Few professionals are admired quite like modern nurses. In a recent assessment from Gallup, 85 percent of American respondents claimed that today’s nurses maintain high or very high ethical standards. Those who appreciate nurses are also impressed by their clinical skills and personal compassion.
While the public’s appreciation for and trust of nurses has remained consistently high over time, the types of care provided by these essential health care workers have changed significantly—as have academic requirements and professional standards. It takes only a brief glance at history to reveal just how far the field has come in a few generations.
Nursing’s jaw-dropping evolution will quickly become evident as you examine our history of nursing timeline. This resource highlights several noteworthy dates and events, including everything from the development of the first nursing schools to wartime activity that helped nurses gain the respect and admiration they deserve.
Changes in Nursing Education Over Time
Nursing education has changed dramatically over time in response to the equally transformative nature of the profession itself. The field has taken several small steps forward to get to where it is today, but a comprehensive overview reveals sweeping changes in how nurses are prepared for the challenges of their chosen profession.
In general, nursing has gone from an extension of traditional caretaking to a decidedly clinical practice. Modern nursing calls on professionals to obtain extensive formal training and certification.
The long-term changes in nursing education have largely been made in response to an evolving sense of what, exactly, makes a nurse competent. Early on, nurses primarily relied on family caretaking experience with few pursuing additional training, knowledge, or skills.
Today, Tottori University’s Mika Fukada refers to nursing competence as a “complex integration of knowledge including professional judgment, skills, values, and attitude,” adding that success in nursing requires an “intelligent practical skill set that integrates or combines different factors and issues in complex ways, specific to each circumstance.”
THE BEGINNINGS OF NURSE EDUCATION
While female caretakers have existed in some form for millennia, the nursing profession as it is known today has origins in the 18th and 19th centuries. Initially, most care occurred at home or, in the Catholic Church, was provided by esteemed monks, nuns, and deaconesses. With urbanization and industrialization, however, came the need for additional options. Formal education was eventually catalyzed by multiple wars in which female nurses provided desperately needed care to save countless lives.
1854: Florence Nightingale and Volunteers Provide Care During Crimean War
Arguably the most well-known development in both nursing and nursing education, Florence Nightingale’s work during the Crimean War demonstrated the value of female nurses and the need for strict sanitation practices. She and dozens of volunteers were sent to poorly maintained military hospitals by Secretary of War Sidney Herbert in response to shocking stories of inhumane conditions.
Known as the “Lady with the Lamp,” Nightingale helped to reduce the death rate in Crimean military hospitals by two-thirds. Today, she is widely regarded as the founder of modern nursing.
1855: The Establishment of the Nightingale Fund
In recognition of Florence Nightingale’s commitment to nursing and contributions to the war efforts in Crimea, several noteworthy individuals worked together to establish the Nightingale Fund. This granted Nightingale £45,000—enough money to establish the first nursing school at St. Thomas Hospital by 1860. The school’s curriculum would largely be based on Nightingale’s 1859 publication Notes on Nursing.
Nurses trained at St. Thomas Hospital were respected all around the world. Many went on to become matrons at some of the most prominent hospitals in the United Kingdom. This, in turn, allowed the high standards of training promoted by Florence Nightingale to take hold on a global scale.
The Nightingale Fund remains influential today. As a modern charity, it provides funding to cover course fees for nurses, midwives, and other health care professionals.
1861: Dorothea Dix Appointed Superintendent of Army Nurses
In the United States, as in Great Britain, it took the devastation of war to bring greater attention to nursing as a profession and the need for targeted nursing education. At this time, war also provided an opportunity for women to prove their capability in high-stakes situations.
Dorothea Dix was a huge force for progress during the Civil War, beating out British physician Elizabeth Blackwell to become the Superintendent of Army Nurses. In this role, Dix set stringent standards, mandating that volunteer nurses be at least 35 years of age and plain-looking.
During her time with the Federal army nursing program, Dix took charge of over 3,000 women. Under her direction, these nurses attended wounded soldiers on both the Union and Confederate sides. Often, these nurses offered the only source of care for Confederate soldiers.
Dix’s efforts led to greater respect for nurses, as well as two flags in honor of her work as the Superintendent of Army Nurses. These flags paid homage to Dix for her “Care, Succor, and Relief of the Sick and wounded Soldiers of the United States on the Battle-Field, in Camps and Hospitals during the recent war.”
1873: Multiple Nursing Schools Founded
A landmark year for nursing education, 1873 saw the founding of several prestigious programs. For example, as the first United States nursing school founded based on Florence Nightingale’s principles, the Bellevue Hospital School of Nursing initially focused on hygiene and patient comfort. Soon, however, the school’s doctors gave lectures on key topics such as anatomy and physiology.
