Section 1 the Profession of Nursing

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Landscape © f9photos/Shutterstock, Inc. NOT FOR SALE OR DISTRIBUTION TheNOT Profession FOR SALE OR of DISTRIBUTION Nursing The rst section of this text introduces © Jones & Bartlett Learning, LLC © Jones the& Bartlettnursing student Learning, to the profession LLC NOT FOR SALE OR DISTRIBUTION NOT FORof SALEnursing. TheOR framework DISTRIBUTION for content in this text is the Institute of Medicine (IOM) core competencies for healthcare professions. The Development © Jones & Bartlett Learning, LLC of Professional Nursing:© History, Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONDevelopment, and the NOTNursing FOR SALE OR DISTRIBUTION Profession chapter discusses the history and development of the nursing profession and what it means © Jones & Bartlett Learning, LLC for nursing© Jones to be a & profession. Bartlett The Learning, LLC NOT FOR SALE OR DISTRIBUTION EssenceNOT of Nursing: FOR SALE Knowledge OR andDISTRIBUTION Caring chapter discusses the essence of nursing, focusing on the need for knowledge and caring and how nursing © Jones & Bartlett Learning, LLC © Jones students& Bartlett develop Learning, throughout LLCthe nursing NOT FOR SALE OR DISTRIBUTION NOT FOReducation SALE programOR DISTRIBUTION to be knowledgeable, competent, and caring. The Nursing Education, Accreditation, and Regulation chapter examines nursing education, accreditation of nursing © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC education programs, and regulation of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the practice of nursing. The Success in Your Nursing Education Program chapter provides information about the nursing student experience. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORThe SALE Development OR DISTRIBUTION of Professional Nursing:NOT FOR SALEHistory, OR DISTRIBUTION Development, and the Nursing Profession

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OBJECTIVES At the conclusion of this chapter, the learner will be able to:

■ Identify key gures and events in nursing history ■ Explain the relevance of standards to the nursing ■ Discuss© critical Jones nursing & historical Bartlett themes Learning, within LLC profession © Jones & Bartlett Learning, LLC the sociopoliticalNOT FOR context SALE of the timeOR DISTRIBUTION■ Discuss the development andNOT roles FORof nursing SALE OR DISTRIBUTION ■ Compare and contrast critical professional associations concepts ■ Describe the current and past image of nursing ■ Examine professionalism in nursing and related critical issues

● Introduction ● Professionalism: Critical Professional Concepts ● From Past to Present: Nursing History ● Nursing as a Profession ● From Paternalism to Professionalism: ● Sources of Professional Direction © Jones & Bartlett Learning,Movement LLC from Trained Assistants with © Jones ●& Professional Bartlett Nursing Learning, Associations LLC Religious Ties to Highly Educated Individuals ● Major Nursing Associations NOT FOR SALE OR DISTRIBUTION● Nurse Leaders: History in the Making NOT FOR SALE● Why Belong OR DISTRIBUTIONto a Nursing Professional ● Florence Nightingale Association? ● The History Surrounding the Development ● The Image of Nursing of Nursing as a Profession ● Conclusion ● Early History ● Chapter Highlights ●© RiseJones of Christianity & Bartlett and the Learning,Middle Ages LLC● Linking to the Internet © Jones & Bartlett Learning, LLC ●NOT Renaissance FOR andSALE the Enlightenment OR DISTRIBUTION● Discussion Questions NOT FOR SALE OR DISTRIBUTION ● Industrial Revolution ● Critical Thinking Activities ● Colonization of America and the Growth ● Electronic Reective Journal of Nursing in the United States ● Case Studies ● Themes: Looking Into the Nursing ● Words of Wisdom © Jones & BartlettProfession’s Learning, History LLC ● References© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9781284048889_CH01_001_039.indd 3 9/3/14 4:59 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4 Section 1: The Profession of Nursing

Key Terms© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Accountability Nursing Scope of practice Autonomy Professionalism Social policy statement Code of ethics Responsibility Standards

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION e past portrayal of nurses as handmaidens and as- Introduction sistants to physicians has its roots in the profession’s religious beginnings. e following sections examine is text presents an introduction to the nursing the story of nursing and explore how it developed. © Jones & Bartlettprofession Learning, and critical LLC aspects of nursing care and © Jones & Bartlett Learning, LLC NOT FOR SALEthe OR delivery DISTRIBUTION of health care. To begin the journey NOT From FOR Paternalism SALE OR DISTRIBUTION to to graduation and licensure, it is important to un- Professionalism: Movement derstand several aspects of the nursing profession. from Trained Assistants with What is professional nursing? How did it develop? Religious Ties to Highly Which factors in uence the view of the profession? © Jones & Bartlett Learning,Educated LLC Individuals © Jones & Bartlett Learning, LLC is chapter addressesNOT FORthese questions. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION e discipline of nursing slowly evolved from the traditional role of women, apprenticeship, human- From Past to itarian aims, religious ideals, intuition, common Present sense, trial and error, theories, and research, as well © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Nursing History as the multiple in uences of medicine, technology, NOT FOR SALE OR DISTRIBUTION politics, war, economics,NOT FOR and SALE feminism OR (Brooks DISTRIBUTION & It is important for nursing students to learn about Kleine-Kracht, 1983; Gorenberg, 1983; Jacobs & nursing history. Nursing’s history provides a frame- Huether, 1978; Keller, 1979; Kidd & Morrison, work for understanding how nursing is practiced 1988; Lynaugh & Fagin, 1988; Perry, 1985). It is © Jones & Bartletttoday Learning, and which societal LLC trends are shaping the © Jonesimpossible & to Bartlett provide a detailedLearning, history LLC of nursing’s NOT FOR SALEprofession. OR DISTRIBUTION e characteristics of nursing as a pro- NOTevolution FOR inSALE one chapter, OR DISTRIBUTIONso only critical historical fession and what nurses do today have their roots events will be discussed here. in the past, not only in the history of nursing but Writing about nursing history itself has its own also in the history of health care and society in gen- interesting history (Connolly, 2004). Historians eral. Today, health care is highly complex; diagnos- who wrote about nursing prior to the 1950s tended tic methods and© therapies Jones have & Bartlettbeen developed Learning, that to LLC be nurses, and they wrote for ©nurses. Jones Although & Bartlett Learning, LLC o er many opportunitiesNOT FOR for prevention,SALE OR treatment, DISTRIBUTION nursing, throughout its history,NOT has been FOR inter- SALE OR DISTRIBUTION and cures that did not exist even a few years ago. Un- twined with social issues of the day, the early publi- derstanding this growth process is part of this discus- cations about nursing history did not link nursing sion; it helps us to appreciate where nursing is today to “the broader social, economic, and cultural con- © Jonesand may &provide Bartlett stimulus Learning, for changes inLLC the future. text in which ©events Jones unfolded” & Bartlett (Connolly, Learning, 2004, LLC NOT“Nursing FOR isSALE conceptualized OR DISTRIBUTION as a practice discipline p. 10). ere wasNOT greater FOR emphasis SALE on OR the “profes-DISTRIBUTION with a mandate from society to enhance the health sion’s purity, discipline, and faith” (p. 10). Part of and well-being of humanity” (Shaw, 1993, p. 1654). the reason for this narrow view of nursing history

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is that the discipline of history had limited, if any, and, in some cases, a mini-museum. Such materials contact with© Jonesthe nursing & profession.Bartlett isLearning, began to LLCprovide an opportunity to identify© Jones how the & school’s Bartlett Learning, LLC change in NOTthe 1950s FOR and SALE 1960s, ORwhen DISTRIBUTION the schol- history has developed and howNOT its graduates FOR SALEhave af- OR DISTRIBUTION arship of nursing history began to expand, albeit fected the community and the profession. e pur- very slowly. In the 1970s, one landmark publica- pose of this chapter is to explore some of the broad tion, Hospitals, Paternalism, and the Role of the Nurse issues of nursing history, but this discussion should © Jones(Ashley, & Bartlett 1976), addressed Learning, social issues LLC as an impor- not replace© the Jones history &of eachBartlett school Learning,of nursing as LLC NOT FORtant aspect SALE of nursing OR DISTRIBUTION history. e key issue consid- the professionNOT developed. FOR SALE OR DISTRIBUTION ered in this document was feminism in the society at large and its impact on nursing. As social history Nurse Leaders: History in became more important, increased examination of the Making nursing, its history, and inuences on that history © Jones & Bartlett tookLearning, place. In addition,LLC nursing is tied to political© Jones e &best Bartlett place to begin Learning, to gain a better LLC understand- NOT FOR SALE ORhistory DISTRIBUTION today. For example, it is very dicult to NOTun- FORing of SALEnursing ORhistory DISTRIBUTION is with a description of its derstand current healthcare delivery concerns with- leaders—that is, the nurses who made a dierence out including nursing (such as the impact of the to the development of the profession. e vignettes nursing shortage). All of these considerations have in Exhibit 1-1 describe the contributions of some an impact ©on Jones health policy, & Bartlett including Learning,legislation at LLCnursing leaders. People do not© operate Jones in a& vacuum, Bartlett Learning, LLC the state andNOT national FOR levels. SALE OR DISTRIBUTIONof course, and neither did theNOT nurses FOR highlighted SALE in OR DISTRIBUTION Schools of nursing often highlight their own this exhibit. Many factors inuenced nurse leaders, history for students, faculty, and visitors. is might such as their communities, the society, and the time be done through exhibits about the school’s history in which they practiced.

This list does not represent all the important fortunate to obtain employment at the Bellevue nursing leaders but does provide examples of the Hospital in New York City. Here I created the rst © Jones & Bartlett Learning,broad range LLCof their contributions and highlights© Joneswritten & reportingBartlett system, Learning, charting and LLC maintaining NOT FOR SALE OR DISTRIBUTIONspeci c achievements. These glimpses are writtenNOT in FORindividual SALE patient ORrecords. DISTRIBUTION the rst person, but they are not direct quotes. Clara Barton (1881) Dorothea Dix (1840–1841) The need in America for an institution that is not I traveled the state of Massachusetts to call attention sel sh must originate in the recognition of some to the present state of insane persons con ned within evil that is adding to the sum of human suffering, or this Commonwealth,© Jones in & cages, Bartlett stalls, pens! Learning, Chained, LLCdiminishing the sum of happiness.© Today Jones my efforts & Bartlett Learning, LLC naked, beatenNOT with FOR rods, SALEand lashed OR into obedience.DISTRIBUTION to organize such an institution haveNOT been FOR successful: SALE OR DISTRIBUTION Just by bettering the conditions for these persons, I the National Society of the Red Cross. showed that mental illnesses aren’t all incurable. Isabel Hampton Robb (1896) Linda Richards (1869) As the rst president for the American Nurses © Jones I& was Bartlett the rst of Learning, ve students to LLCenroll in the Association,© I becameJones active & Bartlettin organizing Learning,the LLC NOT FORNew SALE England OR Hospital DISTRIBUTION for Women and Children NOT FOR SALE OR DISTRIBUTION and the rst to graduate. Upon graduation, I was (continues)

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Exhibit© 1-1 Jones (continued & ) Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION nursing profession at the national level. In 1896, I Lillian Wald (1918) organized the Nurses’ Associated Alumnae of the My goal was to ensure that women and children, United States and Canada, which later became immigrants and the poor, and members of all the American Nurses Association. I also founded ethnic and religious groups would realize America’s © Jonesthe American & Bartlett Society ofLearning, Superintendents LLC of promise of life, liberty,© Jones and the &pursuit Bartlett of happiness. Learning, LLC NOT FORTraining SALESchools for OR Nurses, DISTRIBUTION which later became The Henry StreetNOT Settlement FOR and SALE the Visiting OR Nurse DISTRIBUTION the National League of Nursing Education (NLNE; Service in New York City championed public health later changed to the National League for Nursing nursing, housing reform, suffrage, world peace, [NLN]). Through these professional organizations, I and the rights of women, children, immigrants, and was able to initiate many improvements in nursing working people. education. © Jones & Bartlett Learning, LLC © JonesMary Breckenridge & Bartlett (1920) Learning, LLC Sophia Palmer (1900) NOT FOR SALE OR DISTRIBUTION NOTThrough FOR my SALE own personal OR tragedies,DISTRIBUTION I realized I launched American Journal of Nursing and served that medical care for mothers and babies in rural as editor-in-chief of the journal for 20 years. America was needed. I started the Frontier Nursing I believe my forceful editorials helped guide Service in Kentucky. nursing thought and shape nursing practice and events. © Jones & Bartlett Learning,Elizabeth LLC Russell Belford, Mary© Tolle Jones & Bartlett Learning, LLC Wright, Edith Moore Copeland, Dorothy Lavinia L. DockNOT (1907) FOR SALE OR DISTRIBUTIONGarrigus Adams, Ethel Palmer NOTClarke, FOR SALE OR DISTRIBUTION I became a staunch advocate of legislation to Elizabeth McWilliams Miller, and Marie control nursing practice. Realizing the problems Hippensteel Lingeman (1922) that students faced in studying drugs and solutions, We are the founders of the Sigma Theta Tau I wrote one of the rst nursing textbooks, Materia International Honor Society of Nursing. Each of © JonesMedica & for Bartlett Nurses. I served Learning, as foreign editorLLC of us provided insights© Jones that advanced & Bartlett scholarship, Learning, LLC NOT FORAmerican SALE Journal ofOR Nursing DISTRIBUTION and coauthored the leadership, research,NOT and FOR practice. SALE OR DISTRIBUTION book, The History of Nursing. Susie Walking Bear Yellowtail (1930–1960) Martha Minerva Franklin (1908) I traveled for 30 years throughout North America, I actively campaigned for racial equality in nursing walking to reservations to improve health care and guided 52 nurses to form the National © Jones & Bartlett Learning, LLC © Jonesand Indian & health Bartlett services. Learning,I established the LLC Native Association of Colored Graduate Nurses. American Nurses Association and received NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Mary Mahoney (1909) the President’s Award for Outstanding Nursing Healthcare. In 1908, the National Association of Colored Graduate Nurses was formed. As the rst Virginia Avenel Henderson (1939) professional Black nurse, I gave the welcome I am referred to as the rst lady of nursing. I think address at the© organization’sJones & rstBartlett conference. Learning,of LLC myself as an author, an avid researcher,© Jones and a & Bartlett Learning, LLC Mary AdelaideNOT Nutting FOR (1910)SALE OR DISTRIBUTIONvisionary. One of my greatest contributionsNOT to FOR the SALE OR DISTRIBUTION nursing profession was revising Harmer’s Textbook I advocated for university education for nurses and of the Principles and Practice of Nursing, which has developed the rst program of this type. Upon been widely adopted by schools of nursing. accepting the chairmanship at the Department of Nursing Education at Teachers College, Columbia Lucile Petry Leone (1943) © JonesUniversity, & Bartlett I became the Learning, rst nurse to LLCbe appointed As the founder ©of theJones U.S. Cadet & BartlettNurse Corps, Learning, I LLC NOT FORto a university SALE professorship. OR DISTRIBUTION believe we succeededNOT because FOR weSALE had a saleableOR DISTRIBUTION

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Exhibit© Jones 1-1 (continued & Bartlett ) Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION package from the beginning. The women in the world will be met by nurses prepared in immediately liked the idea of being able to combine transcultural nursing. war service with professional education for the Florence Wald (1975) future. © Jones & Bartlett Learning, LLC I devoted my© lifeJones to the compassionate & Bartlett care Learning, for LLC Esther Lucille Brown (1946) NOT FOR SALE OR DISTRIBUTION the dying. I NOTfounded FOR Hospice SALE Incorporated OR inDISTRIBUTION I issued a report titled Nursing for the Future. This Connecticut, which is the model for hospice care report severely criticized the overall quality of in the United States and abroad. nursing education. Thus, with the Brown report, Joann Ashley (1976) nursing education nally began the long-discussed move to accreditation of nursing education I wrote Hospitals, Paternalism, and the Role of the © Jones & Bartlett Learning,programs. LLC © JonesNurse & during Bartlett the height Learning, of the women’s LLC movement. NOT FOR SALE OR DISTRIBUTION NOT FORMy book SALE created OR controversy DISTRIBUTION with its pointed Lydia Hall (1963–1969) condemnation of sexism toward, and exploitation I established and directed the Loeb Center for of, nurses by hospital administrators and physicians. Nursing and Rehabilitation at Monte ore Hospital Luther Christman (1980) in the Bronx, New York. Through my research in nursing© and Jones long-term & care, Bartlett I developed Learning, a theory LLCAs founder and dean of the Rush© UniversityJones & Bartlett Learning, LLC (core, care, and cure) that the direct professional College of Nursing, I have been linked to the “Rush nurse-to-patientNOT FOR relationship SALE is itself OR therapeutic DISTRIBUTION Model,” a uni ed approach to nursingNOT education FOR SALE OR DISTRIBUTION and nursing care is the chief therapy for the and practice that continues to set new standards chronically ill patient. of excellence. As dean of Vanderbilt University’s School of Nursing, I was the rst to employ African Martha Rogers (1963–1965) American women as faculty at Vanderbilt and © Jones I &served Bartlett as editor Learning, of Journal of Nursing LLC Science, became one© of Jones the founders & Bartlett of the National Learning, Male LLC NOT FORfocusing SALE my attentionOR DISTRIBUTION on improving and expanding Nurses Association,NOT FOR now known SALE as the OR American DISTRIBUTION nursing education, developing the scienti c basis of Assembly for Men in Nursing. nursing practice through professional education, Hildegard E. Peplau (1997) and differentiating between professional and technical careers in nursing. My book, An I became known as the “Nurse of the Century.” I Introduction to the Theoretical Basis of Nursing was the only nurse to serve the American Nurses © Jones & Bartlett Learning,(1970), marked LLC the beginning of nursing’s search© JonesAssociation & Bartlett as executive Learning, director and LLClater as NOT FOR SALE OR DISTRIBUTIONfor a theoretical base. Later, my work led to a NOT FORpresident, SALE and I served OR DISTRIBUTIONtwo terms on the Board of greater emphasis on research and evidence-based the International Council of Nurses. My work in practice. psychiatric–mental health nursing emphasized the nurse–patient relationship. Loretta Ford (1965) Linda Aiken (2007) I co-developed© Jones the rst & nurseBartlett practitioner Learning, program LLC © Jones & Bartlett Learning, LLC in 1965 by integrating the traditional roles of the My policy research agenda is motivated by a nurse withNOT advanced FOR medical SALE training OR and DISTRIBUTION the commitment to improving healthcareNOT outcomes FOR SALE OR DISTRIBUTION community outreach mission of a public health by building an evidence base for health services of cial. management and providing direction for national policy makers, resulting in greater recognition of the Madeleine Leininger (1974) role that nursing care has on patient outcomes. © Jones I& began, Bartlett and continued Learning, to guide, nursingLLC in the © Jones & Bartlett Learning, LLC NOT FORrecognition SALE thatOR the DISTRIBUTION culture care needs of people NOT FOR SALE OR DISTRIBUTION

