evolution of the nursing profession essay

Evolution of Nursing: History, Advancements, and Accomplishments

Tables of Contents

Evolution of Nursing Overview

Women in nursing, evolution of nursing practice, new developments in nursing, future of nursing, evolve in your nursing career.

If trustworthiness were the ultimate prize in an annual sports event in which different career fields competed against each other, the nursing profession would hold one of the longest streaks in the history of that sport. Consider that for 20 consecutive years, the nursing profession has had the highest ethics ranking  among professions , according to a Gallup poll. While the healthcare industry as a whole saw a slight decrease in public perception in 2021 amid the COVID-19 pandemic, the nursing profession held its ground as the  most trusted profession .

The evolution of nursing, and its positive image, was sparked in the 19th century with Florence Nightingale. Her  contribution to contemporary nursing  began in 1854 when she led a corps of nurses to tend to sick and fallen British soldiers during the Crimean War. Since then, the nursing profession has evolved and has played an essential role in transforming society.

In investigating the evolution of nursing, seeing how nursing has changed over time and discussing key figures in the history of nursing are essential. Additionally, looking at developments in nursing and identifying trends can help provide a glimpse into the future of nursing.

Modern-day nursing is very different from the time of the Crimean War and different from the time of both World Wars. Nursing was considered more of a helping role than a professional career.

Today, nurses have a broader range of practice options. They can work in various specializations and focus areas, such as ambulatory care, cardiac care, and emergency rooms, or as certified nurse-midwives (CNMs) or family nurse practitioners (FNPs). Nurses also have various responsibilities, from educating patients on self-care practices to prescribing and administering medications.

The evolution of nursing from a smaller-scope profession to a field with many specialties is primarily a result of improved nursing practice education. Each nursing area  requires different skills , so no matter where nurses are in their careers, they can opt to advance their education to expand their skill sets and practice knowledge.

Nursing has evolved into a field of immense value to the U.S. and the world. Fascinating facts about the nursing profession include the following: Nursing ranks as the most honest, ethical profession in the U.S. Nursing is the largest healthcare profession in the nation. U.S. registered nurse employment growth is projected at 9% from 2020 to 2030. Nine million more nurses are needed to achieve global universal health coverage by 2030.

History of Nursing

Historical documents point to the origin of professional nursing at around A.D. 300, during the Roman Empire. But the evolution of nursing into a modern profession occurred centuries later amid a war-torn Europe. These are key highlights in the  history of nursing :

• Following the collapse of the Roman Empire in A.D. 476, the eastern part of the empire survived, becoming the Byzantine Empire. Here, nursing began rising to For example, in Constantinople during this time, two hospitals were built that had male and female nurses.
• The history of nursing continued from the Middle Ages in Europe to the 10th and 11th centuries. During this time, nurses began working as part of monasteries and other religious organizations.
• The roots of modern nursing began forming in the 18th and 19th centuries. In North America and Britain, health services were expanded and categorized into different nursing branches — the origin of nursing specialties. However, no uniform set of nursing practices existed across these geographic areas.
• When the Crimean War began, nursing advanced into a profession that more closely resembles today’s nursing practice, compared with earlier forms of nursing. The war heightened the need to treat infection-related illnesses and battle wounds that required amputation or suturing, and nurses whom  Nightingale  led stepped up to provide care on the front lines of the war.

Women such as Nightingale, traditionally recognized as the founder of modern nursing, greatly influenced nursing. Following her leadership role during the Crimean War, Nightingale would open the first nursing school in London in 1860.

Over the centuries, many women have contributed to the evolution of nursing. One of the  hidden figures of nursing history  is famed abolitionist Sojourner Truth. She went from being a live-in nurse as a slave for the Dumont family to an appointee at Freedman’s Hospital, providing nursing care for patients. Throughout her life, Truth advocated for nursing education.

The history of women in nursing includes contributions from the following historical figures:

• Mary Breckinridge.  As a nurse in World War I,  Mary Breckinridge  believed that nursing and midwifery could help bring much-needed healthcare to rural America. She founded and launched a service that included nurses on horseback to serve people in rural Kentucky. The service, which was later named the Frontier Nursing Service in 1928, reached more than 1,000 families in rural areas over 700 square miles.
• Virginia Henderson.  Virginia Henderson has helped advance nursing science, from her teaching career launched in 1923 at Norfolk Protestant Hospital, through the extensive research she conducted at Yale University School of Nursing until 1996. Her contributions include authoring several editions of the  Textbook of the Principles and Practice of Nursing  and the  need theory , which focuses on helping educate and encourage patients to become more independent in their care.
• Margaret Sanger.  Among history’s most  famous nurses  is Margaret Sanger. She’s also considered one of the most controversial figures, advocating for birth control when the practice was deemed radical and obscene. Facing the threat of prosecution, she fled to England, where she continued to promote birth control through her writings. Upon returning to the U.S., she advocated for birth control amid prosecution and arrests. Her contributions led to the founding of the International Planned Parenthood Federation (IPPF) in 1952, and ultimately, the Supreme Court’s decision to legalize birth control in 1965.
• Betty Smith Williams.  Minority rights activist, nurse, and administrator  Betty Smith Williams  was the first Black nursing school graduate from Case Western Reserve University. Later in her career, she broke even more barriers as the first Black person to teach at a California college or university. Her contributions to promoting opportunities for Black nurses included cofounding the National Black Nurses Association (NBNA). The American Academy of Nursing welcomed Williams as a fellow in 1980.
• Mary Eliza Mahoney.  For 15 years, Mary Eliza Mahoney worked at the New England Hospital for Women and Children in various roles, including maid, cook, and nurse’s assistant. In 1879, she became the first Black woman to receive professional training and graduate from nursing school. Mahoney, recognized as the  first Black nurse , became a member of the Nurses Associated Alumnae of the United States and Canada in 1896, which later became the American Nurses Association (ANA). Due to the organization’s primary focus on white nurses and delay in accepting women of color, Mahoney helped found the National Association of Colored Graduate Nurses (NACGN).

Individuals who paved the way for a new generation of nurses include Betty Smith Williams, Clara Barton, Dorothea Dix, Florence Nightingale, Margaret Sanger, Mary Breckinridge, Mary Eliza Mahoney, Sojourner Truth, and Virginia Henderson.

Women Nursing in the Civil War

During the American Civil War, the evolution of nursing continued. For example, before the war, women typically provided care to sick family members privately. In the first few months of the war, it became clear that women were needed to support the war effort. Male nurses on the battlefield were soldiers themselves, and as a result, many became casualties of the conflict, limiting nursing resources.

An estimated 620,000 soldiers died during the Civil War, many due to wound-related disease and infection. Soldiers needed care for the wounds, and women volunteered. During the war, women took more prominent public nursing roles, creating opportunities and  inspiration for women in nursing  careers after the war.

Women in nursing in the Civil War influenced the beginning of nursing as a profession after the war, including establishing standards of care and schools to promote nursing as a career further. Two prominent figures who advanced nursing during this time were:

• Dorothea Dix.  In addition to serving as superintendent of Army nurses during the Civil War, overseeing Union Army nurses,  Dorothea Dix  was an activist who set guidelines to protect women in nursing, a field that men dominated. She also advocated for mental health and poor people throughout her career, lobbying to improve mental health hospital and prison conditions.
• Clara Barton.   Clara Barton  is famous for being the founder of the American Red Cross. She was inspired to start the organization in the U.S. after traveling and volunteering in Europe, where she learned firsthand about the International Committee of the Red Cross. Earlier in her career, she was a nurse on the Civil War battlefield, earning the name Angel of the Battlefield.

How Has Nursing Changed Over Time?

Nursing has changed over time, especially in the areas of nursing practice and education. For example, nurses have a broad range of choices for practice options and specializations. A nurse can choose a nurse practitioner (NP) track and acquire the clinical knowledge and essential skills to perform similar activities as doctors, including prescribing medicines in  states with full practice authority . Common activities that nurses perform in their jobs include the following:

• Taking vital signs
• Drawing blood samples
• Recording medical histories on electronic health records (EHRs)
• Assessing and determining symptoms
• Conducting physical examinations
• Ordering or conducting diagnostic tests
• Working with physicians to recommend care options
• Providing education on self-care
• Administering medication

Nurse responsibilities have expanded over time with the heightened importance of patient safety and advanced-nursing practice, which applies science and technology to improve healthcare delivery.

Depending on specialty and type of practice, nurse responsibilities are wide-ranging. Here are examples of nurse specialties:

• Ambulatory care nurse.  Ambulatory care nurses  provide routine medical care for acute illness, chronic disease, and injuries for non-hospitalized or recently discharged patients in outpatient settings.
• Cardiac care nurse.   Cardiac care nurses  regularly collaborate with cardiologists to treat and care for patients with heart disease and related conditions, including coronary artery disease and congestive heart failure, as well as individuals recovering from bypass surgery.
• Certified nurse-midwife.  The  CNM’s  roots in the U.S. began in 1925. Since then, the role has evolved significantly to provide wide-ranging healthcare services for women and newborns, including prescribing medications in some states.
• Emergency nurse.   Emergency nurses  work in fast-paced settings — emergency departments, ambulances, and urgent care centers, for example — treating patients with a wide range of illnesses, from injury and fever to respiratory trauma.
• Family nurse.  FNPs  typically focus on preventive care and the long-term health of individuals of any age, from newborns and children to pregnant and postpartum women and older adults.

Providing nurses with an evidence-based framework to maximize health outcomes is an important aspect of the evolution of nursing and can be traced back to Nightingale. She documented how deplorable hospital conditions affected soldiers recovering from disease and battle wounds and how hot water and soap helped improve patient care.

Evidence-based practice  began appearing in literature in the mid-1990s, but the nursing community didn’t embrace it until the 2000s. In nursing, it’s a systematic approach that integrates clinical expertise with scientific knowledge to improve practice and patient outcomes. For example, a primary tenet in evidence-based practice  implementation in nursing  includes meeting a patient’s needs and weighing each patient’s experiences and preferences.

Evidence-based practice can also help guide nurses to:

• Identify clinical problems and apply effective interventions correctly
• Evaluate current methods to identify areas for improvement
• Apply new knowledge in clinical practice to further advance nursing science
• Deliver higher quality and safer care to improve patient outcomes
• Make better patient care decisions and eliminate activities of little to no benefit to patients
• Streamline healthcare processes through technology and best practices, saving nurses valuable time
• Provide individualized care to patients

Resources on Nursing Changes Over Time

Learn more about the evolution of nursing practice and the different nurse specialties available today in the following resources:

• Explore Specialties, DailyNurse : This resource provides a list of 200 different nursing specialties.
• “25 Types of Nurses,” Healthline : This resource explores the crucial roles for dozens of nurse specialties.
• Incredible Health, A Complete List of Nursing Types : This guide lists the different types of nurse specialties, with information about degree requirements, responsibilities, and more.
• How To Find Your Nursing Specialty, Nomad : This advice guide breaks down 20 nurse specialty options.

Nursing has grown in complexity since its inception. New developments in nursing, such as the increased use of technology (telehealth, automated equipment, EHRs), have become essential components in care delivery. Additionally, a more diverse nursing workforce helps elevate cultural awareness and empowers nurses to better provide care to people with varied backgrounds.

As the aging population continues to expand and amid the sudden shifts in healthcare that COVID-19 has caused, patient care will become more complex. These developments create opportunities to address these challenges. Here’s a list of major developments in nursing:

• Education . Ever since the first nursing school was established in London in 1860, nursing education has paved the way to modern nursing. Nurses are expected to adapt, and education plays a pivotal role in developing new nurses and preparing them for success. A bachelor’s degree provides nurses with the knowledge to meet the needs of today’s patients and ever-evolving and shifting healthcare environments. Modern nursing education also allows nursing graduates to pursue advanced education and choose from a wide array of careers and specializations.
• Diversity, including ethnicity and gender.  Patient populations are more diverse than ever. At the same time, social inequalities that discrimination and other structural factors have created have put some minority groups at risk of not receiving the care they need. The diversification of the nursing workforce helps to address these issues and keep cultural competence at the forefront of patient care.
• Technology, including telenursing and  nursing informatics .  Data is critical to every aspect of modern society, and it’s no different in the nursing field. Through nursing informatics, healthcare organizations can acquire, process, and assess patient data from different sources, providing enhanced knowledge that can benefit nurses in delivering patient care. Telenursing enables nurses to connect with patients through mobile devices and apps, laptops, videoconferencing technology, and remote patient monitoring.
• Leadership . Nurses such as NPs can now lead medical practice, prescribe medicines, and serve on leadership boards at hospitals.

Opportunities and changes in the modern nursing profession include increased focus on ethnic and gender diversity; technological innovations, including telenursing and nursing informatics; leaders who oversee medical practices and serve on leadership boards; and educational options in a wide array of specialties.

Resources on Developments in Nursing

For a glimpse of new developments in the evolution of nursing and how they may impact the future of healthcare, the following resources offer some insights:

• Top 16 Nursing Trends That Will Shape Healthcare in 2022, Altus : This resource provides a top 16 countdown of nursing trends in 2022 and beyond.
• “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, National Academy of Medicine : This resource includes links to articles, reports, podcasts, and more discussing the future of nursing.
• “What Is Telehealth Nursing: Grow Your Skills,” Relias : This resource examines how telehealth in nursing has been around for many years, and why it’s becoming more prominent today.

The U.S. Bureau of Labor Statistics (BLS) reports that 3,080,100 individuals were employed as registered nurses (RNs) in 2020. In terms of  job outlook , the future of nursing careers looks promising. The field is expected to grow by 9% from 2020 to 2030, adding about 276,800 new positions, according to the BLS. Due to this growth and other factors such as nurse retirements and career changes, the BLS projects 194,500 RN job openings per year over the period.

The International Council of Nurses reports that there will be a need for up to  13 million more nurses worldwide by 2030 . Burnout, retirement, and other factors create challenges in retaining nurses. However, this is also creating job opportunities for new nurses and NPs to help fill the nursing gap.

Additionally, a growing demand exists for nurses with bachelor’s or higher degrees to fill high-level leadership roles. These levels of education provide the clinical preparation and knowledge for nurses to help address challenges in the healthcare industry, including helping alleviate the need and fill the gap of primary care physicians.

In fact, many patients go to FNPs as their primary healthcare providers. In some states, FNPs can even start their own practices. As the need for primary care providers grows, there will be an increased need for nurse leaders who can deliver care and leadership.

The work of nurses is critical for the evolution of healthcare systems as many take on increasing responsibility while staying true to their primary purpose: providing high-quality care.

From providing acute care in hospitals to promoting the health of individuals, families, and communities through education, advice, and counseling, the evolution of nursing in modern society has helped advance the U.S. healthcare system and improve the lives of millions of people.

Nursing in modern society also benefits the employment sector. According to a  fact sheet  from the American Association of Colleges of Nursing (AACN), the nursing profession is the largest in the U.S. healthcare industry, with continued growth and leadership opportunities in the field.

A graduate education is recommended for individuals who want to expand their clinical practice skills and pursue their leadership and goals — for example, becoming NPs. NPs can prescribe medicines, which only medical doctors could do in the past, and launch a primary care practice, thanks to the clinical and leadership knowledge they acquire from an advanced nursing education.

• Master of Science in Nursing
• Doctor of Nursing Practice
• Nurse Practitioner Programs

Infographic Sources

American Association of Colleges of Nursing, AACN’s Vision for Academic Nursing

American Association of Colleges of Nursing, Nursing Fact Sheet

Cleveland Clinic, “The Evolution of Nurses as Leaders of Patient Care”

Gallup, “U.S. Ethics Ratings Rise for Medical Workers and Teachers”

HealthTech, “The Impact of Technology in Nursing: Easing Day-to-Day Duties”

Pulse Uniform, 25 Famous Nurses Past to Present World’s Popular Nurse Professionals

Trusted Health, “Black History Month – Notable Nurses Throughout History”

U.S. Bureau of Labor Statistics, Registered Nurses

World Health Organization, Year of the Nurse and the Midwife 2020

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The Evolution of Nursing

As caretakers of children, family and community, it was natural that women were the nurses, the caregivers, as human society evolved. Nursing may be the oldest known profession, as some nurses were paid for their services from the beginning. This was especially true of wet nurses, who nursed a baby when the mother died or could not nurse her child. A woman whose infant did not survive birth, or who was ready to wean her child, or who was capable of nursing more than one baby, would accept employment as a wet nurse, usually going to live in the home of her employer.

The home, in fact, was the center of health care, and for the first two centuries after European exploration of North America, all nursing was home nursing. Even when the nation’s first hospital began in Philadelphia in 1751, it was thought of primarily as an asylum or poorhouse; another century or more would pass before the public viewed hospitals as reputable and safe.

The Civil War gave enormous impetus to the building of hospitals and to the development of nursing as a credentialed profession. Initial wartime volunteers, however, often were seen as no different from “camp followers,” the women (sometimes mistresses and sometimes wives) who followed their soldier men. It was an era of sharp class definitions, and especially in the South, “respectable” women could not be seen in a military hospital.

Some women had the courage and common sense to defy decorum, though, especially in the North, where the US Sanitary Commission became the forerunner to the Red Cross. The best known of these women, of course, is Clara Barton —but her genius was in supply distribution and in development of systems for the missing and dead, not in nursing. Barton herself acknowledged that she actually nursed for only about six months of the four-year war and that other women did much more.

Mary Ann Bickerdyke 1898

Perhaps the best known nurse at the time, was Mary Ann Bickerdyke of Illinois. A middle-aged widow, her accidental career began when she delivered money raised by local charities to the giant, if temporary, hospitals that the Union built at the junction of the Mississippi and Ohio rivers. After witnessing suffering soldiers who had literally no one to care for them, she went on to be the only woman that General William T. Sherman allowed with his army. At the Tennessee battle of Lookout Mountain, she was the sole nurse for some two thousand men.

In the Confederacy, the most prominent nurses were Captain Sally Tompkins and Phoebe Pember. Tompkins was commissioned as an officer in the Confederate army so that she could have the power to commandeer supplies. She converted her Richmond mansion into Robertson Hospital and established a reputation for extraordinary quality: Tompkins’ hospital had by far the lowest death rate of any facility in the North or South, even though physicians sent their worst cases to her. Her staff of six—four of whom were black women still in slavery—treated more than 1,600 patients and lost only 73, an uncommonly low number in an era before germ theory was understood.

Phoebe Levy Pember c. 1855

Phoebe Levy Pember has become somewhat better known since the Post Office recently included her on a series of Civil War stamps. A young widow from a wealthy, Jewish family based in Charleston and Atlanta, she went north to the Confederate capital of Richmond and eventually ran the world’s largest hospital. On an average day, Pember supervised the treatment of 15,000 patients, most of them cared for by nearly 300 slave women.

The war thus led to greater respect for nurses, something that Congress acknowledged in 1892, when it belatedly passed a bill providing pensions to Civil War nurses. More important, the war served as the beginning of moving the profession from the home to the hospital and clinic. The result was an explosion of nursing schools in the late nineteenth century. Usually these schools were closely associated with a hospital, and nurses—all of whom were assumed to be female—lived and worked at the hospital.

Often called “sisters” (as British nurses still are), their lives were indeed similar to those of nuns. Forbidden to marry, they were cloistered in “nurses’ homes” on hospital grounds, where every aspect of life was strictly disciplined. Student nurses were not paid at all, and because too many hospitals valued this free labor over classroom and laboratory time, many spent their days scrubbing floors, doing laundry, and other menial tasks. Curricula improved, however, in part because of the development of a tradition with caps: each nursing school had a distinctive cap that women wore after graduation, and because her educational background was literally visible every day, schools soon raised standards so that their graduates would affirm their quality.

