Celebrating nursing’s rich history this week on Nursing Notes Live with Arlene Keeling, Ph.D., RN, FAAN, the “Centennial Distinguished Professor of Nursing” at the Eleanor Crowder Bjoring Center for Nursing History at the University of Virginia. Every nurse should have a solid basis in the history of our profession. Here’s that interview looking at the history of nursing.
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Jamie Davis: Arlene, welcome to Nursing Notes Live. It’s great to have you show. I always ask our nurses a traditional first question and that first question is why did you want to become a nurse?
Arlene Keeling: Well, I grew up in the 1960s and there was a television show on – two of them actually, Dr. Kildare and Ben Casey – that I watched religiously as a young girl. I was fascinated by the scientific terminology, the high-tech care they provided in hospitals and wondered what things were – like what was subdural hematoma or an epidural hematoma – and then I became a candy-striper at a local hospital and decided that I was in love with nursing. The nurses are the ones who were at the bedside. One incident I remember vividly was them turning a Stryker frame for a spinal cord-injured patient and being fascinated by all that the nurses did.
Jamie: We are so involved in so many of the direct patient care aspects of healthcare that you’re hard-pressed to find someone that’s had a healthcare experience that hasn’t been touched by a nurse in some way.
Arlene: Well, that’s true. As a child, I had had severe kidney disease after a strep throat infection. I was very impressed with the nurse who gave me the penicillin injections and the sulfa medicine. I probably realized that she was saving my life.
Jamie: Now you’re a professor of nursing now at the University of Virginia. Tell us a little bit about what led you through your career path to where you are today because we get a lot of people, especially student nurses and people interested in nursing careers, that ask us about how people define or find their nursing specialty or find their nursing passion. I often like to try to illustrate the different paths that nurses take to reach different points in their career.
Arlene: Okay. Mine was quite complicated perhaps. It seems like I never did anything the easy way. I became a nurse through a diploma program, Mountainside hospital in Montclair, New Jersey. Then I realized in my junior year the ANA position statement came out saying that you should have a BSN in Nursing. So after graduation having worked a year in the Coronary Care Unit I transferred to work in Virginia. I had a cousin at the University of Virginia who highly recommended this university. So I wrote a letter, found out they were very short-staffed in coronary care. I obtained a position and, at the same time, went on to take college courses in the evenings to get my Bachelor of Science in Nursing. Having done that, I also got married, had three children and took a hiatus from my career. It was always intensive care at that point. I stayed home for about five years to raise three children under three. Then I went back to school to get a Masters. While I was getting the Masters, realized how much I liked Nursing Research and with encouragement from several mentors decided to going on for a PhD. After the PhD I was – once again my career transformed – I got a K01 award from NIH and decided to pursue Nursing History. We had just opened one of two Nursing History centers in the United States at UVA. I knew that in the future it would need leadership and as an assistant professor, I had worked on the history of coronary care and was very interested in pursuing some research on the history of prescriptive authority in nursing. So after that I became an assistant professor at UVA and have stayed here. It’s a wonderful university. So I’ve stayed for over 25 years now.
Jamie: That’s great. I like the focus on history of nursing. We learned so much in nursing school but we only briefly touched on the history of nursing if at all. I think that that’s something that I think is may be missed by the students. They don’t understand maybe some of the rich history that’s involved with nursing care. We always talk about Florence Nightingale but the history of nursing goes back much farther than that, doesn’t it?
Arlene: It does. It goes back to the lay midwives who delivered babies from time immemorial to the Sisters of Charity, the Sisters of Mercy in the Middle Ages; to lay midwives in the United States in the Northeast and in the South when we first settled this country; and then to the rise of professional nursing starting in 1873 in the United States after the Civil War. So it’s complicated and longstanding. What I do is look at rather than the major leaders, although I don’t ignore nurses like Lillian Wald or Mary Breckinridge, I tend to focus on the grassroots of nursing practice. For example, in a recent book that John Kirchgessner from St. John Fisher and I edited, we have stories about nurses with coal miners in Appalachia; nurses in frontier in Leslie County, Kentucky; and school of nursing in Virginia; and migrant nursing during the Great Depression and other chapters.
Jamie: It’s fascinating really to think about all the things that nurses have been so involved with throughout their history. They are inextricably intertwined with the history of Public Health in the United States.
Arlene: Oh, definitely. They are also on the frontlines of disasters and evidence at the intersection between Public Health and disasters is in the 1918 flu epidemic, pandemic really, where millions have died worldwide. Nurses were left – with many physicians overseas in World War I, the public health nurses on the frontlines were left to care for patients outside of hospitals. Hospitals were overflowing at that time. So I’ve also written some on the influenza epidemics.
Jamie: What do you think we should be doing more with focusing on history with students in nursing school now? Should there be a required portion of the course load for nurses to really understand where they come from or is the existing process good enough?
Arlene: Now you have touched on a nerve for me. I think history should be mandated in all levels of the curriculum. I’ve written about the role of nursing history in preparing nursing for the future. I think it should be included as an essential of PhD programs and DNP programs because those are the educators of the future and the researchers of the future. They will be teaching others about what I call their cultural DNA. They’re going to have to know a sense of pride in their profession and in order to understand where we are today in nursing I think it’s mandatory that they understand how we got where we are.
