Running head: THE EVOLUTION OF THE NURSE The Evolution of the Nurse Expert Witness The Evolution of the Nurse Expert Witness The Importance of Knowing the History of Professional Nursing Wisdom regarding the history of nursing provides nurses with an appreciation for their profession today (Zerwekh & Claborn, 2009). A classic reason for studying history is to avoid repeating it. However, knowing the history of professional nursing can not only enlighten an individual to changes that need to be performed, but also previous solutions that may be recycled (Zerwekh & Claborn, 2009).
The content of nursing history is only one aspect of its contribution to the profession. Understanding the roots of nursing serves to expand critical thinking skills and promote a sense of professional heritage and identity. The role of a nurse, and the evolution of the practice, is defined through the study of the profession’s history. Awareness of nursing history promotes understanding of the social and intellectual origins of the discipline (Zerwekh & Claborn, 2009). Nursing is an ever-evolving practice. The wealth of its historical knowledge should not be ignored (Zerwekh & Claborn, 2009). History of the Nurse Expert Witness
An expert witness is defined as a person “qualified by knowledge, experience, training, or education to provide a scientific, technical, or other specialized opinion about the evidence or a fact issue” (Murphy, 2005, p. 853). In the United States, the desire for expert testimony arose near the beginning of the twentieth century; however, the need for the nurse expert witness did not achieve recognition until the late 1970s (Cohen, Rosen, & Barbacci, 2008). During court proceedings the adequacy of another nurse’s actions may be questioned. In such a situation, a nurse expert may be summoned for testimony.
Nevertheless, physicians have been the accepted voice to explain standards of nursing care for decades within the court system (Murphy, 2005). Cohen et al. (2008) argue that investigation and testimony concerning the acceptable nursing standard of care should be delegated to a professional nurse expert witness. This individual should demonstrate competent nursing skills in the same or similar field in which they are testifying (Cohen et al. , 2008). The debate concerning the role of the nurse expert in litigation began in 1958 with Goff v Doctor’s Hospital (Cohen et al. , 2008).
This case, along with many others during its time, allowed a physician to serve as “nursing’s voice” (Cohen et at. , 2008, p. 4). The California court permitted the physician to authenticate the role and accountability of professional nurses, which was outside his qualifications (Cohen et al. , 2008). In 1972, physician testimony regarding nursing standards was still admitted into evidence, but his or her role as expert concerning the subject matter began to be questioned. It was not until the 1980s that courts began to recognize nurses as the most appropriate professionals to define the nursing standard of care (Cohen et al. 2008). The battle for the nurse expert witness to establish a permanent position within the courts rages on despite the positive strides the profession made during the 1980s (Cohen et al. , 2008). The case of Flanagan v Labe (1997) excluded the testimony of a registered nurse declaring it “inadmissible” (Cohen et al. , 2008, p. 5). In contrast, a brief submitted by The American Association of Nurse Attorneys, in 2003, was cited when the Illinois Supreme Court determined a nurse was the only qualified individual to present opinion evidence as to the nursing standard of care (Cohen et al. , 2008).
Such examples illustrate the reality that, “while the profession of nursing has assumed greater responsibilities over the years, recognition of those responsibilities does not correlate with greater recognition of nurses’ autonomy” (Cohen et al. , 2008, p. 5). Health Care Practices During the 1970s and 1980s The inception of the nurse expert witness was not the only health care practice to progress and arise during the 1970s and 1980s. Driven by the impressive growth of medical technology and what some considered an inefficient health care system, health insurance costs rose drastically during the 1970s and 1980s.
Health maintenance organizations, or HMOs, and other managed-care systems began to flourish. Many of these systems converted from a non-profit organization to a for-profit organization, which allowed them to take a more assertive stance with regard to the acceptance or denial of patient treatment (Noah, 2007). The true trend of the 1970s and 1980s was nursing autonomy. Nurses began entering the profession with college-level degrees and the post-high school training nurse was slowly phased out (Cohen et al. , 2008).
During this period the practice of hospice care was launched, as well as the nation’s first glimpse at America’s nursing shortage. In 1971, the birth of hospice nursing began in the United States. Florence Wald drew inspiration from Cicely Saunders, from Saint Christopher’s Hospice in London, and worked with colleagues in New Haven, Connecticut to “design a hospice where the patient and family were at the center of care” (Adams, 2008, p. 1). Even though nursing was experiencing increased growth and opportunity within its scope of practice, the profession still struggled with setbacks.
By the 1980s, nurses made up the largest group of health care professionals in the United States, but shortages and high turnover rates plagued the discipline. Thus, the beginning of our nation’s current nursing deficit was seen (Noah, 2007). Most Interesting Aspect and Its Impact on Contemporary Nursing The responsibility and character of the nurse expert witness has become quite extensive throughout the profession’s history (Cohen et al. , 2008). Historically, the nurse expert witness served only as a fact witness in which they were not acknowledged as involved with the patient’s care.
Now, new and expanded roles have emerged for the nurse expert witness, including the life care planner and forensic nurse (Cohen et al. , 2008). Specialized training and education are required for such positions and necessary for the nurse expert witness to gain credibility and value within the legal arena. Because of the demand for these programs, the opportunity for non-traditional nursing roles, such as the nurse expert witness, is increasing and will further intensify in the future (Cohen et al. , 2008). References Adams, C. (2008). Florence Wald (1917-2008): Pioneer in hospice care. Retrieved February 25, 2009 from http://www. ursingadvocacy. org/press/pioneers/florence_wald. html Cohen, M. , Rosen, L. , and Barbacci, M. (2008). Past, present, and future: The evolution of the nurse expert witness [Electronic version]. Journal of Legal Nurse Consulting, 19(4), 3-8. Murphy, E. (2005). The expert nurse witness [Electronic version]. AORN Journal, 82(5), 853-856. Noah, T. (2009). A short history of health care: Jonathan Cohn shows how we got here. Retrieved February 25, 2009 from http://www. slate. com/id/2161736/ Zerwekh, J. and Claborn, J. (2009). Nursing today: Transition and trends (6th ed. ). St. Louis, MO: Saunders Elsevier.