History and Social Context - PowerPoint Presentation

History and Social Context Catherine Hrycyk MScN , RN

Evolution of Definitions of Nursing Florence Nightingale – Notes on Nursing: What It Is and What It Is Not (originally published 1859) Early 20 th century definitions: Harmer and Henderson (1939)Post-WW II definitionsProfessional associations’ definitionsANAICNDefinitions by state legislaturesSee North Carolina definition 2

Evolution of Definitions of Nursing Reflect the social and political context of the time Five common themes in all definitions of nursing: Nurses:Promote healthPrevent diseaseRestore healthAlleviate sufferingAdvocacy for those in need 3

History of Nursing: Classical Times Need to care for ill, infirm, children and elders as old as human society Anient Greece:Special protected sites for the provision of careAncient Rome:Rudimentary regulation of activities that constitute nursing in Lex Duodecem Tabularum (509 BC)Primary goal to protect recipients of careReligious orders dedicated to the provision of care 4

History of Nursing: Medieval Times Religious orders Military units Knight Templars:Often labeled first ‘professional’ nursesMen onlyHad insignia that identified them as nurses and protected them while tending to wounded soldiersNursing pin derived from the insignia5

19th Century: Reform of Nursing Florence Nightingale Reformed nursing practice and education Introduced scientific methodology to nursingTraining: Kaiserswerth, Germany and Sisters of Charity, ParisCrimean War (1854–1956) – hospital set-up in Scutari, TurkeyData collection on morbidity and mortality to reform the British healthcare 1859: Notes on Nursing1860: Founded first modern school for nurses (St. Thomas’ Hospital, London)6

Mid-19th Century: Mary Seacole Jamaican nurse and businesswoman. Greatest black Briton. Did not work with Nightingale during the Crimean War. She was rejected by Nightingale. Expert on cholera – managed the care of the soldiers of CrimeaWas it possible that American prejudices against colour had some root here? Did these ladies shrink from accepting my aid because my blood flowed beneath a somewhat duskier skin than theirs?” (Spartacus Educational, 2014)7

The American Civil War The war created an impetus for nursing training No available professional nurses at the start of the Civil War. Catholic orders served as nurses. Call to duty: Emergence of nurses and nurse leadersCivil War and NursingIt helped advance professional nursing practiceNursing leaders though achieved dramatic improvements in careThe success in the reform of military hospitals served as a model for reform of civilian hospitals nationwide. 8

After the Civil War 1861: Sanitary Commission – relief agency to support wounded and sick soldiers Lobby for creation of nursing schools (Donahue, 1996) 1869: American Medical Association recommended training schools for nurses in large hospitals Inadequate conditions in many hospitals sparked the need for social reformMultiple schools based on Nightingale’s modelClara Barton – nurse leader, founder of American Red Cross9

The Henry Street Settlement Early in 20th Century Influx of immigrants and factory work in northeastern US Infections and overcrowding in inner city tenements1893: Establishment of Henry Street SettlementLillian Wald and Lavinia Dock They sought finances and formalized public health.They treated minor illnesses, prevented disease transmission, and provided health education. Margaret Sanger and Lower East Side (Kennedy, 1970) Immigrant womenSafe contraception and family planning 10

Nursing Licensure Licensure began in New Zealand, followed by British Columbia (Canada), UK and NC (USA) Ellen Dougherty – first registered nurse (NZ)ICN resolution: Each country and state to provide for licensure of the nurses1903: Permissive licensure laws: Nurses did not have to be registered to practice but could not use the title of registered nurse (RN) unless registered. 1923: All states required permissive licensure1947: New York fully mandated licensure1950: NLN and first nationwide State Board Test Pool Examination 11

Historic Events in 20th/21 st Centuries Events influencing nursing:World war 1Flu pandemicTB pandemicWorld war 2Changing role of womenVietnam warHuman rights movementNew pandemics (HIV/AIDS)Climate change and natural disastersTerrorism 12

Social Context: Image of Nursing Media depiction of nurses Nursing caps and other forms of identification Gallup surveys: Nurses were rated No 1 among a number of professions and occupations on honesty and ethics every year since 1994 (except 2001, #2) Nurse Ratched in “One Flew Over the Cuckoo’s Nest” Woodhull Study on Nursing and the Media (1997):“Nurses and the nursing profession are essentially invisible to the media and, consequently, to the American public” 13

Nursing in USA Today The Nursing Workforce Surveys : 1977–2008: National Sample Survey of Registered Nurses (Health Resources and Services Administration [HRSA], 2013)A comprehensive survey of nursing workforce every 4 yearsFinal 2008 report: http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf. 2013: Comprehensive national survey of RNs (Budden, Zhong, & Moulton, 2013)National Council of State Boards of Nursing (NCSBN) and the Forum of State Nursing Workforce Centers (FSNWC) 14

Nurses in the Workforce 2000s RN grew by 24.1% (Health Resources and Services Administration, 2013). 2013 – More than 4 million held licenses as RNs ( Budden et al., 2013). ~2.8 million nurses were working (HRSA, 2013).2008 NSSRN data90% of < 50 years old were employed in nursing full- or part-time.A significant percentage of nurses held two nursing positions.15

Nurses in the Workforce: Gender Dominated by women 2000–2008: Men in nursing increased by 50% (US DHHS, 2010) Overall, 7% of nurses are men. Among NCSBN/FSNWC survey Before 2000: 5% men2010 and 2013: 11% men (Budden et al., 2013)16

Nurses in the Workforce: Age Average age of RN in US is 50: Why? Recent economic downturn and high unemployment rates Older nurses are more likely to remain in the workforce because the nursing field is reasonably protected from the layoffs and downsizing experienced in other professions.RNs < 40 year old were 25.9% of total RN workforce in 200817

