A Perspective of Nursing Over Half a Century: A Fabulous Profession and a Wonderful Career

I began my nursing training in 1977 in a hospital-based programme in a regional community in Australia. A vastly different era- one of starch caps, rigid ward routines, harsh discipline, a homogenous nursing workforce and a time where the hospital was the epicentre of healthcare delivery. It was a training model of the Nightingale era. Once I was a registered nurse, I started working in the intensive care unit and soon transitioned to cardiology and heart failure became my specialty. The advances in the care of people with heart disease, particularly heart failure, have been nothing short of remarkable. I became engrossed in the science and witnessed the power and possibilities of team-based care and the role of nursing in influencing health outcomes. In 1977 life expectancy in Australia was 70 for men and 77 years for women. Today for men and women they can expect to live to 84 and 85 years respectively. These gains have been achieved through advances in clinical medicine, public health and nursing science. As I learned to be a nurse, this was an era that was one of pre-thrombolytic therapy and pre-percutaneous coronary angiography for occluded coronary arteries. It is hard to fathom cardiology services today without the cardiac catheter or echocardiogram laboratory. It is also hard to imagine a time when nurses smoked in the break room. But this in fact is true. At that time acute myocardial infarction was commonly a death sentence. Beta blockers and exercise were contraindicated and antiarrhythmics administered prophylactically. The tool of the cardiovascular clinician was commonly the electrocardiogram, and the best coronary care nurse was the one able to identify complex arrythmia. My doctoral work evaluated a model of nurse coordinated heart failure care, adopting a cardiac rehabilitation model and recognising that individuals were living with a life-limiting illness (Davidson et al. 2010). Now standards in guidelines for heart failure care, exercise and integrated palliative care were novel elements of cardiovascular care at that time. Not only has clinical management changed over the last 50 years but also the profession of nursing. We have witnessed transformation across education, practice, research, leadership and policy. Although the fundamental values and ethos of the nursing profession have not changed, our work environments are markedly different. I have been privileged to be on this journey. The move of nursing education from hospital-based apprenticeship models to university-based education, with bachelor's degrees becoming the minimum entry level in many countries, has been transformational—not just for the profession but also for patient outcomes. My wish is that this would be a global criterion for entry into nursing, but this decision will require political will and a true commitment to improving the health of populations. The evolution of master's and doctoral programmes has allowed nurses to increase their clinical specialisations, lead research programmes and assume leadership positions previously not thought possible. Now nurses are the chief executive officers of health systems, presidents of universities and ministers of health. The role of advanced practice nurses and midwives has contributed to both independent and collaborative practice and paved new pathways of care to improve patient outcomes. Nurse-led models have improved access, quality and patient experience, especially for long-term and complex conditions (Davidson et al. 2025). There have been changes in nurses' roles and they are undertaking tasks traditionally performed by physicians, particularly in primary care, rural health, aged care and low-resource settings. Increasingly the role of nurses in curating the direction of health systems is recognised. Released in October 2010, the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, focused on the intersection between the health needs of diverse, changing patient populations across the lifespan and the actions of the nursing workforce (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine 2011). And now well over a decade since the initial release, this has been a seminal report for charting the course for contemporary nursing. A primary recommendation of this report, nurses should practice to the full extent of their education and training has become a driver for reform globally. Nurses have become leaders in quality improvement, safety and implementation science and systems redesign. Clinical decision-making increasingly integrates best evidence, clinical expertise and patient preferences. Programmes such as the Magnet Recognition Program have reinforced the link between nursing leadership, work environments and patient outcomes. The Magnet Recognition Program designates healthcare organisations aligning nursing strategic goals to improve the organisation's patient outcomes and emphasise the importance of nursing leadership (Yu et al. 2026). As I look back on my working life of half a century of being a nurse, it is useful to look to the future to see what the next 50 years will hold. Technological innovations are advancing at a rapid rate, often outpacing societal debate and discussion. Importantly, although we have seen improvements in life expectancy, these benefits are not evenly distributed through society and health equity is a critical issue to address. Individually and collectively, nurses will face a myriad of interconnected structural, technological, demographic and ethical challenges. But by ensuring our fundamental values and a commitment to person-centred care will be our North Star in navigating both challenges and opportunities (Davidson et al. 2018). Older populations with complex, intersecting physical, cognitive and social needs are increasingly the characteristics of patients. Consequently, issues such as multimorbidity and frailty are fertile areas for research (Davidson et al. 2025). The rising prevalence of anxiety, depression, substance use and loneliness across the life course has increased the complexity of care (Zhang et al. 2024). As individuals continue to live with chronic and complex conditions, there is a rising demand for skilled, compassionate care across all care settings, not just in hospitals. The long-heralded nursing shortage is well and truly upon us. Although much has been written and prophesised, we are