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 American Academy of Nursing

Editorial

“Being a Nurse” in the International Year of the

Nurse and the Midwife

cleanliness to prevent the spread of infection. Florence

Nightingale based her theories on work done during
the Crimean War, where she found that injured sol-
diers were cared for in filthy conditions. There was no
clear understanding of infectious agents, the knowl-
edge of clean environments led to a change in practice,
and thus a change in outcomes (Harimi & Alavi, 2015).
Improved care of patients due to Florence Nightingale
“being a nurse” and better health outcomes was some-
Julia A. Snethen, PhD, RN, FAAN thing to celebrate in the 1800’s. Nurses focus on
improving patient care and health outcomes seems to
be unchanged in the past 200 years and remains some-
The other day I was talking to my son Jaime, who just thing to celebrate.
graduated from college, about the year of the nurse During the Crimean War “being a nurse,” meant
and midwife. As I was discussing the past 200 years being a pioneer who was willing to travel to a foreign
since Florence Nightingale and all that nurses have country, not entirely sure of what they were walking
accomplished, he looked at me intently and asked me into. Those nurses were willing to take the initiative to
if I missed being a nurse. I was surprised not only at provide care to patients in challenging circumstances.
his question but at my reaction. I worked as a staff Unfortunately, “being a nurse” has changed with the
nurse for well over a decade of my career and have current pandemic in the U.S. and across the globe.
been a registered nurse for Jaime’s entire life. In Lives and routines have been altered in ways that
response, I asked him to explain what he meant by his none of us have experienced (or even envisioned) in
question “missing being a nurse” as I was sure that I our lifetime. For nurses on the frontline of caring for
just misunderstood what he asked. In response, my patients with the COVID-19 infection “being a nurse,”
son shared that, while he knew I was a registered means entering a situation where there continues to
nurse, because I do not work in a hospital, and I am be many unknowns. Nurses are on the front line once
not taking care of patients at the bedside, he wondered again to improve patient care by fighting against infec-
if I must miss “being a nurse”. Following his explana- tion to improve health outcomes. In both situations,
tion, Jaime and I had quite an eye-opening discussion though over 150 years apart, nurses have exhibited
about his perception of what a nurse is, and what roles bravery daily, as they potentially risk their own lives to
does one have to play in order to be a nurse. Granted, I care for patients.
am not currently working as a nurse at the bedside or Like nurses serving with Florence Nightingale, we do
involved in direct patient care. However, I have never not have full knowledge of the COVID-19 infection or its
stopped thinking like a nurse, and the lens I use to potential treatment. However, we do have greater knowl-
move through my career has never deviated from that edge of the type of environmental changes required to
of a nurse. Clearly, I didn’t understand that others stop the spread of microbial organisms, which includes
might see “being a nurse” differently. . . this was quite hand washing and cleaning. Thankfully, we also have
an ‘aha’ moment for me! nurses who are prepared to work with interdisciplinary
The World Health Organization has declared 2020 as teams and researchers around the U.S. and the Centers
the International Year of the Nurse and the Midwife (WHO, for Disease Control and Prevention (CDC) is gathering
2020a), coinciding with the 200th anniversary of the and sharing information to minimize the spread of the
birth of Florence Nightingale, viewed by many as the coronavirus infection (Centers for Disease Control and
founder of modern nursing (Harimi & Alavi, 2015). Prevention, 2020).
Contemplating what the public understands about Protecting patients is vitally important, as is protect-
“being a nurse” and why we should celebrate nursing ing the nurses who are caring for patients. In today’s
requires we reflect on the history of nursing, and what world, nurses and other healthcare providers have the
many of us learned in our initial nursing education benefit of personal protective equipment (PPE) that has
courses. The basic care that Florence Nightingale pro- continued to evolve and be refined in response to a
moted was environmental and included maintaining variety of infectious organisms. Watching nurses on
256 Nurs Outlook 68 (2020) 255 257

