Introduction

The primary role of nurses is caring for individuals and communities by supporting them deal with their health problems. In a healthcare setting, nurses assess and monitor patients and share information with other care providers. Nurses ensure that patients are aware of their conditions and the treatment being administered. Nurses also analyse data and give insights that facilitate the provision of patient care. In community health, nurses identify health risks and by analyzing available data develop programs aimed at reducing the occurrences of illness as a result of the identified health risk. Community health nurse work with communities to manage current and future health risks by empowering the community. Over the years, the role of nursing and their contributions to the community has evolved. At present, nurses are communicators, holistic caregivers, instructors, specialists and researchers. This paper will look at the past, present and future contributions of nursing to both rural and urban communities by considering the benefits, disadvantages and the way forward.

Historically, most people lived in small communities where women played the role of nurses. In the course of the revolutionary war, the continental congress passed the medical support law for the army and nurses were allocated at a ratio of 1 nurse for 10 patients (Hayward). While these women were not trained professionally, the experience they gained set the stage for the standardization and expansion of nursing as a career. In 1861, Elizabeth Blackwell, became the first woman to graduate from medical school and developed a course to train women serving as nurses in the army and many women joined the course. In addition, catholic nuns specifically the Sisters of Charity also advanced nursing and served in the Spanish American war as well as the civil war. They became instrumental by opening an estimated 500 hospitals and nursing schools to professionalize and standardize the nursing profession.

The social reform movement of the 19^th century and in specific reference the Settlement House movement was significant in expanding training for women in the field of social work and nursing. In a span of 30 years, there were 400 settlements houses in 32 states. Working mostly in poor and immigrant communities, they worked to improve healthcare and education in poor neighborhoods. This movement also changed the attitudes of the people concerning nursing and by 1860s nursing moved from home into hospitals with skilled nurses treating diseases and illnesses. In the 20^th and 21^st centuries, medical treatment has been transformed by technological developments. Most of the ideas, technologies, procedures, and instruments in use today by the nursing professionals were inconceivable in the 18^th century (Hayward).

As the nursing profession progressed throughout history, nurses have remained significant in promoting the health of the community. In the early days, women took the role of caring for the family and the art of caring was passed from one generation to the other. There were midwives who took care of deliveries and other nursing roles. With increased warfare, the roles of untrained nurses increased, and they were now required to take care of soldiers on the battlefield. The 18^th century was significant in ensuring the nursing profession’s revolutionized and modern form of nursing where nurses work to treat illnesses and diseases emerged in this century. Before that, nurses engaged more in taking care of other people at home.

Past, present and future contributions of nursing

In the early day, nursing acted as a social change tool. In the era of the Settlement House movement, there were many social problems from poverty and discrimination and poor housing in the urban areas. The movement was a method for serving the poor by living among them, and it led to the increased training of nurses to improve healthcare and education. Nursing at this time thus became a tool for social support, activism and social empowerment. The idea of social work emanated from this era due to the need to manage issues that were facing urban areas at the time. By combining healthcare and social work, nurses were able to empower the people through education and better living conditions. Health issues such as cholera which were common and serious in this era were managed as well as the eradication of environmental determinism.

Another major contribution of nursing to the rural and urban communities is sowing the seed of volunteering in times of need. During the Crimean War, Nightingale’s assistance to British soldiers initiated a culture of nurses offering their services in times of need. During disasters, nurses are well suited to provide medical and psychological help to cope with the repercussions. In 2010, when a 7.0 earthquake hit Haiti, nurses volunteered in thousands to assist not only individuals but communities recuperate from the disaster. In the modern world, more than 20,000 nurses work with organizations such as Red Cross to support victims of both manmade and natural disasters (McCollum et al. 7). In the past, most disasters were natural such as floods, earthquakes, landslides or even hurricanes. However, as the world progress, there have risen different manmade disasters such as terrorism which devastate communities in both urban and rural areas. The 9/11 attack in America, for example, devastated the whole nation and nurses were there to provide the needed help.

Nurses do not only volunteer in disasters but also in the advancement of a culture of healthy living as both health employees and participants in the growth of communities. Nurses have the ability and capacity to raise awareness and implement halt interventions for populations at risk. Consider for example the community and acute care setting which a significant part of the healthcare system in the U.S. while most of the nurses in this program work in institutions caring for the ill, there are those who promote healthy living in a community-based settings such a schools, faith-based entities, assisted living, adult daycare centers and other community-based settings (McCollum et al. 8). Such nurses have the primary role of promoting health. Nurses also serve as advisors to friends and family. Nurses help with different decisions on healthy living such as exercising, vaccines, breastfeeding and other healthy items. Such contributions go a long way in promoting health in the communities both in urban and rural areas.

