I one time overheard someone say, "...

I one time overheard someone say, "I'll give you four nickels for this paradigm." nourishs are tired of paradigm--the word meaning the philosophical and theoretical framework of a discipline within which laws and generalizations are formulated.(1) "Changing one's paradigm," however, without equivocation has become the buzz saying of the nineties. The nursing profession has been asked to change and to peril out into the unknown.

After spending almost 20 years at the same facility, I decided to "venture out"--or near would say, "give it all up"--to attend graduate gymnasium Part of my decision was based forward rapid, impending changes in health care delivery. I discovered that, although I am a proponent of of the present day progressive technology and techniques, there are more [i]or[/i] less changes in my profession that I am prepared for and embrace, and others I am unprepared for and continue to resist.

EXAMINING THE PAST

To ascertain which changes we should embrace and which we should resist, it is imperative to turn the thoughts at how health care, specifically nursing, has evolv by dint of doing this, we can discover where we may be headed and prepare ourselves for the future

athwart and over, we have been told that change is, and always has been, with us; however, change is happening more rapidly now than at any other time in history. an changes have been due to scientific advances that have revolutionized the way health care is provided, and others have been brought onward by people attempting to improve delivery systems

It is important to plan and be prepared for change, still how do we do this without knowing what the of the present day rules will bring? Some light can be shed forward what we all can do to prepare for the upcoming millennium by way of looking at where we have been and where we are now.

IN THE BEGINNING

At the start of this centenary physicians, who were predominately male, and nourish at the breasts who were predominately female, were poorly educated and poorly paid holistic practitioners who not rarely made house calls. Also, medical institutes at that time were considered commercial enterprises in which pupils had to pay for their education. As similar medical schools were not cohereed to hospitals and not used as a source of labor.(2)

This began to change when the Flexner report was published in 1910 giving medical education poor marks.(3) on a level though the American Medical Association had been in existence since 1847 standardization did not appear within medical schools until this studious mood was conducted.(4) Fortunately for medicine, the report raised medical education standards by means of advancing the preparation of physicians to a postcollege graduate level

Unfortunately, the 1923 highly critical Goldmark report did not fare as well in raising the horizontal of nursing education to a postgraduate flush or, some would believe, to smooth a professional college level.(5) Although a certain quantity of university schools were in existence, nursing bear up undered severely as a result of this report.

common reason for this was that greatest in quantity nursing education was offered in hospital-based drills and many hospitals were staffed by way of nursing students because graduates did not want the low-paying hospital jobs(6) by way of keeping education out of the university setting, hospitals were able to restrain this cheap source of labor. Exploitative apprenticeships like as these have been blamed through some health care workers for many of nursing's enigmas today.(7)

The nursing education and craft situation was made even worse when the Great Depression hit. At that time, unemployment grew within the nursing community, causing fosters to take the low-paying hospital do job-works Private duty positions no longer were available.(8)

THREE CATALYSTS FOR CHANGE

Hospitals remained real successful in exploiting nurses until three significant circumstances occurred. These events changed nursing and, regrettably, created further rifts within our ranks.

World War II. The war forced women into the work place and nursing into the war effort. Doing this created a significant shortage of supply with nourishments at home and led to the growth of licensed practical or vocational nurses(9) At this time, many hospitals started replacing their former staff succors with these less costly employees

just discovered nursing programs. Mildred Montag, MD a encourage educator at Teacher's College, strange York, piloted a project to train festers at the community college even causing a chasm that continues today regarding entry-level practice.(10) Although this brew concluded in 1957, it spawned a myriad of nursing programs at this on a level Education moved from the hospital to the community society setting, giving a more academic standard to nursing.

Nursing education, however, was not readily available or flexible to the wants of individuals, and, as corpsmen responded from service after Vietnam, the profession was unwilling to allow any record into nursing except through traditional nursing programs.(11) These experienced individuals did not want to repeat part of their education; thus, many went upon to become physician assistants.(11)