The Year of the Nurse & Midwife, 2020

THE YEAR OF THE NURSE & MIDWIFE 2020

A YEAR OF TRIBUTE

Celebrating the nurses of the past; inspiring the next generation of nurses for the future.

THE YEAR OF THE

NURSE & MIDWIFE 2020

Edited by Robert McCall

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Be the future of nursing

A career in nursing is a rewarding and vital role

Training as a nurse gives you the skills and competencies to engage in care that ranges from complex decision making to meeting smaller care needs of patients.

Nursing care helps save lives every day.

Being a nurse is a diverse job, with specialties including adult, children’s, mental health or learning disability nursing.

Plus opportunities to work in a variety of environments from hospitals, community settings, clinics and the military. @thercn @theRCN royalcollegeofnursing

The Royal College of Nursing supports over 450,000 nursing students, nurses and nursing support workers with benefits such as: Learning resources 24/7 access to Europe’s largest nursing library and e-library, with a dedicated team of experts to help with your enquiries.

Guidance and support From networking events to online forums, we’ve got resources for you at every stage of your career.

Careers advice Developed in collaboration with Health Education England, we offer tailored information for nurses to plan their career paths.

Placement support The tools you need to help you get the best from your nursing placement.

Visit rcn.org.uk/become-a-nurse to find out more about a career in nursing

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Nurses make up a large portion of the health care workforce and collectively they use their voice, skills and experience to make a positive impact to the profession.

THE YEAR OF THE NURSE & MIDWIFE 2020

THE YEAR OF THE

NURSE &MIDWIFE 2020

A YEAR OF TRIBUTE Celebrating the nurses of the past; inspiring the next generation of nurses for the future.

CONTENTS Published by West Argyll Technical Publications Ltd

Introducing the Year of the Nurse & Midwife

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Nursing in the First World War

22

How to Become a Nurse

6

Modern Nursing Timeline 28

MANAGING EDITOR Robert McCall DIRECTOR Lynsey Moore DESIGNER Megan Raine ADVERTISING SALES Libby Galbraith, Phil Campbell, John Huss

HEIW Wales

The views contained within are not necessarily those of the publishers, nor of any of the contributors. No element of the content is to be founded upon or reproduced except with the express permission of the publishers. The title and the content in its entirety are the intellectual property of West Argyll Technical Publications Ltd., Registered office: 142 Cromwell Road, London SW7 4EF.

How Nursing has Evolved 14

A History of Nursing

12

Nursing Worldwide

34

A Unique Glasgow Perspective

38

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THE YEAR OF THE NURSE & MIDWIFE 2020

AN INTRODUCTION When 2020 was designated to be the Year of the Nurse & Midwife, no one could possibly have envisaged what kind of a year lay ahead, both for the nursing profession itself, and indeed for the planet as a whole.

What was clearly intended to be a celebration of the devotion and professionalism of nurses and midwives, has now taken place against a tragic and all too poignant backdrop, illustrating those qualities in the starkest possible terms.

In deciding whether it was appropriate that this long-scheduled publication should still go ahead, there were obviously a number of issues which we had to consider. The other more-pressing commitments of those involved; the practicalities of publishing and distributing in the midst of lockdown; and the views of nurses themselves.

However, the over-riding considerations were the same as those which had inspired the original concept of the Year of the Nurse & Midwife. To pay tribute to their dedication and hard work; and to attract young people into the profession for the future. If anything, these considerations have become even more poignant and vital than ever before.

Inevitably, events have taken their toll on many aspects of this publication.

Many of the intended principal contributors, at the WHO, PHE, DHSC and elsewhere, have other matters to occupy their time, and have not been included in the way we had hoped. However, in apologising for that, we feel that the essence of our tribute to the nurses and midwives of the world remains a fulsome and genuine one.

Belatedly, we hope that you all will agree.

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THE YEAR OF THE NURSE & MIDWIFE 2020

HOW TO BECOME A

NURSE

Did you know nursing is the UK’s most employable type of degree, with 94% of students getting a job within six months of finishing their course?

You can also receive up to £8,000 in financial support every year of your degree.

Most people qualify by studying a degree in nursing. Nursing degrees aren’t all about having your nose in a book. There is lots of practical hands on experience with patients in hospital and community settings.

The first thing to decide is which field of nursing you want to study in, so as a first step you should find out more about the options. In all of these fields you’ll have the opportunity to make a real difference to the lives of people each and every day. The four fields of nursing are: adult nursing; children’s nursing; learning disability nursing;and mental health nursing.

There are some degree courses that allow you to study in two of the fields.

These are known as ‘dual field’ degrees. Once you have qualified you’ll be able to work as a nurse anywhere in the UK and even internationally.

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THE YEAR OF THE NURSE & MIDWIFE 2020

ENTRY REQUIREMENTS

WHILE AT UNIVERSITY

Entry requirements for nursing degree courses vary because each university sets its own entry criteria, but you are likely to need at least two (usually three) A-levels or equivalent qualifications at level 3, plus supporting GCSEs including English, maths and a science (usually biology or human biology).

Contact universities directly to find out whether qualifications equivalent to A-levels or GCSEs are acceptable.

Between £5,000 - £8,000 will be available from September 2020 to help undergraduate and postgraduate student nurses fund their studies. Best of all, they won’t need to be repaid. Find out more about with these annual payments and the other financial support available.

Courses often specify preferred or essential A-level or equivalent subjects, such as one science (for example biology) or social science (for example psychology). Some universities offer courses with a foundation year for those without the necessary entry qualifications.

Applications for full-time nursing courses are made through UCAS. For part-time courses, contact individual universities to find out their application procedures.

Which? University has some good tips on writing personal statements.

WHERE TO STUDY

OTHER WAYS TO BECOME

NURSING

A NURSE:

Many universities offer degrees in nursing. You can find a list of courses by using our Course Finder.

Nursing degree apprenticeships The standards for nursing degree apprenticeships have been approved and a small number of NHS organisations have started to advertise vacancies. Nursing degree apprenticeships offer flexible routes to becoming a nurse that don’t require fulltime study at university, although nursing degree apprentices will still need to undertake academic study at degree level and meet the standards laid down by the NMC.

If you already have a degree in a relevant subject, you can often get recognition for this (a process called Accreditation of Prior Experiential Learning - APEL), enabling you to do the course in two rather than three years. You can also find these courses using our Course Finder.

“ Studying a nursing degree allows me to work wherever I want” Cherie Lawrence, Mental health nurse

FINANCIAL SUPPORT

HOW TO APPLY

You will need to secure a position as a nursing degree apprentice and your employer will then release you to study at university on a part-time basis. You will train in a range of practice placement settings.

nursing degree apprenticeship may take you less than four years to complete.

In terms of entry requirements for nursing degree apprenticeships, you will typically need level 3 qualifications as you will be studying to degree level. Those completing a nursing associate apprenticeship will be able to count this training towards the degree-level apprenticeship, and so reduce the length of the apprenticeship. .Vacancies for nursing degree apprenticeships are advertised on the NHS Jobs website and the Government Find an apprenticeship website Read the nursing degree apprenticeship factsheet on the Gov.uk website Nursing associate The role of nursing associate sits alongside existing nursing care support workers and fullyqualified registered nurses in both health and social care.

It opens up a career in nursing to people from all backgrounds and offers the opportunity to progress to training to become a registered nurse. Trainee roles are often available in a variety of health and care settings. This means that nursing associates have wider opportunities and more flexibility to move between acute, social and community and primary care.

A nursing associate is not a registered nurse, but with further training, it can be possible to ‘top up’ your training to become one.

Most nursing degree apprenticeships will take four years. If you already have prior learning and experience, you may get some recognition of this through APEL and so the

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THE YEAR OF THE NURSE & MIDWIFE 2020

SCHOOL OF HEALTH & SOCIAL CARE

Become a graduate nurse of the future Our range of nursing degrees & apprenticeship programmes provide you with the experience and opportunities to become a successful nurse in the 21st century.

Leading the way

Our innovative courses provide the most up-to-date approach and skills required to meet the mental and physical health care needs of the nation. We help develop the leader in you so that you can build effective teams, set patient agendas and influence change.

“We’re trying to create a modern approach to treating mental health issues – seeing patients as people” Eze, BSc (Hons) Nursing (Mental Health)

• BSc (Hons) Nursing (Adult) • BSc (Hons) Nursing (Mental Health) • BSc (Hons) Nursing (Learning Disabilities)*

Culture of care

Nursing is an exciting and rewarding profession which requires you to take care of yourself to enable you to care for others. We will support you to consider and maintain your own personal wellbeing so you’ll be more resilient and efficient when caring for others.

• Nursing Associate Higher Apprenticeship*

“We are excited about developing future nurses who can take care of their own mental health first, empowering them to compassionately care for others.”

