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Amazing Changes and Events

This week’s graded discussion topic relates to the following Course Outcomes (COs).

CO1 Incorporate appropriate historical perspectives into current professional nursing practice (PO 2)
CO4 Compare current professional nursing practice roles with historical roles of the nurse (PO 7)
The mid- to late 20th century was filled with amazing changes and events in professional nursing. Select one of these changes or events, describe it, and explain how that change or event has impacted quality of nursing practice today.

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Week 6: Reading

  • Judd, D., & Sitzman, K. (2014). A history of American nursing: Trends and eras (2nd ed.). Burlington, MA: Jones & Bartlett.

Explore the following chapters:

  • Chapter 9
  • Chapter 10
  • Chapter 11

answer to include citation and references from textbook and a scholarly source.

apa style

Week 6: Lesson

Mid- to Late-20th Century Nursing
Nursing Education Changes
Mildred Montag developed a plan in 1949 to educate nurses at the associate degree level in community colleges. She and others working on this project believed that repetitive practices in diploma programs could be shortened into a 2-year associate degree program with increased general education coursework (Kalisch & Kalisch, 1995). Montag’s plan was that associate degree nurses would function as nurse technicians. The nurse technician was a step between the BSN nurse and the Licensed Practical/Vocational Nurse (LPN/LVN). Montag’s vision of differentiated practice for nurses was not well accepted (Donohue, 1996).

The popularity of the associate degree nursing programs was driven by the nursing shortage of the 1950s and the expanding community college system. Both private and public funding helped the development of the ADN programs (Mahaffey, 2002).

Why did you choose to attend an ADN or diploma program for your prelicensure nursing education?

As operating costs of both hospitals and hospital-based diploma nursing schools increased, schools were forced to charge for tuition, room, and board. Nursing education was no longer cost-free. As laws changed and unlicensed students were no longer allowed to provide nursing care in place of RNs, hospitals reevaluated their ability to sustain diploma schools. In 1952, McManus (as cited by Kalisch & Kalisch, 1995) reported that 90% of U.S. schools of nursing were owned by hospitals. Advancing knowledge and technology moved nursing education away from hospitals and into colleges and universities (Kalisch & Kalisch, 1995).

The number of hospital-based diploma nursing schools, once the only source of quality nursing education, was reduced to only a few programs by the end of the 20th century. The rise of both the associate degree (ADN) and the baccalaureate degree (BSN) programs significantly impacted the viability of diploma programs.

Although baccalaureate education in nursing originated in the early 1900s with the inception of programs at the University of Minnesota in 1919 and Yale University in 1924 (Kalisch & Kalisch, 1995), baccalaureate education in nursing continued its slow growth through the middle of the 20th century. In 1965, the American Nurses Association (ANA) advocated that nursing education take place in educational institutions instead of hospital-based diploma programs. ANA proposed that the minimum for entry into professional nursing practice be a baccalaureate degree in nursing by 1985. The result was great division in the field of nursing and nursing education.

University education for nurses demonstrated rapid growth by the end of the 20th century. With increasing complexity of healthcare technology and knowledge, many employers prefer to hire and promote nurses with a minimum of a BSN. The Magnet Recognition Program for hospitals (developed beginning in the 1980s with first Magnet-designated organization named in 1994) has also spurred many nurses to seek the BSN degree (American Nurses Credentialing Center, 2017).

DiplomaAssociate DegreeBaccalaureate
Nurse practitioners (registered nurses involved in an expanded role, usually in primary care) were introduced in the 1960s. Although they were previously prepared for the role in certificate programs after becoming RNs, changes in Nurse Practice Acts late in the 20th century required that nurse practitioners earn a master’s degree to qualify for licensure as a nurse practitioner (NP). However, NPs already practicing were grandfathered. By 2000, most states had passed some sort of prescriptive authority laws.

