Nursing-- Yesterday, Today, and Tomorrow

By Melda Sue Logan, RN, MSN - Retired; Cheryl Hickman, RN, BSN, MS

Nursing has been, and continues to be, a wonderful career.  Unlike 30 and 50 years ago, today, many diverse opportunities exist in the profession of nursing.  Over the years, nursing education transitioned from the traditional hospital diploma program to programs in universities and colleges.  While the art of nursing is still being taught, today’s fast paced health care system has changed the culture of nursing. 

In the past, patients stayed for many days in the hospital and the nurse got to know “their patients.”  Today, the length of time a patient stays in the hospital has been greatly reduced.  Surgical procedures are being done on an outpatient basis today that only a few years ago entailed a substantial hospital stay.  Historically, nurses focused on many comfort measures such as preparing the patients for meals, morning and bedtime care that included bathing and other daily living activities, talking and listening to patients, and preventing skin breakdown, to name a few.  In years past, staffing was consistent on hospital units and did not fluctuate with patient census.  Patients were not as sick, Intensive Care Units (ICU) were emerging, and technology was not as advanced.

Today, nurses have more “bells and whistles” than ever before in the history of the profession.  Until the late 70s, and on into the 80s, a nurse had to rely mainly on their assessment skills to provide safe, competent patient care.  In today’s world of advanced technology, an array or medical equipment and medical avenues are available to assist nurses with their nursing care.  Increased technology, shorter length of stay for patients, sicker patients, and an aging work force now contribute to the significant change in the work environment and the nursing culture.  A few years ago, nurses wrote pages of nursing notes; today, nurses can point and click to make entries on an electronic medical record.  The electronic medical record now includes documentation that is necessary to meet Joint Commission requirements, CMS requirements, and necessary documentation to support the nursing care given in the event he/she should be questioned as to whether standards of care were met.

Strong assessment skills and being an intent listener to the patient symptoms continue to be attributes of a good nurse.  While, in today’s health care system, nurses have access to more diagnostic and patient care equipment, there is no substitute for strong assessment and communication skills.  Good assessment skills are still as important today as they were in the past.  Machines cannot tell a nurse everything, and machines can fail.  Good communication and assessment skills, compassion, providing comfort measures, and being a patient advocate, coupled with being a safe and competent practitioner are hallmark qualities in the art of nursing.

Today’s technological advances have helped the health care professions greatly.  An excellent example is the medication administration process using a machine (pyxis) and bar coding technology.  In years past, nurses had to handwrite every medicine card for each patient and use trays for “passing” the medication—medicines were “poured” from a stock cabinet.  This process left the door open for increased errors.  Today, every medication is bar coded before being administered to a patient.  The pyxis machines have all patient information downloaded, and there are red flags that alert nurses to potential errors such as the wrong patient, wrong time, wrong pill, etc.  This medication administration process helps the nurse and protects the patient.  Bar coding helps to ensure that the right medicine is given to the right patient.

Infection Control (IC) Departments did not exist in the 70s.  IC departments began to increase in the 80s and are mandatory today.  Pre-1980, Methicillin Resistant Staph Aureus (MRSA) was rare, and hand washing was usually done only after dressing changes or cleaning patients.  Today, MRSA is no longer rare, and strict Body Substance Precautions, an increase in the use of gloves and hand washing guidelines must be followed with all patients.

In the early years of nursing, physicians, nurses and other health care providers had time to conduct round table discussions on the job which were teaching and learning opportunities.  Today, the fast paced and complex health care arena requires a more formal educational and competency based teaching model.  Much has changed in the profession of nursing through the years, and change will continue; what cannot change is the nurse’s commitment to be a patient advocate. 

Throughout the years, nursing has been, and hopefully will always be, the glue that holds the health care team together.  Nurses must never let the glue that binds good nursing practice and patient care lose its cohesive properties.  Patients – then, now, and in the future – will always look to the nurse to help them become well again.  Nurses continue to use their competent practice to help heal.  It is both the art and the science of nursing that we as professionals must cherish and employ in our practice today, tomorrow, and always.