Melsina, Senior Lecturer in Nursing (Mental Health)

Find out more

glos.ac.uk/nursing 8

THE YEAR OF THE NURSE & MIDWIFE 2020

“Nursing has been a lifelong ambition of mine.

When I had my interview at the University of Gloucestershire I knew that was where I wanted to go - the lecturers and tutors were so passionate.”

Leonora, BSc (Hons) Nursing (Adult)

Outstanding facilities

We bring learning to life in our simulated clinical suite, allowing you to develop and practice your skills in an authentic environment. Simulation allows scenarios to be set up such as court rooms, houses and hospital wards, offering students a safe place to practice their approach to challenging situations.

Career ready

Gain real life experience on placements in a variety of healthcare settings.

You’ll deliver person-centred care, working with people with mental and physical healthcare needs, and learning disabilities. From day 1 you’ll begin to see yourself as a leader, driving your own development with the support of a coach and supervisor.

Connected

In conjunction with our partners** we will help you develop the skills and adaptability you need to deliver high quality patient care, while also promoting positive values and visions ensuring everyone has greater control of their health and wellbeing.

*This course is subject to validation. **Courses developed in partnership with Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Care Services, 2Gether NHS Foundation Trust, Gloucestershire Clinical Commissioning Group and Healthwatch.

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www.worklife.salisbury.nhs.uk @SDHRecruitment SalisburyDistrictHospital Salisbury NHS Foundation Trust

Salisbury NHS Foundation Trust is looking to recruit motivated and enthusiastic Nurses and Midwives to be a part of our ambitious plans to make our hospital even better.

The development of our staff is central to the delivery of high quality, safe and effective care and, so you’ll be offered opportunities for ongoing development to help realise your professional and personal ambitions.

For newly qualified nurses we offer a preceptorship programme, to support your transition and develop your knowledge and skills further to build your confidence as an autonomous professional. If you are relocating to Salisbury, we’ll provide some relocation assistance to help with your move (terms and conditions apply).

Voted by the Sunday Times as the best place to live in Britain, Salisbury is an attractive place to live and work and really gives you the best of everything. With easy access to London and local airports, Salisbury also has one of the 31 UNESCO world heritage sites in the UK in the form of Stonehenge and in addition boasts a number of museums and famous landmarks which are well worth a visit. Southampton and Bournemouth are also within easy reach.

We welcome applications from individuals who would like to work part time.

For further information or to apply go to job.salisbury.nhs.uk or email: sft.recruitment@nhs.net

Reach your potential in hospitals that make history We’re committed to supporting you to develop a rewarding career, where you’ll establish the strong clinical foundation you need to progress.

As a newly qualified nurse or midwife, you can: • Benefit from our 12-month preceptorship programme, designed to support you to move from student to confident, competent and qualified practitioner – giving you the best start in your career.

• Sample different environments and specialities and attend in-house training courses, annual nursing conferences, career clinics and study days.

Opportunities across all our 50 specialities include outstanding development pathways, mentoring by senior nurses and great team working in a supportive environment.

To find out more visit: Imperial.nhs.uk/careers

HANNAH, STAFF NURSE

TRAINING TO GROW IN LEADERSHIP ROLE DELIVERING INNOVATIVE PATIENT CARE FULL OF OPPORTUNITY

WE ARE CHOOSE TO STUDY NURSING IN PLYMOUTH, EXETER OR TRURO

APPLY NOW

THE YEAR OF THE NURSE & MIDWIFE 2020

SHAPING THE FUTURE OF THE PROFESSION

By training in Wales, you can unlock many exciting career opportunities with support from experienced nurses and clinicians at every stage of your development.

By practising in Wales you can take advantage of our excellent education and training facilities.

@AaGIC_GIG / @HEIW_NHS @HEIW_NHS

aagic.gig.cymru / heiw.nhs.wales

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THE YEAR OF THE NURSE & MIDWIFE 2020

A LIFETIME OF LEARNING OPPORTUNITIES The NHS in Wales is committed to providing you with lifelong learning opportunities. This means we’ll support your continued professional development across a wide range of routes, which cover everything from workplace-based training to specialist post registration courses. Wales is a place where the learning never stops, where skills and knowledge are shared openly, innovation is embraced and your contribution is valued.

Newly qualified midwives can benefit from our all Wales preceptorship programme. This helps you to consolidate your experience in all areas of practice. Midwives are supported throughout their career by the clinical supervisor for midwives framework. This provides all midwives with a named supervisor, group supervision and one to one support for reflection opportunities and joint learning.

NHS WALES BURSARY

like to start your nursing career in - with specialist tertiary services such as burns, and cardiac surgery, to skilled community teams or in a GP practice.

Or as a newly qualified midwife in Wales, you can work across the full spectrum of birth environments - everything from specialist fetal medicine services to stand alone birth centres and integrated services – giving you both community and hospital based experience.

We embrace diversity, so wherever you study you’ll discover a learning environment that’s vibrant, friendly and inclusive.

GRADUATE TRAINING YOU CAN COUNT ON Wales was the first UK country to educate all its nurses and midwives to graduate level. So nowhere takes your professional development as seriously as us. Our high quality training is recognised around the world.

EXCELLENT EDUCATION AND TRAINING FACILITIES You’ll have access to a range of excellent conference and library facilities managed by a dedicated team of experienced staff.

ADVANCE YOUR CAREER WITH LEADING-EDGE RESEARCH We fund the Research Capacity Building Collaboration (RCBC), to develop research capacity within the nursing and allied health professional workforce.

The initiative provides new and experienced researchers in nursing and midwifery, the opportunity to obtain funding for research projects designed to shape the future of the profession.

SCHEME A CLEAR ROUTE TO In Wales, we have maintained the NHS bursary for student nurses and allied health professionals. This package of support sends a clear message about much we value our healthcare workforce in Wales.

HIGHER EDUCATION THAT

ADVANCED PRACTICE Wales has a career framework, to provide you with a clear route to the post-graduate qualifications needed to become an advanced nurse practitioner.

TICKS ALL THE BOXES

The framework is based around four core areas:

There are several higher education institutions in Wales approved to provide pre and post registration training. By choosing to train in Wales, you can access every field of nursing and midwifery – the choices are truly inspirational.

1.

2.

3.

4.

As a newly qualified nurse you can choose the clinical setting you would

Clinical Practice Education Leadership & Management Research & Innovation

We are also working with the Royal College of Midwives supporting an annual leadership programme, so you can develop your leadership skills and put them into practice.

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THE YEAR OF THE NURSE & MIDWIFE 2020

HOW NURSING HAS EVOLVED? Nursing is one of the very few professions that has remained consistently at the heart of society since its inception. Whilst the ages of industrialisation and computerisation have transformed – and indeed, removed – various vocations, the history of nursing has seen nurses become only more vital in the fabric of a fully-functioning human civilisation. This makes the history of nursing a fascinating topic to study.

THE ORIGINS OF NURSING Nursing has always been at the centre of humanity, with people tending to others and caring for the sick and vulnerable.

However, it wasn’t until the height of the Roman Empire – around 300 A.D. when it was officially recognised as a profession.

During this period, imperial forces decided to establish a hospital within every town under its rule, and hired nurses in each of these institutions to support doctors.

This developed throughout the Byzantine era, and nurses became known as ‘hypourgoi’. The hospitals carried out a number of roles, including housing lepers, refugees and injured citizens. Due to the huge demand for services and lack of stratified hierarchies, nurses’ roles were complex, involving a wide range of responsibilities.

500-600 CE: NURSING AND THE CHURCH Beginning around 500 to 600 CE, medical care in Europe came under the dominion of the Catholic church. Hospitals were instructed to care for the sick, regardless of their nation of origin or religious affinity. This was successful for a few hundred years before the institutions began to decay around 800. In Spain, Emperor Charlemagne decided to restore the hospitals with the latest medical equipment and ordered that each cathedral and monastery in Europe should contain 14

a hospital. This significantly increased the number of nurses across the continent.

This continued throughout the 10th and 11th centuries, with nurses providing patients with any form of care they required or requested – even if it was not necessarily within the bounds of medical services. The model spread throughout Europe and came to be seen as a standard to which nurses should treat their patients. It also became customary during this time for nurses to travel to neighbouring towns to make house calls, in a similar way to how community nurses do today.

MID-1000S: NURSING AS PUBLIC SERVICE The mid-1000’s saw a rise in what were known as ‘charitable houses’. These institutions differed significantly from church and monastery hospitals, largely because they served wealthy patients. The richest of the parents were provided with alms and other medicines, which were used in burial preparations, and became highly sought after. This effectively introduced a new era of nursing.

1800S-1900S: FLORENCE NIGHTINGALE The 1800s saw the age of one of the most influential figures in modern nursing: Florence Nightingale. As most nurses will know, Florence Nightingale began her career as a nurse in the Crimean

war, treating soldiers in battle during the 1850s. At this time, nursing was becoming increasingly vital due to the need for treatment for soldiers on the front line.

