Running head: ISSUES 1

The Issues of Nursing: From Past to Future

Lauren T. Kalanta

California State University, Stanislaus

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Nursing is a profession that has been built on the foundation of compassion, tenacity, and

malleability. In order for the nursing community to build upon this foundation, there needs to be

careful consideration of the future and close analysis of past mistakes. In 2001, a determined

group of nursing professionals called the American Nurses Association (ANA) organized a

summit committee to develop a plan of action that would guide the nursing profession to its

desired future by the year 2010. Nursing Agenda for the Future developed a document that serves

as a roadmap to achieve the goals set forth by the (ANA). This document points out the problem

areas of nursing within the 10 domains that are to be the areas of focus. In order to examine

nursing's extensive journey, there needs to be consideration of nursing's history, the domains,

current issues within nursing and how they relate to the domains, and what the future may

consist of for those involved with the nursing profession.

The Role of the Nurse: Past to Present

The history of nursing is one that has been through trials and triumph. In order to

improve nursing's future, there needs to be an understanding of nursing's history. According to

Finkelman & Kenner (2016), nursing was fundamentally developed by Florence Nightingale and

later carried out by many other influential figures with her teachings and convictions in mind (p.

8). Nightingale, a British woman living in the Victorian era, rearranged the stereotypical

viewpoints of the roles of women being restricted to the home (Finkelman & Kenner, 2016). The

image of a nurse took form with religious roots and a viewpoint that nurses are solely female

handmaidens, assistants, and caretakers with little to no education (Finkelemen & Kenner, 2016).

Nightingale felt that God had called her to nursing and began to apply the beliefs of nurturing

both body and mind during her time spent in the Crimean War (Finkelman & Kenner, 2016).

From her influence, the seed of practice was planted and nursing, as a profession, began to grow
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as the Industrial Revolution brought a need for sanitary reform (Finkelman & Kenner, 2016).

Today, improvements in education and recognition of improper technique have created a career

that provides many different avenues and creates many new roles (Finkelman & Kenner, 2016).

A nurse must provide adequate care to patients while simultaneously communicating with

doctors, advocating the rights of both patient and profession, demonstrating critical thinking

skills, performing emotional labor, and providing support in times of crisis. No longer are nurses

considered to be secondary citizens within the medical community; instead, they are recognized

as educated professionals (Finkelman & Kenner, 2016).

The Public's View

An issue that continues to hinder nurses and their practice today is an outdated and

invalid perception of what a nurse looks like and how they function. With images of nurses

predominantly being women wearing white dresses and caps or wearing stilettos accompanied by

fishnet stockings, comes a false representation of the profession. This is a critical issue since it

undermines nursing as a profession and creates a misconception of a nurse's role in the public's

eye. According to the document written by Nursing Agenda to the Future (2002), in 2002, there

were almost three million nurses in the nation making nursing the largest healthcare profession.

Today, that number continues to grow. With an unclear representation of what a nurse looks like,

what they stand for, and how they function, the profession of nursing can become undervalued.

Domains

As part of the plan towards a desired future state, 10 key areas are discussed in the

document written by Nursing Agenda for the Future (2002) and strategies are developed within

each area. Just as how the committee set goals and plans to meet their desired future state as a

whole, so do members who work within each area to identify a desired future, primary strategies,
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and objectives. These areas, also known as domains, are leadership and planning, economic

value, delivery systems, work environment, legislation/regulation/policy, public

relations/communication, professional/nursing culture, education, recruitment/retention, and

diversity (Nursing Agenda for the Future, 2002).

The first domain discussed is leadership and planning which are both

essential in the coordination of progress. As a leader, accountability must be taken into

consideration when applied to nursing situations. A good leader must be able to apply

evidence based criteria from reliable sources in a collaborative and constructive way

while planning will assist the leader in providing knowledge to others and influencing

decision making.
The second domain is economic value. As providers of cost-effective

healthcare, nurses need to be adequately compensated and valued within public policies.

A primary strategy to reach this objective is to conduct evidence-based research of the

most cost-effective methods and to organize a design for reimbursement. Reimbursement

programs need to coincide with public policy in order to educate the public about

the value of nursing.

The next domain is delivery systems. Within the scope of nursing, there

should to be an easy flow of healthcare delivery. In order to form a model for this type of

delivery, there needs to be implementation of research, education, and practice. This

model needs to be applied across all facets of nursing. The delivery of this model will

provide a stable functioning for healthcare systems.

