The nursing profession as well as the definition of a nurse has evolved over time influenced by the perception of the nurse’s role and sociopolitical events. The layman perceives the nurse’s role purely from the nurse’s personal qualities rather than from the skills, credentials and abilities (Brooks and Kleine-Kracht, 1983). There seems to be no agreement on the definition of nursing due to the frequent role confusion. Storlier (1970) alluded to this fact when he stated that “the glorious thing about nursing is that it can not be defined. The irony is that we never give up trying”. As such nursing has been defined differently by various scholars and institutions. In his extensive study on nursing Green (1979) defined nursing as a discipline that provides care, concern and comfort to recipients experiencing a broad range of health illness through the synergetic combination of the art and science. In 1980 the American Nurses’ Association-ANA defined nursing as the diagnosis and treatment of human responses to actual or potential health problems. Finally based on the concepts of care and health, most commonly associated with nursing, nursing is the study of caring in the human health experience (Newman, Sime and Corcoran-Perry 1991). This paper will look at the evolution of the nursing profession over time, the current perception of the profession and the future role of the nurse.
Nurses have perennially struggled with the problem of image leading to the concerted efforts to improve the public’s perception of the nursing profession (Aber and Hawkins, 1992). The images of nurses and nursing in the Twenty-first Century depend on the person defining it. While the layman may vaguely define the profession mainly influenced be the media’s view other health professionals have a very elaborate and refined view of the nursing professional[ CITATION Lut98 \l 1033 ]. According to a study by Aber and Hawkins (1992) the media has portrayed nurses as professionals in the lower cadre of the health profession that carryout simple tasks, sex objects, sex stereotype, physicians’ handmaidens, idle, abused, vulnerable and only involved in making less important decisions. In addition to the media’s portrayal, contributing to this layman’s image of nursing is the way nurses present themselves. The nurses’ complain of being the poorest prepared and paid of all professions, albeit vehemently objecting to such criticism, has led to the negative stereotype about nurses[ CITATION Lut98 \l 1033 ].
Another important image of the nursing profession in the 21st Century is that of a highly technical and dynamic field. In concert with the expansion and diversification of the medical field the nursing profession has become highly departmentalized and specialized to the extent that there is a constant overlap with other health professionals. This is the view best understood by those in the health professions and a little confusing to the layman. It is common in many countries to find patients for example referring to the nurse as ‘Doctor’. Those in the health professions clearly understand that there are different categories and levels in the nursing profession; for example there are pediatric nurses, psychiatric nurses and others.
Contributing to the ambiguity in the nurse’s images in the 21st century is that with high demand for academic qualification the entry level into the field of nursing has become highly stratified. In other words there are nurses employed with a community college diploma, others with a Bachelor degree, others with a master’s degree and others with a doctorate. Lack of understanding has led to the perception that all nurses are equal[ CITATION Lut98 \l 1033 ]. However the roles played by and the images of nurses in the 21st Century differ according to their academic qualifications so that those with the higher qualifications are involved in management roles. This is an unfortunate development in the profession because the very basic concept of nursing is patient care yet the most highly prepared portion of the nursing population have no or little contact with patients. It is also a deplorable state because it introduces new twist of education versus service so that education has taken prominence in defining the professional.
Three historical views have influenced the evolution of nursing, namely: religion, war and feminism. The basic concept of nursing is care and has historically been associated with religious believes. In the early centuries nursing was the domain of nuns and monks and even today many religious institutions engage in training of nurses. War has always presented the world with situations of humanitarian crisis and strained healthcare services. While in the civil wars of 1860s the focus was on the volunteer system of Army Nursing the preceding wars, particularly World War I, revealed the weakness of this system and caused an increased demand for trained nurses[ CITATION JoA83 \l 1033 ]. The rise of the feminism theories and the fight for gender equity has greatly influenced the nursing profession. Initially the profession was a preserve of prostitutes and female criminals but great women like Florence Nightingale’s and Isabelle Stewart brought a paradigm shift. Hunt (nd) concluded in her recent study that “the feminist movement and nursing have had a somewhat turbulent history. Parallels can be drawn between the changing roles of women and nurses, reflecting nurses continuing struggle for recognition”. With the 21st century providing new health challenges such as lifestyle diseases, toxic environment, antimicrobial resistance, health disparities and bioterrorism the role of nursing must grow to address these challenges. Nurses in the 21st century must be highly trained to work with the emerging sophisticated technologies. Finally nurses in the 21st century ought to be multidisciplinary in training, independent as well as interdependent in execution of their tasks.
Nursing has evolved from the mid 18th century when it was mere house keeping associated with lower social class and often illiterate drunkards to today’s state of being a sophisticated, highly specialized and dynamic[ CITATION JoA83 \l 1033 ]. The many and ambiguous images of nursing and nurses have been established greatly influenced by media and public perception as well as the educational revolution and diversification.
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