Then, deaths from injuries gained in warfare were rife because of the low hygiene standards that caused infections.

Realising this to be the case, Nightingale requested aid from the British government to create better hygiene standards in the battlefield and the hospital, causing deaths from infections to plummet rapidly. The entirety of Nightingale’s impactful career was spent campaigning for sanitary patient conditions – principles which heavily inform the foundations of modern nursing.

In 1860, Nightingale solidified her legacy by opening the first ever nursing school in London – the Florence Nightingale School for Nurses. For the first time, nurses were able to be trained in standardised care procedures, beginning the process of regulating healthcare around the world.

THE YEAR OF THE NURSE & MIDWIFE 2020

This pattern was mirrored in the U.S., where the government invested millions of dollars in the healthcare industry.

LATE 20TH CENTURY: EXPANDING ROLES FOR NURSES WWI AND THE NURSING BOOM 1887 saw the foundation of the British Nurses Association, a union of nurses who sought professional registration. This started a movement in making the nursing profession more officially recognised and regulated. In 1908, the first National Council of Trained Nurses of Great Britain and Ireland was held in London.

The demand for nurses rose yet again during the First World War. At the time it began, the number of nurses in the UK was low, with an estimated 2,200 members enrolled in Queen Alexandra’s Nursing Service.

The huge need for medical care created a resurgence in nursing in the mid-1900s, increasing enrolment to well over 10,000 by the conclusion of the war. Later, in 1916, the Royal College of Nursing was founded with an initial 34 members. In 1919, the Nurses’ Act created the first official register through the General Nursing Council.

In the late 20th century, a growing number of schools began to offer nurse training courses, allowing individuals to qualify as licensed and registered nurses or progress to Masters and Doctorate nursing degrees from 1950 to 1970. The technological age served as a catalyst for this process, with significant developments in research and capability expanding the role of nurses.

This period was also important for opening up the sector to more demographics, with male nurses being allowed to join the professional register in 1951.

The healthcare industry was changed forever in 1948, when the National Health Service was founded, offering free treatment for all patients in the UK at the point of care.

In 1972, the Briggs Committee suggested that all nurses should be prepared through degree study with research-based practice, forging the path for modern nursing education. This era also saw the American Nurses’ Association publishing the first ever American Journal of Nursing, enabling

nurses and other healthcare professionals to stay on the pulse with the latest research in the field. Today, this sector has expanded and diversified, with thousands of nurses checking nursing blogs regularly for the latest news.

In the 20th century, nurse jobs expanded.

Various areas were introduced which nurses could specialise in, including paediatrics, mental health nursing and surgical nursing.

Nurses also became more independent, so that, rather than merely assisting doctors, they became able to diagnose, treat and, in 2002, prescribe to patients themselves.

In 2004, the Royal College of Nurses voted for degree-only preparation for nurses, and in 2009, all nurses in the UK became degree level certified.

Much has changed over the history of nursing, but one thing has remained certain: this challenging yet rewarding career is one of the most important in the world.

To find out more about the history of nursing, check out the RCN’s History of Nursing guide. Or, to keep up-to-date with the latest developments in the sector, and to continue to make nursing history, download the Nursco App or contact us on 020 3954 1917.

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THE YEAR OF THE NURSE & MIDWIFE 2020

THE HISTORY OF

NURSING

Key Dates in Focus

1853 August 22, 1853: Florence

Nightingale takes the position of superintendent at the Institute for the care of sick Gentlewomen in Upper Harley Street, L o n d o n . A g a i n st h e r family’s desires of her to become an obedient wife, she chose a degree in nursing. At the time, nursing had a reputation to be a career for poor women, but Florence felt called into the work.

The aid secretary at war, Sidney Herbert, helped her receive the position.

Source: Florence Nightingale

museum

1855

1865

January 31, 1855: Mary

1865: Agnes Jones of Fahan, Ireland became the first trained Nursing Superintendent of Liverpool Workhouse Infirmary in England. She trained in the Nightingale School at St Thomas Hospital in London. She was asked by William Rathbone to take the leadership of bringing trained nurses to care for the sick in Liverpool. She died of typhus fever at the age of 35.

Seacole leaves London to establish a “British Hotel” at Balaklava, Turkey in the Crimea. The hotel was to provide food and comfortable q u a r t e r s fo r s i c k a n d recovering officers. She was rejected from travelling there by the British Military, but instead of giving up she went there on her own accord. During the war she became known as ‘Mother Seacole’. She was awarded several medals for bravery after the war.

Source: BBC and Mary Seacole website

1859 1859: William Rathbone, merchant and philanthropist in Liverpool, set up the first ever district nursing service.

Initially with only one nurse, he asked Florence Nightingale’s advice on how to expand. At her suggestion, Rathbone persuaded the Infirmary to open a nurse training school, to train both hospital and district nurses. This was established in 1862 and was only the second Nightingale nurse training school, after London.

Source: The Royal Liverpool and Broadgreen University Hospital trust website

1859: Mary Robinson became the first paid nurse in the country to attend the poor.

She was employed by William Rathbone, merchant and philanthropist in Liverpool, to take care of his dying wife, Lucretia. After his wife died, he campaigned for a system of district nurses to allow the poor to have similar care.

He established the Liverpool Training School and Home for Nurses in 1862.

Source: University of Liverpool Special Collections

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Source: Mersey Gateway website

THE YEAR OF THE NURSE & MIDWIFE 2020

Image Source: Wellcome Images

1880 July 1880 Eva Luckes is appointed Matron of the London Hospital at the age of 26. She has only four years of experience as a nurse and the London Hospital is the largest at this time. The hospital, situated in Whitechapel, was the only general hospital serving the east end of London. The hospital has 600 beds and a nursing staff of 128. Ms Luckes addressed the hospital’s inadequate nursing staff in quantity and quality. She developed a new type of training with two years practical and theoretical training with time spent in the wards that did away with three years of work in wards without any instruction or supervision.

1881

1907

May 14, 1881: Mary Seacole dies at the age of 76. Her reputation rivalled that of Florence Nightingale as she is most known for helping wounded soldiers in the Crimea war. Her bravery during the war won her several medals. She had made her own way to the war in order to help British soldiers whom she called “my sons.”

She is buried in St. Mary’s Catholic Cemetery, Kensal Green in North-west London.

May 12, 1907: Florence Nightingale is awarded an Order of Merit. The Order of Merit is a special honour awarded to individuals with high achievements in art, learning, literature and science. King Edward VII founded the order in 1902. It is the sole gift of the Sovereign.

Ms Nightingale was the first woman to receive the merit.

She was recognized for her nursing work as well as her abilities in statistics.

Source: Mary Seacole website

"Foreign Delegates and Organizations". The American Journal of Nursing 1 (12): 861.

1887 December 20, 1887: Ethel Fenwick holds a meeting in her home that will later be known as the British Nurses’ association (BNA). The aim was to uphold the standards of the profession and form an association of nurses.

H.R.H. Princess Christian was approached and agreed to become its First President.

A charter was granted in 1893 and it became known as the Royal British Nurses’ Association.

Source: The Offical Website of the British Monarchy

Source: Royal British Nurses’ Association

Source: Docstoc

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1908

1910

1937

May 1, 1908: The first meeting of the National Council of Trained Nurses of Great Britain and Ireland was held in London. The council was made up of various nurses’ leagues and societies of the day including The Matron’s Council of Great Britain and Ireland, The Registered Nurses’ Society and the Society for State Registration.

Mrs. Bedford-Fenwick was the first president of the council.

The council adopted the British Journal of Nursing as its official journal.

August 13, 1910: At the age of 90, Florence Nightingale d i e s i n h e r s le e p . A s a m u c h re s p e c te d n u rs e , Florence helped change the world of nursing as she made hospitals clean and efficient and made nursing a respected profession. She was nicknamed “The Lady with the Lamp” since she often made nightly rounds during the Crimean War. She was a health reformer, campaigner and nurse. Her writings are still used today as a resource for nurses.

Source: American Journal of Nursing

Source: Florence Nightingale museum

February 15, 1937: Miss Dorothy Lane suggested that a Nurses League should be formed. The inaugural meeting of the League took place February 15, 1937.

Miss Tisdale was appointed as President and Miss Lane became chairman of the committee. The League would: 1. Form a social and professional bond of union between past and present members of staff. 2. Maintain h o s p i ta l i d e a l s o f wo r k and conduct. 3. Endeavour to promote professional interests. The first meeting was held on October 2, 1937.

1915 August 3, 1915: Edith Cavell is arrested in Brussels for harbouring French and British soldiers during World War I. She was recruited in 1907 to bring Nightingale-style nurse training to Belgium, and remained there when the war broke out. She was working to bring healthier and cleaner care to the area when the war started. It is estimated that she helped 200 men escape from behind German lines throughout the year. She willingly admitted what she had done to her captors.