experiencing these threats daily and the failings of health systems around the world are frequently a feature of news broadcasts. Due to an aging workforce, large proportions of the nursing workforce will retire while demand for care is accelerating. And these gaps will be hardest felt in rural, remote, aged care, mental health and primary care settings. Moreover, burnout, moral distress and limited career flexibility threaten the long-term retention of the nursing workforce (Bergman et al. 2025). The short-term fix of relying on international recruitment exacerbates global workforce challenges in low- and middle-income countries and contributes to a range of health effects. In order to address the global workforce challenge, the scope of nursing practice and credentialing frameworks, particularly for advanced practice, need to be more aligned with the needs of individuals, patients and communities, rather than traditional models and pressures from other health professionals (De Raeve et al. 2024). Population aging, increasing clinical complexity and fiscal constraints have created an environment of a pressure cooker, placing considerable stressors on the workforce. Nursing continues to be framed as a cost rather than a value-creating investment for health systems. Compassion, advocacy and a commitment to person-centred care have continued to be enduring values while operating in increasingly complex systems. The COVID-19 pandemic added fuel to this situation and continues to have residual effects. There is increasing recognition of moral distress and burnout and the impact on workforce sustainability, wellbeing and psychological safety. As we deal with treatment complexity there are rising tensions between an emphasis on broad foundational skills, generalism and that of disease specialisation, particularly in the context of multimorbidity. The future holds the promise of AI-driven diagnostics, decision support and robotics that will reshape nursing work. As the most trusted profession in society, the challenge for nurses will be how to ensure person-centred care in technology intensive settings. Important considerations will be how nurses become the stewards of data privacy, algorithmic bias and consent as well as ensuring that technology does not exacerbate health disparities (Davidson and Brown 2025). A welcome change over the last 50 years in the nursing profession has been an increasing focus on equity, the role of social determinants of health and focus on the environment. This has shifted healthcare models to the community as well as virtual domains. Poverty, housing insecurity and structural racism increasingly influence the work of nurses. Fortunately, there has been a shift in perceptions of stigma with increasing advocacy for vulnerable populations. There is increasingly a more focused emphasis on aging, chronic disease, mental health, Indigenous health and marginalised communities (Phillips et al. 2025). Yet poor integration across acute, primary, community and social care contributes to adverse health outcomes. And this remains a tough nut to crack to achieve scalable and sustainable outcomes (Zhang et al. 2025). Heat, disasters, displacement and infectious disease outbreaks reflect a planet under stress, and this will increase both the demand and the complexity of healthcare (Saravanan et al. 2025). Increasing geopolitical instability continues to erode health outcomes. This occurs not only through direct violence, but also through long-term corrosion of social and health system resilience. Of greatest concern, children, women, older adults, people with disabilities and those with chronic illness are the most vulnerable to these stressors (Davidson et al. 2026). Over the last half-century, and my career, nursing has evolved from a predominantly task-oriented, hospital-based occupation to a knowledge driven, research informed, digitally enabled and globally-connected profession. These advances have positioned nursing as a central driver of health-systems performance, equity and innovation—an evolution that continues to accelerate. Lessons from COVID-19 highlight the need for sustained investment in nursing leadership and surge capacity (Daly et al. 2020). I have had the privilege to witness the enormous advances in clinical care and the rise in the professional standing of nursing. But I am continually reminded that these advances cannot be taken for granted. In recent times there have been threats to the professionalism of nursing through decreases in funding and reconfiguration of workforce models (Rice et al. 2026). The future of heart failure management is moving toward precision, prevention and person-centred systems of care, enabled by digital innovation, advanced therapeutics and integrated workforce models. Genomics, proteomics, metabolomics will shape clinical management (Ghazal et al. 2025); and nurses will continue to play a pivotal role in coordination of care models from prevention to palliation. The greatest challenge for heart failure management will be to develop sustainable, scalable models that reduce burden on both the individual and health systems while improving outcomes. Disturbing trends such as greater health disparities and the emergence of heart failure in younger populations will need to be monitored as these demographic changes stand to threaten advances made over recent decades (Parizad et al. 2025). As nurses look to the future, there is no doubt of the importance of our profession, but the critical question is to ensure that health systems see the value of nurses and invest in nursing as a strategic asset rather than a variable cost (Ullman and Davidson 2021). I have no doubt that the nursing profession can adapt to meet future demands, but this will be dependent on skilful leadership and the ability to adapt and evolve according to social, political and economic changes. Over my career, I have observed that strong nursing leadership and educated, competent and credentialled nurses are essential to better patient outcomes, safer care, improved system performance and lower costs. I have had the great privilege of being a nurse and experiencing the power of transformation over the last 50 years. Addressing workforce sustainability, developing innovative models of care and strengthening the leadership and policy influence of nurses will be critical to sustain and build on these advances in healthcare. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.