Old books stacked on a table in the hall, free for the taking; a tell tale sign that someone had recently weeded an office. I can never resist. This time I found an interesting gem-a skinny little 1968 book by a nonnurse person about nursing. It promised to provide a glimpse at how we nurses were/are perceived by others, and also a look-back on where we've been for the last 35 years or so. The author of this gem is Odin W. Anderson, PhD, Professor and Associate Director of the Center for Health Administration Studies, Graduate School of Business, University of Chicago, and the title of his work is Toward an Unambiguous Profession? A Review of Nursing.1 It was the question mark in the title that got me; it left hanging the possibility that, at least in the author's view, nursing might never achieve the status of a well-defined profession making unique contributions to the public good. Suddenly, I needed to know how Dr Anderson had answered the question in his brief 30 pages.

The impetus for the work was a study commissioned by the Illinois Study Commission on Nursing for the purpose of organizing and evaluating data on nurses and nursing in Illinois. Following completion of the aforementioned study, Dr Anderson, according to his note in acknowledgments, decided to compare the state level data with national data and offer some observations and generalizations on his own; hence the book I was now contemplating. I read on, in awe mostly, not at the observations recorded in the book, but at the accuracy of the reflections now advantaged by time. Could today's problems and challenges so easily be foreseen?

The previous owner of the book had neatly underlined in red the passages and phrases that she or he considered important. My eye scanned the underlined words until 3 fundamental facts appeared. First fundamental: Given increased opportunities for employment, especially for women, employers in the health field face labor force recruitment and retention issues. It was an emerging truth in 1968, it is even truer now-good call, Dr Anderson. Only the demand has increased beyond anyone's estimates, and sadly, 35 years of recruitment and retention policies and programs have failed to keep up with demand. Second fundamental: There is a shift in the proportion of patients who suffer from long-term, intractable, and nonlethal illnesses. Right on!! We are a nation primarily dealing with the chronic problems rooted in lifestyle behaviors. Looking back can it be said that far from being trendsetters, our health care system has had difficulty following the trend and shifting the care focus from acute episodic care to prevention and chronic care. A good call not heeded? Third fundamental: There is an attitude in our society toward tasks that are servant nature creating a challenge in distinguishing professional helping service from that normally provided by servants and relatives. Well, Dr Anderson, your observation was right on again. In today's health care, we assume that families can and will become at home caregivers for relatives needing sophisticated care regimes driven by complex and high tech interventions. Thanks for noting some of the roots underpinning our current assumption.

I wondered what this gem of a book had to say about advanced nursing practice that might be relative to today's clinical nurse specialist practice. I was not disappointed. The insightful author noted that all signs seemed to point to increased specialization, increased education, and increased use of technology. He reflected that the nursing profession both historically and structurally has shown much more interest than the medical profession in the psychological and sociological aspects of patients. His comments reflected an understanding that nurses address illness problems- symptoms, functional status, and health risk behaviors. The challenge to nursing, according to Dr Anderson, is to avoid the medical model. Should nursing follow the medical model, he warns, the behavioral aspects of patient care will languish. If the "person-to-person orientation" (his term for describing nursing's focus on and respect for the patient's perspective) emerges as the dominant model, then, he predicts, nursing has a viable model to develop its practice. He carefully notes the tension between the patient orientation and the assistant to the physician orientation will persist as an inherent part of nursing practice. This split perspective, he cautions, is a real challenge to moving toward an unambiguous profession.

So what is the answer to the question, the one in the title of the book-will nursing achieve the status of an unambiguous profession? In the last paragraph Dr Anderson offers his final answer. Noting the controversy in which model to choose, a medical emphasis on "technique" or a nursing model of "tenderness" he states:

Whatever the outcome, "tenderness" and "technique" need to be properly mixed, but, frankly, this writer is not optimistic about a viable emphasis on "tenderness." Our dazzling technological culture continues to show impressive results with technique. As long as this continues, "tenderness" will wait, since its results on patient care cannot be measured clinically.

Oh contraire, Dr Anderson. We are becoming quite sophisticated at measuring the outcomes of nursing care, and so, by your own prediction, we are quite viable. And the message for clinical nurse specialists: Our viability is linked to choosing the nursing model and finding ways to measure and document the outcomes of our practice. Nursing is unambiguous.

References