Our Future Rooted in Our Past
Monday January 14, 2008
Print This- Select Text Size:
Comments
Unprecedented change in the nation's healthcare system is looming, while the ability to attract new nurses still is hindered by sexual and gender stereotypes.
advertisement
Generation X and Y nurses, born and raised in a fast-paced world, thrive on technology and change — and that's a good thing because tomorrow's healthcare system will look much different than when baby boomers entered as young nurses starting in the early 1960s.
Baby boomers remember the days when nursing was a calling and a white uniform, starched cap, and clean, white shoes really meant something in the eyes of the public. Nursing was art as much as a science, and nurses focused on caring for patients in hospital wards, rarely venturing outside those walls.
Armed with highly respected three-year nursing diplomas and a passionate desire to make the world a better place, baby boomer nurses were typical of the generation marked by feminism, civil rights, and anti-war activism: They were going to change the world.
The women's liberation movement demanded independence, equality, and respect for women and encouraged them to explore careers outside teaching and nursing, including medicine. But for dedicated nurses, the movement gave the female-dominated occupation a vision of its full potential for the first time.
"Nurses could see themselves as different, but not inferior to physicians," says Susan Gelfand Malka, a former nurse and nursing instructor who teaches American and women's history at the University of Maryland, College Park. "Most nurses today would not say their primary role is to follow doctors' orders. Before feminism, most nurses would have said that following orders was their job."
Gelfand Malka writes in her recently published book, Daring to Care: American Nursing and Second-Wave Feminism, "Many nurses, while accepting aspects of feminism, did not necessarily self-identify as feminists. Nonetheless, they used, developed, and transmitted feminists ideas."
Even though nurses and feminists did not always embrace one another, the feminist movement paralleled and enabled one of the most significant achievements of nursing's boomer generation — the transformation of nursing from a temporary vocation into a lifelong career and academically grounded profession.
"We [baby boomers] were the first generation that went into nursing thinking of it as a lifelong commitment," says Patricia D'Antonio, RN, PhD, FAAN, associate professor of nursing and the associate director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania, Philadelphia. "Previously, for many women, it was something they would do before getting married and raising children. This is one of the most profound changes in nursing. If you are committed to something, you are less tolerant of things you think aren't effective in the workplace."
Nursing education moved from three-year, hospital-based programs to universities and community colleges where students could earn four-year and two-year college degrees to enter nursing. The creation of nurse practitioners and other advanced practice nurses sprang from a need to provide a higher, specialized level of nursing care and access to health care, especially for people in rural areas of the country.
Although the profession has been unable to agree on requiring the BSN for entry into practice, nursing education forged ahead anyway, offering new ways for people to enter the profession, such as through accelerated programs for adults with degrees in other disciplines. Most recently, the profession has developed the doctorate of nursing practice degree, which puts nurses on a par with other health fields that already have doctorate programs, according to Tim Porter-O'Grady, DM, EdD, ScD(h), FAAN, senior partner, Tim Porter-O'Grady Associates Inc. in Atlanta, a healthcare consulting firm.
That era was marked by the transformation of hospitals into competitive, profitable organizations. Investing in cutting-edge technology, which theoretically improved care and saved nursing hours, often became the priority. Primary nursing, among other areas, was hard hit by cutbacks, according to Marie Manthey, MNA, FRCN, FAAN, the founder of primary nursing and president emeritus of Creative Health Care Management in Minneapolis.
"The '90s was one of the most devastating decades in nursing," says Manthey. "Additional personnel were not being hired, reductions were the norm, and nursing was not considered a desirable occupation."
But boomer nurses stepped up to the plate, keeping themselves vital to the healthcare workforce by growing and fine-tuning nursing specialties.
"Most of the major clinically based nursing organizations have emerged in the last 50 years, and most focus on specialization that has been the result of major innovations in the technology of therapeutics," says Porter-O'Grady.
With certifications and credentials in hand, boomer nurses became instrumental in developing the specialized units needed to manage new technologies, such as ICUs, CCUs, and NICUs. Management and administration also became a specialty requiring bottom-line critical thinking. Today's nurses can achieve career pinnacles, such as becoming vice presidents and CEOs, equivalent to those available to women outside of health care.
However, becoming high-tech and highly specialized has come at a price, according to Marie Shanahan, RN, BSN, HN-BC, a pioneer in the holistic nursing movement and founder and president of The BirchTree Center for Healthcare Transformation in Florence, Mass. Boomer nurses have been sorely challenged to build relationships with patients while attending to screaming alarms and glaring telemetry screens in the new milieu of high acuity and high turnover. In response, they became the leaders of the holistic care movement, which stresses caring for the whole person, according to Shanahan.
By the turn of the millennium, the impact the impending retirement of large numbers of baby boomer nurses would have on the nursing shortage began to hit home. Suddenly it became apparent the healthcare industry had missed out on a decade of nursing workforce development efforts, such as the primary nursing model, according to Manthey.
This realization coincided with the initiation of the Magnet Hospital initiative, which aims to improve staffing levels and to invest in nursing developments such as ongoing education and expert clinicians.
"Young people do not see nursing as the exciting career that medicine is," says Angela Barron McBride, RN, PhD, FAAN, distinguished professor, university dean emerita, Indiana University School of Nursing. "It's not a career the best and brightest are encouraged to go into by high school counselors."
But McBride is more optimistic about the profession than she ever has been. She believes the patient safety movement is shining a bright light on the importance of nursing in the healthcare field. The Institute of Medicine's various reports on patient safety have highlighted the crucial role of nurses and nursing leadership in creating safe environments for patients. "It's phenomenal for the field," says McBride.
Known as the tech-friendly generations, generations X and Y are well-equipped to ride one wave of the future in nursing research. Dubbed practice-based evidence, this form of nursing research employs software and processes used by clinical nurses to collect data during everyday care or through electronic medical records to build specific databases. The goal is to learn from everyday practice and rapidly build evidence taken from large-scale, well-controlled clinical observations, according to Nancy Bergstrom, RN, PhD, FAAN, the Theodore J. and Mary E. Trumble Professor and Director for Aging Research, Center on Aging at the University of Texas School of Nursing at Houston.
Nurses at the point of care also will be performing individual data mining to discover integrated information that relates to specific patients.
"We will really be able to build knowledge out of practice because we will have better data collection mechanisms and better techniques to understand data," says Suzanne Bakken, RN, DNSc, FAAN, the Alumni Professor of nursing and professor of Biomedical Informatics at Columbia University in New York City. "This will put better evidence into the hands of nurses much sooner."
Dan Pesut, RN, PhD, APRN, BC, FAAN, a nurse futurist and associate dean for graduate programs at Indiana University in Indianapolis, believes generation X and Y nurses may better understand how to balance career and personal life to stay fresh throughout decades of nursing, which will help them to share the load of changing the world. They also will transcend professional polarities because of their diversity. Nursing is attracting increasing numbers of young working professionals and college graduates from other fields, including more men and minorities, who are seeking to add meaning to their careers and their lives.
"The diversity of their knowledge and thinking applied to nursing will make for a rich future for the profession," says Pesut.
Catherine Spader, RN, is a frequent contributor to Nursing Spectrum. To comment, e-mail jboivin@gannetthg.com.
Reader Comments
Login