What do you think about as you move through the day, as you care for patients, teach students, and manage care processes? Do you think about mundane things such as "getting done," the recent upsetting skirmish you had with a staff nurse, or the paper that is due as you pursue your next degree? Or, do you think about what could be different, how you can change health care and make a significant impact for patients, students, or for the nursing professions? Do you have hunches? Are they always on your mind as they were for the following nurses?
Florence Nightingale had a hunch-Simple hygiene in the war wards of the Crimea could dramatically reduce mortality rates among wounded soldiers. She cleaned and dressed wounds, provided fresh bed linens, and kept the wards in good order. Mortality rates went down by more than 80%, which she documented with statistics. She faced a lot of resistance for her efforts, but she persisted and the rest is history.
Lillian Wald had a hunch-Deploying visiting nurses in the tenements of New York in the early 1900s would improve the health of European immigrants pouring into the United States. She enlisted a wealthy business man to fund the beginnings of the Henry Street Settlement, and Visiting Nursing was institutionalized to this day.
Margaret Sanger had a hunch-If women could delay or space pregnancies, if they could "plan their families," fewer would die and more would stay healthy to raise their children. She worked as a visiting nurse and saw suffering and poverty as women had child after child. Having learned from Lillian Wald at the Henry Street Settlement, Sanger developed Planned Parenthood, an organization that has survived to this day.
Hildegard Peplau had a hunch-With proper education nurses could be psychotherapists like physicians or psychologists. She developed one of the first Master's in Psychiatric Nursing programs and engaged in independent practice as a nurse psychotherapist. She was undeterred by threats and litigation from the American Medical Association. She paved the way for the psychiatric nurse practitioner role.
Loretta Ford had a hunch-In collaboration with a physician colleague, she designed a new role, the pediatric nurse practitioner, who could assess, diagnose, and intervene in the delivery of well child care. She was the author of the Nurse Practitioner movement, an innovation that is playing a crucial role in health care reform.
These nurse pioneers and their hunches are but a few among the hundreds of nurses who had startling impact on health care, education, and the nursing profession. What did these nurses have in common?
They were daydreamers-They had hunches about what could be and how it could happen. Their ideas went against the grain and were ahead of the times. Imagine that Nightingale's hunch about cleanliness and hygiene predated the confirmation that germs really existed. Wald took care into peoples' homes, and Sanger followed and improved the health of oppressed women who lived in poverty. Peplau opened her own practice, conducted psychotherapy, and dispelled the image of the nurse as handmaiden. Ford collaborated with a physician colleague to create a role where nurses with graduate school preparation could practice to their full scope in the service of children and families. There are now more than 20 states where nurse practitioners practice at full scope like physicians, psychologists, and physical therapists. These nurses filtered the criticism of their work and ideas. They used criticism to improve but discarded unsubstantiated negativity. They developed thick skin. They were persistent doers. They loved to work, and they would not settle for anything but excellence. They thought about their "hunches" all of the time. They were unconcerned about personal prestige. They cared about spreading the work of improving outcomes, about advancing the profession in the service individuals, families, and communities.
What's your hunch? And, are you thinking about it every day?
-Gloria F. Donnelly, PhD, RN, FAAN
Editor