What can we learn from looking to the past? It seems that all disciplines or professions have experienced growth, change, and development over the years. The profession of nursing is no different. Nursing today is complex, stressful, and, at times, quite difficult. We need to know about many more types of medications than those that were used by Florence Nightingale to care for her patients. We have to deal with such things in practice as ethical dilemmas, moral distress, and compassion fatigue. Our current technology can be complicated and sometimes unpredictable. I would guess that the 1920s was a gentler, simpler period for nursing and that perhaps nursing was easier. Or, was it?
Sometimes by looking to the past, we can better understand our present. Let us look back through a nursing textbook and some related nursing guidelines that were first printed in the 1920s and make a few comparisons.
Let us start with the topic of recruitment and retention-a topic that still plagues the profession of nursing today. According to Lounsbery's1 account of the nursing guidelines of the times:
Your nursing should be an exponent of your spiritual state; an outward and visible sign of an inward and spiritual grace. You bestow the priceless blessing of unwearied, skillful care upon one who should thankfully receive it. If you do not go to your patient with a feeling of thankfulness to God for allowing you to assume such a sacred trust as the care of a human life, you are in no condition to undertake the work.
Nursing, then, is an inner calling with a component of spirituality. However, I would also guess that nurses at that time also entered the profession to earn a wage and to get a position where future work would always be available. Did nurses enter the profession for the same reasons then, as nurses do now in the 21st century? I would argue that although individual reasons for becoming nurses may vary, there are more similarities than differences in motivation, between the 1920s and today.
Lounsbery1 also reports:
Nursing is the noblest profession a woman can follow because it is hard, forgetting self & giving your strength to others... Despite everything, enthusiastically accept the toil as inevitable, & make the higher, nobler aim of nursing so real that the lower consideration of your personal comfort sinks into insignificance.
OK... we might not be able to recruit as many nurses today if we used that quote at the head of recruitment ads. It sounds like, in the early 1900s, the nursing profession would wring every drop of blood, sweat, and tears out of you, leaving nothing but a limp dishrag to be tossed aside when you are no longer needed!
Today, as we hear how the nurse should be an advocate for the patient, we are also hearing that the nurse should take care of himself or herself. The quote above suggests that the well-being of the nurse is lower and less noble than the well-being of the patient. That his/her own moral code, and perhaps not representative of the time.
Today, when you look at ads for recruiting nurses to health care organizations, you usually see terms like "challenge," "put the care in health care," or "helping people is your calling." Nursing is portrayed today as a profession where the nurse can make a difference in people's lives. It is about putting our patients first and that principle is still followed in today's nursing practice.
But let there be no doubt: Nursing required hard, uncompromising dedication then and it still does. That has not changed.
Being a perioperative nurse for almost 30 years myself, I was interested to see how operating room (OR) nursing fared as a specialty profession in the past. Currently, there is a shortage of perioperative nurses, so I thought it would be helpful to look to the past to see how nurses were recruited in the surgical environment.
According to Colp and Keller in their 1928 textbook entitled, Textbook of Surgical Nursing,2 the personal qualification of an operating room nurse included the following:
One must be very strong physically to endure the strain & severity of O.R. work... The work is more intense than in any other type of nursing and a strong body is the only one that will hold out to the bitter end... The nature of the work requires that no time be lost and no mistakes made, and consequently everybody is more or less under nervous tension ... emergencies are always arising, and the nurse who "loses her head" is not popular, to say the least, on an operating room staff. (p. 210)
Do these statements still describe what it is like to work in an operating room environment today? If I were to say "yes," it would be with some qualifications.
First, one sign of a civilization's advancement is the rising importance of rational thought, relative to sheer muscular strength. The perioperative nurse still has to lift and move patients and equipment. There are still risks of physical strain and injury. Perioperative nurses still have to crawl under OR tables and beds to hook things up or plug things in. Is the work still intense? Yes, but here is the telling fact. Decades ago, before all the help technology has given us, the ideal nurse would have been very strong physically, whether male or female. Today? The fact that nurses of all sizes can be every bit as effective tells the story quite well. So do nurses need to be as physically strong as described in the previous quote? No, but it still does not hurt to be physically fit!
Are surgical team members still under nervous tension? Why, yes, they are-at times. Do nurses need to have great strength of character? Yes. That has not changed. When patients are literally being opened up and having their insides manipulated, there is no escaping a certain level of pressure associated with the responsibilities of being part of a surgical team.
Do we still need to get to the "bitter end" of surgery? We might not say it exactly in those words today, but there are some surgical cases where the staff members certainly breathe a collective sigh of relief when it is completed and the patient is being transferred to the postanesthesia care unit. As with anything in nursing and health care, some situations or cases will be more difficult than others, and these principles of patient care still apply today as they did in the early 20th century.
Let me tell you a little something about another type of surgical experience. After waiting (this time, outside the OR!) for over 7 hours while my husband was in surgery, the expressions of the 2 surgeons who came through the OR doors were anything but bitter. They were both smiling! "Bitter?" Anything but!
One last tip from the past to apply to the present according to Lounsbery,1 "A nurse should never grumble about her lot" and "Never go about a sick room with a long face; it is enough for the sick one to have to be sick; you are there to be a help and a comfort, not an added anxiety." These statements imply that in the 1920s nurses were complaining about their work and doing so in front of their patients! That does not happen today, does it? Have you ever heard nurses complaining about their jobs? Have you ever complained? Have you ever heard nurses complain within earshot of their patients?
The more things change-the more they stay the same. But some things do not change-the basic principles. And some things do change-the guidelines, or rules, that help us put those principles into practice. As we look forward, let us remember to learn from where we have been and where we are, so that we can take the best of our profession and continue to apply that knowledge and expertise to shape our future nursing practice.
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