There were more female physicians (and hospital administrators) during the 19 th century than most people realize today—and some of these female physicians recognized the need for nurses and worked to professionalize the occupation. Dr. Marie Zakrewska founded a medical school for women in Boston that was affiliated with her New England Hospital for Women and Children in 1862, during the Civil War—and a decade later, in 1872, she began an associated nursing school that was the nation’s first.

Linda Richards c. 1907

Linda Richards was its first graduate and thus is known as America’s first professionally trained nurse. Richards went on to establish her own precedent-setting programs as superintendent of nursing at New York’s Bellevue Hospital and at Massachusetts General Hospital; she also set up the first nursing school in Japan.

Like most educational institutions at the time, these schools did not admit African Americans, and the informally trained black women who nursed during the Civil War seldom were able to obtain credentials. The first credentialed black nurse was Mary Mahoney, who graduated in 1879 from Dr. Zakrewska’s nursing school in Boston. As segregation remained the rule far into the 20th century, Mahoney led the National Association of Colored Graduate Nurses, which began in 1908.

During the four decades between the Civil War and the beginning of the twentieth century, the image of nurses moved from being viewed as somewhat less than honorable to a respected profession. The next century would bring still more changes, and nurses of the 19 th century would scarcely recognize the occupation as it is in the 21 st century. They would, however, agree that a world of difference has occurred in the care of patients, and that has been an unmitigated good—achieved primarily by women.

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Q&A with Author Sarah DiGregorio on Taking Care: The Story of Nursing and Its Power to Change Our World

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We sat down with journalist and critically acclaimed author Sarah DiGregorio to discuss the history and evolution of nursing in her new book, “Taking Care: The Story of Nursing and Its Power to Change Our World.”

Sarah DiGregorio

Sarah DiGregorio is a journalist and critically acclaimed author of, “Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human and Taking Care: The Story of Nursing and its Power to Change Our World.” DiGregorio has written for the New York Times, the Washington Post, the Wall Street Journal, Slate, and Insider, among others. She has been a keynote speaker for many universities, corporations, and professional organizations. She lives in Brooklyn, New York with her daughter and husband.

Q&A with Sarah DiGregorio

Nursejournal (nj): in capturing the long history of nursing, you use a broad definition of “nurse.” so what defines a nurse.

Sarah DiGregio (SD): There have always been skilled and organized practitioners who have focused on maximizing people’s health and well-being in a holistic context. Nurses think about patients not just as different organ systems but as full people. What kind of housing they have, what kind of food and water they have access to, what their community is like. Nurses think about health and wellness in a very relational way.

Is this person a hands-on practitioner? Are they thinking about someone’s well-being in their full context? Are they engaged in the community and thinking about the way that the community can create health or ill health? Today, medicine is one tool of nursing, but it is only one tool — it’s not the focus of nursing. Medicine is very concerned with the processes of disease, the functions of the body, and alleviating illness, whereas nursing is always thinking about prevention and advocacy for public health.

NJ: In “Taking Care,” you trace how nursing has played a key role in establishing and developing societies throughout history. You also point out how nursing skills have been written out of history. Why has the foundational role of nurses been ignored?

SD: The earliest kinds of nursing were done in the home, in very domestic settings. Recording these kinds of stories and telling those stories for posterity doesn’t always serve the victors. For instance, the Roman Empire depended on nurses. The Romans knew that if they didn’t have healthy troops, they would never be able to maintain these far-flung outposts — but nursing is like an invisible hand in these stories.

In the United States, nursing was practiced by enslaved people who brought their own expertise from their own healing traditions. Enslaved people were often forced to work as a nurse, but they also chose to nurse, often within their own communities. The majority of babies born in slave states, both Black and white, were delivered by African-American midwives, and this persisted until the beginning of the 20th century.

Why has nursing been written out of history? It’s a combination of factors. Nursing is done in the home. It’s not a story of domination or power. And it was often done by women and enslaved people whose stories were written out of history on purpose.

NJ: Prior to the past few hundred years, nurses were respected authority figures. Yet modern healthcare places nurses in a subordinate role to physicians. From your perspective, what changed?

SD: I would suggest that we need to go back to the establishment of the first medical schools in Europe. When medical schools were established in the Middle Ages, for the most part women were not able to go to medical school with the notable exception of the University of Salerno. Before this, there were apprenticeships, there were guilds, there was a healthcare system and a healthcare economy. People learned by doing — there was a lot of empirical knowledge passed down in oral traditions.

But then medical schools were established. Suddenly, there was this new kind of practitioner. They were exclusively men. They had to have the status that was necessary to go to these schools. These new practitioners had to invent a difference for themselves because they didn’t have more practical knowledge for actually alleviating suffering and helping people.

The faculty at medical schools embarked on a centuries-long quest to establish why they were better. We went to medical school, we are licensed as physicians, we are educated as physicians — and you’re not. It became illegal to practice medicine without a license, but you could only get a license by going to medical school, and only men of a certain status could go to medical school.

Jacoba Felicie was a very well-established physician in 14th-century Paris. She was charged with practicing medicine without a license, and she was convicted even though her patients testified that she cured them. But she had broken the law because she didn’t have a license.

The idea of a physician as a high-status man who has gone to medical school became the lynchpin in this new hierarchy. Physicians use language about patient safety and quackery to justify the hierarchy. You can trace that language straight through to the present when the AMA says that nurse practitioners are dangerous for patients.

But this new healthcare hierarchy that privileged male physicians had a problem––there were all these other practitioners who had lots of experience, but also, there weren’t enough physicians. Gendering the medical schools and gendering the idea of expertise created a hierarchy that said women could practice healthcare, but they couldn’t give medicines. That evolved into a subordinate female role.

NJ: Florence Nightingale is often the defining figure in nursing history. For many nursing students, Nightingale might be the only historical figure mentioned in textbooks and lectures. Why is that a problem?

SD: It’s a problem because it’s not true. It’s not true that she founded nursing; It’s not even true that she founded modern nursing. And when we say it’s true, we imply that nurses are one kind of person and nursing is one kind of practice. That has served to keep many people out of nursing, and it has served to keep nursing disproportionately white. It has served the modern healthcare hierarchy.

I do not think it’s an accident that Florence Nightingale became the archetypal nurse. When she hired nurses for the Crimean War in 1853, she hired only white women. Mary Seacole , a Jamaican-Scottish woman, tried to join the group and was rejected specifically because of her race.

Nightingale made nursing, which could have been subversive to the social order, quite palatable to those in power. She made sure that the version of nursing that she put forth was one that reinforced social norms instead of disrupting them. And it’s a problem because nursing has come from everywhere. It’s been done by everyone. And if we say nursing is only done by nice white ladies who should keep their heads down and stay out of politics––first of all, it’s not true. Second of all, it robs nursing of its true power.

NJ: Misogyny, racism, and marginalization are central threads in the history of nursing. How can learning about the history of nursing help better prepare today’s nursing students for the challenges of 21st-century nursing?

SD: It’s important for nursing students to know that nursing has been foundational to the establishment of human societies all around the world. Nursing has come from so many different places — nursing has been a fundamental human endeavor. It’s important that nurses understand that nursing is not small. Nursing is just as fundamental to the way that human society functions as art and literature, as medicine. It’s fundamental to how we organize ourselves, and it’s fundamental to how our society functions.

Nurses from marginalized groups and men face a sense that they don’t belong in nursing. That’s not true. Looking at history can absolutely tell us that nursing doesn’t belong to any one group.

There’s a lot of vested interest in nurses not recognizing their own power. Understanding history can help nurses recognize their power. History can let them know that if someone says, “There’s only one way to be a nurse, you have to graduate from nursing school and then you go work on the med-surg unit and that’s how you become a nurse.” That’s one way to become a nurse, but actually, there are so many ways to become a nurse, and there are so many ways that nursing knowledge and nursing expertise can work in the world and can make the world better.

Nurses should understand that they are part of that tradition. Nursing knowledge and expertise are relevant in so many settings. Broadening the lens in this kaleidoscopic way might give nurses a better sense of their own power.

NJ: “Taking Care” tackles important topics like the role of nurses in climate change, reproductive access, and treating substance use disorders. Based on your research, what do you think is missing from nursing education today?

SD: I would suggest that this idea is prevalent in nursing education: you have to go work on the medical-surgical floor, or you have to work in a hospital to be a real nurse. I think that it would be useful for nurses to know more about how they can use their nursing skills and expertise in other settings.

Hospitals are not set up often to fully recognize or value nursing expertise and nursing practice. Hospitals can be a really terrible place for nurses to work, even though we very much need nurses and hospitals. I think it would be good for nursing students to know that there are other ways of being a nurse. Being a nurse is about maximizing people’s health and well-being, thinking about prevention, advocating for people and for populations, and helping people have health literacy. There are so many ways that that skill set can work in the world.

A lot of times nurses do quit. They walk away from nursing because hospitals can be very abusive places to work. I would hope that we can open up more avenues for nurses to work in the world and that nursing schools could be a part of that.

NJ: You note that as many as 57% of newly graduated nurses quit their jobs within the first two years. What are some of the systemic problems that nurses face in the American healthcare system?

SD: When this has been studied, a very large proportion of nurses quit because of burnout. When researchers investigate what people really mean by burnout, it means a lack of support from leadership. It means a lack of safe staffing, so not having enough nurses — having to take care of so many patients that you don’t feel that your care is safe.

Often nurses quit early in their careers because the workplace conditions can be unbearable and there is a disconnect in terms of what they thought that they were going to be doing and what they actually find themselves doing. So many people go into nursing because they’re interested in science and also they want to help people. They want to alleviate suffering. They want to maximize well-being. They want to have meaningful connections with their patients.

And a lot of times, the reality is that the way that hospitals are set up in terms of staffing, that is not possible. Sometimes this is called moral injury, when nurses are asked to do their jobs in a way that they don’t feel is congruent with their values. If I have seven patients and I know I can’t safely take care of seven patients with the conditions that they have, it ends up feeling like you’re actually hurting patients instead of helping patients. That’s something that causes nurses to quit.

NJ: So many of the challenges facing nurses today, from poor working conditions to low wages, have long historical roots, as in your example of early 20th-century nurses who essentially worked in hospitals for free. How can nurses today take on these ingrained problems?

SD: The best way that I know of is unionization. Certainly, there are other ways, but the way that has been most effective in nursing is unionization. Nurses are a very big group of people––they are certainly not homogeneous, they have differing political backgrounds and beliefs. Also, there has been often historically and currently a demand on nurses that they “stay out of politics,” “stay above it, just focus on patient care.” Engaging in organizing, activism, and any kind of political activity is somehow not befitting of a nurse.

Those pressures on nurses have served the interests of corporations that run hospitals to make a profit. When nurses do organize and unionize and fight to have workplace conditions that most benefit patients, they are incredibly powerful. The truth is that none of it could run without nurses. If every nurse walked off the job right now, the entire country would fall apart. There are 5 million registered nurses in this country. Nurses are the largest group of healthcare professionals. They provide the vast majority of patient care, and they are not valued in hospitals the way that they should be.

The California Nurses Association was responsible for lobbying for the only comprehensive staffing legislation in the country — that was brought about by unions. There’s a lot of research that shows that staffing laws actually save lives. You’re more likely to survive or have a good outcome if your nurse has time to take care of you. So it’s not just about nurses, it’s about everybody.

More nurses have joined unions since the pandemic. Maybe it pushed some nurses towards the fight because it became incredibly clear that they would have to fight but it also pushed nurses to quit.

NJ: The COVID-19 pandemic has had an enormous impact on the healthcare system and nurses. What lessons did the pandemic impart for nurses in the future?

SD: I’m in New York, and I remember very clearly when we all came out to bang pots and to clap for the nurses and physicians and everyone else working in our hospitals. It was such a bleak moment. There was nobody on the streets, there were constant sirens. I live down the street from a crematorium, and it was billowing smoke night and day.

There was something so comforting about the ritual of coming together to say there are people out there who are trying to keep our neighbors alive. And at the same time, of course, that was not what nurses needed. What they needed was adequate protective equipment. They needed adequate staffing. They needed for their lives to be valued, and that wasn’t what they got.

The pandemic for nurses may have just reinforced the idea that people don’t know what they do. We put them on a pedestal, but we don’t really give them what they need to do their jobs well or even to stay alive.

I don’t know if the pandemic had a lesson to teach nurses; I think nurses got through it––or many of them got through it––because of their skills and because of camaraderie among nurses and other healthcare staff.

When it came right down to it, when there wasn’t enough PPE, hospitals only sent nurses into the room. Housekeeping didn’t go in, physicians often didn’t go in, unless there was a procedure that was medically necessary where the physician had to be in the room. Nobody went in but the nurses. It was quite clear that nursing care was the only care that was non-negotiable in hospitals. I think nurses knew that already.

I was hoping that there was a lesson for the public. We all have emotions for nurses, we are primed to appreciate them, and we know how important they are. The disconnect is really understanding what they do and what they need in order to do the work that keeps us all healthy. I always wonder if this is a missed opportunity — or maybe it’s still an opportunity — for nurses and the public to come together and understand each other better. Nurses talk to other nurses, and the public gets information from the media. And the media does not quote nurses as experts. A study showed that nurses were quoted as experts in healthcare articles 2% of the time.

So the public is clearly primed to feel grateful for nurses and yet we are living in an information vacuum about nurses. Nurses are saying we don’t need appreciation, we need good working conditions so that we can continue to serve our communities. I think there’s an opportunity there because our interests align– the question is how to get there.

NJ: “Taking Care” investigates the tension between nursing as a caring profession and the power of nurses when they take action. What do you hope nurses and nursing students take away from your book?

SD: I hope that they take away that it’s not a tension. In fact, the power is the caring. Our communities have to function, and we need caring work for our communities to function. If we don’t have it, our communities will not function.

I would like to reimagine caring work as the most powerful work. It is the most complex work. There is nothing more complicated than human beings. I hope that what nurses and nursing students can take from the book is actually doubling down on the caring. The caring does not mean that you need to walk away from fights or express your own power. In fact, the caring is what demands that you take action.

Page last reviewed on November 4, 2023

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The Evolution of Nursing Overview Essay

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When defining the notion of nursing in the context of the 21st century, many people fail to reflect on the historical precedents that contributed to the development of nursing as a separate qualification. Hence, since the beginning of the 19th century, nursing has been recognized as a significant part of healthcare that requires a specific education curriculum and expectations from future professionals. Such a dramatic turn was encouraged by Florence Nightingale, who introduced the idea of professional nursing, implying the specialized preparation of nurses in order for them to be responsible for patient care (Roux, 2017). Prior to Nightingale’s actions, the profession of nursing was not considered useful, as it was nuns and monks who were mostly responsible for patient care at home. However, besides this significant intervention in the history of nursing, there are various precedents that helped shape today’s perception of nursing.

To begin with, it is necessary to dwell on the history of professional nursing in the territory of the United States. Hence, the commencement of nursing traces back to 1872, when the Nurse training school of Woman’s Hospital in Philadelphia was opened (Roux, 2017). Later, other states followed suit and opened facilities for professional nursing training, and they eventually graduated hundreds of successful nurses who advocated for the occupation’s national licensure. For example, Sophia Palmer, a Boston nursing school graduate, became the first editor of the American Nursing Journal, addressing the history of nursing and other various scholarly articles (Roux, 2017). Hence, it may be concluded that the evolution of the nursing profession in the US context is primarily associated with providing nurses with education, professional equipment, and advocacy for the nurses’ labor and civil rights.

Another significant contribution to the development of professional nursing and scope of responsibility took place in the US in 1992. According to the researchers, this year marked nurses’ first cooperation with the National Congress in order to promote nursing a way to improve society and public health (Roux, 2017). As a result, the paradigm of the nursing profession has gone beyond patient care, providing professionals with the ability to lead and manage.

Roux, G. & Halstead, J. (2017). Issues and trends in nursing: Practice, Policy and Leadership (2 nd ed.). Jones & Bartlett Learning.

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The Professional Nurse: Four Decades of Immense Change

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• 1 Author Affiliation : Director, Magnet Recognition Program®.
• PMID: 34910703
• DOI: 10.1097/NNA.0000000000001094

As one of the world's oldest occupations, nursing has seen, inspired, and innovated a host of changes. The evolution has been especially evident for the last 39 years. Since the 1980s, a growing focus on autonomy, research, and evidence-based practice has transformed nursing from a job to a profession. Concepts such as shared governance, interprofessional collaboration, and frontline engagement have transformed nurses from doctors' assistants to empowered and independent clinicians directly impacting patient outcomes and the healthcare environment. As the 30th anniversary of the American Nurses Credentialing Center comes to an end and the original Magnet® research celebrates a 39th birthday, we take a closer look at how the Magnet framework reflects these changes and how Magnet-designated organizations continue to advance nursing practice with innovation, knowledge, and leadership.

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The History of the American Nurses Association

The history of the American Nurses Association (ANA) is best described as the story of individual nurses everywhere. From front-line volunteering in the nineteenth century to the budget cuts of today, nurses face obstacles which unite them. By coming together, we have been able to mobilize nursing’s incisive knowledge of the health care system to stand up for injustice and provide the momentum needed to lead health care forward. 

At the turn of the 20th century, nurses exhibited the very same strengths as we see today; yet without accreditation, licensing or unifying organizations, they had no single voice – no platform from which to lead towards better health care for all. That is where we came in. 

ANA has come a long way since 1896. When the Nurses Associated Alumnae of the United States and Canada first assembled at Manhattan Beach Hotel, near New York City, fewer than twenty of the delegates were nurses. At the corresponding convention just two years later, more than 10,000 nurses were in attendance.  

When the organization became the American Nurses Association in 1911, it was already fighting for the profession to gain the respect it deserved. Policy makers began to recognize the importance of nursing’s value to health care, and through annual conventions and academic journals, the shared wisdom of nurses inspired others to join the profession. 

Over the past 100 years, ANA has built on this spirit of solidarity and action. Protecting the interests of nurses across the United States is an integral part of ANA’s legacy. From lobbying for an eight-hour working day in 1934, to supporting the Fair Pay Act in 1995, to campaigning for wider health care reform today, it has tirelessly safeguarded the rights of its members. 

But far from solely protecting the concerns of its nurses, ANA has always used its position to take a lead role in the protection of public health. Just as a nurse identifies medical conditions through careful observation, so has ANA used the expertise of our membership to confront the health problems of the day head-on. Mental health, primary care shortages and the Zika virus are a mere fraction of the issues addressed through practice and policy development by ANA. 

More than reacting to issues and tackling obstacles, we have fought to see innovation in nursing recognized throughout the profession. ANA has supported recommendations by the National Academy of Medicine (formerly the Institute of Medicine), which would enable nurses to work within their scope-of-practice and use the full extent of their knowledge to best serve patients. By recognizing the true skill level of the profession, nurses are given greater prominence in the health care journey – and patients are the first ones to benefit.

To achieve this recognition, ANA has promoted extensive education and development. From endorsing five-year study for all phases of nursing in 1950, to establishing its own credentialing center in 1990, it has supported nurses in obtaining the skills and confidence they need to succeed. Nurses are more ambitious than ever to build on their qualifications throughout their careers, and the breadth of ANA programs reflects its members’ commitment to improving the profession.

