Nursing has been struggling to be recognized as an academic discipline ever since the 1960s, when the American Nurses Association published a position paper that supported baccalaureate education as the entry level to practice (McCance & McKenna 1999). Previously, most nursing education took place in hospital schools (diploma programs), and the profession was very much under the control of medicine. Now, there's a lot to be said in favor of diploma programs, mostly the fact that diploma graduates usually have much more clinical experience, and are therefore more technically skilled than other entry-level graduates. However, the biggest disadvantage of these schools was that they did not teach nursing theory. Florence Nightengale was incorporated somewhat but the majority of the curricula were medically based. Nurses depended heavily on physiology, sociology, psychology, and medicine to provide academic standing and to inform practice (McEwan and Mills 2014). Some of the nursing classes were taught by the physicians, namely physiology and pathophysiology, and anatomy. Therefore, nurses were taught and trained to be the handmaidens of the physicians. In many circumstances, they were taught precisely what their doctors wanted, and how to anticipate and execute their doctors’ orders. They were also taught how to care for their doctors' patients.
The regulatory and professional organizations in nursing education have required that critical thinking be essential to all nursing programs, but they have not satisfactorily distinguished critical reflection from ethical, clinical, or even creative thinking for decision making or actions required by the clinician. Bittner and Tobin defined critical thinking as being “influenced by knowledge and experience, using strategies such as reflective thinking as a part of learning to identify the issues and opportunities, and