Looking for history behind how RN's and LPNs developed

BRANDY LPN · Jan 29, 2004

I have no idea, but what an interesting question can't wait til there are some replies!!:)

LPN-n-2005 · Jan 29, 2004

anyone?

bluemoose21 · Jan 29, 2004

the answer is on the tip of my tongue on how it actually got started...im lookin through my old books and notes tryin to find it....get back with you later.

Big Bab's · Jan 29, 2004

I honestly have no clue, guess I never really thought about it....now I'm curious to know also.:)

Home Health Columnist / Guide · Jan 29, 2004

historically, the practical nurse profession began because of the shortage of registered nurses during the second world war.

http://www.delmarhealthcare.com/olcs/white/ppts/chapter%2004.ppt

below are some links re nursing history and how nursing education developed and progressed in the us.

from online journal of issues in nursing:

may 2002

overview and summary: the 1965 entry into practice proposal - is it relevant today?

davina j. gosnell, phd, rn, faan

the topic of "entry into practice" is one that has plagued nursing for decades. throughout this period, position statements have been regularly forthcoming from various professional organizations, no doubt the most remembered being the ana "first position on education for nursing" of 1965. each has aroused debate and controversy, more often within the discipline of registered nurses, but also to a lesser extent by other communities of interest including physicians, hospitals, professional and educational organizations and associations, and the general public. the themes of these various documents have been to move formal nursing education out of the service sector and into academic education, to suggest the nature of education needed for the future, and to address nursing's anticipated future. overall, entry into practice has been one of the most contentious issues in all of nursing.

one might question why ojin has chosen at this point in time to address the entry into practice issue. many of the same questions raised with each position document published still remain. are there now different answers to be found? what the reader will realize in examining the positions of authors donley & flaherty, mahaffey, nelson, and joel is that the historical context of nearly half a century suggests varied perspectives in answer to the questions. it is not a matter of finding right and wrong answers but rather in understanding the differences in perspective and context.

especially interesting to note is that during the period of time examined, there has indeed been considerable change in the actual entry into practice demographics. for example, in the early 60's, 75% of all nurses were educated in diploma schools of nursing, 16% in baccalaureate programs, and associate degree nursing was in its infancy. by the year 2000, diploma education had dramatically declined to just 6%, while bsn doubled to 30%, but adn has risen to nearly 60% of all new graduates. indeed, entry into practice has changed! it is also somewhat sobering to note that although the vast majority of today's new nurse graduates are being educated in academic programs, today's nurses are the least educated of all health professionals with two-thirds possessing less than a baccalaureate education. in contrast, most other health professionals (i.e., therapists, speech pathologists, pharmacists) are now requiring entry into practice at the graduate level. each of the authors provide insightful explanations of the evolutionary factors contributing to the entry into practice issue in nursing. themes of professional turmoil, health care economics, feminine oppression, external societal controls, political and governmental policy, and lack of valuing of education are found in the perceptive critiques and analyses of these authors.

in "revisiting the american nurses' association first position on education for nurses," donley and flaherty provide an insightful comparison and contrast between the education scene of the 1960's and the contemporary educational issues in nursing today. the authors offer not only an in depth review of the 1965 ana position paper but clearly describe the parallel political forces and social issues occurring at the time. interesting to note is their observation that "circumstances of 1965 are somewhat similar to those of today." workplace issues, insufficient workforce supply, and lack of professional autonomy are noted to be parallel themes of the two periods.

mahaffey in "the relevance of associate degree nursing education: past, present, future" presents the reader with a comprehensive overview of the remarkable evolution of adn education. the dramatic impact of adn education is realized just in sheer numbers from 7 pilot programs in the 50's to more than 800 programs today. mahaffey, like donley and flaherty, notes parallel societal issues of the decade of the 60's and today, including issues of nurse shortage, decreased interest in nursing as a career, and use of creative educational strategies. an important contribution of adn education is that it has traditionally appealed to the non-traditional student - older, minorities, and males represent nearly twice as many adn students than those in other type programs. despite the relevant significant impact adn education has had on the entry into nursing issue, mahaffey notes that "decisions were sometimes made without significant representation of all program types." she further pleads an essential need for inclusion of the voice of adn educators, as well as nurses in practice, in the groups who are designing a vision for nursing.