Another major contribution of nursing is the prevention of diseases in the community. Community health nurses integrate evidence-based research and the community health needs to provide care based on science and evidence (Adib-Hajbaghery 169). In that such Nurses work in different communities, they have to integrate the socio-economic and cultural needs of the community and adjust care interventions appropriately. From urban to rural areas, nurses observe and research the community to identify health risks and then develop intervention to eradicate or reduce the risks involved. Nursing as a profession, has made it a possibility for health issues to be managed before they even occur. In the years following the settling of the Europeans into the U.S, disease such as Smallpox and Yellow fever spread to America. With no knowledge of such diseases and no vaccine or medication, many people died. In the modern era, however, nurses working in communities are able to identify infectious diseases and prevent them from spreading thus protecting the community. They also administer vaccines for known infections to eradicate them. After routine vaccinations, smallpox was eradicated in the U.S and vaccination stopped in 1972. Without the effort of nurses working in both rural and urban communities, efforts to control such diseases would be unfruitful.

Although the primary role of community nurses is to advance the health of the population in the community, undertaking this role involves other significant sub-roles. Such roles include nurses being leaders, educators, advocates, researchers and caregivers. As advocates, community nurses campaign at federal, state and local level for improved access to healthcare for the community through efficient funding, elimination of health disparities as well as access to other assistance programs. As leaders, community nurses use evidence to operationalize policy changes that bring about quality-based practices. Evidence to support such policy changes is acquired through widespread community research. As community educators, nurses provide information to individuals, families, policymakers and the community as a whole to create an efficient framework for healthy living.

Yet another major benefit of nursing is that it enables the efficient provision of healthcare. In the healthcare system, nurses are mandated to help clients and families came up with health goals and achieve them. Physicians also depend on nurses to administer drugs and undertake other patient monitoring duties such as pain management. The nursing profession is part of a wider system that ensures that there is patient-centred care. Through education and constant communication, nurses ensure that the provision of healthcare to the patients, prevention of hospital-acquired diseases, as well as the spread of infectious disease such as HIV are minimized. All these efforts are aimed at ensuring that the communities achieve maximum healthcare and the cost of healthcare is maintained at affordable levels.

Of the major challenges facing the nursing profession in its contribution to the health of the community is the current laws in states. Most laws in different states limit the ability of nurses to contribute to the innovative provision of healthcare. In the current century, the healthcare challenges facing not only the U.S. but the world has shifted widely. While some of the diseases which had an impact in the communities in the pas such as cholera, smallpox, malaria and yellow fever has been effectively controlled, more serious and deadly illnesses such as Ebola have arisen. The elaborate differentiation of the many types of Cancers and other similar illness have increased the need for improved patient-centred care. The healthcare system has expanded over the last several decades and so has the roles and education of Nurses. Today, nurses are qualified and capable of providing more health services than before. However, while such efforts have been put in place to ensure that nurses are well equipped to handle more roles in the healthcare system, there are physicians and policymakers who challenge the expanding scope of practice for nurses

The above elaboration lays the groundwork on why there are different laws governing the scope of practice of nurse practitioners (NPs). Depending on state laws, the practice scope for NPs may prohibit the prescription of medicine, assessing patient’s conditions, ordering and evaluating tests and admitting patients.  While access to primary care providers has remained limited in the U.S rural areas, NPs have been influential in filling this gap. A study by Ortiz et al. (71), showed that expanded scope of practice for NPs could increase healthcare access, increase healthcare provider supply and improve the quality of healthcare. All NPs in the U.S undergo similar processes of education and training. This begs the question of why the scope of practice for NPs is autonomous in some states but limited in other states. By viewing the expansion of NPs practice as a threat to physicians, the social benefits of improved healthcare to the community is being ignored.

Another major challenge is the ongoing retirement of baby boomer registered nurses. In the 1970s, female and career-oriented baby boomers encompassed nursing as a profession in large number than ever before. This was preceded by the increased spending in healthcare as a result of Medicare and Medicaid introduction. By the 1990s, baby boomer RNS totalled around 1 million which was around two-thirds of the RNs workforce.  Over the last two decades, these RNs have accumulated substantial clinical experience and knowledge. However, while the number of baby-boomer RNs peeked in 2008 at 1.26 million, they initiated retirement in large numbers. Since 2012, an estimated 60,000 RNs exit the field annually, and it is expected that by 2020, baby boomer RNs will be 660,000, and in 2015, the workforce lost 1.7 million experience years.