Programs leading to graduate degrees in nursing proliferated during the 1970s. These programs often focused on clinical specialties, teaching, or administration. The intent was to prepare nurses who could advance the profession through nursing theory and research (Kalisch & Kalisch, 1995).

Nursing Caps and Nursing Pins
Each school developed its own version of the uniform, cap, and pin, which were proudly worn by students and graduates. These symbols tied nursing to a structure of religious and military traditions. Nursing caps were originally designed to cover the hair. Each school also designed its own pin (bestowed at graduation) to help identify the school from which the nurse graduated. These pins and caps were a great source of pride for the wearer who wanted to be clearly identified as a graduate of a particular school.

World War II and the U.S. Cadet Nurse Corps

During WW II, there was a severe shortage of nurses in both civilian and military areas. In 1943, the Bolton Act (proposed by Congresswoman Frances Payne Bolton of Cleveland, Ohio) created the U.S. Cadet Nurse Corps (Kalisch & Kalisch, 1995).

As curricula became standardized and nursing organizations accredited excellent schools, educational requirements became more stringent. In order for schools to be eligible for funding by the U.S. Cadet Nurse Corps (in effect 1943–1948), schools developed a 30-month program (followed by a 6-month clinical residency) that met accreditation standards of the era (Kalisch & Kalisch, 1995). This helped to elevate the quality of nursing education for all nursing schools. Students enrolled in the U.S. Cadet Nurse Corps were required to serve until 6 months after WW II ended (Judd & Sitzman, 2014).

Student nurses in the U.S. Cadet Nurse Corps had their entire education subsidized (tuition and fees, books, uniforms, and stipends). Students were required to be ages 17–35, to be in good health, and to maintain excellent academic performance (Kalisch & Kalisch, 1995).

More than 60,000 American nurses served in WW II (Judd & Sitzman, 2014) in settings including front lines, hospitals (field, evacuation, and base), ships, and airplanes.

Korean War and Vietnam War
Mobile Army Surgical Hospitals (MASH) were developed in WW II but not really used until the Korean War. This revolutionary concept allowed care to be moved close to the front lines, improving survival. The new specialty of flight nursing also emerged during the Korean War (Kalisch & Kalisch, 1995). Many advancements that civilian healthcare personnel today take for granted had their origins in the military. Anti-shock trousers, triage, rapid clotting agents, and trauma surgery techniques are just a few such advancements.

Specialty Nursing Practice and Certifications
The middle of the 20th century was a time of great increase in healthcare knowledge and technology. By the 1960s, with the development of coronary care and intensive care units, nurses began to play a prominent role in the care of critically ill adults and children. The first coronary care units were established in a few American cities in 1961 and 1962. Continuous monitoring of cardiac rhythms coupled with specialized care from nurses skilled in cardiac nursing resulted in improved patient outcomes. Soon, coronary care units were developed at most large hospitals (Kalisch & Kalisch, 1995).

Intensive care units to care for patients with noncardiac critical illnesses soon followed in the 1970s. Because the outcomes were favorable in coronary care units, the decision was made to expand the plan to other critically ill patients. Placing these patients in a unit where they could receive close observation and monitoring, more individualized care from skilled nurses, and rapid intervention in the event of a crisis remains the mainstay of hospitals today. The first intensive care units were actually recovery rooms for patients immediately after surgery (Kalisch & Kalisch, 1995).

The success of intensive care units prompted hospitals to further divide patients on units based on the nature of their ailments, including specialty units for critically ill newborns (neonatal intensive care unit, or NICU). Larger hospitals often have separate units for persons with stroke, renal disease, cardiac issues, burns, respiratory problems, cancer, and other specialties (Kalisch & Kalisch, 1995). Nurses on these units soon became specialists in the nursing care of patients with specific issues, resulting in focused and expert care. Although nurses are educated as generalists, they often choose to specialize in one type of nursing later in their careers. The old adage of “a nurse is a nurse is a nurse” no longer holds true due to the complexity of healthcare today.

