Nursing in the 21st Century
NUR 210
Nursing as an ART

“Nursing…its very essence lies in the
creative imagination, the sensitive spirit,
and the intelligent understanding that
provides the very foundation for effective
nursing care”. Donahue(1985)
Nursing as a SCIENCE
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Nightingale identified nursing as a scientific
discipline separate from medicine
Educational foundation and basic college
credit in scientific disciplines R/T nursing
Highlights

1950’s
• Code of Ethics (ANA)
• 1st CNS programs
• Nursing Research first
published (1952)

1960’s
• Post BSN programs
increase
• Nursing researchers
pioneer clinical
investigations
• International Nursing
Index categorizes
worldwide nursing
articles
Highlights

1970’s
• NP in expanded roles
gain national visibility
• Nurses Coalition for
Action in Politics
formed
• ANA creates AAN to
honor outstanding
nurses
• Nurse theorist come
into national spotlight

1980’s
• MS and Doctorate
programs increase
• Prof. Nursing journals
increase
• More nurses are
nationally “certified”
in 17 specialty areas
• STTI increases its
membership
• NIH has a National
Center for Nrsg. Res.
Nursing Professionalism
at a Crossroad

Briefer professional hx than the traditional
professions

Has been and continues to be primarily a
women’s occupation
Problems
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autonomy and independent decision making
career commitment
collegial relationships
professional worth or rewards
Contemporary Nursing Issues

CONTROL OF NURSING PRACTICE
• extended and expanded role for nurses
• Role: a pattern of behavior associated with a
distinctive social position
• Extended role: a role lengthened in a unilateral
manner (PA)
• Role expansion: multidirectional spreading out (NP)
What services should nurses
provide?

The profession with help from society it
serves should decide what services to offer?
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Managed care
Professional competition
Chronic conditions
Aging population
How should nurses be educated?

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Half of RN’s are ADN
Need for master’s prepared nurses as
clinicians, managers, administrators, and
instructors.
Doctoral-prepared are needed as leaders in
all specialty areas, including education and
research
What payment should nurses
receive for their services?
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Retrospective reimbursement
Prospective prepayment
Managed care = managed cost
Better paying positions requires advanced
degrees
What will be the influence of
nursing on health care policy?

Viewed as colleagues of other health
professions rather than as extensions

Other professions has issues about unique
services, educational preparation, and
payment of services.
Changing Images

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Diversity: most nurses are white and
female, great need for multicultural
diversity, as well as more men
Specialty areas:
• Clinical: age groups, illnesses, abilities or
disabilities, and locales
• Functional: management/administration,
research, and teaching
Traditional vs. Nontraditional
Career Options

More practice options are possible

Trend toward more advance preparation

External barriers to practice options are
presently decreasing, but have the potential
to go either way
Continued:

More attempts are being made at
collaborative practice

Move toward primary care and community
and home health care

Increasing emphasis on wellness programs
in schools, residential living communities,
and industry
Nursing Options
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Nurse-practitioner
Clinical Nurse Specialist
Nurse-midwife
Nurse anesthetist
Case manager/clinical manager
Future of Practice Options

Must take leadership roles

Need to find or generate job opportunities
that allow them to practice as prepared and
grow to their full potential
Nursing Functions

Dependent: performed under delegated
medical supervision or prior routines

Independent/autonomous: initiated as a
result of own knowledge and skills

Interdependent: overlapping functions
shared between nursing and medicine
Educational Requirements

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ADN: 2 years (minimal to be RN)
Move to see the BSN as eligibility to
receive professional licensure
Prepare for generalist, entry-level staff
nurse positions
MN, MS, MA
DNS, PhD, DN, JD, EdD, DPH
Nursing Education: Future
Trends
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Changing Student Profile
Educational Mobility
Shortage of Qualified Nursing Faculty
Technology and Education
Changing Health Care Settings
The Aging Population
Research and Theory
Development
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Clinical trials, intervention research, or
experiments conducted in the real world of
practice
Theory development is needed to guide
research and increase nursing’s scientific
credibility
“New science” with much uncharted
territory
Manage or Administer Health
Care Organizations