Other significant programs launched in 1873 included New Haven Hospital’s Connecticut Training School and Massachusetts General Hospital’s Boston Training School. Many additional schools followed, and, after a decade, there were 35 nursing programs in the United States.
1888: Darius Mills Establishes the First Formal Nursing Program for Men
Misconceptions of nursing as a woman’s work have long plagued the field, but many people are surprised to learn that men have been prominent in the profession since the very beginning. This can be seen with the 1888 establishment of a formal nursing program designed exclusively for men.
Founded by prominent American philanthropist Darius Mills, the male-oriented school of nursing at New York City’s Bellevue Hospital was the first of its kind—but it was soon followed by the Alexian Brothers Hospital School of Nursing and several other similar programs.
1892: First Nursing Class Enrolls at Provident Hospital
As the first training opportunity for African American nurses, Chicago’s Provident Hospital was founded in response to a prominent pastor’s sister being denied admission to the city’s top nursing school due to her race. The project took on a board of trustees, a finance committee, and an executive committee in 1891. The following year, seven women enrolled in the hospital’s first class of nurses.
Not only did Provident’s nursing school provide much-needed opportunities to women of color, the hospital also welcomed black physicians and patients. Dr. Austin Curtis—one of the hospital’s earliest physicians in surgical training—went on to become the first black surgeon-in-chief at D.C.’s Freedmen’s Hospital.
1896: Nurses Associated Alumnae Assembles
During the late 1800s, several nursing alumni associations formed with hopes of keeping in touch and advancing the nursing profession. In 1896, delegates from several top alumni groups gathered at the Manhattan Beach Hotel to form a national professional association.
The original purpose of the Nurses Associated Alumnae was to “establish and maintain a code of ethics; to elevate the standards of nursing education; to promote the usefulness and honor, the financial and other interests of nursing.” Eventually, this organization became the American Nurses Association, which remains incredibly influential to this day.
A CENTURY OF ACCOMPLISHMENT
Following the establishment of the Nurses Associated Alumnae and several acclaimed nursing schools, the profession began to grow rapidly. The profession saw some of its most noteworthy changes in the early 1900s.
1900: Chautauqua School of Nursing Founded
Remote learning existed long before online education took over. Initially, learning from afar meant correspondence education. While multiple schools began to offer this option in the early 1900s, the Chautauqua School of Nursing was among the most respected. Founded in New York in 1900, this three-course option focused on general, obstetric, and surgical nursing.
1915: The National League of Nursing Education Presents a Standard Curriculum
As the first professional nursing organization organized by women, the National League of Nursing Education (NLNE) was highly influential during the early 1900s.
In 1915, the league took a major step forward by presenting a standard curriculum, divided into seven major sections. Each of these areas involved at least two courses, which emphasized practices such as observation and experimentation.
1923: Josephine Goldmark Publishes Forward-Thinking Report on Nursing Education
Nursing education may have taken several important steps forward during the early 1900s, but there was little effort to align the profession with top universities. One key exception? Josephine Goldmark’s Nursing and Nursing Education in the United States, which is often referred to as the Winslow-Goldmark report.
Goldmark’s publication advocated for upgraded nursing education approaches, including the use of accreditation procedures on a national level. Her report was based, in part, on her investigations of over seventy schools of nursing.
1925: Committee on the Grading of Nursing Schools
By the 1920s, many excellent curriculum resources were available, but nursing education still required additional oversight and accountability. Hence, the formation of the Committee on the Grading of Nursing Schools. This group provided a variety of nursing programs with personalized feedback between 1926 and 1934. This helped to pave the way for later accreditation programs.
1943: The Bolton Act Authorizes the Cadet Nurse Corps
Nursing school enrollment increased rapidly during World War II but, initially, not fast enough to provide the number of skilled nurses required on the front—or their equally crucial replacements at home.
In an effort to support civilian hospitals during a time of heavy demand, Congress authorized the Cadet Nurse Corps (CNC) as part of the Bolton Act. While all United States nursing schools were eligible to participate, they needed to be approved by their state’s accrediting agency and linked to hospitals approved by the American College of Surgeons.
During the five years in which the CNC operated, over 124,000 nurses graduated from participating schools. The American Hospital Association claims that the CNC prevented the collapse of civilian nursing during World War II. As such, the ANA and many other organizations have called on Congress to officially recognize CNC participants as veterans.
DEVELOPMENT OF A PROFESSION
During the second half of the 20th century, nurses began to take on a greater range of clinical responsibilities. This increase in autonomy called for more extensive training and often stringent requirements for licensure. This period offered a glimpse of what nursing might look like in the 21st century and beyond.
1947: NLNE Sets a Goal of Bringing Nursing to Higher Education
Nursing programs expanded rapidly following World War II, but most initially involved diploma schools rather than encouraging aspiring nurses to enroll in community or four-year colleges.