From the statistics above it is clear that the healthcare system will experience limited personnel in future. This, coupled with the experience lost by baby boomers retiring presents a challenge to the community. Most of the baby boomers have worked with communities for many years and have the grasp of how to manage or handle most of the health problems facing society today. They are pioneers in preventive nursing, and unlike today where the nursing profession has been commercialized, they understand the psychology behind being a nurse. The departure of these baby boomers will result in loss of expertise and knowledge and this loss will be felt for many years. Combined with the fact that the need for patient-centred care has continued to increase, the health care system can experience more changes in the future.

The way forward

For a full and effective contribution of the nursing profession in the community in the future, there is need for several changes as outlined below.

• Barriers to the scope of practice should be eradicated. Laws on the scope of practice for NPs and other registered nurses should be harmonized to ensure that the shortage of practitioners is addressed. The shortage of primary care providers in rural areas can be addressed by making the scope of practice of NPs autonomous. The Medicaid program should also be expanded to cover NPs services that fall within the scope of practice applicable under different state laws.
• Another recommendation is that nurse residency programs should be increased. It is significant for the state boards of nursing to support new graduates to transition to practice. Today, most institutions require bachelor degrees as the least qualification for nurses and thus funding for Diploma programs should be diverted to nurse residency programs in rural and other critical areas. The shortage of medical practitioners and the increased retirement of baby boomer nurses and the subsequence loss of knowledge and experience indicate that the health system needs to ensure that more nurses get into the system every year and transition successfully (Ulrich 528). Healthcare organizations, philanthropic organizations, Medicare and Medicaid Services should focus on funding residency programs and the evaluation of such programs in their effectiveness in nurse retention, improving patient outcome and expanding competency.
•  Another recommendation is to focus on education. The health need and challenges facing the U.S has shifted drastically. From the ageing population to the increased occurrence of health issues such as substance abuse, cancer, diabetes, HIV/AIDS, mental health and violence, there is need for increased education and training for nurses. The education and training programs used in the 20^th century are not effective in dealing with the health trials of the 21^st century. As population needs and health environments become more multifaceted, nurses need to obtain vital skills in areas such as leadership, system enhancement, evidence-based practice, research, collaboration and teamwork and health policy among others (Perfetto 20). There is need to focus nursing education around community settings as opposed to acute care.
• The other recommendation is to ensure that nurse undertake lifelong learning. Nurses should always be prepared to meet the current and future needs of the people and in that such needs change every day; nurses should also remain updated and improve their learning. For a nurse, learning should not end after graduating rather should be a continuous process. To enable this, faculty should collaborate and partner with organizations to ensure curricula is updated regularly so that graduates can be prepared to meet future needs. In addition, healthcare organizations and education schools should work to foster a culture of long-life learning as well as provide resources for interprofessional persistent competency programs (AnneMarie 6). Education programs should be evaluated for flexibility, adaptability and impact on patient outcomes.

Conclusion

Nursing has contributed greatly to rural and urban communities. Nursing has ensured that health issues that affect communities are managed effectively. Nurse research and use evidence-based practice to develop programs that address health risks elements in the community. While there is shortage of practitioners in the rural areas, nurses fil the gap and address the common health issues facing the rural areas. In a health facility setting, nurses collaborate with other practitioners to provide efficient and effective patient-centred care. Most of the patient monitoring and management issues are managed by the nurses. In a community setting, community nurses develop programs that address high-risk health issues by educating the community and advocating for policies and funding. However, considering that patient needs have changed in the 21^st century, there is need for changes in education, transition to practice, learning and eradication of barriers to practice.

Works Cited

Adib-Hajbaghery, Mohsen. “Nurses Role in the Community”. Nurs Midwifery Stud, vol 2, no. 2, 2013, pp. 169-170.

AnneMarie, Palatnik. “The Future of Nursing”. Nursing Critical Care, vol 11, no. 3, 2016, p. 4.

Hayward, Nancy. “The History of Nursing in the United States”. National Women’s History Museum, 2019, https://www.womenshistory.org/resources/general/history-nursing-united-states. Accessed 24 Oct 2019.

McCollum, Meriel et al. “Nurses Improve Their Communities’ Health Where They Live, Learn, Work, And Play”. Policy, Politics, & Nursing Practice, vol 18, no. 1, 2017, pp. 7-16.

Ortiz, Judith et al. “Impact of Nurse Practitioner Practice Regulations on Rural Population Health Outcomes”. Healthcare, vol 6, no. 2, 2018, p. 65-72.

Perfetto, Linda M. “Preparing the Nurse of the Future”. Nursing Education Perspectives, vol 40, no. 1, 2019, pp. 18-24.

Ulrich, Beth. “Progress on the 2010 IOM future of nursing report and future needs.” Nephrology Nursing Journal vol. 42, no. 6, 2015, pp.  527-529.