Advanced practice nurses (APNs) had limited authority.
Nursing research was minimally supported and recognized.
Today:
Increased enrollment in AD and BSN degree programs.
APNs' roles have expanded to include prescriptive authority in many states.
National Center for Nursing Research established in 1993.
Influence of Healthcare Settings
Rising costs
Complexity of healthcare settings and services
Expanding community health services
Increasing use of ambulatory care services
Technologic Advances
Less invasive diagnostic tools and procedures.
Computerized monitoring systems and critical care interventions.
Expense of new life-saving technology leads to questions of resource allocation.
Access to Healthcare and Financial Resources
Access to healthcare services refers to a person’s ability to find and receive care from a healthcare provider, which is related to income, race, and geographic location.
Healthcare providers are asked to put a dollar value on their services and relate their services to patient outcomes.
Rising healthcare costs spurs debate between quality of life and quantity of life.
Future Challenges for Nursing
Healthcare cost containment
Scientific and technologic advances
Social issues
Find ways to balance the demands of being an adult learner with the responsibilities of adult life.
Evolution of Professional Nursing
Ancient History:
Hippocrates recognizes need for nurses.
Boundary between nursing and medicine often blurred.
Christianity improves status of nursing by attracting intelligent individuals and establishing military nursing orders.
Florence Nightingale:
Improved health laws, reformed hospitals, reorganized military medical services
Established nursing as a profession.
Published Notes on Nursing
Started the Nightingale Training School for Nurses.
Military Influence on American Nursing
Civil War: Dorothea Dix found Nurse Corps of the U.S. Army, expanding nursing’s role; Clara Barton found American Red Cross.
Spanish American War: Volunteer Nurse Corps (1898) established and becomes the Army Nurse Corps (1901); Navy Nurse Corps established in 1908.
World War II: Black nurses first admitted into military service.
Professional Nursing Organizations and Journals Emerge in Early 20th Century:
American Nurses Association (ANA)
National League for Nursing (NLN)
American Association of Colleges of Nursing (AACN)
American Journal of Nursing.
21st Century Nursing:
Nurses need to be able to render care in a wide range of settings, adapt to needs of diverse patients, and be knowledgeable of emerging technologies.
Educational Preparation
Practical Nursing Programs:
Graduates eligible to take the National Council Licensure Exam-Practical Nursing (NCLEX-PN) to become a licensed practical nurse (LPN) or licensed vocational nurse (LVN).
Registered Nurse Programs:
Graduates eligible to take the National Council Licensure Examination-RN (NCLEX-RN).
Programs include diploma nursing programs, associate degree programs, baccalaureate degree programs, and graduate entry programs.
Socialization Into a Profession
Socialization:
A process involving learning both theory and skills and also of internalizing an identity appropriate to a specific role.
Criteria of a Profession:
Having a specific body of knowledge and a set of values and skills that differentiate members of a profession from others.
Skill Proficiency in Nursing:
Benner identified five levels of proficiency in acquiring and developing nursing skills: Novice, Advanced Beginner, Competent, Proficient, and Expert.
Beyond Entry Level Into Practice (Advanced Nursing Education Programs)
RN to BSN
Master’s Degree (MSN/APN)
Doctorate of Nursing Practice (DNP)
Research Doctorate Degree (PhD; EdD, DNS)
Advancing Education
Continuing Education:
Some states require acquisition of continuing education for ongoing licensure.
Certification:
Certification is a voluntary process that provides professional recognition of the knowledge, skills, and abilities within a practice area.
Expanded Nursing Roles
Nurse practitioner (NP)
Clinical nurse specialist (CNS)
Nurse midwife
Nurse anesthetist
Nurse researcher
Nurse administrator
Nurse educator
Professional Nursing Practice
Standards of practice are the minimum acceptable guidelines for providing and evaluating nursing care.
The ANA designates professional nursing responsibilities such as assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
Scope of practice is the legislation describing what nurses are legally authorized to do.
The Nurse Practice Act of each state defines the practice of nursing within the state.
Nurse Practice Acts
Each state’s Nurse Practice Act defines the practice of nursing within its jurisdiction.
The state’s board of nursing sets requirements for licensure.
New nursing graduates must pass the NCLEX to qualify for a nursing license.
Nursing Responsibilities
Patient
Caregiver
Educator
Advocate
Decision maker
Manager and coordinator
Communicator
Nursing Competencies
The Quality and Safety Education for Nurses (QSEN) initiative identified key quality and safety competencies for nurses:
Patient-centered care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Safety
Informatics
Nursing Program Accreditation
Program accreditation is a voluntary process that demonstrates achievement of national standards of excellence.
Organizations accredited by the U.S. Department of Education to accredit nursing programs are the following:
Commission for Nursing Education Accreditation (CNEA): Accredits practical nursing programs, all entry-level registered nurse programs and nursing master’s and doctoral programs.
Commission on Collegiate Nursing Education (CCNE): Accredits baccalaureate and higher degree programs.
Accreditation Commission for Education in Nursing (ACEN): Accredits nursing programs at all levels of education.
Professional Nursing Organizations
American Nurses Association (ANA):
Sets the standards of practice for nurses and makes decisions about the functions, activities, and goals of the nursing profession.
Sigma Theta Tau International (STTI), Honor Society of Nursing:
Provides leadership and scholarship in practice, education, and research to enhance the health of all people.
National Student Nurses’ Association (NSNA):
An autonomous organization that is financed and administered by students that serves as the voice of nursing students.
Nursing Theory
There are four central concepts in nursing practice that are defined and described in nursing theories.
Each nursing theory defines, relates, and emphasizes the following four concepts differently:
Person
Environment
Health
Nursing
Nonnursing Theories Used or Adapted by Nursing
General systems theory (von Bertalanffy)
Human needs theory (Maslow hierarchy of human needs)
Change theory (Lewin)
General Systems Theory
Major assumptions of this theory include the following:
All systems must be goal directed.
A system is more than the sum of its parts.
A system is ever changing, and any change in one part affects the whole.
Boundaries are implicit, and human systems are open and dynamic.
Nursing theorists who have used this approach include Roy, Neuman, Johnson, and Parse.
Maslow Hierarchy of Human Needs
Physiologic needs: The need for oxygen, food, water, elimination, activity, rest, temperature maintenance, and sexuality.
Safety needs: The need to be physically safe and free from fear and anxiety resulting from lack of security and protection.
Love needs: The feeling of belonging and being loved to avoid loneliness and isolation.
Esteem needs: Composed of esteem derived from others (respect) and self-esteem.
Self-actualization needs: The need to maximize one’s potential.
Lewin Change Theory
Change theory offers insight into expected behaviors when significant change occurs within an environment.
Three recognized stages are as follows:
Unfreezing: Recognition of the need for change and the dissolution of previously held patterns of behavior.
Movement: Shift of behavior toward a new and more healthful pattern.
Refreezing: Long-term solidification of the new pattern of behavior.