When American nursing pioneer Alice Fisher wrote to Florence Nightingale in 1877 (see "Background to the ANA Nightingale letter" below), she did so for support, guidance and with a zeal to improve the conditions she witnessed. While the landscape of nursing has changed, it is still by uniting and sharing knowledge that nurses can make the most impactful difference in the 21st century.

Background to the ANA Nightingale letter

Miss Alice Fisher, born in England June 13, 1839, trained at the Nightingale Training School and Home for Nurses. Between the years 1876 and 1888, Alice Fisher reformed the nursing services of four important general hospitals – a feat that has probably never been equaled by any other woman, according to Sir Zachary Cope, M.D., - author of Florence Nightingale and the Doctors.

In 1876, she volunteered to be superintendent of the Fever Hospital, Newcastle on Tyne, where she found wards dirty and unkempt. Under her direction, the hospital known as a “pest house,” was cleaned, nurses trained, and the institution lost its notoriety for ward filth.

Miss Fisher was next called to reorganize the Radcliffe Infirmary in Oxford, and then went to Addenbroke’s Hospital in Cambridge. In 1882, she became superintendent of the General Hospital in Birmingham, remaining to establish a school of nursing.

Miss Fisher wrote to Miss Nightingale on November 23, 1877 from Addenbrooke Hospital, at Cambridge. In her letter, Miss Fisher recounts the difficulties and problems she encountered establishing a worthwhile nursing program and staffing it with good trained nurses. When she went to America to reorganize nursing in the Philadelphia City Hospital (now Philadelphia General Hospital), she faced a political machine that opposed her reformation. She received threatening letters, and even faced bombings.

Then she writes:

….”and now dear Miss Nightingale forgive me if I ask you a very great favor: this is our first Christmas here together – will you write my children and me a little message of encouragement that I may read them on that day. It will be such a help to us all. I should not dare to ask you only I know that you take an interest in and are willing to help even our heartfelt endeavours [sic] to walk worthy of our profession. Forgive me this long letter and believe me every your grateful servant, [s] Alice Fisher”

The ANA Nightingale letter is Miss Nightingale’s response to Miss Fisher’s request for words of encouragement.

After Fisher completed her work in the English hospitals, which included establishing a school of nursing, she travelled to the U.S. in 1884 where she created order from chaos in the Philadelphia City Hospital (now Philadelphia General Hospital) and established the hospital’s training school.

Her nursing career was brief – a mere 13 years after training – but remarkably productive. She died of heart disease in 1888, and is buried in The Woodlands Cemetery, Philadelphia, PA.

The letter was presented to ANA by Edith G. Walker, associate professor, Division of Nursing, University of Massachusetts, Amherst. Ms. Walker, who acquired the letter from a London antique dealer wrote: “The letter is really an inspiration for nurses today…”

Related resources

• Florence Nightingale Letter - 1877 pdf (3.01MB)
• Florence Nightingale Letter - 1877 - Transcription pdf (0.56MB)
• F. Nightingale Letter to Mrs. Robertson July 28, 1893 pdf (0.33MB)
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• Expanded Historical Review of Nursing and the ANA - Members Only pdf (0.36MB)
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evolution of nursing

• Dr. Rachel Andel
• November 8, 2022
• Nursing Essay Examples

Assignment: Evolution of Nursing

Overview: Nursing has evolved significantly over the years, adapting to changes in healthcare, technology, and societal needs. This assignment explores the historical development of nursing, key milestones, influential figures, and how nursing has evolved to meet the demands of the modern healthcare system. You are required to conduct research, analyze historical data, and present your findings in a well-structured essay.(Evolution of Nursing Essay Example)

Instructions:

• Conduct thorough research on the evolution of nursing. Utilize academic journals, textbooks, reputable websites, and historical archives to gather relevant information.(Evolution of Nursing Essay Example)
• Write an essay (word limit: 1500 words) that explores the following aspects of nursing evolution: a. Historical origins of nursing and the role of early caregivers. b. Major developments in nursing during the 19th and 20th centuries. c. Influential nursing theorists and their impact on nursing practice. d. Key milestones in nursing education and professionalization. e. The role of technology in shaping modern nursing practices. f. Current challenges and future prospects for the nursing profession.(Evolution of Nursing Essay Example)
• Your essay should be well-organized, properly referenced, and written in clear, concise language.

Marking Rubric:

• Content (50 points): a. Comprehensive coverage of the evolution of nursing and all assigned aspects (10 points). b. Accurate and well-researched information from credible sources (20 points). c. Clear understanding and explanation of historical developments and key milestones (10 points). d. In-depth analysis of influential nursing theorists and their impact (10 points).(Evolution of Nursing Essay Example)
• Organization and Structure (20 points): a. Clear introduction and conclusion (5 points). b. Logical flow of ideas and well-structured paragraphs (10 points). c. Proper use of headings/subheadings to enhance readability (5 points).
• Writing Style and Clarity (15 points): a. Proper grammar, punctuation, and sentence structure (5 points). b. Use of formal language and appropriate vocabulary (5 points). c. Concise and coherent writing, free from excessive jargon (5 points).
• Referencing and Citations (15 points): a. Correct use of APA/MLA referencing style (5 points). b. Accurate citations for all sources used (5 points). c. Inclusion of a bibliography/reference list (5 points).(Evolution of Nursing Essay Example)
• Originality and Critical Thinking (10 points): a. Unique insights and thoughtful analysis of the subject matter (5 points). b. Demonstration of critical thinking skills and connecting historical context to present-day challenges (5 points).

Total: 100 points

Submission Guidelines:

• Submit your essay as a typed document in PDF or Word format.
• Include a cover page with your name, student ID, course title, and assignment title.
• Ensure proper formatting and adherence to the word limit (1500 words).
• Submit the assignment by the given deadline.

Note: Plagiarism will result in severe academic penalties. Always provide proper references and citations for all sources used in your research

How has nursing practice evolved over time? Discuss the key leaders and historical events that have influenced the advancement of nursing, nursing education, and nursing roles that are now part of the contemporary nursing profession.

Evolution of Nursing Essay Example

As one of the oldest professions, the changes faced and inspired by nursing have contributed to improved patient outcomes and the nursing landscape. The emergence of nursing as a profession is credited to Florence Nightingale in the 19 th Century (Karimi & Alavi, 2015). Florence Nightingale was a British nurse known as the founder of modern nursing. Initially, nursing was not seen as a spectacle career, precisely when it involved nursing strangers. However, Nightingale believed that applying scientific principles and informed education about healthy lifestyles were central to positive patient outcomes. Besides, she believed that nursing was an ideal profession that provided social and intellectual freedom for women.(Evolution of Nursing Essay Example)

Nightingale’s beliefs were first tested in the Crimean War in 1854 with other nurses as they attended to wounded British soldiers based on 19 th -Century science. Nightingale and the team sanitized the walls of the barrack hospitals, provided ventilation, nourished the soldiers, and administered medication efficiently (Glasper, 2020). These actions lowered death rates significantly and mitigated infectious diseases. Nightingale’s actions challenged the existing social norms and justified the value of educated nurses. Since then, nursing practice has significantly evolved since its emergence in the mid-19 th Century.(Evolution of Nursing Essay Example)

Following Nightingale’s footsteps were nurses and nurse leaders such as Linda Richards, who pioneered high-quality and professional nursing in the United States (Glasper, 2020). Alice Fisher, the other notable nurse, immigrated to the United States from England and established a nurse training school and Philadelphia Hospital. Together with renowned nurses who practice in other countries, these nurses sustained Nightingale’s nursing consent.(Evolution of Nursing Essay Example)

Since the 19 th Century, various aspects of nursing have changed, including training/education, nurses’ roles, specialization, and safety and quality of nursing. Nursing education has significantly changed as universities have consistently improved training models and specialties. Nursing education has become more flexible, formal, and complex, with over 170 nursing programs in the United States by the 1960s. The Institute of Medicine (IOM) reports of 2010 and 2021 have definitive recommendations on nursing education, the scope of nursing practice, and the role of technology in advancing the nursing landscape (Wakefield et al., 2021). There has been more emphasis on academic progression as various roles emerge, i.e., nursing is no longer caretaking but a complex integration of skills, judgment, and knowledge.(Evolution of Nursing Essay Example)

Glasper, E. A. (2020). Celebrating the Contribution of Florence Nightingale to Contemporary Nursing.  Comprehensive Child and Adolescent Nursing ,  43 (4), 233-239. https://doi.org/10.1080/24694193.2020.1824256

Karimi, H., & Alavi, N. M. (2015). Florence Nightingale: the mother of nursing.  Nursing and midwifery studies ,  4 (2). https://doi.org/10.17795%2Fnmsjournal29475

Wakefield, M., Williams, D. R., & Le Menestrel, S. (2021).  The future of nursing 2020-2030: Charting a path to achieve health equity . National Academy of Sciences. Available at: http://ebookcentral.proquest.com.lopes.idm.oclc.org/lib/gcu/reader.action?docID=6697061&ppg=1\ (Accessed 7 November 2022)

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nursing , profession that assumes responsibility for the continuous care of the sick, the injured, the disabled, and the dying. Nursing is also responsible for encouraging the health of individuals, families, and communities in medical and community settings. Nurses are actively involved in health care research, management, policy deliberations, and patient advocacy . Nurses with postbaccalaureate preparation assume independent responsibility for providing primary health care and specialty services to individuals, families, and communities.

Professional nurses work both independently and in collaboration with other health care professionals such as physicians. Professional nurses supervise the work of nurses who have limited licenses, such as licensed practical nurses (LPNs) in the United States and enrolled nurses (ENs) in Australia. Professional nurses also oversee the work of nursing assistants in various settings.

Nursing is the largest, the most diverse , and one of the most respected of all the health care professions. There are more than 2.9 million registered nurses in the United States alone, and many more millions worldwide. While true demographic representation remains an elusive goal, nursing does have a higher proportional representation of racial and ethnic minorities than other health care professions. In some countries, however, men still remain significantly underrepresented.

The demand for nursing remains high, and projections suggest that such demand will substantively increase. Advances in health care technology, rising expectations of people seeking care, and reorganization of health care systems require a greater number of highly educated professionals. Demographic changes, such as large aging populations in many countries of the world, also fuel this demand.

Although the origins of nursing predate the mid-19th century, the history of professional nursing traditionally begins with Florence Nightingale . Nightingale, the well-educated daughter of wealthy British parents, defied social conventions and decided to become a nurse. The nursing of strangers, either in hospitals or in their homes, was not then seen as a respectable career for well-bred ladies, who, if they wished to nurse, were expected to do so only for sick family and intimate friends. In a radical departure from these views, Nightingale believed that well-educated women, using scientific principles and informed education about healthy lifestyles, could dramatically improve the care of sick patients. Moreover, she believed that nursing provided an ideal independent calling full of intellectual and social freedom for women, who at that time had few other career options.

In 1854 Nightingale had the opportunity to test her beliefs during Britain’s Crimean War . Newspaper stories reporting that sick and wounded Russian soldiers nursed by religious orders fared much better than British soldiers inflamed public opinion . In response, the British government asked Nightingale to take a small group of nurses to the military hospital at Scutari (modern-day Üsküdar, Turk.). Within days of their arrival, Nightingale and her nurses had reorganized the barracks hospital in accordance with 19th-century science: walls were scrubbed for sanitation, windows opened for ventilation, nourishing food prepared and served, and medications and treatments efficiently administered. Within weeks death rates plummeted, and soldiers were no longer sickened by infectious diseases arising from poor sanitary conditions. Within months a grateful public knew of the work of the “Lady with the Lamp,” who made nightly rounds comforting the sick and wounded. By the end of the 19th century, the entire Western world shared Nightingale’s belief in the worth of educated nurses.

Nightingale’s achievements overshadowed other ways to nurse the sick. For centuries, most nursing of the sick had taken place at home and had been the responsibility of families, friends, and respected community members with reputations as effective healers. During epidemics , such as cholera , typhus , and smallpox , men took on active nursing roles. For example, Stephen Girard , a wealthy French-born banker, won the hearts of citizens of his adopted city of Philadelphia for his courageous and compassionate nursing of the victims of the 1793 yellow fever epidemic .

As urbanization and industrialization spread, those without families to care for them found themselves in hospitals where the quality of nursing care varied enormously. Some patients received excellent care. Women from religious nursing orders were particularly known for the quality of the nursing care they provided in the hospitals they established. Other hospitals depended on recovering patients or hired men and women for the nursing care of patients. Sometimes this care was excellent; other times it was deplorable, and the unreliability of hospital-based nursing care became a particular problem by the late 19th century, when changes in medical practices and treatments required competent nurses. The convergence of hospitals’ needs, physicians’ wishes, and women’s desire for meaningful work led to a new health care professional: the trained nurse.

Hospitals established their own training schools for nurses. In exchange for lectures and clinical instructions, students provided the hospital with two or three years of skilled free nursing care. This hospital-based educational model had significant long-term implications . It bound the education of nurses to hospitals rather than colleges, a tie that was not definitively broken until the latter half of the 20th century. The hospital-based training model also reinforced segregation in society and in the health care system. For instance, African American student nurses were barred from almost all American hospitals and training schools. They could seek training only in schools established by African American hospitals. Most of all, the hospital-based training model strengthened the cultural stereotyping of nursing as women’s work. Only a few hospitals provided training to maintain men’s traditional roles within nursing.

Still, nurses transformed hospitals. In addition to the skilled, compassionate care they gave to patients, they established an orderly, routine, and systemized environment within which patients healed. They administered increasingly complicated treatments and medication regimes. They maintained the aseptic and infection-control protocols that allowed more complex and invasive surgeries to proceed. In addition, they experimented with different models of nursing interventions that humanized increasingly technical and impersonal medical procedures.

Outside hospitals, trained nurses quickly became critical in the fight against infectious diseases . In the early 20th century, the newly discovered “ germ theory ” of disease (the knowledge that many illnesses were caused by bacteria ) caused considerable alarm in countries around the world. Teaching methods of preventing the spread of diseases, such as tuberculosis , pneumonia , and influenza , became the domain of the visiting nurses in the United States and the district nurses in the United Kingdom and Europe. These nurses cared for infected patients in the patients’ homes and taught families and communities the measures necessary to prevent spreading the infection. They were particularly committed to working with poor and immigrant communities, which often had little access to other health care services. The work of these nurses contributed to a dramatic decline in the mortality and morbidity rates from infectious diseases for children and adults.

At the same time, independent contractors called private-duty nurses cared for sick individuals in their homes. These nurses performed important clinical work and supported families who had the financial resources to afford care, but the unregulated health care labour market left them vulnerable to competition from both untrained nurses and each year’s class of newly graduated trained nurses. Very soon, the supply of private-duty nurses was greater than the demand from families. At the turn of the 20th century, nurses in industrialized countries began to establish professional associations to set standards that differentiated the work of trained nurses from both assistive-nursing personnel and untrained nurses. More important, they successfully sought licensing protection for the practice of registered nursing. Later on, nurses in some countries turned to collective bargaining and labour organizations to assist them in asserting their and their patients’ rights to improve conditions and make quality nursing care possible.

By the mid-1930s the increasing technological and clinical demands of patient care, the escalating needs of patients for intensive nursing, and the resulting movement of such care out of homes and into hospitals demanded hospital staffs of trained rather than student nurses. By the mid-1950s hospitals were the largest single employer of registered nurses. This trend continues, although as changes in health care systems have reemphasized care at home, a proportionately greater number of nurses work in outpatient clinics, home care , public health , and other community-based health care organizations.

Other important changes in nursing occurred during the latter half of the 20th century. The profession grew more diverse. For example, in the United States, the National Organization of Coloured Graduate Nurses (NOCGN) capitalized on the acute shortage of nurses during World War II and successfully pushed for the desegregation of both the military nursing corps and the nursing associations. The American Nurses Association (ANA) desegregated in 1949, one of the first national professional associations to do so. As a result, in 1951, feeling its goals fulfilled, the NOCGN dissolved. But by the late 1960s some African American nurses felt that the ANA had neither the time nor the resources to adequately address all their concerns. The National Black Nurses Association (NBNA) formed in 1971 as a parallel organization to the ANA.

Nursing’s educational structure also changed. Dependence on hospital-based training schools declined, and those schools were replaced with collegiate programs either in community or technical colleges or in universities. In addition, more systematic and widespread programs of graduate education began to emerge. These programs prepare nurses not only for roles in management and education but also for roles as clinical specialists and nurse practitioners. Nurses no longer had to seek doctoral degrees in fields other than nursing. By the 1970s nurses were establishing their own doctoral programs, emphasizing the nursing knowledge and science and research needed to address pressing nursing care and care-delivery issues.

During the second half of the 20th century, nurses responded to rising numbers of sick patients with innovative reorganizations of their patterns of care. For example, critical care units in hospitals began when nurses started grouping their most critically ill patients together to provide more effective use of modern technology. In addition, experiments with models of progressive patient care and primary nursing reemphasized the responsibility of one nurse for one patient in spite of the often-overwhelming bureaucratic demands by hospitals on nurses’ time.

The nursing profession also has been strengthened by its increasing emphasis on national and international work in developing countries and by its advocacy of healthy and safe environments . The international scope of nursing is supported by the World Health Organization (WHO), which recognizes nursing as the backbone of most health care systems around the world.

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A world-class city filled with art and culture and an incredible campus that offers cutting edge resources–that’s what students receive at Penn Nursing. And that’s just the start. Penn Nursing and the wider university offer something for everyone, as well as a lifelong community.

Penn Nursing is globally known for educating dynamic nurses—because our School values evidence-based science and health equity. That’s where our expertise lies, whether in research, practice, community health, or beyond. Everything we do upholds a through-line of innovation, encouraging our exceptional students, alumni, and faculty share their knowledge and skills to reshape health care.

Penn Nursing students are bold and unafraid, ready to embrace any challenge that comes their way. Whether you are exploring a career in nursing or interested in advancing your nursing career, a Penn Nursing education will help you meet your goals and become an innovative leader, prepared to change the face of health and wellness.

Penn Nursing is the #1-ranked nursing school in the world. Its highly-ranked programs help develop highly-skilled leaders in health care who are prepared to work alongside communities to tackle issues of health equity and social justice to improve health and wellness for everyone.

Penn Nursing’s rigorous academic curricula are taught by world renowned experts, ensuring that students at every level receive an exceptional Ivy League education . From augmented reality classrooms and clinical simulations to coursework that includes experiential global travel to clinical placements in top notch facilities, a Penn Nursing education prepares our graduates to lead.

American Nursing: An Introduction to the Past

Professional nursing holds a unique place in the American health care system. As members of the largest health care profession, the nation’s 3.1 million nurses work in diverse settings and fields and are frontline providers of health care services. While most nurses work in acute-care settings such as hospitals, nurses’ expertise and skills extend well beyond hospital walls. Working independently and with other health care professionals, nurses promote the health of individuals, families, and communities. Millions of Americans turn to nurses for delivery of primary health care services, health care education. and health advice and counseling. Nurses are critical links in maintaining a cutting-edge health care system.Nursing continues to be an indispensable service to the American public.  

