Essentials of Nursing Leadership & Management, 4th Edition
CHAPTER 15
NURSING YESTERDAY
AND TODAY
Essentials of Nursing Leadership & Management, 4th Edition
Nursing’s Public Image
 25 years ago, society perceived nurses in
gender-linked task-oriented terms
 Popular media have improved somewhat in
the portrayal of nursing’s image
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Defined
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1859: Nightingale
1950: Henderson
1963: Rogers
2002: American Nurses Association
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Leaders
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Florence Nightingale
Lillian Wald
Margaret Sanger
Adelaide Nutting
Mildred Montag
Mary Elizabeth Mahoney
Virginia Henderson
Essentials of Nursing Leadership & Management, 4th Edition
Florence Nightingale
Essentials of Nursing Leadership & Management, 4th Edition
Florence Nightingale
 Best known of the nursing leaders
 Was considered the founder of modern
nursing
 Innovative thinker
 Acted as a change agent
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Born in Florence, Italy, in 1820
 Father saw to her education
 Always showed an interest in the welfare of
those less fortunate
 Insisted in going to Kaiserworth to become
trained as a nurse
Essentials of Nursing Leadership & Management, 4th Edition
Crimean War
 Nightingale was commissioned to go to the
Crimea to investigate the conditions and
make improvements
 She found a disaster
Essentials of Nursing Leadership & Management, 4th Edition
Changes in Care
 Nightingale and nurses cleaned
environment
 Delivered nursing care
 Wrote letters to families
Essentials of Nursing Leadership & Management, 4th Edition
The Nightingale School
 This was an independent educational
institution
 Her book, Notes on Nursing: What it is and
what it is not, set the fundamental
principles of nursing
Essentials of Nursing Leadership & Management, 4th Edition
Health-Care Reform
 Nightingale kept statistical records
 These records convinced the British to
make reforms
 Her work marked the beginning of modern
military nursing
 Her work led to hospital reform
Essentials of Nursing Leadership & Management, 4th Edition
Lillian Wald
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Born in Ohio
 Attended the New York Hospital School of
Nursing
 Thought she wanted to continue in medical
school and entered Women’s Medical
College in New York
Essentials of Nursing Leadership & Management, 4th Edition
The Visiting Nurses
 Wald and Brewster established a
settlement house in New York’s Lower East
Side
 They built an independent nursing practice
 Eventually, they developed a respected
reputation among hospitals and physicians
Essentials of Nursing Leadership & Management, 4th Edition
The Henry Street
Settlement House
 Established 2 years later
 Grew into a well-organized
social service system
 Multiple services were available
Essentials of Nursing Leadership & Management, 4th Edition
Other Accomplishments
 Developed school health nursing
 Organized the Children’s Bureau
 Nursing Service Division of the
Metropolitan Life Insurance Company
Essentials of Nursing Leadership & Management, 4th Edition
Margaret Sanger
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Born in Corning, New York
 Attended the White Plains Hospital School
of Nursing
 Worked at the Manhattan Eye and Ear
Hospital
 Married and became a homemaker
Essentials of Nursing Leadership & Management, 4th Edition
Advocate and Social
Reformer
 Sanger was concerned about the
working conditions of people who lived
in poverty
 A major strike in Lawrence,
Massachusetts, influenced her life
 She intervened on behalf of the children
Essentials of Nursing Leadership & Management, 4th Edition
Sanger the Public Health
Nurse
 Sanger was assigned to
maternity cases on the Lower
East Side
 While caring for a young mother
who had attempted to self-abort,
Sanger began to see a need for
education in family planning
Essentials of Nursing Leadership & Management, 4th Edition
Reform
 Sanger worked toward making
contraceptive information available to
women
 She opened the first birth control clinic in
the United States
 Sanger was arrested; she walked to the
courthouse, refusing to ride
Essentials of Nursing Leadership & Management, 4th Edition
Creation of Planned
Parenthood
 Sanger established Planned
Parenthood
 Today this organization offers
birth control information and
family planning counseling
Essentials of Nursing Leadership & Management, 4th Edition
The Feminist
 Sanger can be considered an early feminist
 She was independent and assertive at a
time when it was not considered politically
correct for a woman to be outspoken
 She used her nursing background to
promote political change
Essentials of Nursing Leadership & Management, 4th Edition
Adelaide Nutting
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Nutting was the first graduate of the
Johns Hopkins School of Nursing
 As a nursing student she won an essay
contest
 She became a close friend of Isabel
Hampton, the director of the Johns
Hopkins School of Nursing
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Education
 Nutting developed the prototype for
diploma school education
 She added a background in the basic
sciences
 Nutting believed that the profession needed
autonomy to advance
Essentials of Nursing Leadership & Management, 4th Edition
Major Contributions
 Nutting created the Department of Nursing
