While many professions may look back at their inception and theories in awe at how vastly they differ from present day, one could easily argue to the contrary about the profession of nursing. Our nursing founder, Florence Nightingale, opened and operated the first nursing school in London, England, in 1860. She made significant contributions to health statistics demonstrating quality patient outcomes directly related to the discipline of nursing. While the fundamentals of nursing she taught remain valid and integral today, this proclamation of hers has become paramount: “For we who nurse, our nursing is something which, unless we are making progress every year, every month, every week, we are going back. No system shall endure that does not march.”
What did Florence mean when she called for a march 159 years ago? Are we making progress every year? That depends on the definition of progress. Healthcare has seen many rapid changes in technology, patient acuity, varying care environments, a flood of high-risk medications, and many other complexities. However, nurses are the ones who ultimately must manage all aspects of the ever-changing needs of patients. Nurses have historically functioned well in their role in crisis management. Whatever needs the patient presents with, whatever the challenge, complexity, hoop that needs jumped through, you can always count on the nurse to do it. While that is admirable and what we have come to appreciate about nurses, it is not sustainable in today’s healthcare system. Nurses need to make time for reflection, assessment of interventions, and review of best practices and evidence-based guidelines. Reflection promotes our ability to recognize complexities, gaps in care, recurring challenges, as well as solutions to issues requiring nursing’s immediate attention.We must become proactive in our roles, provide nursing’s voice at every table where decisions about our practice our made. We must see policy as something we can change, rather than something that happens to us.
Florence’s call to march is directly related to our professional contract as nurses. As our governing body, the American Nurses Association, declares, “There is a social contract between society and the profession. Under its terms, society grants the professions authority over functions vital to itself and permits them considerable autonomy in the conduct of their own affairs. In return, the professions are expected to act responsibly, always mindful of the public trust. Self-regulation to assure quality and performance is at the heart of this relationship. It is the authentic hallmark of the mature profession”. Now, more than ever, we must march! Our profession is projected to lose nearly half a million of us by the year 2025. Six years! There is an urgent need for us to assess and advocate for our profession. We must be the ones to define our value, the outcomes gleaned from practices directly related to nursing. We must advocate for ourselves with the very same fierce advocacy that we do for our patients. They need us to do so. It is our professional duty.
We must pursue support from our employers, our organizations, policies, boards and most of all, each other. We must align our work, our challenges and our profession. Please comment on this blog as an avenue for disseminating “the march.” Share your ideas, thoughts, best practices, challenges, complexities, connections and policies. Let this be our site for bringing our profession together before it’s too late; before you need a nurse.
Deborah Cantlin is continuing care manager for the heart failure and cardiomyopathy program at Dartmouth-Hitchcock in New Hampshire.
Fowler MDM. Guide to nursing’s social policy statement: Understanding the profession from social contract to social covenant.Silver Spring, MD: American Nurses Association. 2015.