Florence Nightingale

Nursing and Hospital Care in the United States

The Beginnings of Nurse Education

The outbreak of the Civil War created an immediate need for capable nurses to care for the enormous number of sick and wounded. About 20,000 women and men served as nurses in both the North and the South. The commendable service rendered by Civil War nurses provided a rationale for future experiments in setting up training programs for nursing. One such program was initiated in Pennsylvania where the Women’s Hospital of Philadelphia offered a six months nurse training course, which graduated its first class in 1869. Similar courses, such as that offered by the New England Hospital for Women and Children were begun in other locales.

Professional Nurse Education Begins  

The success of these first three so-called “Nightingale schools” led to a proliferation of similar nursing schools, or as they were most commonly called, nurse training programs. By 1900, somewhere between 400 to 800 schools of nursing were in operation in the country. These programs followed a fairly typical pattern. The school was either affiliated with or owned by a hospital that provided the students with the clinical experience considered necessary for the education of a nurse. Students received two to three years of training. While in the program students carried out the majority of patient care activities offered in the hospital, receiving only a modicum of classroom education in the form of lectures on patient care and related subjects. At the end of the educational program, students received a diploma and were eligible to seek work as a trained nurse .

The Profession of Nursing Organizes

These changes improved and reformed many aspects of the nurse training system, but problems remained. Reflecting the social and legal status of African Americans at the time, American professional nursing maintained strict racial segregation until the mid-twentieth century. African American individuals wanting to become nurses had to train in a separate educational system and faced a divided employment field in which white and black nurses did not participate equally. Nursing also remained a predominantly female profession. While a few schools admitted men, most schools refused them admission.  

Challenges for Nursing

Employment conditions for nurses also presented challenges. In the early part of the twentieth century, hospitals employed only a few graduate nurses, mainly in supervisory positions. They relied instead on student nurses for the majority of the bedside care provided to patients. Most nurses, once they graduated from their educational program, entered the field of private duty nursing. Private duty nurses were employed by individual patients primarily in their homes. As institutions became the more normative site for delivery of sick care, private duty nurses moved with their patients into the hospital, delivering care to hospitalized individuals who could afford to pay for their own nurse. But for nurses, private duty often did not provide regular and dependable employment; nurses were hired on an ad hoc basis by patients and were oftentimes without a regular source of income. The cost of private duty was also quite high, limiting the number of patients employing private duty nurses. It was not until the mid-twentieth century that hospitals hired nurses as regular staff on a permanent basis, providing full professional nursing services to all hospitalized patients.

Nursing Diversifies  

Despite the many difficulties within the profession, nursing continued to grow as an occupational field and became recognized as an essential health care service by the early twentieth century. Nurses fanned out into diverse fields delivering services to many people outside of hospitals. For example, Lillian Wald founded the Henry Street Settlement House in 1893, which provided nursing and other social services to impoverished populations on the Lower East Side of New York City. Replication of Wald’s work in other parts of the country led to the growth of the field of public health nursing, opening up new employment opportunities for nurses and expanding the type of services provided  by nurses.

The special skills possessed by nurses were easily transferred to different fields of health care. For example, nurses were educated to administer anesthesia during surgery, leading to the specialty field of nurse anesthetists. By the early twentieth century it was quite common to find nurse anesthetists delivering anesthesia in many of the nation’s hospitals. By the 1920s, in some parts of the country, nurse-midwives delivered babies, in many cases to the most impoverished populations.

Mid-twentieth Century Nursing

The community college movement achieved only partial success. Community college programs did graduate many new nurses and often at a lower cost than traditional diploma programs. But, as the needs of late-twentieth-century patients became increasingly more complex, research studies indicated that being treated by nurses prepared at the baccalaureate level improved patient outcomes.  

The Modern Practice of Nursing

  Nursing education also thrived in the latter half of the twentieth century. Significant federal financial support for educating nurses, which became available beginning in the 1960s, permitted the revamping and modernizing of many nursing educational programs. Significantly, increased funding for nursing research permitted nursing to develop a sounder scientific basis for its practice. Nurse researchers today carry out cutting-edge studies that shed light on the ways and means of solving many health care problems and improving nursing services.

Historically, the nursing profession has consistently demonstrated its ability to adapt to changing and varied health care needs. It remains an exceedingly popular and highly respected profession that attracts large numbers of new recruits to its ranks. There is little doubt that nursing will continue to maintain its status as an extremely important profession, serving the health needs of the nation.

Jean C. Whelan (1949-2017) was Adjunct Assistant Professor of Nursing, University of Pennsylvania School of Nursing.

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The evolution of nursing practice: a guide for nursing students, carla johnson.

• October 25, 2023

Nursing is a noble profession that has undergone significant transformations over the centuries. To truly understand the depth and significance of modern nursing, it is crucial to examine it through a historical lens. This article highlights the evolution of nursing practice aimed at nursing students, as well as anyone interested in the rich history of nursing . We will take you on a journey through time, exploring the roots of nursing, the pivotal moments in its development, and the remarkable individuals who shaped it into what it is today.

What You'll Learn

I. The Origins of Nursing

1. ancient civilizations: the birth of caring for the sick.

Nursing can trace its roots back to ancient civilizations, where caregiving for the ill and wounded was a communal responsibility. In ancient Egypt, Greece, and Rome, the concept of nursing was closely intertwined with religion and the belief in the healing powers of the gods. Temples often served as early healthcare centers, where priestesses and other caretakers would tend to the sick.

2. The Influence of Florence Nightingale

The modern concept of nursing, as we know it, was significantly shaped by Florence Nightingale , often regarded as the founder of modern nursing. During the Crimean War, Nightingale and her team of nurses pioneered sanitation and hygiene practices in field hospitals, which led to a drastic reduction in mortality rates. This marked the beginning of nursing as a formal profession, emphasizing the importance of a scientific approach to care.

II. Nursing in the 19th and Early 20th Centuries

1. the victorian era: the lady with the lamp.

Florence Nightingale’s tireless dedication and her iconic lamp earned her the title of “The Lady with the Lamp.” Her pioneering work and the publication of “Notes on Nursing” in 1859 established a strong foundation for nursing education and professionalism. Nightingale’s principles, focusing on cleanliness and compassion, became the cornerstone of modern nursing practice.

2. The American Civil War: Clara Barton and the American Red Cross

In the United States, the Civil War brought nursing to the forefront. Clara Barton, a courageous nurse, tended to wounded soldiers on the battlefield and later founded the American Red Cross. Her efforts not only saved countless lives but also contributed to the development of humanitarian nursing organizations.

III. The Evolution of Nursing Education

1. nursing schools: the birth of formal training.

As the demand for skilled nurses grew, nursing schools began to emerge. In the late 19th century, nursing education shifted from apprenticeship-style training to more structured programs. Nursing students were taught a standardized curriculum and trained in hospitals under the supervision of experienced nurses .

2. Nursing Organizations: Advocating for Professionalism

During the early 20th century, nursing organizations like the American Nurses Association (ANA) were established to promote nursing as a profession. The ANA played a pivotal role in setting standards and advocating for the rights and recognition of nurses. These organizations continue to be influential in shaping the future of nursing.

IV. Nursing in the Mid-20th Century

1. world war ii: the expansion of nursing roles.

World War II created an urgent need for nurses, leading to the expansion of nursing roles. Nurses became an integral part of military healthcare teams , working both on the frontlines and in hospitals. This experience broadened the horizons of nursing practice and paved the way for more specialized roles in the field.

2. The Dawn of Technological Advancements

The mid-20th century marked a period of significant technological advancements in healthcare. Innovations such as antibiotics, life-support machines, and advanced surgical techniques transformed nursing care. Nurses had to adapt to these changes and acquire new skills to meet the evolving needs of patients.

V. Contemporary Nursing Practice

1. the role of nurse practitioners.

In recent decades, the role of nurse practitioners (NPs) has expanded significantly. NPs have become an essential part of the healthcare team, providing a wide range of healthcare services, from diagnosing and treating illnesses to prescribing medications. This expansion of responsibilities has helped address the shortage of primary care providers and improve patient access to care.

2. Evidence-Based Practice

Modern nursing is increasingly focused on evidence-based practice (EBP), which involves making clinical decisions based on the best available research evidence. EBP has become a fundamental aspect of nursing education and practice, ensuring that nurses provide the highest quality care supported by scientific evidence.

The journey through the history of nursing illustrates the incredible evolution of this profession. From its humble beginnings as a communal duty to its current state as a highly respected and specialized field, nursing has come a long way. It is essential for nursing students to recognize the significant contributions of historical figures and pivotal moments in nursing’s development. This knowledge not only instills a sense of pride in the profession but also provides valuable insights into how nursing can continue to progress.

Whether you need help with historical research on nursing or guidance on contemporary nursing practices, our team of experienced writers is here to assist you. Don’t hesitate to reach out and let us be part of your journey to becoming a knowledgeable and compassionate nurse. Together, we can continue the legacy of nursing excellence that has been shaped by the remarkable individuals and milestones discussed in this article.

1. What are the three categories of lenses?

There are three primary categories of lenses: historical lens, cultural lens, and critical lens. These categories represent different approaches to analyzing and interpreting various subjects, including literature, art, history, and more.

2. What are the characteristics of a historical lens?

A historical lens involves examining a subject, such as a literary work or an event, through the context of the time period in which it originated. Characteristics of this lens include considering historical events, cultural norms, and societal influences that shaped the subject.

3. What are the disadvantages of a historical lens?

While a historical lens provides valuable insights, its disadvantages include potential bias or limitations in available historical records. Additionally, it may not always account for the full complexity of a subject, as interpretations can vary based on the historian’s perspective.

4. What is the historical lens of criticism?

Historical lens criticism is an analytical approach that evaluates a subject within its historical context. It seeks to understand how historical factors and events influence the subject, offering a deeper understanding of its significance and relevance in its time.

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• OJIN Homepage
• Table of Contents
• Volume 24 - 2019
• Number 2: May 2019
• Nursing Now! Learning from Past

Nursing Now! Learning from the Past, Positioning for the Future

Dr. Benton hails from the North East of Scotland. He completed his RN education at Highland College of Nursing and Midwifery in Inverness, specializing in both general and mental health practice. He undertook his MPhil degree studying the application of computer assisted learning to post basic psychiatric nurse education at the University of Abertay and received a PhD Summa Cum Laude from the University of Complutence Spain, for his groundbreaking work on an international comparison of nursing legislation. Prior to his current post as Chief Executive Officer of the National Council of State Boards of Nursing, he worked for ten years at the International Council of Nurses based in Geneva, Switzerland. Benton is a prolific author and has published over 200 papers on leadership, workforce, health policy, social network analysis, bibliometrics, and regulation. He is a global expert in regulation and health and nursing policy and has advised governments around the world about both nursing legislation and wider health policy issues.

Beasley began training in 1962 at the Royal London Hospital and worked as a staff nurse. In the 1980s/early 90s, she held senior roles at the Ealing and Riverside Health Authorities, before moving into wider regional nurse director posts at North Thames Regional Health Authority.

She has held a range of senior posts with a broad experience of policy development, leadership, and general management, including Head of Development with the Directorate of Health and Social Care, and Director of Nursing, Human Resources, and Organizational Development with the NHS Executive. She established the London Standing Conference, engaging nurses across the capital in leading service improvement and contributing to improvements in clinical practice across the country. Beasley was appointed as Chief Nursing Officer for England in October 2004 and is the Director within the Department of Health with the lead for Patient and Public involvement, the Allied Health Professionals and Healthcare Scientists, and was also the lead director for the voluntary and community sector. Since retirement she has held a number of non-executive appointments, including chair of the Florence Nightingale Museum Trust and a Trustee of the Burdett Trust for Nursing.

Dr. Ferguson is a global healthcare consultant with more than 35 years of experience designing, implementing, and evaluating health-related strategic plans and programs. As founder of Stephanie L. Ferguson & Associates, LLC, she has worked in 100+ nations as a technical advisor, consultant, and facilitator for the World Health Organization (WHO) and the International Council of Nurses (ICN). For WHO, she develops initiatives to strengthen and evaluate global healthcare delivery, population health outcomes, and health professional education and services. At ICN, she directed the Leadership for Change Programä and the ICN-Burdett Global Nursing Leadership Instituteä in Geneva, Switzerland. Dr. Ferguson was a White House Fellow from 1996-97 and is president-elect of the Foundation’s Alumni Association. She serves on the Bon Secours Mercy Health System board and its Strategy and Finance Committee. She is an elected member of the American Academy of Nursing; the National Academy of Medicine, where she serves on its Nominating Committee; and, the National Academies of Practice. Current faculty appointments include Consulting Associate Professor, Bing Stanford in Washington Program; and, Professor at the University of Lynchburg College of Health Sciences. She holds a PhD from the University of Virginia (UVA), a Master’s degree from the Virginia Commonwealth University, and a BSN from UVA.

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The Nursing Now! campaign, a program of the Burdett Trust for Nursing, is being undertaken in collaboration with the World Health Organization and the International Council of Nurses to create a social movement to improve health globally by raising the profile and status of nurses worldwide. Recently, the Nursing Now! campaign produced a report that was launched at the 2018 WISH Foundation meeting in Qatar that explored how the profession of nursing could contribute to the rapid and cost-effective expansion of high-quality universal health coverage (UHC). In this research study we identified how nurses, relative to the medical profession, are contributing to scholarship on UHC, and explored potential opportunities to leverage already-published research toward this agenda. This article offers background and history about UHC, and discusses the methods , results , recommendations , and limitations of our study. The profession of nursing lags significantly behind the medical profession but can potentially make rapid progress if the isolated efforts of researchers are harnessed and systematic methods of knowledge transfer are applied to existing research on nurse-led services and directed toward the pursuit of UHC. This study establishes a baseline of current nursing scholarship that can be used to assess progress in addressing today’s policy opportunities.

Key Words: Nursing Now! , universal health coverage, nurse-led services, Sustainable Development Goals, bibliometrics

The 33 rd President of the United States (U.S.), Harry Truman, in his oral biography said, “There is nothing new in the world apart from the history you do not know ” ( Miller, 1974 ). Far earlier, Florence Nightingale, in her 1872 addresses to probationers and qualified nurses, said “ For us who nurse, our nursing is a thing, which, unless we make progress every year, every month, every week, take my word for it we are going back ” ( Nash, 1914 ). It is our intention to use the concepts contained within these two quotes – learning from history and the need to make progress – as the synergistic drivers to explore the opportunities that the nursing profession now faces.

The [ Nursing Now!]  campaign seeks to improve health globally by raising the profile and status of nurses worldwide... As we approach the 200 th anniversary of the birth of Nightingale, the Nursing Now! Campaign ( WHO, n.d.a ) is preparing to use this auspicious event as a springboard to the future. The campaign is a program of the Burdett Trust for Nursing ( n.d. ) and is being undertaken in collaboration with the World Health Organization ( WHO, n.d.b ) and the International Council of Nurses ( ICN, n.d. ). The campaign seeks to improve health globally by raising the profile and status of nurses worldwide – influencing policymakers and supporting nurses themselves to lead, learn and build a global movement. Centered on five objectives ( Table 1 ), Nursing Now! continues to mobilize international partners, as well as more than 60 national nursing groups.

Table 1. Nursing Now! Objectives and Goals

It is not possible in a single article to address all the objectives set out by the campaign. Instead, we focus on the pursuit of universal health coverage (UHC) and, when appropriate in our critique of how this can be attained, simultaneously address other objectives. Our research identified how nurses, relative to the medical profession, are contributing to scholarship on UHC, and explored potential opportunities to leverage already-published research toward this agenda. This article offers background and history about UHC, and discusses the methods, results, recommendations, and limitations of our study.

Universal health coverage came to prominence as part of the deliberations on the then Millennium Development Goals... Recently, as part of the World Innovation for Health Summit, Nursing Now! released a report exploring how nurses could contribute to the rapid and cost-effective expansion of high-quality UHC ( Crisp, Brownie, & Refsum, 2018 ). Universal health coverage ( The World Bank, n.d. ) came to prominence as part of the deliberations on the then Millennium Development Goals (MDGs) and was subsequently integrated into discourse on pursuit of the Sustainable Development Goals (SDGs; United Nations, 2015 ). Research has shown that nursing was late to address the opportunities presented in pursuing the MDGs but has a more promising start with the SDGs ( Benton & Shaffer, 2016 ). Benton and Shaffer ( 2016 ) argued that nurses have a wide range of potential contributions to make across all 17 of the SDGs but they noted that the initial focus of the profession was extremely narrow, limiting scholarly activity to targets relating to a small subset of the SDGs.

...nurses need to come to the table prepared to provide evidence rather than opinion. Benton, Pérez-Raya, Fernandez-Fernandez, & González-Jurado ( 2015 ) identified that with today’s increased need to support policy change with graded evidence, nurses need to be more active in generating, curating and presenting robust, reliable and valid research to influence the direction of change. Benton, Al Maaitah, & Gharaibeh ( 2017 ) further argued that if the profession of nursing’s policy voice is to be heard by the WHO, the World Bank Group, and other intergovernmental agencies, then nurses need to come to the table prepared to provide evidence rather than opinion.

Relying on one-off exemplars or unpublished reports is totally inadequate if the criticisms levied by Oxman, Lavis, & Fretheim ( 2007 ) of the WHO policy-making process are to be addressed. While case studies, such as those cited in the report by Crisp et al. ( 2018 ), are interesting and offer a glimpse of the potential contribution of the profession to the pursuit of UHC, they are insufficient to meet the requirements of evidence as set out in the WHO handbook for guideline development (2012). To make a quantifiable difference and gain wide-scale support for systemically implementing such exemplars, more robust, reliable and valid evidence is required.

The Historical Context of Nightingale and Universal Health Coverage Distressed by her observations, Nightingale is perhaps one of the first proponents of delivering UHC to a population. In the midst of the mayhem of the Crimean War, she saw the need for sanitation, nutrition and essential care. Conscious that the absence of these fundamental requirements killed more troops than the injuries inflicted by the enemy, she gathered data to mobilize opinion and resources to address this terrible and unjust situation. Today, even in the absence of war, populations are often confronted with a lack of access to essential health services as well as a wide range of burdens originating from what is now known as the ‘social determinants of health’ ( Nicholson, Yates, Warburton, & Fontana, 2015 ; WHO, 2018 ).

Indeed, so successful was she as a change agent that she is, for many around the world, acknowledged as the progenitor of modern nursing. Nightingale was well educated, an excellent communicator, and connected to eminent and influential leaders of the day, so was able to mobilize resources to bring about change ( River, 2018 ). Indeed, so successful was she as a change agent that she is, for many around the world, acknowledged as the progenitor of modern nursing. Yet for others, she is seen as a founding pioneer in the application of statistics and data visualization, and a formidable advocate of the public health revolution ( Small, 2017 ).

Figure 1. Polar Diagram

(Reproduced courtesy of the Florence Nightingale Museum) [ View full size ]

...she was ahead of her time in using evidence-based argument and what might be viewed today as infographics. Nightingale’s use of data to identify problems and visually convey their meaning is perhaps one of the many important gifts that she has given the profession. Her use of the polar area diagram, Figure 1 , to convey the causes of death and the overwhelming numbers who died from preventable conditions attracted attention, engaged readers in exploring its meaning and left lasting impressions. Clearly, she was ahead of her time in using evidence-based argument and what might be viewed today as infographics. In short, the ability and power to visualize a situation should not be underestimated. Hence, if we are to maintain the progress she advocated, we also need to think about how to identify and communicate issues that impact populations and how, as nurses, we can address the opportunities for health improvement they present.

