“I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.” (Nightingale, 2017, page 8).
This year marks the 200th celebration of Florence Nightingale’s birth on 12 May 1920 (Biography.com, 2020). Nightingale is known as the founder of modern-day nursing (Winkelstein, 2009), whose influence and impact on the world helped mark 2020 as the Year of the Nurse and Midwife by the World Health Organization (WHO) (WHO, 2020). While 2020 was planned to be a year of celebration and recognition for the four million nurses in the United States (ANA, 2020) and over 20 million worldwide (WHO, 2000), we find ourselves instead in challenging and unprecedented times.
Seemingly overnight, we rapidly were engulfed in a global crisis in which nurses, doctors, first responders, and more were at the forefront of battling the impact of coronavirus (e.g., COVID-19) on the health of the public. In a matter of weeks, nurses, along with their physician colleagues, respiratory therapists, and many others involved in the direct care of others, became recognized at a national, if not global, level for their unique contributions. Those contributions include the standard expectation to provide safe, equitable, timely, patient-centered, effective, and efficient care (Institute of Medicine, 2001).
To achieve such desired expectations during this time of crisis, nurses turn to their innate innovative behaviors to derive new solutions for the pervasive unmet needs affecting the health outcomes of their patient populations. Despite the recent surge of recognition and emphasis on nurse-led inventorship and innovation within and surrounding the profession, our history illustrates that the creativity of nurses led to the development of significant care delivery contributions crucial to healthcare today (American Red Cross, 2020; Hiestand, 2000; Vollman, 2004). This article highlights a few nursing contributions that are now healthcare essentials in public health service, critical care, and the education of our future workforce, especially during the current pandemic.
Innovating Public Health Services in America: The American Red Cross
The American Red Cross is nationally recognized as a nonprofit healthcare organization that supports individuals in need and in time of crisis. During the COVID-19 pandemic, donations from the public are (and continue to be) in high demand by the American Red Cross. While standard blood donations are a constant, a new need has emerged for plasma donations from recovered COVID-19 patients for possible use in convalescent plasma treatments (Hahn, 2020). The US is fortunate that, as a nation, we have such a resource available to help support public health needs. However, the American Red Cross has only been active in the US for 139 years.
The American Red Cross started as an idea from nurse Clara Barton, who experienced firsthand the benefits of the Red Cross in Geneva, Switzerland. At that time, the mission of the Red Cross was to care for the sick and wounded by war. Barton sought to bring it to the United States. Although she initially met with some resistance, Barton founded the American Red Cross in 1881 and led the organization during its first 23 years (American Red Cross, 2020). Clara Barton’s selfless efforts to establish an organization equipped to help others in need demonstrates what it means to be a nurse.
Patient Positioning for Transport and Intensive Care
Nursing interventions and treatments based on a patient’s condition are a major aspect of care delivery in tertiary care facilities such as hospitals and health systems. Body positioning and transport are two of these interventions and treatment methods.
In 1926, Elizabeth Kenny, an Australian nurse who cared for patients during World War I, began work on a trauma transport stretcher “by which cases of any kind, could be transported with a minimum of suffering.” (Hely, 1927) Seeing how challenging it was to transport patients in emergency situations, Kenny designed a versatile stretcher: “There are straps and pads and cushions for all emergencies, and the completed stretcher may be adjusted so that the patient may sit up or lie down, or travel in whichever way is most comfortable. Another feature is that if an operation is necessary the patient need not be moved; the stretcher may be used as an operating table—another great advantage in places where there may not even be a hospital, much less an operating theatre.” (Hely, 1927; Hiestand, 2000). Today, stretchers are a staple piece of equipment found among our first responders, emergency departments, and intensive care areas.
In addition to transport, body positioning in a hospital bed is often quite purposeful. During COVID-19, patients with the virus who develop Acute Respiratory Distress Syndrome (ARDS) may be positioned prone to improve ventilation (Ghelichkhani & Esmaeili, 2020). Proning requires positioning the patient face down on the bed. As this is a challenging position for patients in critical condition, nurse Kathleen Vollman saw an opportunity to solve this problem, and invented the Vollman Prone Positioner in the late 1980s (Vollman, 2004). Her patented invention was the foundation of subsequent inventions to help support the safe and consistent prone positioning of patients in ARDS (Vollman, 2004). Had Kathleen not taken her idea and invention forward, we may not have had a solution to help with proning during this COVID-19 pandemic.
