First, they left off the frilly hats. Then they donned trousers. (The quibblers will point out that the men in the profession always steered clear of skirts, when it came to dress code. To them, I would point out that nursing is overwhelmingly a female occupation.)
Next, the students headed for college campuses to gain third-level qualifications. This may sound like a description of the revised role for women during the second World War. In fact, it's a catalogue of the changes wrought in Irish hospitals in the past decade.
In 1994, the first college-associated undergraduate programme for nurses was put on by University College Hospital Galway in association with NUI Galway. This year, nursing applications were processed through the CAO for the first time, with 21 general nursing courses, 12 psychiatric and eight mental-handicap courses. The old apprenticeship model is officially dead.
With students progressing from diploma to degree, there is now a movement towards postgraduate qualifications. Dr Kathleen MacLellan, head of professional development and continuing education with the National Council for the Professional Development of Nursing and Midwifery, says there are taught master's programmes in a number of colleges.
"These are mostly two-year generic programmes but there is a movement toward the inclusion of specialist clinical modules," she says. A handful of nurses have progressed to PhD.
Her own career illustrates the new possibilities. Having trained in St James's Hospital, Dublin, in 1984 to 1987, she completed a master's in community health in TCD in 1994. As an assistant director of nursing at St James's, she concentrated on nursing practice development before leaving to work at Bord Altranais on the "scope of practice" guidelines. She recently obtained a PhD in pain management from TCD.
The naysayers will argue that all of these qualifications are unnecessary in a job where bedpans will still have to be emptied, bed linen changed and patients washed. It has been suggested that nurses want to take over the role of the doctor.
MacLellan disagrees. "The scope of practice guidelines provide an empowering framework for nurses to develop their practice to match the needs of the health service, without being confined by traditional boundaries."
The arrival of third-level education is being matched by new career structures. In the past, the main career path was a management one, leading from ward sister upwards to matron. There were also a few positions in education, working in schools of nursing attached to hospitals.
"Nurses can now progress to clinical nurse specialist post and advanced nurse practitioner posts," says MacLellan. The specialist practice will encompass a "major clinical focus, which comprises assessment, planning, delivery and evaluation of care given to patients/clients and their families in hospital, community and outpatient settings."
MacLellan says these roles bring senior nurses back to their patients. "I recently spoke to a former accident-and-emergency sister who said she felt that becoming an emergency nurse practitioner allowed her to nurse again for the first time in years. Previously, her work was largely managerial."
Many nurses have been operating as specialists for a long time without due recognition or preparation, according to MacLellan. Some 1,000 specialist posts have been confirmed for those already working in these positions. In the future, a higher diploma will be the minimum educational requirement for specialist nurses while those aspiring to advanced nurse practitioner posts will need a relevant master's.
The framework for accreditation was published by the National Council in July this year. As yet, no advanced nurse practitioner posts have been created.
Another new career pathway is opening up for nurses. Mac Lellan says: "For the first time nursing research is being recognised and developed. A national strategy is being developed and will be published later this year. Funding is becoming available, mainly from the Health Research Board.
"Nursing is a practice-based discipline. We have a duty to provide evidence-based care. Patients have a right to equitable treatment of the highest quality. Nurses make up 40 per cent of healthcare providers. There is a huge potential for them to contribute (even more) positively to the care of patients."
The National Council will hold its first annual conference on November 21st and 22nd. Look out for some fiery debate.
