Purpose of this Reflective Journal

My name is Torina and I have been a nurse of a little over 5 years. Most of my career has been in Maternity, Newborn ICU, and Labor and Delivery. That is where my passion is. Helping new mothers and newborns. After graduating with my ASN in 2015, I took some time off of school to gain work experience and start a family. I came back to school a little over a year ago to finish my BSN. I will graduate this semester which I am very excited about. For my Leadership class I am required to have a reflective journal/blog where I will be posting my notes, learning, thoughts, and experiences during the course. This journal will help me reflect in the future of what I learned during my time in this course and also help me organize and thoughts during the course. This will be a great semester as I already feel motivated. 

The Future of Nursing

This week I read a lot about predictions on where healthcare and nursing are headed and what the future will looked like for both.  In the article  I read it talked a lot about the future and how technology is developing greatly and as it develops more discoveries are being made especially in healthcare. People are living longer lives due to technology and living in much different ways then they did even just a few years ago.

Scientists predict that hospitals and long term care centers will become less needed as people are living healthier and longer lives. Hospital stays will become shorter with a greater emphasis on providing education on how to treat yourself and diagnose yourself at home and although hospitals will become less used, they will still be around forever because there is too much money to be made in hospitals and in many urgent situations they will forever still be needed and used. On the other hand the baby boomer generation are becoming opposed to putting their parents into long term care facilities and are more commonly providing care for family members at home which will cause less and less long term care facilities to stay in business. Doctor visits will still need to be made but in different ways. Doctor visits will happen on a screen at the comfort of your own home more frequently then at a hospital or office. Also most nursing schools still teach hospital based practices which will need to change as hospitals are becoming less used. Nursing education will focus more on technology services and educating the public which many older generation nurses are having a difficult time accepting and in a way are mourning the roles they once played with their patients. The public is taking the older generations views into account though because they don’t want to change too quickly in fear of losing these nurses and their healthcare experience. They also predict that Robots will start being used in giving care with the basics as technology continues to develop and think that Robots will be used in the OR to help with basics such as cleaning and getting supplies ready and assisting with instruments during surgery. Robots will be soon used in all areas of nursing for the basics in hopes to alleviate the workload of nurses and allow nurses to focus on other areas such as patient care and teaching.  Also they are predicting that a greater nursing shortage will arise in the near future because the role of a nurse is changing and as the population increases so does the need for nurses.

https://www.americannursetoday.com/nursing-today-and-beyond/

Honestly reading this article gave me anxiety. I may not be an older experienced generation nurse but I still feel that same mourning for the change in role of my career. The reason I got into nursing was because I loved the clinical base nursing and performing clinical practices. I also loved learning about the body and how to take care of it. I hope this never goes away.

It the few short years I have seen a big change though. I have seen more teaching emphasized and specific wording enforced into my practice. I have also seen a greater need for nurses and the workload increased along with a great stress in the computer part of nursing. I feel that more than 50% of my shift is spent documenting on the computer and the other 40% educating patients. I feel that I only use 10% clinical skills. I find myself delegating the clinical tasks to PCTs and others so I have enough time to properly chart and teach. It really makes me sad and I too am mourning in a way for the simplicity nursing used to be. I am starting to believe that nursing is going to become a job where all you do is chart and educated and others will be hired to do the clinical tasks. I hope this is not the cast. Although I am sad to see the changes I definitely understand why things are changing the way they are and I am excited to see what the future holds.

Nursing in the 21st Century

This week I learned that Nursing had been progressing quickly and making huge leaps in the 20th century but the job of a nurse had the biggest shift during the 21st century. Nurses no longer felt helpless and instead worked side by side physicians and were able to contribute to plans of care. Also, nursing was no longer being seen as just a “women’s” job but a job for all races and both genders. Also during the 20th century, once a women was married, they were to stop working in order to be a homemaker but times greatly changed in the 21st century and women were becoming accepted in the work filed much more. There were less stay at home mom’s then ever before.

