- Email: [email protected]
The Need for Professional Education in Operating Room Nursing
THE NEED FOR PROFESSIONAL EDUCATION IN OPERATING ROOM NURSING Dorothy Ellison, R.N. For many years now operating room nursing has been in a state of siege. It has been challenged by the rest of the nursing profession to confirm its status within the nursing hierarchy in hospitals and by nursing educators, in particular, to justify its existence within the curriculum. The majority of schools of nursing-specially those at the baccalaureate level-have reduced to infinitesimal proportions the amount of time allowed students for contact with the operating room. I believe this is a fundamental error-derived from the misunderstanding of the professional nurse’s function in the operating room-of the role of the nurse and of the needs of the patient at this point in the patient’s hospitalization. At the AORN Congress in San Diego in February, 1967, we heard from Dean Lulu Hassenplug, of UCLA School of Nursing, words that vividly betrayed this misunderstanding as she challenged her audience to define the functions and responsibilities of the nurse who practices in the operating room -to tell the educators what are the characteristics of the nurse specialist in the operating room. Her questions were: “What does the nurse need in the way of preparation, as a
Dorothy Ellison, R.N., is assistant professor of surgical nursing at Cornell University-New York Hospital School of Nursing. She is also department head, operating room nursing service at the New York Hospital. Miss Ellison received her Master’s degree from Teacher’s College, Columbia University. She has contributed several articles to the Journal.
50
nurse and as a leader? What does she do that only a nurse can do? Are there differences in the role and responsibilities of the scrub and the circulating nurse? Can these jobs be analyzed and differentiated? Can a nonprofessional do either job, if trained under nurses? Is a nurse needed as operating room supervisor?” Neither the profession, the educators nor the public will accept anything less than solid logic and real evidence in our answers. If students are to be returned to the operating room we must amply justify the use of their time in a nurse’s basic preparation and its relationship to the total objectives of the undergraduate curriculum. Dean Hassenplug claims that operating room nursing has failed to capitalize on its assets, that is, on the general excitement and glamour of the work, on the satisfactions in the working relationships with surgeons, and the feeling of immediate and important accomplishment in the daily care of patients. She states that operating room exclusiveness is fostered both by its physical isolation in hospitals and by failure on the part of operating room nurses to communicate their importance and essentiality. This so-called “exclusiveness” has evidently aroused both jealousy and suspicion in our nursing colleagues, for Dean Hassenplug also criticized operating room nurses for nursing a place, the operating room, rather than patients. Why she made this charge against operating
AORN Journal
room nurses and not against emergency room nurses, recovery room nurses, clinic nurses or delivery room nurses makes one feel that this particular charge is petty and irrelevant. But the fact that such charges are being made may be taken as sufficient evidence in itself of the failure of operating room nurses to communicate effectively. For the nursing functions in the operating room are badly misunderstood by other nurses. Operating room nurses themselves are quite aware that they are nursing surgical patients, and the nursing needs of patients are essentially the same wherever they are. The circumstances and setting push certain needs to the fore and give them priority over others. Operating room nurses have an obligation to communicate to their colleagues which aspects of the care of surgical patients are given priority in the operating room. They have much knowledge of surgery as a special mode of therapy to share with their colleagues. The quality of nursing care along the entire continuum of the surgical patient’s needs could be greatly enhanced if, for example, nurses who give preoperative care were more aware of the implications of each order, test or observation for the immediate success of the surgical procedure and the safety of the patient; and, if nurses who give postoperative care understood more precisely what the operative procedure itself implied for the patient’s needs in the postoperative recovery phase. All of us have had evidence of the relative ease with which operating room nurses can move into the special nursing of patients before or after surgery and the difficulty with which nurses on the surgical floors accommodate to an exchange assignment in the operating room. I take this to be evidence that surgical nurses as a group require more, rather than less, operating room experience. The operation is the pivotal and crucial therapeutic act in the surgical treatment of disease. All that happens to the surgical patient is predicated upon that one decisive ex-
August 1967
perience. In order to plan, to manage the surgical regimen of the patient, and to meet the patient’s needs attendant upon this experience, the nurse needs an intimate knowledge of surgery as a mode of therapy: the diseases amenable to such treatment, how they are diagnosed, the operative methods and techniques employed to treat them, the effects of surgical trauma and anesthesia upon the human body, and the problems of the patient’s recovery, recuperation, readjustment and rehabilitation. The fact that the patient needs a professional quality of nursing care during this experience is justification for the professional nurse’s presence throughout the entire continuum of surgical treatment, including the operation. If we are to answer Dean Hassenplug’s question, “What does the operating room nurse do, that only a nurse can do?” we must know what a nurse is being educated to do. This leads us into a vicious circle, for a nurse will be able to do only what her nursing education prepares her to do. Unfortunately, today’s nursing education is not preparing her for the nurse’s job in the operating room. It becomes necessary for us to define therefore, what is the nurse’s job in the operating room. Only when we have done this will we be able to define the preparation necessary for that job. Those who are doing operating room nursing today are the only persons who are in any position to state or to demonstrate what it is that they do and what needs of the patients they are meeting. This has been a difficult task, for however often we repeat it, we as operating room nurses are not being heard. The fact that technicians are being used in operating rooms is taken by some as evidence that nursing in this field is merely a technical function and that nurses could be replaced by technicians. Why this conclusion is not drawn in other clinical areas where aides, attendants and assistants or technicians are used is a strange inconsistency in reason-
