A Window into Tomorrow’s Nursing

Remember history to shape the future

By Meredith Foxx, MSN, MBA, APRN, NEA-BC, Executive Chief Nursing Officer

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It’s been said that to better understand the future, one must look to the past. In nursing, history has consistently guided the profession’s forward movements. Nurses’ experiences and evidence-based findings have shaped patient care, clinical operations and professional practice.

Learning from history is critical to advancing the nursing profession. Nurse leaders have a responsibility to focus on the future by using the knowledge that has carried them to the present. At Cleveland Clinic, more than 500 nurse leaders recently reflected on the profession’s rich history and how it has influenced current practice and prepared nurses for the future. World-renowned historian Julie A. Fairman, PhD, RN, FAAN, from Penn Nursing at the University of Pennsylvania, spoke to leaders virtually about how the past has informed nursing and healthcare practice. Below are some of the topics she highlighted.

Pandemics

The 1918 flu pandemic solidified nurses’ imperative role in the care of the sick and the health of the well. Nurses’ work was strenuous, life-saving and highly valuable. Patient volumes were incredibly high, as was the risk of death. Approximately 50 million people died between 1918 and 1920. Government officials closed public spaces and implemented social distancing measures (similar to the early days of the COVID-19 pandemic). And just as they are today, nurses were relied on to calm and manage public fear and instill hope.

History shows that even when their own lives are at risk, nurses show up. There’s a continuity to a nurse’s desire to care, ease pain, offer comfort and improve well-being that never wavers. In good times and in bad, nurses put the needs of others before their own, provide care with compassion and empathy and mitigate suffering to make a difference in the lives of those they serve. People know nurses can and will do what they do and provide what is needed during times of great uncertainty. They trust that the essence of nursing will always be there, and they value the expert care of nurses when it’s needed most.

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As Dr. Fairman said, history reminds us that the public trusts nurses, nurses are critical to pandemic response and patients depend on nurses to carry them through life’s toughest challenges. 

Social justice

Dire times also expose how populations are treated and cared for and, just as it has today, social justice issues rise to the surface. 

Nurses as individuals and as part of organizations have long participated in social movements in response to cultural conflict. Throughout history, they sought to improve conditions for themselves and those they served – and movement support wasn’t always positive. According to Dr. Fairman, in the early 1900s, when Eugenics practices emerged, some nurses supported forced sterilization, which they believed addressed class and race issues that would improve communities. During the civil rights movement, while many nurses worked to eliminate segregation by skin color, others fought to maintain segregation in hospitals.

Society’s history of marginalizing races, sexes and classes sheds light on important lessons, Dr. Fairman said. Not all nurses share the same beliefs, but as a profession, we share a common goal to serve the public to the best of our ability. Nurses and organizations need to capitalize on this common goal and work together to welcome, respect and support differences and diversity in our profession. 

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“We can’t just think about changing the surface,” Dr. Fairman said. “Action needs to be more than checking boxes. We need to get to the root of how systems were built and how we’re moving them – and we need to move forward together.”

Public health

There have been many nurse luminaries of the past who’ve led reforms for social justice and other important issues – and one of them is Lillian Wald (1867-1940). Wald was the first to bring nurses into the homes of people living in poverty so they could see firsthand what was needed to care for all people, establishing the role of the public health nurse. Although Wald’s contributions to public health were immense, historically the public health road has been rocky. In the 1950s, there was a notable shift from public health to acute care. And when the COVID-19 pandemic hit, the public health structure was notably unstable.

Moving forward, public health will need to evolve, and health policy will be an important part of the process. “Health policy is embedded in history and it’s good to use history to create health policy,” said Dr. Fairman. 

Together, nurses can create a better future for nursing and healthcare by remembering our history. We can never lose sight of where we’ve been or gone as we build where we are going.