Statement on the Expanded Role of the Nurse

Abstract

The term, "expanded role of the nurse", may be viewed within the historical perspective of nursing, and the roles nurses have assumed in the provision of nursing servies. But for an accident of history, nursing might have pioneered the field of preventive health care. Nurses in the pre-Christian era were concerned to a very high degree with life styles of people, environment and sanitation. Midwives and nurses practised their arts of caring and healing independently. It was not until the development of the science of medicine that nursing seconded itself to medical concerns. At this point the nursing role, as envisioned by its leaders throughout the ages, became subverted. A larger percentage of nurses followed the medical model related to illness care than those nurses who saw nursing in the broader perspective of health. As a result, educational preparation for nurses became oriented to a focus of illness rather than to aspects of prevention and promotion of health about which little had been scientifically determined. Traditionally, in the Western world, the educational preparation and indeed practice of the nurse, has been geared for functions in a dependant role in an institutional setting. The classic curriculum of educational programs ordered content directly on the medical model, and practice was organized according to the hospital ward patient classifications. The major focus in such traditional education programs has been on providing the graduate with the knowledge and skills to provide care in episodes of illness, with only limited concern for health care directed toward increasing the patient's ability to prevent illness and increase his level of health. The result of such an approach is that 80-90 percent of nurses have been caring for the 10 percent of the population requiring institutional care, while only approximately 10 percent of nurses have been involved in the care of the 80-90 percent of the population in the community. This meant that while illness needs of the population have been, on the whole, adequately met, health needs have been provided for in only a limited way through community nursing and medical services. Preparation for health care in nursing has only been provided in university programs which were late to the educational scene.