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Florence Nightingale p. 20). is quote clearly demonstrates that she was © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Florence Nightingale is viewed as the “mother” of outspoken and held strong beliefs, though she lived NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION modern nursing throughout the world. Most nurs- during a time when this type of forthrightness from ing students at some point say the Nightingale a woman was extraordinary. Pledge, which helps all new nurses connect the past Florence Nightingale was British and lived and with the present. e Nightingale Pledge is found worked in the Victorian era during the Industrial © Jonesin Box 1-1& Bartlett. It was composed Learning, to provide LLC nurses Revolution. During© Jones this time, & theBartlett role of women— Learning, LLC NOTwith FOR an oath SALE similar OR to the DISTRIBUTION physician’s Hippocratic especially womenNOT of the FOR upper SALE classes—was OR DISTRIBUTIONclearly Oath. e oath was not written by Nightingale but dened and controlled. ese women did not work was supposed to represent her view of nursing. outside the home and maintained a monitored so- Volumes have been written about Nightingale. cial existence. eir purpose was to be a wife and a She has become almost the perfect vision of a nurse. mother, two roles that Nightingale never assumed. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC However, although Nightingale did much for nurs- Education of women was also limited. With the NOT FOR SALEing, OR many DISTRIBUTION who came after her provided even greater NOTsupport FOR of SALEher father, OR Nightingale DISTRIBUTION did obtain some direction for the profession. A focus on Nightingale classical education, but there was never any expec- helps to better understand the major changes that tation that she would “use” the education (Slater, occurred. In 1859, Florence Nightingale wrote, 1994). Nightingale grew up knowing what was ex- “No man, not ©even Jones a doctor, & everBartlett gives any Learning, other pected LLC of her life: Women of her class© Jones ran the home& Bartlett Learning, LLC denition of whatNOT a nurseFOR should SALE be ORthan DISTRIBUTIONthis— and supervised the servants. AlthoughNOT this FOR was notSALE OR DISTRIBUTION ‘devoted and obedient.’ is denition would do just her goal, the household management skills that she as well for a porter. It might even do for a horse. It learned from her mother were put to good use when would not do for a policeman” (Nightingale, 1992, she entered the hospital environment. Because of her social standing, she was in the company of edu- © Jones & Bartlett Learning, LLC cated and inuential© Jones men, and& Bartlett she learned Learning, the “art LLC NOT FOR SALE OR DISTRIBUTION of inuencing powerfulNOT FOR men” SALE(Slater, 1994, OR p.DISTRIBUTION 143). Box 1-1 The Original is skill was used a great deal by Nightingale as she Nightingale Pledge fought for reforms. Nightingale held dierent views about the I solemnly pledge myself before God and in women of her time. She had “a strong conviction © Jones & Bartlettthe Learning, presence of this LLC assembly, to pass my life in © Jones & Bartlett Learning, LLC that women have the mental abilities to achieve NOT FOR SALE ORpurity DISTRIBUTION and to practice my profession faithfully. NOT FOR SALE OR DISTRIBUTION I will abstain from whatever is deleterious and whatever they wish to achieve: compose music, mischievous, and will not take or knowingly solve scientic problems, create social projects of administer any harmful drug. I will do all in my great importance” (Chinn, 2001, p. 441). She felt power to maintain and elevate the standard that women should question their assigned roles, of my profession,© Jones and will hold& Bartlett in con dence Learning, and LLC she herself wanted to serve people.© Jones When & she Bartlett Learning, LLC all personal matters committed to my keeping and all familyNOT affairs comingFOR toSALE my knowledge OR DISTRIBUTION reached her 20s, Nightingale felt NOTan increasing FOR deSALE- OR DISTRIBUTION in the practice of my calling. With loyalty will sire to help others and decided that she wanted to I endeavor to aid the physician, in his work, become a nurse. Nurses at that time came from the and devote myself to the welfare of those lower classes, and, of course, any training for this committed to my care. type of role was out of the question. Her parents re- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Source: Composed by Lystra Gretter in 1893 for the class fused to support her goal, and because women were NOT FORgraduating SALE from Harper OR Hospital, DISTRIBUTION Detroit, Michigan. not free to makeNOT this type FOR of decision SALE by OR themselves, DISTRIBUTION she was blocked. Nightingale became angry and

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then depressed. When her depression worsened, her of education in improving social problems and be- parents nally© Jones relented & and Bartlett allowed herLearning, to attend LLClieved that education included© moral,Jones physical, & Bartlett and Learning, LLC nurse’s trainingNOT in FOR Germany. SALE is ORventure DISTRIBUTION was kept practical aspects (Widerquist,NOT 1997). FOR Later SALE nurses OR DISTRIBUTION a secret, and people she knew were told that she based more of their interventions on science and ev- was away at a spa for 3 months’ rest (Slater, 1994). idence-based practice. Nightingale was also educated in math and science, Nightingale wrote four small books—or trea- © Joneswhich & wouldBartlett lead herLearning, to use statistics LLC to demon- tises, as they© Jones were called—thus & Bartlett starting Learning, the idea LLC NOT FORstrate theSALE nurse’s OR impact DISTRIBUTION on health outcomes. Had that nursesNOT need FORto publish SALE about OR their DISTRIBUTION work. e it not been for her social standing and her ability titles of the books were Notes on Matters A ecting to obtain some education, coupled with her friend- the Health, Eciency, and Hospital Administration of ship with Dr. Elizabeth Blackwell, nurses might well the British Army (1858a), Subsidiary Notes as to the have remained uneducated assistants to doctors, at Introduction of Female Nursing into Military Hospi- © Jones & Bartlett leastLearning, for a longer LLC period of time than they did. © Jonestals (1858b),& Bartlett Notes Learning,on Hospitals (1859), LLC and Notes NOT FOR SALE OR DISTRIBUTIONAn important fact about Nightingale is thatNOT she FORon Nursing SALE (1860, OR republished DISTRIBUTION in 1992). e rst was very religious—to the point that she felt God three focused on hospitals that she visited, includ- had called on her to help others (Woodham-Smith, ing military hospitals (Slater, 1994). Nightingale 1951). She also felt that the body and mind were collected a lot of data. Her interest in healthcare separate entities,© Jones but both & Bartlettneeded to beLearning, considered LLCdata analysis helped to lay the© groundworkJones & forBartlett ep- Learning, LLC from a healthNOT standpoint. FOR SALE is view OR later DISTRIBUTION served as idemiology, highlighting the NOTimportance FOR of SALEdata in OR DISTRIBUTION the basis of nursing’s holistic view of health. Night- nursing, particularly in a public health context, and ingale’s convictions also inuenced her views of also established the foundation for nursing research nurses and nursing practice. She viewed patients as and evidence-based practice. An interesting fact is persons who were unable to help themselves or who that Notes on Nursing was not written for nurses, but © Joneswere & dying. Bartlett She is quotedLearning, as saying, LLC “What nursing rather for ©women Jones who cared& Bartlett for ill family Learning, members. LLC NOT FORhas to SALEdo … is ORto put DISTRIBUTION the patient in the best con- As late asNOT 1860, FORNightingale SALE had OR not DISTRIBUTIONcompletely dition for nature to act upon him” (Seymer, 1954, given up on the idea of care provided by women as a p. 13). Nightingale also recognized that a patient’s form of service to family and friends. is book was health depends on environmental impacts such as popular when it was published because at the time, light, noise, smells or euvia, and heat—something family members provided most of the nursing care. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC that we examine more closely today in nursing and Nightingale’s religious and upper-class back- NOT FOR SALE ORin DISTRIBUTIONhealth care. In her work during the CrimeanNOT FORground SALE had a major OR impactDISTRIBUTION on her important eorts War, she applied her beliefs about the body and to improve both nursing education and nursing mind by arranging activities for the soldiers, pro- practice in the hospital setting. Nurses were of the viding them with classes and books, and support- lower class, usually had no education, and were often ing their connection© Jones with & Bartletthome—an Learning,early version LLCalcoholics, prostitutes, and women© Jones who were & Bartlettdown Learning, LLC of what is NOTnow often FOR called SALE holistic OR care. DISTRIBUTION Later, this on their luck. Nightingale changedNOT allFOR that. SALEShe be- OR DISTRIBUTION type of focus on the total patient became an integral lieved that patients needed educated nurses to care part of psychiatric mental health nursing. Night- for them, and she founded the rst organized school ingale’s other interest—in sanitary reform—grew of nursing. Nightingale’s school, which opened in from her experience in the Crimean War, and she London in 1860, accepted women of a higher class— © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC worked with inuential men to make changes on not alcoholics and former prostitutes, as had been NOT FORthis front. SALE Although OR sheDISTRIBUTION did not agree with the new the case withNOT previous FOR generations SALE ofOR nurses. DISTRIBUTION e stu- theories about contagion, she did support the value dents were not viewed as servants, and their loyalty

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was to the school, not to the hospital. is point development of the profession (particularly regard- is somewhat confusing© Jones and & must Bartlett be viewed Learning, from ing LLC nurses’ subordinate position© toJones physicians), & Bartlett Learning, LLC the perspectiveNOT that important FOR SALE changes OR were DISTRIBUTION made; failing to encourage nursing educationNOT FORoered SALE at OR DISTRIBUTION however, these were not monumental changes but a university level, and delaying licensure (Freeman, a beginning. For example, even in Nightingale’s 2007). Despite this criticism, Nightingale still school, students were very much a part of the hos- holds an important place in nursing history. © Jonespital; they & staed Bartlett the hospital, Learning, representing LLC free la- © Jones & Bartlett Learning, LLC NOTbor, FOR and they SALE worked OR long DISTRIBUTION hours. is approach de- The HistoryNOT Surrounding FOR SALE OR the DISTRIBUTION veloped into the diploma school model, considered Development of Nursing as an apprenticeship model. Today, diploma schools a Profession have less direct relationships with the hospitals, and in some cases, they oer associate degrees; some When nursing history is described, distinct histori- © Jones & Bartlettoer Learning,baccalaureate LLCdegrees. ere are also few © Jonescal periods & typically Bartlett are discussed:Learning, early LLChistory (AD NOT FOR SALEschools OR DISTRIBUTION of nursing today that are diploma schools NOT1–500), FOR rise SALE of Christianity OR DISTRIBUTION and the Middle Ages (see the Nursing Education, Accreditation, and (500–1500), Renaissance (mid-1300s–1600s), and Regulation chapter). the Industrial Revolution (mid-1700s–mid-1800s). Nightingale’s students did receive some train- In addition, the historical perspective must include ing, which had© not Jones been provided & Bartlett in an organized Learning, the LLC dierent regions and environments© Jones in which & the Bartlett Learning, LLC manner prior toNOT her eorts. FOR Nightingale’sSALE OR religious DISTRIBUTION historical events took place. Early NOThistory FORfocuses SALEon OR DISTRIBUTION views also had an impact on her rigid educational Africa, the Mediterranean, Asia, and the Middle system, and she expected students to have high East. e focus then turns to Europe, with the rise moral values. Training was still based on an appren- of Christianity and subsequent major changes that ticeship model and continued to be for some time span several centuries. Nursing history expands as © Jonesin Britain, & Europe, Bartlett and laterLearning, the United LLC States. e colonists arrive© in JonesAmerica and& Bartlett a new environment Learning, LLC NOTstructure FOR of SALE hospital OR nursing DISTRIBUTION was also very rigid, helps to furtherNOT the FORdevelopment SALE of ORthe nursingDISTRIBUTION with a matron in charge. is rigidity persisted for profession. roughout all these periods and lo- decades, and in some cases may still be present in cations, wars have had an impact on nursing. As hospital nursing organizations. a consequence of the varied places and times in Nurses in Britain began to recognize the need © Jones & Bartlett Learning, LLC © Joneswhich nursing & Bartlett has existed, Learning, major historical LLC events, to band together, and they eventually formed the dierent cultures and languages, varying views on NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION British Nurses Association. is organization took what constitutes disease and illness, roles of women, on the issue of regulating nursing practice. Night- political issues, and location and environment have ingale did not approve of eorts by the British inuenced the profession. Nursing has probably ex- Nurses Association toward state registration of isted for as long as humans have been ill; someone nurses, mostly because© Jones she did & notBartlett trust the Learning, leaders’ always LLC took care of the sick. is does© Jones not mean & that Bartlett Learning, LLC goals regardingNOT registration FOR (Freeman, SALE 2007).OR DISTRIBUTION ere there was a formal nursing position;NOT rather, FOR in most SALE OR DISTRIBUTION were no known standards for nursing, so how one early cases, the nurse was a woman who cared for became a registered nurse was unclear. Many ques- ill family members. is discussion begins with this tions were raised regarding the denition of nurs- group and then expands. ing, who should be registered, and who controlled © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC nursing. Some critics suggest that Nightingale did Early History NOTmake FOR changes, SALE but ORthe way DISTRIBUTION she made the changes Early history NOTof nursing FOR focused SALE on ORthe AncientDISTRIBUTION also had negative eects, including delaying the Egyptians and Hebrews, Greeks, and Romans.

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During this time, communities often had women of caring for the poor and the sick. e church set who assisted© Joneswith childbearing & Bartlett as a formLearning, of nurs- LLCup a system for care that included© Jones the role & Bartlettof the Learning, LLC ing care, andNOT some FOR physicians SALE had OR assistants. DISTRIBUTION e deaconess, who provided careNOT in homes. FOR WomenSALE OR DISTRIBUTION Egyptians had physicians, and sick persons looking who served in these roles had to follow strict rules for magical answers would go to them or to priests set by the church. is role eventually evolved into or sorcerers. that of nuns, who began to live and work in con- © Jones &Hebrew Bartlett (Jewish) Learning, physicians keptLLC records and vents. e© convent Jones was & considered Bartlett a Learning,safe place for LLC NOT FORdeveloped SALE a hygiene OR codeDISTRIBUTION that examined issues such women. eNOT sick FORcame to SALE the convents OR DISTRIBUTIONfor nursing as personal and community hygiene, contagion, care and also received spiritual care (Wall, 2003). disinfection, and preparation of food and water e establishment of convents and the nursing care (Masters, 2005). is occurred at a time when hy- provided there formed the seed for what, hundreds giene was very poor—a condition that continued of years later, would become the Catholic system of © Jones & Bartlett forLearning, several centuries. LLC Disease and disability were© Jones hospitals & Bartlett that still exists Learning, today. LLC NOT FOR SALE ORviewed DISTRIBUTION as curses and related to sins, which meantNOT FORMen SALE were alsoOR involved DISTRIBUTION in nursing at this time. that aicted persons had to change or follow the For example men in the Crusades cared for the sick religious statutes (Bullough & Bullough, 1978). and injured. ese men wore large red crosses on Greek mythology recognized health issues and their uniforms to distinguish them from the ght- physicians© in Jonesits gods. Hippocrates,& Bartlett a Learning,Greek physi- LLCing soldiers. © Jones & Bartlett Learning, LLC cian, is knownNOT as FOR the father SALE of medicine. OR DISTRIBUTION He con- Altruism and connectingNOT care toFOR religion SALE were OR DISTRIBUTION tributed to health care by writing a medical text- major themes during this period. Even Nightingale book that was used for centuries, and he developed continued with these themes in developing her an approach to disease that would later be referred view of nursing. Disease was common and spread to as epidemiology. Hippocrates also developed the quickly, and medical care had little to oer in the © JonesHippocratic & Bartlett Oath Learning,(Bullough & Bullough,LLC 1978), way of prevention© Jones or &cure. Bartlett Institutions Learning, that were LLC NOT FORwhich SALEis still said OR by DISTRIBUTIONnew physicians today and also called hospitalsNOT wereFOR not SALE like modern OR DISTRIBUTION hospitals; inuenced the writing of the Nightingale Pledge. they primarily served travelers and sometimes the e Greeks viewed health as a balance between sick (Kalisch & Kalisch, 1986, 2005). body and mind—a dierent perspective from ear- e Protestant Reformation had a major im- lier views related to curses and sins. pact on some of the care given to the sick and in- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC roughout this entire period, the wounded jured. e Catholic Church’s loss of power in some NOT FOR SALE ORand DISTRIBUTION ill in the armies required care. Generally, in NOTthis FORareas resultedSALE in OR the closingDISTRIBUTION of hospitals, and some period—which represents thousands of years and convents closed or moved. e hospitals that re- involved several major cultures that rose and fell— mained were no longer staed by nuns, but rather nursing care was provided, but not nursing as it is by women from the lower classes who often had thought of ©today. Jones People & took Bartlett care of those Learning, who were LLCmajor problems, such as alcoholism,© Jones or were & formerBartlett Learning, LLC sick and thoseNOT going FOR through SALE childbirth, OR representingDISTRIBUTION prostitutes. is is what FlorenceNOT Nightingale FOR SALE found OR DISTRIBUTION an early nursing role. when she entered nursing.