Work environment is the fourth domain and focuses around improving

conditions within the work setting in order to retain nursing staff. A primary strategy of

this area is to allow nurses to have a voice in decision making through which

collaborative efforts and support can be fostered. Improving the work environment will
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allow nurses to feel secure within their line of practice and allow for individual

improvements.
Another domain is legislation/regulation/policy. Nurses reinforce the

standards that policies and procedures set forth. Nurses need to be involved in healthcare

related policies by collaborating with other policy-makers at all levels including local,

state, national, and international. Holding nursing summits to discuss legislation will

provide a route to nursing involvement in legislation.

Public relations/communication is the next domain that is discussed and

plays a crucial role in healthcare due to nurses being compassionate professionals that

impact the lives of patients, patients' families, staff, and all those surrounding them. Their

influence within healthcare needs to be recognized as a respected image of value.

There must be accurate communication to the public of a nurse's role to uphold the

image.
The seventh area, professional/nursing culture, sets high standards in

teaching, leadership, and cooperation. Setting high standards within the three areas will

help to enhance the positive image of the nurse and increase work satisfaction. A primary

strategy of this domain is to implement professionalism that is supported by education

and leadership. By embracing accountability and responsibility as a key function of their

roles, nurses can achieve the high standards set by professional/nursing culture.
The eighth domain is education. Nursing education is of high importance

due to the fact that it is education that produces highly skilled and competent nurses. A

strategy to improve the nursing practice is to create harmony between educational

organizations and the ever-changing society while defining educational goals for

students.
The next area, recruitment, focuses on attracting skilled nurses for long-

term career development. There needs to be distribution of materials and development of

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opportunities that will draw in nurses. Recruitment needs to create a standardization of

internships that will lead graduates towards appealing career models.

The final domain discussed is diversity which aims to reflect the

population that nursing is caring for. The field of nursing is one that needs to be a melting

pot of diverse cultures, social circles, economic statuses, and ethical backgrounds. A

primary strategy to enforce diversity is implementing health system leadership that values

diversity and provides education.

The problem areas discussed in the document written by the Nursing Agenda for the

Future (2002) are areas in which the nursing career strives towards improvement. Within each

area, an objective and strategy is discussed in order to meet the goals of a desired future set forth

by the (ANA).

Nursing Image Within Public Relations/ Communication

One domain that relates to the current issue of the invalid perception of nursing is public

relation/communication. A common image that the public sees today throughout the media is that

of women in tight fitting uniforms or comedians filling the shoes of male nurses. These types of

images undermine the professional image that has taken decades to accurately portray. According

to the document authored by the Nursing Agenda for the Future (2002), nursing's crucial role in

the healthcare system must be portrayed to the public. To do this, the strategies within the

domain which are efficiently explaining the impact nursing has on the healthcare system,

portraying a professional image of a nurse with an appealing career, and highlighting the

influential powers of nursing, must be utilized. In order to implement change geared towards this

issue, images within social media need to be altered to reflect the true state of nursing by

portraying nurses in accurate uniforms and including diversity amongst characters. Television,

magazines, radio, and billboards are all platforms to display nursing as a profession and define
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their functions to the public eye. With this, the impact of nursing can be explained through

educational television and advertisements of nurses from diverse backgrounds. Communicating

to the public that nurses are vital and professional key elements to the healthcare system, will

uphold the true, valued image of the nurse.

Relevance

Despite the document authored by Nursing Agenda for the Future being written in 2002,

it still contains relevant and vital information that relates to today's current nursing issues. The

ten domains discussed highlight issues that nurses still face in this current day and age. In order

to maintain its relevance, there should be another domain added that addresses the ethics of

nursing. With increasing advances in internet access and technology, there is more room for

dishonesty within the nursing community. There should be a strategy devised that sets universal

boundaries and guidelines that allows nurses to have a clear understanding of what dishonesty

looks like at all educational levels whether it be at the diploma level or the master's level. If this

domain were added, the issue of dishonesty throughout modern technology will be addressed and

relate the document to current issues.

Nursing, as a profession and lifestyle, has triumphed through many trials. From humbled

beginnings to boldly advancing as the nation's number one healthcare profession, nursing has

utilized hindsight and perseverance in order to reach countless goals and to make life-saving

improvements. The nursing community can look back on the days of Nightingale with gratitude

and fondness for the knowledge of past mistakes that have taken nursing down such a

remarkable road. It is the recognition of past mistakes and room for improvement that guides the

nursing profession to a greater state than it once was.

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References

Finkelman, A., & Kenner, C. (2016). Professional nursing concepts: Competencies for quality

leadership (ed. 3. p. 4-16). Sudbury, MA: Jones and Bartlett Publishers.

Nursing Agenda for the Future. (2002). A call to the nation.Washington D.C.: American Nurses

Publishing.