A Detailed Look at the Evolution of Nursing Practice Today

This essay explores the evolution of nursing practice, starting with Florence Nightingale's contributions and tracing the development of nursing roles, education, and practices in the United States. It discusses the shift from informal care to structured nursing programs, the impact of events like the Civil War and World Wars, and the emergence of specialized and advanced practice nurses. The essay also examines the differences between Associate Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN) prepared nurses, highlighting the importance of evidence-based practice and interdisciplinary collaboration in modern healthcare settings. It concludes by emphasizing the need for supportive policies and the critical role of nursing organizations in advancing the profession to ensure safer and better patient outcomes.

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NURSING PRACTICE EVOLUTION
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INTRODUCTION
Nursing is a noble career and is among the jobs where serving humanity is done
passionately. Nursing plays an important role in the medical sector as the nurses provide primary
care to the patients and act as their advocates. Nurses are involved in the assessment of the
patients, diagnosis, administering medications, dressing wounds and evaluating if nursing care is
producing positive outcomes. Nurses are also involved in managerial roles, research and
education.Nursing has evolved in various ways and provides opportunites to specialize in
different cadres and specilaities.
CHANGES IN NURSING PRACTICE
According to Cherry and Jacob,(2016) nursing has evolved with time in America.
Florence Nightingale commonly referred to as the mother of nursing was a trainer of nurses
during the Crimean war to care for wounded soldiers. She founded her own nursing school at St
Thomas Hospital in London in 1860. She wrote books defining what nursing is and what it is
not(Nightingale,2010).In the United States, the nursing care in the 18th century was mainly done
by the relatives while in the 19th-century hospitals began to grow while there was increased
nursing care demand which differed in various hospitals. Dr. Joseph Warrington trained women
on care during childbirth. The civil war led to of nurses taking care of wounded and nursing
program in Hospital of Philadelphia.
Nursing programs began in three schools providing diplomas. The field was dominant
with women. The nursing legislative acts led to the title of registered nurses. The world war led
to a change in nursing practice and more nurses employed as staff nurses. In 1960 programs
offered Bachelor in Nursing degrees known as Baccalaureate. There was a change in more males
in the nursing sector, specialized nurses and advanced practice nurses such as nurse practitioner

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and clinical nurse specialists. The doors also opened for nurses to participate in research
practices.
CHANGE IN SCOPE OF PRACTICE
Newhouse et.al(2011) states that the availability of advanced practice nurse such as nurse
practitioner has led to improved patient outcomes. These nurses whoa re highly trained in a
specific area have the expertise for example geriatrics, oncology, pediatrics, and intensive care.
The approach towards treating the individual is client-centered and more focused on the specific
pathophysiologic changes rather than general care of the patient. Specialized nurses work in their
specialties which leads to increased efficiency.
ASSOCIATE AND BACCALAUREATE NURSING
The associate and baccalaureate education in nursing provides the opportunities for one
to become a registered nurse in the United States. Both equip the students with skills of history
taking, observing signs, and symptoms, triaging, health promotion collaboration with other
healthcare workers. According to Davis Martin (2012), baccalaureate nursing differs from
associate nursing in that it offers research and public health competencies.
BSN NURSE VS ADN NURSE IN CLINICAL SETTING
According to Primm(2012), BSN-prepared nurse has been associated with lower patient
mortality and morbidity. The BSN prepared nurse has skills in public health, health promotion
and increased knowledge of disease types and occurrences. The ADN prepared nurse, on the
other hand, is involved in patient care but on monitoring vital signs and working with medical
equipment. The BSN has participated in hospital rotations hence rich nursing skills in patient
care.

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Oermann(2013) conducted a study comparing the clinical experiences of BSN prepared
nurse and the ADN prepared nurse on decisionmaking. The results showed that the BSN
prepared nurse has better decisionmaking skills and critical thinking compared to the ADN
prepared nurse.
EVIDENCE-BASED PRACTICE IN NURSING
According to Youngblut&Brooten(2012), it is important for nurses to practice evidence-
based care because it provides individualized patient care. The client receives care which is more
effective since it has been tested and proven successful in previous attempts during research
trials or studies conducted over time. Evidence-based practice relies on new technological
advancements and new discoveries leading to new knowledge.
Melnyk, Fineout-Overholt, Gallagher-Ford &Kaplan(2012) states that during the nursing
school BSN nurse is taught research in order to conduct evidence-based care. This renders the
BSN nurse capable of conducting evidenced-based practice easily.
NURSES’ COLLABORATION AND COMMUNICATION
Nurses work hand in hand with other professionals in health care such as physicians
nutritionists, physiotherapists and health records. Nurses communicate verbally and
nonverbally(Evans,2012). This is also enhanced by written documents which are used as
evidence of care in the health sector. Nurses collaborate during ward rounds, transition of care
and implementing physician orders on medications. There is also consultation between various
teams to improve the client’s care
According to Zwarenstein and Bryant,(2011), interdisciplinary collaboration in healthcare
during decision making and ward rounds leads to decreased length of hospital stay and reduced

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hospital expenses. There is also less medical errors occurrence. It is important for nurses and
other healthcare professionals to work together to promote safer patient outcomes.
CONCLUSION
Nursing has changed over time to improve the practice. However, there is a need to
ensure there are policies that favor the nursing profession. The nursing organizations have a role
in delineating the various nursing cadres in the profession. The nursing profession plays a very
important role in the healthcare system hence it requires support.

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REFERENCES
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
Davis-Martin, S. (2012). Research on the differences between baccalaureate and associate
degree nurses. NLN publications, (15-2339), 109-145.
Evans, R. G. (2012). Patient centred medicine: reason, emotion, and human spirit? Some
philosophical reflections on being with patients. Medical humanities, 29(1), 8-14.
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of
evidence-based practice in US nurses: critical implications for nurse leaders and
educators. Journal of Nursing Administration, 42(9), 410-417.
Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., ... &
Weiner, J. P. (2011). Advanced practice nurse outcomes 1990-2008: a systematic
review. Nursing Economics, 29(5), 230.
Nightingale, F. (2010). Notes on nursing: What it is, and what it is not. Lippincott Williams
& Wilkins.
Oermann, M. H. (2013). Differences in clinical experiences of ADN and BSN students.
Journal of Nursing education, 37(5), 197-201.
Primm, P. L. (2012). Differentiated practice for ADN-and BSN-prepared nurses. Journal of
Professional Nursing, 3(4), 218-225.
Youngblut, J. M., & Brooten, D. (2012). Evidence-based nursing practice: Why is it
important?. AACN Advanced Critical Care, 12(4), 468-476.

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Zwarenstein, M., & Bryant, W. (2011). Interventions to promote collaboration between
nurses and doctors. Cochrane Database of Systematic Reviews, (2).