The Nurse as
Professional
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CLASS TWO
Professional Nursing: Image
and Identity
Nursing’s Social Compact
Workforce Demographics
How does the role of the ANA shape
professional nursing practice?
What is our profession’s compact with society?
What is the nursing scope of practice?
What past and present trends influence(d) the
development of nursing in the U.S?
The ANA Advances the
Nursing Profession
What do Nurses Do?
"Nursing is the protection,
promotion, and optimization of
health and abilities, prevention of
illness and injury, alleviation of
suffering through the diagnosis
and treatment of human response,
and advocacy in the care of
individuals, families, communities,
and populations.”
Scope of
Practice
⬤
⬤
The "who," "what,"
"where," "when,"
"why," and "how"
of nursing practice
Scope of practice
bound by state
regulations,
organizational
policies, patient
needs
⬤
⬤
Scope of
Practice:
Ask
Yourself
⬤
⬤
⬤
Did I learn this skill in my basic
nursing program?
Did I learn this skill as part of a
comprehensive training program
which included clinical experience?
Is the skill commonplace in nursing
literature and in nursing practice
that it can reasonably and prudently
be assumed within scope?
Is the skill outlined in the
organization’s policy and procedure
manual?
Does this skill pass the "reasonable
and prudent" standard of nursing?
THE GOALS OF THE
NURSING PROFESSION
(Social Compact)
1.
2.
3.
4.
Organization, delivery, and financing of
quality health care
Provision for the public’s health
Expansion of nursing knowledge and
appropriate application of technology
Expansion of healthcare resources and
health policy
5.
Planning for health policy and regulation
6.
Duties under extreme conditions
.
Code of Ethics
9 provisions
Patient dignity is the foundation
of nursing ethics
⬤
The nurse practices with compassion and respect for the inherent
dignity, worth, and unique attributes of every person
⬤
The nurse’s primary commitment is to the patient, whether an
individual, family, group, community, or population
⬤
The nurse promotes, advocates for, and protects the rights, health,
and safety of the patient
⬤
The nurse has authority, accountability, and responsibility for
nursing practice; makes decisions; and takes action consistent with
the obligation to promote health and to provide optimal care
⬤
The nurse, through individual and collective effort, establishes,
maintains , and improves the ethical environment of the work
settings and conditions of employment that are conducive to safe,
quality health care.
⬤
The nurse owes the same duties to self as to others, including the
responsibility to promote health and safety, preserve wholeness of
character and integrity, maintain competence, and continue personal
and professional growth
⬤
The nurse, in all roles and settings, advances the profession through
research and scholarly inquiry, professional standards development,
and the generation of both nursing and health policy
⬤
The nurse collaborates with other health professionals and the public to
protect human rights, promote health diplomacy and reduce health
disparities
⬤
The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the integrity of
the profession, and integrate principles of social justice into nursing and
health policy
⬤
⬤
⬤
⬤
IOM Future of Nursing Report –goal that 80% of the RN
workforce holds a bachelor’s degree
Promote racial and ethnic diversity of the workforce so it more
closely matches the US population
Wave of retirement, impending shortage, new career
opportunities
Four generations of nurses in the workplace each with
different values and expectations
US RN WORKFORCE BY THE
NUMBERS
Total Number of RNs
4,096,607
National Council State
Board of Nursing
October 2019
The federal government projects that more than
200,000 new registered nurse positions will be
created each year from 2016-2026
•13
Sex & Gender
14
Race & Ethnicity
16
18
19
⬤
Changing
trends in
education
2020 - more nurses (56 percent)
were earning four-year
baccalaureate than two-year
associate degrees (47 percent).
The percentages were mirror
images of each other a decade
earlier; in 2002, 55 percent of
nurses earned an ADN and 45
percent earned a BSN.
BSN IN 10
Dec 20, 2017
⬤ New York Gov. Andrew Cuomo
signed into law a requirement that
nurses earn a BSN within 10 years
of initial licensure.
BSN in 10
Shift from
traditional
BS to MS
to DNP
Route
RN DNP
• 22
⬤
Initiatives
to Provide
a Stable
Supply of
RNS
American Recovery and
Reinvestment Act, 2009
⬤ American Rescue Plan, 2021
⬤
Robert Wood Johnson Foundation
⬤
Johnson & Johnson Campaign for
Nursing's Future
⬤
American Nurses Credentialing
Center (ANCC) Magnet Recognition
Program
23
⬤
Becoming a
Professional
Nurse
⬤
Understand the history of your
future profession – put current
nursing practice into historical
perspective
Socialization – school,
work/organization, professional
activities
⬤
Evolution from Novice to Expert –
trajectory of clinical reasoning skills that
develop over time and with experience
⬤
Working Identity –how you see
yourself as a professional nurse.
