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Clinical Nursing Skills

2.1 Changing with Trends

Clinical Nursing Skills2.1 Changing with Trends

Learning Objectives

By the end of this section, you will be able to:

  • Describe the progression of nursing into a professional discipline
  • Identify current trends in nursing
  • Recognize future trends for nursing professionals

Understanding the history of nursing is crucial for nurses as it provides a foundation for the professional identity and instills a sense of pride and appreciation for the evolution of the profession. By knowing the challenges and achievements of nursing pioneers, nurses can develop a deeper understanding of the values and principles that lie at the foundation of nursing practice. Additionally, understanding the history of nursing allows nurses to better understand current practices, critically evaluate their effectiveness, and actively participate in shaping the future of the profession. The knowledge serves as a source of inspiration, empowering nurses to innovate, advocate, and contribute to the ongoing development and advancement of nursing care.

History of Nursing

The history of nursing is a tapestry woven through time, reflecting the evolving roles and responsibilities of caregivers. It finds its earliest roots in ancient civilizations, where individuals primarily cared for the sick within their communities. Yet, it was Florence Nightingale in the 19th century who sparked a transformative shift. During the Crimean War, she pioneered modern nursing practices, emphasizing hygiene, systematic recordkeeping, and compassion. This laid the foundation for nursing as a respected profession.

As the 20th century unfolded, nursing continued to evolve. Nursing education programs became more structured, and nurses gained recognition for their vital role in health care. Today, nursing encompasses a diverse array of specialties, from critical care to research, and nurses are at the forefront of healthcare delivery, making an indelible mark on the well-being of individuals and communities worldwide.

Beginning of Professional Nursing

The development of modern, professional nursing can be traced back to the efforts of Florence Nightingale and the impact of the Crimean War in the mid-19th century. Nightingale, an Englishwoman who is often referred to as the founder of modern nursing, revolutionized the profession by emphasizing the importance of proper sanitation, hygiene, and evidence-based practice (Matthews et al., 2020).

During the Crimean War (1853–1856), Nightingale and a team of nurses were deployed to the British military hospital in Scutari, Turkey (Matthews et al., 2020). There, Nightingale found extremely poor conditions among the wounded, with rampant infection, poor hygiene, inadequate nutrition, and lack of proper medication. She implemented significant changes in patient care, including improved sanitation and infection control measures in the form of handwashing, frequent cleaning of the wards, and improved ventilation. Additionally, Nightingale gathered important statistical data linking improved hygiene practices to lower disease and mortality rates (Figure 2.2). She used this data to petition the British government for improved sanitary conditions across the British Empire.

Following the war, Nightingale’s efforts gained recognition, and her ideas spread throughout Europe and the United States. The Nightingale Training School for Nurses was established in London in 1860, marking the beginning of formal nursing education. Nightingale’s emphasis on education, professionalism, data collection, and high standards of care laid the foundation for the development of nursing as a respected and skilled profession.

A historical image showing a rose diagram chart identifying military deaths in 1854-1856. The diagram is organized into a circular pattern with wedges of the diagram representing months and adjusted in size to represent the volume of deaths.
Figure 2.2 One of the ways in which Florence Nightingale pioneered the use of evidence-based practice in nursing was capturing data on the causes of death in the British Army and documenting them on her “rose diagram” chart. This chart represents data collected related to the cause of death of British soldiers. (credit: "Nightingale-mortality.jpg" by Florence Nightingale/Wikimedia Commons, Public Domain)

Nursing into the 20th Century

Significant advancements and transformations in the field of nursing were seen in the 20th century. During this period, nursing witnessed a remarkable evolution in education, practice, specialization, and professional recognition. One of the most important advancements has been the shift toward formalized nursing education and the emphasis on evidence-based practice (EBP). Nursing education shifted from being hospital based to having established schools and programs within colleges and universities, offering a more structured and comprehensive curriculum. This new focus began the introduction of licensure and regulation. States and countries began to implement licensure and regulation for nurses to ensure a minimum level of competency and to protect the public. This led to the establishment of nursing boards and regulatory bodies. Scientific knowledge and clinical skills became integral parts of nursing education; evidence-based practice became a fundamental principle. Nurses were trained to critically evaluate research evidence, integrate it with clinical expertise and patient preferences, and apply it to guide their nursing practice. Nurses also began conducting research to improve patient care, develop evidence-based practices, and contribute to the broader healthcare knowledge base.