October 12, 1915: Edith Cavell, a British nurse and humanitarian, is executed in Belgium by a German firing squad for helping hundreds of Allied soldiers escape to the Netherlands during World War I. She was sentenced to death after being found guilty of treason. The night before her execution, she spoke the famous words, “I realise that patriotism is not enough, I must have no hatred or bitterness towards anyone.”

Cavell wanted to be known as “a nurse who tried to do her duty.”

Source: Edith Cavell Trust

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Source: Nurses’ League

THE YEAR OF THE NURSE & MIDWIFE 2020

1947

1979

2004

13 March, 1947: Ethel Fenwick dies at the age of 90. She worked to promote higher standards of professionalism and status within nursing.

Ms Fenwick founded the International Council of Nurses and was a leader in the campaign for state registration of nurses in Britain. She trained as a nurse at Nottingham Children’s Hospital and at the age of 24, she was Matron of St Bartholomew’s Hospital.

She campaigned for nursing rights. She founded the British Journal of Nursing in 1893 and remained its editor until 1946.

1979: Nurse Catherine Hall becomes the first nurse to be invited to sit on the General Medical Council, the doctors’ regulatory body.

October 5, 2004: Nurse educationalist Nancy Roper dies in Edinburgh. Ms Roper developed the activities of daily living theory. It influenced every generation of nurses since its publication in 1976, not just here in the UK but in Europe and the US too. She reminded nurses to look at the whole patient and taught them to look beyond the obvious, such as eating and drinking, to aspects such as sexuality, and death and dying. She received neither a state honour nor an RCN fellowship.

Source: Nurses’ Info

Image source: Wellcome Images

Image source: The Southern Daily Echo Archives

1972 1972: Briggs Report. “Professor Asa Briggs, who was asked to review the education and training required by nurses and midwives, said nurse training was inadequate and basic nursing could only be learnt properly in a clinical setting. He proposed a twotier training course leading to two grades of nurse, a large expansion of training and teaching, and a new statutory body to take control of the nursing, midwifery and health visiting professions – the first step towards creating a new regulator for nurses (the UKCC) in later years.”

The report recommended a number of changes to professional education. This report was the basis of the Nurses, Midwives and Health Visitors Act 1979.

Source: Nursing Times

Source: Nursing Times

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With an ever-ageing population, there has never been a better time to consider nursing as your vocation, first job, or even career!

With breakthroughs in scientific discovery, many of the non-communicable diseases responsible for the early death of mankind have been bought under control – leaving a much larger proportion of the world older than ever before. This has meant an increased demand for all manner of nurses to assist in care of the elderly, alongside increased healthcare needs for individuals across their lifespan. Those unfamiliar to nursing may be unaware of the scale and depth good nursing practice makes to private and public healthcare services, taking strain off doctors and clinicians who may be under pressure to attend to urgent cases. But nursing isn’t all about the convenience and good running of services – there is also an incredible opportunity to look after those in a time of vulnerability and to show compassion to patients on a day to day basis.

Over the last two decades at Sterling Cross, we’ve seen a vast increase in the number of different niche and specialist nursing opportunities arising in reaction to a dynamic healthcare industry. Gone are the days where a nurse had to ‘know it all’ – specialist vacancies and areas of personal interest now mean there’s never been a better time to fill a role and work directly in the aspect of healthcare you are so passionate about. From mental health nurses, paediatric nurses, geriatric specialists, general staff nurses and even more complex roles like becoming an autonomous nurse practitioner, there has truly never been a better time to get involved and care for patients in your niche.

In a changeable time for the nursing industry, there has been a steady decline in the number of new students opting to take up the nursing vocation.

However, the government recently reintroduced nursing bursaries for new students to provide much needed financial support to those on placement and undertaking study and research. Coupled with guaranteed funding from central government for the NHS over the next ten years, those currently qualifying wishing to develop further in a special sector of nursing may be pleasantly surprised to find very competitive salaries and the opportunities for weekend, bank and part time roles. In 2020, the World Health Organization acknowledges 200 years of nursing practice, and there’s no time like the present to ride the wave of new investment, support and qualifications available to further your career in a patient serving role vital to empowering patients.

“ The Sterling Cross process was so easy. I was daunted as an undergraduate with finding my first career in nursing, but I registered my CV and experience with one of Sterling Cross’ recruitment consultants, Kate. Kate took into account my personal circumstances, experience and interest and quickly found a couple of dream vacancies in my area. Sterling Cross match nurses to potential employers to ensure a great fit all round. I love my new role and the people I work with, and I was even able to sign up bank vacancies which I’m notified of. Kate and the team made jumping into a nursing career so much easier and they perform with expertise, passion and interest. If you’re a new grad – DON’T GO ANYWHERE ELSE!” – Jenny, Staff Nurse

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THE YEAR OF THE NURSE & MIDWIFE 2020

NURSING IN THE

FIRST WORLD WAR

BY SEETA BHARDWA The war to end all wars cost millions of life, changed society forever and highlighted the contribution of an entire generation of heroes and heroines. Among those were the nurses who provided vital care and services to treat the soldiers who fought so bravely. Politicians and the public took notice of the contribution that nurses made during the war and this contributed to nursing becoming a regulated profession.

At the start of the war, nursing was unregulated meaning that anybody could call themselves a nurse, and many women offered their services. This changed in 1919.

Women, who had no vote at the time, were initally not allowed on the frontline.

However, this slowly changed as doctors realised that nurses were key to coping with the volume of soldiers with complex care. Year by year their roles developed and they worked in many different scenarios from base hospitals to casualty clearing stations, hospital trains, barges and hospital ships and across all the different war fronts including the Western front, the Eastern front and the Western Mediterranean.

Christine Hallett is Chair of the UK Centre for the History of Nursing and Professor of Nursing History at the University of Huddersfield. She believes that since the War, the role of nurses has been romanticised in popular literature and film.

This in turn has led to people forgetting the vast majority of the important clinical work that nurses carried out, she says, outlining the subject of her book about the role of nurses in the First World War. It is now easy to forget the life for women in Britain was very different back then. Aside from not being able to vote, women’s lives were centred around the home. Few had jobs outside of home life and those that did were usually in domestic service.

RECRUITING NURSES In the beginning recruitment was not difficult for both nurses and Voluntary Aid Detachments (VADs). VADs provided nursing assistance, including comforting patients, providing meals to soldiers, driving ambulances, and administrative

duties. The VAD organisation had been running since 1909 so there were many volunteer nurses already available.

‘Women were keen play their part in the war effort,’ says Ms Hallett.

‘Although they didn’t rush forward with enthusiasm they did see that they ought to be involved and saw it as their duty.’

At the very start of the war the British Medical Military services were reluctant to take female nurses on because they didn’t believe they would be able to cope in field hospitals and base hospitals, Ms Hallett explains. This resulted in a shortage of female nurses, particularly on the Western front, for the first few months of the war.

The trained nurses who did go to France during the first two months of the war were severely understaffed and found it difficult to keep up with the high volume of casualties. The nurses left at home also felt frustrated that the army was so slow to call them to the front.

HOW DID THE PROFESSION DEVELOP? Despite this, nursing was already a highly developed profession with well-equipped training facilities. Before the war, cities such as London, Edinburgh, Manchester and Birmingham had good-quality nursing training schools located within the larger hospitals.

Nurses had access to a number of learning materials such as textbooks and journals.

The most significant journal was The Nursing Mirror, which had grown out of the nursing section of a journal called The

Hospital, as well as the British Journal of Nursing. ‘Nursing was a budding profession but still a very effective one. They were having to cope with very complex surgical techniques in an era where antibiotics and antiseptics were still quite new and anesthesia techniques remained relatively new,’ says Ms Hallett.

World War One: soldier being looked after by nurses. Wellcome Images.

‘Nurses were doing very intricate work but they weren’t really being recognised for it.

They didn’t yet have a professional register so the boundaries for the profession were not closed and anyone could call themselves a nurse,’ she added.

‘They had been campaigning since 1887 for a nurse’s register. One of the things the war did was raise their profile and image as it led to inceased respect for their work and they got a professional register in 1919, through the Nurses Registration Bill.’

The other thing that was impacted by the First World War was the development of the nurses’ clinical practice. While the fundamental care skills were not influenced or altered a great deal, they did have to 23

THE YEAR OF THE NURSE & MIDWIFE 2020

October 1914 onwards. Casualty clearing stations moved much closer to the frontline in 1916 and during 1917 and a lot of these came under shellfire.

Several hundred nurses died during the war, MsHallett says. The majority died from influenza, but some directly from shellfire or on ships that were torpedoed in the Mediterranean or the British Channel.

‘It was important they were close to the frontline because if they had a patient with an infected wound, they had to operate quickly, so having trained theatre nurses and anesthetists close to the frontline was really important to save those lives. They put themselves quite close to danger to do their work,’ she says.

