“Why did you become a nurse?” I get that question sometimes, from friends or acquaintances or patients. If you are a nurse, you’ve been asked too. Some days (the really bad, I-don’t-even-have-time-to-pee and everyone-is-yelling-at-me days), I forget my answer to the question. I ask, “Why am I even doing this?!” So, I need to refocus. Why did I become a nurse?
If you are a nurse, what are your origins as a nurse? If you aren’t a nurse, you know nurses or have been taken care of by nurses. “They” say it “takes a special person” to be a nurse, or you might have some horror story about a really “bad nurse.” How much of our history as nurses (or patients) impacts our healthcare today? What are our origins?
Origin, as defined by Merriam-Webster’s: 1: ancestry, parentage 2 a: rise, beginning, or derivation from a source b: the point at which something begins or rises or from which it derives; also: something that creates, causes, or gives rise to another 3: the more fixed, central, or larger attachment of a muscle. 4: the intersection of coordinate axes. (Merriam-Webster, 2004, p. 875).
There are many books and essays regarding the origins of nursing as a profession. My aim is not to bore you or review an entire history of nursing, but rather to briefly overview some relevant and often overlooked history. (Okay. We are all familiar with and respect Florence Nightengale. But, she is not included in this overview).
Side note: My father once saw an Oprah episode about ancestry.com and enthusiastically joined. He reads incessant history books as a retired grade school teacher. I do not exactly share his same passion for family history. But, the history of nursing is fascinating.
Origins. What is our history? What is our beginning? Are we “the muscle?” What role does a nurse play in healthcare today?
My own family includes many nurses. My mother graduated from a diploma program in 1969 and a BSN program in 1981. She worked medical-surgical (med-surg), on a pediatric burn unit, an adolescent psych ward (unfortunately this experience did not help her much during my adolescence), home health, public health for the Tom Dooley Foundation in Nepal, rural health in MT, and finally Hospice. She has been working Hospice since 1992.
My maternal grandmother was a “flight nurse” in WWII. She flew wounded troops from war zones back to England and the US. During this time there was a roster of nurses, listing which would be assigned to the next flight. After flying, the name would drop to the bottom of the list. Grandma (Helen) was up for her turn. Another nurse wanted to switch with her and go on that flight. So, Helen stayed behind. That plane crashed and everyone on the flight was killed. She was lucky. Unfortunately, Grandma Helen died when I was young. I have so many questions to ask her! My mother still has her letters, signed “Angel in Flight.”
We all have our own histories as nurses, even if we are first-generation or multiple-generation nurses. Nursing as a whole has a more utilitarian origin.
In a nutshell from our nursing textbooks: Nursing has always existed in some form in all cultures. Nursing was traditionally a “lower-class” woman’s job in early Europe (Egnes, 2009). Religious organizations took over and many hospitals in the US today have roots in various churches. The Civil War and other societal changes within the US demanded the need for nurses in the US and soon after training facilities were initiated (Egnes, 2009). Like I said, “in a nutshell.”
Stay with me.
- A rise, a beginning.
Nursing school is not easy. Characters in movies who are “going to nursing school” are cute, empty, and generally “extra” types. Folks do not realize that nursing school is incredibly competitive, stressful, time-consuming, expensive, and challenging. Nursing school is the beginning to actually becoming a licensed professional. Many of us start in other healthcare jobs, such as Certified Nurse’s Assistants, EMTs/paramedics, phlebotomists, etc. but nursing school is a “solid” start on the path to becoming a Registered Nurse or Licensed Practical Nurse.
Nursing schools and training programs have dramatically changed over the years in the United States. There are still incredible barriers to access nursing education, especially for disenfranchised populations such as people of color.
Mary Mahoney was the first African-American woman to be admitted into a nursing school. She was a member of the American Nurses’ Association and fought for equality for nurses of color. She was also very involved in women’s right to vote and was able to vote for the first time in 1920. (“African-American Medical Pioneers, 2003). How far have we come since the 1920s?
According to minoritynurse.com about 75.4% of RNs categorize as “white.” 9.1% of RNs are men, even though men make up approximately 50% of the population. (“Nursing Statistics”, 2014). Nursing has many steps to take to increase diversity. The American Association of Colleges of Nursing has a PDF file available to discuss diversity of nursing: http://www.aacn.nche.edu/media-relations/diversityFS.pdf
But nursing has also made huge strides since the beginning. Nursing has evolved from a “lowly” job to a profession that is largely respected.
- The more central, fixed attachment of a muscle.
Well. We can appreciate this “origins” definition! Think Anatomy and Physiology nightmares. This can be an analogous to many situations.
