The First Generation of Trained Nurses

As the 19th century wore on and medicine became more advanced, the unpredictability of patient care became an increasing problem in the Western World. It was when the public was growing increasingly frustrated with the nursing practice that they learned about the miraculous success of Nightingale and her team; the news of Nightingale’s success came at a critical moment in which the convergence of hospital needs and public outcry demanded a new type of health care professional: the trained nurse Soon hospitals around the western world established schools of nursing, in which they would provide a pupil with lecture and clinical education if the pupil agreed to work for them with no pay for two to three years The establishment of these early schools can be seen as the first major impact of rationalization within the nursing profession given that they were an external control structure that sought to instruct nurses on how to provide care in an efficient, predictable, and calculable manner.Although the development of the schools was a crucial step in the standardization of nursing care, they also homogenized the nursing population by actively discriminating against non-white and non-female prospective pupils. African-American students were denied entry to almost all American training hospitals and were only allowed to enroll at African-American hospitals. Moreover, most hospital-based training systems reinforced the cultural stereotype that nursing was women’s work; in fact, most training hospitals refused to enroll men in their programs (Buhler-Wilkerson & D’Antonio).

Creation of Professional Nursing Organizations

Beginning in the early 20th century, nurses within industrialized societies created professional associations, the first of which was the American Nurses Association which was officially founded in 1911(“The History of the American Nurses Association”). Even more important, they developed official licensing protection for the practice of registered nursing. These associations and licensing regulations created an efficient, predictable, and controlled labor market by setting the standards that differentiated trained nurses, nursing assistants, and untrained nurses. (Buhler-Wilkerson & D’Antonio).

Creation of Critical Care Units

During the latter portion of the 1950s, these hospital nurses were experimenting with innovative reorganizations in the patterns of care in an attempt to increase the efficiency, calculability, predictability, and control of administering health care to critically ill patients. Healthcare professionals ultimately decided to group the most critically ill patients into a separate department, and thus the first modern critical care unit was formed in Pittsburgh in 1959 (Tang & Weil 1452).

Invention of Electronic Health Records

The push for innovation and efficiency during the 1970s not only altered how patient care was administered but also revolutionized how it was documented. By 1972 innovators had created the first Electronic medical records system- also referred to as electronic health records. However, due to high costs, they were not commonly used until the 2000s . Electronic health records were used to record and store the electronic health information of individuals and populations. Nurses’ use of electronic health records made the profession more efficient by streamlining the storage and communication of patient information (“EMR”).

It is important to note that although electronic health records improved the efficiency of healthcare, they also greatly increased the amount of control that nurses are placed under. The electronic health records laid out exact formats of how nurses should record patient data. The visual representations left no room for subjective comments that would allow the nurses to note nuances or anomalies that they observed in collecting the data, which left many nurses feeling micromanaged by external forces (Sherman).

ReMote Command Centers to the rescue?

Interestingly enough, greater external control pushed forward by further rationalization could be the answer to the current pressures many overburdened nurses are experiencing. Innovative Remote monitoring command centers provide nurses with multiple extra sets of eyes and ears to watch over their many patients on busy nights. These command centers are staffed by only a few clinicians but are capable of monitoring patients across multiple hospitals thanks to millions of dollars of computerized monitoring equipment (Gawande).

The constant monitoring facilitated by these systems is extremely beneficial to bedside nurses, who are provided an extra set of eyes and ears to monitor patients, but can also be viewed as an intrusion on the nurse’s autonomy in caring for their patients. Some bedside nurses are visibly unhappy with what they feel is external control being forced upon them by a stranger that peers over their shoulders. Resistance has been so notable that some hospitals have decommissioned their systems entirely; in those that have kept theirs up and running, there have been instances of clinicians covering the cameras with a gown or even ripping them out of the walls. Despite resistance, these systems do improve patient care and have been welcomed by some clinicians (Gawande).

Concluding Statements

In conclusion, it is evident that the rationalization of the nursing profession has drastically improved the lives of both patients and caregivers. As a result of increased efficiency, calculability, predictability, and control the administration of healthcare has become safer and more effective for both patients and nurses. What was once considered a lowly, unregulated profession for the uneducated is now a highly regulated, evidence-based profession that is considered to be one of the most respected professions in the country. With that being said, one should also remember that the regulation and institutionalization of nursing created implicit and explicit barriers to the profession, and thus homogenized the population by purposefully excluding men and people of color. Even today, seventy-seven percent of nurses are white women. Fortunately, however, that percentage is decreasing each generation, and one can be hopeful that the nursing population will one day accurately reflect the racial and gender make-up of the communities they serve (McMenamin)

Another concern addressed in this paper is the role that rationalization has played in the dehumanization of patient care. With that being said, it seems benefits in sanitation, morbidity, and mortality discussed in this paper perhaps justify such an occurrence. Moreover, novel human and non-human technologies created within the framework of rationalization have the potential to combat the very dehumanization that it first spawned. Take, for example, the innovation of virtual reality software that is used to immerse caregiver’s within the perceptual experience of patients so that the caregiver can better understand and predict how the patient might respond to their statements and actions (Hannon). Ultimately, such examples serve to illustrate the broader point that rationalization will continue to play a defining role as nurses everywhere pursue excellence for both themselves and, most importantly, those placed in their care.