The 21st century has been full of change but the biggest change of all was the role of a nurse. Before the 21st century (during the 20th century), nursing was considered a profession where someone would “do for” a patient who was already ill or disadvantaged. The job of a nurse consisted of caring in the late stages of illness and “doing” such as, cleaning, bathing, administering, pampering, feeding, drugging, and discharging. Today in the 21st century thanks to technology, this part of nursing has changed the most. Although nursing still consists of those same duties, so much of nursing today is focused on preventing illness rather than caring for it. The job of a nurse today is teaching/educating, linking, informing, accessing, typing, and researching. Prevention of illness is key to keeping people healthy, therefore the role of the nurse has significantly changed to accommodate our knowledge.

As the public gets more informed and health care knowledge increases along with technology, people should be getting less ill and living longer healthier lives. I can see why there was such a shift in the role of nurse because in order to keep the career of a nurse alive, nurses had to evolve. That is why our job as become so greatly focused on prevention of illness rather than treatment of illness.  Many older generation nurses are having a very difficult time accepting the new role of a nurse and want to keep with old traditions where they gave the care and there was not as great a need for documentation.

I am not going to lie, the reason I love nursing so much is because I loved doing clinical work/treatments and the least favorite part of my job is the charting. I do love educating but I hate the documentation and computer side of things. I have worked in the healthcare as either a nurses aid or a registered nurse now for almost ten years and in the last ten years I have seen this change greatly. I am a little sad to see the old role of a nurse change but I understand why it does need to change and the importance that my new role takes. I think that I will always work in a hospital so I will never lose those clinical skills completely.

https://www.nursingoutlook.org/article/S0029-6554(01)57254-1/fulltext

Nursing in the 1970’s, 80’s, & 90’s

During this time the field of medicine is continuing to grow and develop. In-fact, it really hasn’t really stopped. At times it may have had slower progression but it is still progressing. During the 1970’s, nurses were still going on strike due to poor conditions and benefits in the work place which honestly got the government and congress thinking and pushing for changes. Nursing strikes and shortages caused the field to struggle but made up for it in the long run by causing the career to have an increase in salaries and benefits. Once we had the attention of the government and as nurses were coming back to work and more jobs were becoming available, nursing became unstoppable and it allowed for new studies and focused growth in different areas of nursing to develop. 

This week I read an article about how hospice care came about. The very first hospice care program was started in 1974 by a nurse named Florence Wald. Before this time there was no such thing as “end of life care” or care for a terminally ill patient. Once a patient had been given all possible treatments by the hospital and the doctors felt that the patient was no longer treatable, they would be deemed as terminally ill and all treatments would stop because the hospitals didn’t know how to care for them anymore. The patients would simply be sent home to die. Families, caregivers, and the patients themselves had little care and help at this point. Wald felt a lot of compassion toward terminally ill patients and felt she could do more for them. She did a lot of research and put together a team of doctors and nurses who continued care for patients after hospital treatments had stopped and prior to the patients passing. She called it home care and hospice which was care given to both patients and their families prior to death with a focus on relieving the physical and emotional pain of both. Florence Wald changed how people and the healthcare viewed end-of-life. She showed people that there were very meaningful ways to cope and made death more of a reality, less scary, and a more accepting time of life. Her hospice program did so well that in 1982, congress required that Medicare pay for hospice care and today there are now 3,200 hospice programs in the US alone.

Florence Wald really impacted many lives with her contribution to the world of Hospice nursing. It makes me realize how blessed I really am. I live in a time where there are so many aspects to the medical field and I have full access to all of them. If I’m sick, having a baby, have a parent or loved one who is terminally ill, or I need surgery I have every area of researched and organized expertise right at my fingertips. What a blessing that is! Thinking back on these times also makes me think about what else there is that still needs to be further developed and studied. Infertility, Cancer, New arising diseases and prevention, and the list goes on and on. There is still so much unknown about the medical field and nursing which only allows for so much growth and I truly think that is amazing. I’m am eager to see what new discoveries and treatments as well as what the job of a nurse will look like in the next ten years or so! Grateful to be a nurse now and hopeful to see where it is going.

