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Nursing in the 21st Century

NUR 210

Nursing as an ART

Nursingits 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

Nightingale identified nursing as a scientific

discipline separate from medicine
Educational foundation and basic college
credit in scientific disciplines R/T nursing


Code of Ethics (ANA)
1st CNS programs
Nursing Research first
published (1952)

Post BSN programs
Nursing researchers
pioneer clinical
International Nursing
Index categorizes
worldwide nursing


NP in expanded roles
gain national visibility
Nurses Coalition for
Action in Politics
ANA creates AAN to
honor outstanding
Nurse theorist come
into national spotlight

MS and Doctorate
programs increase
Prof. Nursing journals
More nurses are
nationally certified
in 17 specialty areas
STTI increases its
NIH has a National
Center for Nrsg. Res.

Nursing Professionalism
at a Crossroad

Briefer professional hx than the traditional


Has been and continues to be primarily a

womens occupation


autonomy and independent decision making

career commitment
collegial relationships
professional worth or rewards

Contemporary Nursing Issues


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


The profession with help from society it

serves should decide what services to offer?

Managed care
Professional competition
Chronic conditions
Aging population

How should nurses be educated?

Half of RNs are ADN

Need for masters prepared nurses as
clinicians, managers, administrators, and
Doctoral-prepared are needed as leaders in
all specialty areas, including education and

What payment should nurses

receive for their services?

Retrospective reimbursement
Prospective prepayment
Managed care = managed cost
Better paying positions requires advanced

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

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


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

Clinical Nurse Specialist
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

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

Nursing Education: Future


Changing Student Profile

Educational Mobility
Shortage of Qualified Nursing Faculty
Technology and Education
Changing Health Care Settings
The Aging Population

Research and Theory


Clinical trials, intervention research, or

experiments conducted in the real world of
Theory development is needed to guide
research and increase nursings scientific
New science with much uncharted

Manage or Administer Health

Care Organizations

Skills related to management, leadership,

and fiscal responsibilities

BSN provide these courses

Teach Consumers or

Teaching self-care and resolution of

responses to pathology

Opportunities to teach outside the hospital:

shorter stays and increased severity of

Need for nurse educators


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

implants, genetic therapies, imaging devices

medical artificial intelligence such as
computer-assisted surgery, ECG and fetal
monitoring interpretation, clinical dx., and
genetic counseling
devices for home use

Computer Skills

NIC/NOC: computerized interventions and

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

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


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

Expert care and sensitive communication

will be basic to prolonged confinement
New information: weightlessness, sleep,
nutrition, exercise, and mobility, stress,

Create Dual Careers

Artistic or Analytic
music, art, drama (pediatrics, mental health)
verbal skills, writers, high tech, people persons

Law and business


1983: 1st major article about AIDS for

general public was published

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

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

Misunderstood and ostracized by society

Decreased functional abilities and
increasing dependency on others for
Susceptibility to infection
Nurses can be caregivers, respectors of
personhood, advocates and teachers


Continue Professionalism of Nursing

Extend Practice through Research

Increase Public Awareness of Nursings

Contribution to Health Care

Increase Nursing Influence on Health Care

Policy and Delivery


Become More Globally Aware

Increase the Number of Nurses in Health

Care Leadership and Administrative Roles

Achieve Cultural Diversity and Gender

Balance in Nursing


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

15,000 Web sites that offer some form of

medical advice

Nurses are a resource for consumers

regarding how to find and evaluate medical
information via the Internet.

Quality of Care

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

outpatient and home health care costs grow

at 10% per year.

Hospital spending grew at < 3% per year.

IMAGE of Nursing

Directly related to what the profession

offers society and the value placed on that

Nightingales TV program d/c due to

public outcry from nurses

Pearl Harbor, ER, Desert Storm