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Until near the end of the 20th century, nursing was viewed as an occupation rather than a profession. Nursing has had difficulty being deemed a profession because many of the services provided by nurses have been perceived as an extension of those offered by wives and mothers. Additionally, historically, nursing has been seen as subservient to medicine, and nurses have delayed in identifying and organizing professional knowledge. Furthermore, education for nurses is not yet standardized, and the three-tier entry-level system (diploma, associate degree, and bachelor’s degree) into practice that persists has hindered professionalization because a college education is not yet a requirement. Finally, autonomy in practice is incomplete because nursing is still dependent on medicine to direct much of its practice.

On the other hand, many of the characteristics of a profession can be observed in nursing. Indeed, nursing has a social mandate to provide health care for clients at different points in the health–illness continuum. There is a growing knowledge base, authority over education, altruistic service, a code of ethics, and registration requirements for practice. Although the debate is ongoing, it can be successfully argued that nursing is an aspiring, evolving profession (Finkelman & Kenner, 2013; Hood, 2010; Judd, Sitzman, & Davis, 2010). See for more information on the future of nursing as a profession.

Link to Practice 1-1: The Future of Nursing

The Institute of Medicine (IOM, 2011) recently issued a series of sweeping recommendations directed to the nursing profession. The IOM explained their “vision” is to make quality, patient-centered care accessible for all Americans. Recommendations included a three-pronged approach to meeting the goal.

The first “message” was directed toward transformation of practice and precipitated the notion that nurses should be able to practice to the full extent of their education. Indeed, the IOM advocated for removal of regulatory, policy, and financial barriers to practice to ensure that “current and future generations of nurses can deliver safe, quality, patient-centered care across all settings, especially in such areas as primary care and community and public health” ( ).

A second key message related to the transformation of nursing education. In this regard, the IOM promotes “seamless academic progression” ( ), which includes a goal to increase the number and percentage of nurses who enter the workforce with a baccalaureate degree or who progress to the degree early in their career. Specifically, they recommend that 80% of RNs be BSN prepared by 2020. Last, the IOM advocated that nurses be full partners with physicians and other health professionals in the attempt to redesign health care in the United States.

These “messages” are critical to the future of nursing as a profession. Indeed, standardization of entry level into practice at the BSN level, coupled with promotion of advanced education and independent practice, and inclusion as “leaders” in the health care transformation process, will help solidify nursing as a true profession.

Nursing as an Academic Discipline