A Generation Apart: This Mother-Daughter Nursing Team Discuss the History and Future of the Field
In her official student nurse photo, my mother is wearing a white uniform. It’s 1976 and Linda Schmig is wearing cat’s eye glasses, her blonde hair carefully tucked beneath the white cap that had been emblematic of nurses’ uniforms for decades before my mother enrolled in Illinois Wesleyan University’s nursing program. When my mother graduated with a Bachelor of Science in Nursing and became a registered nurse, she might have been wearing a cap common to so many nurses before her, but in the 1970s, the route she took to get there – four -year bachelor’s degree – was relatively uncommon. Thirty-five years later, my sister Susannah Mohaupt sat for her own official student nurse photo in a BSN program at Blessing-Rieman College of Nursing, her long hair draped stylishly over pristine blue scrubs.
Though they have specialized in different fields, put my mother and my sister in a room together and eventually they compare nursing notes — picking apart a patient care challenge or talking through a new development in tech. I recently talked with them about their experiences entering the field of nursing and pursuing careers in health care.
When she enrolled in the nursing program at Illinois Wesleyan, my mother was one of the first in her family to attend a four-year college. This path to professional nursing was, at the time, still an unusual route, but my mother wanted the job security of a bachelor’s degree, as well as the classroom time it would offer.
“Think about prior to when I was in school, when they mostly just learned on the job, as glorified nursing assistants and that’s how they got the skills,” my mother says now. “Nursing is really a ton of science and math, so much anatomy and all you have to know about the body. You need the classroom time, but that means you don’t get clinical time. When I was school we had two days a week of clinical time.”
My mother supplemented this clinical time with a winter term with the Frontier Nursing Service in the Appalachian Mountains. “It was like a pre-nurse practitioner experience, because those nurses were the only access to healthcare people had. It was literally just nursing service.”
In practice, this was not much different from the ways in which earlier generations of nurses had trained, though in a decidedly different setting.
“Professional nursing education in the US started out in hospitals in the 1880s,” says historian of nursing Amanda L. Mahoney. “Nursing students received general lectures from nursing instructors and physicians here and there but mainly worked providing patient care.” Nursing students remained the primary workforce in hospitals well into the 1960s — just about the time my future mother started reading the Cherry Ames and Sue Barton books. By then, my mother already knew she wanted to be a nurse.
“My experience was 60% theoretical and 40% clinical,” Susannah says, and our mother reminds her of the competitive yearlong internship she did at the hospital in our hometown, cycling through units. Considering that, Susannah says, “I think I had, compared to other programs, less hands-on but more classroom time than nurses before me. And I think the trend now is that there’s less clinical time – and that’s concerning, even though programs say they’re giving more clinical time.”
My sister and my mother agree that nursing students need more exposure to human bodies. Susannah says, “I think you should take a refresher course of A&P in your last year of nursing school, because you don’t know what you’re going to use until you’re actually using it.”
Our mother agrees, based on her own recent and informal refresher with “a book that had all the body’s systems in it.” But she also believes that nursing students need “more time in the operating room, where you can see the body opened up and look in and see what the structure is and see what cholesterol are and what layers of fat are and see what the organs are, what cancer looks like.” Personal experience can make it easier for nursing students to translate their clinical experience into the real-life day-to-day patient care that requires extensive communication with patients.
Before the 1940s, most nurses went into private duty — nursing for hire to provide care in people’s homes. “As Jean Whelan’s work shows, there were not enough private duty nurses in the suburbs and rural areas and too many in urban settings,” Dr. Mahoney says. “Systems for getting nurses to the bedside of sick patients was wildly inefficient. At the same time, physicians couldn’t find nurses for their sick patients outside of major cities and complained about it all the time.”
This lingering sense of an enduring need for nurses helped convince Susannah, who is certified in maternal/newborn nursing, that there was security in the field. But she was also drawn to the less tangible rewards: “I like the interaction with real people at vulnerable periods in their life and making a difference in their lives,” she says.
My mother, who has in the past been certified in oncology and pain management nursing, agrees with the satisfaction of helping people with their healthcare, but notes that the hospital setting is different now than how it was at the beginning of her career 35 years ago. Some of the changes relate to technology: “Some nurses walk in and know how to use computer software, and that’s the stumbling block that us older people have, versus what we already know about ostomies and G tubes and other technical nursing things.”
Some of it, my sister points out, is just about time: “Newer nurses are still learning what’s important and they’re task oriented. More experienced nurses are more intuitive. They know how to talk to patients and they know what information to get out of people. They know what to say. And you just learn that.”
She’s not alone, of course, in remarking on how nursing has changed over time. “Nursing practice — bedside nurses, or RNs — are more autonomous [now] than in previous decades,” says Dr. Mahoney. “Nurses have made a place for themselves at the table, so to speak, and are now routinely part of decision-making teams in patient care.”
My mother takes a positive view of these developments: “Nurses are required to know so much more now … science, math, people skills, time management. Medicine is so complex, detailed, and nurses have to be smart.”
My sister, however, is more guarded in her optimism: “I don’t think people realize how much nurses do. It’s a respected profession, but people don’t know that nurses communicate with labs, pharmacies, doctors. They communicate with social workers and pastoral care. They do consults. They’re juggling a lot for multiple patients at the same time.”
If there’s an increased need for scientific and technical expertise in nursing, then, there’s also a broader need for softer skills, the kind of social skills that make it easy to communicate with patients and other partners in health care. Right after she graduated from nursing school, my sister joined the staff of the pain management clinic where our mother works.
“You could say she taught me everything I know,” my sister says, and she’s not joking. This teacher-student relationship is perhaps most obvious when you explain a medical concern to the two of them. They stand side by side and frown thoughtfully as they listen, furrowing their brows identically as they phrase follow-up questions. Having two nurses in the family is like having Ask-A-Nurse on speed-dial, but without the formal, old-fashioned white cap.