51
ing. It results largely from ignorance and unfamiliarity with both the technician’s role and the nurse’s role, which revolves around these responsibilities : 1. the analysis and solution of patient care problems; 2. the planning of systems of patient care; 3. communicating and implementing the nursing care plan; 4. the instruction and direction of nursing assistants in appropriate activities within the system or plan of care; 5. maintaining continuity of nursing care from the preoperative through the operative, to the patient’s postoperative course; 6. the development of new methods and procedures to keep abreast of the advances in medical knowledge and technology ; 7. the control of their impact upon the patient. To perform at this level the operating room nurse needs advanced study and experience in: 1. aseptic techniqw-the methods of sterilization, disinfection, decontamination and environmental sanitation, based on intensive study of microbiology for the purpose of infection control. 2. operative procedure, anesthetic agents and techniques-based on an expert knowledge of human anatomy and physiology, surgical pathology and pharmacology, for the purpose of comprehending the total impact of surgical trauma and the hazards of anesthesia upon the individual patient. 3. surgical technology-based on the sciences of mathematics, physics, chemistry, electronics and optics to understand the use and function of the instrumentation being developed for the purpose of monitoring and treating disease conditions and of mitigating their effects upon patients. 4. management and leadership skillsbased upon advanced study in psychology and the behavioral sciences for the purpose of comprehending and controlling the human
52
organization and relationships through which nursing care is implemented. There is an increasing demand for qualified operating room nurses ; well-prepared professionals who will be capable of occupying positions in teaching, supervision and administration of nursing services in operating room departments. There is a great need to provide for professional succession in operating room nursing. Technicians and nonprofessionals, no matter how experienced, can never assume the professional role. They have no prospect of becoming the experts, the specialists, the teachers, and the consultants of the future. Only professional nurses can do these things. Nurses must be prepared in sufficient numbers to secure the future for the care of patients undergoing surgery. We need a constant influx of professional talent to gain experience and knowledge in the operating room clinical specialty, in order that there always will be competent nursing specialists to assume the leadership positions in the future. These leaders must be developed, educated and made expert through study and practice. One can fulfill the image of the nurse in the eyes of patients and professional colleagues only by performance. The nurse must exercise skill, demonstrate competence, utilize knowledge in action, intervene on behalf of the patient and perform activities which assist the patient to deal with his disease and overcome his disability or deficiency in health. The nursing profession as a whole, not merely the field of operating room nursing, is being challenged to distinguish the professional from the technical role. As nursing tries to specify whether the “care,” the “cure” or the “coordinating” role has primacy in its clinical functions, we discover that the role of the clinician, the clinical specialist, or the person who “cares” for the patient stands out. In all fields, nurses are returning to the side
AORN Journal
of the patient. They are turning away from managing the nursing unit, to managing the care of patients, to devising and implementing the plan which facilitates the regimen of cure or treatment which is prescribed by the physician. Operating room nurses in general have been singularly fortunate in that they have never entirely given up active participation in direct patient care for strictly managerial functions. Operating room nurses still do scrub and circulate for operations. They still do spend proportionately much more of their working time in direct contact with patients, in the same room with them, acting and intervening in their behalf, than do most nurses in other clinical settings. Operating room nurses have clung to their patient care responsibilities and have been concerned about the appropriate utilization of technical workers in nursing services. They fulfill in large part the role outlined by Dr. Claire Fagin in her article on “The Clinical Specialist as Supervisor,” by acting as a role model to patients and personnel. The operating room nurse demonstrates to the technician and to the patient the knowledge and skills needed to participate in the surgical procedure and to protect the patient, to set up and maintain a sterile field and provide the facilities and equipment needed to perform the operation; and to coordinate the activities of the interdisciplinary team of surgeons, anesthetists, nurses and ancillary workers. The operating room nurse is a participantobserver of the operative procedure and the therapeutic regimen. She is an informal teacher, instigator and innovator. As methods and techniques are developed and changed, she adapts them to the patient’s needs and to the routine of the team. She oversees, assesses and evaluates the total activity. By active participation in the surgical operation, by scrubbing, circulating, teaching and directing, she keeps her skills sharp, extends her
