Origins

My mom the RN

“Why did you become a nurse?” 

Origin, as defined by Merriam-Webster’s: 1: ancestry, parentage 2 a: rise, beginning, or derivation from a source b: the point at which something begins or rises or from which it derives; also: something that creates, causes, or gives rise to another 3: the more fixed, central, or larger attachment of a muscle. 4: the intersection of coordinate axes. (Merriam-Webster, 2004, p. 875).

There are many books and essays regarding the origins of nursing as a profession. My aim is not to bore you or review an entire history of nursing, but rather to briefly overview some relevant and often overlooked history. We are all familiar with and respect Florence Nightengale. But she is not included in this overview because she is an overused person in the conversation. 

Origins. What is our history? What is our beginning? Are we “the muscle?” What role does a nurse play in healthcare today?

1. Ancestry, parentage

My own family includes many nurses. My mother graduated from a diploma program in 1969 and a Bachelor's of Science in Nursing (BSN) program in 1981. She worked medical-surgical (med-surg), on a pediatric burn unit, an adolescent psych ward (unfortunately this experience did not help her much during my adolescence), home health, public health for the Tom Dooley Foundation in Nepal, rural health in Montana, and finally Hospice. She worked for Hospice starting in 1992 and recently retired from nursing in 2017.

My maternal grandmother was a flight nurse in WWII. She flew wounded troops from war zones back to England and the US. During this time there was a roster of nurses, listing which would be assigned to the next flight. After flying, the name would drop to the bottom of the list. Grandma (Helen) was up for her turn. Another nurse wanted to switch with her and go on that flight. So, Helen stayed behind. That plane crashed and everyone on the flight was killed. She was fortunate to survive. Unfortunately, Grandma Helen died when I was very young. I have so many questions to ask her. My mother still has her letters, signed “Angel in Flight.”

We all have our own histories as nurses, even if we are first-generation or multiple-generation nurses. Nursing as a whole has a more utilitarian origin.

In a nutshell from our nursing textbooks: Nursing has always existed in some form in all cultures. Nursing was traditionally a “lower-class” woman’s job in early Europe (Egnes, 2009). Religious organizations took over and many hospitals in the US today have roots in various Christian churches. The Civil War and other societal changes within the US demanded the need for nurses in the US and soon after training facilities were initiated (Egnes, 2009). Like I said, “in a nutshell.”

2. A rise, a beginning.

Nursing school is not easy. Characters in movies who are “going to nursing school” are cute, empty, and generally “extra” types usually played by a young, pretty white woman. Folks do not realize that nursing school is incredibly competitive, stressful, time-consuming, expensive, and challenging. Nursing school is the beginning to actually becoming a licensed professional. Many of us start in other healthcare jobs, such as Certified Nurse’s Assistants (CNAs), Emergency Medical Technicians (EMTs) or paramedics, phlebotomists, etc. but nursing school is a solid start on the path to becoming a Registered Nurse or Licensed Practical Nurse.

Many nurses continue their education to become Advanced Practice Providers such as Family Nurse Practitioners (my current role in 2018), Nurse Midwives, Certified Registered Nurse Anesthetists, and others. These roles are much different from an RN or LPN role and in many states advanced nurses can practice autonomously. Your primary care provider (PCP) might be a nurse practitioner which is why "medical provider" is preferred to physician or "doctor" even though some nurse practitioners have their doctorate degree. See the American Association of Nurse Practitioners (AANP) campaign to increase awareness of these roles in healthcare. 

Nursing programs have dramatically changed over the years in the United States, however, incredible barriers still exist to access nursing education. This is especially true for marginalized populations, namely people of color.

Mary Mahoney was the first Black woman to be admitted into a nursing school in the 1900s. She was a member of the American Nurses’ Association (ANA) and fought for equality for nurses of color. She was also very involved in women’s right to vote and various sources report she was one of the first women registered to vote in the United States in 1920. (“African-American Medical Pioneers, 2003). As a side note, we know that not all women of color (specifically Black women) were able to exercise their right to vote until The Voting Rights Act of 1965. But I digress, as racism, sexism, and homophobia/transphobia in current day still impacts who is working in healthcare roles.

According to Minority Nurse, about 75.4% of RNs categorize as “white.” Only 9.1% of RNs identify as men (“Nursing Statistics”, 2014). There is limited information on the number of LGBTQ+ nurses, and many reasons why some people in this subgroup would not identify gender identity or sexual orientation publicly due to potential employer & patient discrimination. Demographic information for NPs is somewhat limited, but AANP reports their membership (which does not encompass all NPs) is as follows based on most recent data in 2010: "92% of members are female. 97% are not Hispanic or Latino. The racial distribution of membership is: American Indian/Native Alaskan 0.9%, Asian 3.7%, Black/African American 5.7%, Native Hawaiian/Pacific Islander 0.4%, White 90.3%" (AANP, 2010). The educational & healthcare systems have much work to do to decrease barriers & discrimination for those working in & receiving care within healthcare systems. This is just scratching the surface of this topic.

But nursing has also made huge strides since the beginning. Nursing has evolved from a “lowly” job to a profession that is largely respected although arguably misunderstood. 

3. The more central, fixed attachment of a muscle.

Well. We can appreciate this “origins” definition! Think of Anatomy and Physiology nightmares. This can be an analogous to many situations.

Think about the origin of a muscle. How about the deltoid? The origin is the clavicle and scapula. Those bones are not going to move when you move the muscle. Nurse Practitioners, Physicians, and Physician Assistants have their various roles within healthcare. Nurses also have a “scope of practice” and must legally function within that scope too. If you just had the deltoid without the clavicles, you would be in serious trouble. The body simply would not work without its origins, just like a hospital simply would not work without its nurses.

