The Changing Roles of Nurses
by Ann Hillenbrand
In the 40 years professor and American Academy of Nursing Fellow Virginia Burggraf has cared for and served patients, the role of the nurse has changed and expanded.
When Virginia Burggraf started her career in 1964 as a graduate of Cornell University New York Hospital School of Nursing, it was highly irregular for a nurse to earn a bachelor’s degree, although in the same year the American Nursing Association endorsed the practice of all nurses earning a bachelor’s degree. Even now, she says, there is disunity in the education of nurses. Students earning the bachelor of science in nursing degree or the associate of arts in nursing degree have the same opportunity to take the state board-licensing test and be designated a Registered Nurse. The disunity, according to Burggraf, has continued in part because of nursing shortages and the need to fill open positions. Virginia BurggrafSome hospitals are hiring more BSN graduates, and the American Nurses Association now affords hospitals the opportunity to earn a magnet status, which demands that it employ more baccalaureate nurses than nurses at any other level. This status assures patients they will receive quality care.

Burggraf says nursing shortages will not go away until nurses are perceived as deserving good salaries and benefits. “In my 40-year career, there have been about five or six shortages,” she adds. The current shortage, she says, is due to economics, the war in Iraq, changes in women’s roles and changes in healthcare policy. Women didn’t have many professional choices in the 1960s, says Burggraf. “Now they can be dentists, pilots and anything they want to be.” Leaders in the nursing profession and nursing schools strive to make careers in nursing more popular with both male and female students.

Demand for nurses will only grow as the U.S. population ages. A recent report prepared by the State Council for Higher Education in Virginia concluded the Commonwealth alone could face a shortage of 22,000 nurses by the year 2020 unless a strategic plan of action is implemented to increase Virginia nursing schools’ faculty and enrollment.

The shift in patient populations has created new issues in nursing. “The fastest growing population 40 years ago was children,” says Burggraf, “but now those under the age of 18 have been surpassed by those over the age of 65. Medicare was nonexistent back then. We didn’t seem concerned about the aging population because people were dying in their late 60s. Now people are living until they’re 100.”

Serving the aging population is Burggraf’s passion. She has expanded RU’s curriculum in gerontological nursing through a new graduate certificate program and has been awarded more than $260,000 in grants to support gerontological nursing education at the university. “I’m working on creating partnerships with pharmaceutical industries and the nursing home industry so we can form the pieces to make quality of life better for the older adult,” says Burggraf.

Burggraf says the role of the nurse has expanded to become more integral to a patient’s recovery and in the treatment of chronic illness. Four decades ago nurses were the handmaidens of physicians, she says. Now they are part of a care-giving team, which may include a physician, dietitian, nurse, social worker and physical therapist. “We are frontline providers, the first person to see the patient. It is our decision making that determines the resources needed by this person,” says Burggraf. As the healthcare industry begins to realize this, hospitals are offering travel expenses and sign-on bonuses for qualified nursing professionals.

Burggraf says RU’s School of Nursing prepares nurses who think critically concerning care options for their patients. “Some of the challenges we get them ready for now are ethical dilemmas. We are keeping babies alive at 20 weeks gestation, making decisions with parents and making moral value laden decisions. We are preparing students to be on ethics committees in institutional settings and acute care facilities,” she says.

The future is bright for the new nursing graduate. Burggraf is excited for her students and the opportunities they face. She’s excited, too, about the work she has to do. She constantly seeks out ways to augment nursing education at RU through workshops, grants, conferences, guest lecturers and research. Burggraf sums up her passion for her profession with a quote from Robert Kennedy: “Some men see things as they are and ask why? I dream things that never were and ask why not.”