Nursing: a kaleidoscope of opportunities.

ABSTRACT

The profession of nursing is the most diverse of all healthcare professions. It is a recognizable role in some form in every culture. Nurses have never been more vital to the health care industry than they are today. They must be well-educated, adaptable, and ready for change at all times. Fortunately, there is a strong demand for nurses and the career prospects are plentiful.

History of Nursing

From the beginning of time, women have cared for infants and children; thus, nursing could be said to have its roots in "the home." Religion also had a significant role in the development of nursing. During the third and fourth centuries, wealthy matrons of the Roman Empire converted to Christianity and used their homes to provide for the sick. Throughout history, inadequacy of care during the Crimean, American Civil and World Wars has accentuated the need for nurses. Nursing, during the 16th century, changed from having a religious orientation to human welfare and expanding the body of nursing knowledge. Religious organizations closed leading to a shortage of people to care for the sick. It was during this time that women of ill repute were recruited into the nursing profession in lieu of serving jail sentences for their crimes (Taylor, Lillis & LeMore, 2005). In 1896, Charles Dickens portrayal of nurses was evident in his publication of Sairy Gamp. Dickens depicted nurses as neglectful, physically unattractive and partial to whiskey. However, social reforms during the 18th and 19th century changed the role of nurses and the image of women providing nursing care.

Florence Nightingale, born in 1820, grew up in England and was instrumental in changing the image of nursing. Ms. Nightingale began her nursing career at the age of 31 and took on a tremendous task of organizing nursing care during the Crimean War. Nightingale elevated the status of all nurses by establishing a training school for nurses and publishing books about healthcare and nursing education. Today, nursing is a respected occupation because of the efforts by nurses such as Florence Nightingale, Clara Barton, Isabel Hampton Robb, and Mary Mahoney (Kalish & Kalish, 1995). World War II changed the image of women working at home. The war created a need for nurses and resulted in an explosion of new medicine and technology. Many nurses received their basic nursing education in a 3-year, hospital based diploma school of nursing ([Ellis & Hartley, 2003). Later nursing education was a primary factor in prompting educational focus on nursing in university and college environments.

Nursing is not just the care of patients which includes the physical, emotional, social and spiritual dimensions of that person. The art of nursing now includes illness prevention and the promotion and maintenance of health for individuals, families and communities. Nursing is both an art and a science. Nursing is a profession that uses a special body of knowledge and skills to care for people in both health and illness. Nurses function in various roles such as caregiver, communicator, teacher, counselor, leader, advocate, and researcher.

Registered nurses are the largest group of healthcare providers in the United States. It is anticipated that by the year 2010 there will be a nursing shortage (U.S. Department Health and Human Services, 2003). This reduction in nursing workforce will occur at the same time as the population ages, develops chronic illnesses and disabilities that require skilled nursing care. Patients today are more acutely ill or injured than in their past, however, their length of stay has decreased. Nurses must have skills necessary to care for these complex problems of patients today. In addition, the older adult population is growing and this trend means that patient teaching and nursing interventions must be developed for the needs of older patients. Today's healthcare consumer demands more disease prevention, technology, and access to healthcare. Nurses are challenged to provide highly skilled nursing care to meet the demands of today's healthcare consumer. This means being computer savvy and using state of the art technology to care for the acutely ill patient. Gone are the days when nurses were used as housekeepers, laundresses, and cooks. Today, nurses are skilled not only in patient care but in computers, as case managers, and political advocates for the clientele that seek care in our hospitals and clinics.

Nursing has undergone dramatic changes in response to societal needs and influences. The bracketed text is a verbatim repeat of the first paragraph [From the beginning of time, women have cared for infants and children; thus, nursing could be said to have its roots in "the home." Religion also had a significant role in the development of nursing. During the third and fourth centuries, wealthy matrons of the Roman Empire converted to Christianity and used their homes to provide for the sick. Throughout history, inadequacy of care during the Crimean, American Civil and World Wars have accentuated the need for nurses. Nursing's image before the 1800's is reflected in Charles Dicken's (1896) writings of Sairy Gamp as "neglecting, stealing, and physically abusing the sick."] Florence Nightingale's Angel of Mercy established respectability for nursing in the latter part of the 19th century. To understand nursing as it is practiced today and how it will be practiced tomorrow requires understanding social forces affecting the entire health system. Nurses are challenged to care for more acute illnesses, decreased length of stays and less contact time with clients than ever because of shifts from inpatient to outpatient care. With the establishment of health care reform, computerized charting, and telenursing we are confronted with the new nursing era. Registered nurses make up the largest group of health care providers. Yet for the future the supply of nurses is inadequate to meet the demand.

Nursing Education Preparation

Nursing is a unique profession with many levels of clinical practice ranging from technical to advanced practice. The Bureau of Statistics predicts that one million new Registered Nurses (RN's) will be needed by the year 2012. Nursing is the nation's largest health care field with 2.7 million registered nurses nationwide. There are multiple entry points into nursing practice. The three major educational paths that prepare graduates to take the licensing examination for registered nursing are: diploma, associate degree (AD), and baccalaureate (BSN). These basic programs of nursing vary in specific courses offered, program duration and cost. Figure 1 displays a map of educational preparation for entry into nursing practice at the Registered Nurse level.