During the mid and late 1940s, it quickly became evident that change was afoot. At this time, the NLNE expressed a clear interest in associate degree nursing education, as evidenced by multiple discussions with community colleges.
By 1947, NLNE’s board had adopted a goal of moving nursing school to the higher education system. Soon after, a series of pilots revealed the value of two and three-year programs leading to an associate or baccalaureate degrees.
1948: Nursing for the Future Published
In the 1940s, many health care and philanthropic leaders argued over who, exactly, should be responsible for organizing and managing professional schools of nursing. Meanwhile, the National Nursing Council sponsored a report designed to highlight expectations surrounding the profession’s future as well as a plan for standardizing nursing curricula.
1970: The Lysaught Commission Provides Recommendations for Nursing Education
Following a period of rapid growth for associate nursing programs, the National Commission for the Study of Nursing and Nursing Education (commonly referred to as the Lysaught Commission) recommended statewide planning that would determine how nursing programs would be distributed.
The Lysaught Commission also advocated for improved nurse mobility among individual professionals, as well as greater cooperation between nursing education and services programs. This marked a turning point in modern nursing and education.
2008: Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education
Nursing education developments in the 1980s, 90s, and early 2000s largely focused on the creation of new graduate programs targeted at advanced practice nursing and nurse practitioners. This effort was formalized with the Consensus Model for ARPN Regulation, which offered guidance to help states bring greater uniformity to advanced practice registered nursing roles.
There’s no denying that training for nurses has evolved over time. These adaptations have allowed nurses to continue providing the compassionate care their patients desire while also taking on a variety of important clinical roles.
2010: The Institute of Medicine Releases Report on The Future of Nursing
In 2010, the Institute of Medicine developed a blueprint for the next decade of healthcare practice by publishing The Future of Nursing: Leading Change, Advancing Health. This dealt extensively with the impact of the Affordable Care Act (ACA) on nursing practice.
The Future of Nursing advocated for the removal of limits on nurses’ scope of practice. This recommendation was made in recognition of nurses forming the “single largest segment of the health care workforce,” as well as the reality of them spending the “greatest amount of time in delivering patient care as a profession.”
The report also referenced the need for nurses to obtain bachelor’s degrees while also encouraging more to seek graduate-level education. Residency training was also recommended in hopes of giving nursing more hands-on experience.
2015: OSHA Issues Guidelines to Improve Nurse Safety
From overexertion to workplace violence, a variety of concerns have long placed hardworking nurses at risk. In an effort to address these problems, the Occupational Safety and Health Administration (OSHA) issued a safety memo intended to guide health inspections. ANA’s Debbie Dawson Hatmaker said she hoped the memo would “encourage hospitals to take seriously setting a comprehensive program for mobility and safety.”
1999-2020: Nurses Ranked the Most Ethical Professionals
With Americans so sharply divided on any number of issues these days, it’s tough to find anything on which they overwhelmingly agree. If there’s one source of connection, however, it’s trust in nurses. Between 1999 and 2020, an annual Gallup survey of the most trusted professions has placed nurses at the top. The only exception? The 2001 survey, in which firefighters took first place.
Between 2019 and 2020, nurses saw their already glowing reputation improve further. In that year’s poll, 89 percent of respondents claimed that they regarded nurses’ ethical standards as high or very high. Nurses managed to find favor with respondents of all ages, genders, races, and political affiliations.
2020 and Beyond: COVID Transforms Nursing as We Know It
As we’ve seen with nursing in 2020 and 2021, nothing changes health care quite like a pandemic. With the onset of COVID came increased pressure for hardworking nurses. They dealt with long hours, protective equipment shortages, and the stress of a health care system in turmoil. They rose to the occasion, however, adapting to constant changes in professional policies while continuing to provide compassionate care.
In response to all that nursing professionals have overcome, the World Health Assembly has referred to 2020 as the “Year of the Nurse.” ANA President Ernest Grant, PHD, RN, FAAN explains, “Nurses have been tested in every way imaginable during 2020…through it all, [they] have consistently proven they are resilient, selfless, and compassionate, risking their health and safety for the common good.”
If there’s been a bright spot during this difficult time, it’s the increased availability of technological solutions for communicating with patients. Telehealth existed long before COVID, but was underdeveloped until necessity forced healthcare organizations to get creative. Now, patients find it easier to schedule remote visits, which can be valuable when transportation or mental health concerns keep them from communicating with nurses in person.
If you’re interested in joining a new generation of highly skilled nurses, consider enrolling in the RN to BSN degree program from the American Sentinel College of Nursing & Health Sciences at Post University. Reach out today to learn more about our accredited degree programs.
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