Theoretical Foundations of Nursing

Alongside the formalization of nursing education, the development of theoretical foundations in nursing has evolved in response to changing healthcare landscapes and the expanding role of nurses (Current Nursing, 2020). Early nursing theories, like Florence Nightingale’s Environmental Theory in the 19th century, emphasized the nurse’s pivotal role in creating a healing environment. In the mid-20th century, theorists such as Sister Callista Roy and Hildegard Peplau introduced groundbreaking concepts focusing on patient needs and the nurse-patient relationship. More contemporary nursing theorists like Jean Watson and Patricia Benner have contributed valuable insights into human caring and the journey from novice to expert in nursing practice. Madeleine Leininger’s Transcultural Nursing Theory has strongly informed and shaped recent developments in culturally competent nursing care. Nurses also use non-nursing theories to inform nursing care. For example, nurses use Abraham Maslow’s Hierarchy of Needs to assess and prioritize patient needs, understanding that physiological needs like food and safety must be met before addressing higher-level needs like belongingness and self-actualization.

Professional Nursing Organizations

In addition to formalizing nursing education, nursing organizations and associations were established in an effort to unify nurses and promote professional standards. The American Nurses Association (ANA), now the largest organization of registered nurses in the United States, was founded in 1896 as the Nurses’ Associated Alumnae of the United States and Canada (ANA, 2017). (The ANA adopted its current name in 1911.) Its primary objective was to establish a professional organization for nurses and promote high standards of nursing education and practice.

The ANA has focused on advocating for improvements in education, licensure, and working conditions for nurses. It has played a crucial role in the development of standardized nursing curricula and the establishment of state licensing laws for nurses. The ANA initiated the publication of professional journals and nursing literature to promote the exchange of knowledge and best practices. It has continued to advocate for important policy changes such as advocating for the right for nurse practitioners to practice more autonomously and for the right of both documented and undocumented immigrants to purchase health insurance and receive adequate health care (ANA, n.d.). The ANA is one of the most important and influential nursing organizations in the United States as it exists to enhance the nursing profession’s recognition and influence and ensure the delivery of safe, quality care to patients.

Technological Developments

The integration of technology into health care throughout the 20th century is another development that has markedly impacted nursing practice. Technological advancements such as portable and remote monitoring, diagnostic testing and tools, improved evidence-based treatments, and electronic health record (EHR) have vastly changed how nursing care is delivered and improved its efficacy. Tools such as smart pumps, extracorporeal life support (a type of heart bypass machine), and noninvasive mechanical ventilation (ventilation provided without the need for endotracheal intubation) do not just make nursing care more efficient, they improve patient outcomes (Popowicz & Leonard, 2022). The ongoing impact of constantly evolving technologies on nursing is further discussed in 4.3 Informatics.

Specialization of Nursing Roles

Advancements in technology and medical science have spurred the development of specialized areas of nursing. The trend toward specialization has allowed nurses to develop expertise in specific patient populations and healthcare settings. For example, some nurses work specifically with children (pediatrics), while others work solely with patients diagnosed with cancer (oncology), while others specialize in critical care. Specialization also includes expanding nursing practice beyond the traditional roles of bedside care to include broader responsibilities. Today many nurses serve in advanced practice roles, such as nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse-midwives. They may also work in academia, as administrators, in research, or in corporate settings. These roles require additional education and training.