Nurses in the Workforce: Race and Ethnicity Racial and ethnic minorities 37% of Americans. Only 19% of the RN population are minorities (Budden et al., 2013). Hispanics/Latinos: 15.4% of the U.S. vs. 3.6% of RNsBlack/African American: 12.2% of the U.S. vs. 5.4% of RNs. Asian or Native Hawaiian/Pacific Islander: 4.5% of the US vs. 5.8% of RNs 18

Nurses in the Workforce: Education Entry level into Practice Successful completion of pre-licensure education Successful passing the NCLEX-RN . Successfully passing the NCLEX-RN then qualifies you to be licensed as an RN.Multiple educational pathways to qualify to take the NCLEX: Bachelor of Science in Nursing (BSN) degree,Graduate programs (MSN, DNP) Associate of Science in Nursing (ADN) Diploma programs 19

Nurses in the Workforce: Foreign Educated Increasing recruitment internationally educated nurses (3.7% in 2004 to 5.6% in 2008 (Thekdi, Wilson, and Xu, 2011): Strategy to expand the nursing workforce in response to the recent nursing shortages. Issues facing the foreign-educated nurses:Different views of gender, authority, power, and age (Thekdi at al., 2011) . Absolute respect for experts and teachers is common among foreign-educated nurses, creating a permanent barrier between nurse-managers and foreign-educated nurses. 20

Four Most Common Roles Direct patient care Research, teaching undergraduate and graduate students, and managing companies Advanced education, such as master’s and doctoral degrees, are prepared to become researchers, educators, and administrators. Advanced practice nurses (APNs) – includes nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), and certified registered nurse anesthetists (CRNAs). 21

Practice Settings for Professional Nurses Hospitals 63.2% Ambulatory care 10.5% Public and community health 7.8%Home health 6.4%Extended care facilities 5.3%Others ~6.8%(US DHHS, 2010, 3–9)22

Nursing in Hospitals Educational credentials: AND, BSN, MSN, DNP, PhD Entry-level positions require RN licensure BSN may be preferred or requiredAs per research, outcomes better in hospitals with higher proportion of RN’s holding BSNNurse managers - 24-hour accountability, required to have MSNClinical nurse specialists – advance practice roleExample: Oncology clinical specialistStrong focus on evidence-based practice (EBP) 23

Nursing in Communities Community nursing: Lillian Wald (1867–1940) and the Henry Street Settlement in New York City in 1895 Lillian Wald considered the founder for community / public health nursingBroad field of community health nursing Focus on prevention and community educationGovernment and private agenciesHomecare:Emerging specialty distinct from community nursingIncreasing utilization of home based nursing servicesHomecare associated with improved outcomes and is more cost-effectiveAmerican Nurses Credentialing Center (ANCC) 24

Nursing in Schools National Association of School Nurses (NASN) (2015): “School nursing is a specialized practice of professional nursing that advances the well-being, academic success, life-long achievement, and health of students.” Impact of school nursing Requirements including knowledge and skillsCounselling, health curriculum, routine illness, and emergenciesSpecific issues: Abuse, school violence, and obesity25

Other Settings Outpatient settings (clinics) Occupational health Armed forces:Scope of practice different / generally widerPalliative care and end-of-life settingsTelehealthNursing informaticsNursing in faith communitiesEntrepreneurshipNursing education 26

Clinical Nurse Leaders AACN (2008): Clinical nurse leader as a new credential Intent: allow master’s-prepared nurses to oversee and manage care at the point of care in various settings Not intended to be administrators or managers, but are clinical experts Controversy and objection from clinical nurse specialists27

Advanced Practice Nursing Advanced educational and clinical practice requirements beyond basic pre-licensure nursing education. 2008: More than a quarter of a million RNs held the required credentials to work as advanced practice nurses (APNs) (US DHHS, 2010). High patient acceptance and cost-effective Four categories of APNs: nurse practitioner, clinical nurse specialist, certified nurse-midwife, and certified registered nurse anesthetist28

Nurse Practitioner Education: MSN and post-master’s certificates, or DNP (required after 2018) National certification exams Diagnose and treat acute and chronic conditionsBarriers to practiceVaried levels of practice autonomies among statesLack of physician understanding of NP scope of practicePayer policies Care settings29

Clinical Nurse Specialists Initially developed in mental health settings Now work in a variety of settings Master’s or doctoral prepared with expertize in a particular field of practicePerform health assessments, make diagnoses, deliver treatment, and develop quality control methodsCNSs work in consultation, research, education, and administration30

Certified Nurse-Midwife Education: MSN Licensed, independent health care providers Federal law: CNMs are primary care providers. CNMs attended 313,846 births in 2012. (11.8% of all spontaneous vaginal births) (American College of Nurse-Midwives, 2015)CNM-attended births: half the national average rates for cesarean sections and higher rates of successful vaginal births after a previous cesarean 31

Certified Registered Nurse Anesthetist 2015: ~ 48,000 certified registered nurse anesthetists (CRNAs) and CRNA students in the United States (AANA, 2015) Nurse anesthetists administer approximately 30 million anesthetics each year and are the only anesthesia providers in nearly one third of U.S. hospitals (AANA, 2015). Collaborate with physician anesthesiologists or work independently in various settings (AANA, 2015).Education: MSN or higherRequires: National certification and recertification“No difference in the quality of care provided by CRNAs and their physician counterparts” (AANA, 2015)32

Employment Outlook in Nursing Growing opportunities for nurses Technological advancements Increasing emphasis on primary careAging populationHospital care to cost-effective home careLong-term careNursing salaries including advanced practice nursesWage compression – flattening of salaries for experienced nurses33