Reflections and Milestones: A Commentary on Nursing Inquiry, Cardiovascular Care, Research, and Public Health

The year 2020 was declared the International Year of the Nurse and Midwife, honouring both past and present nurses who have made invaluable contributions to the nursing profession. By then, nursing had been established as a profession for more than 200 years. Although nurses have made great progress, becoming part of the clinical team for modern medicine over the last two centuries; our footprint has greatly expanded within the last century, making the last 50 years the most progressive and innovative achievements from nursing in the modern healthcare landscape. In the last 50 years, nurses have been involved in many historic milestones and have also weathered many challenges from natural disasters, health policy shifts, political issues, epidemics, pandemics, and the emergence of new technologies designed to enhance our practice. Furthermore, nurses have expanded their reach, moving from the bedside to the laboratory, from the community to government appointments, and from the classroom to boardrooms, and from local to global impact; Yes, nurses do it all. Nurses have evolved with the changing social, economic, and political landscape, in which all are heavily influenced by the transition from traditional nursing practice to expanding nurses' roles beyond carers but also educators, advocates, leaders, legislators, researchers and scholars (Whalen et al. 2020). One example of a paradigm shift in nursing occurred when there was an influx of nurses pursuing graduate-level education. This began in the late 1960's with the emergence of advanced practice nursing roles (nurse practitioners, clinical nurse specialists, etc. ) and led to the modernisation of nursing education programs (Cantelon 2010). From the 1970's and 1980s to today, nursing education has continued to move in the direction of clinical specialisation, master's degree and doctoral-level training programs that prepare nurses for advanced professional roles. Within the last 50 years, the interest of nurses completing education at the doctoral level has also changed how nurses' function within academic institutions, levelling the playing field between nurses and other doctorally-prepared health sciences professionals (Cantelon 2010). This commentary, grounded in social justice and health equity, highlights defining moments over the past 50 years in nursing across various specialties including scientific inquiry, editorial leadership, and cardiovascular care; all areas which the author has specialised in, throughout their three-decade nursing career. Over the past 50 years, nurses have demonstrated extraordinary resilience while confronting numerous public health crises that have fundamentally shaped modern nursing practice. Beginning with the HIV/AIDS epidemic in the 1980s, nurses provided compassionate care despite incomplete understanding of disease transmission and limited treatment options, bearing immense emotional burdens (Cantelon 2010). During these times, nurses continuously assumed enormous risks while delivering optimal care to patients who frequently lacked access to treatment or felt hopeless about their prognosis. The social, economic, and emotional toll of caring for this population was immeasurable. The 2014–2016 Ebola outbreak proved to be the deadliest on record, with a 90% fatality rate among untreated cases and more than 28, 000 reported cases across the African continent, triggering a global health crisis. This epidemic demanded heightened vigilance from nurses worldwide, requiring frontline response to a disease that posed direct threats to their own lives (Cantelon 2010; Fletcher et al. 2022). While historically, previous generations of nurses had confronted tuberculosis, smallpox, influenza, and other infectious disease outbreaks, this represented an unprecedented challenge for millennial-era nurses who had not yet experienced such widespread critical risk. Guidance from global health agencies including the World Health Organization and the Pan-American Health Organization (WHO/PAHO) became essential, and evidence-based scientific protocols were mandatory to safeguard the health of both patients and healthcare professionals (Cantelon 2010; Fletcher et al. 2022). The global emergence of non-communicable diseases (NCDs) over the past 50 years has fundamentally transformed nursing practice, shifting focus from acute care management to chronic disease management and preventive care models. With increased life expectancy comes greater age-related illness, as chronic conditions including heart disease, diabetes, cancer, and respiratory disorders now represent the leading causes of morbidity and mortality across both high-income and low middle-income countries (Powell-Wiley et al. 2022). The alarming rise in chronic disease prevalence has intensified burdens on patients, families, and communities while significantly impacting healthcare expenditures, compelling health systems to critically reassess their fiscal sustainability and resource allocation strategies. The increase in NCDs has also been at the forefront of nursing research, where nurses have an opportunity to lead intervention studies that promote disease prevention and management (Miller et al. 2025). Nurses play a pivotal role in disaster management, demonstrated profoundly on 11 September 2001, when terrorist attacks on the World Trade Center in New York City, the Pentagon, and in Pennsylvania claimed nearly 3000 lives and injured thousands more. Alongside first responders including police officers, firefighters, and emergency medical service technicians, nurses provided critical care during one of the most devastating modern disasters in United States history. Facing shortages of