A Great Profession Keeps Getting Better

Mary Connaughton, R.N., M.S., still remembers decades later the moment she experienced first-hand how a nurse can make an immediate—and meaningful—difference in a patient’s life.

She was 22, a recent college graduate, working in her first hospital nursing job. “One of my first patients was a man in his 70s who had cancer and was in considerable pain much of the time,” she recalls. “He never appeared relaxed or comfortable. He had no family and no visitors.” On her second day of caring for the man, she brought him his pain medication. “Instinctively, I sat on the side of his bed and placed my hand on his arm without saying a word,” she says. “Within minutes, the fear in his eyes dissolved and he fell asleep. I learned in that moment the healing power of love, presence, and the human touch.”

Since that time, Connaughton and other nurses have seen their profession transformed in just about every way—except one.

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“The one constant is the healing relationship between the nurse, the patient, and the family,” says Connaughton, now principal and owner of Connaughton Consulting, a Newton-based healthcare consultancy. “That has never changed.”

But virtually everything else about nursing has morphed dramatically over the past few decades. Nurses manage more medications, handle more data, and use more new technologies for everything from direct patient care to managing medical records.

Meanwhile, they’ve earned high respect from their patients, their healthcare colleagues, and the general public. In December 2013—for the 12th straight year—nursing topped Gallup’s annual poll of the most-trusted professions, with 82 percent of adults surveyed rating nurses as having “high” or “very high” honesty and ethical standards.

But nurses haven’t always enjoyed autonomy on the job. Just a generation ago, “nursing was a lot about following orders and rigid routines,” recalls Connaughton, who started out as a staff nurse and later moved to administrative positions at Beth Israel Deaconess Medical Center and Mount Auburn and Massachusetts General hospitals.

Today, though, nurses increasingly serve as active proponents. “Over the decades, I’ve seen this emergence of nurses who are real leaders throughout healthcare,” says Jeanette Ives Erickson, R.N., M.S., DNP, chief nurse and senior vice president for patient care services at Massachusetts General Hospital. “They are influential not only in direct care—whether it’s in a hospital or in ambulatory health or somewhere else—but also in every setting that requires very smart, holistic people”—from the insurance industry to the corporate world to Capitol Hill.” In fact, the current US Congress includes at least five nurses, according to the American Nurses Association.

Nurses are even reaching the top executive ranks in both business and academia. Among them is Lea Johnson, R.N., Ed.D, now president of Maria College in Albany, N.Y. Johnson, who started out in marketing and publishing, turned to nursing in the 1990s following her mother’s death from cancer. “I was so impressed with the nursing care that she received that I decided to change careers,” says Johnson, who earned a master’s degree in nursing from the MGH Institute of Health Professions, then spent a decade developing nursing programs at Northeastern University. She also received a doctoral degree in education from the University of Pennsylvania and served as a top administrator at American International College in Springfield before being inaugurated as Maria’s fourth president in 2012.

Johnson is among those who believe today’s nurses need ongoing access to continuing education. “The base of medical knowledge is still doubling every year,” she says. “To keep up, you have to keep on learning. You can’t just stop.”

Ensuring lifelong learning for nurses was among the major recommendations of a landmark 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” from the Institute of Medicine of the National Academy of Sciences. The report emphasized that “nursing education should be viewed as a continuous practice,” says Kevin Whitney, R.N., M.A., an associate chief nurse at MGH and a member of the Massachusetts Action Coalition, a future-focused nursing group that evolved from the report.

Among the coalition’s goals: helping nurses move up the academic ladder. Currently, just 55 percent of Bay State nurses hold bachelor’s degrees; the Institute of Medicine report calls for boosting levels nationwide to 80 percent by 2020. As one step in that direction, state education officials recently endorsed the coalition’s efforts “to provide a seamless, cost-effective, timely, and transparent pathway” from associate degree nursing programs at community colleges to bachelor degree programs at state universities, beginning this fall. “We know from research that nurses who advance their skills are better equipped to deal with the challenging medical cases presented by an aging population,” Richard M. Freeland, the state’s higher education commissioner, said in explaining support for the plan.

Some nurses don’t want to stop at a bachelor’s degree. About 5 percent pursue graduate study to become advance practice nurses (APNs), such as nurse anesthetists, nurse midwives, and nurse practitioners, according to US Department of Labor statistics. Look for that percentage to grow, predicts Laura L. Hayman, R.N., Ph.D., professor and associate vice-provost for research in the College of Nursing & Health Sciences at University of Massachusetts Boston. “The APN role is here to stay,” she says. “Advanced practice nurses are desperately needed in primary care.”

In addition, nurses can expect to play an increasingly important role in healthcare reform. “Affordable care is predicated on the fact of nurses taking larger and more demanding roles in advocating for patients, being able to help them navigate the system, and get acute care as needed—but also on helping people stay well and helping them distinguish when they need healthcare,” says Sister Callista Roy, R.N., Ph.D., professor and nurse theorist at the William F. Connell School of Nursing at Boston College. Bottom line, she says: “The whole thing will not work without really good nursing care.”

Meanwhile, many nurses say they hope to see far more diversity in their ranks in the not-too-distant future. The Bay State nursing workforce is about 84 percent white and 93 percent female, Roy says. “The nursing workforce needs to look more like the patients we are serving,” adds Ives Erickson.

But while plenty of challenges remain, nurses say their profession’s outlook has never been brighter. “It’s a wonderful time to be a nurse,” says Johnson. “The future is ours.”

And even the unrelenting tidal wave of change sweeping over the healthcare landscape won’t affect nursing’s rock-solid core, Connaughton says: “Nurses will never, ever let go of what’s good for the patient.”