
differed enormously
in hospitals operated by religious
nursing orders
patients received high quality care but
in other institutions
nursing care was more variable ranging
from good in some hospitals to haphazard
the beginnings of nurse education
recognizing the importance of good
nursing care to a patient's well-being
some physicians initiated courses for
those interested in nursing
in 1798 valentin siemen a new york physician
physician
organized an early course of lectures
for nurses who cared for maternity patients
patients
an early 19th century program the nurse
society of philadelphia trained women in
caring for mothers during childbirth
and postpartum periods
its founder dr joseph warrington a
strong advocate of providing instruction
for women interested in pursuing nursing
as an occupation
authored an 1839 book entitled the
nurses guide containing a series of
instruction to females who wish to
engage in the important business
of nursing mother and child in the lion
and chamber
this publication which each nursing
society nurse received
represents an early example of a nursing
practice text
between 1839 and 1850 the nurse society
employed about 50 nurses
establishing an early practice of
engaging nurses for care of patients in
the home
the outbreak of the civil war created an
immediate need for capable nurses to
care for an enormous number of sick and wounded
wounded
about 20 000 women and men served as
nurses in both the north and the south
the commendable service rendered by
civil war nurses provided a rationale
for future experiments in setting up
training programs for nursing
one such program was initiated in
pennsylvania where the women's hospital philadelphia
philadelphia
offered a six-month nurse training
course which graduated its first class
in 1869.
similar courses such as that offered by
the new england hospital for women and children
children
were begun in other locales
professional nurse education begins
the year 1873 was a watershed year in
american professional nursing history
in that year three nurse educational
programs the new york training school at
bellevue hospital the connecticut
training school at the state hospital
and the boston training school at
massachusetts general hospital
begin operations these three programs
all based on ideas advanced by florence
nightingale are generally acknowledged
to be the forerunners of organized
professional nurse education in the
united states
the success of these first three
so-called nightingale schools
led to a proliferation of similar
nursing schools or as they were most
commonly called
nurse training programs by 1900
somewhere between 400 to 800 schools of
nursing were in operation in the country
these programs followed a fairly typical pattern
pattern
the school was either affiliated with or
owned by a hospital that provided the
students with the clinical experience
considered necessary for the education
of the nurse
students received two to three years of
training while in the program
students carried out the majority of
patient care activities offered in the hospital
hospital
receiving only a modicum of classroom
education in the form of lectures on
patient care and related subjects
at the end of the educational program
students received a diploma and were
eligible to seek work as a trained nurse
these early nurse education programs
were in reality
little more than apprenticeship programs
that use student nurses for their labor
despite their significant shortcomings
however they proved very popular with
both hospitals and students
and created a pattern of hospital-based
nursing education that persisted until
the mid-20th century
and while many disparaged the exploitive
nature of the nurse education system
the presence of trained nurses with
their emphasis on cleanliness
orderliness and close observation of patients
patients
successfully transformed hospitals into
scientific institutions of care
further the popularity of the schools as
evidenced by their high student
admission rates and the large numbers of
nurses they graduated
testified to the profession's appeal as
an excellent occupation
in which to carve out a career schools
of nursing did improve over time
better oversight of nursing educational
programs by state licensing boards
as well as the increasingly complex
demands of patient care
led the schools to increase the amount
of theoretical instruction
and decrease the amount of direct work
performed by the students
the profession of nursing organizes
as the number of nurses grew in the late
19th century
nursing took on the rudimentary
characteristics of a profession
in the 1890s nurses organized
two major professional associations
the american society of superintendents
of training schools for nurses
later renamed the national league of
nursing education
and the associated alumni of the united states
states
later renamed the american nurses association
association
other major organizations such as the
national association of colored graduate nurses
nurses
and the national organization for public
health nursing
formed in the early 20th century state
nurses associations
also organized and were instrumental in
passing state nurse registration acts
which regulated and provided a licensing
system for nursing practice
the successful passage of nurse
registration acts considered a
significant legislative accomplishment
at the time when women held little
political power
also provided nurses with their modern
legal title
registered professional nurse these
changes improved and reformed many
aspects of the nurse training system but
problems remained
reflecting the social and legal status
of african americans at the time
american professional nursing maintained
strict racial segregation until the
mid-20th century
african-american individuals wanting to
become nurses had to train in a separate
educational system and faced a divided
employment field
in which white and black nurses did not
participate equally
nursing also remained a predominantly
female profession
while a few schools admitted men most
schools refused them admission
challenges for nursing employment
conditions for nurses
also presented challenges in the early
part of the 20th century
hospitals employed only a few graduate nurses
nurses
mainly in supervisory positions they
relied instead on student nurses for the
majority of the bedside care provided to patients
patients
most nurses once they graduated from
their educational program
entered the field of private duty nursing
nursing diversifies despite the many
difficulties within the profession
nursing continued to grow as an
occupational field and became recognized
as an essential healthcare service by
the early 20th century
nurses fanned out into diverse fields
delivering services to many people
outside of hospitals
for example lillian wald founded the
henry street settlement house in 1893
which provided nursing and other social
services to impoverished populations on
the lower east side of new york city
replication of wald's work in other
parts of the country led to the growth
of the field of public health nursing
opening up new employment opportunities
for nurses and
expanding the type of services provided
the onset of world war one created a
critical demand for the special skills
of nurses
about 23 000 american nurses served in
the military delivering care to the
armed forces both in the united states
and at the war front the success of
military nurses in providing essential
care during the war
ensured their participation in
succeeding conflicts
at home nurses continued to provide
essential service to the civilian population
population
the special skills possessed by nurses
were easily transferred to different
fields of health care for example
nurses were educated to administer
anesthesia during surgery
leading to the specialty field of nurse anesthetists
anesthetists
by the early 20th century it was quite
common to find nurse anesthetists
delivering anesthesia
in many of the nation's hospitals by the 1920s
1920s
in some parts of the country nurse
midwives delivered babies
in many cases to the most impoverished populations
populations
during the 1920s and 1930s hospitals
continued to expand
adding more and more patient beds and
delivering care that was rapidly
becoming more complex
nurses were the most essential
ingredient in ensuring that patients
received competent care delivered in a
safe manner
hospitals continued to rely heavily on
student nurses for patient care
but a trend emerged in which hospitals
hired more nurses who had completed
their education and graduated
these nurses initially called general
duty nurses but later referred to as
staff nurses
assumed greater and greater importance
in ensuring that the nation's hospitals
operated efficiently by the 1950s
staff nursing was the nursing's main
mid 20th century nursing
when the united states entered world war ii
ii
nurses duplicated the excellent work
they had performed in world war 1
taking critical positions in the armed
services and ensuring that the military
received appropriate care
about 78 000 nurses served in world war ii
ii
their contributions acknowledged as
essential to victory
the post-world war ii era posed new
challenges for the profession
while the modern intensive health care
system that emerged after the war
demanded larger number of nurses to
handle the increasingly complex and
technical needs of patients
there seemed to be fewer young women the
major population from which nursing drew
its recruits
willing to choose nursing as a career
nursing's image took on a heroic cast
during the war
but the reality for most nurses was that
the work was incredibly demanding
with few financial rewards and poor
working conditions
nursing failed to keep up economically
with other occupations
severe shortages of nurses characterized
the immediate post-war
period threatening the delivery of
health care services to the entire public
public
at the same time internal debates within
the profession
over the type of work in which nurses
should engage and the proper way to educate
educate
a nurse divided nurses into different camps
camps
some educators and other health care analysts
analysts
promoted removing nursing education from
its base within hospital training schools
schools
and placing it in institutions of higher education
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