How has the role of nursing changed over the last 50 years?
Edna Astbury-Ward, registered nurse and senior lecturer, University of Chester: The need for nurses today to be highly trained, well-educated, critical thinkers is a requirement enabling them to make complex clinical decisions that 50 years ago would almost certainly have been made by doctors.
Helen McCutcheon, Florence Nightingale school of nursing and midwifery, King’s College London: As the population’s healthcare needs have changed, so too has the scope of practice for nurses and midwives. This has required a change in education and training to ensure that nurses and midwives can take on new and complex roles.
Compassionate care – a superpower or just part of the job?
Is the internet and technology changing what nurses do?
Andrew Catherall, nursing student, London South Bank University: I think the internet is destroying the paternalism that used to be at the heart of healthcare. Patients are now empowered to take control of their own care and voice their health needs and this is changing the patient-provider dynamic in a very positive way.
Andrea Shaw, second-year student nurse at the University of Nottingham: I think [the internet] presents huge opportunities for nurses to assist patients to self-manage long-term conditions and creates new avenues for peer support.
Janet Davies, director of nursing and service delivery, Royal College of Nursing: The internet empowers patients, but it can also confuse them. I don’t believe healthcare has yet realised the benefits that technology can bring.
What is the impact of needing a degree to be a nurse?
Susan Hamer, organisational and workforce development director, National Coordinating Centre, NIHR Clinical Research Network: Research has demonstrated that a well-educated nurse workforce leads to better patient outcomes. Nurses qualifying today may still be in the workforce in 2050. The more educationally able the workforce is, the better it is for patients and communities.
Davies: Nurse training is now undergraduate level and leads to a degree on registration. The level of knowledge, the ability to reflect and challenge as well as appreciate the need for our practice to be evidence-based is essential.
Are there adequate career pathways?
Davies: One of my biggest concerns is the lack of structured continuing professional development for nurses. Not only is it difficult for nurses to ensure they are always up to date in their practice, we also don’t have a clear, clinical career path supported by relevant education and development.
Shaw: I think this is a big problem in nursing. I think more structured support in terms of study time, funding for continuing education and designated training posts is key to the development of the nursing profession.
Heather Iles-Smith, head of nursing research and innovation, Leeds teaching hospitals NHS trust: What we need are some career pathways that span both academia and clinical practice for those keen on an academic career. The challenge is for NHS trusts to ensure that clinical roles develop alongside the academic element.
What is the role of social media in nursing?
Davies: Social media can be incredibly positive in promoting health and engaging with others about our profession and practice. There are some obvious risks, but with good guidelines and governance they can be managed.
Shaw: I have found Twitter to be amazing. It’s how I organised my shadowing day with a senior nurse; it has enabled me to attend conferences and provided me with many more learning opportunities beyond my course. I also love being able to chat with lots of different people who work in health and social care, from chief executives and consultants to students. Twitter’s given me a voice, and being able to use it professionally has given me a lot of confidence.
What challenges do nurses face?
Hamer: I think that nursing in the current economic environment is too often seen as a cost rather than having an economic benefit for society. Nurses contribute to the health and wealth of this country and investing in a well-educated, well-supported workforce has measurable benefits.
Shaw: The main challenge is that there simply aren’t enough of us. Nurses need time to be able to do their jobs effectively, and if nursing teams are understaffed, nursing can turn into firefighting.
Davies: The thing I hear most [is nurses wanting to have] the time to care how they would like. [They are] dealing with increasing complexity, both in their patients’/clients’ needs and in the system in which they are working.
Catherall: I think we face a problem of public perception. A lot of the fallout from the Francis report landed on the nursing profession. I think we have to demonstrate that our move towards a more academic profession has not robbed us of our caring and has definitely not made us too posh to wash.
Iles-Smith: Remaining present and focused on delivering patient-centred care when there are so many competing demands on the nurse’s time is a major challenge.
Working in A&E is a privilege even if it is stressful and understaffed
What does the future hold?
