Introduction to Nursing History and Professional Practice

Perception of the Nursing Profession

• Nursing consistently ranks among the most trusted professions, alongside other healthcare workers, doctors, and teachers.

• Public perception is often shaped by media representations, such as the television show Nurse Jackie.

• During a class discussion, a student named Alina identified the character Carla from the show Scrubs, noting that she was likely the most sensible character on the program.

Contemporary Examples of Nursing Advocacy and Crisis

• Miss Colorado (Miss Kelly): During a pageant talent segment, Miss Colorado performed a monologue about her interaction with a patient. During the interaction, she repeatedly told the patient, "I'm just a nurse," to which the patient responded, "No. You're not just a nurse," and explained the profound impact she had on him. Despite the message, women on a daytime television show mocked her, questioning why she was wearing a "doctor's stethoscope." This incident sparked significant backlash from the nursing community, clarifying that stethoscopes are professional tools for nurses, not exclusive to doctors.

• Alex Wubbles: An emergency room nurse and former Olympian who became a prominent figure in patient advocacy. While working, she was confronted by a police officer demanding a blood sample from an unconscious patient named Martha (who was allegedly involved in a car accident). In her state, the law required patient consent or a subpoena to draw blood for alcohol levels. Following hospital policy and state law, Wubbles refused to allow the draw without consent. The police officer forcefully arrested her, handcuffing her in the middle of the ER and dragging her out of the building. This event, captured on body cam footage, resulted in a settlement of approximately $\$500,000$ from the city government. Wubbles remained a fierce advocate for patient rights.

• Redonda Vaught: A nurse at a Nashville, Tennessee hospital (specifically involving a case roughly $3$ to $4$ years ago) who was involved in a fatal medication error. While working in an unfamiliar area, she bypassed medication system safeguards and administered the wrong drug to a patient scheduled for a CT scan. Instead of the prescribed anti-anxiety medication (Versed), she administered a paralytic drug called becarotium.

  • The Error: Both medications began with the letter "V." Paralytics like becarotium cause total muscular paralysis while the patient remains conscious. The patient, unable to move or breathe, went into cardiac arrest inside the scanning machine and died.

  • Consequences: Although Vaught self-reported the error, she was eventually fired, lost her license, and faced a high-profile criminal court case. The incident highlighted debates regarding individual nurse responsibility versus systemic hospital errors and competency standards.

Definitions and Foundations of Nursing

• Florence Nightingale’s Definition: Nightingale, the "Mother of Nursing," defined the profession as "an act of utilizing the environment of the patient to assist him in his recovery."

• In her $1816$ book, she expanded on the term, noting that nursing is more than just administrating medicine or applying poultices. It involves the proper use of:

  • Fresh air

  • Light

  • Warmth

  • Cleanliness

  • Quiet

  • Proper selection and administration of diet

• The American Nurses Association (ANA) Definition: Nursing is described as both an art and a science. It is a caring profession focused on:

  • Protection and promotion of health and human functioning.

  • Prevention of illness and injury.

  • Facilitation of healing.

  • Alleviation of suffering.

  • Advocacy in the care of individuals, families, groups, and communities.

Regulatory and Professional Guidelines

• Nurse Practice Act (NPA): Every state (e.g., Arkansas, Texas) has its own Nurse Practice Act. This legislation defines the legal scope of practice for nurses within that specific state. A nurse must be aware of the specific regulations of the state in which they practice, as permissions vary across state lines.

• National Park College Division of Nursing Philosophy: This internal document mirrors ANA standards, describing nursing as a discipline that treats human responses to health conditions through advocacy and professional presence.

Historical Evolution of Nursing

• $1600\text{s}$ and $1700\text{s}$: Healthcare was largely provided by men, specifically members of the church such as priests. They administered herbs, substances, and "poultices," often relying on apothecaries or folk practices. Women who assisted were often in marginalized roles, such as retired prostitutes or the elderly.

• The Almshouse Era: Hospitals (then called almshouses) were reserved for the destitute and poor. Wealthy individuals received medical care in their own homes from private caretakers or "nurse-wives."

• $19\text{th}$ Century Conditions (Pre-$1853$): There was no standard sanitation. Hospitals were sites of cross-contamination; for instance, a patient with a broken leg might be placed next to a patient with smallpox. Dressings were frequently recycled from one bleeding patient to another without cleaning. Waste was often dumped directly next to patient beds.