Preparing the Next Generation of Nurses through Clinical Simulations
As nursing students’ clinical rotations came to a halt during COVID-19, nursing schools across the US turned to innovative clinical simulation strategies and activities to support their students’ learning needs. Clinical simulation dates back to 1910 when A. Lauder Sutherland, a nurse in charge of the Hartford Hospital Training School in Connecticut, invented the first simulation mannequin (Hiestand, 2000). Sutherland “had gotten tired of the makeshift, straw-filled dummies her nurses had been using” and worked with Martha Jenks Chase, a Rhode Island doll maker, on a more realistic mannequin. “Chase jokingly named the doll Miss Demon Strator, but eventually the handful of training dolls she made became known as ‘Mrs. Chase.’” (Weir, 2012)
The mannequin was used to support the application of nursing students’ didactic learning in the classroom to hands on experiential learning through practice (Hiestand, 2000). “Mrs. Chase was used to train nurses how to dress a patient, turn her over and transfer her from bed to bed. Outfitted with movable joints at the hips, arms and legs, the dolls were designed with some help from Chase's husband, who was a doctor.“ (Weir, 2012) One year later, Mrs. Chase was duplicated for distribution to other nursing institutions across the US (Hiestand, 2000). Since that time, the science and art of clinical simulation has significantly advanced and grown to be quite sophisticated, thereby enhancing nursing students’ practical skills and knowledge prior to entering the profession as registered nurses.
Giving Thanks to Nurse Inventorship and Innovation during COVID-19
This brief article is only able to recognize a few of the many nurses who are responsible for the essential inventions and innovations that the nursing profession and healthcare industry depend on daily to deliver quality care for optimal health outcomes. In the months and years that follow this current COVID-19 crisis, we will most certainly uncover additional stories of nurse inventorship and innovativeness that lead us toward a healthcare system that continues to provide products, services, and processes to impact human health for safer, more efficient, effective, timely, equitable, and patient-centered care (Institute of Medicine, 2001). The creative responses by nurses to challenges in the past and present remind us to continue to look to our nurses for help in the future.
Nurses are the health care professionals closest to those in need of care—from the public domain to that of tertiary level care in hospitals and health systems. Their proximity to patients lends them to best identify existing gaps and subsequently identify the necessary inventions and innovations to solve for these gaps. History validates this assessment, as 77 percent of mainstream inventions and innovations are traced back to the initial users in need of a solution to the problem (Von Hippel, 1988). Therefore, as we give thanks to nurses during the Year of the Nurse, we must also recognize how powerful their assessment skills are in helping us invent and innovate the future of healthcare.
- American Red Cross. (2020). Our history: More than a century of compassionate service. Retrieved from: https://www.redcross.org/about-us/who-we-are/history.html
- American Nurses Association. (n.d). About ANA. Retrieved from: https://www.nursingworld.org/ana/about-ana/.
- Biography.com (2020). Florence Nightingale Biography. Retrieved from: https://www.biography.com/scientist/florence-nightingale
- Ghelichkhani, P. & Esmaeili, M. (2020). Prone position in management of COVID-19 patients: A commentary. Archives of Academic Emergency Medicine, 8(1), e48.
- Hahn, S.M. (2020). Coronavirus (COVID-19) Update: FDA encourages recovered patients to donate plasma for development of blood-related therapies. Retrieved from: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-encourages-recovered-patients-donate-plasma-development-blood
- Hely, Ethel G. (1927). Sister Elizabeth Kenny: Story of the “Sylvia” stretcher. Sydney Mail, 23 September 1927, 29-30. Retrieved from: https://trove.nla.gov.au/newspaper/article/158297457#
- Hiestand, W. (2000). Think different: Inventions and innovations by nurses, 1850 to 1950. American Journal of Nursing, 100(10), 72-77.
- Institute of Medicine. (2001). Crossing the Quality Chasm. Washington, D.C.: National Academy Press.
- Nightingale, F. (2017). Notes on nursing: what it is and what it is not. Los Angeles: Enhanced Media Publishing.
- Perth Daily News (1927). 'Sylvia' stretcher: Sister Kenny's invention. Perth, WA: 8 August 1927, 1.
- Vollman, K.M., & Bander, J.J. (2005). Improved oxygenation utilizing a prone positioner in patients with acute respiratory distress syndrome. Intensive Care Medicine, 22, 1105-1111.
- Vollman, K.M. (2004). Nurse entrepreneurship: Taking an invention from birth to the marketplace. Clinical Nurse Specialist, 18(2), 68-71.
- Vollman, K.M. (1989). Prone patient positioner. US Patent 4,827,541. Issued 9 May 1989. Retrieved from https://patentimages.storage.googleapis.com/91/b8/e1/793748fd446bf8/US4827541.pdf
- Von Hippel, E. (1988). The Sources of Innovation. New York: Oxford University Press.
- Weir, W. (2012). At 101, 'Mrs. Chase' is a medical marvel. Hartford Courant, 29 March 2012. Retrieved from: https://www.courant.com/health/hc-xpm-2012-03-29-hc-mrs-chase-hartford-hospital-0328-20120327-story.html
- Winkelstein, W. (2009). Florence Nightingale: Founder of modern-day nursing and hospital epidemiology. Epidemiology, 20(2), 311.
- World Health Organization. (2020). Health workforce: Nursing and midwifery. Retrieved from: https://www.who.int/hrh/nursing_midwifery/en/
About the Author
Tiffany Kelley, PhD, MBA, RN-BC, is the DeLuca Foundation Visiting Professor for Innovation and New Knowledge at the University of Connecticut School of Nursing and the Founder and CEO of Nightingale Apps & iCare Nursing Solutions.