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Home / Latest News / The role of nursing has changed considerably

The role of nursing has changed considerably

Half a century ago, nurses wore starched aprons with cotton caps, were taught hospital etiquette and lived in fear of their ward sister and matron.

Today, the role has changed significantly although not beyond recognition, with modern nurses expected to process complex patient data, carry out research and keep at the cutting-edge of technological advances.

Professor Donna Mead, dean of the Faculty of Health, Sport and Science at the University of South Wales, began nursing in 1974.

She explained nurses in the past were expected to adopt the practices of their ward sister unquestioningly and were not expected to engage in decision-making or problem solving.

Recalling her time as a student nurse, she said: “Every ward sister had her own, sworn-by remedy for the treatment of pressure sores.

“As a student nurse you had to learn what every ward sister’s preference was.  It could be to rub the affected area with insulin or talcum powder, egg white or porridge.

“We realised that in order to apply the various potions, the patient had to be turned and this relived pressure on the skin,” she said.

Throughout her career, Professor Mead has watched an increasing number of nurses become involved in research, not just in universities, but also in the workplace.

She said: “Forty years ago, very few nurses undertook research, but today, every nurse can understand research and can appraise research findings and apply them to practice.

“There is no doubt that the scope of the nursing role has changed. For example nurses today can prescribe drugs. In order to undertake this role, the nurse has to be competent in case management and have the ability to make clinical judgements based on detailed patient assessments.

“We are living in the middle of a knowledge explosion and nursing is not immune from this. We want nurses who are up-to-date and given the pace of knowledge generation, this is a huge ask, with literally hundreds and hundreds of new scientific papers being published every week.”

She added nurses had been forced to specialise to keep up with the demands of new technological advances, with some now specialising in pain relief, diabetes management and breast care.

She explained: “It is their role to be at the cutting-edge of developments in their field and to support other nurses and medical staff in caring for their patients.

 “The basic care needs of patients have not changed fundamentally. A great deal has been written about nurses these days being too posh to wash or too clever to care, but the basic tenet of care is that patients and their families should be cared for with respect and that their dignity will be maintained at all times.”

Looking to the future, Professor Mead hopes nurses will be allowed to develop  research skills alongside  their clinical skills.

She also expects primary care to take on a greater significance and expects care of the elderly to become a major feature of any nursing service.

She said: “Technological developments and improved living standards mean that people survive illnesses and diseases which would have resulted in premature death years ago. We are seeing more complex care needs as individuals develop complex pathologies. We will need nurses skilled in caring for such patient groups.”

She also expects nurses to take on a key role in responding to patients who are increasingly educated and research-savvy, able to look up their symptoms from the vast wealth of information available online.

She said: “It may be that the nurse will develop the role of information advocate more than is the case currently.”

She added cutting-edge developments, such as human genome sequencing could alter the relationship between nurse and patient.

“It will be possible to foretell a person’s likely illness trajectory from birth. This might alter the nurse patient relationship and the skills needed to provide appropriate care,” she said.

Barbara McMillan, who is now retired, started training as a nurse 50 years ago and worked at the Cardiff Royal Infirmary, the former Royal Hamadryad Hospital and the University Hospital of Wales.

She said the role of nurses and their working environment had changed significantly throughout her career. 

“The turnover of patients is much quicker than in my day. In the past, a man with a hernia would have been in hospital for three weeks and now he would be in and out in a day,” she said. Mrs McMillan believes the biggest difference is nurse training.

She said: “The focus of training has changed. In my opinion, too much emphasis is put on qualifications. We used to have some classroom tutorials, but the majority of teaching was done on the wards.  Florence Nightingale did not have a qualification to her name. If you care about people, you will treat them as you would want your own parents to be treated.

“Technology definitely plays a greater part now, but when I was younger, we were warned that if you spent too much time looking at the machines, your patient could be turning blue and you wouldn’t notice.

 “I can’t begin to imagine what the job might look like in 10 years’ time. Technology is moving on at a rate of knots. I just hope nurses will still be in the picture.”

Tina Donnelly, director of the Royal College of Nursing (RCN) in Wales, agreed the biggest changes had taken place in nurse training, with modern nurses now completing nursing degrees, but added academic qualifications did not remove emphasis from caring roles.

“I have heard a lot of criticism in the press that nurses with degrees do not care, but that could not be further from the truth. Just because nurses have more qualifications, does not mean they have less compassion,” she said.

She added the environment in which nurses were working had changed significantly. “What we used to see was patients coming into hospital and staying for a long time. Patients coming in for a gall bladder operation would stay for 10 days, whereas now, it would all be done with keyhole surgery and they would be in and out within 24 hours.”

In the future, she believes Welsh nurses will face challenges presented by an ageing population.

“People are living longer, with more chronic conditions. Life expectancy has increased significantly and in Wales, we have the largest population of over-85s anywhere in Britain,” she said.  “When a patient comes in, they are likely to have a lot of different diseases. If a patient comes in with a heart attack, the nurse will not just be dealing with that, but with everything else too.  If you know you can use your knowledge and skills to make a difference to a patient, then it is empowering, but if you know that you are short-staffed, then it is stressful,” she said.

She added that although technology had changed the role significantly, traditional skills were still crucially important.

“You cannot rely on modern equipment to do it all for you. You still have to interpret the results and you also have to care for the equipment.”

Mrs Donnelly’s vision of the future combines traditional and modern elements of nursing, while embracing technological developments.

She said: “I would like to see nurses continuing to work at the bedside, caring for their patients and using technology appropriately and I would like to see that patients know that nurses have time to care.”

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