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/12/AR2008111202953.html?noredirect=on

Nursing During the 1940’s, 50’s, & 60’s.

Nursing was really evolved during this thirty years. Technology was allowing new discoveries to be made continuously and the study of treatment and medicine was on the move. Times were greatly improving sense the 1920’s through 1930’s and people were beginning to think the great depression was behind them. The economy and health were both greatly improving. Jobs were becoming more readily available and healthcare was more affordable.  Although things seemed to be on the rise, this was still a hard time. WW2 had began and the call for nurses had greatly increased. Devastation was all around. Though the amount of jobs available were increasing, the actual labor of a nurse seemed to stay the same.

This week I read an article about one of the first great nursing shortages that occurred in the 1950s and the first nursing strikes that occurred. We all know that nursing tends to have continuing shortages due to the increased need for nurses as the population continues to grow but one of the very first nursing shortages occurred in the 1950s due to multiple reasons. During the 1920s-1930s there was not a great need for nurses as it was the time of the great depression and any job available was highly coveted. Nurses would work for little money in poor conditions with little complaint. In the 1940s and 1950s the economy had greatly improved and jobs were becoming more readily available. Nurses were becoming tired of the working conditions.

After a nurse graduated, the average salary at this time was $140 per month and some hospitals paid as little as $90 per month. This was very low income for the time and the job of a nurse was hard. The average worked hours a week for a nurse was 48 – 90 hours even though most of the public only worked an average of 38 – 40 hours.

Also many hospitals would not employ married women (this practice continued well into the 1960s in some communities). You could work in hospitals or the public until you got married. Once you were married you would be laid off and could only find work as a private-duty nurse.

The biggest complaints of nurses during this time were, long hours, low salaries, poor living conditions, too few holidays/days off, and job instability. In the late 1950s nurses had had enough and many nurses around the US went on strike. It was reported that in 1957, every nurse at the Virden District Hospital in the Canadian Province, left on strike for three months in hopes to negotiate a pay increase. The hospital fired all of them and in their place hired the former nurses who had to leave the profession due to be married.

Because of this, nobody took the nursing shortage seriously. To add to this, nursing at the time was considered to be: “a natural extension of a woman’s caring and nurturing role as mother, wife, and daughter, and was devalued as such.” The nursing shortage was getting so severe that the government announced that new hospital funding would not be given to hospital boards unless they cold guarantee they had found nurses to staff them, and would not be raiding other facilities to find nurses. The government also recommended that hospitals create pension plans for nurses as a way to encourage woman to work in their facilities. This was not common for woman to have such a privilege and it caught many nurses attention.

A look back at nurses in 1950

Nursing during this time was hard, you either served in war with your life in danger or in a hospital with long growling hours and little pay, or due to being married had to work as a privet nurse which very few people could afford so privet nursing jobs were scarce. I feel that these nurses were extremely strong willed and tough. They had to fight for nursing to be more appreciated and many gave up their jobs in strikes or even lives in war with little recognition to do so.  I am so grateful for what they did. Although at times I still feel that the flexibility and benefits of a nurse still struggle and need improvement, I know that it is much better today because of what these nurses did and how they changed the public view on nursing.  Very grateful for them and all they did.

Nursing in the 1920’s through 1930’s

This week I have come to think that nursing is become much more organized and technology is making a big difference. Nursing at this time doesn’t seem so foreign anymore as it is becoming more similar to what nursing is today which is more diverse, organized, and focused.