Skills related to management, leadership,
and fiscal responsibilities

BSN provide these courses
Teach Consumers or
Professionals

Teaching self-care and resolution of
responses to pathology

Opportunities to teach outside the hospital:
shorter stays and increased severity of
illness
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Need for nurse educators
Entrepreneur
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a contractor and also someone who
undertakes projects requiring
unconventional activity and some risk
20th century: private-duty nurses
screening, counseling, and instruction
before same-day surgery
home health care planning and coordination
alternative birthing arrangements
New Wave of Technology
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implants, genetic therapies, imaging devices
medical artificial intelligence such as
computer-assisted surgery, ECG and fetal
monitoring interpretation, clinical dx., and
genetic counseling
telemedicine
devices for home use
Computer Skills
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NIC/NOC: computerized interventions and
outcomes
Word processing, file management,
accessing information
Data management for staffing and
scheduling, accessing expert practice
consultants, finding appropriate educational
material for client-patient use
Nurse Informatics
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1994 ANA recognized the field of nursing
informatics (NI)
integrates nursing science, computer
science, and information science in
identifying, collecting, processing, and
managing data and information to support
nursing services
certification available
Sports Health and Physical
Fitness
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Interest in prevention
Lifetime individual sports offer potential
involvement of an entire society
Physical fitness of children
Fitness facilities in the workplace
Pioneer in Space Health

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Expert care and sensitive communication
will be basic to prolonged confinement
New information: weightlessness, sleep,
nutrition, exercise, and mobility, stress,
isolation
Create Dual Careers

Artistic or Analytic
• music, art, drama (pediatrics, mental health)
• verbal skills, writers, high tech, people persons

Law and business
AIDS

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1983: 1st major article about AIDS for
general public was published
FACTS:
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difficult disease to catch
CDC Universal Precautions
OSHA is enforcing CDC guidelines
Care required by AIDS clients in not unique
Health Care of the Elderly

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Isolated by: early retirement, trend away
from extended families and the trend toward
segregated retirement communities
Most pervasive security need derives from a
common fear of neglect
Changes in Medicare, Medicaid
2010: >40 million > 65
Similarities of Care
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Misunderstood and ostracized by society
Decreased functional abilities and
increasing dependency on others for
assistance
Susceptibility to infection
Nurses can be caregivers, respectors of
personhood, advocates and teachers
RESPONSES TO CHALLEGES:

Continue Professionalism of Nursing
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Extend Practice through Research
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Increase Public Awareness of Nursing’s
Contribution to Health Care

Increase Nursing Influence on Health Care
Policy and Delivery
Continued:
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Become More Globally Aware
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Increase the Number of Nurses in Health
Care Leadership and Administrative Roles
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Achieve Cultural Diversity and Gender
Balance in Nursing
Globalization

Need to learn about health care beliefs and
practices of other cultures

International nursing forums

Nursing and health care products,
publications and methods and the expanding
nursing knowledge will find new
possibilities in a global economy
Social Change

“Three driving forces--aging, technology,
and costs--will reshape health in the future”

1.6 million new jobs are projected in the
health care industry from 2000 to 2010. RN
account for more than a third of these jobs.

A shortage of more than 1 million nurses by
the end of this decade.
Medicine and the Public Eye
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15,000 Web sites that offer some form of
medical advice
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Nurses are a resource for consumers
regarding how to find and evaluate medical
information via the Internet.
Quality of Care
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Health care as a “purchase”
Nurses in a position to offer the best
services for the best prices (role of NP)
Health care will be a focus on the value of
the product
Quality measures will direct our activities at
work and require us to constantly maintain a
level of excellence
National Health Expenditure

1.5 billion in 2000, 2.2 billion in 2005

move from inpatient to ambulatory services
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outpatient and home health care costs grow
at 10% per year.
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Hospital spending grew at < 3% per year.
“IMAGE” of Nursing

Directly related to what the profession
offers society and the value placed on that
service.

“Nightingales” TV program d/c due to
public outcry from nurses
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“Pearl Harbor”, “ER”, Desert Storm