Nursing is a profound profession based on strong personal principles of personal and professional skills. There is little doubt that nursing practice has been forced to make severe accommodations within this larger societal context as knowledge has continued to increase and attitudes and values have shifted. Nursing is one of the first groups to understand the significance of primary health care and progress toward its implementation. Yet, as gaps in primary health care have occurred, nurses have been willing and able to fill them and provide a highly cost-effective and high-quality service. Nursing means care and professional medical help aimed to support patients and promote health issues. I want to become a registered nurse and support children with AIDS.
For me, nursing is much more than a medical profession but a way of life and thinking. Like the majority of nurses I will readily state belief that their faithfulness or first allegiance is to the patients/clients they serve. I suppose that nurses have dealt admirably with impediments from both society and nursing itself. They have worked constantly for the acceptance of personal values in nursing, and for the promotion of equal opportunities for all minority persons. Numerous nurses have emerged as significant nursing leaders, made valuable contributions to nursing, and brought the concerns of people to the attention of nurses and the general public. Others believe that the expanded roles in nursing fulfill a vital need and provide health care services where either none exist or services are limited. In addition, the assumption of additional functions by nurses is viewed as necessary so that the best possible care be rendered. Whatever the case, the changing environment has called for an education to keep pace with the modern world (Daly et al 2005).
The numbers of registered nurses and their areas of clinical expertise have been steadily increasing. The number of “nursing specialty” areas is remarkable. Much to their credit, nurses have for some time emphasized preventive and primary health care rather than high-tech medical interventions (Daly et al 2005). They have also been more prone to practice in disadvantaged areas with disadvantaged socioeconomic groups. Thus nursing is well-positioned to lead the way toward the resolution of accessibility, quality of care, and cost issues in health care. The question is whether nurses are willing to intellectually view the future from a position of strength, for the time is ripe for creating a major impact on patient care. Are nurses willing to rise to the challenges of change and chaos and seize the opportunities available in medical profession?
The roles and responsibilities of a registered nurse in Australia involve assessing health status of patients, evaluation of health resources required for a patient, nursing care, education and emotional support of patients and their families, task delegation and assessment of physical conditions of a patient through peer review or direct observation. Registered nursing expertise is usually equal to or ranked above administrative positions, and clinical nurse specialist positions may be equal to or above the traditional head nurse or supervisor positions. More and more attention is currently being given to defining and describing advanced practice nursing as dramatic increases are occurring in numbers of generalists, practitioners, and clinical specialists. Yet, there is still a difference of opinion regarding what critics refer to as two models for specialization. The first is the nursing model or clinical nurse specialist (CNS) with emphasis on advanced content from the behavioral sciences, education, and nursing (Daly et al 2005). The focus of this model is the caring role of the nurse. The second model, the collaborative model, builds on acquired nursing skills with advanced knowledge of medicine and the behavioral and biological sciences. Nurse practitioners, nurse anesthetists, and nurse midwives are included in this model, which some nurses believed pushed nursing into a medical role (Clark & Clark 2003).
Political, social, and economic realities are important facets underlying both the determinants of health and ethical decision-making. They can inhibit or enhance the achievement of health and sound ethical practices. Scientific advancement, technological innovations, and crises such as conflicts or wars are having profound effects internationally on health care and on nursing in this time of rapid change. Ethical issues are thus arising from a variety of sources and being created by a variety of circumstances. Progress itself has been one of the key factors. Nurses are faced daily with ethical decision-making. They are now being forced to examine ethics to an even greater degree, from a worldwide point of view. It is one thing to understand and appreciate the ethical ramifications in one’s own setting, still another to think about a global perspective (Fine, 2007). This becomes particularly difficult because the way societies view and think about ethical issues is frequently affected by political and economic changes. In addition, ethical conduct relative to culturally accepted practices varies greatly. In some countries abortion and prostitution are legal; in others they are not (Powers, 2003).
The primary difference in the nursing of today is its maturity that has evolved over the course of the twentieth century. Indeed, new concerns have arisen that may cause nurses to pause and deliberate, such as the increasing use of unlicensed assistive personnel, changed reimbursement systems, the presence of nursing information systems, and a return to alternative forms of health care and healing practices. What must constantly be remembered, however, is that change also brings opportunities. Understanding the nature of change is paramount to the progression and survival of nursing.
