2: EVOLUTION OF PROFESSIONAL ROLES IN NURSING ■ 69support for the associate degree for technical nursing practice (ANA, 1965). The
intention was to limit the scope of practice of the technical nurse, and develop the
leadership aspect of the baccalaureate nurse (Freund, 1990). Ultimately, an increased
demand for nurses related to increased health care funding from the Medicare and
Medicaid programs added to the persistent nursing shortage in hospitals (Lynaugh,
2007). Despite their best intentions, the nursing leadership had difficulty quantifying
the intended levels of care and the lack of differentiation between roles that seemed
to blend nurses together. Today, the nursing profession is well aware of its failed
efforts to ensure that all nurses have a BSN. However, Donley and Flaherty (2008)
write, “If you view the 1965 statement as a call to close hospital schools of nurs-
ing and to move all nursing education inside the walls of colleges or universities,
then the ANA was successful in implementing its vision” (p. 1). Notwithstanding,
they further state, “If, however, you view the 1965 Position Paper as a mandate for a
more educated nurse force to enhance patient care, the goal has not been achieved”
(Donley & Flaherty, 2008, p. 1).
The sustained progress in medical technology and nursing’s emergence as a disci-
pline in the mid- to late 1960s, again offered nurses specialized knowledge and skill in
hospital settings in the newly established cardiac care units (Dreher, 2010). Small groups
of specially trained nurses in these intensive observation units used the skills usually
completed by physicians, which gave nurses a larger scope of practice and perhaps a
boost to their professionalism (Keeling, 2004). Through skilled observation, these nurses
made independent decisions to administer the needed medications based on standing
orders and used the technology to save patients’ lives. Keeling referred to it as “the
blurry line” between medicine and nursing, because these nurses gave medications to
stop arrhythmias and then wrote the verbal orders for physicians to sign at a later time.
Increasingly in the 1960s, many nursing tasks involved using new machines and taking
new measurements from them, although previously these functions had been limited to
the realm of physicians. Physicians, however, embraced the capacity of the RNs to man-
age this ever increasing technology, as they ultimately could not manage and monitor
all of this technology themselves.
Was this real progress toward more nursing professional autonomy? Or was it
simply acquiescence by physicians that their work depended on the good functioning
of nurses and nursing?
■ SUMMARY
From the origins of American nursing in the 1800s through the 1960s, nursing leaders
gradually sought and established higher standards for nurses largely with changes in
society. Woods (1996) has also recognized that the rise of professional nursing has been
led primarily by nurse educators and public health nurses. Ultimately, however, those
“traditionalists” and “professionalizers” (again despite their disagreement on change)
did succeed in raising nursing from being simply everyday women’s work to a profes-
sional career choice for women (and men to a lesser extent), giving women an economic
position in the market, albeit undercompensated and still unnecessarily stereotyped.
The struggle of nurses to gain true professional status continues today, as their scope
of practice and their role in health care expand into the realm of a new doctoral degree,
one day possibly to be required for entry into advanced practice nursing. We can only
imagine how long that will take! But first, the authors of Chapter 3 will characterize the
rise of the role of the first advanced practice nurses in the mid- 1960s.