Current Trends in Nursing

Current nursing trends reflect the dynamic nature of health care. Educationally, there is a growing emphasis on lifelong learning and advanced degrees, as well as an increased focus on diversity, equity, and inclusion. Legislative trends highlight the expansion of nurse practitioners’ roles, granting them greater autonomy to address primary care shortages. Additionally, telehealth and digital health technologies have become integral, enabling nurses to provide remote care. Staffing trends focus on addressing the nurse shortage through strategies like nurse residency programs, efforts to improve nurse-to-patient ratios, as well as flexible staffing patterns to meet the individual needs and preferences of the staff and unit. In the face of these trends, nursing remains at the forefront of health care, adapting to new technologies and evolving roles while delivering quality patient-centered care.

Educational Trends

In 2021, the American Association of Colleges of Nursing (AACN) updated its framework for nursing education in the 21st century. In this updated framework, the AACN identified modern issues that should be included in current nursing education in order to best prepare students for future nursing practice.

According to the AACN, modern nursing education should align with current trends and values, encompassing crucial elements such as promoting diversity, equity, and inclusion within the profession; nurturing proficiency in systems-based practice; fostering competence in healthcare informatics and technology; fostering academic-practice partnerships; and instilling a commitment to continuous and advanced learning throughout one’s nursing career. It should be competency based, an approach that focuses on assessing and developing specific skills, knowledge, and abilities in students, ensuring they are proficient in the essential competencies required for nursing practice rather than just completing a predetermined amount of time in a program.

One of the most important issues in current educational trends is diversity, equity, and inclusion (DEI) (Jolley & Peck, 2022). DEI represents the commitment to recognizing and embracing differences, ensuring fairness, and fostering a sense of belonging for all individuals in order to create a more equitable and enriched nursing profession and healthcare system. Incorporating DEI into nursing education is essential for producing culturally competent, compassionate, and equitable nurses. It enhances nursing education by exposing students to various perspectives and experiences, enabling nurses to provide holistic and patient-centered care that respects and meets the unique needs of diverse populations. Additionally, by fostering DEI in nursing education, programs can attract students from underrepresented backgrounds and create a more diverse nursing workforce, representative of the populations in which we serve. This diversity helps improve access to care, patient satisfaction, and patient outcomes, as individuals tend to feel more comfortable and understood when cared for by healthcare professionals who share their cultural or linguistic background.

Another important purpose of emphasizing DEI is to address health disparity. Healthcare disparities exist among populations due to various factors called social determinant of health (SDOH), which include socioeconomic status, race, ethnicity, physical and social environment, as well as gender. Health disparities can also be attributed to systemic inequalities and biases. Nursing education can equip students with the knowledge and skills to identify and challenge these disparities. By examining the impact of SDOH, discriminatory practices, and healthcare biases, nursing students can become advocates for change, striving to eliminate health disparities and promote social justice (see 5.1 Understanding Cultural Differences).

Furthermore, nursing schools are increasingly recognizing the importance of collaborative practice and incorporating interprofessional education (IPE) into the curriculum. Students from a variety of healthcare disciplines, such as nursing, medicine, pharmacy, and social work, learn together to develop effective teamwork, communication, and shared decision-making skills. IPE prepares nurses to work collaboratively in interprofessional healthcare teams to optimize patient outcomes.

Nursing education also recognizes the need for nurses to assume leadership and management roles in healthcare settings. There is an increasing emphasis on developing leadership competencies, such as effective communication, problem-solving, decision-making, and team management skills. Leadership education equips nurses to advocate for patients, drive quality improvement initiatives, and navigate the complexities of the healthcare system.

Finally, nursing education and training must continually evolve to incorporate the rapid advancement of healthcare technologies and informatics systems. Students today learn to utilize EHRs, telehealth platforms, simulation technologies, and other digital tools to enhance patient care, communication, and data management.