World War One: tending of the wounded in the trenches.Wellcome Images.

become more competent at those care skills says Ms Hallett. This included dealing with muddy patients from the trench with multiple wounds. They would have to remove the dirty uniforms, wash the patient, feed and hydrate them, all in a matter of minutes. That level of treatment was more challenging than it would have been in a civilian hospital.

Nurses had to learn a lot of new technical skills, especially in the area of wound care. Multiple wounds, large wounds and very infected wounds had to be dealt with carefully and with new and varied antiseptic treatments. A typical military nurse would have had to use impregnated dressings, understand the actions of the different antiseptics which they poured and irrigated through wounds. They used a very complex technique called the CarrelDakin wound irrigation technique, using Dakin’s solution, (sodium hypochloride) in a glass bottle. This involved running the irrigation solution through rubber tubes into the deepest part of the wounds to treat them and clean them out.

Wound dressing techniques were different too; nurses were required to pick shrapnel and debris from the wounds, something they would never have had to do before.

The nurses knowledge of antiseptics and surgical techniques became highly developed and advanced to treat and heal the varied wounds the soldiers presented with.

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Nurses played greater roles in surgical treatments than they had before the war Ms Hallett says. Surgical nursing was a very important part of the discipline already but during the war nurses carried out minor surgery themselves when a patient was rushed in from the battlefield and a surgeon was unavailable. The surgeons would delegate minor surgery to the theatre nurses such as pinching up and stitching wounds.

Nurses were also trained up in new techniques such as blood transfusion. The idea of blood transfusion had existed in hospitals from the late 19th century but it was only during the First World War that it was adopted on a mass scale. Partly, this was due to better facilities that enabled nurses to store blood. Nurses also began to train as anesthetists from 1917 onwards and assisted during surgery with this new skill.

Nurses were deployed to work in a variety of settings from recuperation hospitals at home to the front lines. Casualty clearing stations began to staff female nurses from

Evidence from letters and diaries of nurses have shown that nurses and doctors worked closely together. This often led to a blurring of boundaries, because of the emergency of the war setting. Sometimes nurses were performing minor surgery and surgeons made patients comfortable performing nurses’ duties. However, nurses were more likely to take on more of the doctor’s work than doctors were to take on the nurses’ work, Ms Hallett thinks.

Nurses and doctors would often work in surgical teams consisting of a surgeon, anesthetist, a theatre nurse and an orderly would travel together between casualty clearing stations to perform operations.

This meant that they developed good working relationships between the two groups of healthcare professionals. Despite this there were examples of harassment and doctors being autocratic and some senior nurses being quite bullied by senior doctors, but Ms Hallett says that those were fairly isolated cases.

REGISTRATION OF NURSING In 1918, the Representation of the People Act was passed, which allowed women over the age of 30 with a property claim to vote, paving the way for women’s voting right in 1928.

This reflected directly on the introduction on the regulation of nurses in 1919. The College of Nursing (later known as the RCN) was established in 1916 and persuaded a backbench MP, Major Barnett to introduce a private members bill to

THE YEAR OF THE NURSE & MIDWIFE 2020

establish a regulatory system. The bill was finally passed in December 1919 and separate Nurses Registration Acts were passed for England/Wales, Scotland and Ireland.1,2 It is thought that the First World War was the catalyst for achieving regulation as it forced the country and politicians to acknowledge the importance of the work that nurses did.

Mirroring how women in Britain fared after the war, nurses had a lot of these duties taken away from them. Some individual nurses retained some of the work they carried out during the war and became teachers and leaders. However, practicing nurses had their work taken away from them after the war.

‘In the inter-war period, it would have been seen as unprofessional for nurses to engage in minor surgery. They would have to respect the boundaries between them and the surgeon, they reverted back to merely assisting and handing them instruments,’ comments Ms Hallett.

‘In some ways maybe the nurses too felt they had gone beyond the boundaries of their roles. They were accepting of the need to do that. The nurse anesthetists had this role taken away them. Even though they had thorough training and were able to administer a range of anesthetics. In the US they continued the role which they had been doing since before the war. In Britain [nurses] were returned to a scrub nurse role.’

DISPELLING MYTHS From the end of the war until the present day the romantic idea of the nurse during wartime has become pervasive in popular culture. One example of this is, highlighted

by Ms Hallett, the image created by Ernest Hemmingway, after he fell in love with one of his nurses in a military hospital during the First World War. He wrote the book A Farewell to Arms about this relationship.

‘These depictions and images of nurses have always been there with us. When you look at what nurses are doing in films, you don’t see them doing important clinical work or being a professional person, she’s just a romantic figure,’ she adds.

The other very obvious way the role of the nurse in the First World War has been romanticised is through the image of the VADs. A lot of the literature and films in the 20th century depicted people like Vera Britain, having been the most famous VAD, as being bullied by the professional nurses. ‘The atmosphere in the military hospital is shown as being very controlling and in those depictions the VAD is being portrayed as the nurse and the actual nurse as the manager, which is a false image,’ says Ms Hallett. ‘The VADs owed all of their skills and knowledge to the mentorship and supervision of the trained nurses, they couldn’t have done it without the trained nurses, plus they held the whole service together and did a lot of the work themselves.’

This can be translated to nursing in the present day as nurses are encouraged to take on advanced work, more could be done to ensure they, and the healthcare assistants they work with, get the recognition they deserve.

Carriage of the wounded in the trench.

Wellcome Images.

Ernest Hemmingway

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Our Nursing and Midwifery courses are part of a unique partnership between Kingston University and St George’s, University of London, giving you excellent opportunities for personal and professional growth.

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THE YEAR OF THE NURSE & MIDWIFE 2020

THE NURSING

TIMELINE 1796 Smallpox vaccine discovered by Edward Jenner 1816 Rene Laennec invented stethoscope 1818 British obstetrician James Blundell performs first transfusion of human blood 1844 Dr Horace Wells, American dentist, uses nitrous oxide as an anesthetic

1850 1854 Florence Nightingale goes to Turkey to lead a team of nurses caring for soldiers in the Crimean War Laennec and the use of the stethoscope. Wellcome Images

1855 Mary Seacole establishes the British Hotel, a convalescent home for soldiers in the Crimean War 1860 Nightingale Training School opens at St Thomas’s Hospital in London. One of the first institutions to teach nursing and midwifery as a formal profession, the training school was dedicated to communicating the philosophy and practice of its founder and patron, Florence Nightingale 1867 Antiseptic Principles of the Practice of Surgery published by Joseph Lister

Florence Nightingal e attending wounded. Wellcome Images

1887 British Nurses Association created; united nurses who sought professional registration 1899 Felix Hoffman develops aspirin

1900 1900s More hospitals establishing their own training schools for nurses; in exchange for lectures and clinical instruction, students provided the hospital with two or three years of skilled free nursing care 1908 The first meeting of the National Council of Trained Nurses of Great Britain and Ireland was held in London

Unloading of baggage for a group of Queen Alexandra’s Imperial Military Nursing Service.

28

1914-18 World War One; Queen Alexandra Imperial Military Nursing Service (QAIMNS) developed with 10,500 nurses enrolled

THE YEAR OF THE NURSE & MIDWIFE 2020

1916 Royal College of Nursing founded with 34 members 1919 Nurses Act established the first professional register help by the General Nursing Council 1922 Insulin first used to treat diabetes 1928 Scottish bacteriologist Sir Alexander Fleming discovers penicillin 1932 Lancet Commission on Nursing explores how to make nursing 1939-45 more attractive to young women in order to deal with shortage of trainees icillin Production.

Advertisement for Pen Wellcome Images.

1937 Bernard Fantus starts the first blood bank at Cook County Hospital in Chicago World War Two; many nurses enrolled in QAIMNS again gaining officer status 1940 The state enrolled nurse is formally recognised with two years of training 1943 Microbiologist Selman A. Waksman discovers the antibiotic streptomycin, later used in the treatment of tuberculosis and other diseases

Portrait of Selman A. Wak sman in his laboratory. Wellcome Ima ges.

1948 National Health Service offered free treatment for all at the point of care

1950 1951 Male nurses were allowed to join the professional register 1952 Paul Zoll develops the first cardiac pacemaker to control irregular heartbeat 1953 James Watson and Francis Crick at Cambridge University describe the structure of the DNA molecule 1967 Salmon Report proposes the development of nursing to include the management of hospitals The heart. Wellcome

Images.

1967 South African heart surgeon Dr Christiaan Barnard performs the first human heart transplant 1972 Briggs Committee suggests a move to degree preparation of nurses and that practice be based on research 1978 First test-tube baby is born in the U.K. 1983 Griffiths Report establishes general management in the NHS, largely taking leadership away from nurses and doctors.

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THE YEAR OF THE NURSE & MIDWIFE 2020

g administration Nurse during a dru rd. Wellcome on a UK hospital wa Images.