August 1967
sphere of competence and keeps abreast of developments. Operating room nursing is indeed being regarded as a specialty field of clinical nursing practice. It has become a question now of whether it is the function of the basic educational program to prepare the nurse for specialization. I t must be agreed that a basic or undergraduate program cannot prepare the specialist. This is the function of postgraduate education. One becomes specialized only through extensive study and practice in a particular and limited realm of activity. However, one does not become a specialist in any field without a foundation in the general field. If surgery as a mode of therapy and its effects on patients are not taught in the basic curriculum, there will be no nurses to specialize in surgical nursing or in operating room nursing at the graduate level. Nursing is unique among the professions in that it does not prepare its specialists at the graduate level. It is also unique in that it does not prepare all its practitioners in university or college settings. The ANA position paper on education is designed to remedy this fundamental difficulty for the future. For the future also we can anticipate that nursing will prepare the practitioners within the general system of education. What then will be the function of the clinical facilities now used by nursing educators? Some proposals have been made which see the technical level of health workers, nurses, technicians and physicians’ assistants being prepared in junior or community colleges in two-year programs which offer a core curriculum for the so-called “generalist.” At the professional level, health workers of all types -physicians, nurses, pharmacists, dentistswould have a basic core curriculum in health sciences in four-year programs in senior colleges and universities. Specialization for the particular clinical profession would be offered at the graduate level. Nurses would become specialists in the
53
clinical facility of their choice. An internship or residency type of program would be offered at the graduate level in hospitals, laboratories, public health agencies, clinics or other special care facilities for patients in various categories ; for example, infants, mothers and families, the aged; groups of patients undergoing special modes of therapy such as medicine, surgery, psychiatry ; groups of patients with special disease or health problems, such as cardiovascular, cancer, stroke; or persons with particular rehabilitation or adjustment problems, paraplegia, amputation, deafness, blindness, etc. The operating room would be one area of clinical specialization for professional nurses. Study and clinical experience in the four areas
previously described would prepare a nurse for this field. Operating room nursing preparation in the future will have to fit within the patterns of nursing education that will be developed. Operating room nurses must be vigilant in observing the trends and must be vocal and clear in defining the knowledge and skills needed at both the technical and professional level, for practitioners of this clinical specialty. The future offers operating room nursing a valuable opportunity to re-enforce the vital role it plays in safeguarding the surgical patient at the most crucial period in his hospitalization and in maintaining the quality of surgical services to the public.
ONE YEAR LATER-ANA POSITION PAPER ON NURSING EDUCATION The American Nurses’ Association’s o5cial position paper on nursing education made three major points about educational preparation for future nurses: 1. “Education for nurse practitioners should take place in institutions of learning within the general system of education. 2. “The bachelor’s degree should be minimum preparation for beginning professional nursing practice. 3. “The associate degree--or the credential awarded hy junior colleges-should be the minimum preparation for technical nursing practice.” T he forward to the position paper stated: “The position paper recognizes the realities of today and sets directions for the future. It points u p the need for the upgrading of all educational programs to encompass new scientific knowledge and to enrich nursing care. . . I t gives the foundation for effecting needed change i n an orderly, constructive way.” Enrollment figures for the last decade in nursing education programs appear to validate the position paper statements. Total Enrollment
1955
1965
__ Diploma 93,760 95,902 Associate 1,084 11,564 Baccalaureate 17,437 30,378 These figures indicate a gradual shift as nursing joins the educational mainstream. Dr. Rohert K. Merton, the association’s consultant sociologist, stated to the governing body of the ANA House of Delegates: “If there was ever any doubt on the part of any of you that mid-twentieth century nursing represents a profession, surely that doubt has been erased in this historic convention. “The action that you have taken in expressing your approval of the position paper does, I believe, capture your entire development as a profession. Th e position paper does not in any way affect what you already have, a full professional identity. The position paper addresses itself exclusively to the impending and long overdue changes in the system of nursing education. “During the interim between 1966 and that unknown time at which the vast majority of practicing nurses will have acquired at least a baccalaureate education, during that long interim, every nurse practitioner will continue to enjoy and to deserve by virtue of the quality of work she does, the standing as a professional practitioner.” Within one year the stage is set for discussions and action through regional an d community planning efforts for nursing education. ~
54
AORN Journal
Dorothy Ellison, R.N., is assistant professor of surgical nursing at Cornell University-New York Hospital School of Nursing. She is also department head, operating room nursing service at the New York Hospital. Miss Ellison received her Master’s degree from Teacher’s College, Columbia University. She has contributed several articles to the Journal.
