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What Would Nightingale Say About Advanced Practice Nursing?

Tuesday June 29, 2010
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Today's nurses face a host of complicated issues in their day-to-day practice. During the centennial of Florence Nightingale's death, Nurse.com asked noted Nightingale scholars to predict what the founder of modern-day nursing would make of it all.

What would Florence Nightingale think about advanced practice nurses?

The advent of advanced practice nurses occurred in the 1960s. Consequently, it is clear that Nightingale did not directly address the concept or necessarily anticipate that nurse practitioners would be a part of the professional landscape in the 20th and 21st centuries. However, it is possible to examine the role of advanced practice nurses and identify how their interface with patients and physicians relates to outcomes in healthcare.

Advanced practice nurses were originally conceived to meet healthcare shortages, particularly in underserved areas. The initial specialization was the pediatric nurse practitioner, but now there are multiple areas of specialization to meet care needs that are both age- and specialty-focused. This expansion of primary care providers has increased accessibility to care and management of chronic disease conditions. Certification remains state-controlled and varies relative to prescriptive authority and admission privileges.

Nightingale originally understood nursing to exist in the hospital setting, but she quickly laid the foundation for health visiting (public health nursing) and nurse midwifery, which philosophically is an advanced practice role. She believed that the object of providing care, in any setting, was to improve the patient's health status.

Nightingale defined health as, "not only to be well, but to use every power that we have to use." This is a dynamic definition that implies health is a relative concept that speaks to the patient's ability to maximize his or her potential relative to health status. It is not based on the presence or absence of disease; rather, the focus is on caring as opposed to the curing focus of the physician. Nurse practitioners provide patients high quality care including diagnosis, treatment and long-term management. These individuals function to extend the physician base, providing care which otherwise would simply be absent. Surely, this would be with the blessing of Nightingale as being within the purview of modern nursing.

Louise C. Selanders, RN, EdD, FAAN, an author and internationally recognized Florence Nightingale scholar, is professor and Master's Degree Program director at the College of Nursing, Michigan State University, East Lansing.Send a letter to editorNTL@gannetthg.com or post a comment below.