“My love and heart have always been in elder care.”

Sandy Lee entered the nursing profession 29 years ago after completing a gerontological nurse residency program in the Texas Medical Center. She spent the next two years as a bedside-care nurse doing what was typical and expected of nurses then.

“I would come on board in the morning, get reports, assess my patients, perform treatments, administer medication and then document all of that at the end of the day,” Lee said. “Everything was paper-based, all handwritten notes.”

Lee now is an assistant clinical professor in the University of Houston College of Nursing and manager of the college’s RN to BSN program. The program is for nurses who have associate’s degrees and want to complete their bachelor’s. Lee says the last two decades have seen a tremendous leap forward for the profession.

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Sandy Lee, assistant clinical professor at the UH College of Nursing, says the profession has changed significantly and demonstratively, particularly in the areas of technology, and professional and educational opportunities.

“The profession has changed significantly and demonstratively,” she said. “In professional and educational opportunities, in technology, certainly. It’s related to patient safety.”

In 1999, a report from the Institute of Medicine —To Err is Human: Building Safer Health Systems—described an environment of high error rates in U.S. hospitals resulting in a human cost in the thousands and a systems cost in the billions. It called for better controls on quality care. The Institute of Medicine is a nonprofit organization and component of the U.S. National Academy of Sciences that provides research and recommendations on public health. The call for patient safety became a catalyst for changes that included technological advances and educational opportunities for nurses. Then, in 2010, the Institute of Medicine issued a challenge for 80 percent of nurses to secure a four-year degree in nursing by the year 2020 in the report, “The Future of Nursing: Leading Change, Advancing Health.”

“We found through that report that nurses were not operating at their capacity of educational background and competencies. That’s when we began the national effort to push and create the RN to BSN programs. They’d been there all along, but there wasn’t a ‘market drive,’” Lee said.

Nurses today, she said, want to pursue advanced roles in health care. She said in many nursing situations today, a four-year degree is required, and not having one can limit advancement.

“We are change agents, leaders, innovators, collaborators and partners with the health care team,” Lee said. “And, in order to do that, it takes a comprehensive education, well-grounded in general education and sciences and the arts, but also encompasses all aspects of health care. We save lives.”

“There are nurses now who want leadership or management roles and are coming back for the BSN. The demographic has changed. They’re coming straight from community college. They want to be an ICU nurse but can’t get that job. Or their employer is now requiring it (BSN) and helping them.”

While the challenge from the Institute of Medicine was an important change influence in nursing, there was another that cannot be ignored—technology. In the past, to ask an X-ray technician for immediate results on a patient may have meant waiting several hours at least. With digital images, the X-ray can be transmitted almost immediately with an answer just as quickly. Ask a veteran nurse about charting and you will likely hear about all the time it took to write out—physically, with a pen, on a chart—all medications dispensed to a patient, all care plans, prescriptions and changes in the patient’s conditions in the course of his or her shift.

“I started when everything was on paper, charts weighed 80 pounds and each shift wrote in their designated color (black or blue on days, green on evenings and red for night shift),” said Lisa Cannon, a 23-year veteran of the nursing profession. “We slowly moved to charting vitals and I & Os (intake and output) and sometimes ordered labs. Eventually, everything moved to computers. I don’t even need to carry a pen. Even the pharmacy delivery person has me ‘sign’ his phone!”

Using computers and other technology to ensure quality care for patients may have ushered in something new—the nursing specialization. Nursing Informatics is a specialized area of study that integrates nursing, computer and information science to create and maintain patient information and systems. Nursing students can pursue graduate degrees or certifications in nursing informatics—an indication of the opportunities that have expanded for nurses in the last 20 years. Specialization in nursing is almost the norm today—pediatric nursing, intensive care nursing, forensic nursing, nurse practitioner, public health nursing, to name a few.

Nurses today are essential participants in patient care, working with health care teams, physicians or as independent nurse practitioners in every part of life, spending the greatest amount of time with patients in the health profession.

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“Nurses play a critical role in patient care,” said Kathryn Tart, professor and founding dean of the UH College of Nursing. “By having a nurse who is educated, who has had real-world experiences and hands-on training from faculty with access to expanded instruction and research opportunities, you create a health care professional prepared to lead through the challenges of the industry with creativity and skill.”

“We are change agents, leaders, innovators, collaborators and partners with the health care team,” Lee said. “And, in order to do that, it takes a comprehensive education, well-grounded in general education and sciences and the arts, but also encompasses all aspects of health care. We save lives.”