50
nurse and as a leader? What does she do that only a nurse can do? Are there differences in the role and responsibilities of the scrub and the circulating nurse? Can these jobs be analyzed and differentiated? Can a nonprofessional do either job, if trained under nurses? Is a nurse needed as operating room supervisor?” Neither the profession, the educators nor the public will accept anything less than solid logic and real evidence in our answers. If students are to be returned to the operating room we must amply justify the use of their time in a nurse’s basic preparation and its relationship to the total objectives of the undergraduate curriculum. Dean Hassenplug claims that operating room nursing has failed to capitalize on its assets, that is, on the general excitement and glamour of the work, on the satisfactions in the working relationships with surgeons, and the feeling of immediate and important accomplishment in the daily care of patients. She states that operating room exclusiveness is fostered both by its physical isolation in hospitals and by failure on the part of operating room nurses to communicate their importance and essentiality. This so-called “exclusiveness” has evidently aroused both jealousy and suspicion in our nursing colleagues, for Dean Hassenplug also criticized operating room nurses for nursing a place, the operating room, rather than patients. Why she made this charge against operating
AORN Journal
room nurses and not against emergency room nurses, recovery room nurses, clinic nurses or delivery room nurses makes one feel that this particular charge is petty and irrelevant. But the fact that such charges are being made may be taken as sufficient evidence in itself of the failure of operating room nurses to communicate effectively. For the nursing functions in the operating room are badly misunderstood by other nurses. Operating room nurses themselves are quite aware that they are nursing surgical patients, and the nursing needs of patients are essentially the same wherever they are. The circumstances and setting push certain needs to the fore and give them priority over others. Operating room nurses have an obligation to communicate to their colleagues which aspects of the care of surgical patients are given priority in the operating room. They have much knowledge of surgery as a special mode of therapy to share with their colleagues. The quality of nursing care along the entire continuum of the surgical patient’s needs could be greatly enhanced if, for example, nurses who give preoperative care were more aware of the implications of each order, test or observation for the immediate success of the surgical procedure and the safety of the patient; and, if nurses who give postoperative care understood more precisely what the operative procedure itself implied for the patient’s needs in the postoperative recovery phase. All of us have had evidence of the relative ease with which operating room nurses can move into the special nursing of patients before or after surgery and the difficulty with which nurses on the surgical floors accommodate to an exchange assignment in the operating room. I take this to be evidence that surgical nurses as a group require more, rather than less, operating room experience. The operation is the pivotal and crucial therapeutic act in the surgical treatment of disease. All that happens to the surgical patient is predicated upon that one decisive ex-
August 1967
perience. In order to plan, to manage the surgical regimen of the patient, and to meet the patient’s needs attendant upon this experience, the nurse needs an intimate knowledge of surgery as a mode of therapy: the diseases amenable to such treatment, how they are diagnosed, the operative methods and techniques employed to treat them, the effects of surgical trauma and anesthesia upon the human body, and the problems of the patient’s recovery, recuperation, readjustment and rehabilitation. The fact that the patient needs a professional quality of nursing care during this experience is justification for the professional nurse’s presence throughout the entire continuum of surgical treatment, including the operation. If we are to answer Dean Hassenplug’s question, “What does the operating room nurse do, that only a nurse can do?” we must know what a nurse is being educated to do. This leads us into a vicious circle, for a nurse will be able to do only what her nursing education prepares her to do. Unfortunately, today’s nursing education is not preparing her for the nurse’s job in the operating room. It becomes necessary for us to define therefore, what is the nurse’s job in the operating room. Only when we have done this will we be able to define the preparation necessary for that job. Those who are doing operating room nursing today are the only persons who are in any position to state or to demonstrate what it is that they do and what needs of the patients they are meeting. This has been a difficult task, for however often we repeat it, we as operating room nurses are not being heard. The fact that technicians are being used in operating rooms is taken by some as evidence that nursing in this field is merely a technical function and that nurses could be replaced by technicians. Why this conclusion is not drawn in other clinical areas where aides, attendants and assistants or technicians are used is a strange inconsistency in reason-
51
