Lesson 1, Topic 1
In Progress

Significant Changes in Nursing during the Twentieth Century

May 11, 2021

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Significant Changes in Nursing for the Twenty-First Century

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Nursing practice is affected by various societal factors, along with developments that are more internal to the field. Demographics of the population, women’s health care issues, men in nursing, rising numbers of persons with fewer socioeconomic advantages seeking health care, and bioterrorism threats are a few of the societal factors that influence nursing today.
Demographic Changes

Because the demographics of the population are changing, nursing education and practice must also change and adapt. Life expectancy of the population as a

FIGURE 1-6 A, Nursing uniforms in the early years. B, Nursing uniforms today.

(A, Copyright the Royal Columbian Hospital, New Westminster, B.C. B, from Sorrentino SA, Remmert LN: Mosby’s textbook for nursing assistants, ed 8, St. Louis, 2012, Mosby.)
whole is rising, and increasing numbers of older adults are seeking health care for chronic illnesses.
Women’s Health Care Issues

The unique health care needs of women are recognized. Research studies specific to these needs have increased, in part as a result of federal mandates that require inclusion of women in studies. Areas of interest for women’s health include reproductive health, heart disease, and cancer (Agency for Healthcare Research and Quality, 2011).
Nursing is responding in two ways to women’s health care issues and the women’s movement. Nurses, most of whom are women, are increasingly asserting their equal rights as humans, employees, and health care professionals. Encouraged by the women’s movement, they have sought greater autonomy and responsibility in providing care. In addition, the women’s movement has helped women to become more aware of their own unique needs. Nurses have learned to encourage female patients to seek more responsibility for and control over their bodies, health, and lives in general.
Men in Nursing

The number of men in the nursing profession has increased. Currently, fewer than 15% of nursing program graduates are male. Less still is the percentage of men who are actively licensed and working. Men have had a role in nursing throughout its history, but the influences of war promoted the profession for women. Gender discrimination and stereotypes have further restricted the roles of men in nursing. Management, emergency departments, and surgical settings are common areas of practice for male nurses (American Society of Registered Nurses, 2008).
Human Rights

Nursing advocates for the rights of all individuals. Beyond this basic requirement, the profession has promoted the rights of specific segments of the population through the creation of bills of rights. Such bills address the rights of hospitalized patients, those who are dying, older adults, and pregnant women. These bills of rights speak to the need to respect all patients as unique individuals and ensure quality care for all.
Medically Underserved

Soaring rates of unemployment, homelessness, undocumented workers, and poverty, combined with the enormous rise in health care costs, have led to an increased number of individuals in the United States who are unable to afford health care. These groups when combined represent a sizable population of those who are potentially unable to obtain health insurance or pay outright for health care (Baker, 2012). The Department of Homeland Security estimated in 2010 that approximately 10.2 million illegal immigrants were in the United States.
Presently, health care costs account for nearly 18% of the nation’s gross domestic product. In 2009, nearly 1 in 5 Americans was without health insurance (Kaiser Health News, 2010). Limited access to health care is another concern that hinders individuals with mental health disorders and those who live in rural areas. Initiatives to provide increased services in rural and community-based clinics offer assistance to these populations. Nursing engagement in health promotion activities to both prevent and manage illness and chronic conditions is one such solution.
Frequently, nurses who work in these settings have a higher degree of training and function as advanced practice nurses, so they have the capability to provide direct health care. This area of nursing is rapidly expanding as more nurses seek to work with this underserved population.
Nursing Shortage

The United States continues to face a nursing shortage. The nation is expected to need an increase of more than 700,000 nurses by 2020, which is a 26% increase (Bureau of Labor Statistics, 2012). Despite strategies to reduce the shortfall of nurses, the supply is not expected to meet the growing demand. The nursing workforce is aging; the average age of nurses is 42.6 years. In the coming decade, many nurses who are currently working are expected to retire.
Nursing, once considered a prime career choice for women, now faces competition as women look at other promising career options (American Association of Colleges of Nursing, 2012). Schools of nursing also are facing a shortage of qualified educators, which further hinders growth of the profession.

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