In the 1920’s through the 1930’s WW1 is coming to an end and it seems like it is a new era for growth and refinement that is until the wall street stock market crashed and lead to the the great depression in 1929. Up until this time, most nurses were hired by a household to be a private in-house nurse meaning, they were privately employed by the patient or the patient’s family themselves and the nurse would provide care for the entire length of illness or injury and would work around the clock. These nurses were paid by the patient or patients families themselves but when the great depression occurred people stopped being able to afford private nursing care and stopped hiring private nurses. This caused a huge shortage of jobs and caused most nurses to look for work in hospitals. At the time, working in a hospital as a graduate nurse was looked down upon because it meant you had failed as a public duty nurse. Most nurses who worked in a hospital setting were student nurses and not actually graduate nurses.

The overall health of the public took a major decrease during the great depression because nobody sought treatment due to not being able to afford healthcare. The public was suffering from situations which were detrimental to overall health such as malnutrition, overcrowding and extremely poor sanitation. Hospitals were struggling with increased illness but decreased patient counts and empty beds. Hospitals were loosing funding and many had to close. Nurses who were lucky enough to get a job had a large workload with little pay and restricted hours. To provide more job opportunities, hospitals changed shifts from two twelve hour shifts per day to three eight hour shifts to allow three nurses to work in each day instead of just two. It became common for many hospitals to restrict nurses to work a maximum of forty-eight hours per week.  On average, a nurse only made 15$ a month and in some cases had to resort to working for only room & board without salary. Hospitals favored student nurses because they could get away with paying them less.

In a hospital, the common nursing duties included scrubbing floors, washing screens, serving meals, caring for patients, cleaning equipment such as (needles, bed pans, bandages), stoking the furnace, and even painting the hospital rooms. The workload was heavy but nurses maintained a positive attitude as they were just grateful for the chance of employment.

The Great Depression immensely impacted nursing working conditions today. It’s what lead to the shift of nurses working as private duty nurses to working in a hospital setting. It changed the way hospital employed nurses were viewed and it impacted the workflow for nurses as supplies were scares causing a demand for creativity and a greater study in the art of nursing.

The Great Depression was such a hard, stressful, and even scary time but really shifted the direction of nursing. I love working in a hospital and I’m glad that the view of a hospital nurse changed so greatly during this era. I would say that it flipped completely and hospital nursing is now a huge focus and is amazing today because of this time period. I feel so grateful that I didn’t have to work during the great depression. It would be so hard to wake up everyday knowing it could be your last of employment when you so greatly needed income. I feel glad that I chose a profession that seems to always have a need. Even during a time so devastating as the great depression, there was still a high need for nurses. Nursing definitely has a sense of job security because there will always be sick people who need medical attention in any situation. I’m very grateful times are better today and hope and pray that they always stay that way!

https://sites.google.com/site/nursing1930s/home/influential-figures-in-nursing-1920-1940

Nursing in 1900 – 1919

We are now in the early 1900s and already a lot has happened causing nursing to make large adaptions and changes. In my studies this week I came to realize that nursing at this time was really starting to make a push on the public in many ways. Nursing was no longer being offered just to the poor and ill in a hospital setting but also to the public. 

My research article i read this week, talked about the very first school nursing programs. In the early 1900’s children were missing a lot of school due to common illnesses. If a teacher felt a student was sick, they would be sent home immediately but not given any treatment or consulting on the type of illness. Children would miss days up to weeks of school which was becoming a big problem. In 1902 a nurse named Linda Lavanceh Rogers was assigned by the Henry Street Settlement which was a program set up to assist with the public and their needs in the New York Community. Rogers was employed to be a nurse in a public school basically as an experiment to see if it would help raise the children’s school attendance. Having a nurse in the schools gave the children a chance to be assessed and treated quickly. The results of having a school nurse astonished the public and led to employment of school nurses throughout the entire country. After this, the term “public health nurse” became well known and the role of the school nurse expanded to include teaching of student wellness, disease prevention, and health education. Public health nursing gained such acknowledgment that in 1912 the National Organization for Public Health Nursing was founded and a program was set up to expand public health nursing into community based nursing services as well.