Rise of Christianity and the Renaissance and the Enlightenment Middle Ages © Jones & Bartlett Learning, LLC e Renaissance© Jones had a &major Bartlett impact onLearning, health and LLC NOT FOR e rise SALE of Christianity OR DISTRIBUTION led to more structured nurs- the view ofNOT illness. FOR is SALEperiod was OR one DISTRIBUTION of signi- ing care, but still it was far from professional nurs- cant advancement in science, though by today’s ing. Women continued to carry most of the burden standards, it might be viewed as limited. ese early

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discoveries led to advancements that had never been the best light for healing—ultimately made the dif- imagined before.© Jones & Bartlett Learning,ference. LLC Discovering methods for ©preventing Jones disease & Bartlett Learning, LLC is is the NOTperiod, FOR spanning SALE many years,OR DISTRIBUTIONof Co- and using this information in diseaseNOT prevention FOR SALE is OR DISTRIBUTION lumbus and the American and French Revolutions. an important part of nursing today. Public and com- Education became more important. Leonardo da munity health are certainly concerned with many of Vinci’s drawings of the human anatomy, which were the same issues that led to critical new discoveries so © Jonesdone to help& Bartlett him understand Learning, the human LLC body for many years ago,© such Jones as contamination & Bartlett of foodLearning, and LLC NOThis FORsculptures, SALE provided OR detailsDISTRIBUTION that had not been water and preventingNOT diseaseFOR worldwide.SALE OR DISTRIBUTION recognized before (Donahue, 1985). e 18th century was a period of many discoveries and changes Industrial Revolution (Dietz & Lehozky, 1963; Masters, 2005; Rosen, e Industrial Revolution brought changes in 1958), including the following: © Jones & Bartlett Learning, LLC © Jonesthe workplace, & Bartlett but many Learning, were not positive LLC from ■ Jenner’s smallpox vaccination method was NOT FOR SALE OR DISTRIBUTION NOTa health FOR perspective. SALE OR e DISTRIBUTIONcrowded factories of this developed during a time of high death rates era were hazardous and served as breeding grounds from smallpox. for disease. People worked long hours and often ■ Psychiatry became a medical specialty area, under harsh conditions. is was a period of great through the inuence of Freud and others. exploitation of children, particularly those of the ■ e pulse© Joneswatch and & the Bartlett stethoscope Learning, were lower LLC classes, who were forced ©to Joneswork at &very Bartlett Learning, LLC developed,NOT changing FOR SALEhow physical OR DISTRIBUTIONassess- young ages (Masters, 2005). NoNOT child FORlabor laws SALE OR DISTRIBUTION ment was conducted. existed, so preteen children often worked in fac- ■ Pasteur discovered the process of pasteuriza- tories alongside adults. Some children were forced tion, which had an impact on food and milk to quit school to earn wages to help support their contamination. © Jones & Bartlett Learning, LLC families. Cities© were Jones crowded & Bartlettand very dirty, Learning, with LLC ■ Lister used some of Pasteur’s research and epidemics erupting about which little could be NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION developed approaches to antiseptic surgery; done. ere were few public health laws to alleviate as a result of work, he became known as the the causes. father of surgery. Nightingale and enlightened citizens tried to ■ Koch studied anthrax and cholera, both ma- reform some of these conditions. Indeed, as Night- © Jones & Bartlett Learning,jor diseases of LLC the time, demonstrating that © Jonesingale stated & Bartlett in Notes on Learning, Nursing (1992), LLC “there are NOT FOR SALE OR theyDISTRIBUTION were transmitted by water, food, and NOTve FORessential SALE points inOR securing DISTRIBUTION the health of houses: clothing. As a result of this work, he became pure air, pure water, ecient drainage, cleanliness, known as the father of microbiology. and light.” Nightingale strongly supported more ■ Klebs, Pasteur, Lister, and Koch all contrib- eorts to promote health and felt that this was uted to the development of the germ theory. more cost-eective than treating illness—important All of these© Jonesdiscoveries & and Bartlett changes Learning,had an healthcare LLC principles today—but ©she Jones did not &sup Bartlett- Learning, LLC impact on nursingNOT over FOR the long SALE term andOR changed DISTRIBUTION port progressive thought at the timeNOT regarding FOR con SALE- OR DISTRIBUTION the sociopolitical climate of health care. Nightingale tagion and germs. ese ideas are good examples did not agree with the new theory of contagion, but reecting the inuence of the environment and cul- over time the nursing profession accepted these new ture in which a person lives and works on personal © Jonestheories, &which Bartlett remain Learning,critical components LLC of pa- views and problems.© Jones If one &did Bartlett not know Learning,anything LLC NOTtient FOR care today.SALE Nightingale OR DISTRIBUTION stressed, however, that about the historyNOT of FORthe time, SALE one might OR wonderDISTRIBUTION the mind–body connection—putting patients in why Nightingale held these ideas to be important.

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Colonization of America and the Although some nurse leaders such as Dock Growth© of Jones Nursing & inBartlett the Learning, LLCwere ardent suragists, Nightingale© Jones was not& Bartlett inter- Learning, LLC United StatesNOT FOR SALE OR DISTRIBUTIONested in these ideas, even thoughNOT womenFOR SALEin Brit- OR DISTRIBUTION e initial experiences of nursing in the United ain did not have the right to vote. Nightingale felt States were not much dierent from those described that the focus should be on allowing (a permissive for Britain and Europe. Nurses were of the lower statement indicative of women’s status) women to © Jonesclass &and Bartlett had limited Learning, or no training; LLC hospitals were own property© Jones and then & linking Bartlett voting Learning,rights to this LLC NOT FORnot used SALE by the OR upper DISTRIBUTION classes, but rather by the ownershipNOT right (Masters,FOR SALE 2005). OR ere DISTRIBUTION was, how- lower classes and the poor. Hospitals were dirty and ever, communication across the ocean between U.S. lacked formal care services. and British nurses. ey did not always agree on Nursing in the United States did move for- the approach to take on the road to professional- ward, as described in Exhibit 1-1 demonstrating ism; in fact, nurses did not always agree on this issue © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the nursing activity and change that occurred within the United States. Nurse leaders and prac- NOT FOR SALE ORover DISTRIBUTION time. Signicant steps were taken to improveNOT FORticing SALEnurses helped OR nursingDISTRIBUTION to grow into a profes- nursing education and the profession of nursing. sion during times of war (the American Revolution, e rst nursing schools—or, as they were called, the Civil War, the Spanish–American War, World training schools—were modeled after Nightin- War I, World War II, the Korean War, the Vietnam gale’s school.© JonesSome of &the Bartlett earlier schools Learning, were in LLCWar, and modern wars today).© eJones website & Experi-Bartlett Learning, LLC Boston, NewNOT York, FOR and SALE Connecticut. OR DISTRIBUTION e same encing War: Women at War, whichNOT is FOR mentioned SALE in OR DISTRIBUTION approach was taken in these schools as in Britain: the “Linking to the Internet” section of this chapter, Stress was placed on moral character and subservi- oers information about nurses who served in these ence, with eorts to move away from using lower- wars, providing leadership and further developing class women with dubious histories, as was done the nursing profession. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC in the early days of nursing even in the United In the 1930s, the Great Depression also had NOT FORStates SALE(Masters, OR 2005). DISTRIBUTION Limitations regarding what an impactNOT on the FOR nursing SALE eld, “resulting OR DISTRIBUTION in wide- women could do on their own still constituted a spread unemployment of private duty nurses and major problem. Women could not vote and had the closing of nursing schools, while simultaneously limited rights. is situation did begin to change creating the increasing need for charity health ser- © Jones & Bartlett inLearning, the early 1900s LLC when women obtained the right© Jones vices & for Bartlett the population” Learning, (Masters, LLC 2005, p. 28). NOT FOR SALE ORto DISTRIBUTIONvote, but only with great eort. e Nurses’NOT FOR is meant SALE that OR there DISTRIBUTION were fewer student nurses to Associated Alumnae, established in 1896, was re- sta the hospitals. As a consequence, nurses were named the American Nurses Association (ANA) hired, albeit at very low pay, to replace them. Until in 1911. Isabel Robb and Lavinia Dock led this that time, hospitals had depended on student nurses eort. At the same time, the rst nursing journal, to sta the hospitals, and graduate nurses served as American ©Journal Jones of Nursing & Bartlett (AJN), Learning,was created LLCprivate-duty nurses in homes.© Using Jones students & toBartlett sta Learning, LLC through theNOT ANA. FOR e SALEAJN was OR published DISTRIBUTION until hospitals continued until the NOTuniversity-based FOR SALE nurs- OR DISTRIBUTION early 2006, when the ANA replaced it with Ameri- ing eort grew; however, during the Depression, can Nurse Today as its ocial journal. e AJN, the there was a greater need to replace nursing students oldest U.S. nursing journal, still exists today, but is with nurses when schools closed. On one level, this © Jonespublished & Bartlett by a company Learning, not associated LLC with ANA. could be ©seen Jones as an improvement & Bartlett in Learning,care, but the LLC NOT FORIts content SALE has ORalways DISTRIBUTION focused on the issues facing low pay obstacleNOT wasFOR dicult SALE to overcome, OR DISTRIBUTION resulting nurses and their patients. in a long history of low pay scales for nurses.

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In 1922, the Goldmark report, Nursing and ere is some belief that this decision still impacts Nursing Education© Jones in the United & Bartlett States, had Learning, a major the LLC current nursing shortage, though© Jones its scope & has Bartlett Learning, LLC impact on nursingNOT education; FOR SALE this report OR recomDISTRIBUTION- varied over the last few years. WhenNOT more FOR nurses SALEare OR DISTRIBUTION mended that university schools of nursing should needed, some of the nurses who are laid o move be established. In 1948, the Brown report was also into new jobs or careers or leave the workforce so critical of the quality of nursing education. is led they are not available when the need for nurses in- © Jonesto the implementation & Bartlett ofLearning, an accreditation LLC program creases again. e© Jones latter half & ofBartlett the 20th Learning, century LLC NOTfor FORnursing SALE schools, OR which DISTRIBUTION was conducted by the represented a periodNOT of FOR rapid SALEchange in OR reimburse DISTRIBUTION- National League for Nursing (NLN). Accreditation ment for health care, owing to the growth of health is a process of reviewing what a school is doing and insurance and the establishment of Medicare and its curriculum based on established standards. (See Medicaid; such rapid changes are now being seen the Nursing Education, Accreditation, and Regulation again in the 21st century with the passage of the © Jones & Bartlettchapter.) Learning, Movement LLC toward the university setting © JonesAordable & CareBartlett Act of Learning,2010. During LLCthese times, NOT FOR SALEand OR away DISTRIBUTION from hospital-based schools of nursing NOTtypically FOR more SALE nurses OR and DISTRIBUTIONother healthcare providers and establishment of standards with an accredita- are needed. e Healthcare Delivery System: Focus tion process were major changes for the nursing on Acute Care chapter discusses some of these is- profession. e ANA and the NLN continue to sues in more detail. e Health Policy and Political establish standards© Jones for practice & Bartlett and education Learning, and Action: LLC Critical Actions for Nurses ©chapter Jones examines & Bartlett Learning, LLC to support implementationNOT FOR of SALE those standards.OR DISTRIBUTION In the most significant issue in currentNOT healthcareFOR SALE OR DISTRIBUTION addition, the American Association of Colleges of delivery—namely, the healthcare reform of 2010 Nursing (AACN) developed a nursing education (Patient Protection and Aordable Care Act of 2010). accreditation process (discussed in the Nursing Edu- Little has been said in this description of nurs- cation, Accreditation, and Regulation chapter). ing history about the role of men and minorities © Jones e &Carnegie Bartlett report, Learning, Educating Nurses: LLC A Call in nursing; these© Jonesgroups had & littleBartlett involvement Learning, in LLC NOTfor RadicalFOR TransformationSALE OR DISTRIBUTION, describes the current sta- the profession’sNOT early history.FOR SALE is lack OR of diversity DISTRIBUTION tus of nursing education. Patricia Benner led this plagues nursing even today, though certainly there study of current nursing education (Benner, Sut- has been improvement. Segregation and discrimi- phen, Leonard, & Day, 2010). It is the most signi- nation also existed in nursing, just as they did in cant review of nursing education since the Gold- the society at large. e National Association of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC mark and Brown reports. is report is discussed in Colored Graduate Nurses closed in 1951 when the NOT FOR SALEthe OR Nursing DISTRIBUTION Education, Accreditation, and Regulation NOTANA FOR began SALE to accept OR African DISTRIBUTION American nurses as chapter. members. Nevertheless, concern remains about the In the 1940s and 1950s, other changes occurred limited number of minorities in health care. e in the healthcare system that had a direct impact Sullivan Commission’s report on health profession on nursing. Certainly,© Jones scientic & Bartlett discoveries Learning, were diversity, LLC Missing Persons: Minorities© Jones in the Health & Bartlett Learning, LLC changing care, NOTbut important FOR SALEhealth policy OR changes DISTRIBUTION Professions (Sullivan & Sullivan Commission,NOT FOR 2004), SALE OR DISTRIBUTION occurred as well. e Hill-Burton Act (1946) es- is an important document oering recommenda- tablished federal funds to build more hospitals; as tions to improve diversity in the health professions. a result of this building boom, at one point in the e American Association of Colleges of Nursing responded to this critical report by recommending © Jones1980s, there & Bartlett were too many Learning, hospital beds. LLC In turn, © Jones & Bartlett Learning, LLC many nurses lost their jobs in hospitals because their the following actions (AACN, 2004): NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION salaries represented the largest operating expense ■ Health profession schools should hire diver- and there were not enough patients to ll the beds. sity program managers and develop strategic

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plans that outline specic goals, standards, woman’s role. e poet Walt Whitman was a nurse policies,© Jones and accountability & Bartlett mechanisms Learning, to LLCin the Civil War. us, there© Joneswere men & in Bartlett nurs- Learning, LLC ensureNOT institutional FOR SALE diversity OR and DISTRIBUTION cultural ing, though few, and some wereNOT well FOR known—but SALE OR DISTRIBUTION competence. perhaps not for their nursing (Kalisch & Kalisch, ■ Colleges and universities should provide an 1986). Early in the history of nursing schools in array of support services to minority students, the United States, men were not accepted, and this © Jones & includingBartlett mentoring, Learning, resources LLC for developing may have been© Jones inuenced & Bartlettby the gender-segregated Learning, LLC NOT FOR SALEtest-taking OR skills, DISTRIBUTION and application counseling. housing forNOT nursing FOR students SALE and ORthe model DISTRIBUTION of ap- ■ Schools granting baccalaureate nursing de- prenticeship that focused on women (Bullough, grees should provide and support bridging 2006). In part, this female dominance was also the programs that enable graduates of 2-year result of nursing’s religious roots, which promoted colleges to succeed in the transition to 4-year sisters as nurses. is made it dicult for men to © Jones & Bartlett Learning,institutions. LLC Graduates of associate degree© Jones come & into Bartlett the system Learning, and the culture—it LLC was a NOT FOR SALE OR DISTRIBUTION(AD) nursing programs should be encourNOT- FORwomen’s SALE profession. OR DISTRIBUTION aged to enroll in baccalaureate nursing pro- After the major wars—such as World Wars I grams and supported after they enroll. and II, the Korean War, and the Vietnam War— ■ AACN and other health profession orga- medics came home and entered nursing programs, nizations© Jones should & work Bartlett with schools Learning, to pro- LLCand they continue to do so.© InJones 1940, &the Bartlett ANA Learning, LLC moteNOT enhanced FOR admissions SALE ORpolicies, DISTRIBUTION cultural did recognize men by havingNOT a session FOR onSALE men OR DISTRIBUTION competence training, and minority student in nursing at its convention. With the return of recruitment. medics from the wars, many of whom were men, ■ To remove nancial barriers to nursing ed- and the movement of schools of nursing into more ucation, public and private funding orga- academic settings, more men began to apply to © Jones & nizationsBartlett should Learning, provide scholarships,LLC loan nursing programs.© Jones Men & in Bartlett nursing have Learning, to contend LLC NOT FOR SALEforgiveness OR programs, DISTRIBUTION and tuition reimburse- with male-dominatedNOT FOR medicine, SALE whichOR DISTRIBUTION has had an ment to students and institutions. inuence on the practice. Male nurses were also ■ Congress should substantially increase fund- able to get commissions in the military (Bullough, ing for diversity programs within the Na- 2006). e changes did have an impact, but the tional Health Service Corps and Titles VII © Jones & Bartlett Learning, LLC © Jonesincrease & Bartlett in salaries Learning,and improvement LLC in work con- and VIII of the Public Health Service Act. ditions had the strongest eect on increasing the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ese recommendations and eorts to improve number of men in nursing. the number of minorities in all health professions In 2001, Boughn conducted a study to explore have had some impact as will be discussed in the why women and men choose nursing. e results of Nursing Education, Accreditation, and Regulation this study indicated that female and male participants chapter, but© Jonesmore improvement & Bartlett is required. Learning, is LLCdid not dier in their desire to© care Jones for others. & Bartlett Both Learning, LLC topic also NOTrelates toFOR the problemSALE ofOR healthcare DISTRIBUTION dis- groups had a strong interest inNOT power FOR and empower SALE- OR DISTRIBUTION parities, as noted in other chapters. ment, but female students were more interested in e number of men in nursing has increased using their power to empower others, whereas male over the years but still is not where it should be. students were more interested in empowering the © JonesMen & served Bartlett as nurses Learning, in the early LLC history period, profession.© e Jones most signicant & Bartlett dierence Learning, was found LLC such as in the Crusades, and monks provided care in in the expectations of salary and working conditions, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION convents. However, after this period, men were not with men expecting more. Why would not both accepted as nurses because nursing was viewed as a males and females expect higher salaries and better