Legislative Trends

Current legislative trends in nursing include ongoing efforts to improve healthcare delivery, enhance patient and nurse safety, expand the scope of nursing practice, and address the nationwide nursing shortage.

Many states are expanding the scope of practice for advanced practice registered nurses (APRNs), including nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists. Legislative changes are granting APRNs greater autonomy in diagnosing and treating patients, prescribing medications, and practicing independently (ANA, 2022). This is particularly helpful in areas with provider shortages, where APRNs can help fill primary care provider needs and other crucial roles.

Another means to address provider shortages is telehealth, which gained significant importance during the COVID-19 pandemic. Legislation is being enacted to support and regulate the use of telehealth services, ensuring that nurses can provide remote care to patients across state lines. These legislative efforts aim to increase access to health care, particularly for underserved populations in rural and remote areas. Legislation is also being introduced to address the nursing shortage and promote workforce development. Related initiatives include increased funding for nursing education programs, scholarships, and loan forgiveness programs to incentivize nursing careers, and the establishment of nursing residency programs to support the transition of new graduates into practice.

The Nursing Licensure Compact (NLC) is an initiative for allowing nurses to practice across state lines without obtaining additional licenses and is one way to address nursing shortages in underserved areas. The NLC has gained momentum, with many states enacting legislation to join the compact. This legislative trend facilitates the mobility of nurses and supports the provision of care in regions with workforce shortages or during emergencies.

Finally, legislation is being introduced to address workplace violence against healthcare professionals, including nurses (Table 2.1). These laws aim to establish protections, prevention strategies, and reporting mechanisms to ensure a safe work environment for nurses and other healthcare providers.

Current Legislative Trend Examples of Proposed or Enacted Legislation How Will This Law Help?
Enhanced autonomy for advanced practice registered nurses (APRNs) R. 8812, the Improving Care and Access to Nurses (I CAN) Act. This proposed legislation aims to eliminate care obstacles permanently and enhance the availability of services offered by APRNs within the Medicare and Medicaid programs. It improves the type and availability of services that APRNs are able to provide within the Medicaid and Medicare programs.
Telehealth expansion Advancing Telehealth Beyond COVID-19 Act of 2022. Extends certain expanded Medicare benefits for telehealth services enacted during COVID-19 to December 31, 2024. Allows for the continued provision of certain telehealth services for patients who use Medicare until late 2024.
Nursing shortages R. 851/S. 246, the Future Advancement of Academic Nursing (FAAN) Act. This proposed legislation would provide funding to increase the number of nursing faculty and improve nursing educational programs. The funding provided would increase the number of nursing faculty and availability of places for students in nursing schools, ultimately increasing the number of new graduate nurses available for employment.
Violence against nurses R. 1195/S. 4182, the Workplace Violence Prevention for Health Care and Social Service Workers Act. This law would enact strict standards for healthcare employers and hold them accountable for acts of workplace violence against their employees. This law will ensure protections for nurses in the workplace against workplace violence from patients, families, coworkers, and others.
Table 2.1 Legislation Related to Current Nursing Trends (Source: ANA, 2022.)

Staffing Trends

One of the most urgent and important trends in nursing staffing is the nursing shortage. The persistent nursing shortage has been significantly exacerbated by the impact of the COVID-19 pandemic. Prior to the pandemic, there was already a shortage of nurses, driven by factors such as an aging workforce with an increasing number of retiring nurses, increased healthcare demand due to an aging population, and an insufficient pipeline of new nurses due to a shortage of nursing school openings and faculty availability. However, COVID-19 introduced new challenges. The pandemic placed an unprecedented burden on healthcare systems, creating an urgent need for nurses to care for a surge in patients. At the same time, many nurses experienced heightened levels of burnout, physical and emotional fatigue, and increased risk of illness, leading some to take early retirements or leave the profession. Furthermore, nursing education programs struggled to adapt to remote learning and provide clinical experiences safely, limiting the number of new graduates entering the workforce. As a result, the existing nursing shortage has deepened, necessitating urgent attention and strategic solutions to ensure adequate nursing staff to meet the healthcare needs of communities, both during the pandemic and in its aftermath.