Synergizing Perspectives Bibliometrics provides a means to synthesize the scholarly landscape... To bring together the two concepts identified in the quotes by Truman and Nightingale, we turn to a relatively new approach to examine the scholarly literature. Bibliometrics provides a means to synthesize the scholarly landscape and derive from the resulting analysis insights into the current and historical evolution of scholarship in the area of interest. Furthermore, through informed critique and consideration of the current policy landscape, future opportunities for contributions by nurses can be identified ( Benton, Cusack, Jabbour, & Penney, 2017 ; Benton & Ferguson, 2017a ). Accordingly, we seek to identify how nurses, relative to the medical profession, are contributing to scholarship on UHC and explore potential opportunities to leverage already-published work toward this agenda.

This study used bibliometrics to analyze the published and peer-reviewed scholarship relating to UHC. As a means to assess the contribution of the nursing profession, we make a comparison with contributions of the medical profession. In addition, further bibliometric analysis is conducted in relation to nurse-led services as a means to explore how leading-edge practice may contribute to the attainment of UHC. As we contend, this is an opportunity for nurses around the world, irrespective of work setting, to make a difference to the health and well-being of all. As the study did not involve human subjects and the data is available to anyone with access to the Scopus database, no ethical approval was required.

The Role of Bibliometrics Bibliometrics has its origins in the informational sciences but is increasingly used by nurses to examine diverse aspects of nursing scholarship. This can relate to the output of specific journals, institutions, or individuals ( Benton & Alexander, 2016 ; Benton, 2017a ). Also, it is used to track the evolution of scholarship in entire domains of interest or in more focused studies of interventions ( Benton, Cusack, Jabbour, & Penney 2017 ; Benton, 2017b ). In short, it is a flexible approach and can provide a wide range of metrics ranging from actual physical connections between authors to the identification of potential relationships between frequently occurring words in the titles and abstracts of papers ( Yan and Ding, 2012 ).

In this article, a limited set of measures is used due to the ambitious scope of the analysis where three related, but different, data sets are examined: UHC both in relation to medicine and nursing, as well as nurse-led services. To that end, only those metrics used in the article will be elaborated. For those wishing a more comprehensive understanding of the potential usages of bibliometric analysis, there is a wide range of texts to consult ( Cronin & Sugimoto, 2014 ; Gingras, 2016 ; TUDelft, 2017 ).

Data Source and Extraction There are a variety of bibliographic databases that could be used to extract data for this study. However, in terms of medical and nursing scholarship coverage, the most comprehensive database of peer-reviewed content is found in Scopus (Elsevier) and accordingly is the database of choice ( De Groote & Raszewski, 2012 ). To identify source material, standard keyword searching, along with the use of logical operators to narrow the search and the application of category delimiters (e.g., removing non-English articles), was used. Data was then extracted in comma-separated value files ready for uploading directly into the analysis software.

Data Analysis VOSviewer uses multidimensional scaling to identify relationships between the variables of interest. Van Eck and Waltman ( 2010 ) conducted an analysis of a range of bibliographic analytical and visualization tools and concluded that VOSviewer was the most flexible and comprehensive. Since that time, there have been regular enhancements to the software package and, as a result, version 1.6.9 was used ( Van Eck & Waltman, 2018 ). VOSviewer uses multidimensional scaling to identify relationships between the variables of interest. It then graphically represents these through visualization of similarities by placing those that are most closely related in near proximity. Those that have a more distant relationship are placed furthest apart.

As indicated earlier, there are a range of metrics that can be examined. For the purposes of this study, we limited the analysis to co-authorship, co-occurrence, and co-word analysis. The reason for selecting these three approaches related to our desire to examine how collaborative scholars are (co-authorship); the general dimensions addressed by the authors (co-occurrence); and as a means of identifying more detail within the various domains, the content of the scholarship currently addressed (co-word analysis). Each of these is briefly discussed below.

One way to look for the presence or absence of invisible colleges is to look at the co-authorship links relating to scholarship in a particular topic... Co-authorship Analysis. Diana Crane ( 1972 ) identified that scholars often create informal networks across institutions and beyond national country borders. She identified these as ‘invisible colleges’ and contended that the ability to mobilize advocacy in a coordinated manner across these networks can often make the difference between success and failure in influencing policy positions or completing research. One way to look for the presence or absence of invisible colleges is to look at the co-authorship links relating to scholarship in a particular topic where authors have contributed three or more times to the topic.

Co-occurrence Analysis. Co-occurrence analysis provides a means, through examination of the keywords used to describe the paper, to identify and describe underlying domains of scholarship contained within the corpus of publication being addressed by authors. This can help identify areas where there may be enough evidence to conduct further synthesis and thereby potentially strengthen the lines of argument that can be presented to policymakers.

Co-word Analysis. To obtain a more granular analysis of the content of scholarship, co-word analysis is used to identify patterns of commonly used terms within the titles and abstracts of the papers under review. This is particularly helpful when looking at topics where there is only a limited number of publications.

The systematic search of Scopus resulted, after cleaning of data (i.e., removing non-English articles), in 2,471 UHC medical papers; 200 UHC nursing papers; and 1,495 nurse-led services papers. All subsequent analysis is based on the entirety of the content of these data sets.

There are a large number of unconnected authors who have, up to this point, contributed one or two papers each. Contrasting Medicine and Nursing Co-authorship analysis of the UHC medicine data ( Figure 2 ) demonstrates a well-developed network of invisible colleges. However, in the case of nursing, repeated contributions of three or more papers come from three individual authors and a single group of three collaborators. However, there is no connection between the three individuals and the small group. There are a large number of unconnected authors who have, up to this point, contributed one or two papers each.

Figure 2. Co-authorship Network Relating to Medical Articles on UHC

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To look at the focus of this work, it is necessary to turn to co-occurrence analysis. By examining keywords used to classify the various papers, it is possible to identify underlying themes. Mapping data from the UHC nursing papers provides a very simple segmented visualization, as can be seen in Figure 3 . There are four high-level clusters of terms that delineate material relating to: the provision of services redesign and the pursuit of the MDGs through health insurance; the use of advanced practice to facilitate access to primary healthcare; the linkage between attainment of reduced maternal and child mortality through midwifery and the health workforce; and the public health continuum from community to global health.

Figure 3 UHC Nursing Co-occurrence Analysis

The situation relating to medicine is far more complex as can be seen from the 10 overlapping clusters of terms in Figure 4 . These clusters relate to non-communicable and lifestyle diseases; essential services access and socioeconomic factor impacts; health cost-related poverty; human resources for health; health systems strengthening and the link to cost, access and quality in the Asian region; cost effectiveness and healthcare financing; healthcare reform and primary care provision; health inequalities and their links to poverty; health systems strengthening and the link to cost, access and quality in the sub-Saharan Africa region; and communicable disease burdens.

Figure 4 Medicine Co-occurrence Analysis

...nurse scholars are addressing the topic of UHC through a high-level general perspective... To gain deeper insight into the content of the publications, we conducted co-word analysis of the titles and abstracts. This, coupled with the co-occurrence analysis results, can help identify areas where there may be sufficient evidence to conduct a systematic review or meta-analysis. This potentially strengthens the lines of argument to present to policymakers. Unfortunately, Figure 5 confirms and elaborates slightly the findings identified in the co-occurrence analysis. That is, nurse scholars are addressing the topic of UHC through a high-level general perspective (e.g., healthcare reform; poverty and vulnerable groups; workforce, regulation and scope of practice; and access and quality). Hence, as will be seen later, an alternative approach is needed if nurses are to identify sufficient evidence to support evidence-based policy contributions to UHC.

Figure 5 Co-word Analysis of Nursing Titles and Abstracts from UHC Published Work

...medical scholarship is more clinically orientated, outcomes-focused, and comprehensive in addressing the balance between costs, access and quality of services. Examination of Figure 6 , and contrasting the results of the co-word analysis of UHC medical literature with those identified from nursing, highlights that medical scholarship is more clinically orientated, outcomes-focused, and comprehensive in addressing the balance between costs, access and quality of services. The profession of nursing could learn from these differences and, if appropriate, collaborate with existing groups or initiate parallel nurse-focused programs of research. If we only look at UHC scholarship output, we see that the medical profession is currently in a stronger position to advocate for evidence-based change. This may be one reason why the medical profession tends to dominate the policy formulation landscape.

Figure 6 Co-word Analysis of Medical Titles and Abstracts from UHC Published Work

Leveraging Wider Nursing Scholarship As indicated in the introduction, Crisp et al. ( 2018 ) highlighted a movement toward nurse-led services and this may provide a contribution to address provision of UHC. Indeed, authors such as Benton, Chapman, & Smith ( 2003 ) and Williamson et al. ( 2006 ) have already demonstrated the role that nurse-led services can play to increase access, reduce costs and improve quality. It is, therefore, logical to explore the literature on this topic to determine the potential to identify evidence that can be leveraged toward the UHC agenda. By examining some of the same metrics, it may be possible to provide concrete suggestions about how nursing scholarship can better contribute to the pursuit of UHC.

As was the case with UHC, where there is only limited collaboration between authors who have written three or more papers on the subject, co-authorship in nurse-led services was only marginally more connected than the UHC nursing landscape ( Figure 7 ).

Figure 7 Co-authorship Network Relating to Nurse-led Services

Another way to look at nurse-led services collaboration is to examine the authors’ countries of origin. Another way to look at nurse-led services collaboration is to examine the authors’ countries of origin. In this case, three countries are dominating scholarship, the United Kingdom, United States and Australia ( Figure 8 ). Additionally, it is clear there is already a diverse range of low-, middle-, and high-income countries contributing to nurse-led services scholarship. As Figure 8 shows, it would appear that authors tend to collaborate in geographically proximal groups. This may well provide a target for increased local and regional collaboration, as well as opportunities to leverage local and regional connections among policymakers.

Figure 8 Co-authorship Network Relating to Nurse-led Services by Author Country of Origin

Co-occurrence analysis of the nurse-led care scholarship revealed six domains of inquiry focusing on cardiovascular services; service reform; elder care; primary care; mental health; and advanced practice roles ( Figure 9 ). Several of these dimensions contained a significant quantum of publications that probably warrant further detailed inquiry via targeted integrative or systematic reviews. Such work may then provide more definitive guidance that could be more widely disseminated and implemented. Due to the client group orientation of some of this work it may be possible to engage other activist communities, such as user groups or condition-specific interest groups, to amplify any nursing messages.

Figure 9 Co-occurrence Analysis of Nurse-led Care Data Set

Discussion and Recommendations

Far too often the innovative work of nurses goes undocumented, unreported, and unacknowledged... Far too often the innovative work of nurses goes undocumented, unreported, and unacknowledged and as a result, makes the discovery of our history more difficult. Benton, Chapman, & Smith ( 2003 ) identified the wealth of innovation that takes place in a single health delivery system by nurses and, through systematically gathering evidence, was able to raise the profile of the profession within the system as well as provide a means to disseminate such practices more widely. Subsequently, Benton ( 2012 ) demonstrated that innovative practices by nurses were globally widespread across low-, middle-, and high-income countries. Yet nurses often do not report such efforts.

If nurses are to maximize their contributions, they need to document their endeavors in peer-reviewed journals. Such publications will facilitate discovery, provide assurance of scientific rigor and offer a mechanism to contribute to systematic reviews and meta-analysis, thereby informing policy choices. This analysis of the profession’s current contribution to UHC demonstrates that we have a way to go. But by reframing some of the existing work to address UHC, accelerated progress is possible. Increasingly, nurses are pursuing post-graduate degrees, so there is a growing quantum of scholarship available. Faculty and facility nurse leadership should encourage the publication of such work as part of a strategy toward raising the profession’s visibility and policy presence as well as a means of acknowledging contributions that individual and teams of nurses are making.

We could do this rapidly by leveraging existing work and reframing it in the form of policy briefs... Contributing to the Cost, Quality and Access Debate As noted in the analysis of UHC evidence, nurses must examine and report on all three aspects of the cost-quality-access triangle ( Benton, 1994 ). Each must be explored from multiple stakeholder perspectives. This may be possible though collaboration with economists and other members of the wider academic community. Nurses need to frame their work more broadly by highlighting their meta-policy-level contribution to UHC, SDGs, and other global initiatives, adding value, impact, and effect to the clinical improvements they can deliver.

By systematically curating and publishing the evidence, we can avoid duplicative efforts and maximize the application of nursing innovation, knowledge, and impact. We could do this rapidly by leveraging existing work and reframing it in the form of policy briefs rather than leaving it to languish in research journals ( Wong, Bazemore, Green, & Miller, 2017 ). Although beyond the scope of this article, it would be possible through further bibliometric analysis of both systematic and meta-analytical studies to identify key content that could provide valuable material to take to the policy table.

The lack of any corpus of connected nursing authors is an important finding and represents a major opportunity. Invisible Colleges From the co-authorship analysis of UHC data it is appropriate to conclude that the profession of medicine is more prolific and coordinated in its contributions. As Diana Crane ( 1972 ) noted, there exist a number of well-connected invisible colleges that collaborate and leverage their unique contributions for the furtherance of the discipline. The lack of any corpus of connected nursing authors is an important finding and represents a major opportunity. By establishing networks of colleagues there is potential to generate synergy across areas of inquiry that will better position the profession to influence individual governments and global policy.

It is perhaps not surprising that networks of UHC research collaboration do not exist. The lack of networks across nursing leadership, especially at the global level, is well documented ( Benton & Ferguson, 2014 ; 2016 ). The same authors also demonstrated that with modest input via e-mail, networks could, once established, be maintained relatively easily ( Benton & Ferguson, 2017b ). These networks could provide the platform for coordinated advocacy. Furthermore, this analysis demonstrates that nurses are pursuing a number of emergent areas of research on UHC and this may be an opportunity for nurse academics and/or the WHO Nursing Collaborating Centers to develop these into full programs of research and policy action.

Only by documenting nurses’ work can their impact on health outcomes be properly examined. Comprehensive Workforce Strategy Unfortunately, the work of nurses is almost invisible due to their lack of inclusion within the electronic health record ( Moody, Slocumb, Berg, & Jackson, 2004 ). Nursing care is frequently costed as part of room and board. Since nursing is the largest of all the health professions, and in some cases nurses can deliver up to 80% of care, lack of documentation of nursing interventions and consequent impacts on patient outcomes makes any workforce strategy at best imprecise, and at worst meaningless. Only by documenting nurses’ work can their impact on health outcomes be properly examined. Only when such data is available will it be possible to undertake correlation studies to inform decisions about team composition through the optimization of costs, access, and quality by actively considering the effective and efficient contribution of various team members.

Supportive Legislation and Regulation The literature did highlight that some of the work, both in the UHC and the nurse-led services space, is examining issues of scope of practice. This is a critical component of health systems redesign. Regulation that was developed for the industrial era must be replaced by regulatory processes that are fit for today’s complex, global, and digital world ( Benton, 2017b ). Recent developments such as the NCSBN Regulatory Atlas ( Global Regulatory Atlas, n.d. ) provide information on 319 jurisdictions encompassing 20.5 plus million nurses from around the globe. This database is expanded on a weekly basis and the figures are correct as of March 7, 2019. The atlas offers a way for jurisdictions to compare and contrast their approach with those of other countries. Use of such tools provides a means of reaching out to peers and, through dialogue, gain insights on ways to reform regulation and legislation.

To be effective, nurses must engage at all policy levels and avoid a sole focus on high-level dialogue. Profile and Status Often nurses become fixated on representation at the highest policymaking tables ( Juma, Edwards, & Spitzer, 2014 ; Nagle, 2014 ; Polansky, Gorski, Green, Perez, & Wise, 2017 ). This is important, but only part of what needs to be done if the nursing voice is to be heard and its profile and status raised. To be effective, nurses must engage at all policy levels and avoid a sole focus on high-level dialogue. To this end, Brownson, Chriqui, & Stamatakis ( 2009 ) suggested a need to better understand barriers and levers for engaging and bringing about policy change. Recent work by Woodward, Smart, and Benavides-Vaello ( 2016 ) identified that one way to address this is to target modifiable factors that support the contribution of nurses to policy and politics.

Three modifiable factors were identified: integration of political education in the nursing curriculum; the value of active psychological engagement; and the value of collective influence. Furthermore, Benton and Shaffer ( 2016 ) have suggested that by equipping nurses with the necessary skills, the profession of nursing has a wide range of contributions to make across all 17 of the sustainable development goals. Sometimes this can be accomplished through action, sometimes through advocacy, and sometimes through the alignment of the profession with others. To do this, Benton, Al Maaitah, & Gharaibeh ( 2017 ) highlighted a need to clearly set out policy and political competencies needed by nurses at all levels and not simply promote it as an opportunity to lobby government.

Ellenbecker et al. ( 2017 ) made a partial attempt to address this in a publication about a staged approach to educate nurses in health policy. However, while their proposals are a welcome addition, they cluster Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) competencies together; draw upon U.S. nursing literature, and fail to explore work undertaken in the wider policy space. The work of Ellenbecker et al. ( 2017 ) needs further exploration to differentiate between DNP and PhD roles, as well as include policy competencies for both the sub-baccalaureate level and diploma-prepared individuals. It is only when nurses contribute in such a wide manner, at all levels, that the potential of the nursing profession will be optimized, its voice heard, its profile raised, and its contribution valued.

Promoting Existing Resources

This study has identified several opportunities for nurses to contribute to the UHC policy landscape. To assist in pursuing such opportunities, there are a great deal of freely accessible resources to help nurses develop policy advocacy skills. Some are highly focused and address a single dimension of raising a policy voice and the visibility of the profession, such as guides to writing for scholarly publication or writing policy briefs ( Wiley, 2014 ; Young & Quinn, 2017 ). Other material is far more comprehensive and provides what can best be described as a series of distance learning modules or a toolkit that offers a relatively comprehensive grounding in various aspects of contributions to health policy ( WHO Western Pacific Region, 2005 ). Nursing Now! could curate such resources and include them on its website, providing a focused, high-quality suite of documents to share with partners and nursing groups affiliated with the campaign.

We do not need to reinvent the wheel, but we do need to disseminate knowledge more effectively and efficiently as our scholarship and networks grow. Exploiting Growing Capacity Florence Nightingale was well-educated, well-connected, and grounded in the realities of practice. She was also passionate about finding solutions to the problems she identified. As more and more nurses attain higher levels of education, the capacity to emulate Nightingale’s work and those that followed in her footsteps is enhanced. To this point, nursing as a profession has not been as prolific in the scholarship space as has medicine. The findings of this study serve as a benchmark to measure progress. As a result of this study, we can now look at creation of invisible colleges and development of themes as we address topics relevant to the SDGs in general, and UHC in particular. Most importantly, we can leverage some existing work toward the UHC agenda. We do not need to reinvent the wheel, but we do need to disseminate knowledge more effectively and efficiently as our scholarship and networks grow. That is the challenge we face as we enter the bicentennial of Nightingale’s legacy. By looking at successes of other nurse luminaries from around the world, we can, as Nightingale posited, keep moving forward, building upon lessons learned, and tackling opportunities identified.

A Global Social Movement and Recommendations to Advance It One objective of Nursing Now! is to develop a global social movement. By looking at co-authorship from the perspective of the countries from which authors originate and are connected, it is possible to identify and leverage existing networks. We believe that digital platform links, once made, can be maintained ( Benton & Ferguson, 2017b ). We note that nurses tend to develop proximal geographic links, but with the advent of social media as a tool in knowledge transfer, wider and more rapid dissemination is possible ( Reed, 2018 ). Accordingly, we recommend that existing professional societies, associations, and regional structures (e.g., the WHO regional offices) capitalize on this when seeking to obtain policy input at national, regional, and global levels.