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working conditions? Is this still part of the view of grow (U.S. Department of Health and Human Ser- nursing and nurses© Jones from nursing’s & Bartlett past? Learning,vices, LLC 2010). Before 2000, 6.2% of© RNsJones were men;& Bartlett Learning, LLC Luther ChristmanNOT FOR was SALEa well-known OR DISTRIBUTION nurse by 2008, this percentage had increasedNOT FOR to 9.6%. SALE OR DISTRIBUTION leader who served as a nurse for many years, retir- Male and female RNs are equally likely to have a ing at the age of 87, and after retirement he con- baccalaureate degree, but male RNs are more likely tinued to be an active voice for the profession and to also have a non-nursing degree. © Jonesfor men &in Bartlettnursing until Learning, his death in LLC 2011. Ac- © Jones & Bartlett Learning, LLC NOTcording FOR to SALESullivan OR(2002), DISTRIBUTION Christman stated that Themes: LookingNOT FOR into SALE the OR DISTRIBUTION “men in medicine were reluctant to give up power Nursing Profession’s History to women and, by the same token, women in nursing have fought to retain their power. Medicine, Nursing’s past represents a movement from a role however, was forced to admit women after ar- based on family and religious ties and the need © Jones & Bartlettmative Learning, action legislation LLC was enacted” (2002, p. © Jonesto provide & Bartlettcomfort and Learning, care (because LLC that was NOT FOR SALE10). OR “Sadly,” DISTRIBUTION Christman reported, “nursing, with a NOTperceived FOR asSALE a woman’s OR DISTRIBUTIONlot in life) to educated majority of women, was not required to adhere to professionals serving as the “glue” that holds the armative action policies” (Sullivan, 2002, p. 12). healthcare system together. From medieval times Today, more men and minorities enter baccalaure- through Nightingale’s time, nursing represented a ate degree programs© Jones than any& Bartlettother level Learning,of nurs- role LLC that women played in families© to Jones provide &care. Bartlett Learning, LLC ing education, NOTas supported FOR bySALE national OR workforce DISTRIBUTION is care extended to anyone inNOT need, FOR but after SALE OR DISTRIBUTION data from the NLN and the AACN on an annual Nightingale highlighted what a woman could do basis (Cleary, 2007; Sochalski, 2002). ere is an with some degree of education, physicians/doc- organization for men in nursing, the American tors recognized that women needed to have some Assembly for Men in Nursing (http://www.aamn. degree of training. Education was introduced, © Jonesorg), and & men Bartlett are also Learning,members of other LLC nursing but mainly to ©serve Jones the need & Bartlettof hospitals Learning, to have LLC NOTorganizations. FOR SALE OR DISTRIBUTION a labor force. NOT us, theFOR apprenticeship SALE OR model DISTRIBUTION of ere is no question that the majority of nursing was born. Why would nursing perceive nurses are White females, and this needs to change. a need for greater education? Primarily because ere has been an increase in the number of male of advances in science, increased knowledge of and minority nurses, but not enough. ere is a germs and diseases, and increased training of doc- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC greater need to actively seek out more male and tors, nurses needed to understand basic anatomy, NOT FOR SALEminority OR DISTRIBUTION students (Cohen, 2007). Men and minor- NOTphysiology, FOR SALE pathophysiology, OR DISTRIBUTION and epidemiology to ities in nursing should reach out and mentor stu- provide better care. To carry out a doctor’s orders dent nurses and new nurses to provide them with eciently, nurses must have some degree of un- the support they require as they enter a profession derstanding of causes and eects of environmen- predominantly ©composed Jones of & White Bartlett women. Learning, More tal LLC exposures and of disease causation.© Jones us, & the Bartlett Learning, LLC media coverageNOT would FOR also be SALE helpful ORin publiciz DISTRIBUTION- move from hospital nursing schoolsNOT to FORuniversity SALE OR DISTRIBUTION ing the role of men and minorities in nursing; for training occurred. example, when photos are distributed to local me- Critics of Nightingale suggest that although dia, and to media in general, they should empha- the “lady with the lamp” image—that is, a nurse size the diversity of the profession. Men still consti- with a light moving among the wounded in the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tute a very small percentage of the total number of Crimea—is laudable, it presented the nurse as a NOTregistered FOR nursesSALE (RNs) OR livingDISTRIBUTION and working in the caring, take-chargeNOT person FOR who SALE would OR go toDISTRIBUTION great United States, although their numbers continue to lengths and even sacrice her own safety and health

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to provide care (Shames, 1993). e message sent to the public© was Jones that nurses & Bartlettwere not powerful. Learning, ey LLC Professionalism© Jones & Bartlett Learning, LLC were caring,NOT but theyFOR would SALE not ghtOR to DISTRIBUTION change the Critical Professional NOTConcepts FOR SALE OR DISTRIBUTION conditions of hospitals and patient care. ey instead acted, as many do today, as victims. Hospitals “owned” nurses and considered them cheap labor. Today, nursing is an applied science, a practice pro- © JonesToday, & Bartlettmany hospitals Learning, still hold LLCthe same view, fession. To© appreciate Jones the & relevance Bartlett of thisLearning, statement LLC professionalism NOT FORthough SALE they would OR DISTRIBUTIONnever admit it publicly. is requires anNOT understanding FOR SALE of OR DISTRIBUTION view of health suggests that doctors are de ned by and how it applies to nursing. Nursing is more than their scope of practice in treating diseases, whereas just a job; it is a professional career requiring com- nurses are seen as promoting health, adding to the mitment. Table 1-1 describes some di erences in view of the lesser status of nursing (Shames, 1993). attitudes related to an occupation/job and a career/ © Jones & Bartlett Learning, is view also has LLC led to problems between the ©two Jones profession. & Bartlett Learning, LLC NOT FOR SALE ORprofessions, DISTRIBUTION as they argue over which professionNOT is FOR But SALE what doesOR this DISTRIBUTION really mean, and why does better at caring for patients. e view that nurses are it matter? As described previously in this chapter, angels of mercy rather than well-educated profes- getting to where nursing is today was not easy, nor sionals reinforces the idea that nurses care but really did it happen overnight. Many nurses contributed do not have© Jonesto think; &this Bartlett view is perpetuated Learning, by LLCto the development of nursing© Jones as a profession; & Bartlett it Learning, LLC advertisementsNOT that FOR depict SALE nurses asOR angels DISTRIBUTION or caring mattered to them that nursesNOT be FORrecognized SALE as OR DISTRIBUTION ethereal humans (Gordon, 2005). Most patients— professionals. especially at 3 a.m., when few other professionals are available—hope that the nurse not just caring, Nursing as a Profession but a critical thinker who uses clinical reasoning © Jonesand &judgment Bartlett and Learning,knows when toLLC call the rest of e current© Jonesde nition & of Bartlett nursing, asLearning, established LLC NOT FORthe team. SALE OR DISTRIBUTION by the ANANOT (2010c), FOR is “the SALE protection, OR DISTRIBUTIONpromotion,

Table 1-1 Comparison of Attitudes: Occupation Versus Career © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Occupation Career Longevity Temporary, a means to an end Lifelong vocation Educational preparation Minimal training required, usually University professional degree program associate degree based on foundation of core liberal arts Continuing© Jones education & Bartlett Only whatLearning, is required for LLC the job Lifelong learning, continual© Jones effort to &gain Bartlett Learning, LLC NOT FOR SALEor OR to get DISTRIBUTION a raise/promotion new knowledge, skills,NOT and abilities FOR SALE OR DISTRIBUTION Level of commitment Short-term, as long as job meets Long-term commitment to organization personal needs and profession Expectations Reasonable work for reasonable Will assume additional responsibilities pay; responsibility ends with shift and volunteer for organizational © Jones & Bartlett Learning, LLC ©activities Jones and &community-based Bartlett Learning, events LLC NOT FOR Source: SALE From Wilfong, OR D.,DISTRIBUTION Szolis, C., & Haus, C. (2007). Nursing school success: Tools for constructingNOT your FOR future . Sudbury,SALE MA: JonesOR and DISTRIBUTION Bartlett.

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and optimization of health and abilities, prevention nature of nursing, but a denition is needed here to of illness and injury,© Jones alleviation & Bartlettof suering Learning, through gain LLC further understanding of nursing© Jones as a profes & Bartlett- Learning, LLC the diagnosis andNOT treatment FOR SALEof human OR response, DISTRIBUTION sion. Is nursing a profession? WhatNOT is a profession?FOR SALE OR DISTRIBUTION and advocacy in the care of individuals, families, Why is it important that nursing be recognized as a communities, and populations” (p. 10). Box 1-2 profession? Some nurses may not think that nursing provides several denitions of nursing that provide is a profession, but this is not the position taken © Jonesa historical & perspective Bartlett on Learning, the development LLC of a def- by recognized ©nursing Jones organizations, & Bartlett nursing Learning, edu- LLC NOTinition FOR for nursing.SALE OR DISTRIBUTION cation, and boardsNOT of FORnursing SALE that are OR involved DISTRIBUTION in e Essence of Nursing: Knowledge and Caring licensure of nurses. Each state has its own denition chapter contains a more in-depth discussion of the of nursing that is found in the state’s nurse practice

The following list provides a timeline of some of the de nitions of nursing. Florence Nightingale© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Having “chargeNOT of the FOR personal SALE health ofOR somebody DISTRIBUTION … and what nursing has to do … is to putNOT the patient FOR SALE OR DISTRIBUTION in the best possible condition for nature to act upon him.” (Nightingale, 1859, p. 79) Virginia Henderson “The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities © Jonescontributing & Bartlett to health Learning,or its recovery (orLLC to peaceful death) and that he would© Jones perform & unaided Bartlett if he had Learning, LLC NOT FORthe necessary SALE strength, OR willDISTRIBUTION or knowledge. And to do this in such a way asNOT to help FOR him gain SALE independence OR DISTRIBUTIONas rapidly as possible.” (Henderson, 1966, p. 21) Martha Rogers “The process by which this body of knowledge, nursing science, is used for the purpose of assisting human beings to achieve maximum health within the potential of each person.” (Rogers, 1988, p. 100) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC American Nurses Association NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.” (ANA, 2004, p. 4) International Council of Nursing “Nursing encompasses© Jones autonomous & Bartlett and collaborative Learning, care LLCof individuals of all ages, families, groups© Jones and & Bartlett Learning, LLC communities,NOT sick or FORwell and SALE in all settings. OR Nursing DISTRIBUTION includes the promotion of health, preventionNOT of FOR SALE OR DISTRIBUTION illness and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.” (International Council of Nursing, n.d.)

Sources: Nightingale, F. (1859). Notes on nursing: What it is and what it is not (commemorative ed.). Philadelphia, PA: Lippincott; Henderson, V. © Jones(1966). & The Bartlettnature of nursing: Learning, A de nition and its implications LLC for practice, research, and education. ©New Jones York, NY: Macmillan; & Bartlett Rogers, M. (1988). Learning, LLC NOT FORNursing scienceSALE and art: OR A prospective. DISTRIBUTION Nursing Science Quarterly, 1, 99; American Nurses Association.NOT (2004). FOR Nursing SALE scope and ORstandards DISTRIBUTION of practice. Silver Spring, MD: Author; International Council of Nursing. (n.d.). Retrieved from http://www.icn.ch/

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act, but the ANA denition noted here encompasses as well as mechanisms for accountability. Nurses the common© Jonescharacteristics & Bartlett of nursing Learning, practice. LLCmake contributions to society© (theJones community & Bartlett in Learning, LLC In general,NOT aFOR profession—whether SALE OR DISTRIBUTIONnursing or which nurses practice), and NOTbecause FOR of this, SALE nurses OR DISTRIBUTION another profession, such as medicine, teaching, or have a relationship to the society and its culture and law—has certain characteristics (Bixler & Bixler, institutions. Nurses do not operate in a vacuum, 1959; Finkelman, 2012; Huber, 2014; Lindberg, without concern for what the individuals in a com- © JonesHunter, & Bartlett & Kruszewski, Learning, 1998; Quinn LLC & Smith, munity and© theJones community & Bartlett need. Understanding Learning, LLC NOT FOR1987; ScheinSALE & OR Kommers, DISTRIBUTION 1972): needs andNOT providing FOR care SALE to meet OR those DISTRIBUTION needs are ■ A systematic body of knowledge that provides directly connected to the social context of nursing. the framework for the profession’s practice ere are critical value assumptions related to the ■ Standardized, formal higher education contract between nursing and society that provide ■ Commitment to providing a service that an explanation of the importance of this contrac- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC benets individuals and the community tual relationship” (ANA, 2010a, pp. 6–7). ese NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ Maintenance of a unique role that recognizes assumptions include the following: autonomy, responsibility, and accountability ■ Humans manifest an essential unity of mind, ■ Control of practice responsibility of the pro- body, and spirit. fession through standards and a code of ■ Human experience is contextually and cul- ethics© Jones & Bartlett Learning, LLC turally dened. © Jones & Bartlett Learning, LLC ■ CommitmentNOT FOR to SALEmembers OR of theDISTRIBUTION profes- ■ Health and illness are humanNOT experiences.FOR SALE e OR DISTRIBUTION sion through professional organizations and presence of illness does not preclude health, activities nor does optimal health preclude illness. Does nursing demonstrate these professional ■ e relationship between the nurse and the patient occurs within the context of the val- © Jonescharacteristics? & Bartlett Nursing Learning, has a standardized LLC content, © Jones & Bartlett Learning, LLC ues and beliefs of the patient and the nurse. NOT FORalthough SALE schools OR of nursing DISTRIBUTION may congure the con- NOT FOR SALE OR DISTRIBUTION tent in dierent ways; there is consistency in content ■ Public policy and the healthcare delivery sys- areas such as adult health, maternal–child health, tem inuence the health and well-being of behavioral or mental health, pharmacology, assess- society and professional nursing. ment, and so on. e National Council Licensure ■ Individual responsibility and interprofes- © Jones & Bartlett ExaminationLearning, (NCLEX) LLC covers standardized content© Jones & sionalBartlett involvement Learning, are essential. LLC NOT FOR SALE ORareas. DISTRIBUTION is content is based on systematic, recogNOT- FORAutonomy SALE OR, responsibility DISTRIBUTION, and account- nized knowledge as the profession’s knowledge base ability are intertwined with the practice of nursing for practice (ANA, 2010a), and it is expected to be and are critical components of a profession. Auton- oered in higher education programs. e Nursing omy is the “capacity of a nurse to determine his/her Education, Accreditation, and Regulation chapter dis- own actions through independent choice, including © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC cusses nursing education in more detail. It is clear, demonstration of competence, within the full scope though, thatNOT the focusFOR of SALE nursing ORis practice—care DISTRIBUTION of nursing practice” (ANA, 2010a,NOT p.FOR 39). ItSALE is the OR DISTRIBUTION provided to assist individuals, families, communities, right to make a decision and take control. Nurses and populations. have a distinct body of knowledge and develop com- Nursing as a profession has a social contract petencies in nursing care that should be based on © Joneswith & society, Bartlett as described Learning, in Nursing’s LLC Social Policy this nursing© knowledge.Jones & When Bartlett this is accomplished,Learning, LLC NOT FORStatement SALE: “ e OR authority DISTRIBUTION for the practice of profes- nurses canNOT then practice FOR nursing.SALE “ResponsibilityOR DISTRIBUTION re- sional nursing is based on a social contract that ac- fers to being entrusted with a particular function” knowledges professional rights and responsibilities (Ritter-Teitel, 2002, p. 34). “Accountability means