Both external and internal forces are involved in the process of change and directly or indirectly affect the nursing discipline. External forces are generally believed to be the strongest, although internal forces may have a positive or negative effect (Suzie & Rn 2006). At the beginning of the 21st century, nursing changes and grows in response to perceived social need, parallels the development of the social welfare system, and reflects society’s attitude toward sickness and health. Its history documents a detailed account of the growth of an occupation in its quest for professionalization, an intimate view of the work experiences of women in a culture traditionally dominated by men, and the impact of nursing on patient care in hospitals (Clark & Clark 2003). “This move effectively equated professional caring more with the supervisory tasks of counseling and listening, the sort of work that a senior registered nurse might feel drawn towards, while the work of scrubbing the patients and cleaning the beds could be delegated to less qualified junior staff” (Fine 2007, p. 137).
Eventually the trend toward specialized care units gained momentum, and various nursing roles evolved. These roles became known as expanded roles and extended roles. Although the terms are frequently used interchangeably, there is a difference between the two. The extended role refers to a physician extender with a cure orientation; the physician retains authority and decision-making power. The expanded role is an expansion or broadening of care-oriented nursing in which the nurse collaborates with the physician when such collaboration is indicated in specific situations (Powers, 2003). The issue of allocation of scarce health-related resources has become almost paramount, leading to serious ramifications for institutions, health care personnel, and consumers around the globe. Ethical questions of the past were related to affluence; the problems of today deal with scarcity. Yet, efforts to control costs have been erratic, with various reasons given to explain high costs. Initially the problem of increasing hospital costs was attributed to poor management.
During the past decade nursing practice has been characterized by rapidly increasing responsibility, accountability, autonomy, and authority inpatient care. It is a decade of practice measurement and outcome research in health care. Potentially, further differentiation of roles will occur as relationships between nurses and physicians are transformed and new patterns of governance within the nursing hierarchy are established. Collaboration will be the byword as health professionals can no longer practice independently; boundaries are collapsing (Suzie & Rn 2006). The need for highly technically skilled nurses in hospitals will continue, but they will, in all probability, be accountable for their practice to a nurse with advanced preparation who will serve as the case manager for a group of patients. Departmental governance and the participation of nurse representatives in institutional, agency, and practice policies will continue and must escalate (Saethre, 2007).
Nurses are making powerful contributions to health care with innovative community practices that promote health, accessibility, and lower costs and facilitate a high quality of care. They established a precedent of direct access to professional nursing services by the consumer. The potential for nursing clinics to effectively assist with community problems, both disease-related and social, is undeniable, and the advantages of community-based care are numerous: ease in accessibility; services and care that are sensitive to religious, racial, and cultural norms; community participation in the identification of needs; and increased comprehensive services through collaboration with social service agencies. An additional factor with centers affiliated with universities or schools of nursing is their use as sites for clinical experiences for both undergraduate and graduate students. Nursing educators may also use them as sites for faculty practice (Suzie & Rn 2006). As with the early settlement houses and nursing clinics, the philosophy that health issues are intricately and intimately connected with a variety of human issues is embraced. Family structure, social support systems, employment, education, choice in lifestyle, and environment are believed to contribute to the health and well-being of a community and its members. Thus the primary focus of nursing services is on health promotion and health education.
Nursing is in a unique position to exercise courageous and visionary direction in creative health promotion practices and holistic care. Nursing is in a strategic position to help promote and facilitate this paradigm shift in health care. Nursing is in a key position to shape and provide primary health care. Nursing has been and still can be a strong social force and advocate for change. Thus it is essential that nursing create international links among nursing communities, since all nurses around the globe are facing common issues and experiencing increasing social pressures. The environments in which nurses work worldwide have drastically changed, presenting even greater challenges. The world has, however, witnessed the eradication of a killer disease. Through the efforts of WHO, smallpox became the first disease ever eliminated by vaccination. The last case was diagnosed in the small coastal town of Merka in southern Somalia in 1977. Tuberculosis, however, is spiraling out of control. In the past ten years it has spread dramatically as a result of overcrowding and poverty, the spread of AIDS, and the resurgence of tuber.
Clark, P. F., Clark, D.A. (2003). Challenges Facing Nurses’ Associations and Unions: A Global Perspective. International Labour Review, 142 (1), 29.
Daly, J. Speedy. S., Jackson, D. (2005). Professional Nursing: Concepts, Issues, and Challenges. Springer.
Fine, M. (2007). The Social Division of Care. Australian Journal of Social Issues, 42 (2), 137.
Powers, B.A. (2003). Nursing Home Ethics: Everyday Issues Affecting Residents with Dementia. Springer.
Saethre, E. J. (2007). Conflicting Traditions, Concurrent Treatment: Medical Pluralism in Remote Aboriginal Australia. Oceania, 77 (1), 95.
Suzie, H., Rn, K. (2006). Nursing Theories: Conceptual and Philosophical Foundations. Springer.