⮚ May be challenged by other’s
perceptions about nursing
Step back: The History
and Social Context
of Nursing
Mid–
NineteenthCentury
Nursing
in England:
The Influence
of Florence
Nightingale
(1820-1910)
and others
Founder of modern nursing
Notes on Nursing: What It Is
and What It Is Not establishes nursing's unique
body of knowledge
Founded the first training
school for nurses in London
(1860)
⬤
Florence
Nightingale
Notes on
Nursing
(1860)
⬤
⬤
⬤
⬤
⬤
Ventilation and
Warming
Health of the
House
Professional
Demeanor
Noise Reduction
Variety
Food and
Nutrition
⬤
⬤
⬤
⬤
⬤
⬤
mini bio
Bed and Bedding
Light
Cleanliness of
Rooms and Walls
Personal
Cleanliness
Hopes and
Advice
Observation of
the Sick
⬤
1861-1873:
The
American
Civil War:
An Impetus
for Training
for Nursing
⬤
Move toward formal education of
nurses
Three American schools were
modeled after Nightingale's school
and opened in 1873:
⮚ Bellevue Training School for
Nurses (New York City)
⮚ Connecticut Training School for
Nurses (New Haven)
⮚ Boston Training School for
Nurses at Massachusetts
General Hospital
⬤
⬤
Discrimination
in Early
Training
⬤
Discrimination against male,
African-American, and Jewish
applicants
First school exclusively for men:
⮚School for Male Nurses at
the New York City Training
School (1986)
First school exclusively for African
Americans:
⮚Atlanta Baptist Female
Seminary (later Spelman
College)
29
Clara Barton
(December 25,
1821 – April
12, 1912)
Harriet Tubman (b. circa 1820
Mary Seacole
(1805 – 14 May 1881)
Jamaican-born
Mary Seacole
pioneered nursing
and medical care
in the Crimean
War
Walt Whitman
1819- 1892
Poet and Civil War
Nurse
•33
“The Wound Healer” by Whitman
Stanza 1:
An old man bending I come among new faces,
Years looking backward resuming in answer to children,
Come tell us old man, as from young men and maidens that love me,
(Arous'd and angry, I'd thought to beat the alarum, and urge relentless
war,
But soon my fingers fail'd me, my face droop'd and I resign'd myself,
To sit by the wounded and soothe them, or silently watch the dead;)
Years hence of these scenes, of these furious passions, these chances,
Of unsurpass'd heroes, (was one side so brave? the other was equally
brave;)
Now be witness again, paint the mightiest armies of earth,
Of those armies so rapid so wondrous what saw you to tell us?
What stays with you latest and deepest? of curious panics,
Of hard-fought engagements or sieges tremendous what deepest
remains?
34
Nursing's
Focus
on
Social
Justice:
Nursing's Focus on Social Justice
The Henry Street Settlement
⬤
Henry Street Settlement
⮚
Established 1893 NYC
⮚ Founded by Lillian Wald
⮚ Purpose: address serious
health conditions of immigrants
⮚ Service: visiting nurses, wellbaby clinics, disease
prevention, health education,
minor illness treatment
Nursing's Focus on
Social Justice
Margaret Sanger
September 14, 1879 September 6, 1966
⬤
Estelle Massey Osborne (1901-1981)
First African American woman to earn a Master’s degree in Nursing,
fought for visibility and educational equality for all nurses…
Professionalization
Through
Organization (cont.)
⬤
1896: American Nurses
Association (ANA)
⮚ Founded by
⮚ Isabel Hampton Robb
⬤
Professionalization
Through Organization
The National League
of Nursing
⬤
Chicago World's Fair (1893)
⮚ Several nursing leaders
emerged after gathering there to
share ideas.
• Isabel Hampton Robb
• Lavinia Lloyd Dock
• Bedford Fenwick
• Paper by Florence
Nightingale
What became the National League
for Nursing (NLN; with its early
name) was formed at this meeting
NLN
39
⬤
Professionalization
Through
Organization
(cont.)
⬤
⬤
1899: International Council of
Nurses (ICN)
1908: National Association for
Colored Graduate Nurses
1916: African-American students
admitted to ANA through
constituent states in the North
Health Care Issues and Trends
in the Modern Era:
driving forces for change in nursing care,
and delivery of healthcare
1931-1945: Challenges of the Great
Depression and World War II
NEED FOR
NURSES
prompted Congress
to budget for nursing
education.
124,000 volunteer
student nurses were
certified by the
Cadet Nurse Corps.
42
1945-1960:
The Rise of
Hospitals:
Bureaucracy,
Science, and
Shortages
⬤
The Hill-Burton Act (1946) provided
funds to construct hospitals
⬤
Rapid expansion of facilities
resulted in an acute shortage of
nurses
⬤
Result: "Team nursing" was
introduced
⬤
The nursing shortage prompted the
creation of associate degree in
nursing (ADN) programs
Copyright © 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an
imprint of Elsevier Inc.