One objective of  Nursing Now!  is to develop a global social movement. Entities such as the WHO Nursing Collaborating Centers should initiate and promote publication of policy briefs as parallel documents to systematic and meta-analytical studies. As a starting point, a bibliometric analysis of such studies should be conducted to identify areas that will make an optimal nursing contribution to the pursuit of UHC and help address other relevant SDGs. Furthermore, journals should mirror the efforts of the International Nursing Review to highlight policy implications of published scholarship. Such efforts, we believe, will provide a rich source of material for use in local, national, regional, and international advocacy efforts.

Recent work ( Benton, Al Maaitah, & Gharaibeh, 2017 ; Ellenbecker et al., 2017 ; Woodward et al. 2016 ) has identified the need for increased education in political participation and policy analysis. We recommend further work to expand and elaborate the competencies proposed by Ellenbecker et al. ( 2017 ) to equip nurses with the necessary knowledge, skills, and behaviors to effectively contribute to and influence policy at all levels.

Limitations

Due to software limitations, we were unable to analyze material published in any language other than English. However, this resulted in the rejection of less than 2% of the papers. Examination of the titles suggests that these papers were replicative in terms of material. Therefore, we believe that this limitation had minimal impact on our findings.

We set out to examine how nurses contribute to UHC scholarship and compare it with the contributions of the medical profession. In the process, we have identified that the profession of nursing lags significantly behind the medical profession, but can potentially make rapid progress if the isolated efforts of researchers are harnessed and the existing work on nurse-led services is applied to the pursuit of UHC. We have established a baseline of current nursing scholarship that can be used to assess progress. And, we have offered concrete suggestions for further work.

In pursuing our focus on UHC, we have also addressed other dimensions of the Nursing Now! objectives. Specifically, we have identified opportunities to increase and improve the dissemination of effective and innovative practice in nursing; examine the medical contribution to UHC for opportunities for collaboration and/or the pursuit of original work; and propose leveraging existing work and adding value by curating the evidence and through the production of policy briefs to inform change.

If the profession of nursing can harness the full potential of its enormous global workforce...then the possibilities for change are limitless. If the profession of nursing can harness the full potential of its enormous global workforce through energizing and engaging staff at all levels in policy processes, then the possibilities for change are limitless. The impact on access, quality, and cost would be truly profound, and would be a fitting tribute to the work of Nightingale and so many other outstanding nurses that have contributed to our profession over the years. In reality, it is not just Nightingale that we should celebrate but instead use the bicentennial as a focus for all nurses who contributed to the advancement of our profession.

If Nursing Now! can bring about the planned global social movement, then the 200th anniversary of Nightingale’s birth in 2020 could form the basis of a paradigm shift for the profession. More importantly, imagine the impact on the health of nations and the attainment of UHC that such a change would bring. As Truman reminded us, familiarity with history can provide us with insights into the challenges we face. We believe that this bibliometric analysis has provided lessons that position the nursing profession to pick up the mantel vacated by our predecessors. It is now up to us to continue to march forward.

David C. Benton, PhD, RN, FRCN, FAAN Email: [email protected]

Christine J. Beasley, DBE, RN Email: [email protected]

Stephanie L. Ferguson, PhD, RN, FAAN, FNAP Email: [email protected]

Benton, D .C. (1994). The NHS market: NHS counter culture. Nursing Standard , 8 (19), 48-50. doi: 10.7748/ns.8.19.48.s59

Benton, D. C. (2012). Advocating globally to shape policy and strengthen nursing’s influence OJIN: The Online Journal of Issues in Nursing, 17(1), Manuscript 5. doi: 10.3912/OJIN.Vol17No01Man05

Benton, D. C. (2017a). Using bibliometrics to support revalidation requirements. Nursing Standard, 32 (1), 44-51. doi: 10.7748/ns.2017.e10589

Benton, D. C. (2017b). Bibliometric review: Identifying evolving and emergent regulatory trends. In Regulation 2030 First Steps on a Journey. Journal of Nursing Regulation , 8 (2), S5-S14. doi: 10.1016/S2155-8256(17)30125-4

Benton, D. C., & Alexander, M. (2016). The Journal of Nursing Regulation at age 6: A bibliographic analysis. Journal of Nursing Regulation, 7 (2), 4-8. doi:10.1016/S2155-8256(16)31072-9

Benton, D. C., Al Maaitah, R., & Gharaibeh, M. (2017). An integrative review of pursuing policy and political competence. International Nursing Review, 64 (1), 135-145. doi: 10.1111/inr.12275

Benton, D. C., Chapman, C., & Smith, E. (2003). Sharing experience and learning. Nursing Management, 10 (8), 24-27. http://dx.doi.org/10.7748/nm2003.12.10.8.24.c1957

Benton, D. C., Cusack, L., Jabbour, R., & Penney, C. (2017). A bibliographic exploration of nursing’s scope of practice. International Nursing Review, 64 (2), 224-232. doi: 10.1111/inr.12337

Benton, D. C., & Ferguson, S. L. (2014). How nurse leaders are connected internationally: An exploratory study. Nursing Standard. 29 (16), 44-48. doi: 10.7748/ns.29.16.42.e9060

Benton, D. C., & Ferguson, S. L. (2016). How anxiety about communication affects the role of nurse leaders in international social networks. Nursing Management, 23 (2), 30-37. doi: 10.7748/nm.23.2.30.s27

Benton, D. C., & Ferguson, S. L. (2017a). Opportunities for change: The United Nations working for health and growth report. Nursing Management, 24 (5), 26-30. doi: 10.7748/nm.2017.e1604

Benton, D. C., & Ferguson, S. L. (2017b). Sustaining a global social network: A quasi-experimental study. International Nursing Review, 64 (1), 42-49. doi: 10.1111/inr.12270

Benton, D. C., Pérez-Raya, F., Fernandez-Fernandez, M. P., & González-Jurado, M. A. (2015). A systematic review of nurse-related social network analysis studies. http://dx.doi.org/10.1111/inr.12161

Benton, D. C., & Shaffer, F. (2016). How the nursing profession can contribute to the Sustainable Development Goals. Nursing Management, 23 (7), 29-34. doi: 10.7748/nm.2016.e1534

Brownson, R. C., Chriqui, J.F., & Stamatakis, K.A. (2009). Understanding evidence-based public health policy . American Journal of Public Health, 99 (9), 1576-1583. doi: 10.2105/AJPH.2008.156224

Burdett Trust for Nursing. (n.d.). Nursing Now . Retrieved from https://www.btfn.org.uk/nursing-now/

Crane, D. (1972). Invisible colleges: Diffusion of knowledge in scientific communities. Chicago, IL: University of Chicago Press.

Cronin, B., & Sugimoto, C.R. (2014). Beyond bibliometrics: Harnessing multidimensional indicators of scholarly impact. Cambridge, MA: Massachusetts Institute of Technology.

Crisp, N., Brownie, S., & Refsum, C. (2018). Nursing and midwifery: The key to the rapid and cost-effective expansion of high-quality universal health coverage . Retrieved from the World Innovation Summit for Health website: http://www.wish.org.qa/wp-content/uploads/2018/11/IMPJ6078-WISH-2018-Nursing-181026.pdf

De Groote, S. L., & Raszewski, R. (2012). Coverage of Google Scholar, Scopus and Web of Science: A case study of the h-index in nursing. Nursing Outlook, 60 (6), 391–400. doi: 10.1016/j.outlook.2012.04.007

Ellenbecker, C. H., Fawcett, J., Jones, E. J., Mahoney, D., Rowlands, B., & Waddell, A. (2017). A staged approach to educating nurses in health policy. Policy, Politics and Nursing Practice, 18 (1), 44-56. doi: 10.1177/1527154417709254

Gingras, Y. (2016). Bibliometrics and research evaluation: Uses and abuses. Cambridge, MA: MIT Press.

Global Regulatory Atlas. (n.d.). NCSBN Global Regulatory Atlas. Retrieved from https://regulatoryatlas.com/

International Council of Nurses. (n.d.). Nursing Now. Retrieved from https://www.icn.ch/what-we-do/campaigns/nursing-now

Juma, P. A., Edwards, N., & Spitzer, D. (2014). Kenyan nurses involvement in national policy development processes. Nursing Research and Practice, 2014, 1-10. doi: 10.1155/2014/236573

Miller, M. (1974). Plain Speaking: An oral biography of Harry S. Truman. New York, NY: Tess Press.

Moody, L. E., Slocumb, E., Berg, B., & Jackson, D. (2004). Electronic health records documentation in nursing: Nurses’ perceptions, attitudes, and preferences. Computers Informatics Nursing, 22 (6), 337-344.

Nagle, L. (2014). An interview with Dr. Judith Shamian President, International Council of Nurses. Nursing Leadership, 27 (1), 26-30.

Nash, R. (1914). Florence Nightingale to her nurses: A selection from Miss Nightingale’s addresses to probationers and nurses of the Nightingale School at St. Thomas’s hospital. London, England: Macmillan and Co., Limited.

Nicholson, D., Yates, R., Warburton, W., & Fontana, G. (2015). Delivering universal health coverage: A guide for policy makers. Retrieved from the World Innovation Summit for Heath website: http://www.wish.org.qa/wp-content/uploads/2018/01/WISH_UHC_Forum_Report_08.01.15_WEB.pdf

Nightingale, F. (1859). A contribution to the sanitary history of the British army during the late war with Russia. London, England: John W. Parker and Son.

Oxman, A. D., Lavis, J. M., & Fretheim, A. (2007). Use of evidence in WHO recommendations. The Lancet, 369 (9576), 1883-1889. doi: 10.1016/S0140-6736(07)60675-8

Polansky, P., Gorski, M. S., Green, A., Perez, G. A., & Wise, R. P. (2017). Nurses leading change to advance health. Nursing Outlook, 65 (6), 746-752. doi: 10.1016/j.outlook.2017.04.004

Reed, M. S. (2018). The research impact handbook (2 nd ed.). Huntly, Scotland: Fast Track Impact Ltd.

River, C. (2018). Florence Nightingale: The life and legacy of the most famous nurse in history. Lexington, KY: Charles River Editors.

Small, H. (2017). A brief history of Florence Nightingale and her real legacy, a revolution in public health. London, England: Robinson.

TUDelft. (2017). Research positioning and trend identification [Booklet]. The Hague, Netherlands: Delft University of Technology. Retrieved from http://aida.tudelft.nl/toolbox/aida-booklet

United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development [PDF file]. Retrieved from https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf

Van Eck, N. J., & Waltman, L. (2010). Software survey: VOSviewer. A computer program for bibliometric mapping. Scientometrics. 84 (2), 523-538. doi: 10.1007/s11192-009-0146-3

Van Eck, N. J., & Waltman, L. (2018). VOSviewer manual [PDF file] . Leiden, The Netherlands. University of Leiden. http://www.vosviewer.com/documentation/Manual_VOSviewer_1.5.4.pdf

Wiley. (2014). Writing for publication: An easy to follow guide for nurses wanting to publish their work [PDF file] . Oxford, England: John Wiley and Sons, Inc. Retrieved from http://www.wiley-docs.com/HSJ-14-63694_Writing_for_Publication_lowres.pdf

Williamson, T., Rawle, A., Bacon, E., Cooper, E., Eastwood, J., Evans, A.,…Whitworth, J. (2006). An evaluation of a nurse-led unit: An action research study. Manchester, England: University of Salford/Derbyshire County PCT. http://usir.salford.ac.uk/12868/1/PDF_Nurse_Led_Evaluation_FINAL_REPORT_05.02.07.pdf

Wong, S. L., Bazemore, A. W., Green, L. A., & Miller, B. F. (2017). How to write a health policy brief. Families, Systems and Health, 35 (1), 21-24. doi: 10.1037/fsh0000238

Woodward, B., Smart, D. & Benavides-Vaello, S. (2016). Modifiable factors that support political participation by nurses. Journal of Professional Nursing, 32 (1), 54-61. doi: 10.1016/j.profnurs.2015.06.005

The World Bank. (n.d.). Universal health coverage. Retrieved from https://www.worldbank.org/en/topic/universalhealthcoverage

World Health Organization. (n.d.a). Nursing Now. Retrieved from https://www.nursingnow.org/

World Health Organization. (n.d.b). Nursing Now campaign. Retrieved from https://www.who.int/hrh/news/2018/nursing_now_campaign/en/

World Health Organization Western Pacific Region. (2005). Health service planning and policy-making: A toolkit for nurses and midwives. Geneva, World Health Organization. http://apps.who.int/iris/handle/10665/207061

World Health Organization, World Bank Group, Organization of Economic Cooperation and Development. (2018). Delivering quality health services: A global imperative for universal health coverage. Geneva, Switzerland: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/272465/9789241513906-eng.pdf?ua=1

Yan, E. & Ding, Y. (2012). Scholarly network similarities: How bibliographic coupling networks, citation networks, co-citation networks, topical networks, co-authorship networks and co-word networks relate to each other. Journal of the American Society for Information Science and Technology, 6 3(7), 1313-1326. doi: 10.1002/asi.22680

Young, E. & Quinn, L. (2017). An essential guide to writing policy briefs [PDF file] . Berlin, Germany: International Centre for Policy Advocacy. Retrieved from http://www.icpolicyadvocacy.org/sites/icpa/files/downloads/icpa_policy_briefs_essential_guide.pdf

May 31, 2019

DOI : 10.3912/OJIN.Vol24No02Man05

https://doi.org/10.3912/OJIN.Vol24No02Man05

Citation: Benton, D.C., Beasley, C.J., Ferguson, S.L., (May 31, 2019) "Nursing Now! Learning from the Past, Positioning for the Future" OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 5.

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Deontology and Utilitarianism in Nursing

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Preserving paradise: USC students learn about sustainable hospitality in the Galápagos

The Galápagos Islands: the name alone conjures images of tropical beauty and natural treasures. Spanish Captain Diego de Rivadeneira called them "Las Islas Encantadas" on his first visit in 1546, and that nickname lingers still. Charles Darwin's studies there in 1835 played a big part in the development of his theory of evolution. Now, University of South Carolina students follow in his scholarly footsteps.

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The second visit was to the Metropolitan Cruise Lines expedition ship La Pinta. There too, the students observed and asked questions while touring and meeting with the crew. They also wrote papers with operations suggestions.

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The last business visit was to Ranti Coffee. "It’s a Galápagos-only company. They have their own tree, roasting room and showroom, all on San Cristóbal," Ayres says. The students took a close look at every part of the operation, again discussing and questioning and offering their suggestions for operational improvements.

The hospitality and tourism industry is by far the largest economic driver in the Galápagos, employing 40 percent of residents. With 97 percent of the islands set aside as a national park, it is an ideal setting for studying sustainable hospitality and tourism, a topic of critical importance in South Carolina. USC’s School of Hospitality and Tourism Management has produced many of the current leaders of those industries, and the next generation is learning through experiences like these.

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As all USC trips do, the most recent Maymester excursion offered many chances for students to explore, including nature hikes, snorkeling at spots including the world-famous Kicker Rock, scuba diving (students can earn certification through USC, and College of HRSM professor and certified instructor Richard Southall teaches a class on sustainability, eco-tourism, and the diving industry in the Galápagos) and of course plenty of time to enjoy some of the world’s most beautiful beaches.

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What is nursing professionalism? a concept analysis

1 Nursing College of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

2 Linfen Hospital Affiliated to Shanxi Medical University (Linfen People’s Hospital), Linfen, 041000 Shanxi People’s Republic of China

3 The Third Peoples Hospital of Taiyuan, Taiyuan, 030001 Shanxi People’s Republic of China

Yangjie Chen

4 The First Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi People’s Republic of China

Qiaohong Wang

Associated data.

Data used to support the findings of this study are available from the corresponding author upon request.

Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking.

Walker and Avant’s strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study.

The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism.

Conclusions

This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Introduction

The COVID-19 outbreak has exposed deficiencies in the underinvestment of the global health system, including the shortage in nursing resources and nursing staff, and a similar situation is noted in China ( https://www.icn.ch/news/investing-nursing-and-respecting-nurses-rights-key-themes-international-nurses-day-2022 ). An unbalanced number of nurses and patients, high work pressure, lack of social occupational identity and other reasons have led to job burnout, low job satisfaction, and even the resignation of many nurses. Research has also shown that the lack of nursing professionalism adversely affects patient care and patient outcomes [ 1 ]. Ohman [ 2 ] pointed out that lower levels of professionalism may cause negative outcomes, such as turnover and attrition and lower productivity.

In recent years, researchers have tried to solve the above problems through professionalism.

However, nursing professionalism plays a more important role in clinical nursing. Some studies have shown that professionalism can improve the professional knowledge and skills of nurses and ameliorate reductions in institutional productivity and quality [ 3 ]. Higher levels of professionalism can improve nurses’ autonomy and empowerment, increase their recognition and facilitate organizational citizenship behaviours, establish nursing care standards and even improve quality services [ 4 , 5 ].

Nursing professionalism has been discussed for several decades. Hall (1968) developed the Professionalism Inventory Scale [ 6 ]. Miller et al [ 7 ] (1993) first specified the 9 standards criteria of nursing professionalism (educational background; adherence to the code of ethics; participation in the professional organization; continuing education and competency; communication and publication; autonomy and self-regulation; community service; theory use, development, and evaluation; and research involvement.). Yeun et al. (2005) summarized five themes regarding nurses’ perceptions of nursing professionalism: self-concept of the profession, social awareness, professionalism of nursing, the roles of nursing services, and originality of nursing [ 8 ]. Yoder defined nursing professionalism based on six components: acting in the patients’ interests; showing humanism; practising social responsibility; demonstrating sensitivity to people’s cultures and beliefs; having high standards of competence and knowledge; and demonstrating high ethical standards [ 9 ]. Although some researchers have explored the concept of professionalism. How can professionalism be evaluated in nursing clinical practice? Few studies have shown a clear conceptualization of nurses’ professionalism [ 10 , 11 ]. To nurture nursing professionalism, the concept of professionalism must be clarified.

Given that the meaning of professionalism varies across time, contexts, or cultures, it is difficult to define, quantify or measure professionalism [ 12 , 13 ]. The operational definition of nursing professionalism in studies has shortcomings. Sullivan et al. [ 14 ] found professionalism to be a multidimensional concept, but some papers have addressed only one dimension, such as values [ 15 ] or behaviours [ 16 ]. Moreover, professionalism is considered a complex concept. The links and dynamic processes between these different inner characteristics have not been included in the concept. Thus, a comprehensive definition of nursing professionalism, including its characteristics and the relations between them, is necessary.

Recognizing and understanding the concept of nursing professionalism may be an essential step towards providing quality care for people. It may also provide more information for further developing nursing professionalism for nurses.

Method of concept analysis

Walker and Avant’s method used linguistic philosophy techniques to contribute to the philosophical understanding of a concept [ 17 ]. The W & A method is considered a mark of the positivist paradigm, which views the concept as a stable factor that can be reduced or extracted from its context of application [ 18 ]. This study used Walker and Avant’s method, which assumes that nursing professionalism is a relatively mature and stable concept (numerous studies on nursing professionalism have been published to date). This approach to conceptual analysis, although not perfect, is helpful in clarifying the concept of nursing professionalism.

