Julie Fairman

Scale, Causes, and Implications of the Primary Care Nursing Shortage

As the demand for health care consistently rises and many individuals, even within developed countries, lack access to primary care services, a better understanding of how primary care is defined, the main causes of the primary care shortage both within the United States and across the globe, and key solutions to these issues are paramount. Upon review of the US and international primary care literature, the authors first briefly discuss the fluidity of how primary care is defined and how it is applied in nations with differing levels of health care infrastructure. The main causes of the deficit both domestically and globally are then examined. Finally, upon careful review of the research produced within the past seven years, this article suggests strategies that maximize the primary care workforce: the effective use of technology, task shifting, interprofessional teams, and more consistent primary care data to build workforce strategies.

Histories of nursing: The power and the possibilities

This article challenges the dominant paradigm of understanding the history of nursing as only that of relative powerlessness. By moving away from the stance of educators deeply concerned about the inability of the profession to gain control over entrance requirements and into the realm of practice, we use examples from our own work to discuss alternate histories of power. We acknowledge historical circumstances of invisibility and gender biases. But we argue that when we look at the history of practice, we see as much evidence of strength, purpose, and successful political action. Finally, we call for an acknowledgement of the rich and complex nature of the many different histories we can tell in nursing. And we suggest that an admitted inability to advance in one area of the discipline has not meant an inability to move in others.

Reimagining Nursing's Place in the History of Clinical Practice

This work posits how medical history might be conceptualized if nurses and nursing history was used as the analytical lens. Nursing is seen not as a separate part or subsection of medical history, but rather one that is deeply embedded in the relationships and social order of clinical practice. Nursing is an analytical category in and of itself. By approaching nursing as such a category, we enlarge “new notions of historical significance” to encompass personal, political, public, and private activities that constitute medical experiences.

The Council for the Advancement of Nursing Science, Idea Festival Advisory Committee: good ideas that need to go further.

The Council for the Advancement of Nursing Science, Idea Festival Advisory Committee: Good ideas that need to go further Antonia M. Villarruel, PhD, RN, FAAN*, Julie A. Fairman, PhD, RN, FAAN Office of the Dean, University of Pennsylvania School of Nursing, Philadelphia, PA Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA

Not All Nurses are Good, Not All Doctors are Bad...

American health care is highly dependent upon the collaborative work of nurses and physicians: without the efforts of both professions, health care as we know it could not be provided. Yet, the relationship between nurses and physicians is oversimplified to the point that the two professions often talk about themselves and each other using the language of exclusion and victimization. Many medical scholars present their profession as normative and prioritized, casting the skills of medical diagnosis and prescription of treatment (rather than the combined efforts of several professions) as the most essential and rigorous components of health care. In turn, many nurses write about their victimization by physicians and state that nursing’s claims for autonomy and authority require toppling medicine from its lofty pedestal of cultural authority. This approach is taken by Thetis M. Group and Joan Roberts, in their book Nursing, Physician Control, and the Medical Monopoly.1 They offer a

The roots of collaborative practice: nurse practitioner pioneers' stories.

Perhaps the problems of doctor and nurse are nor so much professional, as simply human. We [physicians] must learn to share-to share rewards, both psychological and economic-and to share responsibiliry in a risk-fraught world where our training has taught us to depend only on ourselves .... And we must learn to communicate sufficiently wirh one another so that each may function effeccively, and safely, and reasonably efficiendy. 1

Nursing for the Future, from the Past: Two Reports on Nursing from the Institute of Medicine

In 2010, the Institute of Medicine, in association with the Robert Wood Johnson Foundation, released a major study of the nursing profession. The Institute of Medicine last published a major, broad-based study of the nursing profession in 1983. This brief historical analysis examines the context and key recommendations for each report and provides concrete examples of outcomes of the 1983 report. We argue that despite similarities in context and recommendations, the two reports differ in target audience and implementation strategies, and that nursing is currently better positioned to use the report as a blueprint to improve patient care, as well as garner outside support, than it was in 1983.

Enfermeiras americanas do Serviço Especial de Saúde Pública e a formação de recursos humanos na Enfermagem Brasileira

Objective To historicize the changes in training human resources in nursing in Brazil during the period from 1942 to 1961 based on the presence of 35 American nurses assigned to work in cooperation with Special Public Health Service. Method The sources used for the study were reports written by American nurses who described their impressions, suggestions, and the activities they carried out in the country. These were analyzed based on the discourse analysis of Michel Foucault. Results The period mentioned was marked by an American presence in nursing projects developed by the Special Public Health Service. The discourses indicated that the period was marked by many changes in Brazilian nursing, particularly with respect to attracting and training human resources for the profession. Conclusion The results indicate that the American nurses, through what they said and their influence, were central to the consolidation of a new paradigm in the training of nursing professionals in Brazil.Objetivo Recrear la historia de los cambios en la formacion de recursos humanos en enfermeria en Brasil, en el periodo de 1942 a 1961, a partir de la presencia de 35 enfermeras americanas que fueron destinadas a trabajar en cooperacion con el SESP. Metodo El estudio utilizo como fuentes los informes escritos por dichas enfermeras las cuales reportaron sus impresiones, sugerencias y actividades desarrolladas en el pais y fueron analizadas desde el analisis del discurso de Michel Foucault. Resultados el periodo mencionado estuvo marcado por la presencia americana en los proyectos de enfermeria desarrollados por el Servicio Especial de Salud Publica (SESP). Los discursos indicaron que el periodo mencionado fue marcado por muchos cambios en la enfermeria brasilena, en especial con respecto a la captacion y formacion de recursos humanos para la profesion. Conclusion Los resultados indican que las enfermeras americanas, a traves de sus discursos y por medio de la influencia, fueron fundamentales para la consolidacion de un nuevo paradigma en la formacion de los profesionales de enfermeria en Brasil.

History counts: How history can shape our understanding of health policy

Historians of nursing can inform and provide perspective and context to the discipline and to policy makers. This article provides several examples of the interplay of history and health policy debates across time and place. From issues of the nursing workforce to discussions about the skill level needed to safely care for patients and the issues of practice boundaries, history provides evidence for shaping our understanding of and engagement with health policy. History offers a way to understand the present and think about the future. It illustrates a critical perspective for both action and advocacy.

Go to Ruth's House: the social activism of Ruth Lubic and the family health and birth center.

This case of the work of Ruth Watson Lubic, an internationally known nurse midwife and women’s and children’s health care activist, provides a modern-day example of the intersection of forceful individual personalities, nursing as a type of activism in itself, and grassroots and local actions that produce larger movement-based activist organizations. Her work as a nurse midwife, in partnership with other nurse midwives, physicians, and community members, illustrates how the efforts of individual actors at a grassroots community level can be as significant as larger traditionally situated activist movements on the lives of everyday citizens.