[FIGURE 1 OMITTED]

Diploma nursing programs are two to three year programs based in the hospital setting. Many of diploma nursing programs are affiliated with community colleges.

Associate degree nursing programs are typically two to three years offered at junior or community colleges. The associate degree registered nurse Graduates of these programs may transfer for completion of baccalaureate completion program for RNs.

Baccalaureate degree programs are four years in length at a university setting. Graduates are prepared for leadership and management positions. In addition, this course of study prepares the student for graduate study. Traditionally, baccalaureate programs require the first two years in general education courses such as the humanities and science courses with the last two years of study in nursing, research and clinical practice.

Accelerated degree programs are options for students who have already obtained a degree and wish to pursue nursing as a career.

Master's and doctoral degrees offer potential leadership positions in the profession. Nurses with advanced degrees may be researchers, nurse practitioners, nurse anesthetists, clinical specialists, educators or administrators. A new trend in nursing education is introduction and emergence of the practice doctorate for advanced practice nurses. The practice doctorate is a model that provides additional knowledge and skills for the advanced practice nurse.

Nursing Specialties 

In the United States there are a multitude of specialty areas within nursing both inside and outside of the hospital. These opportunities encompass care throughout the lifespan and are based on patient needs. There are over 200 nursing specialties and sub-specialties. Examples include: surgery, emergency, pediatric, psychiatric, school, public health, OBGYN, neonatal, nurse midwifery, and many others. Nurses who choose a specialty for focus can become certified in that area, signifying that they possess expert knowledge of the specialty. Additionally, certified nurses often earn a salary differential over their non-certified co-workers, and research has shown that these nurses have higher rates of patient satisfaction, as well as lower rates of work-related errors in patient care (Johnson and Johnson, 2005).

Advanced Practice Nursing

Advance practice nurses have been an integral part of the health care system for years-, and today, there are more nurses who are returning to school to complete a Master of Science in Nursing to attain one of these highly sought opportunities within this diverse profession. Advance practice nursing specialty areas may include: nurse practitioner, nurse anesthetist, and nurse midwife. Upon completion of the specific program, the candidate must pass a national certification examination. Beginning salaries for nurse practitioners in Mississippi average $65,000/year. However, certified nurse anesthetists and certified nurse midwives typically command higher salaries. The salary figures, however, vary according to experience and location of practice with rural areas paying more (American Association of Colleges of Nursing, 2006).

A nurse practitioner is a registered nurse with advanced academic and clinical experience, who works independently and/or in collaboration with a physician in the delivery of health care services (American College of Nurse Practitioners, 2006). Nurse practitioners may practice in a variety of settings including the emergency departments, after-hour clinics, and industries, as well as school clinics and primary care settings. In addition, nurse practitioners have prescriptive authority.

Certified registered nurse anesthetists (CRNAs) administer anesthesia to patients during surgical procedures in a variety of settings including operating rooms or outpatient settings.

Certified nurse midwives are trained to care for women during labor and birth as well as provide gynecological and postpartum care.

Conclusions

Overall, nursing education has multiple entry points into practice. Each of these programs differs and provides career opportunities in a variety of specialties and settings. The individual must carefully evaluate each type of program and determine which best fits his/her needs and expectations.

References

American Association of Colleges of Nursing. (2006). Retrieved March 29, 2006 from http://www.aacn.nche.edu.

American Association of Nurse Anesthetists. (2006). Nurse Anesthetists at a Glance. Retrieved March 29, 2006 from http://www.aana.com/crna/ataglance.asp.

American College of Nurse Practitioners. (2006). Retrieved March 31, 2006 from http://www.nurse.org/acnp/facts/whatis.shtm 1.

American College of Nurse-Midwives. (2006). Retrieved March 29, 2006 from (http://www.midwife.org).

Ellis, J. & Hartley, C. (2003). Nursing in today's world: Challenges, issues, trends. (8th ed.) Philadelphia: Lippincott Williams & Wilkins.

Johnson and Johnson Healthcare. (2005). Retrieved March 30, 2006 from http://www.discovernursing.com.

Kalish, P. and B. Kalish. (1995). The advance of American nursing. 3 ed. Philadelphia: J.B. Lippincott.

Taylor, C. C., Lillis & LeMore, P. (2005). Fundamentals of Nursing: The art and science of nursing care. 5 ed. 2005, Philadelphia: Lippincott Williams & Wilkins.

U.S. Department Health and Human Services. (2002). Projected supply, demand, and shortages of registered nurses 2000-2010.

Paper was sponsored by the University Nursing Associates (UNA).

Lisa Haynie, RN, Ph.D (1)., Tina Martin, RN, Ph.D. (1), Anne Norwood, Ph.D., RN (1), CFNP, Mary Tan, Ph.D., RN (2), Marilyn May, RN, MSN, (1) Jean Walker, RN, Ph.D. (1) and Amanda Ellis, RN, MSN (1)

(1) University of Mississippi School of Nursing, Jackson, MS

(2) Holmes Community College, Ridgeland, MS

Corresponding Author: [e-mail]