and Health at Teachers College at
Columbia University
 She became the first professor of nursing in
the world
 She was instrumental in developing
university education for nursing
Essentials of Nursing Leadership & Management, 4th Edition
Mildred Montag
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Developed the curriculum for associate
degree nursing programs
 Proposed two levels of nursing
 Described a curriculum to educate what
she referred to as the “technical nurse”
Essentials of Nursing Leadership & Management, 4th Edition
Contributions to Nursing
 Associate degree nursing (ADN) education
has exerted a profound impact on nursing
education
 ADN is the primary model for basic RN
education
Essentials of Nursing Leadership & Management, 4th Edition
Contributions to Nursing
Montag’s major achievement was to shift
nursing education from hospital, servicebased facilities to institutions of higher
learning
Essentials of Nursing Leadership & Management, 4th Edition
Mary Elizabeth Mahoney
Essentials of Nursing Leadership & Management, 4th Edition
Background
 She was born free on May 7, 1845, in
Dorchester, Massachusetts
 She showed an interest in nursing during
her adolescence
 She worked for 15 years at the New
England Hospital for Women and Children
 She was as a cook, held a janitor’s position,
and spent time as a washerwoman and an
unofficial nurse's assistant
Essentials of Nursing Leadership & Management, 4th Edition
Education
 At the age of 33, she applied to the
hospital’s nursing program and was
accepted as a student
 16 months later, Mary and four white
students completed the rigorous course
 She ended her nursing career as director of
an orphanage in Long Island, New York
Essentials of Nursing Leadership & Management, 4th Edition
Contributions to Nursing
 Recognized the need for nurses
to work together to advance the
status of black nurses within the
profession
 Cofounded the National
Association of Colored Graduate
Nurses (NACGN)
Essentials of Nursing Leadership & Management, 4th Edition
Virginia Henderson
Essentials of Nursing Leadership & Management, 4th Edition
Background
 Born in 1897 in Kansas City, Missouri
 Attended the U.S. Army School of Nursing
 Continued her career in public health
Essentials of Nursing Leadership & Management, 4th Edition
Nurse Educator
 Attended Columbia Teacher’s College
 Joined the faculty
 In 1953 joined the Yale School of Nursing
Faculty, where she remained for 40 years
Essentials of Nursing Leadership & Management, 4th Edition
Contributions to Nursing
 She published the four-volume
Nursing Studies Index
 She pioneered the work that is
considered the essence of modern
nursing
 Her most important writing, The
Principles and Practice of Nursing, is
considered the equivalent of
Nightingale’s work
Essentials of Nursing Leadership & Management, 4th Edition
Contributions
 Henderson actively participated in nursing
organizations
 Sigma Theta Tau International Nurses
Honor Society named its library in honor of
her contributions
Essentials of Nursing Leadership & Management, 4th Edition
Henderson’s Legacy
 Recognized as the “first lady of nursing”
 Many colleagues refer to her as the “21st
century Florence Nightingale”
 She represents the essence and the spirit
of nursing to all of us
Essentials of Nursing Leadership & Management, 4th Edition
Men in Nursing
Essentials of Nursing Leadership & Management, 4th Edition
Early History
 Early Egyptian priests practiced nursing
 The first nursing school started in India in
250 BC, and only men were considered
“pure enough” to be nurses
 Nursing was practiced by men during the
Byzantine Empire
Essentials of Nursing Leadership & Management, 4th Edition
The 19th Century
 Male and female slaves served as
nurses
 During the Civil War, the
Confederate army used men as
nurses, whereas the Union army
used women
 In 1863 the Alexian Brothers opened
the first hospital in this country and
educated men as nurses
Essentials of Nursing Leadership & Management, 4th Edition
The 20th Century
 The ANA first admitted nurses to its
membership in 1930
 Men were not allowed to serve as nurses in
the military until the conclusion of the
Korean War
 Today the number of men in nursing is
increasing, resuming their historical role as
caregivers
Essentials of Nursing Leadership & Management, 4th Edition
PROFESSIONAL
ORGANIZATIONS
Essentials of Nursing Leadership & Management, 4th Edition
American Nurses Association
(ANA)
 Works for improvement of health
standards
 Availability of health-care
services
 Fosters high standards for
nursing
Essentials of Nursing Leadership & Management, 4th Edition
ANA’s “Social Policy”
Statement
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The social context of nursing practice
The nature and scope of nursing practice
Specialization in nursing practice
Regulation of nursing practice
The ethics of nursing practice reviewed by
the House of Delegates
Essentials of Nursing Leadership & Management, 4th Edition
American Nurses Association
(ANA)
 Stimulates and promotes the professional
development of nurses
 Advances nurses’ economic and general
welfare
Essentials of Nursing Leadership & Management, 4th Edition
National League for Nursing
(NLN)
 Membership is open to other health
professionals and interested consumers, not
just nurses
 Participates in test services, research, and
publication
 Lobbies actively for nursing issues
 Currently working with ANA and other nursing
organizations on health-care reform.