Sometimes nurses are referred to as doctor’s “helpers.” Nurses are not “helpers.” When non-advanced practice nurses (RNs, LPNs) follow medical provider orders, there is consideration regarding why the provider has ordered a particular medication, therapy, diagnostic test, or lab. Sometimes nurses do not know the answer, and there needs to be clarification with the provider. Much of the job needs to be done autonomously, while following orders and staying within scope of practice. In the hospital setting, a nurse is not “managed” by a physician or other APP. Nurse managers do that job. 

We’ve heard the cliché that “nurses are the heart of healthcare!” The heart is a muscle. But, the majority of healthcare is a business within our capitalist system, whether we like that aspect or not and that is another topic entirely with multiple layers of complexity.

Sometimes the humanity of healthcare is lost in the economics and politics of that system. Of course, everyone from janitors and housekeepers to therapists and front office staff are the “human” aspect of healthcare for patients. We all have power to advocate for our patients. Nurses, especially, have incredible power as patient advocates and the same is true in the provider role. That is, of course, our job.

So, the big question is: Are nurses the clavicles of healthcare or the heart?

4. Intersection of axes

Popular media has misconstrued the role of nurses. Simply blaming "the media” alone, however, is simplistic as even educational systems reinforce some of these misconceptions. This misunderstanding impacts the way regular people (er--not nurses) understand and treat nurses. Folks sometimes think a nurse’s job is to simply give bed baths, follow provider's orders without critical thinking, and hold hands. That may be in the history of nursing, but these basic nursing care roles are no longer the role of a nurse. The advanced practice provider roles are even more often misunderstood, or assumed that the "next step" is becoming a physician when in fact that is not the end goal. 

Nurses (RNs specifically in this paragraph) have many roles. RNs multitask patient needs, prioritize cares, recognize signs and symptoms of declining patients, consider pathophysiologies of disease, learn about new medications and procedures, change wound dressings, listen to complaints and praise, communicate with medical providers, ask questions, read nursing journals on the latest evidence-based practice, hold their bladders for far too long, walk on their feet for twelve hours, tell off-colored jokes, and drink coffee (at least, most nurses). Nurses are not angels or saints. Nurses get mad sometimes. Nurses make mistakes, just like everybody else. Sometimes nurses feel downright incompetent, so they also ask a lot of questions. Nurses are just human. There are “good” nurses and “bad” nurses, and a lot of funny ones but none are one-dimensional.

One patient can take a lot of coordination. The nurse working on a hospital floor needs to communicate with therapies, the nurse’s aid, the medical provider, the housekeeper, and the family. Sometimes this role can be incredibly frustrating, especially when there are five different people and five different plans of care. But, this role is vital to the patient’s outcome.

Nurses help to facilitate overall care for a patient. If any of the pieces are disjointed or missing, the patient’s care might suffer. Nurses are right in the thick of a patient’s care. Nurses really want all the pieces to fit together and for patients to receive the best care (most nurses, that is). Nurses don’t always “agree” with the patient’s choices, because we all come from different backgrounds and experiences.

Our individual origins as nurses are many. The origins of nursing are complex and ever-evolving.

So, why did I become an RN in the first place?

I started doing nurse’s aide work in high school and had various jobs as a nurse’s aide for about seven years. I always bonded with and enjoyed the geriatric population (I’ve been schooled that the correct word is “mature”). I love working with folks who have dementia, except when they are trying to punch me.

I loved anatomy and physiology (except the memorizing origins and insertions part) and chemistry, and just “how things work” overall. The body is kind of fabulous.

I had the privilege of interning at a hospital in Ghana for six months (which is a separate conversation & one that I have mixed feelings about regarding international aid work). I did random housekeeping and paperwork and wrote down verbal orders from the medical provider on rounds. I ran to the pharmacy for medications. I helped with what I could when there was only one nurse in a full ward of adults and kids. Those nurses were badass. They knew how to improvise. I remember thinking, “I want to do that.” “I want to be that good.”

Of course, because of my origins, I was “never” going to be a nurse because my mom was a nurse. But, my mom is a great nurse.

*This "Origins" essay was originally written in 2014 and updated in 2018. Some of the statistics unfortunately do not have recent updates, so older article credits remain. Since the original article was written, I have worked as an RN in many other environments outside of the hospital including assisted living, crisis mental health, and a county jail. I learned over time that I preferred some of these other healthcare settings opposed to working on a hospital floor. I worked six years in total as an RN and while still working part-time at the jail, continued my education with a Master's program to become a Family Nurse Practitioner (FNP). I have since graduated, obtained my licenses, and have been working as an NP in a rural clinic for nine months at the time of this writing. 

References:

African-American Medical Pioneers: Mary Eliza Mahoney 1845-1926. (2003). Retrieved December 4, 2014, from http://www.pbs.org/wgbh/amex/partners/early/e_pioneers_mahoney.html

American Association of Nurse Practitioners (AANP) (2010). Retrieved September 10, 2018 from https://www.aanp.org/research/aanp-research/10-research/146-member-demographics

Egenes, K. (2009). History of Nursing. In G. Roux (Ed.), Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow (pp. 2-8). Sudbary, MA: Jones and Bartlett.

Merriam-Webster's Collegiate Dictionary (11th ed., p. 875). (2004). USA: Merriam-Webster, Incorporated.

Nursing Statistics. (2014). Retrieved December 4, 2014, from http://www.minoritynurse.com/minority-nursing-statistics