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being responsible and accountable to self and others 2. Nursing: Scope and Standards of Practice (ANA, for behaviors and© Jonesoutcomes & included Bartlett in one’s Learning, pro- LLC2010b) was developed by the© JonesANA and & itsBartlett Learning, LLC fessional role. ANOT professional FOR nurse SALE is accountable OR DISTRIBUTION for members. Nursing standards,NOT which FOR are “au SALE- OR DISTRIBUTION embracing professional values, maintaining profes- thoritative statements dened and promoted sional values, maintaining competence, and main- by the profession by which the quality of prac- tenance and improvement of professional practice tice, service, or education can be evaluated” © Jonesenvironments” & Bartlett (Kupperschmidt, Learning, 2004, LLC p. 114). A (ANA, 2010b,© Jones p. 67), &are Bartlett critical to Learning,guiding LLC NOTnurse FOR is also SALE accountable OR DISTRIBUTIONfor the outcomes of the safe, qualityNOT patient FOR care. SALE Standards OR describe DISTRIBUTION nursing care that the nurse provides; what nurses minimal expectations. “We must always re- do must mean something (Finkelman, 2012). e member that as a profession the members are nurse is answerable for the actions that the nurse granted the privilege of self-regulation because takes. Accountability and responsibility are not the they purport to use standards to monitor and © Jones & Bartlettsame Learning,thing, however. LLC A nurse often delegates tasks © Jonesevaluate & Bartlett the actions Learning, of its members LLC to en- NOT FOR SALEto OR other DISTRIBUTION sta members, telling sta what to do and NOT FORsure a SALEpositive impactOR DISTRIBUTION on the public it serves” when. e sta member who is assigned a task is (O’Rourke, 2003, p. 97). responsible both for performing that task and for Standards include a scope of practice state- the performance itself. e nurse who delegated the ment that describes the “who, what, where, when, task to the sta© person Jones is accountable & Bartlett for theLearning, deci- why, LLC and how” of nursing practice.© eJones ANA &de Bartlett- Learning, LLC sion to delegateNOT the task. FOR Delegation SALE is ORdiscussed DISTRIBUTION in nition of nursing is the critical foundation.NOT FOR As noted SALE OR DISTRIBUTION more detail in the Work in Interprofessional Teams in Box 1-2, the denition of nursing evolved and chapter. will most likely continue to evolve over time as needs change and healthcare delivery and practice Sources of Professional evolve. Nursing knowledge and the integration of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Direction science and art, which are discussed in more detail NOT FOR SALE OR DISTRIBUTION in e EssenceNOT of Nursing: FOR Knowledge SALE ORand DISTRIBUTIONCaring Professions develop documents or statements about chapter, are part of the scope of practice, along with what the members feel is important to guide their the denition of the “what and why” of nursing. practice, to establish control over practice, and to Nursing care is provided in a variety of settings by inuence the quality of that practice. Some of the © Jones & Bartlett Learning, LLC © Jonesthe professional & Bartlett registered Learning, nurse, who mayLLC have an important sources of professional direction for NOT FOR SALE OR DISTRIBUTION NOTadvanced FOR degreeSALE and OR specialty DISTRIBUTION training and exper- nurses follow: tise. Additional information about the standards, 1. Nursing’s Social Policy Statement (ANA, 2010c) as well as the nurse’s roles and functions, is found is an important document that is mentioned throughout this text. Part of being a professional is elsewhere in this chapter. is social policy having a commitment to the profession—a com- statement© describesJones the & professionBartlett of Learning, nursing mitment LLC to lifelong learning, adhering© Jones to standards, & Bartlett Learning, LLC and its professionalNOT FOR framework SALE and OR obligations DISTRIBUTION maintaining membership in professionalNOT FOR organiza SALE- OR DISTRIBUTION to society. e original 1980 statement has been tions, publishing, and ensuring that nursing care is revised three times—in 1995, 2003, and 2010. of the highest quality possible. is document informs consumers, government To go full circle and return to the social con- © Jonesocials, & Bartlett other healthcare Learning, professionals, LLC and tract, nursing ©care Jones must be & providedBartlett and Learning, should LLC NOT FORother importantSALE OR stakeholders DISTRIBUTION about nursing and include considerationNOT FOR of health, SALE social, OR cultural, DISTRIBUTION its denition, knowledge base, scope of practice, economic, legislative, and ethical factors. Content and regulation. related to these issues is discussed in other chapters

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in this text. Nursing is not just about making some- Nursing specialty groups—in some cases, in one better;© it Jones is about &providing Bartlett health Learning, education, LLCpartnership with the ANA—have© Jones developed & Bartlett spe- Learning, LLC assisting patientsNOT andFOR families SALE in making OR DISTRIBUTION health de- cialty standards, such as thoseNOT for FOR cardiovascular SALE OR DISTRIBUTION cisions, providing direct care and supervising others nursing, neonatal nursing, and nursing informatics. who provide care, assessing care and applying the However, all nurses must meet the generic standards best evidence in making care decisions, communi- regardless of their specialty. © Jonescating & andBartlett working Learning, with the treatment LLC team, de- e Code© Jones of Ethics & for Bartlett Nurses (ANA, Learning, 2010a) LLC NOT FORveloping SALE a plan OR of care DISTRIBUTION with a team that includes describes nursing’sNOT FOR central SALE beliefs and OR assists DISTRIBUTION the pro- the patient and family when the patient agrees to fession in controlling its practice. is code is “the family participation, evaluating patient outcomes, profession’s public expression of those values, duties, advocating for patients, and much more. and commitments” (ANA, 2010a, p. xi). Implemen- e Apply Quality Improvement chapter dis- tation of this code is an important part of nursing’s © Jones & Bartlett cussesLearning, safe, quality LLC care in more detail, but as ©the Jones contract & Bartlett with society. Learning, As nurses practice, LLC they need to NOT FOR SALE ORstudent DISTRIBUTION becomes more oriented to nursing educaNOT- FORreect SALEthese values. OR e DISTRIBUTION Ethics and Legal Issues chapter tion and nursing as a profession, it is important to focuses on ethical and legal issues related to nursing recognize that establishing standards is part of be- practice and describes the code in more detail. ing in a profession. e generic standards and their State boards of nursing also assume an im- measurement© Jones criteria, which & Bartlett apply to allLearning, nurses, are LLCportant role in guiding and© in Jones some cases & Bartlettdeter- Learning, LLC divided intoNOT two FORtypes ofSALE standards: OR standards DISTRIBUTION of mining professional directionNOT through FOR legislation. SALE OR DISTRIBUTION practice and standards of professional performance. Each state board operates under a state practice act, e major content areas of the standards follow which allows the state government to meet its re- (ANA, 2010b, pp. 9–11). sponsibility to protect the public—in this case, the Standards of Practice (competent level of prac- health of the public—through nursing licensure re- © Jonestice based& Bartlett on the nursing Learning, process) LLC quirements.© EachJones nurse & must Bartlett practice, Learning, or meet the LLC NOT FOR1. Assessment SALE OR DISTRIBUTION descriptionNOT of, nursing FOR asSALE identied OR in DISTRIBUTIONthe state in 2. Diagnosis which the nurse practices. Regulation is discussed in 3. Outcomes identication more detail in the Nursing Education, Accreditation, 4. Planning and Regulation chapter. © Jones & Bartlett Learning,5. Implementation LLC (coordination of care, health© Jones & Bartlett Learning, LLC teaching and health promotion, consultation, NOT FOR SALE OR DISTRIBUTION NOT FORProfessional SALE OR Nursing DISTRIBUTION and prescriptive authority) 6. Evaluation Associations Standards of Professional Performance (compe- Nurses have a history of involvement in organiza- tent level of behavior in the professional role) tions that foster the goals of the profession. e exis- 1. Ethics© Jones & Bartlett Learning, LLCtence of professional associations© Jones and organizations & Bartlett Learning, LLC 2. EducationNOT FOR SALE OR DISTRIBUTIONis one of the characteristics of NOTa profession. FOR A SALE profes- OR DISTRIBUTION 3. Evidence-based practice and research sional organization is a group that has specic goals, 4. Quality of practice objectives, and functions that relate to the mission of 5. Communication a specic profession. Typically, membership is open © Jones6. &Leadership Bartlett Learning, LLC to members© ofJones that profession & Bartlett and requires Learning, payment LLC NOT FOR7. Collaboration SALE OR DISTRIBUTION of dues. NOTSome organizationsFOR SALE have OR more DISTRIBUTION specic 8. Professional practice evaluation membership requirements or may be by invitation 9. Resource utilization only. Nursing has many organizations at the local,

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state, national, and international levels, and some the perception by some nurses of the ANA’s lack organizations function© Jones on all & of Bartlett these levels. Learning,of LLC response to vital nursing issues.© JonesIn addition & toBartlett Learning, LLC ProfessionalNOT organizations FOR SALE often publishOR DISTRIBUTION jour- being a professional organization,NOT the FORANA isSALE a OR DISTRIBUTION nals and other information related to the profes- labor union, which is not true for most nursing sion and oer continuing education opportunities professional organizations. Participation in the la- through meetings, conferences, and other formats. bor union is optional for members, and each state © JonesAs discussed & Bartlettpreviously, Learning,many of the organizations, LLC organization’s stance© Jones on unions & Bartlett has an impact Learning, on LLC NOTparticularly FOR SALE ANA, have OR been DISTRIBUTION involved in developing membership. eNOT ANA’s FOR major SALE publication OR is DISTRIBUTION Amer- professional standards. Professional education is a ican Nurse Today. key function of many organizations. Some orga- e organization’s 2012 annual report identi- nizations are very active in policy decisions at the es the eight pillars on which the organization bases government levels and in taking political action to its programs, products, and services (ANA, 2012): © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ensure that the profession’s goals are addressed. is ■ Leadership: We prepare and support nurses NOT FOR SALEactivity OR DISTRIBUTION is generally done through lobbying and ad- NOT FORto advocate SALE and OR lead DISTRIBUTION in a full range of prac- vocacy. Some of the organizations are involved in tice and policy settings. In fall 2012, ANA advocacy in the work environment, with the aim launched its Leadership Institute with pro- of making the work environment better for nurses. grams focused on addressing the needs of Major Nursing© Jones Associations & Bartlett Learning, LLCdeveloping leaders. In 2013,© Jones programs & are Bartlett Learning, LLC planned for emerging and advanced leaders. e following NOTdescription FOR highlights SALE someOR DISTRIBUTIONof the NOT FOR SALE OR DISTRIBUTION ■ Cornerstone Documents: ese documents major nursing organizations (keep in mind that articulate the views of ANA on ethical, pro- many other professional organizations exist). Or- fessional and policy issues that impact con- ganizations that focus on nursing specialties have temporary nursing practice and nursing’s expanded. Other organizations related to nursing © Jones & Bartlett Learning, LLC unique ©contributions Jones & Bartlettto patients, Learning, health LLC education are described in the Nursing Education, NOT FOR SALE OR DISTRIBUTION care andNOT society. FOR Examples SALE include OR the DISTRIBUTION Code Accreditation, and Regulation chapter. Exhibit 1-2 of Ethics for Nurses and Scope and Standards lists some of these organizations and their websites. of Practice. American Nurses Association. e ANA is the or- ■ Scope of Practice: We promote and support © Jones & Bartlettganization Learning, that represents LLC all RNs in the United © Jonesthe & ability Bartlett of RNs Learning, and APRNs LLC to practice NOT FOR SALEStates, OR DISTRIBUTIONbut not all RNs belong to the ANA. e NOT FORto theSALE full extent OR DISTRIBUTIONof their knowledge and ANA also represents nurses who are not members professional scope through multiple strat- because many in government and business view the egies. is pillar also encompasses ANA’s ANA as the voice of nursing. When the ANA lob- recognition of specialty scope and standards. bies for nursing, it is lobbying for all nurses, not just ■ Care Innovation: We inuence national pol- its membership.© is Jones organization & Bartlett represents Learning, more LLCicy to advance nursing service© Jones delivery mod& Bartlett- Learning, LLC than 3.1 millionNOT RNs FOR through SALE its 54 ORconstituent DISTRIBUTION els to enhance patient-centricityNOT andFOR to exSALE- OR DISTRIBUTION member associations and state and territorial asso- pand economic opportunities for nurses. ciations, although the actual membership is only ■ Quality: is work encompasses ANA’s com- approximately 180,000 (ANA, 2013). is shift in mitment to advocate and promote nursing © Jonesmembership & Bartlett must be considered Learning, in light LLC of gener- quality ©and Jones patient safety& Bartlett outcomes Learning, through LLC NOTational FOR issues. SALE New ORnurses DISTRIBUTION typically do not join or- researchNOT and FORmeasurement, SALE ORcollaborative DISTRIBUTION ganizations, and there is continual unrest regarding learning, consultative services, and advocacy.

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Academy of Medical–Surgical Nurses: http://www.medsurgnurse.org Academy of Neonatal Nursing: http://www.academyonline.org American Academy of Ambulatory Care Nursing, http://www.aaacn.org © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC American Academy of Nurse Practitioners: http://www.aanp.org NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION American Academy of Nursing: http://www.aannet.org American Assembly for Men in Nursing: http://aamn.org American Association for the History of Nursing: http://www.aahn.org American Association of Colleges of Nursing: http://www.aacn.nche.edu © Jones & Bartlett Learning,American Association LLC of Critical-Care Nurses:© http://www.aacn.org Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONAmerican Association of Diabetes Educators: http://www.diabeteseducator.orgNOT FOR SALE OR DISTRIBUTION American Association of Legal Nurse Consultants: http://www.aalnc.org American Association of Managed Care Nurses: http://www.aamcn.org American Association of Neuroscience Nurses: http://www.aann.org American© JonesAssociation & of Bartlett Nurse Anesthetists: Learning, http://www.aana.com LLC © Jones & Bartlett Learning, LLC AmericanNOT Association FOR ofSALE Nurse Attorneys:OR DISTRIBUTION http://www.taana.org NOT FOR SALE OR DISTRIBUTION American Association of Occupational Health Nurses: http://www.aaohn.org American College of Nurse–Midwives: http://www.midwife.org American College of Nurse Practitioners: http://www.acnpweb.org © Jones American& Bartlett Holistic Learning, Nurses’ Association: LLC http://www.ahna.org © Jones & Bartlett Learning, LLC NOT FORAmerican SALE Nephrology OR DISTRIBUTION Nurses’ Association: http://www.annanurse.orgNOT FOR SALE OR DISTRIBUTION American Nurses Association: http://www.nursingworld.org American Nurses Foundation: http://www.nursingworld.org/anf American Nursing Informatics Association: http://www.ania.org © Jones & Bartlett Learning,American Organization LLC of Nurse Executives: http://www.aone.org© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONAmerican Psychiatric Nurses Association: http://www.apna.orgNOT FOR SALE OR DISTRIBUTION American Public Health Association–Public Health Nursing: http://www.apha.org American Radiological Nurses Association: http://www.arinursing.org American Society of PeriAnesthesia Nurses: http://www.aspan.org American© JonesSociety of &Plastic Bartlett Surgical Nurses:Learning, http://www.aspsn.org LLC © Jones & Bartlett Learning, LLC AssociationNOT for FOR Nursing SALE Professional OR Development: DISTRIBUTION http://anpd.org NOT FOR SALE OR DISTRIBUTION Association of Camp Nurses: http://www.campnurse.org Association of Nurses in AIDS Care: http://www.anacnet.org Association of Pediatric Hematology/Oncology Nurses: http://www.apon.org © Jones Association& Bartlett of PeriOperative Learning, Registered LLC Nurses: http://www.aorn.org© Jones & Bartlett Learning, LLC NOT FORAssociation SALE ORof Rehabilitation DISTRIBUTION Nurses: http://www.rehabnurse.org NOT FOR SALE OR DISTRIBUTION (continues)

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Exhibit© 1-2 Jones (continued & ) Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Association of Women’s Health, Obstetric and Neonatal Nurses: http://www.awhonn.org Commission on Graduates of Foreign Nursing Schools: http://www.cgfns.org Council of International Neonatal Nurses: http://www.coinnurses.org © JonesDevelopmental & Bartlett Disabilities Learning, Nurses Association: LLC http://www.ddna.org © Jones & Bartlett Learning, LLC NOT FOREmergency SALE Nurses OR Association: DISTRIBUTION http://www.ena.org NOT FOR SALE OR DISTRIBUTION Home Healthcare Nurses Association: http://www.hhna.org Hospice and Palliative Nurses Association: http://www.hpna.org Infusion Nurses Society: http://www.ins1.org © Jones & BartlettInternational Learning, Association LLC of Forensic Nurses: http://www.iafn.org© Jones & Bartlett Learning, LLC NOT FOR SALE ORInternational DISTRIBUTION Council of Nurses: http://www.icn.ch NOT FOR SALE OR DISTRIBUTION International Homecare Nurses Association: http://ihcno.org International Society for Psychiatric–Mental Health Nurses: http://www.ispn-psych.org International Transplant Nurses Society: http://itns.org National Alaskan© Jones Native American & Bartlett Indian Learning,Nurses Association: LLC http://www.nanainanurses.org© Jones & Bartlett Learning, LLC National AssociationNOT FOR of Clinical SALE Nurse OR Specialists: DISTRIBUTION http://www.nacns.org NOT FOR SALE OR DISTRIBUTION National Association of Neonatal Nurses: http://www.nann.org National Association of Orthopaedic Nurses: http://www.orthonurse.org National Association of Pediatric Nurse Practitioners: http://www.napnap.org © JonesNational & BartlettAssociation ofLearning, School Nurses: LLC http://www.nasn.org © Jones & Bartlett Learning, LLC NOT FORNational SALE Black Nurses OR Association:DISTRIBUTION http://www.nbna.org NOT FOR SALE OR DISTRIBUTION National Council of State Boards of Nursing: https://www.ncsbn.org National Gerontological Nursing Association: http://www.ngna.org/ National League for Nursing: http://www.nln.org National Nursing Staff Development Organization: http://www.nnsdo.org © Jones & BartlettNational Learning, Student LLCNurses Association: http://www.nsna.org© Jones & Bartlett Learning, LLC NOT FOR SALE OROncology DISTRIBUTION Nursing Society: http://www.ons.org NOT FOR SALE OR DISTRIBUTION Pediatric Endocrinology Nursing Society: http://www.pens.org Society of Gastroenterology Nurses and Associates: http://www.sgna.org Society of Pediatric Nurses: http://www.pedsnurses.org Society of Trauma© Jones Nurses: & http://www.traumanurses.org Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Society of UrologicNOT FORNurses SALEand Associates: OR DISTRIBUTIONhttp://www.suna.org NOT FOR SALE OR DISTRIBUTION Society for Vascular Nursing: http://www.svnnet.org State Nurses Associations: http://www.nursingworld.org/functionalmenucategories/aboutana/whoweare/ cma.aspx © JonesTranscultural & Bartlett Nursing Learning, Society: http://www.tcns.org LLC © Jones & Bartlett Learning, LLC NOT FORWound, SALE Ostomy ORand Continence DISTRIBUTION Nurses Society: http://www.wocn.orgNOT FOR SALE OR DISTRIBUTION

