mohammad khan's ePortfolio

Nursing education: Discussion on current social, economic and/or political factor that might influence changes in nursing education and practice the way that Baer described such factors for the last millennium. What should be the role of nurses today and what about BS in ten?

Nursing is one of the oldest professions that have existed from the beginnings of the history of mankind.  The nursing profession become more accepted after the entrance of Florence Nightingale, the woman who would not only reform nursing as it existed at that time but also lay the foundation for nursing as a profession. The history of the nursing profession confronted many issues and obstacles over time. Some of these issues are inequality based on gender and race, autonomy of nurses, settings and types of education, maintenance of the standards of the nursing profession, control of nursing practice, lack of funds for education, ethical dilemmas, and also disagreements among the nurses. Challenges from each decade made the nursing profession more rich and well-respected to all.

In 2010, the Affordable Care Act (ACA) was passed by Congress.  Due to the ACA, the broadest changes occurred to the healthcare system since the 1965 creation of the Medicare and Medicaid program. More and more people were covered, there was a demand of quality and safe care with low cost, pay per service, the hospital not being reimbursed for the treatment of patients with HAI (www.cms.gov), etc. This caused hospitals to downsize staffs due to extra costs. As a result, there are not enough openings for newly graduated nurses. Newly graduated nurses are facing financial burden due to student loans they used in college. The changes in the nursing education, such as moving the entry level nursing practice to bachelor’s degree requires extra costs and financial burden for many nurses including me. On the other hand, the public demands that nurses should know how to care for patients with the diagnoses of complex and multiple chronic diseases.  Nurses have to be prepared with higher education and knowledge to meet the needs of society for higher quality, safer, more affordable, and accessible healthcare. According to the article of Stokowski (2011), “Nursing role must change to meet the public’s demand for us in the future. The public want to know that nurses who are providing care are competent,” explained by Dr. Bleich. “There is a tsunami of people coming into the healthcare system at the upper echelons of age, with multiple diagnoses and chronic conditions. We need to reshape the healthcare system so that we can intervene outside of traditional sick care system. We just have to know more.”

The IOM reported in 2011 on ‘Future of Nursing: Leading Change, Advancing Health,’ creating an extra pressure on nurses that an associate degree in nursing should not be the terminal education for nursing profession. Nurses should acquire a higher level of degree to be a full partner with physicians and other healthcare providers. There are four key messages from the IOM (2010), “1. Nurses should practice to the full extent of their education and training, 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression, 3. Nurses should be full partners, with physicians and other professionals, in redesigning healthcare in the United States, 4. Effective workforce planning and policy making require better data collection, and an improved information infrastructure.” We have to be ready to take the challenges of the twenty first century by equipping ourselves with a higher level of knowledge and skills. Nurses have gone through many controversies and discriminations’ such as doing menial tasks, being unable to get married, being unable to maintain a solvent life due to low pay or no paid training, a lack of security for later life, and also being considered as low class citizen, etc. According to the article ‘American Nursing: 100 Years of Conflicting Ideals and Ideas’ by Baer (1992, p.17), “Since these nurses were not permitted to be currently married, they were either widows or single women. In 19th century America, that meant they were without vote, without husbands to assert power on behalf…..The physicians and administrators did not promise to protect the nurses, and patients did not pledge to care for them in their older year……. From the beginning of formal nursing in America(1873) the primary task was caring for patients, but before antibiotics, surgery and technology, this work was often menial in nature and mainly required managing excrement, emesis and foul body fluids.”  Baer also pointed to one 19th century physician, who wrote, “A nurse’s toil is great, her duties often disgusting, her pecuniary remuneration small in comparison with requirements and her labors.” We want to learn from the past but we don’t want to go back to that era. “Beginning in the 1960s, new types of nurses, who specialized in different hospital settings such as intensive care units, and nurse practitioners who were trained to deliver a variety of primary care services began to appear on the health care scene. The emergence of these ‘advanced practice nurses’ enabled hospitals and other health care facilities to deliver more efficient, less costly, and safer health care services (Egnes,).” Today, nurse practitioners, clinical nurse specialists, and other specialty-area nurses are well established and carry out a significant portion of health care activities. Stokowski (2011) in her article mentioned it as “the rise of modern nursing education”. In the same article, according to Dr. Bleich, “Knowledge in our field is expanding, and patients are becoming more complex and challenging to manage.” Therefore, nurses have to be ready to face and overcome the challenges and acquire the highest level of education and training to meet public demands.

In conclusion, the nursing profession has gone through and still going through many hurdles. Any change in regulation of healthcare impacts nurses significantly, because nurses are the biggest healthcare work force. Based on the consideration of age and physical ability, some nurses should have the opportunity of grandfathering. The IOM’s call for moving the entry level for the nursing practice to a bachelor’s degree created a tremendous challenge for some nurses.  It is true that today, nursing is a well accepted and respectful profession which put responsibility on us to prepare ourselves accordingly. 

My opinion on BS in ten: I completely agree with this new BS in ten because to take the challenge of 21^st century and be the equal partner with physician and other professional and also improve nursing profession we should further our education to highest level possible.

 

References:

Chokshi, D. A. (2017). JAMA Forum: The Human Consequences of Repealing the Affordable Care Act. Retrieved 2019, from News @JAMA: https://newsatjama.jama.com/2017/01/18/jama-forum-the-human-consequences-of-repealing-the-affordable-care-act

Egnes, K. J. (n.d.). History of Nursing. In K. J. Egnes, History of Nursing (p. p23). Jones and Bartlett publishers, LLC.

Ellen, B. (1992). American Nursing:100 years of conflicting ideals and ideas. Journal of NewYork State Nurses Association, 16-21.

IOM. (201). The future of nursing: leading change, advancing health. Washington DC: National Academy press.

Laura, S. (2011). Overhauling nursing education. www.medscape.com.