Jamie: We certainly come a long way from the early roots of what you can call, I guess, modern nursing to become an individual, highly respected in the healthcare profession among, if not, the most trusted among the most trusted members of professional society in our culture. That didn’t happen by accident. That happened because of a lot of leadership decisions that happen in our past.
Arlene: That is very true and it happened mostly actually at the grassroots level where nurses interacting with patients establish a sense of trust. One example is in Mary Breckinridge’s work in the Frontier Nursing Service in Appalachia where the nurses were at first looked at with a little bit of suspicion by the local culture and then once they had safely delivered one woman of a baby and cured another child of strep throat with their magic penicillin, they were all of a sudden accepted by the community and allowed into the houses. So we see the sense of trust repeated with nurses on the Navajo reservation. Providing basic comforts like chicken soup during an illness as well as the medicines that were being dispensed.
Jamie: So what else do you like to focus on with nursing and history? Because I think that it’s interesting the way you keep touching on the frontier aspect of nurses that we’re always pushing out on the borders of society to reach those underserved populations. Now we have underserved populations both in inner city settings as well as underserved populations out in very rural settings. These are two very diverse communities.
Arlene: They are but what they have in common is that nurses show up and provide care where other people don’t want to be. It’s not the most desirous part of the city. It’s often with the homeless or in inner-city clinics and this we have a long history with the Visiting Nurse Association especially the one under Lillian Wald and Henry Street Settlement. I guess I am an advocate for the underserved and with the Affordable Care Act now in place and the mandate to work to the full extent of their profession, I would argue that nurses have long been doing that. They’ve just been doing it very quietly and sometimes surreptitiously. Not paid for what they are doing. But in one of the books I wrote about the history of prescriptive authority, we see nurses dispensing and furnishing drugs long before there were laws against that.
Jamie: As a journalist and a nurse I’m very proud whenever I read stories of new states enacting additional laws to expand the practice of Advanced Practice Nurses in their communities and areas. It just reminds me as I think about this discussion with you about nursing history that the history of nursing is a living breathing thing. It’s going on around us every day. We’re seeing history being made by nurse practitioners opening up clinics and in communities all around the country right now to fill a need that is so desperately wanted in those areas.
Arlene: That’s very true. Just like the nurse practitioners are opening nurse-run clinics now to serve a need in the past, to me it’s a recycled solution. There were numerous clinics. As I’ve said Mary Breckinridge had eight clinics in the Appalachian area of Kentucky and they were run by nurses. Doctors would visit maybe once a week or one specialist would come to look at children’s tonsils. But mostly the nurses were on their own working from what they call medical and obstetrical routines to guide their practice. Today we see 60% of all anesthesia in rural hospitals is given by nurses. That was the case when the Mayo Clinic hired nurse anesthetists in the late 19th century.
Jamie: That tradition is just being continued by nurses all over the country.
Jamie: So when we look at research and why it’s important for nurses to continue to grow our body of nursing research, that isn’t something that’s new either. We’ve long been involved with research and collecting data and analyzing that data for better healthcare.
Arlene: Exactly. One good example of that is Alice Magaw, a nurse anesthetist at the Mayo Clinic who kept statistics on her anesthesia in 1901 and published about it. It’s not new that nurses look at data. Florence Nightingale also use statistics with the British Army in the Crimea to prove her point that deaths were occurring in Scutari Barracks right over the sewers that was where the infections were coming. To me studying nursing history is another important research tool that is often overlooked. At UVA today, we have at least five PhD students doing their dissertations on Nursing History. Understanding for example what nurse anesthetist Olive Berger did at Johns Hopkins with the blue baby surgeries or what nurses did in mill towns, in the cotton mills of Southwest Virginia. I think understanding the context in which nursing exist today can inform how we decide about nursing and healthcare policy.
Jamie: So as we wrap up, do you have any advice for that nursing student that’s listening to this episode or perhaps a nurse who is getting ready to go back to school and listening to this episode about some of the direction they might focus on with regard to nursing history. Is there a particular place they should start?
Arlene: Well, it’s funny you should ask that. All of my doctoral students, I ask them the day they entered the class – and this could apply to any level student – what area are you interested? Is it obstetrics or violence against women or is it critical care and palliative care or end-of-life care? And then they should sort of reach out from there and begin to look at the history instead of just doing a lit review of the last 20 years, which most professors will ask them to do just get the most recent literature, I would suggest they go back as far as they can. For example, I had a student who was interested in Parish Nursing. She thought it started in the late 1980s in Chicago. I suggested that she might want to look at the Middle Ages and then at the Lutheran deaconesses at Kaiserswerth, Germany where Florence Nightingale studied. Now she is completely hooked on the topic. She and I are leading a tour to Kaiserswerth, Germany in September with our History Center at UVA. So it opens worlds of possibilities in their thinking about where they fit in this larger picture of nursing.
Make sure you check out the entire May 2015 issue of Nursing Notes to learn more about how nurses have healed throughout history. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our Get to Know nurse Donna Sabatino. Donna is an HIV/AIDS nurse educator and community liaison manager with the Janssen Therapeutics Infection Disease franchise. Sabatino is also a member of the Johnson & Johnson Nurse Innovation Council of Excellence (NICE). You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes and check out the new podcast player at DiscoverNursing.com!