in "education for professional nursing practice: looking backward into the future" nelson provides a retrospective review of educational developments in nursing since 1965. she too, as have the previous authors, identifies the similarities of societal and political pressures felt by nursing, both then and today. in contrast to mahaffey's compelling argument as to the important contributions of adn education, nelson expresses concern that as in the past when, diploma programs served the needs of hospitals, so too today's associate degree nursing program has become primarily a vocational program with a terminal degree and serves as a lucrative offering for technical and community colleges. she then provides a series of compelling arguments in support of rationale for bsn entry into practice, and notes that several organizations have expressed preference for the bsn, including the american organization of nurse executives and the veterans administration. she concludes that, "doors to future educational changes should be kept open, but moving education to the bsn level is the first step."

the last article by joel entitled "education for entry into nursing practice: revisited for the 21st century" suggests that nursing education has not been in control of its own destiny but rather, "nursing has been dominated by an external loss of control" and has been "swept along by a host of societal and educational circumstances." joel reiterates for us the true characteristics of a profession - service oriented, learned, and autonomous. of service, she notes that service orientation must be relevant to the times and carefully orchestrated to meet specific societal needs. to be learned requires not only a unique body of knowledge and skill and considerable educational investment and rigor but also "cognitive artfulness." autonomy, she reminds us, has two perspectives: the autonomy of the field of work and autonomy of the individual. she concludes that "nursing has resisted the normal course of occupational development" and notes that nurses have traditionally derived their identity from their statutory title, rn, rather than from their academic preparation. the clear differences in clinical competency between the associate degree nurse and the graduate level advanced practice nurse have been unquestionably demonstrated. joel suggests further pursuit of this differentiation of practice and presents the view that "nursing would always be a work in the process of becoming."

and so, as you, the reader, reflect on the issues of entry into practice not only from the perspectives of these authors, but from your own unique vantage point, i challenge you to share your thoughts, new insights, and reactions to these authors by either writing a letter to the editor or by submitting a morificecript which will further elucidate the issue of entry into practice. we look forward to hearing from you.

http://www.nursingworld.org/ojin/topic18/tpc18ntr.htm

revisiting the american nurses' association first position on education for nurses

http://www.nursingworld.org/ojin/topic18/tpc18_1.htm

the relevance of associate degree nursing education: past, present, future

: http://www.nursingworld.org/ojin/topic18/tpc18_2.htm

education for professional nursing practice: looking backward into the future

http://www.nursingworld.org/ojin/topic18/tpc18_3.htm

education for entry into nursing practice: revisited for the 21st century

http://nursingworld.org/ojin/topic18/tpc18_4.htm

the 1965 entry into practice proposal - is it relevant today?

http://nursingworld.org/ojin/topic18/tpc18ntr.htm

info re lpn's:

history of the licensed practical nurse association of nebraska

http://www.nehca.org/lpnan/wherewecame.htm

the history of licensed practical nursing in canada

http://www.clpnbc.org/pdf/historyoflpn2003.pdf

http://www.nflpn.org/education.htm

http://www.mshealthcareers.com/careers/lpn.htm

100 years of nursing history re ana and development of nursing see:

voices from the past, visions of the future: ana's centennial presentation

http://nursingworld.org/centenn/index.htm

from american association for the history of nursing, inc:

nursing history internet resources

http://www.aahn.org/weblink.html

Alnamvet · Jan 29, 2004

With the exception of 1 year RN accelerated programs for those who already have a Bachelors or Masters degree, the core RN curriculum should not take more than 2 years of full time study. A BSN should not be a minimum requirement for entry level practice because it only has the required 2 years worth of nursing courses, plus the remaining liberal arts and science requirements found in any Bachelors program in any major. If there is a push for Bachelors prepared nurses, the office weenies at the ANA need to simply state that a Bachelors degree, any major in that degree, plus the requisite nursing courses qualifies as a BSN (if you start fresh in a BSN program), or BSN equivalent, if you bring to a nursing program a Bachelors or higher degree. This is a turf battle perpetuated by bean counters who would like to see every non-BSN RN forced to go into hock to get a BSN, or face being phased out as a licensed professional RN. :rolleyes:

Aedana · Dec 20, 2007

I think it's funny how even as some things change, others stay the same. Even back then, nursing shortages and man/woman power issues were a problem. :-)

Aethon · Feb 15, 2008

I think diploma acquired nursing is the best possible way to go. Hands on experience coupled with academic information equals success. I wish I had that kind of education when released from the gaits.

