How the Field of Nursing Has Changed Over Time Discussion Paper

The field of nursing has changed over time. In a 750‐1,000 word paper, discuss nursing practice today by addressing the following:

Explain how nursing practice has changed over time and how this evolution has changed the scope of practice and the approach to treating the individual.
Compare and contrast the differentiated practice competencies between an associate and baccalaureate education in nursing. Explain how scope of practice changes between an associate and baccalaureate nurse.
Identify a patient care situation and describe how nursing care, or approaches to decision‐making, differ between the BSN‐prepared nurse and the ADN nurse.
Discuss the significance of applying evidence‐based practice to nursing care and explain how the academic preparation of the RN‐BSN nurse supports its application.
Discuss how nurses today communicate and collaborate with interdisciplinary teams and how this supports safer and more effective patient outcomes.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Read Chapter 3 in Dynamics in Nursing: Art and Science of Professional Practice.


Read \”Creating a More Highly Qualified Nursing Workforce,\” by Rosseter (2015), located on the American Association of Colleges of Nursing (AACN) website.

URL: \”The Impact of Education on Nursing Practice,\” by Rosseter (2017), located on the American Association of Colleges of Nursing (AACN) website.

URL: \”Scope of Practice,\” located on the American Nurses Association (ANA) website.  How the Field of Nursing Has Changed Over Time Discussion Paper

How the Field of Nursing Has Changed Over Time

The field of nursing has undoubtedly undergone a lot of transformation with the passage of time. This could be considered as an inevitable eventuality as technology was bound to revolutionize all aspects of our social and professional lives. With the passage of time, there has been a movement towards more awareness of the need for the provision of quality healthcare. Currently, nursing education and training emphasizes the use of evidence-based practice (EBP) as the yardstick for measuring the quality of healthcare (Melnyk & Fineout-Overholt, 2019). Many years ago when nursing was more of an art than a science, there was no regard for the efficacy of interventions used. Many of the nursing interventions were used just as a matter of tradition and not based on research. This has now changed with the widespread application of the concept of clinical inquiry. EBP is now best practice in nursing clinical practice. Part of the reason for this change is in the fact that nursing education has also undergone evolution with time. In 2010, a landmark report by the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) titled the Future of Nursing: Leading Change, Advancing Health was published. The report came up with suggestions that were aimed at strengthening nursing practice and the place of nurses in the healthcare food chain. Two of the most important recommendations in this report were (i) the removal of all barriers to practice for all nurses (so that they can be allowed to practice to the fullest extent of their education, training, and skills), and (ii) increasing the number of nurses with a baccalaureate degree to 80% by the year 2020 (Hooper, 2016; ANA, n.d.). These recommendations capture the spirit that had already been reigning within the nursing profession over the years. An example is the preference of having baccalaureate nurses with bachelor’s degrees as opposed to those with an associate degree. The former are more attuned to EBP because of education on research and are therefore more likely to engage in clinical inquiry. This paper looks at the evolution of nursing with the passage of time with a focus on the difference between an associate and a baccalaureate degree in nursing.


How Nursing Practice Has Changed Over Time and a Comparison Between Associate and Baccalaureate Education in Terms of Practice Competencies

As stated in the introduction above, there have been remarkable changes in nursing as a profession over the years to the current time. This change has been evident in the approach to practice and education of nurses. Initially, nurses were meant to be helpers to physicians and would only be concerned with carrying out orders written by the clinicians without questioning. This period is represented by the early days of nursing when Florence Nightingale first went to take care of wounded soldiers in the Crimean War in the mid 19th century. This meant that nurses were passive care givers who did not have to understand disease and its management in any deep sense. The matter of scope of practice was not relevant as nurses were only carrying out orders given by physicians. They were not independent clinicians in any sense. This was to change later in the mid 20th century, about 100 years since Nightingale laid the foundations of nursing education and nursing practice. The change came when the concept o the advanced practice registered nurse (APRN) came about. Postgraduate education and training of nurses in the four roles of nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist began in earnest (Sabo et al., 2017). At this time, the question of scope of practice became relevant as these APRNs would practice as clinicians and treat illnesses, injuries, and disease without necessarily requiring the input of a physician. To date, this change has brought about the clamor for APRNs to have autonomous or full practice authority (FPA) across all states (Duncan & Sheppard, 2015). Definitely, the approach to treating the individual also changed in that nurses would no longer be mere helpers to physicians but also clinicians in their own right. They would be able to offer primary healthcare to communities and populations that sorely needed it.

