The evolution of nursing

"For us who nurse, our nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it, we are going back."

— Florence Nightingale

Progress has always been part of nursing. Nurses have advanced in knowledge, technology and standards since Florence Nightingale (considered the founder of modern nursing) wrote her landmark book, "Notes on Nursing: What It Is, and What It Is Not," in 1859.

"I still give that book to young nurses, and we could use it as the basis for our curriculum," said Susan Gunby, dean and professor at Georgia Baptist College of Nursing of Mercer University. "She was a great visionary, and so much of her advice holds true."

During National Nurses Week (today through May 12) Nightingale would, no doubt, be surprised at modern intensive care units with their mazes of machines, monitors and medications, yet she would have no trouble recognizing the nursing role in those settings. The nurses would be at patients' bedsides.

"Nurses are the 'constant of constancies' in the health care setting," Gunby said. "They're there, behind the scenes, taking care of things that have to be done. After a cancer diagnosis or a birth, someone has to help a patient and family cope, to perceive the unasked questions, to see the patient as a real person. Nurses are there at the critical junctures of people's lives."

That much hasn't changed, but the education and practice of nursing have continuously evolved.

Beyond the bedside, nurses manage health care facilities and run community programs and corporate safety initiatives. They work for insurance companies, law firms and government agencies, and they serve in the military. Many have advanced degrees to serve as primary health care providers or teachers.

"Today's nurses have limitless opportunities," Gunby said.

When Gunby attended the Georgia Baptist Hospital School of Nursing from 1965 to 1968, nursing students were young, unmarried women who lived in dorms and had curfews. They took classes and staffed the hospital's afternoon and evening shifts.

"We learned by doing and graduated knowing we had the discipline and endurance," Gunby said. "There was no doubt about being prepared or that we could depend on each other."

Today's students (about 7 percent are men) train in college or university nursing programs and gain experience through clinical rotations in hospitals, clinics, public health centers and other locations. With too few clinical sites and instructors available for nursing students, patient simulators have become welcome teaching tools. Teachers program simulation mannequins with common and rare scenarios to help students hone their skills for fast-paced, high-tech workplaces.

'Passion for babies'

"Nursing school was a life-changing experience and taught me that there will always be more to learn," said Ashley Upchurch, a labor and delivery nurse at Gwinnett Medical Center in Lawrenceville. "I wanted to be a nurse from age 4 and had a passion for babies. Nursing is hard work — a lot of responsibility — but it's so rewarding."

Most delivering mothers don't realize how much nurses do for them, said Becky Steed, a labor and delivery nurse at Piedmont Hospital. Expectant parents are overwhelmed with questions and anxieties. Nurses learn to rely on their instincts and to "be on their toes" at all times, because situations can change quickly, Steed said.

"It's a privilege to be with them on this special day. If the outcome is happy, it's the happiest time. When it's sad, it's awful, but I still want to be there. They need a nurse to be sensitive and supportive," Steed said.

Patients aren't the only people who rely on nurses.

"Doctors rely on us to be their eyes, too," said Upchurch, 24. "When we call for an order, we're telling the physician what we need to help the patient."

Patients often ask Upchurch, who has been on the job less than a year, if she's old enough to help them. Her answer: "Yes, I can!"

Computers, electronic charts and other technologies help nurses work more efficiently, but "your main tools are your hands and your heart," Upchurch said. "You never want to get so wrapped up in paperwork that you forget that your laboring patient is going through one of the most amazing times in her life. I want my nursing to be as hands-on as possible."

After 27 years in critical care, Michele Aldoretta is still pleased when patients tell her that she has "the lightest touch" and that they sense she's there to provide care.

"We often have people on oscillators — the most aggressive kind of ventilation," said Aldoretta, an intensive care unit nurse and clinician at Northside Hospital in Atlanta. "They are in the worst possible shape, but when you pull them through and they come back to thank you, my heart just quickens. That's a good feeling."

Finding a niche

Aldoretta has discovered that handling critical situations, multisystem organ dysfunctions, ever-changing equipment and emergency codes and helping families grieve over the loss of patients are her niche in nursing.

"I don't feel stressed; I feel right at home. You keep up with the technology as it comes and realize that it has allowed us to make huge strides in medicine," she said.

Patients used to come out of brain resection surgeries partially paralyzed or not able to talk.

"Now — with image scanners, laser and microsurgery techniques — we see tremendous results. Our patients walk and talk. They do fabulously," Aldoretta said.

As part of the hospital's Rapid Response Team, she helps solve patients' problems before they become life-threatening. Her unit has piloted programs to dispense medication to help prevent blood clots and ulcers.

"If it works in ICU, it can work anywhere," she said. "This job is emotionally and physically draining, but I still have a passion for helping people. That's what keeps me here."

The worsening shortage of nurses nationwide, coupled with much sicker patients and greater demands on the health care system, call for innovative solutions to attract, train and retain nurses. Their clinical, critical-thinking, decision-making, team-building and leadership skills will help solve health care problems.

Julie Churchman, a nurse and mother of six who has worked for 21 years in the emergency department at Piedmont Hospital, is never sure whether her "home life prepares her for the ED [emergency department] or the ED prepares her for home."

It's an academic question, because she applies her assessment and problem-solving skills to both roles. "Nurses live their skills full time," she said.

Like most nurses today, Churchman practices under evidence-based protocols that allow her to work more autonomously and collaboratively with physicians. As a triage nurse, Churchman is usually the first person to see a patient. She decides quickly what must be done and orders tests accordingly.

"The emergency room is busier, because patients are living longer with chronic conditions," she said. "There are more drugs and interventions, but just keeping up with all the changes is one of the biggest challenges of nursing."

Called on to serve a population that is sicker, heavier and more culturally diverse than ever — and despite shortages of practitioners, faculty and funding — most nurses would identify with Becky Steed's statement that she "would definitely choose this career again."

"I can't tell you the specific moment — sometime between six months and a year into practice — when I crossed over that line from student to nurse and knew I could handle whatever comes up," she said.

Florence Nightingale would recognize that as the sound of a nurse going forward.