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P-I Focus: Crisis in nursing has its roots in an image problem
Sunday, September 3, 2000
By NANCY FUGATE WOODS
Throughout history, models for nursing have centered on working with the hands. Rooted in religious orders, early nursing was practiced by male monks caring for victims of the Black Death, famines and wars. The model of self-sacrifice born in that era was amplified in later years when women began providing home- and, later, hospital-based care.
Public health nurses in Washington state were often the only health care resource in remote areas, dedicating themselves to the people in their care.
Despite many leadership roles for nurses in the decades that followed — on battlefields and in schools, in neonatal intensive care units and in nursing homes — the imagery of nursing as manual labor primarily performed by women has been perpetuated. Seeing nursing this way allows the practice to be viewed like motherhood — an essential but unpaid contribution to the work of society, with rewards that are largely intrinsic to the job.
It is this imagery that is perhaps at the root of the present nursing shortage, now estimated at 300,000 positions nationwide and expected to double by the end of the decade. Although there are many demographic, social and educational factors involved, the shortages seem primarily fueled by an aging nursing work force and a lack of new nurses to fill the voids left as these workers retire.
One begins to see the scope of the problem when you add in: a booming population of older adults needing nursing care, deficiencies in public policy for financing this and other health services, the constantly changing structure of health care organizations and the issue of pay inequity for nurses. But it is the pervasive image of nursing as a risky, low-status profession grounded in manual labor that is the greatest impediment to its future as a profession.
This is not to dismiss the importance of nursing as a hands-on art form. One has only to be comforted while in pain to sense the power of healing touch. Nurses today also "touch" families when they counsel them through crisis and serious illness; when they craft policies that touch children with special needs; when they work in medically underserved communities; when they improve care for the elderly.
Moreover, the faces behind the touching hands have changed. Today's nurses are increasingly male, increasingly from diverse ethnic backgrounds, increasingly drawn to nursing from other professional careers. They come to nursing school because they want to make a difference in the world, and they leave with the tools to do just that.
Nurses in the 21st century perform critical services at every level of need. Nurses help families learn to care for children who are able to live at home with serious health problems, sometimes requiring the use of complicated breathing equipment. Nurses who practice in hospitals make life-saving decisions and detect possibly fatal complications. Nurses in community health make changes in the community to benefit entire populations, some by instituting changes in public policy. Nurse practitioners in Washington state have prescriptive authority and provide primary care for people of all ages.
In these and hundreds of other ways, the work of nursing has deep intellectual and scientific roots. In addition to the many practice roles of modern nursing, today's nurse scientists also make important contributions to health care research that are not widely known or appreciated.
For example, few are aware that there is a National Institute of Nursing Research, one of the National Institutes of Health. Breakthroughs in nursing science from the University of Washington School of Nursing are providing a better future for the infants of migrant farm worker families, for runaway youth, for children in Head Start programs and for teens with serious mental illness living at home.
Nurse scientists are studying how to help individuals and their families deal with the consequences of breast or prostate cancer. They have developed parent-training programs to prevent possible future violent behavior in young children. Or they are studying better ways to control cancer pain, better ways to care for elderly people with Alzheimer's disease and ways to help people age in good health.
At the UW School of Nursing, we are preparing nurses to care for the very young and the very old, from community health departments to critical care units in hospitals. We are developing nurse scientists to enrich our knowledge base at each of these levels.
Moreover, we are educating nurse leaders to broaden the impact of nursing knowledge upon the health care system much as one pebble spreads a network of ripples across a pond. We are providing nursing education through programs at three UW campuses as well as to individuals living in remote rural areas using computer-based learning technology.
But none of this will matter if future students don't hear about the powerful contributions nurses make and the meaningful careers so many of us enjoy. Students come to nursing schools because they want to make a difference in the world. Now more than ever, nursing offers that opportunity.
Dr. Nancy Fugate Woods is dean of the University of Washington School of Nursing. The school was recently rated the top nursing school in the country for the 14th consecutive year in a national survey by U.S. News & World Report.
UW SCHOOL OF NURSING DEAN
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