Using the structured method of Walker and Avant enables conceptual clarity to be obtained based on an inductive identification of the concept’s attributes, antecedents and consequences. The concept analysis helps to clarify meanings and develop operational definitions, considering evidence from a wide range of information resources for further research or clinical practice [ 17 , 19 ]. These features make this method particularly useful for the analysis of the concept of ‘nursing professionalism’. The conceptual attributes as well as antecedents and consequences are based on the research team's analysis of the literature using Walker and Avant’s strategy and are not the product of a priori theoretical categories.

Walker and Avant’s [ 17 ] eight-step method includes the following: 1) selecting a concept; 2) determining the aims or purposes of analysis; 3) identifying all uses of the concept; 4) determining the defining attributes of the concept; 5) constructing a model case; 6) constructing borderline, contrary, invented, and illegitimate cases; 7) identifying antecedents and consequences; and 8) defining empirical references.

Selection criteria

The inclusion criteria were as follows: related to the concept of nursing professionalism; included nurse professionalism, nursing spirit, or nurse spirit; written in the English language; qualitative, quantitative, mixed methods or systematic reviews; published between 1965 and 2021 (when professionalism was first introduced by nursing in 1965); and published in books or dictionaries. We excluded articles published in nonpeer reviewed journals, editorials and letters to the editor.

Data sources

We searched several online databases, including PubMed, Scopus, and CINAHL, for articles published from 1965 to 2021. We searched the words that appear in the title, abstract, and keyword section of the studies.

(((((((((Nursing professionalism[Title]) OR (Nursing professionalism[Title/Abstract])) OR (Nurse professionalism[Title])) OR (Nurse professionalism[Title/Abstract])) OR (Nursing spirit[Title])) OR (Nursing spirit[Title/Abstract])) OR (Nurse spirit[Title])) OR (Nurse spirit[Title/Abstract])).

TI Nursing professionalism OR AB Nursing professionalism OR TI Nurse professionalism OR AB Nurse professionalism OR TI Nursing spirit OR AB Nursing spirit OR TI Nurse spirit OR AB Nurse spirit.

TITLE-ABS-KEY (Nursing professionalism) OR TITLE-ABS-KEY (Nurse professionalism) OR TITLE-ABS-KEY (Nursing spirit) OR TITLE-ABS-KEY (Nurse spirit).

Any quantitative or qualitative studies published in English focusing on nursing professionalism were included in the study. Two researchers independently screened titles and abstracts to determine the selection criteria for electronic retrieval and application. The study was included only when both researchers agreed that the study met the inclusion and exclusion criteria. If the two researchers’ judgements were different, a third person was consulted to resolve the issue. Researchers identified the different usages of the concept and systematically recorded the characteristics of the concept that appeared repeatedly [ 17 ].

We used definitions and examples in the systematic record (Table ​ (Table2) 2 ) to define a cluster of antecedents, attributes and consequences (Figs. ​ (Figs.1 1 and  2 ) frequently associated with the concept [ 20 ].

Flowchart of the study selection process of the concept analysis

The connotations of nursing professionalism

Antecedents, attributes, and consequences of nursing professionalism

We identified 6013 studies on nursing professionalism. After excluding duplicates, irrelevant studies, studies that were not original scientific studies or articles, and studies published in languages other than English, 138 studies were selected for analysis. Tables 1 and ​ and2 2 show some typical literatures used in this study.

The attributes of the nursing professionalism

Uses of the concept

Dictionary definitions of the concept.

The Merriam-Webster Dictionary defines professionalism as ‘the conduct, aims, or qualities that characterize or mark a profession or a professional person’ [ 48 ], whereas the Cambridge Dictionary [ 49 ] defines professionalism as ‘the combination of all the qualities that are connected with trained and skilled people’. These definitions are generic and difficult to use to clarify the factors involved in nursing professionalism.

Definitions of the concept reported in the literature

Hwang et al. [ 50 ] defined professionalism as commitment to a profession and professional identity level. Health-care workers demonstrate professionalism through attitudes, knowledge, and behaviours, which reflect approaches to the regulations, principles, and standards underlying successful clinical practices [ 33 ]. Nursing professionalism reflects the value orientation, concepts of nursing, work attitude and standards of clinical nurses [ 51 ].

Subconcepts

The Nightingale Spirit, named in honour of the founder of professional nursing, refers to the spirit of altruism, caring, and honesty [ 52 ]. In the past, the Nightingale Spirit advocated that nurses are willing to dedicate themselves, but the term currently encompasses more innovation [ 53 ]. E-professionalism is defined as evidence provided by digital means, attitudes and behaviours reflects the traditional models of professionalism [ 54 ]. Nurses use the internet to communicate about work or daily life, blurring the boundaries between individuals and professions; thus, e-professionalism applies to nurses [ 55 ].

The defining attributes of nursing professionalism

The defining attributes of the concept aim to understand its meaning and differentiate it from other related concepts [ 17 ]. The key defining attributes are as follows.

Nursing professionalism is multidimensional

Nursing professionalism is a three-dimensional concept based on the knowledge, attitudes, and behaviours that underlie successful clinical practice [ 33 ].

Professionalism can be conceptualized as a ‘systematic body of knowledge’ with complex configurations of work expertise [ 21 ].

Professionalism refers to the attitude that represents levels of recognition and commitment to a particular profession [ 22 ]. Hall [ 6 ] noted that nurses’ attitudes have a high correspondence with the behaviours of the respondent. Measuring professionalism at the cognitive level can be thought of as measuring potential professionalism at the behavioural level. Researchers noted that given the reduced restrictions of environmental constraints, measuring professionalism at the cognitive level may be more precise than measuring it at the behavioural level [ 23 ].

Nursing professionalism is often described as a set of professional behaviours [ 11 ]. Some researchers judge whether nurses exhibit professionalism through their behaviours. Miller [ 24 ] (1988) developed the Wheel of Professionalism in Nursing Model. The model is considered a framework for understanding professional behaviours among nurses. Kramer [ 56 ] (1975) quantified professionalism by assessing the number of professional books purchased, subscriptions to journals, and the number of articles published.

In addition, the perspective of professional identity formation complements the behaviour-based and attitude-based perspectives on professionalism [ 57 ].

The formation and development of professionalism are dynamic processes

Nursing professionalism is an inevitable, complex, varied, and dynamic process [ 58 ].The professionalism concept is considered ever-changing, replacing static or definitive views [ 59 ].

Socialization process

Nursing professionalism is instilled through a process of socialization in formal nursing education [ 25 ]. Nurses’ socialization process begins with formal, entry-level education to acquire knowledge and skills.

Yeun et al. [ 8 ] (2005) discussed the developmental process of nursing professionalism in which the individual’s thoughts and beliefs are formed by socialization factors through perception. These thoughts and beliefs may in turn influence the individual’s professional image or self-concept, thereby influencing nurses’ actions and performance.

Process of interaction

The dynamic of professionalism is also reflected in the process of interaction. Dehghani et al. [ 26 ]noted that nursing professionalism means the appropriate interaction of the individual and the workplace and the maintenance of interpersonal communication.

Culture oriented

One study showed that altruism is an essential element of medical professionalism in Asia or North America but not Europe [ 27 ]. In China, medical professionalism was influenced by its longstanding Confucian traditions [ 28 ]. Therefore, any definitions of professionalism should match its rooted culture and be validated with respect to the culture and context in which it is applied [ 60 ].

The connotation of nursing professionalism

Professional, having a systematic nursing knowledge system.

The nursing process is considered a method for solving problems or dilemmas in a logical and scientific manner [ 11 ]. Freidson [ 29 ] (2001) noted that professionals perform their specialized work only with the required training and experience. Professionals have specific, tacit, almost esoteric knowledge to do their work [ 61 ]. Miller et al. [ 7 ] considered that a formal university education with a scientific background is critical for professionalism in nursing.

Professional certification

Nurses actively seek specialty certification given their personal commitment to the nursing profession [ 30 ]. Specialty certification promotes nursing professionalism. When attaining the highest levels of clinical knowledge, nursing professionalism also indicates personal responsibility and dedication to best practices [ 31 ].

Lifelong learning and participation in continuing education

Due to professional and ethical obligations, nurses should sustain continuous professional growth and development to maintain individual competence. Professional growth in nursing requires lifelong learning. Lifelong learning includes continuing education and self‐study, seeking advanced degrees, etc. [ 62 ].

Continuing education is one of the indicators of professionalism. Professionals keep up with the latest developments in the field and partake in continuing education. Additionally, continuing education is as important as other criteria for increasing professionalism in nursing [ 7 , 32 ]. Ongoing education brings fresh knowledge to health care, consequently leading to more efficient and quality service for people.

Evidence-based practice

Evidence-based practice (EBP) is a hallmark of professionalism [ 33 ]. Dollaghan [ 63 ] (2004) reported that we identify and use the highest quality scientific evidence as an integral part of our efforts to provide the best patient care; EBP is a knowledge base that responds to specific clinical issues in a clear, intelligent, and serious manner while considering clinical practice in the context of the highest-quality scientific evidence available.

Innovation in nursing helps to improve patient care quality and improve nurses’ job performance [ 64 ]. Shen et al. [ 34 ] noted that innovative education plays an important role in the professional quality of undergraduate nursing students.

Striving for excellence

Striving for excellence is a requirement and attribute of nursing professionalism. There is a growing need in nursing practice to possess knowledge and skills in quality improvement science, translational research, and implementation science [ 35 ]. Clinical nurses have the same responsibilities as nursing scientists.

Caring is considered the core attribute of nursing professionalism

The practice of caring is central to nursing [ 65 ]. Caring is defined as the moral ideal of nursing [ 36 ]. Therefore, caring is an important core attribute of nursing professionalism.

Creating a caring-healing environment

Nurses devoted to creating a caring-healing environment embody professionalism. Caring means nurses should create a healing environment at all levels by providing a supportive, protective environment as well as a corrective mental, physical, societal, and spiritual environment for patients. People’s basic needs include a clean environment, comfort measures, safety concerns, and feeling safe or protected [ 65 ].

Displaying kindness/concern/empathy for others

A nurse is defined as someone caring for the ill within the hospital setting [ 66 ]. Caring means showing or having compassion, concern and empathy for others [ 37 ]. Caring behaviours are an interactive and mental process between patients and nurses [ 38 ]. Displaying kindness and concern for others is shown by love, compassion, support and involvement [ 39 ].

Using all methods of knowing support and involvement

‘Human problems reside in ambiguity, paradox, and impermanence’. Therefore, suffering, healing, miraculous cures, and synchronicity are all part of knowing support and involvement.

Researchers suggest that nursing comprises Caritas Nursing, Energy Nursing, Transpersonal Nursing, Holistic Nursing, or Contemplative Nursing…… It goes beyond ordinary nursing. Nursing should have higher standards with excellence for caring, healing, and peace in the world. Therefore, caring means using all methods of knowing support and involvement [ 65 ].

Embracing the unknowns and miracles in life and practising loving

Nursing is a special profession. Nurses confront special circumstances daily and witness people’s struggles with life and death. Everyone has his or her own specific story about his or her experiences and predicaments. Each person seeks his or her own meanings to find inner peace and balance in the midst of fear, doubts, despair, and unknowns. Therefore, the care of nurses is not to blindly sacrifice their own needs but to be a real nurse, embracing the unknowns and miracles in life and caring for patients [ 65 ].

The central tenet of professionalism is to put the needs and best interest of others over self-interests. Altruism is an engagement in caring acts towards others without expecting something in return [ 67 ].

Patients first

To be altruistic means to put others’ needs before your own. Altruism is the selfless concern for others and doing things with the other person’s well-being in mind [ 40 ].

During pandemics, nurses were considered to have a high sense of duty and dedication to patient care [ 41 ]. Front-line nurses perceive high work engagement, especially in self-dedication [ 42 ]. Grøthe et al. [ 43 ] showed that cancer patients in a palliative unit appreciate nurses who have the most dedication and expertise characteristics.

• Public service

Due to a strong sense of civic and social responsibility, nurses participate in public service. Nurses volunteer as participants in summer camps, schools, or health-care teams. Nurses are also committed to responding to large-scale crises, such as the terrorist attacks on the World Trade Center in New York, as well as national and international relief efforts, such as tsunamis and Hurricane Katrina [ 44 ].

• Disaster and infectious disease rescue

Individuals involved in providing disaster relief face many challenges, experience fatigue and personal suffering, and encounter numerous personal stories of life and death [ 45 ]. Nurses have played a significant role in the fight against infectious diseases such as severe acute respiratory syndrome (SARS) and the coronavirus disease 2019 (COVID-19) pandemic [ 68 ]. Nurses are closest with patients. Nurses provide intensive care, regularly assessing and monitoring airways, tubes, medications, and physical therapy. Nurses are also devoted to reducing complications. Nurses assist with daily living activities when patients are unable to care for themselves [ 46 ].

• Community service

In addition, emphasizing professionalism means respecting values and commitment to community service delivery [ 69 ].

According to Walker and Avant [ 17 ], cases help further clarify concepts.

Model cases (a real case example)

Model cases help demonstrate all the defining attributes of a concept and helps to better articulate its meaning [ 17 ].

MS A is a 63-year-old nursing director. She worked in clinical nursing and management for 42 years. As she progressed from a new nurse to a nursing expert, she gradually poured her enthusiasm (Multidimensional: Attitudes) into nursing work (Dynamic). She believes that the core of nursing professionalism in China is dedication and responsibility (Culture oriented). In 2020, COVID-19 broke out in Wuhan, China. She led a team to Wuhan to provide support (Multidimensional: Behaviours), reflecting the spirit of altruism (Altruism). She actively promoted exchanges and cooperation among disciplines and the development of academic conferences. She guided students to pay attention to practical innovation and develop evidence-based innovations (Professional). Although she is retired, she still imparts knowledge and experience to students everywhere (Multidimensional: Behaviours). She stated that the development of nursing professionalism is very difficult and requires nursing education and role models. (Multidimensional: Knowledge). The role of a nurse is like that of a mother, bringing care to the people (Caring).

Borderline cases (a real case example)

Borderline cases provide the examples that contain the most defining attributes of the concept [ 17 ].

B is a novice nurse. When working in the infection ward, she was so worried about being infected. She was reluctant to care for patients and wanted to escape from the ward environment. Fortunately, her nurse manager fully understood her situation and helped her adapt to work and reduce her anxiety. B observed that her nurse manager had been helping patients solve problems and giving them comfort and hope. This prompted her to think about what nursing truly means. In 2020, she volunteered to help COVID-19 patients (Altruism).

Related cases (a real case example)

Related cases are related to the concept but do not contain all its defining attributes [ 17 ].

C is a novice nurse. After graduating from nursing school, he became a nurse in the emergency department. He saw many patients who died or recovered, which made him realize the importance of caring (Caring). He said that emergency nurses need strong professionalism (Multidimensional: Attitudes). He participated in social service activities (Multidimensional: Behaviours), for example, promoting knowledge of cardiopulmonary resuscitation (Altruism) in the community. After working for five years, he returned to school for a master’s degree to help the head nurse conduct nursing research or evidence-based practice (Professional). In his Asian cultural milieu, his is embarrassed about his identity as a male nurse (Culture oriented), but he believes he can do well.

Contrary cases (a fictional case example)

A contrary case does not include any defined attributes of the concept [ 17 ].

D is a nurse in paediatrics. She disliked nursing when she was a nursing student and even did enjoy communicating with patients (poor dynamics). She was exhausted after work and felt her life was out of balance. One of the values of the hospital where she worked was dedication, which confused her (Poor culture orientation). She considers it unrealistic to require professionalism (Poor nursing professionalism knowledge) and thinks that taking care of new-borns is particularly troublesome (Poor nursing professionalism attitudes), so she is always careless in her work (Multidimensional: poor attitude). D’s child felt ill last week, so she secretly reduced a patient’s medicine (Poor nursing professionalism behaviours) and took the remaining medicine home for her child (lack of altruism). She stopped doing so after her colleagues sensed something strange. One day, a baby kept crying; D reported it to the doctor and did not make further observations (Poor professional). When the shift nurse took over, she observed abnormal limb activity on one side of the child. The child’s family asked the nurse to bear legal responsibility. D said it was no big deal; she no longer wanted to be a nurse (Poor dynamic, professionalism not established).

Antecedents

Antecedents are events that occur before the intended concept [ 17 ].

Macro antecedents

Jin [ 28 ] suggested that the conceptualization of professionalism is influenced by culture. Employees defined organizational culture underlies an organization’s values and beliefs [ 70 ]. Nursing professionalism may be supported by a variety of cultures, so a firm understanding of and personal congruence with each particular culture is essential [ 71 ].

Religious beliefs

Religiosity is another contributing factor in the cultivation of altruism [ 72 ]. Taylor noted that nurses’ job motivation and views of the patient and nursing services are affected by their religious beliefs [ 73 ].

Micro antecedents

Snizek [ 74 ] (1972) reported that devotion to work is a professional value originating from a sense of calling to the field. Liaw et al. [ 75 ] (2016) found that nursing students who had caring and compassionate qualities as the most common personal characteristics strongly believed that they were called to nursing.

Individuals who pursue excellence in the workplace may be described as motivated and devoted to their work. Attree [ 76 ] (2005) noted that nurses’ perceived lack of autonomy over their practice could impact quality of care.

Personal characteristics

Nursing professionalism is influenced by various factors, such as educational background, personal interests, professional satisfaction, and professional values [ 77 , 78 , 79 ]. In each country, nurses with higher educational levels may have a higher level of professionalism [ 22 ]. Professionalism is thus a trait related to personal character and upbringing [ 80 ]. Researchers [ 81 ] have demonstrated that professionalism is positively associated with female gender, striving for professional goals, and acceptability. One study found that people’s values tend to shift to emphasize altruism over personal gain as they age [ 79 ]. Nursing professionalism is closely associated with personality traits (extraversion, conscientiousness, and agreeableness) [ 82 ].

Consequences of nursing professionalism

Consequences are events or incidents that are the result of the occurrence of a concept [ 17 ].

Consequences for patients 

Professionalism is one of the decisive factors that critically influences patient satisfaction [ 50 ]. Professionalism can also improve practising nurse career development and the quality of service [ 81 ].

Consequences for nurses

Studies have shown that professionalism and a sense of belonging with colleagues and managers affect the satisfaction [ 83 ] and retention rate of nursing students in academic institutions [ 84 ]. Izumi et al. [ 85 ] (2006) found that good nurses felt pride and happiness in caring for patients closely related to their professionalism.

Empirical references

As the last step to concept analysis, empirical references can further clarify the concept and facilitate its measurement [ 17 ].

Hall’s professionalism inventory scale

Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism: (a) use of professional organizations as major referents, (b) belief in public service, (c) self-regulation, (d) a sense of calling to the field, and (e) autonomy. Nursing researchers used Hall’s Professionalism Inventory Scale to measure professionalism in nursing [ 22 , 47 ]. Snizek [ 74 ] (1972) modified the professionalism scale to more closely match the clinical context of nursing and better reflect the professionalism of nursing staff.

Kramer’s index of professionalism

Kramer (1974) [ 86 ] constructed an index of professionalism that includes indicators of behaviours, such as the number of professional books published, subscriptions to professional journals, hours spent on professional reading, continuing education, participation in professional organizations, number of professional publications, speeches given, committee activity, and participation in research.