daily reports in the news one can visually see the per- nurses, physicians and the patients (Sullivan-Marx,
sonal protective equipment (PPE) in use to minimize March 22, 2020) which will hopefully influence health
nurse’s exposure to the corona virus. And we also see policy.
how scarce that equipment is and how unprepared “Being a nurse” means many things and the engage-
our country is for such a pandemic. ment in health policy is one of those important things.
As there are not enough PPEs for nurses to use, hos- Transformation of health policies has advanced glob-
pitals are preparing for PPEs to be re-used. Of great ally through the work of professional nursing organi-
concern is that in the process of re-using gowns, zations. A lesson to consider from this pandemic is the
nurses could be spreading the virus when donning or need for nurses to review our health policies and con-
removing a used gown. Nurses, who throughout his- sider the need for new or revised health policies. The
tory have focused on protecting patients, want to vision of the American Academy of Nursing focuses on
make sure that they are not inadvertently spreading “Transforming health policy and practice through
the virus to other patients, colleagues, the community, nursing knowledge and leadership” (https://www.aan
or themselves and their family members. Therefore, net.org/about/strategic-plan-2017-20). As an organiza-
without adequate supplies of PPE available to protect tion, The American Academy of Nursing has worked
nurses, there is no way to ensure the safety of nurses. in partnership with the American Nurses Association
Without nurses, who is there to care for any of us who to improve healthcare through policy change. Fellows
might be sick? in the American Academy of Nursing are in a variety
Nurses at all levels of practice and education are of professional roles, and “being a nurse” within the
engaged in “being a nurse” by fighting this healthcare Academy as Cipriano and Berkowitz (2016) stated: The
battle in a variety of roles. Leadership in nursing con- Academy engages its fellows in initiatives that will
tinues to be strong, as the current corona virus pan- enhance the quality of health and the profession of
demic has made evident. Nurse leaders around the nursing, promote healthy aging and human develop-
nation and across the globe have stepped up as health- ment, reduce health disparities and inequalities, shape
care has rapidly changed. Nurse educators have rap- healthy behaviors and environments, integrate mental
idly restructured academic programs in ways that we and physical health, and strengthen health delivery
have never seen in history. In an amazingly short systems (p. 3).
period of time, nurses in the academic setting have Another issue all have been forced to acknowledge
moved to on-line or alternative course options across during the pandemic is the inadequate number of
all academic programs for the foreseeable future. nurses that are currently available. “Being a nurse”
Nurse leaders have been in the forefront of “being a requires educating nurses who are adequately pre-
nurse” as they are figuring out the logistics of provid- pared to use their critical thinking skills daily to care
ing the safest care to patients, while protecting health- for patients in unexpected and challenging situations
care providers. A scarcity of the volume of resources or circumstances. It takes a significant amount of edu-
required for provision of care has put a strain on the cational preparation in both the didactic and clinical
healthcare community. Therefore, great energy is arena, over the course of several years, to achieve the
being put into making sure the healthcare community goal of “being a nurse”. Healthcare cannot wait until a
has the resources that are needed. Obtaining resources medical crisis, such as the current pandemic, arises to
has been complex, from nurses who have identified make sure that we have enough nurses to meet the
the needed resources, to the manufacturers and gov- needs in healthcare.
ernment officials who are trying to make sure resour- The pandemic highlights the ongoing need to recruit
ces are in place to meet the increased demand. It was individuals to embark on a career of “being a nurse”.
nurse leaders who loudly and consistently worked to The WHO has estimated that there will be a 9 million
demand resources for those providers on the front nurse and midwife deficit by 2030 if action is not taken
lines. (WHO, 2020b). An inability to meet the demand for
“Being a nurse” means being a lifelong learner, and nurses would limit the ability to meet healthcare
the pandemic has been a learning experience. Nursing needs across the globe. Nursing as a discipline has a
organizations took rapid action to gather and continu- wealth of opportunities that nurses can pursue as
ally update information on the pandemic. The regular illustrated on the WHO website (WHO, 2020a) where
updates that are being disseminated are invaluable nurses and midwives from around the globe have
resources that have enabled nurses to be as knowl- shared their stories about the healthcare that they pro-
edgeable as possible. Updates have come at an espe- vide in their daily life as a nurse or midwife.
cially fast paced time that is rife with so many Among the many opportunities for nurses to con-
unknowns. Leaders amongst the national nursing sider while “being a nurse” during The Year of the Nurse
organizations have served as a resource for informa- and the Midwife is that of the advanced practice nurse,
tion at the highest levels in the nation, including nurse educator, and nurse scientist. All roles in nurs-
attending meetings at the White House (American ing are important and can contribute to ensuring that
Academy of Nursing, 2020) and on the news channels new nurses are prepared for a career in nursing. The
where our AAN President Eileen Sullivan-Marx spoke coronavirus pandemic has reaffirmed the concern
boldly about the urgent needs for supplies to protect across the discipline regarding the alarming decline of
 Nurs Outlook 68 (2020) 255 257 257