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■ Work Environment: ANA advocates a cul- ■ Raise the Voice is a campaign to ensure that ture© of Jones safety. ese& Bartlett programs Learning, promote a LLC more Americans hear ©about Jones and understand & Bartlett Learning, LLC healthyNOT and FOR safe SALEenvironment OR forDISTRIBUTION patients the new possibilities NOTfor transforming FOR SALE the OR DISTRIBUTION and nurses. healthcare system. ANA fellows are working ■ Safe Stang: ese programs, products, and in partnership with other organizations in services assist nurses in promoting safe sta- this initiative. Practical innovators are iden- © Jones & ingBartlett at every practiceLearning, level and LLC in all settings. tied© knownJones as Edge& Bartlett Runners. Learning, LLC NOT FOR■ SALEHealthy ORNurse DISTRIBUTION: We champion the health, ■ eNOT ANA FORprovides SALE expert panelsOR DISTRIBUTION to address safety and wellness of the nurse through current healthcare concerns. programs, products and services with your ■ e Council for the Advancement of Nurs- health in mind. ing Science serves as a voice for nurse scien- Content on all of these pillars is included in tists and supports development of nursing © Jones & Bartlett thisLearning, text, as they LLC are critical elements of health care© Jones & science.Bartlett Learning, LLC NOT FOR SALE ORtoday. DISTRIBUTION NOT FOR■ SALE e Geropsychiatric OR DISTRIBUTION Nursing Collabora- e ANA has three aliated organizations: the tive’s goal is to improve nursing education American Nurses Foundation (ANF), the Ameri- regarding the care of elders who have de- can Academy of Nursing (AAN), and the American pression, dementia, and other mental health Nurses Credentialing© Jones Center & Bartlett (ANCC). Learning, LLC disorders. © Jones & Bartlett Learning, LLC American NursesNOT Foundation. FOR SALE “ e OR American DISTRIBUTION Nurses American Nurses CredentialingNOT Center. FOR e SALE Amer- OR DISTRIBUTION Foundation is the only philanthropic organization ican Nurses Credentialing Center (ANCC) was with a mission to transform the nation’s health established by the ANA in 1973 to develop and through the power of nursing. We help nurses step implement a program that would provide tangible © Jonesinto &leadership Bartlett roles Learning, in their communities LLC and recognition© ofJones professional & Bartlett achievement. Learning, rough LLC NOT FORworkplaces SALE to ensure OR DISTRIBUTIONthat they can play a meaning- this program,NOT many FOR nurses SALE meet certication OR DISTRIBUTION require- ful role in shaping decisions on the quality and ca- ments and pass certication exams in specic nursing pacity of health care” (ANF, 2012). In 2012, ANF practice areas—for example, pediatric nursing, adult awarded $1.16 million in grants. psychiatric and mental health nursing, nurse execu- American Academy of Nursing. e AAN was es- tive, gerontological nursing, informatics nursing, and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tablished in 1973, and it serves the public and the many more. After receiving certication, nurses must NOT FOR SALE ORnursing DISTRIBUTION profession through its activities to advanceNOT FORcontinue SALE to adhere OR to DISTRIBUTION specic requirements, such as health policy and practice (AAN, 2013b). e completion of continuing education. academy is considered the “think tank” for nursing. e ANC C engages in the following major ac- Membership as an academy fellow is by invitation; tivities (ANC C, 2013): fellows may© thenJones list “FAAN” & Bartlett in their Learning, credentials. LLC ■ Accreditation Program:© e Jones ANC C & Accredi Bartlett- Learning, LLC ere are approximatelyNOT FOR 2100SALE fellows, OR representingDISTRIBUTION tation program recognizesNOT the FOR importance SALE of OR DISTRIBUTION nursing’s leaders in education, management, prac- high-quality continuing nursing education tice, and research. is is a very prestigious organiza- (CNE) and skills-based competency pro- tion, and fellows have demonstrated their leadership. grams. Around the world, ANCC-accredited AAN also publishes the journal Nursing Outlook. organizations provide nurses with the knowl- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Examples of some of the AAN’s current proj- edge and skills to help improve care and pa- NOT FORects follow SALE (AAN, OR 2013a): DISTRIBUTION tientNOT outcomes. FOR SALE OR DISTRIBUTION

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■ Certication Program: ANC C’s Certication ■ Goal I—Leader in Nursing Education: En- Program© enables Jones nurses & Bartlettto demonstrate Learning, their LLChance the NLN’s national ©and Jones international & Bartlett Learning, LLC specialtyNOT expertise FOR and SALEvalidate ORtheir knowlDISTRIBUTION- impact as the recognized NOTleader inFOR nursing SALE OR DISTRIBUTION edge to employers and patients. rough tar- education. geted exams that incorporate the latest nurs- ■ Goal II—Commitment to Members: Build a ing practice standards, ANC C certication diverse, sustainable, member-led organiza- © Jonesempowers & Bartlett nurses Learning,with pride and LLCprofessional tion with© theJones capacity & toBartlett deliver the Learning, NLN’s LLC NOT FORsatisfaction. SALE OR DISTRIBUTION mission NOTeectively, FOR eciently, SALE and OR in DISTRIBUTION accor- ■ Pathway: e Pathway to Excellence Pro- dance with the NLN’s values. gram recognizes a healthcare organization’s ■ Goal III—Champion for Nurse Educators: Be commitment to creating a positive nursing the voice of nurse educators and champion practice environment. e Pathway to Excel- their interests in political, academic, and © Jones & Bartlett Learning,lence in Long LLC Term Care program is the rst © Jonesprofessional & Bartlett arenas. Learning, LLC NOT FOR SALE OR toDISTRIBUTION recognize this type of supportive work set- NOT FOR■ Goal SALE IV—Advancement OR DISTRIBUTION of the Science of Nurs- ting, specically in long-term care facilities. ing Education: Promote evidence-based nurs- Pathway organizations focus on collabora- ing education and the scholarship of teaching. tion, career development, and accountable American Association of Colleges of Nursing. AACN leadership© toJones empower & nurses.Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ■ is the national organization for educational programs Magnet NOTRecognition FOR Program SALE: ANC OR C’s DISTRIBUTION Mag- NOT FOR SALE OR DISTRIBUTION net Recognition Program is the most pres- at the baccalaureate level and higher. e organiza- tigious distinction a healthcare organization tion is particularly concerned with development of can receive for nursing excellence and qual- standards and resources and promotes innovation, ity patient outcomes. Organizations that research, and practice to advance nursing education © Jonesachieve & Bartlett Magnet Learning,recognition are LLC part of an (AACN, 2013).© eJones organization & Bartlett represents Learning, more LLC NOT FOResteemed SALE group OR that DISTRIBUTION demonstrates superior than 725 schoolsNOT of FORnursing SALE at the baccalaureateOR DISTRIBUTION nursing practices and outcomes. and higher levels. e dean or director of a school ■ Credentialing Knowledge Center: ANC C’s Cre- of nursing serves as a representative to the AACN. dentialing Knowledge Center provides educa- e organization holds annual meetings for nurse tional materials and guidance to support nurses educators that focus on dierent levels of nursing © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and organizations in their quest to achieve education. e AACN has been involved in creating NOT FOR SALE OR successDISTRIBUTION through its credentialing programs. NOTand FOR promoting SALE new rolesOR andDISTRIBUTION educational programs, which will be discussed in other chapters of this text. National League for Nursing. NLN is a nursing Examples of these roles are the clinical nurse leader organization that focuses on excellence in nursing (CNL) and the doctor of nursing practice (DNP). education. Its membership© Jones is & primarily Bartlett composed Learning, of e LLC major AACN publication is the© JonesJournal of &Pro Bartlett- Learning, LLC schools of nursingNOT and FOR nurse SALEeducators. OR e DISTRIBUTION NLN fessional Nursing. NOT FOR SALE OR DISTRIBUTION began in 1893 as the American Society of Superin- is organization’s strategic goals and objec- tendents of Training Schools. Its major publication tives for 2014–2016 are as follows (AACN, 2013): is Nursing Outlook. It holds a number of educational ■ Goal 1: Provide strategic leadership that advances professional nursing education, re- © Jonesmeetings &annually Bartlett and provides Learning, continuing LLC education © Jones & Bartlett Learning, LLC and certication for nurse educators. search, and practice. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION is organization has four major goals (NLN, ● Objective 1: Lead innovation in baccalau- 2013): reate and graduate nursing education that

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promotes high-quality health care and and protecting the future of AD nursing in the new© Jones knowledge & generation.Bartlett Learning, LLCmidst of healthcare changes.© Its Jones major goals & Bartlettfollow Learning, LLC ● ObjectiveNOT FOR 2: Establish SALE collaborative OR DISTRIBUTION rela- (N-OADN, 2011): NOT FOR SALE OR DISTRIBUTION

tionships and form strategic alliances to ■ Collaboration Goal: Advance associate degree advance baccalaureate and graduate nurs- nursing education through collaboration ing education. with a diversity of audiences. ● Objective 3 ■ © Jones & Bartlett Learning,: Increase the visibilityLLC and par- Education© Jones Goal: & Advance Bartlett associate Learning, degree LLC NOT FOR SALEticipation OR of DISTRIBUTION nursing’s academic leaders as nursingNOT education. FOR SALE OR DISTRIBUTION advocates for innovation in nursing. ■ Advocacy Goal: Advocate for issues and activ- ■ Goal 2: Develop faculty and other academic ities that support the organization’s mission. leaders to meet the challenges of changing healthcare and higher education environments. Sigma Theta Tau International. Sigma eta Tau In- © Jones & Bartlett Learning,● Objective LLC 1: Provide opportunities for aca© -Jonesternational & Bartlett (STTI) Learning,is a not-for-prot LLC international NOT FOR SALE OR DISTRIBUTIONdemic leaders to strengthen leadership NOTand FORorganization SALE based OR in DISTRIBUTION the United States. is nurs- administrative expertise. ing honor society was created in 1922 by a small ● Objective 2: Expand initiatives that recruit group of nursing students at what is now the In- and develop a diverse community of nurse diana University School of Nursing. Its mission is educators© Jones throughout & Bartlett their Learning, academic LLCto provide leadership and scholarship© Jones in & practice, Bartlett Learning, LLC careers.NOT FOR SALE OR DISTRIBUTIONeducation, and research to improveNOT FOR the health SALE of OR DISTRIBUTION ● Objective 3: Increase opportunities for all all people (STTI, 2013). Membership in this orga- members of the nursing academic unit nization is by invitation to baccalaureate and grad- to participate in AACN programs and uate nursing students who demonstrate excellence initiatives. in scholarship and to nurse leaders who demon- © Jones &■ GoalBartlett 3: Leverage Learning, AACN’s LLCpolicy and pro- strate exceptional© Jones achievements & Bartlett in nursing. Learning, STTI LLC NOT FOR SALEgrammatic OR leadership DISTRIBUTION on behalf of the pro- has 405,000NOT members, FOR approximatelySALE OR DISTRIBUTION130,000 of fession and discipline. whom are active members, and 86 countries are ● Objective 1: Serve as the primary voice for represented in its membership. baccalaureate and graduate nursing edu- Schools of nursing form association chap- cation through media outreach, advocacy, ters. e chapters are where most of the work of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC policy development, and data collection. the organization takes place. ere are 488 chap-

NOT FOR SALE OR DISTRIBUTION● NOT FOR SALE OR DISTRIBUTION Objective 2: Respond to the needs of a diverse ters, which include schools in Australia, Botswana, membership and external stakeholders. Brazil, Canada, Colombia, England, Ghana, Hong ● Objective 3: Implement initiatives to in- Kong, Japan, Kenya, Malawi, Mexico, the Nether- crease diversity among nursing students, lands, Pakistan, Portugal, Singapore, South Africa, faculty,© Jones and the & workforce. Bartlett Learning, LLCSouth Korea, Swaziland, Sweden,© Jones Taiwan, Tanzania,& Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONWales, and the United States.NOT is isFOR an important SALE OR DISTRIBUTION National Organization for Associate Degree Nursing. organization, and students should learn more about e National Organization for Associate Degree their school’s chapter (if the school has one) and Nursing (N-OADN) represents associate degree aspire to an invitation for induction into STTI. (AD) nurses, AD nursing programs, and individual Inductees meet specic academic and leadership © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC member nurse educators. e organization focuses standards. NOT FORon enhancing SALE the OR quality DISTRIBUTION of AD nursing education, e NOTmajor STTIFOR publications SALE OR are DISTRIBUTION Journal of strengthening the professional role of the AD nurse, Nursing Scholarship, Reections on Nursing Leadership,

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and the newest publication, Worldviews on Evi- of the country and to network with other nursing dence-Based Nursing© Jones. e &organization Bartlett Learning,manages students. LLC Annual conventions attract© Jones more &than Bartlett Learning, LLC the major onlineNOT library FOR for nursingSALE resources, OR DISTRIBUTION the 3000 nursing students and are NOTheld at FOR dierent SALE OR DISTRIBUTION Virginia Henderson International Nursing Library, sites each year. is professional networking af- through its website. fords students opportunities to learn about graduate education, specialty groups, and nursing careers. International Council of Nurses. e International rough NSNA, students can also get involved © JonesCouncil of& NursesBartlett (ICN), Learning, founded in LLC 1899, is a © Jones & Bartlett Learning, LLC in the NSNA Leadership University (http://www NOTfederation FOR ofSALE 130 national OR DISTRIBUTION nurses associations repre- NOT FOR SALE OR DISTRIBUTION .nsna.org/Membership/LeadershipUniversity.aspx). senting approximately 16 million nurses worldwide rough this program, students have the opportu- (ICN, 2013). is organization is the international nity to be recognized for the leadership and man- voice of nursing and focuses on activities to better agement skills that they develop in NSNA and to ensure quality care for all and sound health policies © Jones & Bartlett Learning, LLC © Jonesearn academic & Bartlett credit for Learning, this experience. LLC NOT FOR SALEglobally. OR DISTRIBUTION It has three major goals: NOT FOR SALE OR DISTRIBUTION ■ To bring nursing together worldwide Why Belong to a Nursing ■ To advance nurses and nursing worldwide Professional Organization? ■ To inuence health policy e previous section described many nursing pro- e ICN ©focuses Jones primarily & Bartlett on professional Learning, fessional LLC organizations, as noted ©in inJones Exhibit & 1-2, Bartlett Learning, LLC nursing practiceNOT (specic FOR health SALE issues, OR Interna DISTRIBUTION- and there is further informationNOT in the FOR Nursing SALE OR DISTRIBUTION tional Classication of Nursing Practice), nursing Education, Accreditation, and Regulation chapter regulation (regulation and credentialing, ethics, about some of these organizations. Why is it im- standards, continuing education), and socioeco- portant to belong to a professional organization? nomic welfare for nurses (occupational health and Belonging to a nursing association requires money © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC safety, salaries, migration, and other issues). e for membership and commitment to the associa- NOTICN FOR headquarters SALE isOR in Geneva, DISTRIBUTION Switzerland. is tion. CommitmentNOT involvesFOR SALEbeing active, OR DISTRIBUTIONwhich organization represents more than 130 national means that it takes time. Membership, and it is nurse associations, such as the ANA, and more hoped active involvement, can help nurses develop than 16 million nurses. leadership skills, improve networking, and nd © Jones & BartlettNational Learning, Student Nurses LLC Association. e National © Jonesmentors. &Additionally, Bartlett Learning,membership givesLLC nurses NOT FOR SALEStudent OR DISTRIBUTION Nurses Association (NSNA) has a member- NOTa voice FOR in SALEprofessional OR issues DISTRIBUTION and, in some cases, ship of approximately 60,000 students enrolled in health policy issues, and it provides opportunities diploma, AD, baccalaureate, and general graduate for professional development. Nurses who attend nursing programs (NSNA, 2013). It is a national meetings, hold oces, and serve on committees or organization with chapters within schools of nurs- as delegates to large meetings benet more from ing. Its major ©publication Jones is& ImprintBartlett. Joining Learning, the membership LLC than those who do© not Jones participate. & Bartlett Learning, LLC NSNA is a greatNOT way toFOR get involvedSALE andOR to DISTRIBUTION begin Submitting abstracts for a presentationNOT FORor poster SALE OR DISTRIBUTION to develop professional skills needed for the future at a meeting is excellent experience for nurses and (such as learning more about being a leader and a oers even more opportunities for networking with follower, critical roles for practicing nurses). e other nurses who might also provide resources and © JonesNSNA website & Bartlett provides Learning, an overview LLCof the orga- mentoring for ©professional Jones &development. Bartlett Learning, LLC NOTnization FOR and SALE its activities. OR DISTRIBUTION (See “Linking to the In- Joining a professionalNOT FOR organization SALE OR and becomDISTRIBUTION- ternet.”) Attending a national convention is also a ing active in the work of such an organization is a great way to nd out about nursing in other areas professional obligation. Nurses represent the single