The behavioural inventory for professionalism in nursing (BIPN)

The Behavioural Inventory for Professionalism in Nursing [ 7 ] (BIPN) identifies professional behaviours and values among nurses. The nine categories in the BIPN are (1) educational background; (2) adherence to the code of ethics; (3) participation in the professional organization; (4) continuing education and competency; (5) communication and publication; (6) autonomy and self-regulation; (7) community service; (8) theory use, development, and evaluation; and (9) research involvement.

Definition of the concept

Based on the present analysis, we define nursing professionalism as follows: ‘Nursing professionalism is a multidimensional concept manifested by the knowledge, attitudes, and behaviours that underlie successful clinical practice. Nursing professionalism is dynamicized through a process of socialization in formal nursing education. This feature is also reflected in the process of interaction. Therefore, nursing professionalism should match its rooted culture.

The connotations of nursing professionalism include professional, caring, and altruism. These connotations are detailed as follows:

• Possesses a systematic nursing knowledge system; professional certification
• Exhibits lifelong learning and participation
• Participates in evidence-based practice
• Demonstrates innovation
• Strives for excellence
• Creates a caring-healing environment
• Displays kindness/concern/empathy for others
• Uses various methods of knowing support and involvement
• Embraces the unknowns and miracles in life and practices loving
• Patient-first

A conceptual model of nursing professionalism is shown in Fig.  2 .

Defining the connotation of nursing professionalism

Nursing professionalism has been defined as professional, caring, and altruistic.

Professional values are characteristic of nursing professionalism. Nursing work requires rich knowledge and scientific evidence-based work to improve the quality of nursing services for patients. Nurses need lifelong learning, qualification certification, and participation in academic and practical activities.

Caring is regarded as the core of professionalism. This study suggests creating a caring-healing environment, displaying kindness/concern/empathy for others, employing all methods of knowing support and involvement, embracing the unknowns and miracles in life and practising loving to care for people to obtain high professionalism. This study notes that nursing professionalism emphasizes care for the individual patient and that the nurse does everything possible to create a caring and healing environment for patients. In different health systems worldwide, nurses have incorporated caring about nursing professionalism into everything they do. This characteristic is consistent with Nightingale's view that “Nurses need to be sensitive. A nurse must use her brain, heart and hands to create healing environments to care for the patient’s body, mind and spirit” [ 87 , 88 ].

Nursing has an altruistic nature, and people interested in helping patients are attracted to this profession [ 89 ]. However, some studies have shown that altruistic care is equated with self-sacrifice, self-denial, and unidirectional and unconditional care [ 90 ]. Care for a nurse’s own needs is equally important, but nurses should be able to put aside their own needs when required to focus on the needs of others [ 91 ]. Nurses should view self-care and altruism as dialectical. Self-realization and providing care for others are not conflicting concepts [ 92 ].

Defining the attributes of nursing professionalism

In this study, we defined nursing professionalism as multidimensional, dynamic, and culture oriented.

Nursing professionalism is a multidimensional concept that includes knowledge, attitudes, and behaviour. Previous studies have defined professionalism as the degree of commitment by individuals to the values and behavioural characteristics of a specific career identity [ 6 , 7 ]. However, current research on nursing professionalism is mostly single dimensional. The Behavioural Inventory for Professionalism in Nursing (BIPN) is based on Miller’s model and is used to measure professional behaviours among nurses [ 7 ]. Hall’s Professionalism Inventory Scale [ 6 ] identified five attitudinal attributes of professionalism. This study highlights that it is also necessary to focus on the knowledge dimension of professionalism. Nursing students and nurses should first understand the nursing professionalism that is necessary to become a nurse, which may be the first step in developing professionalism. Nursing students and nurses need to know the values that are necessary to practice the nursing and not have vague impressions. Some studies have shown that nursing students or nurses learn values and norms in informal trainings [ 93 ]. Therefore, this study suggests that the development of assessment tools for the knowledge dimension of professionalism is also necessary. Multidimensional evaluation tools are not available for nursing professionalism. Thus, clarifying the multidimensional nature of nursing professionalism will contribute to the development of multidimensional evaluation tools.

Moreover, understanding the dynamics of professionalism is helpful for cultivating nursing professionalism in stages and steps. Inquiries into medical professionalism should be integrated into the culture of social media interaction [ 94 ]. Nursing educators and managers should dynamically cultivate nursing professionalism in their interactions.

Differences in the connotation of nursing professionalism are noted in different cultures. This study suggests that the cultivation and evaluation of nursing professionalism need to consider the cultural attributes of different regions and countries.

Future research directions

• Exploring the antecedents of nursing professionalism can help schools or hospitals cultivate nursing professionalism and develop courses and specific measures.

The macro antecedents of nursing professionalism include culture and religion, and the micro antecedents include calling, autonomy, and personal characteristics. Some researchers have explored methods to cultivate nursing professionalism; for example, role modelling, feedback, group discussions, case-based discussions, reflection, holding ethical rounds, and reports potentially represent more effective methods [ 95 ]. Some researchers have tried to enhance professionalism through social media [ 96 ]. One of the findings this study is that nursing professionalism is complex and its cultivation difficult. Studies have shown that didactic lectures are ineffective for teaching professionalism [ 97 ]. The development of true nursing professionalism requires national advocacy and the immersion of a good professional environment that incorporates professionalism into daily nursing practice. Role modelling is considered an effective method for developing professionalism in nursing [ 98 ]. Therefore, this study suggest that studies should be actively conducted to deeply discuss the causes and processes affecting professionalism and to cultivate and intervene at macro and micro levels as well as the key time periods and populations that form professionalism to truly shape the formation of professionalism. Moreover, an environment for building professionalism [ 99 ] is very important. Williams [ 100 ] (2015) considered that the development of professionalism should begin as early as the first semester of an undergraduate nursing course. One of the themes of nursing students’ professional identity development is ‘doing-learning-knowing-speaking’. Students should develop professionalism in all these areas of nursing practice.

• The relationship between nursing professionalism and health outcomes or nurses’ human resources needs to be further studied.

Our research suggests that the ultimate goal of nursing professionalism is to serve patients with professional knowledge and special professional quality. The public has become increasingly aware of certain possibilities, limitations, and consequences of professionalism. COVID-19 significantly increased the discussion of professionalism and patient outcomes.

Improving professionalism has a positive impact on job satisfaction, professional quality of life, and the willingness to continue in the profession [ 101 , 102 , 103 ]. Therefore, it is important to improve support for nurses, create a good environment for professionalism, and establish a training system for professionalism, thus paving the way to enhance training in professionalism and create opportunities for nurses.

Implications for nursing management

In April 2020, the World Health Organization (2020) issued the First State of the World’s Nursing 2020 [ 104 ]. The report highlighted that nursing professionals are the largest occupational group in the health sector, numbering 27.9 million worldwide. Nurses spend more time with patients than any other health care professionals [ 105 ].

Worldwide, nursing professionalism is considered important and associated with expectations. This study clarifies the concept of nursing professionalism and contributes to a framework for developing a theoretical model as well as instruments to measure the concept. A conceptual model of nursing professionalism may increase nurse managers’ insight into nurses’ behaviours and values, creating a good working environment.

Nurse managers should integrate nursing professionalism into their philosophy, mission, and objectives and provide necessary resources, tools, and projects to develop professionalism among nurses. Nurses should cultivate professionalism to provide good nursing services to patients. Further research should explore the relationship between nursing professionalism and patient health outcomes and formulate effective training programs for professionalism.

Limitations

This conceptual analysis has some limitations. First, research on nursing professionalism published in English may be conducted in different countries and cultures. However, it is also necessary to obtain a more comprehensive and mature concept of the study of different national languages. Second, the lack of research on the combination of all elements of professionalism may lead to overestimation of the impact of these subelements on professionalism. Third, the concept analysis focused on the research process and the researchers’ perspectives, possibly reflecting a lack of other professional understandings of nursing professionalism in medical groups. In addition, the concept analysis included a risk of selection bias, extraction bias, and analysis bias because the study selection process, data extraction, and analysis were all conducted by two researchers. Despite these risk, the studies were all described accurately and systematically.

Nursing professionalism is one of the important foundations of clinical nursing. It is multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism has been defined as providing people care based on principles of professionalism, caring, and altruism. The definition, attributes, antecedents, consequences, and reference analysis of the experience of nursing professionalism determined in this study provide a theoretical basis for future research. This information can be used to evaluate nursing professionalism, develop assessment tools, or generate theory-based training courses and interventions.

Acknowledgements

The authors would like to thank Hui Yang for the great efforts made in designing the research. We would like to thank linbo Li for providing valuable suggestions for this study.

Author’s contributions

Hl C and HY made substantial contributions to conception and design. HL C, YJ S, YM W, YF D Collectioned and analysis the data. Hl C was a major contributor in writing the manuscript. XY H, YJ C, QH W revised it critically for important intellectual content. All authors read and approved the final manuscript.

Postgraduate Education Innovation Program of Shanxi Province in China (No. 2020BY067).

Availability of data and materials

Declarations.

Our study was approved by the ethical committee of The First Hospital of Shanxi Medical University,Shanxi, China,(approval no. 2020K061).

Not applicable.

There is no conflict of interest in this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

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Yejun Song, Email: moc.qq@9109580601 .

Yanming Wu, Email: moc.621@6927myw .

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Xingyue He, Email: moc.361@320eHeuygnix .

Yangjie Chen, Email: moc.qq@8011856511 .

Qiaohong Wang, Email: [email protected] .

Hui Yang, Email: moc.361@0202iuhyq .

The state of AI in early 2024: Gen AI adoption spikes and starts to generate value

If 2023 was the year the world discovered generative AI (gen AI) , 2024 is the year organizations truly began using—and deriving business value from—this new technology. In the latest McKinsey Global Survey  on AI, 65 percent of respondents report that their organizations are regularly using gen AI, nearly double the percentage from our previous survey just ten months ago. Respondents’ expectations for gen AI’s impact remain as high as they were last year , with three-quarters predicting that gen AI will lead to significant or disruptive change in their industries in the years ahead.

About the authors

This article is a collaborative effort by Alex Singla , Alexander Sukharevsky , Lareina Yee , and Michael Chui , with Bryce Hall , representing views from QuantumBlack, AI by McKinsey, and McKinsey Digital.

Organizations are already seeing material benefits from gen AI use, reporting both cost decreases and revenue jumps in the business units deploying the technology. The survey also provides insights into the kinds of risks presented by gen AI—most notably, inaccuracy—as well as the emerging practices of top performers to mitigate those challenges and capture value.

AI adoption surges

Interest in generative AI has also brightened the spotlight on a broader set of AI capabilities. For the past six years, AI adoption by respondents’ organizations has hovered at about 50 percent. This year, the survey finds that adoption has jumped to 72 percent (Exhibit 1). And the interest is truly global in scope. Our 2023 survey found that AI adoption did not reach 66 percent in any region; however, this year more than two-thirds of respondents in nearly every region say their organizations are using AI. 1 Organizations based in Central and South America are the exception, with 58 percent of respondents working for organizations based in Central and South America reporting AI adoption. Looking by industry, the biggest increase in adoption can be found in professional services. 2 Includes respondents working for organizations focused on human resources, legal services, management consulting, market research, R&D, tax preparation, and training.

Also, responses suggest that companies are now using AI in more parts of the business. Half of respondents say their organizations have adopted AI in two or more business functions, up from less than a third of respondents in 2023 (Exhibit 2).

Gen AI adoption is most common in the functions where it can create the most value

Most respondents now report that their organizations—and they as individuals—are using gen AI. Sixty-five percent of respondents say their organizations are regularly using gen AI in at least one business function, up from one-third last year. The average organization using gen AI is doing so in two functions, most often in marketing and sales and in product and service development—two functions in which previous research  determined that gen AI adoption could generate the most value 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. —as well as in IT (Exhibit 3). The biggest increase from 2023 is found in marketing and sales, where reported adoption has more than doubled. Yet across functions, only two use cases, both within marketing and sales, are reported by 15 percent or more of respondents.

Gen AI also is weaving its way into respondents’ personal lives. Compared with 2023, respondents are much more likely to be using gen AI at work and even more likely to be using gen AI both at work and in their personal lives (Exhibit 4). The survey finds upticks in gen AI use across all regions, with the largest increases in Asia–Pacific and Greater China. Respondents at the highest seniority levels, meanwhile, show larger jumps in the use of gen Al tools for work and outside of work compared with their midlevel-management peers. Looking at specific industries, respondents working in energy and materials and in professional services report the largest increase in gen AI use.

Investments in gen AI and analytical AI are beginning to create value

The latest survey also shows how different industries are budgeting for gen AI. Responses suggest that, in many industries, organizations are about equally as likely to be investing more than 5 percent of their digital budgets in gen AI as they are in nongenerative, analytical-AI solutions (Exhibit 5). Yet in most industries, larger shares of respondents report that their organizations spend more than 20 percent on analytical AI than on gen AI. Looking ahead, most respondents—67 percent—expect their organizations to invest more in AI over the next three years.

Where are those investments paying off? For the first time, our latest survey explored the value created by gen AI use by business function. The function in which the largest share of respondents report seeing cost decreases is human resources. Respondents most commonly report meaningful revenue increases (of more than 5 percent) in supply chain and inventory management (Exhibit 6). For analytical AI, respondents most often report seeing cost benefits in service operations—in line with what we found last year —as well as meaningful revenue increases from AI use in marketing and sales.

Inaccuracy: The most recognized and experienced risk of gen AI use

As businesses begin to see the benefits of gen AI, they’re also recognizing the diverse risks associated with the technology. These can range from data management risks such as data privacy, bias, or intellectual property (IP) infringement to model management risks, which tend to focus on inaccurate output or lack of explainability. A third big risk category is security and incorrect use.

Respondents to the latest survey are more likely than they were last year to say their organizations consider inaccuracy and IP infringement to be relevant to their use of gen AI, and about half continue to view cybersecurity as a risk (Exhibit 7).

Conversely, respondents are less likely than they were last year to say their organizations consider workforce and labor displacement to be relevant risks and are not increasing efforts to mitigate them.

In fact, inaccuracy— which can affect use cases across the gen AI value chain , ranging from customer journeys and summarization to coding and creative content—is the only risk that respondents are significantly more likely than last year to say their organizations are actively working to mitigate.

Some organizations have already experienced negative consequences from the use of gen AI, with 44 percent of respondents saying their organizations have experienced at least one consequence (Exhibit 8). Respondents most often report inaccuracy as a risk that has affected their organizations, followed by cybersecurity and explainability.

Our previous research has found that there are several elements of governance that can help in scaling gen AI use responsibly, yet few respondents report having these risk-related practices in place. 4 “ Implementing generative AI with speed and safety ,” McKinsey Quarterly , March 13, 2024. For example, just 18 percent say their organizations have an enterprise-wide council or board with the authority to make decisions involving responsible AI governance, and only one-third say gen AI risk awareness and risk mitigation controls are required skill sets for technical talent.

Bringing gen AI capabilities to bear

The latest survey also sought to understand how, and how quickly, organizations are deploying these new gen AI tools. We have found three archetypes for implementing gen AI solutions : takers use off-the-shelf, publicly available solutions; shapers customize those tools with proprietary data and systems; and makers develop their own foundation models from scratch. 5 “ Technology’s generational moment with generative AI: A CIO and CTO guide ,” McKinsey, July 11, 2023. Across most industries, the survey results suggest that organizations are finding off-the-shelf offerings applicable to their business needs—though many are pursuing opportunities to customize models or even develop their own (Exhibit 9). About half of reported gen AI uses within respondents’ business functions are utilizing off-the-shelf, publicly available models or tools, with little or no customization. Respondents in energy and materials, technology, and media and telecommunications are more likely to report significant customization or tuning of publicly available models or developing their own proprietary models to address specific business needs.

Respondents most often report that their organizations required one to four months from the start of a project to put gen AI into production, though the time it takes varies by business function (Exhibit 10). It also depends upon the approach for acquiring those capabilities. Not surprisingly, reported uses of highly customized or proprietary models are 1.5 times more likely than off-the-shelf, publicly available models to take five months or more to implement.

Gen AI high performers are excelling despite facing challenges

Gen AI is a new technology, and organizations are still early in the journey of pursuing its opportunities and scaling it across functions. So it’s little surprise that only a small subset of respondents (46 out of 876) report that a meaningful share of their organizations’ EBIT can be attributed to their deployment of gen AI. Still, these gen AI leaders are worth examining closely. These, after all, are the early movers, who already attribute more than 10 percent of their organizations’ EBIT to their use of gen AI. Forty-two percent of these high performers say more than 20 percent of their EBIT is attributable to their use of nongenerative, analytical AI, and they span industries and regions—though most are at organizations with less than $1 billion in annual revenue. The AI-related practices at these organizations can offer guidance to those looking to create value from gen AI adoption at their own organizations.

To start, gen AI high performers are using gen AI in more business functions—an average of three functions, while others average two. They, like other organizations, are most likely to use gen AI in marketing and sales and product or service development, but they’re much more likely than others to use gen AI solutions in risk, legal, and compliance; in strategy and corporate finance; and in supply chain and inventory management. They’re more than three times as likely as others to be using gen AI in activities ranging from processing of accounting documents and risk assessment to R&D testing and pricing and promotions. While, overall, about half of reported gen AI applications within business functions are utilizing publicly available models or tools, gen AI high performers are less likely to use those off-the-shelf options than to either implement significantly customized versions of those tools or to develop their own proprietary foundation models.

What else are these high performers doing differently? For one thing, they are paying more attention to gen-AI-related risks. Perhaps because they are further along on their journeys, they are more likely than others to say their organizations have experienced every negative consequence from gen AI we asked about, from cybersecurity and personal privacy to explainability and IP infringement. Given that, they are more likely than others to report that their organizations consider those risks, as well as regulatory compliance, environmental impacts, and political stability, to be relevant to their gen AI use, and they say they take steps to mitigate more risks than others do.

Gen AI high performers are also much more likely to say their organizations follow a set of risk-related best practices (Exhibit 11). For example, they are nearly twice as likely as others to involve the legal function and embed risk reviews early on in the development of gen AI solutions—that is, to “ shift left .” They’re also much more likely than others to employ a wide range of other best practices, from strategy-related practices to those related to scaling.

In addition to experiencing the risks of gen AI adoption, high performers have encountered other challenges that can serve as warnings to others (Exhibit 12). Seventy percent say they have experienced difficulties with data, including defining processes for data governance, developing the ability to quickly integrate data into AI models, and an insufficient amount of training data, highlighting the essential role that data play in capturing value. High performers are also more likely than others to report experiencing challenges with their operating models, such as implementing agile ways of working and effective sprint performance management.

About the research

The online survey was in the field from February 22 to March 5, 2024, and garnered responses from 1,363 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, 981 said their organizations had adopted AI in at least one business function, and 878 said their organizations were regularly using gen AI in at least one function. To adjust for differences in response rates, the data are weighted by the contribution of each respondent’s nation to global GDP.

Alex Singla and Alexander Sukharevsky  are global coleaders of QuantumBlack, AI by McKinsey, and senior partners in McKinsey’s Chicago and London offices, respectively; Lareina Yee  is a senior partner in the Bay Area office, where Michael Chui , a McKinsey Global Institute partner, is a partner; and Bryce Hall  is an associate partner in the Washington, DC, office.

They wish to thank Kaitlin Noe, Larry Kanter, Mallika Jhamb, and Shinjini Srivastava for their contributions to this work.

This article was edited by Heather Hanselman, a senior editor in McKinsey’s Atlanta office.

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