1983 United Kingdom Central Council for Nursing, Midwifery and Health Visiting sets up a new professional register with four branches (mental health, children, learning disability and adult) reflecting former types of training and qualifications: Registered General Nurse, Enrolled Nurse (General), Registered Mental Nurse, Enrolled Nurse (Mental), Registered Nurse for the Mentally Handicapped, Enrolled Nurse (Mental Handicap), Enrolled Nurse, Registered Sick Children’s Nurse, Fever Nurse, Registered Midwife and Registered Health Visitor.

1986 Project 2000 sets out the move to diploma level nurse training based in colleges/ universities rather than hospital based schools 1996 Dolly the sheep becomes the first mammal cloned from an adult cell

2000 2000 First draft of human genome is announced; the finalized version is released three years later 2002 Nurses are able to prescribe medication 2004 RCN votes for degree only preparation 2008 Nursing research demonstrated on the world stage 2009 All nursing courses in UK become degree level

30

THE YEAR OF THE NURSE & MIDWIFE 2020

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THE YEAR OF THE NURSE & MIDWIFE 2020

AN INTERNATIONAL CAREER

VIEWING THE PRACTICE OF NURSING WORLDWIDE

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THE YEAR OF THE NURSE & MIDWIFE 2020

According to the International Council of Nurses (ICN), the scope of nursing practice “encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings.” National nursing associations further clarify the scope of nursing practice by establishing particular practice standards and codes of ethics. National and state agencies also regulate the scope of nursing practice. Together, these bodies set forth legal parameters and guidelines for the practice of nurses as clinicians, educators, administrators, or researchers.

EDUCATION FOR NURSING PRACTICE Nurses enter practice as generalists.

They care for individuals and families of all ages in homes, hospitals, schools, long-term-care facilities, outpatient clinics, and medical offices.

Many countries require three to four years of education at the university level for generalist practice, although variations exist. For example, in the United States, nurses can enter generalist practice through a twoyear program in a community college or a four-year program in a college or university.

Preparation for specialization in nursing or advanced nursing practice usually occurs at the master’s level.

A college or university degree in nursing is required for entrance to most master’s programs. These programs emphasize the assessment and management of illnesses, pharmacology, health education, and supervised practice in specialty fields, such as pediatrics, mental health, women’s health, community health, or geriatrics.

Research preparation in nursing takes place at the doctoral level.

Coursework emphasizes nursing knowledge and science and research methods. An original and substantive research study is required for completion of the doctoral degree.

HOSPITAL-BASED NURSING PRACTICE Hospital nursing is perhaps the most familiar of all forms of nursing

practice. Within hospitals, however, there are many different types of practices. Some nurses care for patients with illnesses such as diabetes or heart failure, whereas others care for patients before, during, and after surgery or in pediatric, psychiatric, or childbirth units. Nurses work in technologically sophisticated critical care units, such as intensive care or cardiac care units.

They work in emergency departments, operating rooms, and recovery rooms, as well as in outpatient clinics. The skilled care and comfort nurses provide patients and families are only a part of their work. They are also responsible for teaching individuals and families ways to manage illnesses or injuries during recovery at home. When necessary, they teach patients ways to cope with chronic conditions. Most hospital-based nurses are generalists. Those with advanced nursing degrees provide clinical oversight and consultation, work in management, and conduct patient-care research.

from nursing, social, and public health sciences informs community health nursing practices. In many countries, ensuring that needed health services are provided to the most vulnerable and disadvantaged groups is central to community health nursing practice. In the United States, community health nurses work in a variety of settings, including state and local health departments, school health programs, migrant health clinics, neighbourhood health centres, senior centres, occupational health programs, nursing centres, and home care programs. Care at home is often seen as a preferred alternative for caring for the sick.

Today home-care nurses provide very sophisticated, complex care in patients’ homes. Globally, home care is being examined as a solution to the needs of the growing numbers of elderly requiring care.

COMMUNITY HEALTH

Mental health (or psychiatric) nursing practice concentrates on the care of those with emotional or stressrelated concerns. Nurses practice in inpatient units of hospitals or in outpatient mental health clinics, and they work with individuals, groups, and families. Advanced-practice mental health nurses also provide psychotherapy to individuals, groups, and families in private practice, consult with community organizations to provide mental health support, and work with other nurses in both inpatient and outpatient settings to meet the emotional needs of patients and families struggling with physical illnesses or injuries.

NURSING PRACTICE Community health nursing incorporates varying titles to describe the work of nurses in community settings. Over the past centuries and in different parts of the world, community health nurses were called district nurses, visiting nurses, public health nurses, home-care nurses, and community health nurses. Today community health nursing and public health nursing are the most common titles used by nurses whose practices focus on promoting and protecting the health of populations. Knowledge

MENTAL HEALTH NURSING PRACTICE

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THE YEAR OF THE NURSE & MIDWIFE 2020

THE CARE OF CHILDREN The care of children, often referred to as pediatric nursing, focuses on the care of infants, children, and adolescents. The care of families, the most important support in childrens’ lives, is also a critically important component of the care of children.

Pediatric nurses work to ensure that the normal developmental needs of children and families are met even as they work to treat the symptoms of serious illnesses or injuries. These nurses also work to promote the health of children through immunization programs, child abuse interventions, nutritional and physical activity education, and health-screening initiatives. Both generalist and specialist pediatric nurses work in hospitals, outpatient clinics, schools, day-care centres, and almost anywhere else children are to be found.

THE CARE OF WOMEN The care of women, especially of childbearing and childrearing women (often called maternal-child nursing), has long been a particular nursing concern. As early as the 1920s, nurses worked with national and local governments, private charities, and other concerned professionals to ensure that mothers and children received proper nutrition, social support, and medical care. Later, nurses began working with national and international agencies to guarantee rights to adequate health care, respect for human rights, protection against violence, access to quality reproductive health services, and nutritional and educational support. Generalist and specialist nurses caring for women work on obstetrical and gynecological units in hospitals and in a variety of outpatient clinics, medical offices, and policy boards. Many have particular expertise in such areas as osteoporosis, breast-feeding support, domestic violence, and mental health issues of women.

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GERIATRIC NURSING PRACTICE Geriatric nursing is one of the fastestgrowing areas of nursing practice.

This growth matches demographic need. For example, projections in the United States suggest that longer life expectancies and the impact of the “baby boom” generation will result in a significant increase in the number of individuals over age 65. In 2005 individuals over 65 accounted for about 13 percent of the total population; however, they are expected to account for almost 20 percent of the total population by 2030. Moreover, those over 65 use more health care and nursing services than any other demographic group. Most schools of nursing incorporate specific content on geriatric nursing in their curricula.

Increasingly, all generalist nurses are prepared to care for elderly patients in a variety of settings including hospitals, outpatient clinics, medical offices, nursing homes, rehabilitation facilities, assisted living facilities, and individuals’ own homes. Specialists concentrate on more specific aspects of elder care, including maintaining function and quality of life, delivering mental health services, providing environmental support, managing medications, reducing the risks for problems such as falling, confusion, skin breakdown, and infections, and attending to the ethical issues associated with frailty and vulnerability.

NURSE PRACTITIONERS Nurse practitioners are prepared at the master’s level in universities to provide a broad range of diagnostic and treatment services to individuals and families. This form of advanced nursing practice began in the United States in the 1960s, following the passage of health care legislation (Medicare and Medicaid) that guaranteed citizens over age 65 and low-income citizens access to health care services. In response, some nurses, working in collaboration with physicians, obtained additional

training and expanded their practice by assuming responsibility for the diagnosis and treatment of common acute and stable chronic illnesses of children and adults.

Initially, nurse practitioners worked in primary care settings; there they treated essentially healthy children who experienced routine colds, infections, or developmental issues, performed physical exams on adults, and worked with both individuals and families to ensure symptom stability in such illnesses as diabetes, heart disease, and emphysema. Today nurse practitioners are an important component of primary health care services, and their practice has expanded into specialty areas as well.

Specialized nurse practitioners often work in collaboration with physicians in emergency rooms, intensive care units of hospitals, nursing homes, and medical practices.

CLINICAL NURSING SPECIALISTS Clinical nursing specialists are prepared in universities at the master’s level. Their clinically focused education is in particular specialties, such as neurology, cardiology, rehabilitation, or psychiatry. Clinical nursing specialists may provide direct care to patients with complex nursing needs, or they may provide consultation to generalist nurses.

Clinical nursing specialists also direct continuing staff education programs.

They usually work in hospitals and outpatient clinics, although some clinical nursing specialists establish independent practices.

THE YEAR OF THE NURSE & MIDWIFE 2020

NURSE MIDWIVES Nurse midwives are rooted in the centuries-old tradition of childbirth at home. Midwives, rather than obstetricians, have historically been the primary provider of care to birthing women, and they remain so in many parts of the industrialized and developing world. In the United States in the 1930s, some nurses began combining their skills with those of midwives to offer birthing women alternatives to obstetrical care. The new specialty of nurse-midwifery grew slowly, serving mainly poor and geographically disadvantaged women and their families. The women’s movement beginning in the 1960s brought a surge in demand for nursemidwives from women who wanted both the naturalness of a traditional delivery and the safety of available technology if any problems developed.