Keeling (2007) claimed that the advent of the coronary care unit did more to blur the lines between medicine and nursing practice. Nurses are the ones to recognize potentially lethal heart rhythm disturbances and to operate the complex life-saving equipment. The use of external cardiac massage (now known as BLS or CPR) facilitated these changes. Prior to coronary care units, only physicians were responsible for interpreting cardiac rhythms. Standing orders allowing nurses to draw blood, administer IV fluids and emergency medications, and administer oxygen improved patient outcomes (Keeling, 2007).

Although RN licensure indicates that nurses have met the minimum requirements of preparation and knowledge to practice nursing, specialty nursing certification indicates that the RN possesses a higher level of specific knowledge and experience.

Are you currently certified in a nursing specialty? Planning to become certified?

The trend for nurses to seek individual certification in specialty nursing practice has grown significantly, especially in the past 20 years (Judd & Sitzman, 2014). Many professional nursing organizations have a related certification body that manages the specialty nursing certification exams and renewal criteria. To honor nurses who have earned specialty certification, Certified Nurses Day is celebrated on March 19.

Renewal of nursing certification is usually needed every 3 to 5 years. Requirements often include some combination of practice in the specialty, continuing education related to the specialty, and/or retesting.

Specialty nursing certification indicates

experience in the specialty area;
expert knowledge in specialty area;
desire to support excellence;
continuing experience and knowledge updates; and
commitment to the profession.
Although some nurses believe that care by certified nurses promotes better patient outcomes, Krapohl, Manojlovich, Redman, and Zhang (2010) indicated that there was no relationship. Those authors called their work a first step towards understanding the relationship between certification and patient outcomes, but they recommended further research in this field. In 2013, Boltz, Capezuit, Wagner, Rosenberg, and Secic concluded that nurse certification may positively influence patient outcomes. What can you find on this topic in the scholarly nursing literature?


How long has certification in your specialty been in existence? How has it affected the quality of nursing practice in your area of expertise?

As the number of intensive care areas increased rapidly in the 1960s and 1970s, the American Association of Critical-Care Nurses (AACN) responded by establishing the CCRN certification program. AACN has been administering critical care nursing certification exams since 1975 (American Association of Critical-Care Nurses & AACN Certification Corporation, 2003).

Some employers assist nurses with certification costs by helping to pay for study courses or materials, testing fees, continuing education, or recertification fees. Other employers pay an hourly differential to certified nurses. However, these benefits are not universal and differ widely by employer.

Professional Nursing Organizations
As specialty nursing units increased in number, professional nursing specialty organizations developed to serve those nurses. This increase began in the 1970s and has continued as nursing continues to diversify. A few of today’s professional nursing specialty organizations include the following.

American Association of Critical-Care Nurses
Association of Women’s Health, Obstetric, and Neonatal Nursing
Emergency Nurses Association
Academy of Medical-Surgical Nursing
American Public Health Association—Public Health Nursing Section
Association of periOperative Registered Nurses
American Society of Pain Management Nursing
American Organization of Nurse Executives
American Assembly for Men in Nursing
American Holistic Nurses Association
American Association for the History of Nursing
National Association of Neonatal Nurses
And many more!
Benefits of professional nursing specialty organizations include the following areas targeted to each particular specialty.

Journal and newsletter subscriptions
Access to members only sections of websites
Discounted fees for continuing education in the specialty
Eligibility for research and education scholarships
Discounted fees for certification
Networking both locally and nationally with other nurses in the specialty
Ability to influence the public and legislators on issues relevant to the specialty
Participation in shaping the future of the nursing specialty
What is your nursing specialty? Do you belong to its professional nursing organization? Why, or why not?

This week, we have examined the significant progress in professional nursing during the mid- to late 20th century, including the development of nursing specialties, nursing specialty organizations, and specialty nursing certification. We can only imagine where the future will take our profession!

