Yes, I agree ..........GREAT question!
I think the focus of care delivery has changed.......since 1978 when I started nursing. I mean, think about the fact that a patient having surgery for cataracts might be hospitalized > a week, on strict bed rest, and with sandbags on both sides of his/her head!!!......that was back then. NOW the patient comes in for procedure and returns home the same day!!! In this regard, WAY more patient education is necessary. Most surgeries, in the "old days" would come in the night before, have a prep done and hopefully get some pre-op teaching. So I would call this change, an opportunity for greater patient education (now I mean).
Another positive change which is advantageous to nursing (but not ALL would agree!) is computerized records and documentation. It was overwhelming to learn and adjust to at the time, but now I LOVE it!! You can find out everything......like who gave exactly what medication at what time, current lab values, patient health history, which MDs ordered what test or med and what time!!! These facts are very helpful to me, working on an interdisciplinary team and communicating with nurses all over the hospital.
I do agree there seems to be a bit more "scripting" of practice by management types. I think this translates to less freedom of practice. This is unfortunate, but falls under the old "patients and families first, RIGHT after the computerized documentation!!!".
Family focus is more prevalent these days. We are also working with internet savvy patients and families.........many read all about their diagnosis and treatment of same on the internet. This makes them question us more, which is fine.
Over all......there are days that I say to myself, "I am glad to be at the top of the hill, looking down, than at the bottom climbing up"..........regarding nursing. Usually the days of feeling happy and satisfied with my job and how I am able to do it, out number the other days