Has nursing science taken a back seat to medicine, bureaucracy, and hospital dominance?
How closely has nursing today followed its history and values? In the past nurses practiced wherever their knowledge and skills were needed whether the location was the home, battlefield, or poorhouse. Many nurses were responsible for opening the first hospitals, for instance Jeanne Mance in Montreal, Canada, Jensey Snow in Petersburg, Virginia and Sally Tompkins during the Civil War. People went there for nursing care.
Nursing’s core values ensured that those who needed medical care were able to get it regardless of social class, circumstances or location. There are many examples in American nursing history of nurses providing care to those who needed it but could not access it. Think of the Frontier Nurse Service founded by Mary Breckinridge.
Nursing values involve social responsibility, advocacy and cultural sensitivity. The nursing profession also understood the importance of the environment on health and sought in many ways to positively change environmental conditions to improve health. A preventive philosophy addresses the underlying causes of ill health.
At the turn of last century Lillian Wald advocated for outdoor playgrounds for children. Nurses also understand that good health is more than the absence of disease. Often their ideas were far ahead of their time and the medical establishment opposed the new ideas of good sanitation, nutrition and access to fresh air. Nurses understood that the best medical care took place in the patient’s community or environment. This reflection on historical events and core nursing values allows insight into current health care discussions.
All throughout nursing’s history the profession has strove to increase access to health care for the universal population, not just for those who could afford it. Nursing was the first profession to support Medicare in 1959 despite opposition from other medical disciplines. The nursing profession also supported the attempts in 1994 to reform health care which eventually was defeated. It was that same year that 2 professors from the University of South Carolina wrote an article about their vision of professional nursing education. Although this article is at least a decade and a half old the questions they ask are as relevant today as when it was written.
One of their assertions was that the majority of health care would take place in the home by 2010. This is a return to nursing’s roots as most health care took place in the home at the beginning of the last century. What has happened from 1994 to 2011 that has prevented this from happening? Is that an ideal scenario? How much progress has been made in advancing public health care? Perhaps a look at the questions the article posed might shed some light on circumstances today.
The authors assert that in the half century before 1994 the medical hospital paradigm dominated nursing education thus slowing progress of the nursing profession and resulting in the suppression of true nursing values. They also questioned whether following medical orders quickly and efficiently should be the basis of nursing.
Was there a difference between doctor delegated medical tasks and nursing practice? Do nurses practice more autonomously in a human versus medical setting; ie the community? Is nursing science valued in a hospital setting? How much are nurses true to their values in a setting where the patient is out of their own context and identified by disease or medical condition? Does hospital training of new nurses ensure perpetuation of medical agenda and not nurse science? Has nursing science taken a back seat to medicine, bureaucracy, and hospital dominance?
Remember it has only been a little over a century since the first Bachelor of Nursing was granted at the University of Minnesota and only 8 decades or so since the opening of the first independent school of nursing, Yale University.
Fast forward to 2011, 17 years after the article was written. How much progress has been made towards a more sustainable health care(versus disease treatment) system and how have nurses been involved? Today, nurses have become active in policy formation and political activity. In returning to past nursing heritage the philosophy has shifted from ‘treat when sick’ to primary preventative care. The nation and policy makers are slowly understanding that autonomous nurse practice will achieve the goal of enabling citizens to maintain good health.
One example of nurse led innovations in health care is the American Academy of Nurses Edge Runners program. The nurse led initiatives focus on increasing access to community health and range in services for the very young to senior citizens. Two examples are the Nurse Family Partnership and the 11 Street Clinic in Philadelphia. Through ongoing communication AAN encourages application and spread of nursing innovations. Favorable new policy has advanced those concepts. For instance the PPACA mandates 50% of funding of graduate nurse education through clinical settings in the community.
Are today’s nursing students being well prepared to practice autonomously in the community where the majority of patients live, work, and play as opposed to the minority that are in a hospital setting? Are they being taught to synthesize their knowledge and apply it through critical thinking? Not only that, do they balance critical thinking with conversation/dialogue?
If not then nursing education must emphasize nursing theory and science specific to nursing care. It must focus training on helping students understand population, community and family dynamics in order to become a meaningful presence that promotes wellness and quality of life within the community. Students must be able to envision their nursing practice beyond assessment for disease and medical treatment of that disease, and the nursing profession must be able to articulate its values and uniqueness as a health discipline. Then the public will understand the value of autonomous nurse practice.
The defining characteristics of any profession are: Technical specialized knowledge, code of ethics, fiduciary duty, and control over practice. It is this last one where nurses will be able to transform the present health care system through autonomous nursing practice in the community where the majority of health or lack of it occurs.
Is current medical care meaningless to the millions of citizens who currently don’t or can’t access the medical system? If autonomous nursing practice were carried out in more locations in the community what effect would that have on the health care system and what would that mean to the many people for whom good health is not a reality?
- Sources:
Nursing Theory-Based Practice in the Home and the Community: The Crux of Professional Nursing Education. Advanced Nurse Science 1994:17 (2) 41-53
http://www.aannet.org/files/public/ImplementingHealthCareReform.pdf