emergency equipment and essential blood products for transfusion, nurses treated patients with severe physical and psychological trauma, exacerbating the burnout and compassion fatigue commonly experienced among nurses in such crisis situations. Nurses have also played an integral role in caring for populations during wars, political conflicts, and natural disasters, responding to health risks and injuries from earthquakes, hurricanes, tsunamis, wildfires, and other severe weather events (Fletcher et al. 2022). Recognising this essential role, disaster response training is now incorporated into continuing nursing education programs and integrated into foundational nursing curricula. The COVID-19 pandemic has proven to be the most formidable challenge confronting healthcare systems in the 21st century, particularly for frontline nurses caring for patients with a highly infectious disease when treatment options were limited and no vaccine or cure in sight (Fletcher et al. 2022). Despite constrained resources, ventilator shortages across the United States, severe staffing deficits, and a healthcare system under extreme strain, nurses persevered. As nurses continue working in a healthcare landscape drastically transformed by COVID-19, pre-existing challenges have intensified during these unprecedented times (Fletcher et al. 2022). Nurses have proactively identified and formally addressed critical threats to both patient and nurse safety. Nursing inquiry is not a new concept. Dating back to the early 19th century, Florence Nightingale pioneered nursing research through her data collection, making the inference that poor hygiene conditions contribute to negative health outcomes (Cantelon 2010; Whalen et al. 2020). Early models for guiding quality improvement date back to the 1960s with the development of the Donabedian Framework, which provided a systematic approach to quality improvement and measurable outcomes (Whalen et al. 2020). Another sustainable approach used for nursing inquiry is the concept of evidence-based medicine that was first introduced in the early 1990s in an article published in the Journal of American Medical Association, and soon after introduced and integrated into nursing as evidence-based practice (EBP). This innovation became the standard for integrating key findings from scientific literature to influence clinical problem solving and to improve safety and overall health outcomes for patients (Whalen et al. 2020). Over the last three decades, nursing-led EBP models, such as the Johns Hopkins Nursing-Based Practice (JHNEBP) model, the Iowa Model for Evidence-Based Practice to Promote Quality Care, and Melnyk and Fineout-Overholt's hierarchy models have become well known and widely used for informing EBP and QI projects that inform policies and procedures across diverse healthcare settings (Whalen et al. 2020). These models align not only with practice improvement initiatives in healthcare organisations but are also integrated in the curriculum for advanced practice programs, and doctoral education programs such as the Doctor of Nursing Practice focused on understanding EBP and QI as competencies for translating existing research into usual care practices. Nurses as researchers have come along way. Unlike 50 years ago, nurses now serve as principal investigators on large-scale studies including randomised controlled trials, pilot studies, quantitative and qualitative research and leading interdisciplinary team-based and evidence-based studies that engage community members in advancement of research and practice (Cantelon 2010). Nurses remain a critical part of applying and obtaining research funding from government agencies and philanthropic organisations to secure funding to advance nursing science. Since 1985, the National Institute of Health (NIH) in the U. S. , established its own National Center for Nursing Research (NCNR), after many years of rejecting the notion of nurses as researchers, independent from the medical research community (Cantelon 2010). A year later, the NCNR became the National Institute for Nursing Research (NINR) and still exists today with opportunities for nurses to lead nationally sponsored research that focused on promoting wellness, reducing disease risk, and improving disease management. The NINR's opportunities are built on the foundation laid by nursing scientists of the past, creating their own scientific community; marking a significant transformation that would catapult nursing research into a global impact (Cantelon 2010). As nursing research has emerged over the last few decades, there has also been a massive increase in dissemination of research among nurses, as nursing organisations have created forums for showcasing the importance of nursing inquiry activities across the hospital, communities, legislative settings, and beyond (Whalen et al. 2020). Organisations such as Sigma Theta Tau International Honor Society of Nursing, founded in Indiana, USA by six nursing students in 1922, has transformed nursing into a global society with members across six continents; actively providing nurses a platform to share and disseminate their research and practice initiatives, on a global scale. Other national nursing organisations, such as the International Council of Nurses, Royal College of Nursing, American Nurses Association, Canadian Nurses Association, and the Australian Nursing and Midwifery Federation, are among hundreds of nursing organisations that promote the display of nursing research and excellence on national and global stages; this is powerful. Nursing as a profession has made much progress in the dissemination of research through these conferences; however, another impactful avenue for dissemination has been consistently through publication of research in peer-reviewed