Josie Johnson
Prof. Scott Olsen
IWC 100
12 February 2022
Nursing Then and Now
In terms of a career, few are as personal and as expansive as nursing. Nurses provide intimate, essential care in a variety of settings. They’re in factories, caring for those who work on the line; in hospitals, caring for the sick and the wounded; and in schools, caring for students. The profession is wide-ranging and provides many opportunities in countless locations. My grandmother, Roberta Johnson, was a nurse for several years after graduating from St. Luke’s Hospital School of Nursing in Fargo, North Dakota in 1965. Following her graduation, she gained hands-on experience in a variety of nursing practices and different places. She worked in surgery, an industrial setting, long-term care, and intensive care. Yet, over the past several decades, healthcare professions have changed dramatically. Patient care, record keeping, and even uniforms are almost unrecognizable to the nurses of the mid-twentieth century.
My grandmother was a nurse for most of her working years, beginning her career at St. Barnabas Hospital in Minneapolis, Minnesota. At St. Barnabas, she worked in surgery where she cared for patients before, during, and after their surgeries. When her husband left for basic training, she moved north to live with her mother and work in the hospital in Roseau, Minnesota, where she grew up. She wished she could have had a little more time in Minneapolis, saying, “It was an interesting place, I kind of wish I could have stayed there and worked because I really enjoyed that. They did all kinds of surgery there that I hadn’t been exposed to before.” Roseau, a rural town just south of the Canadian border, was not able to provide the procedures she had assisted with in Minneapolis. She soon found that nursing in rural places like Roseau came with a very different set of challenges than a more urban hospital like St. Barnabas. In comparing the two contrasting settings, she said, “in the urban setting I think you’re more specialized, and in the rural setting you do what needs to be done, whatever it is.” This still holds true today.
Today, rural nursing is still broad work. Nurses in rural hospitals, like the one in Roseau, work in the emergency room, the clinic, the operating room, the delivery room, and wherever else they are needed. Rural nursing requires expertise in several different areas, but also in several different patient demographics. For nurses in rural hospitals, it would not be uncommon to see a young child who needs vaccinations, followed by an elderly man with back pain in the very next appointment. They must be flexible, with wide-ranging knowledge in how to care for people of any age. Angeline Bushy, a nursing professor at the University of Central Florida, discussed the rural nursing practice in her 2002 article, saying, “Historically, their specialty area of practice is being an ‘expert generalist’. Their greatest attribute is knowing about formal and informal community resources and how to access these for client systems” (109). Rural nurses have a great understanding of the resources that are available in their communities, and how their patients can access them. They play key roles in their communities, in and out of the hospital.
In general, healthcare differs based on the size of the community. According to a 2007 article written by Dr. Christiane Brems, who specializes in applied research with a specific interest in healthcare promotion and rural healthcare delivery at Stanford, rural healthcare systems are more likely to see cases of alcohol and other substance abuse, economically disadvantaged patients, patients belonging to a minority group, and women of childbearing age (8-9). Based on Brems’ preliminary findings, the previous overarching qualitative themes of the topic supported the quantitative data that was collected for this research (5). Brems’ data found rural healthcare providers to be more flexible than their urban counterparts, writing, “Rural healthcare providers, of necessity, find that they must use a very broad set of clinical skills, serving both as the specialist and generalist depending on the needs of their communities” (4). While rural hospitals have more generalized providers, urban hospitals have the advantage when it comes to range of care. With more staff, more funding, and more room for specialization, urban healthcare systems can provide more services and more advanced care to the residents of their community.
Overall, my grandmother preferred the rural setting to the urban nursing setting, saying, “You get to know the people – you get to know your neighbors. It’s hard in a way because you’re working with your neighbors who are going through a lot of problems, and it’s hard to see that, but it’s also very rewarding.” Nurses in a small town are much more likely to personally connect with their patients, which is important in establishing a sense of trust between a person and their healthcare provider. In smaller communities, it’s easier for nurses to see how much they impact the people they care for, because of how close-knit they all are.