Influential Pioneers in Nursing History

• Florence Nightingale:

  • A wealthy woman who rejected the traditional path of marriage to seek fulfillment in caregiving.

  • She led $30$ nurses and $15$ nuns to care for soldiers during the Crimean War in the $1850s$.

  • She introduced foundational hygiene practices: bathing patients, providing proper food and water, improving laundry services, and prioritizing sunshine and air.

  • As a statistician, she crunched numbers to prove that her interventions reduced the death rate by $2/3$.

  • Known as the "Lady with the Lamp," she famously made rounds at night; it is humorously suggested she turned patients every $2$ hours as she walked from one end of the tent to the other.

  • She founded the Nightingale Training School for Nurses at St. Thomas Hospital.

• Linda Richards: Recognized as America’s first trained nurse ($1873$ graduate from New England Hospital). She is responsible for introducing doctor’s and nurse’s notes (documentation), establishing the requirement for nursing uniforms, and opening the first nursing school in Japan.

• Mary Mahoney: The first African American registered nurse in the United States ($1879$ graduate). She co-founded the National Association of Colored Graduate Nurses (NAGCN), which later merged with the ANA. The Mary Mahoney Award is a prestigious honor given to nurses who assist minority groups.

• Clara Barton: A former schoolteacher who organized medical supplies (bandages and gauze) during the American Civil War. In $1881$, she held a meeting in her New York City apartment that led to the founding of the American Red Cross.

• Lillian Wald: A pioneer of community health nursing who provided services to the poor in New York City. She was instrumental in the Henry Street Settlement and was involved with the NAACP, the Women's Trade Union, and the ACLU.

• Lavinia Dock: An influential nurse feminist and a founder of the organization that became the National League for Nursing (NLN). She was a significant activist for women’s suffrage and the passage of the $19\text{th}$ Amendment in $1920$.

• Margaret Sanger: A nurse who advocated for women’s bodily autonomy and birth control rights. She faced imprisonment for her activism and founded Planned Parenthood.

• Mary Breckinridge: Following the loss of her children, she studied midwifery in England and returned to establish the Frontier Nursing Service in Kentucky. She created a system where midwives were accessible by horseback within a $6\text{ mile}$ radius, significantly lowering infant mortality rates. She also founded the first midwifery school in the United States.

Diversity and Legal Milestones in Nursing

• Edward D. Lyon: The first male commissioned into the Army Nurse Corps, entering at a time when the corps was composed of over $4,000$ women.

• Joe Hogan: A male applicant who challenged the sex discrimination policy of the Mississippi University for Women. In $1982$, his case reached the Supreme Court, which ruled that publicly funded schools could not exclude students based on sex, citing the $14\text{th amendment}$'s Equal Protection Clause. Justice Sandra Day O’Connor delivered the majority ruling.

• Dr. Ernest Grant: A renowned burn care expert and the first male president ($36\text{th}$) of the American Nurses Association (ANA). In $2026$, he was recognized as one of six ANA "Living Legends."

• Ildaura Murillo-Rohde: A Hispanic nurse who founded the National Association of Hispanic Nurses in $1975$ to advocate for Latino/Hispanic nurses and patients. She also established the Dr. Rohde Award for Educational Excellence.

• Eddie Bernice Johnson: The first registered nurse to become a congresswoman (entering the profession in $1955$). She was the first Black woman to chair the House Committee on Science, Space, and Technology. She was pivotal in passing the CHIPS and Science Act and served $30\text{ years}$ in Congress before leaving in June $2023$.

• Jean Watson: is a prominent nursing theorist known for her Theory of Human Caring, which emphasizes the importance of the nurse-patient relationship and the caring aspect of nursing. Her work focuses on the concept of caring as a critical component of nursing practice, advocating for a holistic approach that takes into consideration the emotional, spiritual, and social aspects of patient care. Watson believes that caring promotes healing and fosters a supportive environment that enhances well-being and health outcomes. Additionally, she discusses the significance of a caring consciousness and how it shapes the way nurses interact with patients and their families.

Questions & Discussion

• Participant Alina: Shared knowledge of the character "Carla" from the television show Scrubs, describing her as the most sensible character.

• Query on Pageant Talent: A student asked about the monologue performed by Miss Colorado (Miss Kelly) regarding her nursing profession.

• Query on Slide Content: A student asked if the current slideshow was available on YouTube. The response was that the slideshow itself is not on YouTube, but a study guide provided to the students serves as an outline for the material.