journals (Cantelon 2010). The Journal of Advanced Nursing (JAN) opened these opportunities for nurses to publish 50 years ago, although not the first to do it. JAN, like its preceding journals, spearheaded a paradigm in how nurses, at a time when the profession was shifting its focus on advanced research, education, and practice, a timely transition that has sustained over time. Nurses, as researchers, have more than 3000 reputable and indexed peer-reviewed journals in the field of nursing and allied health to disseminate research, adding the role of ‘author’ to the already diverse roles that nurses hold. Nurses as authors have achieved a wide range of dissemination pathways, from peer-reviewed articles to books, textbooks, chapters, and monographs, now expanding into high-tech platforms including YouTube videos and podcasts. Another significant nursing accomplishment includes serving as peer-reviewers, editors, and editors-in-chief of nursing journals (Cantelon 2010). Although there's a relatively small number of nurses in editorial roles, this function remains critical to the advancement of nursing science. Nurse editors serve as gatekeepers of knowledge dissemination, bearing the substantial responsibility of ensuring the highest quality content is integrated in scientific literature (Cantelon 2010). Whether leading national or international journals, these editorial roles elevate nurses as leaders across diverse specialties, contributing their research expertise to a broad spectrum of scientific topics and audiences. Cardiovascular disease (CVD) represents the world's most burdensome condition, claiming 17. 9 million lives annually and standing as the leading cause of death, hospitalisation, and disability, globally (Miller et al. 2025). This staggering burden has been exacerbated since 1990 by shifts in modifiable risk factor exposures, including increased tobacco use, physical inactivity, and poor dietary habits. Additional behavioural risk factors, including uncontrolled hypertension, elevated serum glucose and lipid levels, excessive alcohol consumption, and rising rates of overweight and obesity further compound this crisis (Miller et al. 2025). The economic impact is equally burdensome. In the United States alone, CVD-related costs surpass 350 billion annually, with projections that healthcare expenditures will exceed 1 trillion by 2030. Perhaps most concerning is the disproportionate disease burden among disadvantaged groups, where alarming rates contribute to health disparities observed worldwide (Powell-Wiley et al. 2022). In this context, nurses have emerged as essential leaders in addressing the CVD epidemic; uniquely positioned to specialise in cardiovascular care across diverse healthcare settings (Cantelon 2010; Miller et al. 2025). Globally, nurses are advancing equitable access through research, advocacy, and education. Their expanding organisational leadership role marks a significant evolution in cardiovascular medicine, with nurses now actively contributing to cardiovascular organisations that were historically physician-dominated. This transformation positions nursing at the forefront of both CVD prevention and care delivery, offering hope for reducing disparities and improving outcomes in this critical area of global health (Miller et al. 2025). Key moments and significant developments, innovation, and milestones in cardiovascular nursing have also shaped the advancement of nurses' involvement in scientific inquiry. In the U. S. , the American Heart Association and American College of Cardiology (AHA/ACC) are known to develop guidelines based on research to provide a compass to health care providers for research-based treatment modalities (Miller et al. 2025). Since 1980, guidelines were categorised into the following topic areas: arrhythmia, prevention, acute and stable ischemia, heart failure, valvular heart disease, and vascular medicine. Historically, the round table discussions involved physicians, and nurses were not included in these discussions at the time. Nurses became formally involved in writing American Heart Association (AHA) guidelines for acute and chronic heart conditions through collaborative efforts with the American College of Cardiology (ACC), with significant integration beginning in the 2010s and increasing substantially by the 2020s (Miller et al. 2025). While the AHA and ACC have produced clinical guidelines since 1980, the inclusion of nurses as voting members on writing committees for major heart condition guidelines became particularly pronounced in the 2010s, especially in specialised areas such as hypertension, heart failure, valvular heart disease, and adult congenital heart disease (Miller et al. 2025). Major milestones in nurse involvement include the 2017–2018 guidelines for Adults with Congenital Heart Disease, Hypertension and Heart Failure, which began specifically listing Advanced Practice Nurses (APNs) and specialised nurses on their writing committees. This trend expanded in the 2020s, with high-impact guidelines such as the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure explicitly noting APN inclusion in the writing and a team-based The Cardiovascular Nurses Association has been in this with the AHA and ACC to provide nursing expertise for guidelines in prevention, hypertension, and chronic major treatment nurses have to AHA scientific with in when a scientific addressing nursing in cardiovascular and care was published in the Journal of the American Heart cardiovascular including the Society of Cardiology and the Society of and New have nurses in prevention, and treatment This paradigm shift a team-based approach to care that nurses' critical roles in management, prevention, and care (Miller et al. 2025). 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