The differentiated practice competencies between a nurse with an associate degree and the one with a bachelor’s degree are evident. The two are similar in that they are levels of education and training that make the nurse more efficient, discerning, and a critical thinker when delivering care to the patient. They both result in better patient outcomes. However, there is a major difference in that the ADN nurse is trained to acquire more practical competencies. The ADN nurse does not have competencies in leadership and research. In contrast, the BSN nurse also possesses practical competencies but in addition also has research and leadership competencies (Nightingale College, 2017). These differences in competencies are what cause changes in scope of practice between a BSN nurse and an ADN nurses. An ADN nurse assists physicians and other clinicians by taking care of their patients through administering medications, taking vital signs, and recording the patient’s condition. On the other hand, a BSN nurse is a clinical nurse leader who manages, delegates, and directs a clinical team in the delivery of evidence-based nursing care.  How the Field of Nursing Has Changed Over Time Discussion Paper

An example of a patient care situation that can illustrate this difference in scope is a sudden change in the acuity level of a patient who then needs transfer to the critical care unit. The ADN nurse will concern themselves with keeping patient parameters within physiological levels by administering oxygen, making the patient comfortable, and reassuring the patient amongst other things. As for the BSN nurse, they will be concerned with decision making. They will inform the multidisciplinary team members of the change in the patient’s condition and the need to transfer them to the ICU. In other words, they will provide leadership and direction.

Importance of Applying EBP to Nursing Care and Contemporary Nurse Communication and Collaboration with Interdisciplinary Teams

It has been stated in the introduction to this paper that EBP is the current philosophy of practice for the nursing profession. The importance of applying it to nursing practice is that it is the only kind of practice that guarantees the realization of desired patient outcomes. The fact that EBP makes use of only those interventions that have proven efficacy supported by research evidence means that these interventions have a high likelihood of succeeding. The academic preparation of an RN-BSN nurse supports the application of EBP in that the nurse is trained in leadership and research. Knowledge about research is paramount for understanding and practicing EBP.

Nurses today communicate and collaborate with interdisciplinary members through a variety of means. This is mainly through technological interfaces such as the EHR platform. Nurses are the largest group of users of any EHR system in any healthcare organization. They can communicate with other team members using the system and also using the components such as the patient data management system or PDMS. This facilitates the provision of safe care leading to desirable patient outcomes.


Nursing as a profession has changed tremendously over time. This has been more evident in terms of nurse education and training. With greater educational achievement and broader training, nurses became practitioners in their own right with the need to have a more autonomous practice environment. This paper has used the example of the ADN nurse and the BSN nurse in illustrating the changes that have taken place in nursing with the passage of time.


American Nurses Association [ANA] (n.d.). IOM future of nursing report.

Duncan, C.G. & Sheppard, K.G. (2015). Barriers to nurse practitioner full practice authority (FPA): State of the science. International Journal of Nursing Student Scholarship, 2.

Hooper, V.D. (2016). The Institute of Medicine report on the future of nursing: Where are we 5 years later? Journal of PeriAnesthesia Nursing, 31(5), 367-369.

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Nightingale College (January 31, 2017). ADN vs BSN debate: These are the real differences between ADN and BSN prepared nurses.,well%20as%20clinical%20skills%20training

Sabo, J.A., Chesney, M., Tracy, M.F., & Sendelbach, S. (2017). APRN consensus model implementation: The Minnesota experience. Journal of Nursing Regulation, 8(2), 10-16.  How the Field of Nursing Has Changed Over Time Discussion Paper






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