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largest voting bloc in any state. By using this polit- and Services Administration (HRSA) as well as ical power© through Jones nursing & Bartlett and other Learning, professional LLC$20 million for the Nurse Managed© Jones Health & ClinicsBartlett Learning, LLC organizations,NOT nurses FOR can SALE speak ORin one DISTRIBUTION powerful (NMHCs) as authorized underNOT Title FOR III of theSALE Pub- OR DISTRIBUTION voice. Yet as nurses, we have often failed to pull to- lic Health Service Act” (ANSR, 2013). gether. Membership in a professional organization e example set by this organization shows is one way to develop one strong voice. how nursing can band together to have a greater © Jones &Students Bartlett can beginLearning, to meet LLCthis professional voice about© criticalJones healthcare & Bartlett policy issuesLearning, such as LLC NOT FORobligation SALE by joiningOR DISTRIBUTION local student organizations the need toNOT expand FOR the SALEnursing profession.OR DISTRIBUTION Nurs- and developing skills that can then be used after ing is one of the largest healthcare professions, and graduation, when they join professional organiza- nurses have many opportunities to serve as leaders tions. Membership oers opportunities to serve as in health care. Nurses work in a variety of settings, a committee member and even chair a commit- such as hospitals, clinics, home health care, nursing © Jones & Bartlett tee.Learning, Organization LLC communication methods ©can Jones care &facilities Bartlett (long-term Learning, care, rehabilitation), LLC phy- NOT FOR SALE ORbe DISTRIBUTIONobserved, and the student can participateNOT in FORsician SALEoces, school OR DISTRIBUTIONhealth, hospice care, employ- the processes. ment services, and numerous other service sites. e Nursing organizations give members the op- majority of nurses work in acute care hospital set- portunity to participate in making decisions about tings, but this is changing as more care moves into nursing and© Joneshealth care & Bartlettin general. Learning, When new LLCthe community. © Jones & Bartlett Learning, LLC nurses enterNOT the profession FOR SALE today, they OR nd DISTRIBUTION a health- According to the BureauNOT of Labor FOR Statistics’ SALE OR DISTRIBUTION care system that is struggling to improve its quality employment projections for 2010–2020 released and keep up with medical changes; one of the key in February 2012, the registered nursing work- issues impacting this struggle is the variation in the force is expected to be the top occupation in terms nursing shortage over time. To demonstrate the crit- of job growth through 2020. e number of em- © Jonesical concern& Bartlett about thisLearning, issue, the following LLC is an ex- ployed nurses© Jones is predicted & Bartlett to grow from Learning, 2.74 mil- LLC NOT FORample SALEof how professionalOR DISTRIBUTION organizations can come lion in 2010NOT to 3.45 FOR million SALE in 2020, OR an DISTRIBUTION increase of together and advocate for patient care. 712,000 or 26%. Over this period, another 495,500 e Americans for Nursing Shortage Relief nursing workforce replacements are expected to be Alliance (ANSR) represents a diverse cross-section needed, bringing the total number of job openings of healthcare and professional organizations. e for nurses due to growth and replacements to 1.2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ANSR includes 54 nursing organizations col- million by 2020 (U.S. Bureau of Labor Statistics, NOT FOR SALE ORlectively DISTRIBUTION representing approximately 2.7 millionNOT FOR2012). SALE In the past OR ve DISTRIBUTION years, there has been a nursing nurses, healthcare providers, and supporters of shortage, but this mismatch in supply and demand nursing issues who have united to address the na- has decreased for now. e Tri-Council for Nurs- tional nursing shortage. As an example, the ANSR ing, in a statement in 2010, cautioned that while sent letters© to Jones both the & U.S. Bartlett Senate andLearning, the U.S. LLCincreases in the nursing shortage© Jones slowed because & Bartlett of Learning, LLC House of RepresentativesNOT FOR SALE in June 2013,OR DISTRIBUTION urging the the economic downturn, duringNOT which FOR fewer SALE nurses OR DISTRIBUTION following: “As you begin your consideration of the left their jobs, and with some increase in enroll- FY 2014 Labor, Health and Human Services, and ment numbers in nursing programs throughout the Education (LHHS) Appropriations bill, the under- United States, we have not resolved the long-term signed members of the ANSR (Americans for Nurs- problem of the nursing shortage. As the number of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ing Shortage Relief) Alliance urge you to fund $251 nurses in practice and nursing school enrollments NOT FORmillion SALE for the OR Title DISTRIBUTION VIII—Nursing Workforce uctuate, NOTthe nursing FOR shortage SALE will OR impact DISTRIBUTION access to Development programs at the Health Resources care in the years to come (Tri-Council for Nursing,

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2010). Because of demographic changes, the older healthcare professionals, government agencies and adult population© inJones the United & Bartlett States is increasing Learning, legislators LLC at all levels of government,© Jones and ultimately & Bartlett Learning, LLC rapidly, and theNOT A ordable FOR CareSALE Act ORpromises DISTRIBUTION to the profession’s self-identity. Just asNOT individuals FOR may SALE OR DISTRIBUTION extend insurance coverage to more people; taken to- feel depressed or less e ective if others view them gether, these developments signal that the demand negatively, so professionals can experience similar for nurses will increase. e greater demand, in reactions if their image is not positive. Image in- © Jonesturn, is expected & Bartlett to lead Learning, to more nursing LLC shortage uences everything© Jones the profession & Bartlett does or Learning, wishes LLC NOTproblems FOR asSALE well as OR shortages DISTRIBUTION of other healthcare to do. How nursesNOT view FOR themselves—their SALE OR DISTRIBUTIONprofes- professionals. sional self-image—has an impact on professional Nursing is a profession. It meets all the require- self-esteem (Buresh & Gordon, 2006). How one is ments for a profession. In the early part of its his- viewed has an impact on whether others seek that tory, nursing was not viewed as such, as the review person out and how they view the e ectiveness of © Jones & Bartlettof nursing Learning, history described LLC earlier in this chapter, © Joneswhat that & person Bartlett might Learning,do. Every time LLC a nurse says NOT FOR SALEbut OR it isDISTRIBUTION now recognized as a profession built on a NOTto family,FOR friends,SALE or OR members DISTRIBUTION of the public that he “core body of knowledge that re ects its dual com- or she is a nurse, the nurse is representing the pro- ponents of science and art” (ANA, 2010c, p. 22). fession. Gordon stated, “We cannot expect outsid- O’Rourke (2003) explains that the profession of ers to be the guardians of our visibility and access nursing “subscribes© Jones to the notion& Bartlett that the Learning, service to LLC public media and health policy© arenas. Jones We must& Bartlett Learning, LLC orientation andNOT ethics ofFOR its members SALE is OR the basis DISTRIBUTION for develop the skills of presenting ourselvesNOT FORin the me-SALE OR DISTRIBUTION justifying the privilege of self-regulation,” and “that dia and to the media—we have to take the respon- the profession is responsible for developing a body sibility for moving from silence to voice” (Buresh & of knowledge and techniques that can be applied in Gordon, 2000, p. 15). practice along with providing the necessary training “Although nurses comprise the majority of © Jonesto master & such Bartlett knowledge Learning, and skill” (pp.LLC 97–98). healthcare professionals,© Jones they & Bartlettare largely invisible.Learning, LLC NOT eFOR Essence SALE of Nursing: OR Knowledge DISTRIBUTION and Caring chap- eir competence,NOT skill, FOR knowledge, SALE and OR judgment DISTRIBUTION ter explores the art and science of the profession of are—as the word ‘image’ suggests—only a re ec- nursing. tion, not reality” (Sullivan, 2004, p. 45). e public views of nursing and nurses are typically based on personal experiences with nurses, which can lead © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The Image of to a narrow view of a nurse often based on only a NOT FOR SALE OR DISTRIBUTIONNursing NOTbrief FOR personal SALE experience. OR DISTRIBUTION is experience may not provide an accurate picture of all that nurses can Image may appear to be an unusual topic for a nurs- and do provide in the healthcare delivery process. ing text, but it is not. Image is part of any profes- In addition, this view is in uenced by the emotional sion. It is the ©way Jones a person & appears Bartlett to others, Learning, or response LLC of a person to the situation© Jones and the & en- Bartlett Learning, LLC in the case of aNOT profession, FOR the SALE way that OR a profes-DISTRIBUTIONcounter with a nurse. NOT FOR SALE OR DISTRIBUTION sion appears to other disciplines and to the general But the truth is that most often the nurse is in- public—in nursing’s case, consumers of health care. visible. Consumers may not recognize that they are Image and the perception of the profession a ect interacting with a nurse, or they may think some- recruitment of students, the view of the public, one is a nurse who is not. When patients go to their © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC funding for nursing education and research, rela- doctor’s o ce, they interact with sta , and often NOTtionships FOR withSALE healthcare OR DISTRIBUTIONadministrators and other these patients NOTthink thatFOR they SALE are interacting OR DISTRIBUTION with

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a registered nurse. Most likely, they are not—the e nurse’s voice is typically silent, and this fac- sta person© isJones more likely & Bartlett to be a medicalLearning, assis- LLCtor has demoralized nursing ©(Pike, Jones 2001). & is Bartlett is a Learning, LLC tant of someNOT type FOR or a licensed SALE practical/vocational OR DISTRIBUTION strong statement and may be NOTa confusing FOR one. SALE What OR DISTRIBUTION nurse. When in the hospital, patients interact with is the nurse’s voice? It is the “unique perspectives many sta members, and there is little to distin- and contributions that nurses bring to patient care” guish one from another, so patients may refer to (Pike, 2001, p. 449). Nurses have all too often been © Jonesmost & sta Bartlett as nurses. Learning, Uniforms do LLC not even help silent about© whatJones they &do Bartlettand how they Learning, do it, but LLC NOT FORidentify SALE roles, ORas many DISTRIBUTION sta wear scrub clothes this has beenNOT a choice FOR that SALE nurses have OR made—to DISTRIBUTION be and lab clothes, and there has been less emphasis silent or to be more visible. Both external and inter- placed on professional attire. nal factors have impacted the nurse’s voice and this is does not mean that the public does not silence. e external factors include the following value nurses—quite the contrary. When a person (Pike, 2001): © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tells another that he or she is a nurse, the typical ■ Historical role of nurse as handmaiden (not NOT FOR SALE ORresponse DISTRIBUTION is positive. However, many people do NOTnot FOR SALEan independent OR DISTRIBUTION role) know about the education required to become a ■ Hierarchical structure of healthcare organi- nurse and to maintain current knowledge, or about zations (has often limited the role of nursing the great variety of educational entry points into in decision making and leadership) nursing that© allJones lead to &the Bartlett RN qualication. Learning, Con- LLC ■ Perceived authority and© Jonesdirectives &of Bartlettphysi- Learning, LLC sumers generallyNOT FORview nurses SALE as goodOR peopleDISTRIBUTION who cians (has limited theNOT independent FOR SALErole of OR DISTRIBUTION care for others. For the 11th consecutive year, an an- nurses) nual Gallup Poll found that nursing ranked as num- ■ Hospital policy (has often limited nursing ber one in the annual list of occupations rated for actions and leadership) honesty and ethical standards, with 81% of respon- ■ reat of disciplinary or legal action or loss © Jonesdents & agreeing Bartlett with Learning, this assessment. LLC is high vote of job© Jones (might limit & Bartlett a nurse when Learning, he or she LLC NOT FORof condence SALE has OR been DISTRIBUTION a consistent annual result in needsNOT to speak FOR out—advocate) SALE OR DISTRIBUTION the poll (Jones, 2010). What is not mentioned is Nurses who can deal with the internal factors that knowledge and competency are required to do can be more visible and less silent about nursing. the job properly. e internal factors to consider include these: You might wonder why it is so important for © Jones & Bartlett Learning, LLC © Jones &■ Bartlett Learning, LLC nurses to make themselves more visible. You chose Role confusion NOT FOR SALE ORnursing, DISTRIBUTION so you know that it is an important proNOT- FOR■ SALELack of professionalOR DISTRIBUTION condence fession. Nevertheless, many students have a nar- ■ Timidity row view of the profession, much closer to what ■ Fear is portrayed in the media—the nurse who cares ■ Insecurity for others,© albeit Jones with & less Bartlett understanding Learning, of the LLC ■ Sense of inferiority © Jones & Bartlett Learning, LLC knowledgeNOT base requiredFOR SALE and competency OR DISTRIBUTION needed Nurses’ loss of professionalNOT pride FOR and SALEself-es- OR DISTRIBUTION to meet the complex needs of patients. ere is teem can also lead to a more serious professional limited recognition that nursing is a scientic problem: Nurses feel like victims and then act like eld. e profession needs to be more concerned victims. Victims do not take control, but rather about visibility because nursing is struggling to see others as being in control; they abdicate re- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC attract qualied students and keep current nurses sponsibility. ey play passive–aggressive games to NOT FORin practice. SALE OR DISTRIBUTION exert power.NOT is FOR can be SALE seen in ORthe public DISTRIBUTION image

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of nurses, which is predominantly driven by forces healthcare professionals? Suzanne Gordon, a jour- outside the profession.© Jones It also & aects Bartlett the nurse’s Learning, abil- nalist LLC who has written extensively ©about Jones the nursing & Bartlett Learning, LLC ity to collaborateNOT with FOR others—both SALE otherOR DISTRIBUTIONnurses profession, noted that often the mediaNOT areFOR accused SALE OR DISTRIBUTION and other healthcare professionals. It is all too easy of representing nursing poorly when, in reality, the for nurses to feel like victims, and this perception media are simply reecting the public image of has led in many ways to nurses viewing physicians nursing (Buresh & Gordon, 2006). Nurses have © Jonesin a negative & Bartlett light, emphasizing Learning, that LLC“Physicians not taken the ©lead Jones in standing & Bartlett up and discussing Learning, LLC NOThave FOR done thisSALE to us.” OR As a DISTRIBUTIONconsequence, nurses have their own imageNOT of nursing—what FOR SALE it is OR and whatDISTRIBUTION it problems saying that they are colleagues with other is not. It is not uncommon for a nurse to refuse to healthcare professionals and acting like colleagues. talk to the press because the nurse feels no need to “Colleagueship [boldface added] involves entering do so or sometimes because the nurse fears reprisals into a collaborative relationship that is characterized from his or her employer. When nurses do speak © Jones & Bartlettby mutual Learning, trust and LLCresponse and an understanding © Jonesto the press, & Bartlett often when Learning, being praised LLC for an ac- NOT FOR SALEof OR the perspectiveDISTRIBUTION each partner contributes” (Pike, NOTtion, FOR they say,SALE “Oh, ORI was DISTRIBUTION just doing my job.” is 2001, p. 449). Colleagues have the following char- statement undervalues the reality that critical quick acteristics: thinking on the part of nurses saves lives every day. What is wrong with taking that credit? Because of ■ Do not let interprofessional or intraprofes- these types of responses in the media, nursing is not sional competition© Jones and & antagonismBartlett fromLearning, the LLC © Jones & Bartlett Learning, LLC directing the image, but rather accepting how those past driveNOT the present FOR andSALE the future OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION outside profession describe nursing. ■ Integrate their work to provide the best care Gordon and Nelson (2005) comment that ■ Acknowledge that they share a common nursing needs to move “away from the ‘virtue goal: quality patient care script’ toward a knowledge-based identity” (p. 62). ■ Recognize interdependence © Jones & Bartlett Learning, LLC e “virtue script”© Jones continues & toBartlett be present Learning, in cur- LLC ■ Share responsibility and accountability for NOT FOR SALE OR DISTRIBUTION rent media campaignsNOT FOR that areSALE supported OR DISTRIBUTIONby the patient care outcomes profession. For example, a video produced by the ■ Recognize that collegial relationships are safe National Student Nurses Association mentions ■ Handle conict in a positive manner knowledge but not many details; instead, it in- What is unexpected is how nurses’ silence may cludes statements such as “[Nursing is a] job where © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC actually have a negative impact on patient care. is people will love you” (Gordon & Nelson, 2005). NOT FOR SALEfactor OR mayDISTRIBUTION inuence how a nurse speaks out or ad- NOTHow FOR helpful SALE is this OR approach? DISTRIBUTION Is this view of be- vocates for care that a patient needs; how eective ing loved based on today’s nursing reality? Nursing a nurse can be on the interprofessional treatment practice involves highly complex care; it can be team; and how nurses participate in healthcare pro- stressful, demanding, and at times rewarding, but gram planning ©on Jones many levels. & Bartlett Each nurse Learning, has the it LLCis certainly not as simple as “everyone© Jones will &love Bartlett Learning, LLC responsibility andNOT accountability FOR SALE to dene OR himselfDISTRIBUTION you.” Why do nurses continue toNOT describe FOR them SALE- OR DISTRIBUTION or herself as a colleague, and empowerment is part selves in this way? “One reason nurses may rely of this process. so heavily on the virtue script is that many believe e role of nursing has experienced many this is their only legitimate source of status, re- changes, and many more will occur in the future. spect, and self-esteem” (Gordon & Nelson, 2005, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC How has nursing responded to these changes p. 67). is, however, is a view that perpetuates the NOTand FOR communicated SALE ORthem DISTRIBUTION to the public and other victim mentality.NOT FOR SALE OR DISTRIBUTION

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Landscape ©© f9photos/Shutterstock, Jones Inc. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ConclusionNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

is chapter has highlighted the history of nursing, societal trends, image of nursing, and other inuences that shape nursing as a profession. It presented an overview of the remainder of this text. Professional nursing © Jonesincludes & Bartlett many key aspectsLearning, that will LLC be discussed in more detail: art ©and Jones science of & nursing; Bartlett education; Learning, critical LLC NOT FORissues relatedSALE to ORhealth DISTRIBUTION care, such as those involving consumers; theNOT continuum FOR of SALE care; the OR healthcare DISTRIBUTION delivery system; policy, and legal and ethical concerns; the ve core competencies; and current issues regarding the practice of nursing.

