Delaware’s nurses are vital during the COVID-19 crisis, providing care and comfort. (Pictured here: a team of ChristianaCare nurses)
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Since the beginning of March, stark images and heroic stories have emerged nonstop, highlighting nurses—committed, focused, often exhausted and frustrated—at the center of caring for those suffering amid the COVID-19 pandemic.
Recognizing nurses as integral to the front-line battle against the pandemic, communities have responded with an outpouring of love and appreciation. The nation’s metropolises have encouraged apartment-bound residents to step onto balconies at hospital shift changes to celebrate those who give their time and risk their safety to care for the ill. Social media is awash in cartoons, photos and memes recognizing nurses. It’s no surprise, then, that these tributes have gone—no pun intended—viral.
“Registered nurses are the backbone of a hospital system and make up the largest category of clinical staff,” says Lynne Voskamp, interim vice president of patient care and chief nursing officer of Beebe Healthcare. “There are many lines of defense against the spread of coronavirus, but these skilled health care professionals provide hands-on care for patients in our inpatient, outpatient, and physician practices.”
Nurses carry a heavy load, with multiple duties and responsibilities, she explains. “RNs collaborate with physicians, check on a patient’s needs frequently, provide communication to family members, make sure medications are accurate, assist with the discharge instructions, case management, and fulfill many other important aspects of patient care,” she says. “Nurses play a key role in the prevention of infection and are leading the way for Beebe’s preparedness for COVID-19 in Delaware. Nurses also are vital in this national emergency, as they provide therapeutic healing and care by reducing pain, fear and anxiety patients may experience during this crisis.”
A history of caring
The mother of modern nursing, Florence Nightingale knew she had a deeper calling when, as a child in the 1830s, she discovered her passion for caretaking. Despite the odds (society frowned on formal education for affluent young ladies of her stature), Nightingale followed her dream and left a legacy that would enhance lives the world over.
Nightingale, born in Italy and raised in England, went on to train at the Institution of Protestant Deaconesses at Kaiserswerth in Germany, where she would learn the basic nursing skills she would use for the rest of her life. She rose to fame as the “Lady with the Lamp,” treating military soldiers at a British hospital during the Crimean War, introducing basic sanitation techniques and lowering the mortality rate in the process. She eventually opened the first professional nursing school in the world in 1860, at St. Thomas Hospital in London.
In honor of her 200th birthday, the World Health Organization designated 2020 as the Year of the Nurse and Midwife to highlighting these professionals. Were it not in conjunction with Nightingale’s bicentennial, it would have seemed oddly prescient that WHO chose this as the year nurses would be regarded not just as committed professionals but as superheroes.
Regulating a new profession
The concept of professional nursing was formalized in the First State on May 5, 1909, when the Board of Examiners for the Registration of Nurses of the State of Delaware was established and held its first meeting.
According to Pamela Zickafoose, executive director of Delaware’s Division of Professional Regulation, the board began licensing nurses on June 19 that same year. By December 1909, 53 professional nurses had been licensed by the state.
“During this time, nurses were educated in hospital-based nursing programs for a three-year period. Most of the theory was taught by physicians, and the head nurses supervised the clinical component, which consisted of on-the-job training,” Zickafoose says.
Back then, nurses were not issued licensure exams; licenses were granted by waiver. There also were no designations delineating between registered nurses, licensed practical nurses or advanced practice registered nurses like certified nurse midwives.
The licensing exam wasn’t created until 1912 and, at that time, consisted of a five-day test by hand offered only twice a year. The first national exam was developed in January 1944 and was used by multiple boards of nursing to help streamline the profession.
“By April 1944, several thousand candidates had taken this exam and 17 states had membership in the test pool. This test was the first machine-scored test allowing prompter issuance of licenses. In 1949, the six examinations of the SBTP included medical nursing, surgical nursing, obstetric nursing, nursing of children, communicable disease nursing and psychiatric nursing,” Zickafoose says.
A growing field
Around the time regulatory practices for nurses were created in Delaware, hospitals opened their own nursing schools for select students to better supply their health care systems with qualified medical staff.
The nursing school at Milford Memorial Hospital opened in 1907. Saint Francis Hospital in Wilmington and other nearby hospitals also founded nursing schools in the early 1900s. Beebe Hospital, the first hospital to open in Sussex County, opened the Beebe Hospital Training School for Nurses in 1921 and later renamed it the Margaret H. Rollins School of Nursing.
Programs offered at Beebe’s nursing facilities helped lay the groundwork for the statewide board of nursing to begin accrediting such schools.
“Beebe was the first school in Delaware to seek accreditation, which prompted the Board of Examiners to draft legislation giving specific power to the board for accrediting schools. This later became a vital component of the Nurse Practice Act and one of the primary functions of the Board of Nursing,” says Dr. Karen Pickard, Margaret H. Rollins School of Nursing’s program administrator.
Nursing schools at hospitals, in the beginning, were often open only to young, unmarried Caucasian women. Nonwhite students like African-American scholar Jane Evelyn Mitchell often had to travel long distances to earn a nursing education.
Mitchell, a graduate of Howard High School, the University of Delaware and Washington College, embarked on a celebrated nursing career at Delaware Psychiatric Hospital, eventually becoming its director of nursing services, vice president of the Delaware Nurses Association and the president of the Delaware State Board of Nursing, along with filling many other volunteer roles.
As time changed the needs of the profession, most of the nursing schools housed at hospitals throughout the state closed, yielding to larger school programs like the one at Delaware Technical Community College. Beebe’s nursing school remains the only school located on hospital grounds in Delaware.
The school now collaborates with other educational facilities in the state to help its students earn higher levels of education through agreements with the University of Delaware, Wilmington University and Wesley College.
“Over the past 110-plus years, nursing has changed dramatically due to advances in technology, pharmaceuticals, evidence-based practice and education,” Zickafoose says.
Once nursing was regulated by the state of Delaware, several changes were implemented. For example, the definition of advanced practice nurses was added to the rulebooks in 1983 and continuing education became required in 1989 to ensure nurses were working the most up-to-date information available. The statewide Joint Practice Committee was created in 1994, with prescriptive authority language implemented for nurses the same year.
Multistate licensure for registered nurses and licensed practical nurses was added in 2000 to make it easier for nurses to work across state lines. Criminal background checks before licensure became required in 2004. Currently, registered nurses, licensed practical nurses and advance practice registered nurses combined hold nearly 30,000 active licenses in Delaware. To expedite licensing, the Division of Professional Regulation will eventually implement DelPROS, a new online system, Zickafoose says. Compact licensure for Advanced Practice Registered Nurses (APRNs) is on the horizon and will eventually improve access to care and decrease the licensure burden for APRNs.
In designating 2020 as the Year of the Nurse and Midwife, the World Health Organization said it hopes to showcase the profession’s importance, as well as advocate for nurses, midwives and their patients while sharing their stories.
“WHO’s vision of improved global health will only become a reality if there is a massive investment in nursing. The research evidence is clear: Having more nurses leads to better health outcomes. The potentially catastrophic shortage of nurses we face over the next decade can be avoided, but only if governments act swiftly and decisively to turn this situation around,” says International Council of Nurses Chief Executive Officer Howard Catton in a press release. “But we also want to use 2020 to bust myths and traditional stereotypes about nursing, show the public the reality of 21st-century nursing and the amazing difference nurses can make when they are enabled to perform at the top of their game.”
Published as “Living Nightingale’s Legacy” in the May 2020 issue of Delaware Today magazine.