Sharon writes:
< How did other professions break away from nursing and 
separate themselves?  Perhaps we need to do some research into those experiences 
and draw upon them rather that trying to reinvent the wheel.  Not just in 
general, but what specifically happened at what times along the path to 
establishing, for instance, physical or occupational therapy as a profession? >

When I entered nursing school in 1948, PT was already a separate specialty. 

Just recently, I underwent a PT assessment by an RPT, and then received 
the program he designed, at the hands of a PT assistant, and I was very 
impressed with his knowledge and skill.

I remember when the Byrd respirator was introduced, and respiratory treatments
were just one more treatment for a nurse to work into her routine. And 
subsequently, when the body of knowledge became so researched and defined, 
those who wished to further the practice of respiratory therapy 'ran with 
the ball', and created and obtained legalization of the respiratory therapy
profession. Now, unless a nurse specializes in the area of respiratory care with 
advanced training (like Paula Meier), nurses now know just the general principles,
and what NOT to do as far as respiratory issues, and look to RT's as colleagues
in the respiratory care of the patient.

Dietetics was well established academically by the time I entered nurses training,
but our hospital had but one RD when I was assigned a 6 week stint in the diet 
kitchen (for disciplinary purposes of the nursing school director, I still believe
to this day!)

Although social work and dietetics were was also academically well established
by the time I entered nurses training, our hospital didn't get a social worker
until the late 1960's, and any 'social work' follow-up on maternity patients  
got done by nurses. It wasn't particularly that nurses looked upon social work
as 'theirs' and wanted to practice it as part of their 'domain', but that the 
patient needed the services, and there seemed to be no other way of getting it
for them! Those of us who felt strongly enough about the importance of social work 
for patients, found ourselves more comfortable in public health nursing.

And lest anyone think that nursing itself hasn't had, and isn't having 'growing
pains', in 1948, I entered what I believe was a very good 3 year diploma 
program conducted by a hospital. A dozen or so years later, academically prepared
leaders became a major force in the few nursing organizations that there were 
then, and we heard how we as a profession, would never get any respect and credibility unless we
took the same college preparatory courses as other professions, and gained a
bachelor's degree in nursing before entering practice. Since the academic 
preparation took so much time, there was less clinical practice, which many 
hospitals realized had to be made up by an interneship. Very few cities had any
sort of a program where one with a diploma could "bridge" over into a degree,
especially without giving up her seniority and salary to attend full-time schooling.

In the meantime, the shortage was growing and the schooling of Licensed Practical 
Nurses became more standardized, and began to also be provided in an academic setting
rather than a hospital controlled setting, and even then, because of shortages, and 
perhaps impatience, other educators started the two year nursing programs. And so, 
to this day, graduates of 2 year associate programs, 3 year diploma programs, and 
4 year baccalaureate programs, are all considered qualified to take the same legal
state nurse registration exam. To paraphrase an ironic statement I made in a JOGN 
article I wrote about nursing certification in the 1970's, "with friends like this 
in our profession, who needs enemies?"

And it continues even yet. One must have a BSN to enter a Master's program to specialize
as a nurse practitioner or a clinical nurse specialist, and while there are doctoral 
programs for those desiring further leadership and academic practices in nursing fields, 
not only are there now 'bridge' programs from a diploma or associate degree to a 
BSN, there are bridge programs for those with baccalaureates in other fields to get a 
BSN (which one must have to be permitted to go into a MSN program.) And there are even
Doctoral programs to allow others with advanced degrees in other fields to gain entry 
into the nursing profession at the doctoral level in order to assume advance leadership
positions!!!

In the meantime, the profession of Physician's Assistant has evolved. And the nursing
home industry is urging state legislative bodies to legalize the creation of medication
technicians to administer meds in nursing homes!And nursing specialty organizations
continue to proliferate, and the larger organizations to splinter into causes for
affecting legislation and bargaining purposes.

So don't think that the 20 year history of the LC profession is unique in having 
growing pains!
Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA    

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