lindarn · Feb 21, 2008

With the exception of 1 year RN accelerated programs for those who already have a Bachelors or Masters degree, the core RN curriculum should not take more than 2 years of full time study. A BSN should not be a minimum requirement for entry level practice because it only has the required 2 years worth of nursing courses, plus the remaining liberal arts and science requirements found in any Bachelors program in any major. If there is a push for Bachelors prepared nurses, the office weenies at the ANA need to simply state that a Bachelors degree, any major in that degree, plus the requisite nursing courses qualifies as a BSN (if you start fresh in a BSN program), or BSN equivalent, if you bring to a nursing program a Bachelors or higher degree. This is a turf battle perpetuated by bean counters who would like to see every non-BSN RN forced to go into hock to get a BSN, or face being phased out as a licensed professional RN.

Why don't other health care professionals so the same thing? They all require at least a Bachelors Degree in the career field, and then a Masters or a Doctorate as entry into practice. They do not allow second career Bachelors prepared individuals to jump ahead of other stiudents in the program. Physician Assistants who want to become MDs have to start as Freshman in Medical School, they do not have "accelerated MD programs", to allow a student to graduate "faster from Medical School". Why the push to short change nursing education?

RECREATIONAL THERAPISTS have a Bachelors Degree as entry into practice, all to help you "Reacreate" on a cruise ship, or the Hospitality industry! Physical Therapy ASSISTANTS have an Associates Degree as entry into practice.

But RNs and LPN/LVNs, who literally have patients' lives in their hands, have either an Associates Degree, Diploma, or in the case of LPN/LVNs only have a one year post HS education. And we are not only the lowest educated of all other health care professionals, we are also the lowest paid, have the least autonomy, and by far, receive the least amount of respect. Does anyone see the big picture? The public equates worth with education.

We allow hospitals to control our profession. We allow ourselves to be brainwashed into continuing to allow our profession to not progress educationally, as have the other health care professionals. We allow hospitals to brainwash us into believing that "nurses don't need higher educational levels to do their jobs. BSNs shoudn't be paid more because, 'Well, they do the same job as you. Why should that 'uppity BSN, be paid more than you' "?

It is the same old story- devide and conquer. It still works. We will remain underdogs

in the workplace until we finally accept that more education is necessary to claim our place as Health Care Professionals, who are paid a salary commensurate to their education, level of responsibility, and contribution to positive to posive patient outcomes.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Miss Mab · Feb 21, 2008

Why don't other health care professionals so the same thing? They all require at least a Bachelors Degree in the career field, and then a Masters or a Doctorate as entry into practice. They do not allow second career Bachelors prepared individuals to jump ahead of other stiudents in the program.

Hi Linda,

I'm confident our views are alligned on many of our professsion's issues, as usual the above post was spot on!

However, the above underlined confused me a bit. Can you clarify what you mean by 'jumping ahead of other studenst'?

Thanks.

jjjoy, LPN · Feb 22, 2008

Why don't other health care professionals so the same thing? They all require at least a Bachelors Degree in the career field, and then a Masters or a Doctorate as entry into practice. They do not allow second career Bachelors prepared individuals to jump ahead of other stiudents in the program. Physician Assistants who want to become MDs have to start as Freshman in Medical School, they do not have "accelerated MD programs", to allow a student to graduate "faster from Medical School".

From http://www.allalliedhealthschools.com/faqs/physician_assistant.php

Physician Assistant Degrees

Until recently, PA programs awarded certificates and associate degrees in addition to master's and bachelor's degrees. Now the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) requires that all programs offer graduate level degrees.

Physician Assistant Bachelor's Degree (BA-PA)

This accelerated 4-year program allows you to earn your bachelor's degree in conjunction with your graduate level PA certificate. The first two years usually involve courses in basic sciences, mathematics and liberal arts. The third and fourth years include nine months of clinical course work and 12 months of clinical rotations. Most BA-PA programs admit students into the program on a conditional pre-professional status, until the first two years are complete.

Physician Assistant Master's Degree (MA-PA)

Schools that confer the master's degree require you to have earned a bachelor's prior to entering the program. The first year emphasizes coursework in anatomy and physiology, pharmacology, microbiology, internal medicine, pediatrics, emergency medicine, obstetrics and gynecology, geriatrics, surgery and psychology. The second year emphasizes clinical experience in primary care and medical specialties.