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Nursing Through the Decades

A salute to the art and science of healthcare's frontline professionals

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May 6, 2012
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Deborah Baker remembers the days in nursing when nurses had to handwrite medicine cards for each patient. Trays were used for passing out medications, after the drugs were taken from a stock cabinet. Infection control departments were rare or nonexistent, and patients stayed for days in the hospital. She worked in a busy practice, filing charts and correspondence for medical records.

Flash forward to today, a few decades later. Baker, now chief nurse executive at Mount Auburn Hospital, has seen a world of change in nursing. In a quiet unit in the ICU, with the beeping sounds of a heart monitor behind her, she shows how nurses can point and click to make entries on an electric medical record, instead of writing pages of nursing notes.

Even with an aging population and more chronic illnesses like obesity and diabetes taking their toll, there is a shorter length of stay for patients.

There is an array of diagnostic and patient care equipment for nurses, who continue to rely on their assessment and communication skills for 24/7 care.

Bar coding technology makes medication errors practically non-existent. And in many ways, said Baker, “technology has helped to bring nursing back to the bedside. We have streamlined care coordination and processes to make the nursing work day more efficient and productive, allowing more time for the caring components of the practice.”

A recent Institute of Medicine report, The Future of Nursing, celebrates nurses, the largest component of the healthcare work force, and charges them to lead change and collaborate and coordinate care across teams of healthcare professionals. It also calls for nurses to be lifelong learners, filling expanding roles and mastering technological tools and information management systems.

“As we face the most fundamental changes any of us have ever witnessed in healthcare, it is important to understand the role that nurses can play in shaping healthcare redesign,” said Jackie Somerville, chief nursing officer at Brigham and Women’s Hospital. “The system, and most importantly our patients and their families, need the voice of the nursing community at the table now more than ever. It is critical that every nurse articulates his or her practice, their unique contributions, and the skill set that makes them equal partners in the conversation about the future of healthcare.”

Nurses continue to outrank other professions in Gallup’s annual Honesty and Ethics survey. Eighty-one percent of Americans say nurses have “very high” or “high” honesty and ethical standards, which speaks to the importance of advocacy by nurses for patients and families in an increasing complex medical system.

The number of baccalaureate, masters, and doctorate-prepared nurses has also been increasing, with compelling evidence that patient outcomes improve when nurses are more highly educated. “Nursing has always been described as ‘an art and a science,” said Gaurdia Banister, executive director of nursing administration at Massachusetts General Hospital. “Caring and compassion have always been linked with knowledge from the biological, behavioral, physical, and social sciences to make clinical decisions.”

Studies continue to identify altruism—wanting to make a difference in someone else’s life—as the primary reason students enter the nursing profession. Meg Doherty, head of Norwell VNA and Hospice, which serves 23 communities across the South Shore of Boston, and an employer of nurses for the past 30 years, believes that professional competence can be taught, but that the personal quality of caring is an inherent skill.

“Caring can be enhanced and nurtured through emulation, but it is either there to begin with or it is not,” said Doherty. “We look for the personal characteristic of caring during the employee interview, using specific behavioral questions.” Doherty also pointed out that, upon graduation, a nurse applicant for licensure in the Commonwealth of Massachusetts must be “of good moral character” in order for the Board of Registration in Nursing to find the individual to be a safe and competent practitioner. “This is why nursing remains one of the most trusted professions as we continue to provide safe, competent nursing care,” Doherty added.

The enactment of the President Obama’s Affordable Care Act will add 32 million Americans to the roles of the insured. With a healthcare system that is already under stress because of a shortage of primary care providers, nurses of all specialties, and especially nurse practitioners, will play a critical role in wellness and the prevention and early detection of diseases.

“I knew I wanted to become a nurse since I was eight years old,” said Nancy O’Rourke, a nurse practitioner at Good Samaritan Medical Center in Brockton and Massachusetts state representative for the American Academy of Nurse Practitioners. She started as a candy striper, and discovered she loved taking care of people. After working as an RN for a few years, she decided she wanted to be able to understand more about the human body and illness and became a nurse practitioner. “That was 22 years ago, and it was the best decision, I ever made,” said O’Rourke.

With healthcare becoming increasingly complex, said Mass General’s Gaurdia, “who would you want caring for your mother, father, siblings, spouse/partner? Wouldn’t you want the very best? I know I would.”

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