3. Nursing Care Florence Nightingale, 1855 The Granger Collection, N. Y. 1952, A child receiving TB vaccine at a school in Bulacam UNICEF/ICEF-2539 Surgery Perioperative nurses Robert Llewellyn Corbis Physicians & nurses examine children with clef palate & lip at the Xion Jingxi Hospital China Photos/Getty Images 1960โs-Establishment of Medicare & Medicaid programs-> โ demand for geriatric nursing Pediatric nurses care for infants, children, and adolescents/Sean JusticeโThe Image Bank/Getty Images U.S. Army Nurse Corps recruitment poster from World War II/National Library of Medicine, Bethesda, Md.
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5. Nurse Anesthetist (CRNA) TIMELINE 1800s 1910-30s 1940s 1950s 1970-1990s โฆ Traced to Catholic sisters administering chloroform during civil war โฆ After civil war, graduate nurses used as Nurse Anesthetists โฆ 6 mo Nurse Anesthetist program โฆ Alice Magnaw, mother of anesthesia โฆ Nurse anesthetistsโ right to administer analgesic by physicians questioned โฆ #sโ โ during WWI โฆ Great Depression era, physicians & nurses anesthetists compete for same jobs โฆ WWII defined anesthesia as a medical specialty โฆ Anesthesiologists became board certified โฆ Certified as CRNAs โฆ Role expand due to physician shortage in military โฆโ #s of males choosing Anesthesiologist & CRNA positions โฆโ demand because of the Korea & Vietnam War โฆ Building credibility & defending practice โฆ CRNAs could bill for services โฆ โ financial support โฆ โ physician pressure โฆ Overcome barriers to reimbursement โฆ Master degree required
7. Nurse Midwife (NM) Timeline 1600s 1900s 1950s 1970s 1990s โฆ Nurse midwives brought to US with the slave trade & European immigration โฆ Well respected during this period โฆ Nurse midwives blamed for high maternal & infant mortality โฆ Established schools for midwifery โฆ โ usage in urban areas & โ usage in poor & European communities โฆ โ demand because of high birth rate & post war โฆ Hospitals opened its doors to midwives โฆ โ # of master degree programs โฆ Among 1st to advocate graduate education โฆ โ demand โฆ shortage of OB physicians โฆโ funding โฆ Physicians supported certified NM โฆ Medical team continues to supervise their practice โฆ โ demand โฆ Role expanded โฆ Recognized by every state โฆ Granted prescriptive privileges & 3rd party reimbursement โฆ Master degree preferred but not required
9. Clinical Nurse Specialist (CRNA) Timeline 1900-30s 1940-1950s 1960-70s 1980s 1990s โฆ Specializa-tion in nursing began (anesthesia, TB, lab, OR, dietetics, public health, and psychiatric ) โฆ โ demand for psychiatric nurses โฆ โ funding because soldiers returned from WWII with medical problems โฆ CNS role development โฆโ # s of CNSs โฆ Defined as expert practitioners & change agents, โฆ Master prepared โฆ Early 80s, represented 42% of APN โฆ Late 80s, โ #s of CNS due to cost constraints โฆ Role shift from clinical to education โฆ Considered clinical expert & should not be doing patient care โฆโ employment opportunities โฆ โ master level enrollment because of โNP, intro of acute care nurse practitioners, & hospitalsโ financial challenges โฆ A # of CNS also prepared & worked as NP
11. Nurse Practitioner (NP) Timeline 1800-1960s 1970s 1980s 1990s 21 st Century โฆ Psychiatric Nursing 1 st specialty โฆ Nurse clinician defined as nurse with advance knowledge โฆ NPs not afforded the same status as cardiac CNS (can not diagnose & treat) โฆ โ demand due to physicians specialization โฆ NP operated & prescribe medication under the direction of the physician โฆ NP role perceived as enticing nurses to switch to medical side โฆ Supported by physicians โฆ Confronted with โ resistance by organized medicine โฆ Conflict between NPs & CNS by ANA โฆ AMA opposed any attempt to empower non physicians โฆ NPs fight for prescriptive authority & reimbursement โฆ Assumed multiple roles โฆ Master degree required โฆ Gained prescriptive authority for narcotics prescription โฆ โ demand โฆ Multiple groups developed to represent PN ( ANCC, AANP, etc.) โฆ Battle over prescriptive authority โฆ Full recognition by insurers & health care organizations โฆ Doctorate NP (DNP) degree proposed by AACN to standardize the practice
13. Physician Assistant (PA) Timeline 1900s 1920s 1960s 1990s Current โฆ 1903, state licensure registration โฆ Goldmark study resulted in the establishment of collegiate nursing vs. hospital based schools โฆ Curriculum founded on nursing education โฆ Missed opportunity for professional nursing (slow to respond) โฆ PA role developed โฆ C ollege degree not required โฆ PAs worked under the director of a license preceptor โฆ Created tension with the role of NP โฆ T rained according to the medical model . โฆ Degree requirement varies (associate, baccalaureate, or master)
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