Shaw: With the publication of the Five Year Forward View it seems clear the direction of travel is to get many more nurses out into the community, so I think there will be a lot of opportunities and possibly new roles for nurses outside of an acute hospital setting. I think the use of technology will become more ubiquitous, and hopefully there will be more nurses involved in research as the all-graduate workforce starts moving into the profession.
Hamer: The future for clinical research nursing is really exciting. We are continuing to grow the number of studies and opportunities for patients to engage in research. The variety of work makes it attractive to a diverse range of nurses who we are able to grow and develop.
Davies: Our population will continue to get older, and people will require skilled, dedicated professionals to meet their health needs. Nursing will have a key role in promoting health and keeping people well as well as supporting them during times of illness. We will be leading teams and working in many different settings, using technologies we currently can’t imagine. Nursing will change again in the next 50 years, but the fundamentals will be the same. And despite all the challenges it will still be a great profession.
Discussion commissioned and controlled by the Guardian, hosted to a brief agreed with the NIHR Clinical Research Network. Funded by the NIHR Clinical Research Network
In 1960, during her first month at the Food and Drug Administration, Dr. Frances Oldham Kelsey took a bold stance against inadequate testing and corporate pressure when she refused to approve release of thalidomide in the United States. The drug had been used as a sleeping pill and was later proven to have caused thousands of birth deformities in Germany and Great Britain.
Born Frances Oldham in 1914, on Vancouver Island, British Columbia, she earned both her bachelor of science and master of science degrees from McGill University, Montreal, in 1934 and 1935. In 1938 she earned her Ph.D. from the University of Chicago, and went on to teach there from 1938 to 1950. Dr. Frances Oldham married Dr. Fremont Ellis Kelsey, a fellow faculty member at University of Chicago, in 1943. Their two daughters were born while she earned her medical degree at the University of Chicago Medical School.
Dr. Kelsey then worked as an editorial associate at the American Medical Association before teaching pharmacology at University of South Dakota from 1954 to 1957. She was a general practitioner there from 1957 to 1960. In 1960 she moved to Washington, D.C., and began her long and distinguished career at the Food and Drug Administration, where she later became chief of the Division of New Drugs, director of the Division of Scientific Investigations, and deputy for Scientific and Medical Affairs, Office of Compliance.
Dr. Frances Kelsey took her stand against thalidomide during her first month at the Food and Drug Administration, on her first assignment. The task was supposed to be a straightforward review of a sleeping pill already widely used in Europe, but Kelsey was concerned by some data suggesting dangerous side effects in patients who took the drug repeatedly. While she continued to withhold approval, the manufacturers tried everything they could to get around her judgement.
In November 1961, reports began to emerge in Germany and the United Kingdom that mothers who had taken thalidomide during pregnancy were now having babies with severe birth defects. Dr. Helen Taussig learned of the tragedy from one of her students and traveled to Europe to investigate. By testifying before the Senate, Tauusig was able to help Kelsey ban thalidomide in the United States for good. At least 4000 children in Europe were affected by the drug, but thanks to Kelsey's rigorous professionalism a similar tragedy was averted here in America.
On August 7, 1962, President John F. Kennedy awarded Frances Kelsey the highest honor given to a civilian in the United States, the President's Award for Distinguished Federal Civilian Service. She was the second woman to ever receive the award. Kennedy acknowledged "Her exceptional judgment in evaluating a new drug for safety for human use has prevented a major tragedy of birth deformities in the United States. Through high ability and steadfast confidence in her professional decision she has made an outstanding contribution to the protection of the health of the American people."
Kelsey helped shape and enforce amendments to FDA drug regulation laws to institutionalize protection of the patient in drug investigations. These regulations required that drugs be shown to be both safe and effective, that informed consent be obtained from patients when used in clinical trials, and that adverse reactions be reported to the FDA. In 1995, the town of Mill Bay, British Columbia, honored Dr. Kelsey by naming the Frances Kelsey Secondary School for her. In 2000, Kelsey was inducted into the National Women's Hall of Fame, and in 2001, at the age of 87, she became a Virtual Mentor for the American Medical Association.