Class of 1998: A Journey Through Two Decades of Nursing

This August marks the twentieth year I’ve been a nurse. This milestone has induced much reflection on my career and the advancements I have seen over the last two decades. Nurses General Nursing Article Magazine

Class of 1998: A Journey Through Two Decades of Nursing

This article is featured in the July 2018 edition of our allnurses Magazine...

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If you graduated in 1998 or the few years before or after, you have likely started to notice that you are no longer among the "young" nurses. You now stand with tenure among nurses who have written the letters R.N. or L.P.N. after their names even longer. It's funny to tell stories to younger nurses. Tales of paper charting and lower nurse-patient ratios bring glassy stares to their eyes. This place of tenure is a new adventure.

During the trip down memory lane, I have started to review some of the significant changes that have happened over the last twenty years and even considered what the future might bring. Here are a few of my memories and ponderings for the future.

Nursing School

I started my nursing journey by attending an Associate's Degree program at a Community College. It was hard, as are all nursing programs.

I had no intention of ever returning to school. However, advancements in technology changed my mind. I received my BSN in 2012 and a Masters Degree in Healthcare Administration in 2016 without ever leaving the comfort of my home.

Today, there are many options for nurses that were unheard of even 20 years ago. We can choose from traditional educational programs to online courses and certifications. Many nurses are enrolling in Nurse Practitioner programs as the need for advanced degree nurses continues to rise.

I can only imagine what kind of advancements lie ahead. New laws like the BSN in 10 that was just passed by New York will likely further change the look of nursing education (University of Buffalo, 2018). Will Associate Degree programs still be around? I'll let you know in 2038.


The NCLEX has undergone many changes over the years. Initially a paper-and-pencil test, the NCLEX was given only a few times each year in large venues (National Council on State Boards of Nursing, 2014). It would take several weeks or even months before nurses received their results, leaving candidates nervously awaiting the mail (National Council on State Boards of Nursing, 2014).

In 1994, the National Council on State Boards of Nursing (2014) pioneered computerized testing for licensure exams (National Council on State Boards of Nursing, 2014). They were the first healthcare organization to use this progressive method for entry-level knowledge licensing (National Council on State Boards of Nursing, 2014).

When I took the exam, I answered approximately 110 questions when the test shut off. Of course, I had no idea if it turned off because I had passed or failed. I remember crying like a baby from pure stress and exhaustion.

A few short weeks later, I hugged and kissed the mailman when he knocked on the door and handed me the most anticipated envelope I have ever received. It was addressed to me and had the letters R.N. on the outside of the envelope revealing my results.

Today, because of the progressive nature of nursing, computerized testing is the standard across many healthcare disciplines (National Council on State Boards of Nursing, 2014).

Electronic Medical Records

In my first few jobs, we used all written documentation. A lot of time was spent keeping notes and paying particular attention to what was written. Mistakes created a risk management nightmare that led to uncomfortable conversations with the nurse manager.

While some healthcare sectors began using technology in the 1990's, many did not fully integrate until several years later (net health, 2016). In 1991, the Institute of Medicine recommended that every physician should be using computers by the year 2000 to improve patient care (net health, 2104).

Today, electronic medical records allow most healthcare facilities to be paperless. As we look towards the future, advancements in portability and interoperability will likely pave the way through the next few decades.


Having spent a good bit of my career in home care, I have seen significant advancements in telemedicine. From home monitoring for at-risk pregnancies to chronic management of CHF, heart failure, and diabetes, telemedicine has made aging in place easier for many patients.

Telemedicine also offers nurses new career opportunities. Many nurses can work into advanced age due to options like telephonic case management, telephone triage, and quality assurance. These positions use nursing knowledge without the stress and physical demands of hospital nursing.

As we look to the future, mobile health and telehealth will offer programs that allow nurses to improve the care management process and increase patient engagement (mHealth Intelligence). Future advancements in mobile health technologies will catapult nurses forward as dispensers of healthcare information (mHealth Intelligence).


I started working in July 1998. My first job was on a medical-oncology unit in a moderately sized community hospital in Springfield, Ohio. If memory serves me correct, my starting pay was around $16 an hour. The Bureau of Labor Statistics (1999) reports that the average salary for registered nurses in 1998 was $43,070.

Today, nurses make much more. According to the 2018 allurses Salary Survey results the average hourly nurse makes $65,350. This salary seems more in alignment with the work of nurses, however with the continued advancements, increased nurse-patient ratios, and extreme stress levels, further pay adjustments may be needed.

The Next Twenty

What advancements will happen over the next twenty years? It is exciting to reminisce about the improvements of the past and dream of the ones in the future. Nursing continues to grow at a faster speed than other industries. The need for nurses will never end.

I am excited about the future of nursing. There will be bumps in the road along the way, but the possibilities are endless.


Bureau of Labor Statistics (1999) Annual wages of nurses, doctors, and other health care workers. Bureau of Labor Statistics. Retrieved from: Annual wages of nurses, doctors, and other health care workers : The Economics Daily : U.S. Bureau of Labor Statistics

University at Buffalo, School of Nursing. (2018). New York's new BSN in 10 law: What you need to know. University at Buffalo. Retrieved from: New York's BSN in 1 law: What you need to know | January 3, 218 - School of Nursing - SUNY - University at Buffalo

National Council of State Boards of Nursing. (2104). Pencils Down, Booklets Closed. National Council of State Boards of Nursing. Retrieved from:

Net Health (2016). What is the History of Electronic Medical Records? Net Health. Retrieved from: What is the History of Electronic Medical Records? [infographic & Video] - Net Health

mHealth Intelligence. Telehealth, mHealth Make Nurses Pivotal Presence in Healthcare. MHealth Intelligence. Retrieved from:

Telehealth, mHealth Make Nurses Pivotal Presence in Healthcare

Workforce Development Columnist

Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She enjoys empowering other nurses to find their passions and create a unique nursing career that fits their passions, desires, and gifts. She is owner of www., a website dedicated to helping women find their creative passions through writing and co-owner of, a start-up Nursing CE company that will offer online courses soon.

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Specializes in LTC, assisted living, med-surg, psych.

I graduated in 1997 and can hardly believe all the changes in nursing. I haven't worked in 4 years so I know there's been a lot more since I left the workforce. Electronic charting and med administration, new drugs, new wound care procedures---I keep up with it all through Allnurses. Of course, some things remain the same, especially NETY and high nurse-to-patient ratios. But overall, nursing is an exciting and dynamic field which will always be needed, even as technology advances. Long live nurses!

I need to take 15 hours of CEU's.

Specializes in Travel, Home Health, Med-Surg.

I started working as an RN around the same time for $16.00/hr also. All paper charting including hand written care plan, all meds in patient's room in a locked drawer (except narcotics), inforced visiting hours, charge nurse actually made decisions re: when patients admitted etc...i could go on...yes things have changed, some for the better, and some for the worse..i definetly will not be a nurse in 20 years but do expect to see many changes still to come, we will see...

Specializes in Allergy and Immunology.

I have only been a nurse for 9 years....But, the mere thought of taking a pencil and paper NCLEX and then waiting months for results... is absolutely terrifying!! Kudos to all that came before computerized NCLEX. I was a wreck for 1 DAY waiting for results!