Numbers of nurse-midwives in the United States grew from fewer than 300 in 1963 to over 7,000 in 2007. Today most nurse-midwives are prepared in universities at the master’s level. They deliver nearly 300,000 babies every year, and, in contrast to traditional midwives, who deliver in homes, nurse-midwives do so mainly in hospitals and formal birthing centres. Global demand for nurse-midwifery care is projected to grow significantly.

NURSE ANESTHETISTS Nurse anesthetists began practicing in the late 19th century.

Trained nurses, who at that time were becoming an increasingly important presence in operating rooms, assumed responsibility for both administering anesthesia and providing individualized patient monitoring for any reactions during surgical procedures. Nurse anesthetists proved their value during World War I, when they were the sole providers of anesthesia in all military hospitals. Today nurse anesthetists are established health care providers. In the United States alone they provide two-thirds of all anesthesia services and are the sole

providers of anesthesia services in most rural American hospitals. Nurse anesthetists train at the postgraduate level, either in master’s programs in schools of nursing or in affiliated programs in departments of health sciences. They work everywhere anesthesia is delivered: in operating rooms, obstetrical delivery suites, ambulatory surgical centres, and medical offices.

NATIONAL ORGANIZATIONS In virtually every country of the world, there is a national nursing organization that promotes standards of practice, advocates for safe patient care, and articulates the profession’s position on pressing health care issues to policy boards, government agencies, and the general public. Many national nursing organizations also have associated journals that publicize research findings, disseminate timely clinical information, and discuss outcomes of policy initiatives. In addition, most nursing specialty and advanced practice groups have their own organizations and associated journals that reach both national and international audiences. There are a wide variety of nursing specialinterest groups. Different unions also engage in collective bargaining and labour organizing on behalf of nurses.

INTERNATIONAL ORGANIZATIONS

LICENSING Given the critical importance of standardized and safe nursing care, all countries have established mechanisms for ensuring minimal qualifications for entry into practice and continuing nursing education.

Those countries with centralized health systems, such as many European and South American countries, enact national systems for nurse licensing. Countries with decentralized and privatized systems such as the United States cede to states and provinces the authority to determine minimal nurse licensing requirements. In most instances licenses are time-limited and can be revoked if circumstances warrant such an action. Licensing renewal often depends on some method of certifying continued competence.

The International Council of Nurses (ICN), a federation of over 128 national nurses associations based in Geneva, speaks for nursing globally. The World Health Organization (WHO) has had a long-standing interest in promoting the role of nursing, particularly as independent community-based providers of primary health care in Third World and other underserved countries. The International Committee of the Red Cross (ICRC) and its national affiliates have long recognized the critical role of nursing in disaster relief and ongoing health education projects.

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A UNIQUE GLASGOW PERSPECTIVE ON

NURSING HISTORY Until the mid-nineteenth century, nursing was not an activity, which was thought to demand either skill or training. Nor did it command respect.

As Florence Nightingale was to put it, nursing was left to ‘those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else’.

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The intimate body services to be done for the patient were considered to be unseemly or immodest for young unmarried or wellbred females, especially if not a family member. Cleaning and feeding of another person were regarded as domestic tasks performed by servants.

Also, before 1880, the hospital treatment of illness was fairly rare. Where home services were adequate, a sick person was attended by the family doctor and nursed either by female family members or servants. However, from the middle of the nineteenth century, the discovery and application of anaesthetics and antiseptic surgery advanced medical technique and allowed all classes to seek treatment in hospitals. From the 1860s onwards, a series of nurses’ training schools began to produce fairly large numbers of educated women who were eagerly accepted by hospital authorities whose medical officers, patients and public opinion in general were demanding higher levels of nursing skill in the wards.

The 20th century brought innovations in may fields of nursing, of course. It was during the development of antiseptic surgery in Glasgow, there were further innovations in patient care in the wards of the Royal. The first steps were taken to improve the training of nurses and the calibre of women entrusted with nursing duties. Florence Nightingale (1820-1910) was hailed as a heroine for her work with thirty volunteers in caring for troops in the Crimean War. There were three types of hospital in Glasgow at that time: Voluntary Hospitals which were managed by independent boards of directors and funded from public donations.

Poor Law Hospitals which were managed and funded by the local parish Poor Law authorities; Municipal Hospitals which were provided by the Glasgow Local Authority and used entirely for the treatment of infectious disease.

The Local Authority, the Police Board, opened its first hospital in 1865. Its nurses were considered amongst the worst available as the risks attached to fever Glasgow Royal Infirmary. Wellcome Collection.

nursing were great. Dr J.B. Russell, then Medical Superintendent of the hospital expressed himself forcefully, ‘I admit that at present nursing is the last resource of female adversity. Slatternly widows, runaway wives, servants out of place, women bankrupt of fame or fortune from whatever cause, fall back on hospital nursing’.

In the hospital’s first year, Russell wanted to introduce ‘a more systematic means of instruction’ for his nurses. Although the typhus emergency of that year proved too distracting he instituted a few practical ground rules for the selection and training of nurses. He attempted to select applicants with no nursing experience but of good character who could be trained to an acceptable level. Training consisted only of reading and of some practical instruction.

All nurses were supplied with Florence Nightingale’s book and were taught by example by one of Russell’s good nurses.

In 1881, training was put on a more formal footing. Nurses were appointed as full members of staff only after a year’s training, which had lectures, practical demonstrations and work experience ending with a written and oral examination.

Candidates who passed were awarded a certificate of Proficiency in Nursing of the first, second or third class.

Fever nurses spent an average of fourteen hours on duty and had an afternoon off every fortnight. Parallel to improvements in training were advances in living conditions, wages and working hours. Fever nurses spent an average of fourteen hours on duty and had an afternoon off every fortnight, though they had an advantage in that rough domestic chores were excluded from their duties from the beginning.

Nursing in Scottish Poorhouses in the mid-nineteenth century was almost entirely done by the inmates themselves, people who were unpaid, unsuitable and untrained for the task. Between 1875 and 1896 the central Poor Law Authority in Scotland Board of Supervision issued many circulars to local parish authorities urging them to introduce paid, trained nurses to their poorhouse hospitals. The Board of Supervision in 1885 organised a register of trained nurses who would be acceptable to them for parochial employment. The nurses had to satisfy requirements on age and qualifications. The real incentive lay in a money reward if parishes co-operated.

Part of the cost of the nurses could be charged to the government’s annual medical relief grant.

The Barony in Glasgow was one of the first parishes to adopt the Board’s recommendations. In 1880, the Barony Board employed five paid nurses and a female superintendent. The nursing staff were divided into three categories, namely the trained Staff Nurses (day and night), probationers who were nurses in training, and pauper assistants who cleaned the wards. Training continued to be important, probationers had to take written and oral examinations before being accredited as trained nurses. The resident medical officer was interested in nurses training and inaugurated a short course of lectures for nurses which developed in the next ten years into regular twice weekly lectures for two periods of six months each. Progress was much slower in the other two Glasgow Parishes, Govan Combination Parish and Glasgow City Parish.

Before the 1870s in the voluntary hospitals, the most valued qualities if found for a nurse were gentleness and respectability.

The Royal Infirmary would try bribery, giving ‘prizes to a day and a night nurse in each department for good conduct, kindness to the patients and cleanliness in the wards’ rather than provide extensive education or training.

Views began to change in the 1870s and 1880s in the appointment of matrons or lady superintendents, who themselves had received a systematic training in nursing by the larger hospitals. Before this, their duties had been mostly housekeeping. It became easier to organise systematic training for nurses under matron’s control. This usually consisted of a course extending over two and later three years. Apprenticeship formed most important part of training with the trainee or probationer carrying out routine work under the supervision of a sister or staff nurse. Lectures from the medical staff on subjects such as bandaging or the use of common medical instruments supplemented practical work.

Lectures from doctors began in the Maternity Hospital in 1871; in the Western Infirmary in 1875; in the Royal Infirmary in 1878; and in the Sick Children’s Hospital in 1888. They continued to be given voluntarily and gratis by the doctors.

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Hospitals which provided this pattern of education became recognised training schools for nurses. However in the 1890s, several people in Glasgow including the eminent surgeon, Dr William Macewen began to suggest that more was required than this simple basic training if nurses were to respond to medical developments.

Dr Macewen believed that the modern nurse needed more than a good liberal education. She must be given a specific grounding in anatomy, physiology, therapeutics, medicine and surgery ‘sufficient to enable her to follow with intelligence the movements of the disease and the treatment she was entrusted to carry out.’

Extensive improvements in nursing training began in Glasgow first in the Royal Infirmary and were very much due to the energy and determination of Mrs Rebecca Strong, the Matron. The Infirmary’s new regulations in 1893 required reasonable evidence of educational attainment before nursing applicants could be accepted.

