I hope you all had a wonderful Case Management week. You deserve it!!
As I was writing last month’s article, I started to reflect on how lucky I was to choose Nursing as a career. When I was in high school, teaching and nursing were two of the most popular careers for women and I was going to be a teacher. Then one day a good friend asked me to go with her to a meeting of our high school’s Future Nurses Club. I joined the club with her and the two of us decided to become nurses instead of teachers. I have thanked her ever since (except during the summers when I wished I had chosen to be a teacher so I would have had the summer off). We did both go on to obtain a Master’s in Education degree (our second love).
In the late 1960s, career opportunities open to women were quite limited. Married women had only recently entered the workforce and were typically working in roles that did not require a college degree, e.g. sales clerk, typist, bank clerk, telephone operator, waitress, etc. Only 1 of 5 women with children under the age of 6 and 1 of 4 women with children over the age of 16 held jobs. In 1967, the workforce was comprised of only 14.8% women versus 43.2% today and they were only paid 60% of the male rate versus 77% today. In 1970, one-half of working women 30-34 years of age worked as teachers.
After World War II, in the 1940s, college became more popular with enrollment doubling between 1940 and 1960. Women began attending college more in the 1950’s but were not typically enrolled in programs thought to be more “male-oriented”, e.g. math, engineering, law, philosophy, medicine, etc. In the late 1960s only 7.6% of women obtained 4-year college degrees. The top degrees awarded for men and women were in the following fields: education (22%), business (14%), English (8%), history (5.5%), Psychology (5%), and the Arts (4%).
You probably noticed that nursing was not mentioned. The first Bachelor of Nursing program began in 1909. BSN programs were becoming more popular in the 1950s, but they did not generate large numbers of students. Since the programs were not able to meet the demands for nurses, hospitals started to develop their own 3-year registered nurse diploma programs. These programs became very popular since they were shorter in duration, less costly, and available locally. They provided educational classes and a large amount of on-the-job training for the students and a “free labor force” for the hospitals. Two-year associate degree (ADN) programs also became popular at this time, again in an attempt to meet the demand for nurses.
In 1964 the American Nurses Association recommended adopting the 4-year university program as the standard to promote educational consistency and the Federal Nurse Training Act provided funds for baccalaureate nursing education. These initiatives led to the adoption of BSN programs as the norm and resulted in the reduction in diploma and ADN programs.
I thoroughly enjoyed the hospital-sponsored diploma program that I attended. The school was located at the hospital site and attended classes, worked, and lived there for 3 years. So we were very involved in “all things nursing”. It was a great to be able to learn something one day and then be able to immediately put that knowledge to use in the hospital the next day under the watchful eye of skilled, dedicated mentors. It was a great way to learn!
Those years also make me think of the way nursing has changed over the years. Many of you could never even imagine what nursing was really like back then. We used metal bedpans for patients that we sterilized in large “bedpan hoppers” on each unit; we did not have individual plastic bedpans for each patient. We manually counted and managed IV drips; we did not have automatic, electronic IV units. We filled syringes with the medication from the vial for each patient instead of getting pre-filled syringes for each patient dose from the pharmacy. We used glass thermometers to take temperatures, which meant it took at least 2 minutes to get an accurate reading for each patient. Patients needing oxygen were in O2 tents, which made caring for them very difficult and gave them a sense of isolation. We did not have any computers or technological tools, since those had not been invented yet. All documentation was done in paper charts – no computerized records. And once we graduated and became an RN, we started our first job making $2.10 per hour!! I know many of you cannot even imagine working in these conditions, but we did. And it is amazing that we were able to accomplish as much as we did.
Our first jobs were in clinical roles in a hospital, doctors’ office or clinic, visiting nurse or public health organization, school, or long term care facility. There were not as many clinical nursing settings to work in as there are today and very few non-clinical roles. While there were some case management jobs, they were not as plentiful as they are today. We did not have roles in nursing call centers, utilization management, community health, outpatient surgery, urgent care, occupational health, or health plans, because they did not yet exist. And we definitely did not have positions like mine, working for technology companies helping to develop software that nurses use (because we did not have any software!).
Nursing is so special. You can move from one type of nursing setting to another throughout your career, having very different jobs, but always maintaining your nursing career. In my 50 years of nursing I have worked as a clinician, educator, manager, content and program developer, consultant, and executive in a variety of settings - ER, Labor and Delivery, triage, case and utilization management, sales, and software technology. I have changed jobs, but I have never left nursing. And I have loved every minute of it.
There have been many significant advances in the medical field since I began my nursing career. These are some of the technologies, medications, and other innovations that were developed:
- Portable Defibrillator
- Ultrasound, CT scans and MRIs
- Laser technology
- Organ Transplants
- DNA and Human Genome Project
- Artificial Organs, e.g. Kidney, Heart
- Stem Cell Therapy
- Insulin Pump
- Knee and Hip Replacements
- Prosthetic limbs
- Synthetic Blood
- Statin and HIV Drugs
- Vaccines for Measles, Mumps, Rubella, Chickenpox, Pneumonia, Lyme Disease, Meningitis, Hepatitis A, B, & C
- Technology: Internet, computerized records, wireless, mobile technology
- Telehealth and telemonitoring
It is amazing what has occurred in the past 50 years and it is even more amazing to imagine what types of new advances will occur in the next 50 years, especially given the availability of technological advances that will be possible in the future.
As we “baby boomers” retire, the nursing shortages are going to become even more apparent. Statistics for 2017 show that there are 3.3 million active licensed RNs in the U.S., but about 500,000 baby boomer nurses are expected to retire by 2022. This means over 1 million new nurses will be needed by that time.
In addition, there are 2.51 million community and social service workers in the U.S. Projections estimate that healthcare social worker demands will increase by 19% between 2014 and 2024, adding about 31,000 new positions. They also estimate that the addition of treatment programs for mental health and substance abuse will also increase social worker demand, creating a 19% growth by 2024, adding 22,000 new positions.
However, do not count on all nurses or social workers who reach retirement age to actually retire. Some love their career so much that they retire and then go back to work. For example, there are two 92 year-old nurses who became nurses in 1946, retired in their late 60s, found retirement wasn’t for them, and then returned to nursing to work another 25 years!
· Florence Rigney is the oldest working nurse in the U.S. She works 2 days a week in the Operating Room at a hospital in Tacoma, Washington. She originally retired at age 67, but then asked if she could return about 6 months later. She never imagined she would continue to work another 25 years, but says she loves to interact with patients. Her co-workers admire her for her speed and dedication and say “if you hesitate for even a second (because you are tired), she’ll just keep on going”. (Click here to see a video of her working in the OR).
So, don’t count all of us out, just because we have reached the age of 65. We still have a lot of knowledge and experience to share. But we are ready to turn over the torch to a new, dedicated, motivated, energetic group of nurses and social workers to carry on case management’s goals of professionalism, leadership, quality care, and commitment to excellence.
This article is published in the CMSA newsletter for Oct 2017