Nursing and Social Work: Long-lasting, Rewarding Careers

As I was writing last month’s article, I started to reflect on how lucky I was to choose Nursing as a career. When I was in high school, teaching and nursing were two of the most popular careers for women and I was going to be a teacher. Then one day a good friend asked me to go with her to a meeting of our high school’s Future Nurses Club. I joined the club with her and the two of us decided to become nurses instead of teachers. I have thanked her ever since (except during the summers when I wished I had chosen to be a teacher so I would have had the summer off). We did both go on to obtain a Master’s in Education degree (our second love).

In the late 1960s, career opportunities open to women were quite limited. Married women had only recently entered the workforce and were typically working in roles that did not require a college degree, e.g. sales clerk, typist, bank clerk, telephone operator, waitress, etc. Only 1 of 5 women with children under the age of 6 and 1 of 4 women with children over the age of 16 held jobs. In 1967, the workforce was comprised of only 14.8 percent women versus 43.2 percent today, and they were only paid 60 percent of the male rate versus 77 percent today. In 1970, one-half of working women 30-34 years of age worked as teachers.

After World War II, in the 1940s, college became more popular with enrollment doubling between 1940 and 1960. Women began attending college more in the 1950’s but were not typically enrolled in programs thought to be more "male-oriented", e.g. math, engineering, law, philosophy, medicine, etc. In the late 1960s only 7.6 percent of women obtained 4-year college degrees. The top degrees awarded for men and women were in the following fields: education (22 percent), business (14 percent), English (8 percent), history (5.5 percent), Psychology (5 percent), and the Arts (4 percent).

You probably noticed that nursing was not mentioned. The first Bachelor of Nursing program began in 1909. BSN programs were becoming more popular in the 1950s, but they did not generate large numbers of students. Since the programs were not able to meet the demands for nurses, hospitals started to develop their own 3-year registered nurse diploma programs. These programs became very popular since they were shorter in duration, less costly, and available locally. They provided educational classes and a large amount of on-the-job training for the students and a "free labor force" for the hospitals. Two-year associate degree (ADN) programs also became popular at this time, again in an attempt to meet the demand for nurses.

In 1964 the American Nurses Association recommended adopting the 4-year university program as the standard to promote educational consistency and the Federal Nurse Training Act provided funds for baccalaureate nursing education. These initiatives led to the adoption of BSN programs as the norm and resulted in the reduction in diploma and ADN programs.

I thoroughly enjoyed the hospital-sponsored diploma program that I attended. The school was located at the hospital site and attended classes, worked, and lived there for 3 years. So we were very involved in "all things nursing." It was a great to be able to learn something one day and then be able to immediately put that knowledge to use in the hospital the next day under the watchful eye of skilled, dedicated mentors. It was a great way to learn!

Those years also make me think of the way nursing has changed over the years. Many of you could never even imagine what nursing was really like back then. We used metal bedpans for patients that we sterilized in large "bedpan hoppers" on each unit; we did not have individual plastic bedpans for each patient. We manually counted and managed IV drips; we did not have automatic, electronic IV units. We filled syringes with the medication from the vial for each patient instead of getting pre-filled syringes for each patient dose from the pharmacy. We used glass thermometers to take temperatures, which meant it took at least 2 minutes to get an accurate reading for each patient. Patients needing oxygen were in O₂ tents, which made caring for them very difficult and gave them a sense of isolation. We did not have any computers or technological tools, since those had not been invented yet. All documentation was done in paper charts – no computerized records. And once we graduated and became an RN, we started our first job making $2.10 per hour! I know many of you cannot even imagine working in these conditions, but we did. And it is amazing that we were able to accomplish as much as we did.

Our first jobs were in clinical roles in a hospital, doctors’ office or clinic, visiting nurse or public health organization, school or long term care facility. There were not as many clinical nursing settings to work in as there are today, and very few non-clinical roles. While there were some case management jobs, they were not as plentiful as they are today. We did not have roles in nursing call centers, utilization management, community health, outpatient surgery, urgent care, occupational health, or health plans, because they did not yet exist. And we definitely did not have positions like mine, working for technology companies helping to develop software that nurses use (because we did not have any software!).

Nursing is so special. You can move from one type of nursing setting to another throughout your career, having very different jobs, but always maintaining your nursing career. In my 50 years of nursing I have worked as a clinician, educator, manager, content and program developer, consultant, and executive in a variety of settings - ER, Labor and Delivery, triage, case and utilization management, sales, and software technology. I have changed jobs, but I have never left nursing. And I have loved every minute of it.

There have been many significant advances in the medical field since I began my nursing career. These are some of the technologies, medications, and other innovations that were developed:

• Portable Defibrillator
• Ultrasound, CT scans and MRIs
• Laser technology
• Organ Transplants
• DNA and Human Genome Project
• Artificial Organs, e.g. Kidney, Heart
• Stem Cell Therapy
• Insulin Pump
• Knee and Hip Replacements
• Prosthetic limbs
• Synthetic Blood
• Statin and HIV Drugs
• Vaccines for Measles, Mumps, Rubella, Chickenpox, Pneumonia, Lyme Disease, Meningitis, Hepatitis A, B, & C
• Technology: Internet, computerized records, wireless, mobile technology
• Telehealth and telemonitoring