Rural nursing is not limited to the hospital setting; it also includes the nurses who work in schools, factories, and other settings within a rural area. My grandmother was the very first industrial nurse in Roseau, at the Polaris factory, describing the work as, “More or less taking care of industrial wounds, you know, people that would get injured on the job. It’s a lot of record-keeping, and a lot of insurance work.” My grandmother didn’t like this area of nursing as much as the typical settings, saying, “I felt like an insurance clerk rather than a nurse.” Although she was still contributing to the community, she wasn’t doing so in the way she wanted. She ultimately returned to the hospital to work, because she was much more passionate about it.
My grandmother’s era of nursing was very different from that of today’s nurses. When asked about it, my grandmother noted three primary differences between nursing then and now: education, computerization, and autonomy. She also briefly mentioned the change in uniforms between 1965 and now. Specifically, she described the “drab” gray dresses with white collars she wore in nursing school; the starched, white dresses and matching caps she wore in the hospital; the scrubs she wore in surgery; and the scrubs of the nurses we see today.
As new methods of care arise, healthcare professionals must keep up with the times, which requires more education to keep up with the ever-growing body of knowledge that modern medicine is composed of. My grandmother said, “There’s so much more to learn now, that we didn’t even know about back then,” and joked that if she were to do it all over again, “I’d have to study harder, now.” The degree that she earned at St. Luke’s was what was then known as a “diploma.” Shortly after her graduation from the program, the United States began to shift the dynamic of the nursing program. Dr. Beatrice Kalisch, a nursing professor at the University of Michigan, published a book that discussed the variety of advancements that the American nursing profession has undergone in the past century, including nursing education. In her book, she states, “Economic pressures on hospitals and other developments in society increased the movement of nursing education programs into the colleges and universities” (432). Instead of the hospital-based nursing education that my grandmother received, the standard of education was being shifted to associate, baccalaureate, and bachelor’s degrees in nursing. In 1954, just 1%, or 1,132 nursing students, were enrolled in associate-degree nursing programs in the United States, as compared to 1966’s 15,338 enrolled associate-degree nursing students (Kalisch and Kalisch 433).
My grandmother graduated with 37 other young women, which seems small compared to the graduating classes of colleges and universities today. St. Luke’s Hospital School of Nursing was not unlike the majority of nursing schools across the country at that time, offering only one program specifically for nurses, which separated the nursing students from the rest of those pursuing a college education. Because of this, my grandmother spent most of her time with her classmates, saying, “we were pretty secluded in our own little group.” However, they took classes at North Dakota State University when they were unable to take them at St. Luke’s. This exposed them to what would be considered a “standard” college education. Today, however, this is the norm for nursing students. They attend classes and on-campus events with other college students, not just those in their field.
The second major change in the nursing profession that my grandmother has observed is the prevalence of computers in today’s healthcare model. When she was nursing, all the charting being done was by way of pen and paper. Now, all of the charting is done on a computer of some form. When discussing the use of computers, my grandmother said, “We didn’t even know what a computer was, I guess, at that time.” Computers entered healthcare in the early 1990s and helped make record-keeping and communication more efficient in the hospital. Brems writes, that in 1993, “Some health care organizations had already installed computer systems for a variety of purposes: to quickly retrieve patient histories; to record diagnoses and patient care; to order tests, X-rays, and supplies; to assign beds and nursing staff; to gather statistics on patients, illnesses, and care; and to generate bills and insurance claims” (478). Messages that were once sent by handwritten notes or by phone call were moved to the computer. Charting by paper and pen required rewriting the same things in multiple locations: on the patient’s chart, on a prescription, on the bill, or on a note for a consulting physician. With a computer, information only needs to be entered once and transferred to wherever it is needed, saving a lot of the time that would have been spent on paperwork.
The third major change that my grandmother noted is the increased autonomy that nurses have now. Nurses have a much more understood importance to the healthcare system today than they once did. In the past, nurses were seen as inferiors, who were simply tasked with orders from a physician, which ultimately led to inefficient health care. Christiane Brems described this inefficiency, writing:
The physician generally had little interest in seeing the optimal use of the dull potentialities and skills of the nurse. He wanted an assistant who would do what he told her to do. The physician wanted to make use of an extra pair of eyes and ears and hands, but he was not concerned with developing a pattern of work that would allow the maximum combined output of a nurse and himself to achieve better health care for patients. (443)
Nurses have always been important to the healthcare system but are now seen as more independent. For example, when my grandmother was still nursing, she wasn’t allowed to start an IV, as hospitals had specialized IV teams on staff to begin IVs. Capitalizing on nurses’ skills allows facilities to provide much more effective healthcare.