The need for nurses in the public was great both at home and across sea’s. In 1914 WW1 broke out and the desperation for nurses arose. Over 20,000 nurse were sent to serve on war front. Many of these nurses were just volunteers with little to no training. This put a large focus and strain on education and training programs available. I’m sure it also put a gratitude on already trained and prepared nurses. WW1 really set the tone and changed nursing. It gave nursing the push it needed to get people interested in the field because the demand for trained nurses was so great. It also helped with the women’s rights movement by allowing trained professional woman to work in active battle and to hold high titles. It also helped define the role of a nurse and helped with legal programs and the finalizing of professional titles.

Nursing greatly evolved during this time. I had a great-grandfather who fought in this war and I feel so grateful for him and for the the trained nurses who served. I’m sure the wounded soldiers and their families were also very grateful to the courageous woman who took the liberty of getting the training before hand so they were prepared to save lives. Due to these courageous nurses example I hope that if I was ever put in a situation where I had to serve as a nurse in combat, I would follow their lead and do as they did.

Nursing in the 1880’s through 1899

We are almost to the 1900’s and I have learned so much about the history of nursing thus far. Nursing has come so far in a considerably short amount of time. During my studies this week I learned that during the 1880’s through 1899 (just before the 1900’s), the development of educational programs were becoming the main focus on nursing at this time. Education programs were being established everywhere including the very first nursing program to have ever been offered at a university.  In 1893 Howard University in Washington D.C was the first university to ever offer a nursing program in a university setting. Up until this point all nursing programs had only been offered through either hospitals, churches, or private academies but never in an actual university setting. Howard University set the trend for institutions to offer a higher level of nursing education where one would graduate with a degree from a university in nursing. This was a big deal and caused the study of nursing to be considered degree worthy.

Backing up a little bit, I found that in 1885 the very first ever nursing textbook to be written by a nurse was published. Before this only physicians were known to have written the textbooks for nurses. The textbook was called “A Textbook of Nursing” written by Clara S. Weeks Shaw. Clara Shaw was a graduate of the New York Hospital Training School and the Superintendent of a Training School for Nurses in Paterson, New Jersey. Her book included instruction in areas such as “the sick room,” “the observation of symptoms,” and “medicines and their administration” written by the point of view and observations of a nurse.

Continuing with the development of educational programs, In 1886 the very first nursing school for African American women opened up in Atlanta Georgia called Spelman Seminary. This was a big deal because African American women had previously experienced severe segregation when applying to nursing school even though they were greatly needed in caring for people of color and in colored hospitals. Like African American’s, all Men also experienced some segregation in the nursing profession because it was mainly considered a women’s job and so they too were unable to get acceptance to nursing schools, but the need for men was soon recognized and the very first nursing school for just men opened in 1888 at Bellevue Hospital in New York City called The Mills Training School for Men.

The evolution of nursing really has changed and grown considerably in a short amount of time.  I believe that nursing made such astonishing development in such a short amount of time because the need for nurses was in great demand and continues to be today. Nursing is an ever evolving career. As technology and traditions change, nursing will change right along with it and I believe it will continue to make great changes and contributions. It’s interesting to me that nursing has so much background and history compared to many career’s today. It makes me so proud to be a nurse and I hope to always remember how far nursing has come. With that, I have a goal to be more accepting to change in my career as a nurse because I know that nursing is always evolving. Sometimes change can be difficult and that is why I have learned that knowing the background and history is so important because it gives you incite and allows you to become more accommodating.

 

 

Nursing in the 1860’s & 1870’s

This week our assigned research topic was nursing in the 1860’s through the 1870’s. In the attempts of finding the article of choice, it seemed that there was a similar topic among the multiple articles I read for this time period which was the topic of education. I have come to learn that during the 1860’s to the 1870’s education was really starting to take way and nursing programs were steadily being organized and carried out. Women during the 1800’s did not have a lot of rights as far as education and working in an occupation went, yet nursing programs were mostly geared towards women. With each war, the need for trained nurses increased and the push for women to get an education and occupation in nursing was stressed on society.