ing. It results largely from ignorance and unfamiliarity with both the technician’s role and the nurse’s role, which revolves around these responsibilities : 1. the analysis and solution of patient care problems; 2. the planning of systems of patient care; 3. communicating and implementing the nursing care plan; 4. the instruction and direction of nursing assistants in appropriate activities within the system or plan of care; 5. maintaining continuity of nursing care from the preoperative through the operative, to the patient’s postoperative course; 6. the development of new methods and procedures to keep abreast of the advances in medical knowledge and technology ; 7. the control of their impact upon the patient. To perform at this level the operating room nurse needs advanced study and experience in: 1. aseptic techniqw-the methods of sterilization, disinfection, decontamination and environmental sanitation, based on intensive study of microbiology for the purpose of infection control. 2. operative procedure, anesthetic agents and techniques-based on an expert knowledge of human anatomy and physiology, surgical pathology and pharmacology, for the purpose of comprehending the total impact of surgical trauma and the hazards of anesthesia upon the individual patient. 3. surgical technology-based on the sciences of mathematics, physics, chemistry, electronics and optics to understand the use and function of the instrumentation being developed for the purpose of monitoring and treating disease conditions and of mitigating their effects upon patients. 4. management and leadership skillsbased upon advanced study in psychology and the behavioral sciences for the purpose of comprehending and controlling the human
52
organization and relationships through which nursing care is implemented. There is an increasing demand for qualified operating room nurses ; well-prepared professionals who will be capable of occupying positions in teaching, supervision and administration of nursing services in operating room departments. There is a great need to provide for professional succession in operating room nursing. Technicians and nonprofessionals, no matter how experienced, can never assume the professional role. They have no prospect of becoming the experts, the specialists, the teachers, and the consultants of the future. Only professional nurses can do these things. Nurses must be prepared in sufficient numbers to secure the future for the care of patients undergoing surgery. We need a constant influx of professional talent to gain experience and knowledge in the operating room clinical specialty, in order that there always will be competent nursing specialists to assume the leadership positions in the future. These leaders must be developed, educated and made expert through study and practice. One can fulfill the image of the nurse in the eyes of patients and professional colleagues only by performance. The nurse must exercise skill, demonstrate competence, utilize knowledge in action, intervene on behalf of the patient and perform activities which assist the patient to deal with his disease and overcome his disability or deficiency in health. The nursing profession as a whole, not merely the field of operating room nursing, is being challenged to distinguish the professional from the technical role. As nursing tries to specify whether the “care,” the “cure” or the “coordinating” role has primacy in its clinical functions, we discover that the role of the clinician, the clinical specialist, or the person who “cares” for the patient stands out. In all fields, nurses are returning to the side
AORN Journal
of the patient. They are turning away from managing the nursing unit, to managing the care of patients, to devising and implementing the plan which facilitates the regimen of cure or treatment which is prescribed by the physician. Operating room nurses in general have been singularly fortunate in that they have never entirely given up active participation in direct patient care for strictly managerial functions. Operating room nurses still do scrub and circulate for operations. They still do spend proportionately much more of their working time in direct contact with patients, in the same room with them, acting and intervening in their behalf, than do most nurses in other clinical settings. Operating room nurses have clung to their patient care responsibilities and have been concerned about the appropriate utilization of technical workers in nursing services. They fulfill in large part the role outlined by Dr. Claire Fagin in her article on “The Clinical Specialist as Supervisor,” by acting as a role model to patients and personnel. The operating room nurse demonstrates to the technician and to the patient the knowledge and skills needed to participate in the surgical procedure and to protect the patient, to set up and maintain a sterile field and provide the facilities and equipment needed to perform the operation; and to coordinate the activities of the interdisciplinary team of surgeons, anesthetists, nurses and ancillary workers. The operating room nurse is a participantobserver of the operative procedure and the therapeutic regimen. She is an informal teacher, instigator and innovator. As methods and techniques are developed and changed, she adapts them to the patient’s needs and to the routine of the team. She oversees, assesses and evaluates the total activity. By active participation in the surgical operation, by scrubbing, circulating, teaching and directing, she keeps her skills sharp, extends her
August 1967
