Role of the Nurse - 1000

Role of the Nurse and Historical Perspectives

Instructor Information

  • Elayna Bronson, MSN, RN

  • Normandale Community College

Objectives

After completing this course, students will be able to:

  • Describe the definitions of nursing.

  • Explain how nursing qualifies as a profession.

  • Compare and contrast various levels of education in nursing.

  • Recognize the history of nursing and nursing practice.

  • Identify current trends in nursing.

What is Nursing?

  • Definition of Nursing: Nursing integrates the art and science of caring and focuses on:

    • Protection, promotion, and optimization of health and human functioning.

    • Prevention of illness and injury.

    • Facilitation of healing.

    • Alleviation of suffering through compassionate presence.

    • Diagnosis and treatment of human responses and advocacy in care for individuals, families, groups, communities, and populations in recognition of humanity's interconnectedness.

    • Source: American Nurses Association (2021). "Nursing: Scope and Standards of Practice, Fourth Edition."

What is a Nurse?

What a Nurse Does:

  • Vital signs measurement.

  • Health assessments.

  • Wound care.

  • Patient education.

  • Additional responsibilities include various tasks in patient care.

Who a Nurse Is:

  • Adheres to professional standards.

  • Engages in autonomous practice.

  • Acts as a patient advocate.

  • Participates in research activities.

  • Functions as an innovator in healthcare settings.

Nursing as a Profession

  • Definition of a Profession: An occupation whose core element is based on mastering a complex body of knowledge and skills. It is a vocation that applies specific scientific knowledge and art in service to others.

    • Source: Cruess SR, Johnston S, Cruess RL. "Profession": a working definition for medical educators. Teach Learn Med. 2004 Winter;16(1):74-6.

Criteria Determining Nursing as a Profession:

  • Possesses a unique body of specific knowledge.

  • Requires formal education (School, clinical, lab) culminating in passing the NCLEX (National Council Licensure Examination).

  • Upholds a code of ethics, specifically the ANA Code of Ethics.

  • Adheres to established standards of care.

  • Engages in ongoing research facilitated by the National Institute of Nursing Research (NINR).

  • Exercises autonomy in practice, including the ability to make independent decisions beyond physician directives.

Standards of Care

  • Definition: The established standards of practice within nursing professional and specialty areas, serving as benchmarks by which a nurse's performance is evaluated.

  • Legal Measurement: Standards serve as a measure for the legal evaluation in malpractice cases.

Types of Standards:

  1. External Standards:

    • Developed by the American Nurses Association (ANA).

    • Governed by state nurse practice acts, nursing specialty practice group criteria, and federal agency regulations.

  2. Internal Standards:

    • Specific policies and procedure manuals of hospitals, clinics, and agencies that apply to nursing practice.

Examples of Standards of Care:

  • Medication Administration: Involves a triple check for documenting the 5 rights of medication administration.

    • Right patient, right drug, right dose, right route, right time.

  • Use of the Reasonably Prudent Person standard in assessing nursing actions.

  • Accreditation standards, such as the ACEN Criterion 4.4:

    • Curriculum must be developed and regularly reviewed by the faculty and implemented as published.

  • Compliance training must be maintained annually for adherence to established standards.

HIPAA (Health Insurance Portability and Accountability Act)

  • Signed into law in 1996 by President Clinton to protect individual health information while ensuring the flow of necessary health information to provide high-quality care.

  • Minimum Necessary Rule: Ensures that protected health information access is limited to the minimum necessary data to fulfill the intended purpose according to work responsibilities.

    • IMPORTANT: Only access the necessary protected health information required for your job.

Historical Background of Nursing

Key Figures and Events:

  1. 19th Century:

    • Florence Nightingale: Published "Notes on Nursing" (1859), laid the foundation for modern nursing.

    • Harriet Tubman: A nurse and abolitionist, notable for her role in the underground railroad and Civil War nursing efforts.

  2. 20th Century:

    • World War I: Increased demand for trained nurses; nurses received officer ranks, serving on frontlines and contributing to reduced casualties.

    • Lavinia Dock: A nursing leader advocating for women's rights; authored the first nurses’ manual on medications.

    • 1950: "Code for Professional Nurses" published in the American Journal of Nursing.

Additional Historical References:

  • World War II:

    • Significant shifts in medicine and care delivery, including the transition from diploma programs to associate degree programs, increased technological advancements, and a rise in critically ill patients.

    • War often catalyzed major changes in nursing practices and education.

Pathway to Becoming a Nurse (Entry into the Profession)

  • LPN: Licensed Practical Nurse.

  • RN-Associate Degree (AD or ADN): Two-semester program, limited scope of practice, often a starting point for many nurses.

    • May require BSN for some employment opportunities as a condition of continued employment.

  • RN-Bachelor’s Degree (BSN): Four-year program with a more comprehensive focus on community and population health, leading to better patient outcomes and enhanced career opportunities.

  • RN-Master’s Degree (MSN): Advanced practice routes often require a previous Bachelor’s degree in a non-nursing field.

Impact of COVID-19 on Nursing

  • Increased prestige and recognition of nurses as heroes.

  • Greater appreciation and awareness of nurses' work.

  • Highlighted the vital role of nurses as patient advocates.

  • Surge in demand and financial incentives for travel nurses.

  • Issues regarding understaffing led to increased quitting rates among nurses.

  • Adaptation to working in potentially unsafe environments.

  • Broader implementation of telehealth services.

Current Trends in Nursing

  • Continued emphasis on acquiring a BSN for competitive nursing positions.

  • Most RNs currently hold an ADN, leading to a push for higher education standards.

  • The rise of for-profit nursing schools.

  • Multiple licensure across state lines for nursing practice.

Exam Question Sample (NCLEX Style)

  • A nursing instructor outlines criteria establishing nursing as a profession. What points correctly describe these criteria? (Select all that apply)

    • Nursing has a defined body of specific knowledge.

    • Nursing interventions rely on medical practice.

    • Nursing possesses standards of practice.

    • Nursing is regulated by the medical industry.

    • Nursing adheres to a code of ethics.

    • Nursing is influenced by ongoing research.

Answers Explanation

  • Similar to the exam question sample,

    • Correct responses reinforce that nursing has distinct knowledge bases, ethical codes, and influences from ongoing research, alongside dedicated standards of practice.

References

  • Accreditation Commission for Education in Nursing. (2023). Standards and criteria. Available at: https://www.acenursing.org/acen-accreditation-manual/accreditation-standards/

  • Garofalo, M. E., & Fee, E. (2015). Lavinia Dock (1858-1956) Picketing, parading, and protesting. American Journal of Public Health, 105(2), 276-277. doi:10.2105/AJPH.2014.302021

  • History.Com Editors. (2023). Florence Nightingale. Available at: https://www.history.com/topics/womens-history/florence-nightingale-1

  • Lasater, K.B., et al. (2021). Is hospital nurse staffing legislation in the public's interest? An observational study in New York State. Med Care, 59(5), 444-450. PMID: 33655903

  • National Institute of Nursing Research. (n.d.) Available at: https://www.ninr.nih.gov/

  • Whelan, J. C. (n.d.) American nursing: An introduction to the past. University of Pennsylvania. Available at: https://www.nursing.upenn.edu/nhhc/american-nursing-an-introduction-to-the-past/