Coronary care units (intensive care units specifically for patients with cardiac problems) were developed in the mid-1960s.
View Answer
Why were associate degree nursing programs developed?
View Answer
American Association of Critical-Care Nurses & AACN Certification Corporation. (2003). Safeguarding the patient and the profession: The value of critical care nurse certification. American Journal of Critical Care, 12, 154–164.

American Nurses Credentialing Center. (2017). History of the Magnet program. Retrieved from http://www.nursecredentialing.org/magnet/programov…

Boltz, M., Capezuit, E., Wagner, L., Rosenberg, M.-C., & Secic, M. (2013). Patient safety in medical-surgical units: Can nurse certification make a difference? MEDSURG Nursing, 22(1), 26–37.

Donohue, M. P. (1996). Nursing: The finest art (2nd ed.). St. Louis, MO: Mosby.

Judd, D., & Sitzman, K. (2014). A history of American nursing: Trends and eras (2nd ed.). Burlington, MA: Jones & Bartlett.

Kalisch, P. A., & Kalisch, B. J. (1995). The advance of American nursing (3rd ed.). Philadelphia, PA: J. B. Lippincott.

Keeling, A. W. (2007). Blurring the boundaries between medicine and nursing: Coronary care nursing, circa the 1960s. In P. D’Antonio, E. D. Baer, S. D. Rinker, & J. E. Lynaugh. (Eds.). Nurses’ work: Issues across time and place (pp. 257–281). New York, NY: Springer.

Krapohl, G., Manojlovich, M., Redman, R., & Zhang, L. (2010). Nursing specialty certification and nursing-sensitive patient outcomes in the intensive care unit. American Journal of Critical Care, 19(6), 490–498.

Mahaffey, E. H. (2002). The relevance of associate-degree nursing education: Past, present, future. Online Journal of Issues in Nursing, 7(2).

7 hours ago
i will send you a sample work if you do not mind.

Hello Class-
In the early 1940’s infectious diseases were rampant. Mortality from diseases such as syphilis, TB, whooping cough, and pneumonia were on the rise. According to Judd and Sitzman(2014) the widespread practice of administering Penicillin (PCN) to those infected with diagnosable infections worked to reduce morbidity and mortality rates. Early on, identifiable issues stemming from PCN usage were pin pointed. Such obstacles included the potential for allergic reactions to occur. The development of alternative antibiotic therapies was regarded as the solution necessary to combat allergic reactions.
The benefits of antibiotic therapies seen today cannot be ignored. Overall patient recovery from infectious diseases continues to progress. However, the impact of antibiotic treatments seen today are not all favorable outcomes. Over prescription of antibiotics paved the way for the eventual development of “super” infections. Mutations of bacteria have resulted in strains of bacteria resistant to standard antibacterial interventions. The use of diagnostic tests to determine to causative bacterial organism has succeeded in allowing practitioners to prescribe the most beneficial medication. According to Jackson, Czaplewski, and Piddock (2018) the regulatory oversight associated with prescription of antibiotics is slowly evolving. Scientific impediment continues to exist, and hinders advancements in new antibiotic treatments. Our current crisis can only be reversed through the education of medical practitioners, pharmaceutical agencies, and patients. This will aide in the development of new generations treatments and bolster patient outcomes. This alone will not succeed in combating the current catastrophic challenges to improved treatment of infections. Changes in patient care plans must occur, and reflect usage of antibiotics only when urgent bacterial infections are present. Patients may not approve when they are not presented with a prescription for every little cough and sneeze. However, when one truly needs and antibiotic they will rest assured the infection will be appropriately eradicated.
Jackson, N., Czaplewski, L., & Piddock, L. (2018). Discovery and development of new antibacterial drugs: learning from experience? Journal of Antimicrobial Chemotherapy. 73(6): 1452-1459.

Judd, D. & Stizman (2014). A History of American nursing: Trends and eras. (2nd ed.). Burlington, MA: Jones & Bartlett.



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