When Toni Gibson ventured into her career as a Licensed Practical Nurse back in 1978, nurses wore starched white uniforms topped by a perky cap. They saw themselves more as doctors' helpers than health care professionals in their own right, and were taught to rely on gut instinct to assess patients' needs.

Thirty-two years later, Gibson, now assistant vice-president of nursing for Blue Mountain Health System, looked back recently at the changes the nursing profession has undergone over the decades.

Gibson, a registered nurse with a bachelor of science degree in nursing and master's degree in health administration, took the trek into the past as part of Blue Mountain Health System's celebration this month of National Nurses' Week.

"There have been many changes since the time of (legendary nurse) Florence Nightingale," Gibson said. "But I think the changes have been good."

Nightingale, whose 190th birthday anniversary was May 12, once said that "Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter's or sculptor's work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God's spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts."

According to the American Nurses Association, there are about 3.1 million registered nurses in the United States. Of that number, 2.4 million are actively employed.

Not only are there many, but their reputation is stellar. The nation's nurses rank first for their honesty and integrity, with 82 percent of Americans rating them 'high' or 'very high', according to a 2005 Gallup Poll. Nurses have consistently rated first every year but one after being added to the list in 1999, ANA said.

Gibson's journey began in 1978.

"I started at Gnaden Huetten Hospital, before we became Blue Mountain Health System. My first job was as an LPN," she said. "Since then, I've been in many different areas of the hospital. I've worked in home health care, where I started. I've worked in the nursing home, in medical/surgical. Most of my experience has been in critical care. I was an Intensive Care Unit nurse for many years, then I became the director of the ICU and medical/surgical."

Nursing has evolved since it began as a profession in the 1800s.

"It was an undesirable job," Gibson said. It was a job for the immoral women and the illiterate women. Those early nurses, besides taking care of patients, would have to scrub the floors and stoke the fires. It used to be a life of drudgery."

By the 1970s, nursing had come into its own.

"Nurses had become better educated," Gibson said. "The education many years ago was a three-year diploma. Now, there is a heavy focus on the bachelor of science in nursing program. Nurses need to be credible and well-rounded, more well-rounded than coming through the diploma school. They want us to have more education because we do interact with physicians, we interact with administration and with other disciplines like social service and physical therapy."

That education is life-saving. According to the American Nurses Association, a study done by Linda Aiken of the University of Pennsylvania and published Sept. 23, 2003, in the Journal of the American Medical Association found that the educational level of registered nurses working in hospitals has a significant impact on whether patients survive common surgeries. Most significantly, the study found that raising the percentage of registered nurses with bachelor's degrees from 20 percent to 60 percent would save four lives for every 1,000 patients undergoing common surgical procedures.

With the higher education came respect, and a more active role in treating patients.

"When I started, nurses were helpers or assistants to the doctors. I remember when a physician came onto the unit, the nurse got up out of her chair and the physician sat down," Gibson said. "Today, we have more of a collegial relationship. We're working together to create a plan to get the patient better. I think that physicians respect the nurses today much more than they did many years ago because we're not so task-oriented; we do more critical thinking."

Nurses are "less caretakers and more patient advocates than they were many years ago," she said. "For instance, a patient comes in with abdominal pain, and the nurse finds out he has an alcoholic component that maybe he is not sharing. We share those kinds of things with the physician. We take all that information and apply it to getting the patient better."

Perhaps not quite as crucial were changes in the uniform.

Gibson recalls the starched white nurses' uniforms and caps in the 1960s and 1970s. She said, "Then, it started to evolve to a more comfortable style of uniform. Now, we wear scrubs. The complaint that we hear sometimes from patients is that everyone wears scrubs, and how do I know the cleaning lady from the nurse from the nurse aid?" she said.

It is a valid complaint. Gibson would like to see, not necessarily a return to starched whites, but "at least maybe two parts white. I think it lends respect." Hospital staff do wear name tags with their titles, but "sometimes patients can't see if they don't have their glasses on," she said.

Along with education and uniforms, technology has also changed the profession.

"I can remember years ago we had to use our senses, we had to assess and evaluate our patients using all of our facilities, with touch and listening. Today, you don't even have to take a blood pressure you have a machine do it for you. You can see heart rhythms and heart rates. You can check pulse oxymetry. It's not a bad thing. It's actually a good thing because it does free up the nurses' time to do other things and spend more time with the patient."

Technology is a big part of medicine today.

When Gibson graduated from nursing school, "there was a focus on 'use your gut feeling.' If you feel that there's something there, make sure the doctor knows about it. Today, we have the diagnostics and the technology to pursue what the symptoms are and what's going on with that patient," she said.

Salaries have also changed dramatically.

"I still have my first paycheck, and I don't think I made much money about $5 an hour," Gibson said. Recent nursing shortages have bumped up salaries.

"We're attracting a better caliber of person, and we're attracting more males," Gibson said. "There is definitely a role for men in nursing, especially in the critical care areas. They seem to gravitate to the emergency rooms and the ICU's and the operating rooms."

Nurses today are also more highly trained in specific areas of health care.

Years ago, "when you walked in the door, there was a huge bulletin board, and it told you where to go medical/surgical, rehab or whatever," Gibson said. "You just went where you were told. But now, a nurses is not a nurse is a not a nurse any more. We require far more education for nurses. Our ICU nurses, our telemetry nurses must have advanced cardiac life support (training). We have our psych units, we need to have Behavioral Emergency Response Training. We're much more specialized, and our education needs to meet the demands of some of that specialization. We didn't see that many years ago."

All in all, the changes have moved the nursing profession forward, Gibson said.

"I've never regretted going into nursing. There are a lot of opportunities in nursing," she said. "For me, it's been a very exciting career, with a lot of challenges and rewards."