nurses becoming scientists. Nurse scientists educated higherlogicdownload.s3.amazonaws.com/AANNET/

to work with interdisciplinary research teams are c8a8da9e-918c-4dae-b0c6-6d630c46007f/UploadedI
mages/Academy_Calls_for_Rapid_Response_to_the_
needed to prevent the transmission and find a treat-
Coronavirus_Pandemic_3_18_20.pdf
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are vital to caring for patients, including implementing navirus Disease 2019 (COVID-19: Cases and Updates.
into practice the outcomes from research on coronavi- Retrieved from. https://www.cdc.gov/coronavirus/
rus that is already being conducted. Nurse educators 2019-ncov/cases-updates/index.html.
are pivotal to the educational preparation of students Cipriano, P., & Berkowitz, B. (2016). Nursing strong — the
across all levels of nursing programs. American Academy of Nursing and ANA. The American
Nurse, 48(1), 3.
This editorial was originally focused on celebrating
Harimi, H., & Alavi, N. M. (2015). Florence Nightingale: The
The Year of the Nurse and the Midwife. However, at the Mother of Nursing. Nursing and Midwifery Studies, 4(2),
same time, the landscape within nursing and health- e29475. http://dx.doi.org/10.17795/nmsjournal29475.
care settings changed daily, and literally hour by hour. Sullivan-Marx, E. (March 22, 2020). Dean Eileen on MSNBC
With each turn on the rollercoaster of change, the con- discussing latest COVID-19 developments (3/22/20).
stant has been the excellence and strength of nurses Retrieved from. https://www.youtube.com/watch?
across the nursing profession. Nurses have been in the time_continue=73&v=GAaKqcI8FXc&feature=emb_title
World Health Organization (2020). Year of the Nurse and
trenches, through many wars, demonstrating how
the Midwife 2020. Retreived from. https://www.who.
important nurses are to healthcare. During the current int/news-room/campaigns/year-of-the-nurse-and-the-
war against the coronavirus, nurses and nursing stu- midwife-2020.
dents have been expressing their fears regarding expo- World Health Organization (2020). 2020 International Year
sure to COVID-19. Unlike nurses during the history of of the Nurse and Midwife: a catalyst for a brighter
our discipline, we have the technology and ability to future for health around the globe. Retrieved from.
https://www.icn.ch/news/2020-international-year-
develop and provide nurses with PPEs. PPEs as well as
nurse-and-midwife-catalyst-brighter-future-health-
plans and preparations must be made going forward, around-globe, retrieved 3/19/2020.
for protecting the safety of nurses when taking care of
patients. Processes need to be in place to not only Julia A. Snethen, PhD, RN, FAAN
ensure that nurses are safe when they are practicing, Professor and PhD Program Director,
but to encourage individuals to become nurses in order University of Wisconsin-Milwaukee,
to meet the growing need for healthcare providers. As College of Nursing
we celebrate The Year of the Nurse and the Midwife it is a Associate Editor,
good time to look not just at our history, but an oppor- Nursing Outlook Milwaukee, Wisconsin
tunity to map out our future moving forward!

E-mail address: julia@uwm.edu

REFERENCES

0029-6554/$ – see front matter

Ó 2020 Elsevier Inc. All rights reserved.
American Academy of Nursing (March 18, 2020). American https://doi.org/10.1016/j.outlook.2020.04.004
Academy of Nursing Calls for Rapid Response to the
Coronavirus Pandemic. Retrieved from. https://