Retaining and attracting new and experienced nurses has become a priority for healthcare organizations. Strategies such as improved work environments, competitive compensation packages, professional development opportunities, flexible scheduling options, and recognition programs are being implemented to enhance nurse job satisfaction and reduce turnover. Many organizations are partnering with nursing schools for academic and clinical partnerships in an effort to recruit new graduate nurses. Organizations are also focusing on fostering a positive and supportive culture that promotes nurse well-being and engagement.

Many healthcare organizations and policymakers are recognizing the importance of appropriate nurse staffing ratios to ensure patient safety and quality of care. Efforts are being made to establish and enforce optimal nurse-to-patient ratios, particularly in acute care settings. These ratios aim to balance workload and provide nurses with manageable patient assignments, reducing stress for nurses, ensuring safe and high-quality care, and improving outcomes for patients. The use of acuity tools to accurately capture patient needs and match them with appropriate nurse coverage is one way organizations are seeking to optimize nurse staffing.

Technological advancements are also impacting nursing staffing trends. The integration of EHRs, telehealth platforms, and healthcare informatics systems into practice can streamline documentation, communication, and care coordination, reducing administrative burdens and optimizing nurse workflow. Automation and robotics are also being explored to assist with routine tasks, allowing nurses to focus more on direct patient care.

Future Trends for the Nursing Profession

The future of the nursing profession holds many exciting opportunities as well as challenges that must be addressed as the profession continues to evolve. There is an increasing recognition of the importance of nursing self-care to combat burnout and ensure long-term career sustainability. Nurses are becoming advocates not only for themselves but also for systemic changes in healthcare policy and equity. Additionally, the rapid expansion of telehealth and digital healthcare delivery, catalyzed by the COVID-19 pandemic, is expected to continue, requiring nurses to adapt to new modes of care and communication. These trends collectively reflect a nursing profession that is dynamic, responsive to emerging technologies, and driven by a commitment to holistic care, social justice, and the well-being of both patients and healthcare providers.

Nursing Self-Care

The growing importance of nursing self-care stems from the recognition that nurses are susceptible to physical, emotional, and mental exhaustion due to the demanding nature of their profession. Nurses often work long hours, face high levels of stress, and prioritize the well-being of others over their own needs. As a result, they are at risk for developing burnout, compassion fatigue, and moral distress (Wolotira, 2023). Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. On the other hand, compassion fatigue is the emotional and physical exhaustion that results from providing empathetic care to those experiencing trauma or suffering. Then moral distress is the emotional and psychological distress experienced when nurses are aware of the ethically right course of action but are constrained from pursuing it due to external factors or institutional limitations. Burnout, compassion fatigue, and moral distress can lead to symptoms such as difficulty concentrating, exhaustion, trouble sleeping, isolation, anxiety, decreased empathy, and absenteeism. Left untreated, these issues can lead to even more serious issues such as depression, post-traumatic stress disorder, and suicidal thoughts or behaviors.

Self-care practices—such as adequate rest, exercise, healthy eating, and stress management—contribute to improved physical and mental well-being. Engaging in self-care activities helps nurses recharge, reduce stress levels, build resilience, and prevent the detrimental effects of burnout and compassion fatigue. By prioritizing their own well-being, nurses can better cope with the demands of their profession and maintain a positive mindset. Nurses who are physically and emotionally well can offer compassionate and attentive care, make sound clinical decisions, and effectively communicate with patients and their families. Consequently, self-care for nurses contributes to better outcomes for patients, including improved satisfaction, adherence to treatment plans, and overall well-being. Encouraging self-care practices and providing resources can also lead to decreased absenteeism, improved job satisfaction, and higher retention rates among nurses.

