I've written before about the changes in home healthcare since my personal beginnings in the 1970s. How I wish I had kept a journal to record both the extraordinary stories as well as the mundane. Some events are forever etched in the hard drive of my brain, but many, if not most, are lost among the many experiences involved in raising a family, attaining additional degrees, and life in general. So much of healthcare literature is penned by academics, with few recordings from the rank and file. As editor of Home Healthcare Now I added the column A Day in the Life of... with the intention of capturing the stories of everyday clinicians-the ground troops, so to speak.
Some years ago after cleaning out her mother's house, a friend gave me a pile of nursing journals from the 1960s, knowing I enjoyed the historical aspects of nursing. As I paged through the journals, my eyes landed on the letters to the editor page and an idea was born. I phoned a friend, also interested in history of nursing, and we hatched a plan. We would read through 105 years of letters to the editor of the American Journal of Nursing to find out what the rank and file considered important professional issues. This journal was chosen because it is the longest continuously running nursing journal. We decided to randomly select two issues from each year and went to work. My preconceived expectation was that we would see evidence of a maturing profession-from its infancy in 1900 to adulthood. What we found instead was five themes that persisted throughout the entire 105 years!
We found tension among nurses in their opinions of nursing as a calling versus nursing as a paid profession-in other words, self-sacrifice versus self-care. Was nursing a ministry in which the patient's comfort and happiness were all the reward we needed? Or were we trained and educated as professionals who deserved recognition, both monetary and otherwise? Our historical beginnings in the military and religious orders set the stage for the former. Education and complexity in healthcare point to the latter. Disagreement on educational and professional preparation was another theme that began with the trained versus untrained nurse at the turn of the century, progressed to the diploma versus associate degree nurse (ADN) graduate in the 1960s and 1970s, and finally to the baccalaureate of science degree prepared nurse (BSN) versus the ADN nurse, and certified versus noncertified nurse.
We struggled with our image throughout those years as well. To shed the legacy of the pre-Florence Nightingale "nurses" (largely inmates and alcoholics, neglectful and abusive toward their patients) stellar character and appearance were demanded of women entering the newly formed schools of professional nursing. As the years went on, everything from hairstyle to gum chewing, and "Love a Nurse PRN" bumper stickers were fodder for letter writers. The fourth theme was nurse-physician relationships-fragile, contentious, and yet mutually dependent. Because physicians were instrumental in the building of the early schools of nursing and often provided lectures, they viewed nursing as an offspring of medicine-a perpetually childlike and beholding offspring. Nurses struggled for independence, like teenagers escaping from helicopter parents, and continue to carve out their unique role in patient care to this day. The last theme was pride about the unique emphasis on holistic care practiced by nurses-an emphasis on religion, culture, and family (Anthony & Barkell, 2008). The study consumed our lives for more than a year, but what a bird's eye view of the profession we gained!
Speaking of documenting rank and file nursing, I just finished reading another great book by Theresa Brown, RN. She does a fantastic job of documenting everyday nursing on the oncology unit where she works in Pittsburgh, Pennsylvania (Brown, 2015). As a columnist for the New York Times, she is, in my opinion, THE leader in translating and relating what nurses do to the public. We couldn't ask for a better spokesperson-articulate, grounded, and proficient. Her previous degrees (including a PhD) in English, and a professorship at Tufts University made her a great writer but also lend credibility to her writing. Her first book about nursing was titled Critical Care and should be mandatory reading for every nursing student (as well as anyone contemplating nursing as a career) (Brown, 2010).
So, whatever your profession in home care-physical, occupational, or speech therapy, social work, minister, home healthcare aid-document what you do. Write for our Commentary or Day in the Life of... column. Keep a journal. Write letters to the editor. No one will know of your unique contributions unless you write about them.
Best wishes,
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