Throughout the centuries, nursing has been an evolving entity; changing and adapting in response to a wide range of stimuli. Contemporary nursing practice has its historical roots in poorhouses, private homes, and battlefields. During the late 19th century, Florence Nightingale provided a foundation for nursing and a basis for autonomous nursing practice as distinct from medicine. Early nurse training schools consisted of hospital-based education programs. Instructors were from hospital organizations or the medical community and taught from a personal perspective with emphasis on the viewpoint that nurses were there to aid doctors and care for all of the patient’s needs while maintaining a sanitary environment suitable for adequate nourishment and healing. Nursing students were little more than maids providing a service to the hospital and hopefully learning along the way. An excerpt from the Probationer’s Diary, in which Dorothy Green a probationer nurse in 1899, notes:
After breakfast I washed dishes, swept and dusted the dining room, then had my first lesson on bedmaking…. Then I swept and dusted the ward, cleaned the refrigerator, scrubbed the waste pails, basins, bath tub and sink, cleaned the bath room and ward kitchen, polished the brass and zinc, and kept up a general scouring and scrubbing until noon, when I went to the Training School for dinner, and, returning at 12:30, helped to get ready the patients’ dinner, which is served at 1; carrying trays away again, fed my old men, and after washing dishes and sweeping and dusting the dining room was told to go off duty for two hours. One hour of my off duty was spent in class, after which I returned to the hospital to serve supper and wash dishes again (AAHN, 2007, para.4).
The apprenticeship training model, as described by Dorothy Green over 119 years ago, flourished during the 20th century mainly because it improved care for patients and provided a minimal allowance for nursing student services, thus lowering hospital costs.
Table 1: From beginner to Ph.D.: The progression of nursing education
| Early 1900s | 1920s – 1930s | 1940s – 1950s | 1960s - Present |
|---|---|---|---|
| Practical nursing | Practical nursing | Practical nursing | Practical nursing |
| Nightingale Schools | Diploma schools | Diploma schools | Diploma schools |
| Diploma schools | BSN | BSN | BSN |
| ADN | ADN | ||
| Postgraduate education | Postgraduate education | Master’s degree | Master’s degree and CNL |
| EdD for nurses | Doctorates for nurses | Ph.D., DNSc, ND, DNP | |
| Abbreviation of key terms: ADN- associate degree in nursing; BSN-bachelors of science in nursing; CNL- clinical nurse leader; DNP- doctorate of nursing practice; DNSc-doctorate of nursing science; EdD- doctorate of education; ND-nursing doctorate; Ph.D.- doctorate of philosophy Scheckel. M (2009). | |||
Throughout the 1960s and 70s, nursing education programs have gradually incorporated into institutions of higher education. This paradigm shift in nursing moving into higher education opened up the profession to a more diverse population including minorities, men, and married women. Nursing students today are beneficiaries of a long history of nursing education that is characterized by a continued emphasis on advocacy for ensuring the preparation of nurses for practice. Currently, the need for new approaches to how nurses are prepared is fueled by numerous factors including the demands of students, faculty, clinical environments, and the overall healthcare field. Upgrading nursing knowledge through education is an essential ingredient to informing change, now and for the future of the nursing profession.
Pathways to Growing as a Nurses
There are many pathways to grow as a nurse; however, for the purpose of this blog, pathways refers to clinical and educational pathways only. I will use one of my favorite nurse theorist, Dr. Patricia Benner to explain the clinical pathway of growing as a nurse in table 1. Then in table 2, I will explain the educational pathway to advancing as a nurse.
Table 2: The clinical pathway based on Dr. Benner’s Novice-to-Expert Model
| Stages | Years | Skill |
|---|---|---|
| Novice | 1st year of clinical education | These nurses have no experience of situations in which they are expected to perform and therefore follow rules in providing care to patients. |
| Advanced Beginners | 2-3 years | These nurses are more aware of long-term goals; but, still lack the experience-based ability to look holistically at the clinical picture of a patient. |
| Competent | 2-3 years | These nurses are more aware of long-term goals; but, still lack the experience-based ability to look holistically at the clinical picture of a patient. |
| Proficient | 3-5 years | These nurses begin to develop a feeling of intuition, and experience teaches the proficient nurse what typical events to expect in a given situation and how to modify plans in response to these events. |
| Expert | 5 years | These nurses display an intuitive understanding of clinical situations, can accurately focus on the pertinent issue of patients’ encounters and understand what is needed and why. |
Table 3: The nursing educational highway
 Education |  Brief Description |  Time to get there |  Career Investment |  Return on Investment |
|---|---|---|---|---|
| PhD, DNSc, ND, DNP | APRN: Eligible to pursue licensure as nurse practitioners, certified nurse midwives, certified clinical nurse specialists, and certified nurse anesthetists. Also, nurse educators, clinical nurse leadership, nursing administration, among other areas. | 4-7 years | $73,200 | $96,000-$117,540 |
| Master’s degree | APRN: Eligible to pursue licensure as nurse practitioners, certified nurse midwives, certified clinical nurse specialists, and certified nurse anesthetists. Also, nurse educators, clinical nurse leadership, nursing administration, among other areas. | 1-2 years | $35,000-$60,000 | $95,000-$182,000 |
| BSN | Roles include providing care, advice and emotional support to individuals, families, and communities with advancement and leadership abilities. | 4 years | $40,000-$200,000 | $59,000-$82,990 |
| RN- level Diploma | Roles include providing care, advice and emotional support to individuals, families, and communities but limited in advancement and leadership. | 2-3 years | $18,000-$40,000 | $59,000-$71,000 |
| ADN | Roles include providing care, advice and emotional support to individuals, families, and communities. but limited in advancement and leadership. | 2-3 years | $6,000-$40,000 | $59,000-$71,000 |
| LPN/LVN | The role is to provide basic nursing care under the direction of RNs or doctors. | 12-18 months | $5,000-$25,000 | $32,510-$60,420 |
| CNA | The role is to help patients with daily living task under the direction of an RN | 6-12 weeks | $200-$350 | $26,590 |
| Note: Abbreviation of key terms: ADN- associate degree in nursing; BSN-bachelors of science in nursing; CNL- clinical nurse leader; DNP- doctorate of nursing practice; DNSc-doctorate of nursing science; EdD- doctorate of education; ND-nursing doctorate; Ph.D.- doctorate of philosophy. The salary information listed is based on a national average and actual salaries may vary greatly based on specialization within the field, location, years of experience, and a variety of other factors. This table is an aggregate of data retrieved from the U.S. Bureau of Labor Statistics. | ||||
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References
AAHN. (2007). Extract from a probationer’s diary orange training school for nurses. Retrieved online March 28, 2018, from https://www.aahn.org/training-circa-1984.
Scheckel. M (2009). Nursing Education: Past, Present, Future. Jones and Bartlett Learning. Retrieved online March 28, 2018, from http://www.jblearning.com/samples/0763752258/52258_CH02_Roux.pdf.
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by Francella Smoker