To address the growing importance of nursing self-care, nurses and the people who train them can implement various strategies. These include promoting self-care awareness and education, encouraging self-care practices in nursing education programs and continuing professional development, providing resources and support systems for nurses, fostering a culture of work-life balance, and implementing policies that prioritize employee well-being.

Nursing’s Role in Telehealth and Technology

Nursing’s role in telehealth and technology is expanding rapidly, transforming the way health care is delivered and accessed. Telehealth is a method of using telecommunications technology to provide healthcare services remotely. Nurses are increasingly at the forefront of utilizing telehealth and embracing technology to provide care, enhance patient outcomes, and improve healthcare efficiency. Table 2.2 identifies some key aspects of nursing’s growing role in telehealth and technology.

Nursing Role What It Is Why It Is Important
Remote patient monitoring Patients’ vital signs, symptoms, and health data are collected remotely through wearable devices or home monitoring systems. Nurses analyze and interpret the data, identify potential issues, and provide timely interventions. This allows for proactive management of chronic conditions, early detection of complications, and reduction in hospital readmissions.
Virtual consultations and triage Nurses conduct virtual consultations, provide triage services, and offer expert advice through telehealth platforms. Nurses assess patients’ symptoms, provide guidance, offer education, and determine the appropriate level of care needed. Through tele-triage, nurses help patients access timely care, alleviate unnecessary emergency department visits, and optimize healthcare resources. Nurses are also involved in delivering telehealth education and coaching to patients on disease management, medication adherence, lifestyle modifications, and self-care techniques.
Telehealth nursing hotlines Nurses staff telehealth nursing hotlines, providing 24/7 access to healthcare advice and guidance. They address nonemergency concerns, answer questions, and offer recommendations for self-care. Telehealth nursing hotlines serve as a valuable resource for patients seeking immediate assistance and contribute to the efficient utilization of healthcare services.
Collaboration and care coordination Nurses play a central role in coordinating and facilitating virtual care team meetings, discussing patient care plans, and ensuring effective communication between healthcare professionals. Telehealth facilitates collaboration and care coordination among healthcare providers. Nurses contribute their expertise, advocate for patients, and ensure continuity of care across various healthcare settings.
Health informatics and data analysis Nurses with expertise in health informatics and data analysis are crucial in leveraging technology to manage and analyze large volumes of healthcare data. They use electronic health record (EHR) to document and access patient information, generate insights, and make evidence-based decisions. Nurses play a vital role in ensuring accurate and meaningful data collection, contributing to quality improvement initiatives and research endeavors.
Table 2.2 Nursing Roles in Telehealth and Technology

Nursing Advocacy

Recent trends in nursing self-advocacy reflect a growing recognition among nurses of the importance of advocating for themselves, their professional rights, and their well-being. Self-advocacy refers to the proactive and assertive act of nurses advocating for their own well-being, professional growth, and rights within the healthcare system. Nurses are increasingly engaging in networking and working with professional organizations to amplify their voices and advocate collectively. They may join nursing associations and participate in local, national, and international nursing networks to share experiences, exchange ideas, and collaborate on initiatives. They may also utilize social media platforms and digital networks to connect, share information, and mobilize in support of each other. Regardless of the methods, more and more nurses are speaking up about the importance of work-life balance, self-care practices, and access to resources that support their emotional and psychological well-being.

A top priority is the creation of safe and healthy work environments that prioritize their well-being. Nurses are vocal about the importance of appropriate nurse-to-patient ratios, manageable workloads, and adequate rest breaks. Other important issues concern the implementation of policies and practices that prevent workplace violence, address bullying and harassment, and promote a culture of respect and support. Nurses also advocate for the implementation of wellness programs, access to mental health resources, and support services that address the unique stressors and challenges faced by nurses.

In addition to advocating for safer and more supportive work environments, nurses want more opportunities for professional growth and recognition. They seek fair compensation, benefits, and opportunities for career advancement, such as professional development programs, mentorships, and pathways for specialty certification.


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