43
The
The Vietnam
Vietnam Era
Era –
1961
- 1975
– 1961
- 1975
1961-1982:
The Great
Society,
Vietnam,
and the
Changes in
Roles for
Women
⬤
⬤
⬤
1965: Medicare and Medicaid
ensured access to health care for
the elderly, poor, and disabled
Increased employment and
specialization for nurses in
hospitals
⮚ Intensive care, cardiology,
psychiatry, additional
responsibilities due to shortage
of primary care physicians
Great Society reforms of President
Lyndon B. Johnson fostered the
certified nurse practitioner (CNP)
role
45
•Copyright © 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. .
•46
•Copyright © 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. .
•47
Dr. Loretta Ford
Nurse Practitioner Pioneer
•Copyright © 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. .
•48
•Copyright © 2014, 2011, 2007, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. .
•49
1983-2000:
Challenges
for Nursing:
HIV/AIDS
and Life
Support
Technologies
⬤
Spread of the human
immunodeficiency virus (HIV)
⬤
Global initiatives included
research for treatment,
prevention, and services in
resource-poor nations,
especially Africa
⬤
Preventive measures included
massive changes in the daily
routines of nurses
50
2001-2015:
The Post
9/11 Era
and
Natural
Disasters
51
War in Iraq and
Afghanistan
⬤
Serious war injuries
require long-term
rehabilitation and nursing
care, with needs including:
lower extremity injuries,
missing limbs, PTSD,
neurologic deficits, etc.
52
Health Care
Reform
⬤
2010: Affordable Care Act
(ACA) signed by President
Obama
⬤
Banned lifetime coverage limits
for extreme medical conditions
⮚
⮚
⮚
⮚
Young adult coverage to age 26
Prevention of coverage denial
to children under 19 with
preexisting conditions
Coverage of preventive services
Right to appeal coverage
decisions
•54
Dec 2017
Individual Mandate in ACA Repealed
with passing of new tax code
⬤
⬤
⬤
⬤
Issues in
Contemporary
Healthcare
⬤
⬤
⬤
⬤
⬤
Physician Assisted Dying (Death
with Dignity)
Family Planning – Abortion Rights
Genetic Testing
Rise of Social Media
Patient Safety in the Hospital
Setting
Use of Hospital Rating Stats tied to
Reimbursements
Sexual Abuse and Harassment
#metoo movement
Use of Electronic Medical Record
and patient confidentiality
Access to Care!
NURSING IN THE AGE OF COVID
⬤
⬤
⬤
⬤
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Heightened need for team-based care
infection control
person-centered care, and other skills that really speak to the
strengths of nurses.
Every day can be one of crisis for nurses, patients, and their families
in a pandemic
Nurses are prepared to lead right now by drawing on past
experiences
•57
Building a
professional
identity and
image
The
Feminization
of Nursing
59
Men Choosing Nursing: Negotiating a Masculine Identity in a
Feminine World (O’Connor, 2015)
The nurse in the man: Lifting up nursing or lifting himself? (Lim
& Sanchez-Vera, 2013)
Washington Center for Equitable Growth
Working Paper Series
‘Forget
About the Stigma’: Male
Nurses Explain Why Nursing
Is a Job of the Future for Men
By CLAIRE CAIN MILLER and RUTH FREMSON
Jan 4th, 2018
“Forget about the stigma. The pay is great, the
opportunities are endless and you end up
going home every day knowing that you did
something very positive for someone else.”
Jorge Gitler, 50
Men desire to be caring, and you get a chance
to have a career that allows you to care for
people meaningfully.”
Graham Seaton, 41
“It’s not just a job. You have this sense of
purpose, this sense of service, that you’re in
this to really help improve people’s lives.”
Jonathan Auld, 44
“My mother’s a nurse, but for some reason it
had never occurred to me to become a nurse
until I had a conversation with another man,
who used to be an E.M.T. but became a
nurse, and something just clicked.”
Peter Stach, 36
62
Why is this still a thing?
The View and Nursing Stigma
https://www.youtube.com/watch?v=nDzHl1yyElc
NYU nurses respond the the View
https://www.youtube.com/watch?v=6xnvXb2g4OE&t=16s
63
REVIEW:
Becoming a
Professional
Nurse
⬤
Socialization – school,
work/organization, professional
activities
⬤
Evolution from Novice to Expert
–trajectory of clinical reasoning
skills that develop over time and
with experience
⬤
Working Identity –how you see
yourself as a professional nurse.
⮚ May be challenged by other’s
perceptions about nursing