The nursing profession has grown astronomically since the days of Florence Nightingale. While we may have once served as handmaidens to the whims and needs of god-like physicians, the definition of what it means to practice as a nurse is light-years away from the era of our diminutive status and relative servitude.

It's true that the public may still not fully understand the breadth and depth of the nursing profession. However, we nurses know that our scope of practice and autonomy have grown by leaps and bounds, and a plethora of specialties and practice settings has opened doors of opportunity hitherto unknown by our older nursing colleagues.

Opening doors to advanced practice

During the latter decades of the 20th century, nursing saw significant growth in advanced practice nursing programs, with many APRNs realizing that private, independent and autonomous practice was a true reality in a growing number of states.

Currently, in more than 20 U.S. states, APRNs can practice without physician supervision or oversight. Many in the public health community hail this as a victory for patients who seek affordable, convenient and high-quality professional medical care in areas where there exists a dearth of available primary care physicians.

And with the implementation and expansion of the Affordable Care Act, the need for skilled APRNs to deliver primary care to an increasing number of newly insured Americans is a true phenomenon worthy of notice.

Meanwhile, the ascendance of the doctor of nursing practice (DNP) designation caused many in the physician community to feel threatened by the rise of independently practicing nurses who could now literally be called "doctor." Having said that, a shortage of primary care physicians — especially in underserved rural and urban areas opened the door for APRNs to seize golden opportunities to serve a public in dire need of primary care.

Gains and growth for the baccalaureates

Apart from the increasing opportunities for APRNs, baccalaureate-prepared nurses are also seeing avenues for growth and professional expansion. Several studies have demonstrated that patient mortality decreases as the number of baccalaureate-prepared nurses on a unit increases.

While many may argue that these studies are inherently flawed, the writing is on the wall that the bachelor's degree is rapidly becoming a requirement of employment for many facilities in the United States. Thus, job opportunities and positions of responsibility are open to those with the sought-after bachelor's degree already under their metaphoric belt.

Of course, growing pains are also unavoidable, even in nursing. Vocal disagreements over the aforementioned movement toward the bachelor's degree as the standard preparation for all nurses has certainly caused some rancor in various quarters.

Physician groups still lobby against autonomous practice for APRNs, and there is misunderstanding about other expanding nursing roles. Even so, expansion and growth is inevitable in today's healthcare environment.

Expanding roles, new roles

With the rise of various alternative practice opportunities, plenty of nurses are also seizing the moment, leaving the bedside in pursuit of more nontraditional roles.

Board-certified nurse coaches (NC-BC) are finding employment with insurance companies in corporate settings and other environments where the role of the nurse coach as health and wellness expert is recognized and valuable.

Nurses with and without advanced practice training are also realizing the possibility of offering independently delivered services to an eager public, including private duty case management, elder care and wellness consulting.

In areas such as case management, school nursing, oncology nursing, infusion nursing and many other specialties, widely recognized accreditation programs open additional doors for nurses willing to commit to the rigors of the accreditation process.

The early 21st century and beyond

No one can fully predict exactly what fruit the 21st century will bear for nurses and the nursing profession. But if we consider the current trends, increasing autonomy and significant expansion of opportunity is most certainly in the offing.

Nurses must continue to read the writing on the wall, while speaking out publicly on health issues of contemporary importance. Nurses' voices are gaining prominence and recognition, and as the most trusted profession in the United States, nurses are in a position to leverage their collective power and voice for the good of all.