Another major change in the autonomy of the nurse is the rise of advanced nursing practices. Nurse practitioners (NP), certified nurse anesthetists (CRNA), and certified registered nurse midwives (CRNM) are growing careers and are especially important to rural healthcare systems. Angeline Bushy writes, “At this point in time it is not unusual for an advanced practice NP to be a primary healthcare provider in rural and medically under-served regions” (109). Today, several of the general healthcare providers in Roseau’s hospital, along with many other rural hospitals, are advanced nurse practitioners.
Not only do advanced practice nurses provide high-quality care to their patients, but they also benefit healthcare systems from an economical standpoint. Christiane Brems writes, “Expanding the role of the nurse could alleviate exorbitant health costs facing Americans. It was much less expensive for the public to train a nurse practitioner or midwife than it was to train a midwife than it was to train a physician to perform the same services, and the quality of health care rendered could be even higher” (452). Both the education and salary of a physician are more financially taxing on hospitals than that of advanced practice nurses, so hiring nurse practitioners makes sense for smaller healthcare systems that might receive less government funding than larger ones do. Nurses save money for the hospital, while also providing superior care to their patients. A strong background in nursing allows nurse practitioners to provide some of the most sensitive, competent care to their patients.
The compassionate care that nurses provide are the backbone on which the healthcare system stands. Most nurses, including my grandmother, are very satisfied in their career choices. While discussing the reasoning behind wanting to become a nurse, she said, “I had wanted to be a nurse ever since I was a little girl, so I went for it. And I don’t regret it at all.” She later mentioned that if she were to do it all again, she would choose to be a nurse again. She said that in all of her different jobs, she felt that the work that she was doing was very rewarding. This is a trend that is seen throughout the nursing field, accounting for much of the reported career satisfaction in the profession.
The intimacy of the relationship between nurses and patients allows nurses to go home knowing they’ve made a difference. In an article discussing why nurses do what they do, Lauren Mochizuki, a registered nurse, said, “What I find most rewarding about my career as a nurse is that I have the opportunity to help people in their most vulnerable, and unexpected, moments. For some, coming to the emergency department can be one of the worst days of their lives. As their nurse, my job is to make them feel safe, comfortable, and cared for” (“Why I Love Being a Nurse”). The compassion that nurses bring to their professions is unparalleled in any other line of work. My grandmother’s experiences were not unlike that of other nurses, and could, if given the time, tell stories from her nursing career for hours. She joked, “I could write a book.” Stories from the nursing home, the emergency room, and the operating room are the ones that stuck with her the most vividly. She said, “there’s a lot of things that you remember that are good and bad.” The personal relationships that nurses form with their patients allows for better insight into their needs. This insight allows healthcare professionals to create better care plans that are tailored to each patient, rather than a one-size-fits-all approach.
Nursing is a unique profession of ever-changing approaches, hard work, and utmost importance. Without nurses, our healthcare systems would be unable to function as they do today. They play key roles in virtually every healthcare setting imaginable, providing essential care and comfort to people around the world. Healthcare will continue to grow and change to help our providers give the best, most efficient care to those in need, with nurses facilitating that care every step of the way. Nurses like my grandmother helped grow the healthcare system into what it is today, and it will be nurses who help grow it into what it will become.
Works Cited
Bushy, Angeline. “International Perspectives on Rural Nursing: Australia, Canada, USA.” Aust. J. Rural Health, vol. 10, no. 2, 2002, pp.104-11.
Brems, Christiane, Johnson, Mark E., Warner, Teddy D., Weiss Roberts, Laura. “Exploring differences in caseloads of rural and urban healthcare providers in Alaska and New Mexico.” Public Health, vol. 121, no. 1, 2007, pp. 3-17.
Johnson, Roberta. Personal Interview. 4 February 2022.
Kalisch, Philip Arthur, and Beatrice J Kalisch. Advance in American Nursing. Philadelphia: JB Lippincott, 1995.
“Why I Love Being a Nurse.” Carson-Newman University, 23 April 2021, www.onlinenursing.cn.edu/news/why-i-love-being-a-nurse