Think about the origin of a muscle. How about the deltoid? The origin is the clavicle and scapula. Those bones are not going to move when you move the muscle (unless you crash your bike and break them, but you get the point). Physicians (and Physician Assistants and Nurse Practitioners) have their various roles within healthcare. Nurses also have a “scope of practice” and must legally function within that scope. If you just had the deltoid without the clavicles, you would be in serious trouble. The body simply would not work without its’ origins, just like a hospital simply would not work without its’ nurses.
Sometimes nurses are referred to as doctor’s “helpers.” We are not “helpers.” When we follow physician orders, we think about why the physician has ordered a particular medication, therapy, diagnostic test, or lab. Sometimes we do not know the answer, and we need to clarify or question the provider. Much of our job needs to be done autonomously, while following orders and staying within our scope of practice. In the hospital setting, a nurse is not “managed” by a physician. There are nurse managers.
We’ve heard the cliché that “nurses are the heart of healthcare!” The heart is a muscle. But, healthcare is a business (whether we like that aspect or not).
Sometimes the humanity of healthcare is lost in the economics and politics of that system. Of course, everyone from janitors and housekeepers to therapists and nurses are the “human” aspect of healthcare for patients. We are the ones that have power to advocate for our patients. Nurses, especially, have incredible power as patient advocates. That is, of course, our job.
(So, the big question is: Are nurses the clavicles of healthcare or the heart?)
- Intersection of axes
The media has misconstrued our jobs as nurses. This impacts the way regular people understand and treat nurses. Folks sometimes think a nurse’s job is to simply give bed baths, follow doctor orders without critical thinking, and hold hands. That may be in the history of nursing, but these basic nursing care roles are no longer the role of a nurse.
Nurses have many roles. We multitask patient needs, prioritize cares, recognize signs and symptoms of declining patients, consider pathophysiologies of disease, learn about new medications and procedures, change wound dressings, listen to complaints and praise, communicate with physicians, ask questions when we aren’t sure of the answer, read nursing journals on the latest evidence-based practice, hold our bladders, walk on our feet for twelve hours, tell off-colored jokes, and drink coffee (at least, most of us). We are not angels or saints. We get mad sometimes. We make mistakes, just like everybody else. Sometimes we feel downright incompetent, so we ask a lot of questions. We are just human. There are “good” nurses and “bad” nurses, and a lot of nutty ones.
One patient can take a lot of coordination. The nurse needs to communicate with therapies, the nurse’s aid, the physician, the housekeeper, and the family. Sometimes this role can be incredibly frustrating, especially when there are five different people and five different plans of care. But, this role is vital to the patient’s outcome.
Nurses help to facilitate overall care for a patient. If any of the pieces are disjointed or missing, the patient’s care might suffer. We are right in the thick of a patient’s care. As the sunset inspirational poster says, “Communication is Key!” Sometimes our communication needs a lot of improvement, but we are working on it. We really want all the pieces to fit together and for our patients to receive the best care. We don’t always “agree” with the patient’s choices, because we all come from different backgrounds and experiences.
Our individual origins as nurses are many. The origins of nursing are complex and ever-evolving.
So, why did I become a nurse?
I started doing nurse’s aide work in high school and had various jobs as a nurse’s aide for about seven years. I always bonded with and enjoyed the geriatric population (I’ve been schooled that the correct word is “mature”). I love working with folks with dementia (except when they are trying to punch me).
I loved anatomy and physiology (except the memorizing origins and insertions part) and chemistry, and just “how things work” overall. The body is kind of fabulous.
I had the privilege of interning in a hospital in Ghana for six months. I did random housekeeping and paperwork and wrote down verbal orders from the doctor on rounds. I ran to the pharmacy for medications. I helped with what I could when there was only one nurse in a full ward of adults and kids. Those nurses were badass. They knew how to improvise. I remember thinking, “I want to do that.” “I want to be that good.”
Of course, because of my origins, I was “never” going to be a nurse because my mom was a nurse. But, my mom is a great nurse.
(And I’m sure she appreciates this extra-gigantic picture of her).
African-American Medical Pioneers: Mary Eliza Mahoney 1845-1926. (2003). Retrieved December 4, 2014, from http://www.pbs.org/wgbh/amex/partners/early/e_pioneers_mahoney.html
Egenes, K. (2009). History of Nursing. In G. Roux (Ed.), Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow (pp. 2-8). Sudbary, MA: Jones and Bartlett.
Merriam-Webster’s Collegiate Dictionary (11th ed., p. 875). (2004). USA: Merriam-Webster, Incorporated.
Nursing Statistics. (2014). Retrieved December 4, 2014, from http://www.minoritynurse.com/minority-nursing-statistics