Chapter One: Nursing Today

What is the average nurse?

„ Member of the largest group of health care
providers in US.
„ Employed in a Hospital
„ Caucasion
„ Female
„ 46.8 years old
„ Married
„ BSN prepared

Where do Nurses Work?

„ Majority Over ½ In Hospital Based
settings

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Practice Opportunities for
Nurses
„ Community
„ Entrepreneur
„ Occupational Health
„ School Nurse
„ Hospice/palliative care
„ Case management
„ Telehealth
„ Faith community
„ Informatics

Nursing Roles: Similarity and

Differences
„ Entry Level-RN Licensure
„ Positions may require Advance degrees

Employment Outlook
„ Growing need and opportunities
„ Salaries

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„ 1. In 2001 the average age of a
registered nurse was
1. 25.2 years
2. 35.6 years
3. 46.8 years
4. 55.9 years

„ The nursing credential required to hold

a position as a staff nurse in a hospital
is a/an
„ 1. RN license
„ 2. Baccalaureate degree
„ 3. Master’s degree
„ 4. Diploma

Chapter 2: The History and

Social Context of Nursing

“History of nursing is rich, filled with

struggle, neglect, missed opportunities,
vision, courage and victory” Chitty

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Ancient Times

Religious influences

Middles Ages

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Nursing in Early 19th Century
America

Florence Nightingale
„ Considered founder
of Modern Nursing
„ Influential in
Developing Nursing
Education
„ Defining Nursing
Practice
„ Nursing
Administration

Florence Nightingale
„ `Florence Nightingale Notes on
Nursing: What It Is and What It Is not
„ Philosophical basis
„ Nursing Education
„ Holistic-
„ Need for a theoretical base for nursing practice
„ Promote an environment conducive to healing
„ Nursing Body of Knowledge based- Not
Medical knowledge based

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1861-1865: American Civil War

Dorothea Dix- Civil War

Mary Ann Bickerdyke

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Phobe Pember

1869-1900 The Roots Take

Hold
„ 1873 First Training schools Modeled
after St Thomas Hospital School of
Nursing
„ Bellview Training School for Nurses, NY
„ Connecticut Training School for Nurses in
New Haven
„ Boston Training School for Nurses at
Massachusetts General Hospital

Isabel Hampton Robb-

Founder of ANA and NLN

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Lillian Wald-First Community
Health Nurse

Mary Mahoney- First African

American Professional Nurse

1900-1917: New Challenges

„ AJN first published
„ 1903 First Licensure Laws, NC,NJ,NY,VA
Helped define what nursing was

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Martha Minerva Franklin:
Co- Founder of NACGN

1917 Flu Epidemic and WWI

Jane Delano

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 Flu Epidemic

1920-1930
„ 1929 Nurses officially given rank in the
military
„ 1920 19th Amendment-Right to vote
„ Goldmark Report
„ Nursing and Nursing Education in the
United States 1923
„ Found wrong-Service Delivery vs. education
„ Nursing education –Belongs in university
setting

Mary Breckinridge

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1931-1945 Great Depression
and WWII
„ Great Depression-closure of Nursing
schools
„ Move to pay graduate nurses to work in
hospitals- change in how hospitals were
stafffed

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1945-1960 Bureaucracy,
Science and Shortage
„ 1946 Hill Burton Act- Increased building of
hospitals
„ Increased medical advance and specialization
„ Nursing Shortage
„ Team nursing
„ Technical Nurse-ADN programs- Mildred Montage
„ Integration of ANA

1961-1985: New roles for

Nurses
„ CCU for specialized care of MI patient
„ Nurse Practitioner roles
„ Title XVIII of Social Security act 1965
„ Medicare and Medicaid
„ Vietnam War

1986-2004 Managed Care and

New Challenges

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Lessons of History

The Social Context for Nursing

Traditional Socialization of
Women
„ Stereotypes

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Nursing, Feminism and
Women’s Movement

Men in Nursing

Image of Nursing

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Social Phenomena Affecting
Nursing
„ Aging population
„ Consumerism
„ Cultural Diversity
„ Advances in Technology
„ Violence in America

Imbalance of Supply and

Demand
„ Nursing Shortage
„ Solutions?

