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History and Social Context

History and Social Context. Catherine Hrycyk , MScN , RN. History and Social Context. Work in pairs. Answer the following questions (write them down): Where do nurses work? What is the public image of nursing? Whom do nurses report to?. Evolution of Definitions of Nursing.

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History and Social Context

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  1. History and Social Context Catherine Hrycyk, MScN, RN

  2. History and Social Context • Work in pairs. Answer the following questions (write them down): • Where do nurses work? • What is the public image of nursing? • Whom do nurses report to?

  3. Evolution of Definitions of Nursing • Reflect the social and political context of the time • Florence Nightingale – Notes on Nursing: What It Is and What It Is Not (originally published 1859) • Early 20th century definitions: Harmer and Henderson (1939) • Professional associations’ definitions • ANA • ICN • Five common themes in all definitions of nursing. Nurses: • Promote health • Prevent disease • Restore health • Alleviate suffering • Advocacy for those in need

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

  5. History of Nursing: Medieval Times • Religious orders • Military units • Knight Templars: • Often labeled first ‘professional’ nurses • Men only • Had insignia that identified them as nurses and protected them while tending to wounded soldiers • Nursing pin derived from the insignia

  6. 19th Century: Reform of Nursing Florence Nightingale • Reformed nursing practice and education • Training: Kaiserswerth, Germany and Sisters of Charity, Paris • Crimean War (1854–1956) – hospital set-up in Scutari, Turkey – used scientific methods to evaluate morbidity and mortality • Introduced scientific methodology to nursing, first RECORDED nurse scientist • Data collection on morbidity and mortality to reform the British healthcare • 1859: Notes on Nursing • 1860: Founded first modern school for nurses (St. Thomas’ Hospital, London)

  7. Historic Events Affecting Nursing in USA • The American Civil War: • The war created an impetus for nursing training • No available professional nurses at the start of the war. • It helped advance professional nursing practice • Nursing leaders though achieved dramatic improvements in care • The success in the reform of military hospitals served as a model for reform of civilian hospitals nationwide. • After the Civil War: • 1861: Sanitary Commission – relief agency to support wounded and sick soldiers • schools for nurses in large hospitals • Multiple schools based on Nightingale’s model • American Red Cross • Clara Barton – nurse leader, founder of American Red Cross

  8. The Henry Street Settlement • Early in 20th Century • Influx of immigrants and factory work in northeastern US • Infections and overcrowding in inner city tenements • 1893: Establishment of Henry Street Settlement • Lillian 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 women • Safe contraception and family planning

  9. 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 nurses • 1903: 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 licensure • 1947: New York fully mandated licensure • 1950: NLN and first nationwide State Board Test Pool Examination

  10. Historic Events in 20th/21st Centuries Events influencing nursing: • World war 1 • Flu pandemic • TB pandemic • World war 2 • Changing role of women • Vietnam war • Human rights movement • New pandemics (HIV/AIDS) • Climate change and natural disasters • Terrorism

  11. Nursing in USA Today The Nursing Workforce Surveys : National Sample Survey of Registered Nurses (Health Resources and Services Administration [HRSA], 2013) • A comprehensive survey of nursing workforce every 4 years since 1977 • Final 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)

  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) • 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. 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 data • 90% of < 50 years old were employed in nursing full- or part-time. • A significant percentage of nurses held two nursing positions.

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

  15. Nurses in the Workforce: Age • Average age of RN in US is over 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 2008

  16. 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 RNs • Black/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

  17. Nurses in the Workforce: Education Entry level into Practice • Successful completion of pre-licensure education • Successful passing the NCLEX-RN. Successfully passing the NCLEX-RNthen 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. • The number of BSN and graduate prepared nursing steadily increasing

  18. 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. • Importing nurses from countries with comparable/equivalent education • Issues facing the foreign-educated nurses: • Different views of gender, authority, power, and age (Thekdi at al., 2011) . • Absolute respect for experts and teachers among foreign tranined nurse creates permanent barrier between nurse-managers and foreign-educated nurses.

  19. Four Most Common Roles • Direct patient care • Administrative roles • Research and education • Advanced practice

  20. Practice Settings for Professional Nurses • Acute care settings (e.g. 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)

  21. Nursing in Hospitals • Educational credentials: ADN, BSN, MSN, DNP, PhD • Entry-level positions require RN licensure: • BSN may be preferred or required • As per research, outcomes better in hospitals with higher proportion of RN’s holding BSN • Nurse managers - 24-hour accountability, required to have MSN or higher • Clinical nurse specialists – advance practice role • Example: Oncology clinical specialist • Strong focus on evidence-based practice (EBP)

  22. 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 nursing • Broad field of community health nursing • Focus on prevention and community education Homecare: • Emerging specialty distinct from community nursing • Increasing utilization of home based nursing services • Homecare associated with improved outcomes and is more cost-effective • American Nurses Credentialing Center (ANCC)

  23. 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 skills • Counselling, health curriculum, routine illness, and emergencies • Specific issues: Abuse, school violence, and obesity

  24. Other Settings • Outpatient settings (clinics) • Occupational health • Armed forces: • Scope of practice different / generally wider • Palliative care and end-of-life settings • Telehealth • Nursing informatics • Nursing in faith communities • Entrepreneurship • Nursing education

  25. 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

  26. 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 • Graduate education: • Minimum MSN with post-MSN certificate • DNP - required after 2018)

  27. Advanced Practice Nursing • Nurse Practitioner (NP): • Diagnose and treat acute and chronic conditions • Clinical Nurse Specialists (CNS) • Initially developed in mental health settings, now work all settings • Perform health assessments, make diagnoses, deliver treatment, and develop quality control methods • Certified Nurse-Midwife • Focus on maternal and reproductive health • Certified Registered Nurse Anesthetist • Manage sedation during invasive procedures

  28. Employment Outlook in Nursing • Growing opportunities for nurses • Technological advancements • Increasing emphasis on primary care • Aging population • Shift from hospital care to cost-effective home care • Increased need for long-term care • Nursing salaries including advanced practice nurses • Wage compression – flattening of salaries for experienced nurses

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