1. Nursing history provides a framework for un- 5. e sources of professional direction include derstanding© Jones how nursing & Bartlett is practiced Learning, today. LLC ANA documents that describe© Jones the &scope Bartlett of Learning, LLC 2. e historyNOT of FOR nursing SALE is complex OR and DISTRIBUTION has been practice, accountability, NOTand an FORethical code.SALE OR DISTRIBUTION inuenced by social, economic, and political 6. Professional organizations play a key role in factors. shaping nursing as a profession. 3. Florence Nightingale was instrumental in 7. e image of nursing is formulated in many changing the view of nursing and education to ways by the public, the media, interprofes- © Jones &improve Bartlett care delivery. Learning, LLC sional© colleagues, Jones and& Bartlett nurses. Nursing’s Learning, image LLC NOT FOR4. Nursing SALE meets OR theDISTRIBUTION critical requirements for a as a professionNOT FOR has bothSALE positive OR and DISTRIBUTION negative profession. aspects.

1. How might knowing more about nursing his- 5. Why are standards important to the nursing tory affect your personal view of nursing? profession and to healthcare delivery? 2. How© Jonesdid the image & Bartlett of nursing inLearning, Nightingale’s LLC 6. Review the ANA standards© Jonesof practice & and Bartlett Learning, LLC timeNOT inuence FOR nursing SALE from theOR 1860s DISTRIBUTION through professional performance. NOTAre you FOR surprised SALE OR DISTRIBUTION the 1940s? by any of the standards? If so, why? 3. How would you compare and contrast ac- 7. How would you explain to someone who is countability, autonomy, and responsibility? not in health care the reason that nursing em- 4. Based on content in this chapter, how would phasizes its social policy statement? © Jones & Bartlettyou de ne professionalismLearning, inLLC your own words? © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Landscape © f9photos/Shutterstock,© Jones Inc. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CriticalNOT FOR Thinking SALE OR DISTRIBUTION Activities NOT FOR SALE OR DISTRIBUTION

1. Describe how the Nightingale Pledge has rele- 4. Complete a mini-survey of six people (non- vance today and how it might be altered to be nurses), asking them to describe their image of more relevant. Work with a team of students nursing and nurses. Try to pick a variety of peo- © Jones to& accomplish Bartlett this Learning, activity and arrive LLC at a con- ple. Summarize© Jones and analyze & yourBartlett data to Learning,iden- LLC NOT FORsensus SALE statement. OR DISTRIBUTION tify any themesNOT and FOR unusual SALE views. How OR does DISTRIBUTION 2. Interview two nurses and ask them if they what you learned relate to the content in this think nursing is a profession, and determine chapter? List the similarities and differences, and the rationale for their viewpoint. How does then discuss your ndings with a group of your what they say compare with what you classmates and compare with their ndings. © Jones & Bartlett Learning,have learned LLC about professionalism in this © Jones 5. Analyze & Bartletta television programLearning, that focuses LLC on a chapter? healthcare situation/story line. How are nurses NOT FOR SALE OR 3. DISTRIBUTION Attend a National Student Nurses Association NOT FORdepicted SALE compared OR with DISTRIBUTION other healthcare profes- meeting at your school. What did you learn sionals? Compose a letter to the program describ- about the organization? What did you observe ing your analysis, and document your arguments to in the meeting about leadership and nursing? support your viewpoint. This could be done with Do you have any criticisms of the organization a team of students; watch the same program and and how© might Jones it be improved?& Bartlett Learning, LLCthen discuss opinions and observations.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© JonesElectronic & Bartlett Learning, Reection LLC Journal © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Circuit Board: ©Photos.com You are asked to develop an Electronic Reection Journal that you will use after you complete each chapter. This is the place for you to comment on some aspect identi ed at the end of the chapter. You may also keep notes about issues that you want to expand on—reect on—as you progress through your nursing education. If you are using technology that allows you to make visuals, use drawings and graphics to © Jones & Bartlettexpand Learning, your journal LLC thoughts. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONIn your rst entry in your Electronic Reection Journal,NOT considerFOR SALEthe following OR questions DISTRIBUTION related to the image of nursing. Connect your responses so that you can better understand the importance of image to the profession and the meaning of profession.

1. Why is the image of nursing important to the profession? To health care in general? 2. What role do you think you might have as a nurse in inuencing the image of nursing? Provide speci c examples.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3. What isNOT your opinion FOR about SALE nursing OR uniforms, DISTRIBUTION and how do you think they inuence the imageNOT of nursing?FOR SALE OR DISTRIBUTION 4. What stimulated your interest in nursing as a profession? Was the image of nursing in any way related to your decision, and in what way did it impact your decision? 5. Special assignment for this chapter: Write your own de nition of nursing and include it in your Electronic Reection Journal. Work on this de nition throughout this course as you learn more about © Jones nursing.& Bartlett Save the Learning, nal draft, and atLLC the end of each semester or quarter,© Jones go back to& yourBartlett de nition Learning, and LLC NOT FORmake SALE any changes OR youDISTRIBUTION feel are necessary. Keep a draft of each de nitionNOT so that FOR you can SALE see your OR changes. DISTRIBUTION When you graduate, review all your de nitions; see how you have developed your view of professional nursing. Ideally, you would then review your de nition again one year post graduation.

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Landscape ©© f9photos/Shutterstock, Jones Inc. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC LinkingNOT FOR to SALE the OR Internet DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

■ American Association for the History of Nursing: http://www.aahn.org ■ Directory of Links: http://dmoz.org/health/nursing/history © Jones &■ BarbaraBartlett Bates Learning, Center for the LLC Study of the History of Nursing,© JonesUniversity & of Bartlett Pennsylvania: Learning, LLC NOT FOR SALE http://www.nursing.upenn.edu/history/Pages/default.aspx OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ■ Experiencing War: Women at War (Includes nurses): http://www.loc.gov/vets/stories/ex-war-womenatwar.html ■ National Student Nurses Association: http://www.nsna.org ■ American Assembly of Men in Nursing: http://aamn.org © Jones & Bartlett Learning,■ Nursing: LLC e Ultimate Adventure pamphlet© Jones (NSNA): & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION http://www.nsna.org/Publications/Ultimate_Adventure.aspxNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CASENOT STUDIES FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Landscape © f9photos/Shutterstock, Inc. Case Study 1 © Jones & Bartlett You and your Learning, friends in the nursing LLC program are having lunch after© aJones class that &covered Bartlett content Learning, LLC NOT FOR SALEfound in ORthis chapter. DISTRIBUTION One of your friends says, “I was bored whenNOT we got FOR to all thatSALE information OR DISTRIBUTIONon professionalism and nursing organizations. What a waste of time. I just want to be a nurse.” All of you are struggling to gure out what you have gotten yourself into. You turn to your friends and suggest it might be helpful to have an open discussion on the comment just made. So over lunch you all talk about the comment made by one of your friends. It was clear that the students who had read the chapter were better able to discuss the issue, but everyone had an opinion. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Case Questions NOT FOR SALE OR DISTRIBUTION Here are some questions to consider: 1. What is the purpose of nursing organizations? 2. What role should professional organizations assume to increase nursing status in the healthcare system? 3.© What Jones are some & Bartlettof the advantages Learning, and disadvantages LLC to joining a professional organization?© Jones & Bartlett Learning, LLC 4.NOT What doFOR you knowSALE about OR your DISTRIBUTION school’s NSNA chapter? How would you join yourNOT school’s FOR stu- SALE OR DISTRIBUTION dent nursing association? 5. Which nursing organization mentioned in this chapter interests you and why? Compare your response with those of your other classmates. 6. Search on the Internet for a specialty nursing organization and pick one that interests you. What © Jones & Bartlettcan you Learning, nd out about theLLC organization? © Jones & Bartlett Learning, LLC (continues) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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CASE STUDIES© Jones & CONTINUED Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Landscape © f9photos/Shutterstock, Inc. Case Study 2 The NSNA chapter in your school wants to help the school develop a campaign to increase enrollment. You have volunteered along with three other members to meet with the associate dean © Jonesto & discuss Bartlett ideas for Learning, the campaign. TheLLC associate dean tells you that the© school Jones is going & toBartlett use its Learning, LLC standard marketing materials. She shows them to you. The materials focus on the importance of NOT FORbeing SALE a caring ORperson DISTRIBUTION to be a “good” nurse. When you ask to see printNOT materials FOR and SALEmaterials toOR DISTRIBUTION go on the Internet, you are told that the focus is on print and you see a photo of a nurse holding a patient’s hand. Case Questions © Jones & Bartlett Learning, 1. How do LLCyou respond to this marketing material?© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 2. Which recommendations would you make? NOT FOR SALE OR DISTRIBUTION 3. How might you get data from fellow students to support your recommendations?

© Roobcio/Shutterstock, Inc. Jamie White, MSN, RN © Jones Staff Nurse,& Bartlett Neonatal Learning,Intensive Care Unit, LLC University of Oklahoma Medical© Center, Jones Oklahoma & Bartlett City, Oklahoma Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION What would have made the transition to your rst nursing job easier? e transition to my job was very easy. What made it this way was working in the unit for a year and a half as a nurse partner and clerk. If you already know the basics of the unit, then transition is much easier.

© Jones & Bartlett What Learning, things were LLC included in your education that© Jones were most & Bartletthelpful? Least Learning, helpful? LLC NOT FOR SALE OR eDISTRIBUTION most helpful educational tool was the group/teamNOT work. FOR Nursing SALE is allOR about DISTRIBUTION being a member of a team and relying on others to help you perform your job more e ciently. e other helpful experience was how nursing school changes your mind-set of school and work. Nursing is ever changing, and so is nursing school. I remember being stressed out my rst semester due to the ever-changing environment© and Jones no clear & line.Bartlett Now, I Learning,understand why LLC it’s that way—because nursing© is Jonesthat way. &I Bartlett Learning, LLC cannot tell NOTyou the FOR least helpful, SALE only OR because DISTRIBUTION for everything I thought at the time hadNOT no purpose, FOR SALE OR DISTRIBUTION I found the purpose when I entered the eld.

What advice would you give entering students? My advice would be to come into nursing if you truly want to touch people’s lives. Nursing is full of frus- © Jonestrations & andBartlett politics, butLearning, if you are in LLC it for the love of people, then you© will Jones do ne. & Bartlette best feeling Learning, I get LLC NOT FORis to hand SALE a family OR their DISTRIBUTION sick infant for the rst time and to see the hopeNOT and love FOR that SALEis expressed. OR DISTRIBUTION

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Landscape ©© f9photos/Shutterstock, Jones Inc. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ReferencesNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

American Academy of Nursing (AAN). (2013a). AAN initiatives. Buresh, B., & Gordon, S. (2006). From silence to voice: What Retrieved from http://www.aannet.org/initiatives-policy nurses know and must communicate to the public (2nd ed.). American Academy of Nursing (AAN). (2013b). About AAN. Toronto, Ontario: Canadian Nurses Association. © Jones &Retrieved Bartlett from http://www.aannet.org/about-the-academy Learning, LLC Chinn, P. (2001).© Jones Feminism & and Bartlett nursing. In Learning, J. Dochterman LLC American Association of Colleges of Nursing (AACN). (2004, & H. Grace (Eds.), Current issues in nursing (6th ed., pp. NOT FORSeptember SALE 20). OR AACN DISTRIBUTION endorses the Sullivan Commission 441–447).NOT St. Louis, FOR MO: SALE Mosby. OR DISTRIBUTION report on increasing diversity in the health professions (press Cleary, B. (2007, July). Report given at the American Academy release). Washington, DC: Author. of Nursing Workforce Commission Committee on Prepa- American Association of Colleges of Nursing (AACN). (2013). ration of the Nursing Workforce, Chicago, IL. Strategic plan. Retrieved from http://www.aacn.nche.edu/ Cohen, S. (2007). e image of nursing. American Nurse Today, © Jones & Bartlett Learning,about-aacn/strategic-plan LLC © Jones &2(5), Bartlett 24–26. Learning, LLC American Nurses Association. (2010a). Guide to the code of eth- Connolly, C. (2004). Beyond social history: New approaches to NOT FOR SALE OR DISTRIBUTIONics for nurses. Interpretation and application. Silver Spring,NOT FORunderstanding SALE OR the state DISTRIBUTION of and the state in nursing history. MD: Nursesbooks.org Nursing History Review, 12, 5–24. American Nurses Association (ANA). (2010b). Nursing: Scope Dietz, D., & Lehozky, A. (1963). History and modern nursing. and standards of practice. Silver Spring, MD: Author. Philadelphia, PA: Davis. American Nurses Association (ANA). 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(2005). & Bartlett An end to Learning,angels. American LLC NOT FORRetrieved SALE from OR http://www.nursecredentialing.org/Func DISTRIBUTION - JournalNOT of Nursing FOR, 105(5), SALE 62–69. OR DISTRIBUTION tionalCategory/AboutANCC Gorenberg, B. (1983). e research tradition of nursing: An American Nurses Foundation (ANF). (2012). Retrieved from emerging issue. Nursing Research, 32, 347–349. http://www.anfonline.org/Main/AboutANF/2012- Huber, D. (Ed.). (2014). Leadership and nursing care management Report.html (5th ed.). Philadelphia, PA: Saunders. Americans for Nursing Shortage Relief (ANSR). (2013). ANSR International Council of Nurses (ICN). (2013). Our mission. © Jones & Bartlett Learning,health policy. LLCRetrieved from http://www.ansralliance.org/© Jones &Retrieved Bartlett from http://www.icn.ch/about-icn/ics-mission Learning, LLC NOT FOR SALE OR DISTRIBUTIONindex.html NOT FORJacobs, SALEM. K., & Huether,OR DISTRIBUTION S. E. (1978). Nursing science: e Ashley, J. (1976). Hospitals, paternalism, and the role of the nurse. theory practice linkage. Advances in Nursing Science, 1, New York, NY: Teachers College Press. 63–78. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educat- Jones, J. (2010, December 3). Nurses top honesty and ethics for ing nurses: A call for radical transformation. San Francisco, 11th year: Lobbyists, car salespeople, members of Congress CA: Jossey-Bass. get the lowest ratings. Gallup. Retrieved from http://www. Bixler, G., &© Bixler, Jones R. (1959). & eBartlett professional Learning, status of nurs- LLC gallup.com/poll/145043/Nurses-Top-Honesty-Ethics-© Jones & Bartlett Learning, LLC ing. American Journal of Nursing, 59, 1142–1147. List-11-Year.aspx Boughn, S. (2001).NOT Why FOR women SALE and men chooseOR nursing.DISTRIBUTION Nurs- Kalisch, P., & Kalisch, B. (1986). eNOT advance FOR of American SALE nurs- OR DISTRIBUTION ing and Healthcare Perspectives, 22, 14–19. ing (2nd ed.). Boston, MA: Little, Brown. Brooks, J. 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Shames, K. H. (1993). e Nightingale conspiracy: Nursing comes to Tri-Council for Nursing. (2010). Joint statement from the power in© the Jones 21st century .& Montclair, Bartlett NJ: Enlightenment Learning, Press. LLC Tri-Council for Nursing on recent© registeredJones nurse & supply Bartlett and Learning, LLC Shaw, M. (1993). e discipline of nursing: Historical roots, demand projections. Washington, DC: American Associa- currentNOT perspectives, FOR future SALE directions. OR Journal DISTRIBUTION of Advanced tion of Colleges of Nursing. NOT FOR SALE OR DISTRIBUTION Nursing, 18, 1651–1656. U.S. Bureau of Labor Statistics. (2012). Employment projection. Sigma eta Tau International (STTI). (2013). STTI organiza- Retrieved from http://www.bls.gov/news.release/ecopro tional fact sheet. Retrieved from http://www.nursingsoci- .t06.htm ety.org/aboutus/mission/Pages/factsheet.aspx U.S. Department of Health and Human Services, Health Re- © JonesSlater, & V. Bartlett(1994). e educational Learning, and philosophical LLC inuences sources© and Jones Services Administration,& Bartlett Bureau Learning, of Health LLC on Florence Nightingale, an enlightened conductor. Nurs- Professions. (2010). e registered nurse population: Find- NOT FORing SALE History Review OR, 2 DISTRIBUTION, 137–151. ings fromNOT the March FOR 2008 SALE national sampleOR DISTRIBUTIONsurvey of reg- Sochalski, J. (2002). Nursing shortage redux: Turning the corner istered nurses. Retrieved from http://datawarehouse.hrsa on an enduring problem. Health A airs, 21, 157–164. .gov/nursingsurvey.aspx Sullivan, E. (2002). In a woman’s world. Reections on Nursing Wall, B. (2003). Science and ritual: e hospital as medical and Leadership, 28(3), 10–17. sacred space, 1865–1920. Nursing History Review, 11, 51–68. Sullivan, E. J. (2004). Becoming inuential: A guide for nurses. Widerquist, J. (1997). Sanitary reform and nursing. Nursing His- © Jones & Bartlett Learning,Upper Saddle LLCRiver, NJ: Pearson Education. © Jones &tory Bartlett Review, 5, 149–159. Learning, LLC NOT FOR SALE ORSullivan, DISTRIBUTION L., & Sullivan Commission. (2004). Missing persons:NOT FORWoodham-Smith, SALE C.OR (1951). DISTRIBUTION Florence Nightingale: 1820–1910. Minorities in the health professions. Battle Creek, MI: W. K. New York, NY: McGraw-Hill. Kellogg Foundation.