In learned about one of the very first nursing schools started in the USA at a women’s hospital in Philadelphia opened by a surgeon of the name Samuel Gross.  He believed that nurses were more valuable than his greatest medication and cared a great deal about nursing. The school opened in the 1863 and was established during those first few years until 1869 when it became a well known school of nursing.  It was a six month course in nursing where both women who just nursed families and wanted more education on how to do so along with other women who planned on having nursing as an occupation. Both types of students could enroll in the course and received the same education, training, and instruction. The women who were there to better learn to nurse their sick family members and not make it an occupation had to pay two dollars a course of ten lectures. On the other hand, women who were there to become nurses as an occupation only had to pay seventy five cents for a course of ten lectures or ten cents for a single lecture. It was cheaper if you were going to pursue the entire six month course as a nursing occupation, rather than just taking the course to help your family care.

Although both set of training got the same education, the nursing occupation students did get higher skilled one on one work with instructors and had a greater focus on the ability to look more closely at their patients bodies and develop a plan of care. They were referred to having an education closer to a physicians education.

You can see the benefits applied to the occupation students. This shows that the USA really was encouraging women to get an education in nursing at the time which is so interesting to me because I think that a lot of people focus greatly on women’s rights and when they began, yet women were getting more rights to education and occupation then I think many realized. I was definitely surprised to learn that women were encouraged from early on to get an education in nursing during times of what was thought to be segregation. 

I am so grateful for those first women who took a leap of faith and decided to pursue an education and occupation in nursing during a time when it wasn’t easy to do so. I’m also grateful for all the hard working men and women who put countless hours and care to organize programs and get things moving. I think that if things didn’t start when they did and didn’t progress how they did, our knowledge and history would greatly suffer today.

Samuel Gross, “Report of the Committee on the Training of Nurses.” Transactions of the American Medical Association, 1896: 161-74

 

Nursing in the 1830’s 1840’s & 1850’s

This is a busy week for me and their was a lot to do but I did learn a lot  about the culture and social standing of nursing during these times. 

To start,  I found that in the early 1830’s the protestant reformation caused all monasteries to close and land to be overruled which lead nursing as a profession to become a job for the lower class “common” woman who were either too old or too sick to get a job doing anything else. These woman had no knowledge of nursing and no experience. Due to becoming a job of lower class, the lifestyle had taken a turn for the worst. Some hospital records exposed the actions of these nurses which included, fighting, foul language, intimate relationships with patients, falling drunk on duty, taking delight in patients death, and robbery. The actions of nurses had become so scandalous and drew much attention that even Charles Dickens wrote about it in his novel called “Martin Chuzzlewit”. This continued into the early 1840’s until some British social reformers pledged to have religious programs put into place in hopes to change the lifestyle and actions of nurses. In 1848-1850 an English protestant sisterhood of nurses was formed at St. Johns which for 15 pounds of sterling silver a sister could join the sisterhood. This sisterhood provided each nurse with a two year education, training, housing, and a small salary but each nurse had to commit to working for St. Johns House for at least five years after. The promise was that as long as they were living in the house, each nurse would be protected and provided with basic necessities. This allowed rules and tight religious restrictions to be placed on each nurse. By the 1850’s nursing had started to change coarse for social standing. Florence Nightingale came along in the 1850’s and was a big advocate on changing nursing into an upper class career and was one of the main reasons today that nursing is an honorable career choice. Florence would banish nurses if they did anything that would shame the social standing of a nurse.  

https://www.jblearning.com/samples/0763752258/52258_ch01_roux.pdf

I find it so interesting that so many people wanted to change the course and social standing of nursing during this time. It must have been pretty bad. It’s interesting to me that it just took a few very strict type A personality people in high standing to make this change.  I love my profession and I’m so grateful for all the people who made the change and made it what it is today!