Candidates had to take a preliminary formal examination or produce Leaving Certificates from the Scottish Education Department. Once accepted into the training school, probationer nurses received a more thorough and technical education than that which was currently offered even in the most respected of British Training Hospitals. It involved two courses in the theory of anatomy, physiology and hygiene and two on practical nursing. All lecture courses were accompanied by oral or

written examinations and a class certificate was given at the end of each set.

Other British Hospitals around the turn of the century quickly adopted this more rigorous and theoretical approach.

Parallel with the new training scheme were corresponding changes in financial reward and other indicators of status.

Accommodation improved along with nurses’ hours which decreased from an average of fifteen hours a day in the 1870s to an average of eleven in the 1890s.

The nature of their duties changed too, with domestic chores being limited or ended to allow the nurse to concentrate almost exclusively on patient care. Beginning in the 1870s as the ‘Nightingale Revolution’ filtered through, Glasgow’ s hospitals took the initiative in sponsoring greater improvements.

An important function of the Royal Hospital for Sick Children was the in the training and education of nurses in the special skills required to nurse ill children.

Later, one nurse, Sister Laura developed a baby food and was fondly remembered in a children’s rhyming jingle in a ball playing game.

Sister Laura walks like this Pit a pat pat, pit a pat pat.

However, for the male nurse it could be difficult in a female dominated environment.

A male nurse found it awkward at times in paediatrics in Yorkhill in the 1980s when there had been few male nurses.

Without the help of Sir William MacEwan and Mrs Rebecca Strong there might never have been established the first preliminary nursing school at Glasgow Royal Infirmary.

In the early 1880s great changes had begun and were imminent in surgery and nursing.

Until around 1850, surgery was a matter of screaming pain, stinking pus and hospital gangrene. Nursing care was primitive and nurses were ill paid, ill trained and often of ill repute. The introduction of general anaesthesia in the late 1840s abolished some of the pain of surgery but it was not until 1865 that Lister first instilled carbolic acid into a wound in Glasgow Royal Infirmary that control of wound infection began to be possible. The turning point in nursing was Florence Nightingale’s work in the Crimean War in the mid 1850s and the setting up of her own training school in St. Thomas’s Hospital in London.

Rebecca Strong and William Macewen had both been inspired with enthusiasm at the original source. Strong had been trained in the Nightingale Training School in St Thomas’s Hospital and helped Miss Nightingale to organise the nursing service at Netley Military Hospital. She became Matron of Glasgow Royal Infirmary in 1879.

Sir William Macewen had been one of Joseph Lister’s surgical dressers. Each needed the other. Macewen performing new operations under strict asepsis needed intelligent trainable nurses to tend his patients. Mrs Strong needed Macewen, a renowned surgeon to help forward her plans to raise the standards of nursing. “ I look on you and the nurses as part of myself and any honour which might be conferred on me is something which should be shared by you”, Macewen writes after his triumph on the presentation of his paper on osteotomy (the procedure to straighten limbs bent by rickets) at the Congrès International des Sciences Medicales in 1884 to Mrs Strong.

Glasgow Royal Infirmary, 3/4 front.. Credit- Wellcome Collection.

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Olivia Brittian remembers her training at the Victoria Infirmary and the Royal Infirmary.

Nightingale Training School, St Thomas. Wellcome Collection.

He writes of his great reception:

‘ because I know you will be pleased to hear then as you are so mixed up with everything I do in the surgical way.

I look on you and the nurses as part of myself and any honour which might be conferred on me is something which should be shared by you’.

Mrs Strong did resign in 1885 and became Matron of a private nursing home. The Royal Infirmary Board would not build a residential home for her nurses. Macewen missed her and was determined to see her ideas and innovations succeed. By 1893, the nurses home had been built and Mrs Strong was back in office in the Royal Infirmary.

She set up her first probationer’s training course in January of 1893, allocating nurses time for lectures and study. The course consisted of six weeks of lectures on anatomy, physiology and hygiene with examinations and class certificates for each

subject. This became the pattern of nursing schools throughout Britain and overseas as Mrs Strong travelled widely and became internationally known for her pioneering work.

Florence Nightingale’s Nursing School continued to influence nurse training.

Until the 1960s, the ward sister controlled the ward in which student nurses learned.

Consultants were classified as visitors and had appointed times to conduct their rounds. The ward was closed to allow the patient to rest. Rigorous routine, the basis of the apprenticeship training was argued to have become restrictive. In the early 1960s, reform was sought and the timetable of the ward revised. Hospital life was to be nearer to home life, with longer sleeps in the morning and rest during the day.

Sir William Macewen. Wellcome Collection.

“ Yes, I started nurse training in 1963 in the Victoria Infirmary, in the southside of Glasgow. In those days, all nurses were trained in a hospital and you just chose the hospital that you wished to go to. I chose the Victoria Infirmary in actual fact as they treated my brother after a bad accident and actually saved his arm and I felt that they were a good hospital and the training in 1963 was very much ward based.

You had opportunities to go into the classroom and learn but then most of your actual education or training was on the wards themselves and it was very much a 24/7 training in that you had to do day duty, night duty, evening shifts, split shifts and you could be on night duty and have to come off in the morning and go for lectures, because if you were in the middle of a medical block, maybe a consultant would be coming to teach about a particular disease process.

I did a four year course because I combined both general nursing and orthopaedic nursing just because I was just a few days seventeen when I started the course.”

Similarly, Ann Jarvie recalls being a resident at the Royal Infirmary. “ We were also resident. We had to live in for at least the first year. You could get permission to live out in the second year providing you were going to live at home. And you could get permission to live out in your third year in a flat providing your parents gave permission for that to happen. So we knew each other very well because we were resident and in those days when you were on night duty as a student nurse, you didn’t stay in the nurses’ home in the Royal you went down to Belvidere, meant to be quieter and that you would get sleeping during the day. But I think the relationship between, doctors and nurses was substantially different in those days because everybody worked longish hours. Because people were resident

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A ward off the Bellahouston theatre Royal Glasgow Infirmary. Wellcome Collection.

Infirmary. Wellcome Collection.

they got to know each other in quite a different way and there was quite a bit of social activity within hospitals so it felt very much being part of a team.�

Following recommendations in the Briggs Report (1972) that there should be an extension of graduate training in nursing, a joint committee of the University and the Greater Glasgow Health Board was set up to consider the possibility of introducing a degree at the University. Professor Edward McGirr was Dean of the Faculty of Medicine at this time. It was thought there was a local need for the course and likely that sufficient numbers would apply.

The course was to admit up to 25 students 42

A ward off the Bellahouston theatre Royal Glasgow Infirmary. Wellcome Collection.

to the four year course which would lead to the award of an ordinary degree. The course would combine academic study and professional training.

The degree would confer the status of Registered General Nurse and be recognised by the General Nursing Council for Scotland. Teaching was to be carried out by the University and hospitals in the Greater Glasgow Health Board area.

In addition, students were to attend an introductory course of four weeks to gain an insight into patient care in hospitals and health centres and the responsibilities of nursing and the allied professions. This was established with the help of the General Medical Council for Scotland.

Professor Edward McGirr, Dean of the Faculty of Medicine. Source: University of Glasgow.

Year of the Nurse and Midwife The Queen’s Nursing Institute (QNI) is the oldest nursing charity in the world.* We support the nurses who work in people’s homes and communities, delivering vital care to those with complex health needs.

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Nurses carry out a huge range of vital work with patients in the community every day.

• They deliver care in people’s homes, communities, GP surgeries and clinics - and do vital outreach work with people who are experiencing homelessness.

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Many people would be unable to live at home without the support that they get from community nurses and their teams.

Consider a career as a community nurse and be a part of this vital workforce.

To find out more about nursing in the community, go to Charity number: 213128 *Guinness World Records

www.qni.org.uk.

Be the future of nursing THE YEAR OF THE NURSE & MIDWIFE 2020

A career in nursing is a rewarding and vital role

Training as a nurse gives you the skills and competencies to engage in care that ranges from complex decision making to meeting smaller care needs of patients.

Nursing care helps save lives every day.

Being a nurse is a diverse job, with specialties including adult, children’s, mental health or learning disability nursing.

Plus opportunities to work in a variety of environments from hospitals, community settings, clinics and the military. @thercn @theRCN royalcollegeofnursing

The Royal College of Nursing supports over 450,000 nursing students, nurses and nursing support workers with benefits such as: Learning resources 24/7 access to Europe’s largest nursing library and e-library, with a dedicated team of experts to help with your enquiries.

Guidance and support From networking events to online forums, we’ve got resources for you at every stage of your career.

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Visit rcn.org.uk/become-a-nurse 44 to find out more about a career in nursing

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Nurses make up a large portion of the health care workforce and collectively they use their voice, skills and experience to make a positive impact to the profession.