Troubled past of ''invisible'' profession

Article Abstract:

The current shortage of nurses is not an isolated situation. Due to paradoxes within the profession, nursing has repeatedly undergone cycles of shortage and oversupply. Trained nurses made possible the development of modern hospitals, yet they have remained rather powerless within the medical structure. Almost all nurses have been white and female, and the profession has been divided with regard to training, appropriate age, site of work, and other issues. The earliest nurses rose from two relatively powerless sources: middle-class, frequently impoverished women who came into homes to provide care; and recovering destitute patients in almshouses providing care to other patients. As nurses began to organize as a profession they chose to identify themselves solely as women, with mixed benefits for the profession. Education followed the reforms that occurred in medicine in the mid-19th century. Student nurses, who received room, board, and training, were unpaid and often the sole care-givers in hospitals. Their labor allowed the number of hospitals to multiply. In the 1890s, leaders in the nursing profession, who came from the ranks of middle- and upper-class nurse educators, called for standards and licensure as a way of ensuring quality care. Once graduated, nurses were expected to leave the hospital and work in home settings; they competed with untrained nurses for private duty work. Public health nursing also became important for a while, but was rather powerless due to unstable funding. As more hospitals opened, the field of nursing became crowded. This trend, plus poor economics during the Depression, led nurses to return to hospitals for work. During favorable economic times, nurses have always tended to leave hospitals for other work sites. Nurses cared for the wounded in the Spanish-American War and the First World War, but they did not receive permanent commissions until 1947. Nursing shortages during World War II contributed to the development of the role of the licensed practical nurse. The women's movement also affected the profession, and multiple voices have made it difficult for the nursing to achieve unity. Although female nurses have come from widely varying backgrounds, discrimination against men and minority women continued. Nursing specialization and the development of allied health professions have also prevented nursing from developing a discrete identity. It now waits to be seen if nursing, in heavy demand, with more autonomy than ever, will exercise its power in society. (Consumer Summary produced by Reliance Medical Information, Inc.)

History, Political aspects

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Nursing: breaking the bonds?

Article Abstract:

Nursing as a profession faces important problems, as can be seen by the conflicting expectations attached to the current situation, in which nurses are better-educated than ever before, but still expected to ''serve at the bedside''. An overview of the future of nursing is presented, with input from health professionals in administrative, research, and academic positions. Nurses, in general, prefer to work in more personalized settings than the large, 21st-century hospital is likely to offer. The pressures in such institutions are discussed. In coming years, nurses will face a variety of non-hospital job choices, including peer review organizations, work for insurance companies, outpatient and home care, rehabilitative care, hospice work, and health care administration. Rural areas, which have experienced even more nursing shortages than cities, attract nurses with nursing diplomas or associate degrees, rather than academic degrees. As rural hospitals close, the numbers of these nurses, who are dedicated to hospital nursing, dwindles. Nurses are badly needed in nursing homes, where they currently make up only 12 percent of the total patient care staff. Military and community health nursing are also discussed. A key question for the nursing profession of tomorrow is the degree of independence nurses will attain. Some specialists within nursing, such as nurse anesthetists, have moved in this direction, but are still largely excluded from affluent, urban communities. At issue are legal recognition and reimbursement. Physicians, as can be imagined, resist such trends. The worst outcome would be erosion of the public trust in both professions. Nursing shortages are widespread, and the movement of licensed practical nurses, licensed vocational nurses, men, and minorities into the ranks of registered nurses is occurring very slowly. The reasons for this are discussed. The nursing profession remains stratified by class and income; the modern manifestation of these attributes are differences in educational levels. Basic issues concerning women's identities as people who care, and people who are professionals, further complicate the future of nursing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Study and teaching, Job satisfaction

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Nursing: new power, old problems

Article Abstract:

Nursing, entering the 1990s with full awareness of the pressures brought on by chronic shortages of nurses, faces significant problems, some of which are not new. The profession's basic conflicts between external image and internal identity, and between itself and medicine, continue to assert themselves. A 1988 report from the US Department of Health and Human Services Secretary's Commission on Nursing described shortages in every sector of health care. Nursing homes, in particular, have high vacancy rates, while home health care has fewer problems recruiting and keeping nurses. Critical care nursing and advanced practice specialties, such as anesthesia, are particularly affected by shortages. The problem is a consequence of increased demand, sicker patients, declining student enrollment, poor pay, and stressful working conditions. Most qualified nurses are already working, and a pool of potentially recruitable people does not exist. Is the question one of short supply, or excessive demand? Nursing leadership maintains that, if nurses were used more efficiently and more exclusively for nursing duties, the shortage problem would be greatly ameliorated. Salaries are also not the issue that they were formerly, and many nurses think that they are adequately compensated. More pressing issues are the use of assistants, physician-nurse relationships, and the levels of education that should be required of nurses; these are evaluated. The appropriate duties for nurses remain to be clearly defined, as does the position occupied by the helping-through-caring role that nurses have traditionally taken. This ultimately feminine identity dilemma may be part of the problem that handicaps the profession, according to one administrator, formerly a nurse. While shortages have empowered nurses in some arenas, the old issues of educational standards, nursing assistants, and the relationships with doctors remain unresolved. After all this time, the possibility that these issues cannot be solved by the profession may need to be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Supply and demand, Education, Statistics, Nurse and physician, Nurse-physician relationship

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