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„ The emergence of professional nursing
is usually attributed to the influence of
1. Florence Nightingale
2. Myra E. Levine
3. Imogene King
4. Martha Rogers

„ Which movement fueled the 1972

development of the Patients’ Bills of
Rights?
„ 1. Feminist movement
„ 2. “High-tech” nursing movement
„ 3. Consumer movement
„ 4. Movement toward excessive patient
abuse

Chapter Three: The

Development of Nursing as a
Profession

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Margretta Styles, 1985

„ ‘In the beginning, God created nursing.

He (or She) said, “ I will take a solid,
simple, significant system of education
and an adequate, applicable base of
clinical research, and on these rocks will
I build my greatest gift to mankind-
nursing practice” on the 7th day He (or
She) threw up his hands. And has left
the rest up to us.’

Definition of a Profession Vs
Occupation
„ Position
„ Job
„ Occupation
„ Profession
„ Professional
„ Professionalism

Three ways to Define a

Profession
„ Process Approach - Continuum of
Professional Development
„ Power Approach- Independence and
Power (Money)
„ Trait Approach-Multiple criteria

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Characteristics of a Profession
„ Flexner report 1910
„ Richard Hall 1968
„ Bixler and Bixler1945-1959

Comparison of Profession to Occupation

Evolution from Occupation to Profession

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Common Treads
„ Service/altruism
„ Specialized Knowledge
„ Autonomy/ethics

Trait Criteria-10 traits

„ Functions at a High Intellectual Level

„ Individual Responsibility and Accountability
„ Specialized Body of Knowledge
„ Serve the Public- Altruistic
„ Motivation to Public Service not Personal Gain
„ Organized Strong Professional Organization Represents
Profession and Controls Quality of Practice
„ Code of Ethics
„ Learned in Institutions of Higher Education
„ High Degree of Autonomy and Independence of Practice
„ Strong Professional Identity

Areas that nursing has not

met the criteria
„ Learned in Institutions of Higher
Education
„ High Degree of Autonomy and
Independence of Practice
„ Strong Professional Identity

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 Comparison of Profession to Occupation

Evolution from Occupation to Profession

Professionalism Continuum

„ Job------------------------------------Profession
„ Where is Nursing?

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Professional Accountability-
Elements
„ Organizational Accountability-Professional
Standards
„ Standards of Clinical Nursing Practice p385
„ Values and priorities
„ Direction for practice
„ Framework for evaluation
„ Define public and client outcomes
„ Education- accreditation
„ State Board of nursing
„ NLN
„ Certification-specialty practice
„ American Nurse Credentialing center

Professional Elements Con’t

„ Legislative: Practice acts
„ Legal definition of role and scope of practice
„ Purpose is to protect the public
„ Insure minimum standards of entry
„ Licensure and renewal
„ Discipline
„ Individual
„ Maintain professional competency
„ CEU, education, membership
„ Student

Nursing Contract with Society

„ Obligation to those who receive nursing
care
„ Nursing Social Policy Statement
„ Nursing Code of Ethics

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„ A nurse tells a peer, “I’m sick of being a low-paid
drudge! I hate being a preceptor for new nurses, and
I hate working on that unit research project. I think
I’ll go find a job outside of nursing.” The nurse who
hears this can assess that the nurse speaking is
„ 1. Expressing ideas uncharacteristic of a professional
nurse
„ 2. Motivated by having had a bad day
„ 3. Behaving unprofessionally
„ 4. Unaware of his/her limitations and ability to cope
effectively

„ An experienced nurse would demonstrate collegiality

with a novice nurse by which of the following?
„ 1. Allowing the novice plenty of independence to “get
his feet wet”
„ 2. Overlooking mistakes to avoid embarrassing the
novice
„ 3. Encouraging the novice to “opt out” of a unit-
based research project so he can complete his other
assignments more easily
„ 4. Offering to serve as a mentor to the novice with
mutually agreed upon goals

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