The Nurses Reality Shift: Using History to Transform the Future

Nursing Book Club

The Nurses Reality Shift: Using History to Transform the Future

By Leslie Neal-Boylan (Sigma Theta Tau International, 2014)
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Reviewed By Christine Contillo, RN, BSN, PHN

Author Leslie Neal-Boylan, RN, Ph.D., CRRN, APRN-BC, FNP, says she wrote her new book, The Nurse’s Reality Shift: Using History to Transform the Future, as “a look back at how far we’ve come while spotlighting issues and events that continue to plague us.” One might also say that the more things change, the more they remain the same.

Neal-Boylan herself has spent 35 years as a nurse, but she bolsters her own opinions with an oral history from her own mother, who began her nursing career in the 1920s, combined with data from a survey of 608 nurses spanning different backgrounds, ages, cultures and educational achievements. The bibliography also lists many primary and secondary sources.

After a brief history of nursing, the author contrasts the nurses’ different experiences. From these well-told stories, we see that the parallels are as striking as the differences. 

At the turn of the last century, nurses were beginning to understand the causes and treatment of infections and the importance of good nutrition to health and healing. Then as now, nurses had the specialized knowledge the general public needed and were well-suited to caring for the sick as well as educating others in how to carry out that work.

Those early nurses also struggled with their professional image, education and treatment by colleagues, just as we do now. As Neal-Boylan recounts, today’s new graduates, like their counterparts of decades ago, feel that they haven’t had enough clinical time, that they’re inadequately prepared for a full case load on a hospital unit, and that they are led by nursing administrators who have little understanding of the issues involved in clinical settings.

While in some ways the experience of nursing has remained much the same over the years, today’s healthcare setting is changing rapidly. One of the issues Neal-Boylan highlights is that nurses aren’t taught enough about the role they can play in policy change and advocacy. In a climate where reimbursement can greatly affect decisions about patient care, we are uniquely positioned to provide quality patient education and health promotion.

Neal-Boylan also notes that nurses would be well advised to learn more about the business aspect of modern hospitals, with which nurses are generally unfamiliar, and use our skills to define our role rather than waiting for hospital administrators to define it for us. The Institute of Medicine has called for the BSN to become practically the entry-level degree by 2020. The Nurse’s Reality Shift helps us envision an educational experience with common curricula to better prepare nurses to deal with the ever-increasing difficulty of patient care. 

After finishing the book, I was struck by the important role we have played through centuries of healthcare. Our importance and our expertise have only increased. How sad that we continue to let physicians tell us how to run our profession. There are now 3 million nurses in the U.S. — We should be involved in our state and national organizations to directly participate in the rapid evolution of the healthcare world rather than waiting until it gets to our local clinic.     

Christine Contillo, RN, BSN, is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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