sphere of competence and keeps abreast of developments. Operating room nursing is indeed being regarded as a specialty field of clinical nursing practice. It has become a question now of whether it is the function of the basic educational program to prepare the nurse for specialization. I t must be agreed that a basic or undergraduate program cannot prepare the specialist. This is the function of postgraduate education. One becomes specialized only through extensive study and practice in a particular and limited realm of activity. However, one does not become a specialist in any field without a foundation in the general field. If surgery as a mode of therapy and its effects on patients are not taught in the basic curriculum, there will be no nurses to specialize in surgical nursing or in operating room nursing at the graduate level. Nursing is unique among the professions in that it does not prepare its specialists at the graduate level. It is also unique in that it does not prepare all its practitioners in university or college settings. The ANA position paper on education is designed to remedy this fundamental difficulty for the future. For the future also we can anticipate that nursing will prepare the practitioners within the general system of education. What then will be the function of the clinical facilities now used by nursing educators? Some proposals have been made which see the technical level of health workers, nurses, technicians and physicians’ assistants being prepared in junior or community colleges in two-year programs which offer a core curriculum for the so-called “generalist.” At the professional level, health workers of all types -physicians, nurses, pharmacists, dentistswould have a basic core curriculum in health sciences in four-year programs in senior colleges and universities. Specialization for the particular clinical profession would be offered at the graduate level. Nurses would become specialists in the
53
clinical facility of their choice. An internship or residency type of program would be offered at the graduate level in hospitals, laboratories, public health agencies, clinics or other special care facilities for patients in various categories ; for example, infants, mothers and families, the aged; groups of patients undergoing special modes of therapy such as medicine, surgery, psychiatry ; groups of patients with special disease or health problems, such as cardiovascular, cancer, stroke; or persons with particular rehabilitation or adjustment problems, paraplegia, amputation, deafness, blindness, etc. The operating room would be one area of clinical specialization for professional nurses. Study and clinical experience in the four areas
previously described would prepare a nurse for this field. Operating room nursing preparation in the future will have to fit within the patterns of nursing education that will be developed. Operating room nurses must be vigilant in observing the trends and must be vocal and clear in defining the knowledge and skills needed at both the technical and professional level, for practitioners of this clinical specialty. The future offers operating room nursing a valuable opportunity to re-enforce the vital role it plays in safeguarding the surgical patient at the most crucial period in his hospitalization and in maintaining the quality of surgical services to the public.
ONE YEAR LATER-ANA POSITION PAPER ON NURSING EDUCATION The American Nurses’ Association’s o5cial position paper on nursing education made three major points about educational preparation for future nurses: 1. “Education for nurse practitioners should take place in institutions of learning within the general system of education. 2. “The bachelor’s degree should be minimum preparation for beginning professional nursing practice. 3. “The associate degree--or the credential awarded hy junior colleges-should be the minimum preparation for technical nursing practice.” T he forward to the position paper stated: “The position paper recognizes the realities of today and sets directions for the future. It points u p the need for the upgrading of all educational programs to encompass new scientific knowledge and to enrich nursing care. . . I t gives the foundation for effecting needed change i n an orderly, constructive way.” Enrollment figures for the last decade in nursing education programs appear to validate the position paper statements. Total Enrollment
1955
1965
__ Diploma 93,760 95,902 Associate 1,084 11,564 Baccalaureate 17,437 30,378 These figures indicate a gradual shift as nursing joins the educational mainstream. Dr. Rohert K. Merton, the association’s consultant sociologist, stated to the governing body of the ANA House of Delegates: “If there was ever any doubt on the part of any of you that mid-twentieth century nursing represents a profession, surely that doubt has been erased in this historic convention. “The action that you have taken in expressing your approval of the position paper does, I believe, capture your entire development as a profession. Th e position paper does not in any way affect what you already have, a full professional identity. The position paper addresses itself exclusively to the impending and long overdue changes in the system of nursing education. “During the interim between 1966 and that unknown time at which the vast majority of practicing nurses will have acquired at least a baccalaureate education, during that long interim, every nurse practitioner will continue to enjoy and to deserve by virtue of the quality of work she does, the standing as a professional practitioner.” Within one year the stage is set for discussions and action through regional an d community planning efforts for nursing education. ~
54
AORN Journal