In our contemporary times where everything better is characterized as modern and innovative, dealing with the word “traditional” seems to have a negative connotation because it can mean being not open to change or being trapped in the old-fashioned ways. In reading Newton’s article entitled “In Defence of the Traditional Nurse”, the author takes a feminist stance on the traditional roles that need to be maintained in professionalizing the field of nursing.
She emphasized that nurses should be equipped with the right abilities and skills to be able to act on behalf of any patient. That, the self-autonomy of this profession is not entirely needed. By stringently enumerating a nurse’s functions in terms of the specific needs of hospitals, physicians, and patients for them, Newton emphasized that a responsibility of the nurse that supersedes it all is to maintain a humanitarian presence in hospitals where a system without the nurse would “turn into a mechanical monster” (p. 694). Although Newton made salient points in most of her arguments, the article is bent on concentrating more on the stereotype that it seems to refuse to recognize new roles for nurses that may arise in the future.
On establishing the arguments, Newton started on identifying the stereotypical concept of the public about nurses. She emphasized that nurses are known for the humanistic care that they provided to patients. As all we know, most nurses are women and these individuals can express maternal, feminine, and tender feelings to patients who are sick. In the arguments given, it is only natural for the nurses to bestow this “maternal” care to patients because it is part of their job.
In most nursing books, we all know that this profession emphasizes nurses providing strength, will, and knowledge (in conjunction with or in place of medicine, surgery, or institutionalization) to help other people to be independent. However, when nurses assume multiple roles, and as the number of roles increases so does role stress, resulting in role strain. Role stress occurs when role obligations are unrealistic, vague, conflicting, or irritating.
It is generated by the social structure or system; the source is primarily external to the person. Role stress may create role strain, an emotional reaction accompanied by psychological responses, such as anxiety, tension, irritation, resentment, and depression, and negative social responses. This must be what played on Newton’s mind why she advocated the maintenance of these traditional roles for nurses.
Although it is not arguable that some traditional roles can still define what nurses should be limited to do, our fast-changing times require nurses to upgrade the skills and responsibilities they need to do to become effective. Newton supported the stereotype concept of nurses was a correct view of nursing and this was what constituted public the expectations of the nursing profession as well. Traditional nurse practice acts allow only conventional nursing activities.
They limit the nurse’s responsibilities to traditional patient care, disease prevention, and health maintenance. Traditional nurse practice acts don’t allow registered nurses (RNs) to participate in such expanded nursing activities as diagnosis, prescription, and treatment. At present, only a few states continue to have such limited practice acts because modern nurses need to break new grounds to ride the waves of change.
Behind the arguments of Newton, we all are aware that scientific development and new technological advances in the 21st century will create situations and questions that nurses must learn to face, besides knowing how to give “maternal care”. Genetic engineering and the identification of disease-carrying genes present problems regarding confidentiality and possible discrimination of patients when nurses will be working on these cases.
As their traditional roles dictate that they are advocates of patients, nurses find themselves on the front line in many of these situations. Analysis, discussion, and debate among nurses, other health care providers, ethicists, and attorneys will take place to develop an understanding and agreement on public policy and laws regarding these scientific advances.
Behind all these changes, advancement in the health care system will also provide new nursing opportunities. The roles of the advanced practice nurse (APN) and clinical specialist have taken on new dimensions. APNs act as primary care providers in areas such as emergency care, critical care, and community health. Many work as first surgical assistants. Additionally, APNs work as nurse-midwives and nurse anesthetists. With these expanded roles come added responsibilities and legal issues. This is why nurses will need to understand the legalities involved with these new technologies to practice safely and effectively.
Being regarded as professionals, nurses as trained workers must focus also on their roles in social awareness. Scientific achievements have opened up new ground for nursing exploration. Nurses can find career opportunities as forensic nurses, legal nurse consultants, and nurse attorneys. Behind all these, traditional roles can remain intact but the roles need to be expanded and upgraded to answer the needs of the patients.
Behind the fears that nurses will commit unethical mistakes because of their overlapping roles, the American Nurses Association (ANA) published a document, The Nursing Practice Act: Suggested State Legislation, to serve as a guide for states in developing their nurse practice acts. This document described the nursing practice as including but not limited to “administration, teaching, counseling, supervision, delegation, and evaluation of practice and execution of the medical regimen, including the administration of medications and treatments prescribed by any person authorized by state law to prescribe” (ANA, 1981, p. 6).
Because registered nurses not only provide care to patients and clients directly but also supervise the care given by others, state nurse practice acts permit professional nurses to delegate, but they do not permit delegating by licensed vocational/practical nurses. An important aspect of the delegation process is the ethical responsibility of nurses to refuse any responsibilities for activities that they do not have the expertise to carry out safely and competently.
Also, establishing and implementing standards of practice are major functions of a professional organization, like ANA for nurses. The purpose of standards of clinical nursing practice is to describe the responsibilities for which nurses are accountable. The standards
- reflect the values and priorities of the nursing profession,
- provide direction for professional nursing practice,
- provide a framework for the evaluation of nursing practice, and
- define the profession’s accountability to the public and the client outcomes for which nurses are responsible (ANA, 1998, p. 1).
In 1991, the ANA developed standards of clinical nursing practice that are generic and provide for the practice of nursing regardless of area of specialization. They were revised in 1998. The ANA and various specialty nursing organizations have further developed specific standards of nursing practice related to the practice of nursing in a specialty area. Moreover, specific professional nursing values are stated in the ANA code of ethics, in standards of nursing practice, and in the legal system itself.
Professional values are preferred standards that guide behavior and are used for evaluating behavior. With these guides, even if the nursing profession undergoes many changes, their roles will always be outlined and their ethical values will always be intact.
Ultimately, the nurses must become flexible and expand their horizons beyond their traditional roles. Although Newton is right that nurses must maintain their traditional roles, she must also recognize the need to improve these roles and make them more practical for modern times. Nurses must understand the roles they and others play and societal expectations associated with those roles. However, these roles need to expand and nurses should always be ready to face the challenges that society, technology, and even the government is requiring them to do.
Competence in nursing practice is determined and maintained by various credentialing methods, including licensure, registration, certification, and accreditation. The purpose of these credentialing methods is to protect the public’s welfare and safety. Standards of practice published by national and state or provincial nursing associations and agency policies, procedures, and job descriptions further delineate the scope of a nurse’s practice. With all these, we can be confident to say that nurses can go beyond the traditional and face the modern nursing profession with flying colors.
References
American Nurses Association (ANA). (1981). The Nursing Practice Act: Suggested state legislation. Kansas City, MO: ANA.
American Nurses Association (ANA). (1998). Standards of Clinical Nursing Practice. Washington, DC : ANA.
Newton, L. (2006). “In Defence of the Traditional Nurse”, In Kuhse, H. & Singer, P. (Eds). Bioethics: An Anthology. Malden, MA: Blackwell Publishing, pp. 690-697.