Essentials of Nursing Leadership & Management, 4th Edition
National League for Nursing
Accreditation Commission
 Accredits colleges and schools of nursing
Essentials of Nursing Leadership & Management, 4th Edition
National Organization for
Associate Degree Nursing
(NOADN)
 Associate degree nursing programs
prepare the largest number of new
graduates for RN licensure
 Began in 1986
Essentials of Nursing Leadership & Management, 4th Edition
Role of NOADN
 Strong educational programs
 Dynamic education of students in a variety
of settings
 Emphasis on life-long learning
 Continued articulation with colleges and
universities
Essentials of Nursing Leadership & Management, 4th Edition
Specialty Organizations
 Nurses may join specialty organizations
 Provide nurses with information regarding
standards of practice and evidence-based
practice within specialty areas
Essentials of Nursing Leadership & Management, 4th Edition
Educating Nurses
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Practical Nursing programs
Diploma programs
Associate degree programs
Baccalaureate degree programs
Essentials of Nursing Leadership & Management, 4th Edition
Educating Nurses
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Master’s degree programs
Doctoral programs
External degree programs
Continuing education
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Theory
Essentials of Nursing Leadership & Management, 4th Edition
What is Theory?
 Word theory comes from Greek theoria
 Means “to contemplate”
 Provides an explanation of why something
happens the way it does
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Theory
 Nurses use theory to help them think
critically and to make decisions supported
by scientific principles
 Nursing theory provides a knowledge base
for decision-making
Essentials of Nursing Leadership & Management, 4th Edition
Reasons for Nursing Theory
 Throughout history, most nursing care has
been built on tradition and intuition
 Many consumers do not understand what
nursing is and what nurses do
 Nurses need to conduct research to
validate nursing actions
Essentials of Nursing Leadership & Management, 4th Edition
Common Concepts in Nursing
Theory
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Person
Health
Nursing
Environment
Essentials of Nursing Leadership & Management, 4th Edition
Nursing Theory as a Basis for
Practice
 In the middle of the 20th century, nurses
believed theories from other disciplines
could enhance nursing practice
 These theories could not define or describe
nursing practice
Essentials of Nursing Leadership & Management, 4th Edition
Nurse Theorists
 An interest in defining nursing knowledge
increased
 Graduate programs produced nurses with
an interest in research and theory
development
Essentials of Nursing Leadership & Management, 4th Edition
Nurse Theorists
 Started creating philosophies, or systems
of basic principles, and conceptual models
 Described ideas and their relationships to
one another to explain nursing
Essentials of Nursing Leadership & Management, 4th Edition
Role of Nurses in Research
 Practicing nurses play a major role in
identifying researchable patient problems
 Help gather data for research
Essentials of Nursing Leadership & Management, 4th Edition
Current Trends
 Aging baby boomers
 Emphasis on economics
Essentials of Nursing Leadership & Management, 4th Edition
Changes
 Historical perspective
 Managed care
 Insurance
Essentials of Nursing Leadership & Management, 4th Edition
Effect on Nursing
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Elimination of positions
Changes in the practice environment
Quality-of-care issues
Nursing shortage
Essentials of Nursing Leadership & Management, 4th Edition
Effect on Nursing
 Preventing patient care errors
 Emphasis on outcomes
 Changing competencies
Essentials of Nursing Leadership & Management, 4th Edition
Changing Competencies
 Critical thinking skills
 Understanding of systems
 Care management
Essentials of Nursing Leadership & Management, 4th Edition
Changing Competencies
 Team-building and communication skills
 Negotiating, collaborating, conflict
management skills
 Cultural competency
Essentials of Nursing Leadership & Management, 4th Edition
Changing Competencies
 Flexibility
 Technological competence
 Business skills
Essentials of Nursing Leadership & Management, 4th Edition
Communicating Nursing’s
Role
Essentials of Nursing Leadership & Management, 4th Edition
TriCouncil
 ANA, NLN, AACN, AONE
 Designed a campaign to communicate the
contributions of nurses
Essentials of Nursing Leadership & Management, 4th Edition
Three Areas
 Nurses as resource people
 Nurses as health-care coordinators
 Nurses as expert practitioners
Essentials of Nursing Leadership & Management, 4th Edition
Using Nursing Influence
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Carry your license
Use your special training and experience
Become a double agent
Network with and empower colleagues
Essentials of Nursing Leadership & Management, 4th Edition
Using Nursing Influence
 Eliminate “the enemy within”
 Focus on operations
 Organize as a supportive group
Essentials of Nursing Leadership & Management, 4th Edition
Conclusion
Essentials of Nursing Leadership & Management, 4th Edition
Conclusion
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Nursing has a rich and exciting history
Nursing is cyclical
Nursing is diverse
Nursing deals with individuals, their health,
and their environments
 To meet the needs of the future, nurses
need to become involved in theory
development and research
Essentials of Nursing Leadership & Management, 4th Edition
Conclusion
 Nurses need to take the lead in
movement toward a clearer
identity and role delineation of
the profession
 To achieve nursing goals, the
value of nursing and acceptance
of its professional status must
be recognized