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Nursing has evolved into a modern profession from its beginnings in early civilization.
Throughout nursing history, it has been shaped and molded by many nurses into its current
form. Nursing in the past has taken many different roles in response to changing political
climates, war and scientific advances.
Caring for the sick and ill has been a need since the beginning of civilization. Early
caregivers were often chosen to do so at birth, whether because of a family heritage or
tradition. Methods of caring and healing at that time were passed on from generation to
generation through oral history. Most often, these caregivers were female, but some
cultures chose men to do the caring and healing.
Nurses were first formed into an organized group in the early Christian era. Nursing
ideals were well aligned with Christian virtues, and women often participated in the
church providing nursing services as deaconesses. These women were selected by the
church to provide care to people in their homes. Receiving care in the home was considered
to be safer, as opposed to hospitals. The earliest hospitals were started by religious
organizations, with care provided by monks and nuns.
Later, as a result of the Protestant Reformation, hospitals run by religious orders
were closed. Nursing care regressed, often becoming the job of lower class women.
Municipal hospitals often had uneducated attendants instead of nurses. Out of this
disorganization, Florence Nightingale became the founder of modern nursing. She established
nursing as a profession by starting the first secular nursing school in the world at St.
Thomas' Hospital in London. The Nightingale School of Nursing became a model for nursing
schools around the world, allowing for the creation of professionally trained nurses.
Modern nursing in the United States arose after the Civil War. During the Civil War,
nurses cared for the wounded and ill using their knowledge and experience gleaned from
caring for ill family members. Some nurses who provided care to soldiers during the Civil
War went on to have a great impact on the nursing profession. These famous nurses include
Dorothea Dix, Clara Barton, and Walt Whitman. Clara Barton went on to found the American
Red Cross. Dorothea Dix championed the reform of mental hospitals and institutions. Walt
Whitman made the work of nurses during the Civil War famous with his poetry.
Inspired by the success of the Nightingale nursing schools, the first nursing school in
the United States, the nurse training school at the Women's Hospital of Philadelphia,
was opened in 1872. Linda Richards was the first nursing school graduate in the country,
while soon after, Mary Mahoney became the first African American nursing school graduate.
Initially, nursing schools did not have the support of the physicians and were founded
with the help of social activists. By 1900, there were 432 nursing schools.
Many famous nurses were educated in these first nursing schools. Mary Breckenridge was
a nurse midwife and founder of the Frontier Nursing Service. Lillian Wald formed the
Visiting Nurse Association, and worked to provide care to patients in their homes and
coined the term public health nursing. Mary Adelaide Nutting became the world's first
professor of nursing at Columbia University.
Most early nursing graduates were employed in private homes. They provided nursing care
to families who could afford to hire a private nurse. During the Great Depression, many
nurses were affected as families could no longer afford to employ a private nurse. At
the same time, hospital nursing jobs were scarce as patients could not afford to stay
in a hospital for care. As a result, the American Nurses Association issued a position
statement encouraging nurses to work eight hour shifts which could employ three nurses
in a twenty-four hour period, versus working twelve hour shifts which could only employ
two nurses in a twenty-four hour period.
During the 20th century, many medical advances were made. With the advent of microscopes
and diagnostic tools, there was a better understanding of disease processes, causative
agents and treatments. Time intensive surgeries could be completed with the development
of anesthesia and anti-septic agents. Because of these advances, the need for educated
nurses grew, leading to a boom in nursing education.
Along with the boom in professional nursing education, nursing theories started to form.
The very first nurse theorist was Florence Nightingale, who postulated the Environment
Theory. Other famous nurse theorists include Jean Watson, Madeleine Leininger and Sister
Calista Roy to name a few. Jean Watson formed the Philosophy and Caring Model that
includes Watson's Ten Carative Factors. Madeleine Leininger formed the Culture Care
Diversity and Universality theory that focused on transcultural nursing. Sister Calista
Roy created the Adaptation Model and theorized that the patient is an open, adaptive
system.
Nurses caring for the wounded and providing life-saving treatments on the battlefield
during war brought recognition to the nursing profession. The first professionally trained
nurses to participate in war efforts were during the Spanish-American War in 1898. Later,
in 1901, the Army Nursing Corps was founded, followed several years later by the Navy
Nursing Corps. By the end of World War I, there were 21,000 Army nurses and 1,386 Navy
nurses. During World War II, the Bolton Act of 1942 was passed, which created the U.S.
Cadet Nurse Corps, designed to quickly prepare nurses for military service. During the
war, over 77,000 nurses served in the armed forces.
After World War II, there was a severe nursing shortage, as nurses who had served during
the war left to fulfill wife and mother roles, or were not interested in working as a
staff nurse in the hospital. In 1951, in response to the nursing shortage, the associate
degree in nursing program was established. These programs allowed for nurses to be trained
in two years, as opposed to the three or four required for a baccalaureate. Later, in the
1970's, there was a growth in the number of graduate degree programs in nursing, leading
to the creation of the advanced practice nurse role. The establishment of the nurse
practitioner role in the 1970s led to a need for expansion of the nurse practice laws.
Nurse practitioners have fought to lobby for changes to the law to allow them to practice
to the full extent to which they have been trained. Currently, nurse practitioners are
seeking the ability to practice independently without the collaboration of a physician.
This is already a reality in twenty-two states and the District of Columbia.
Nursing today has evolved into a science all its own. It has its own research, scientific
journals, theories and models. It encompasses aspects of psychology, sociology, and
medicine and health promotion. Despite the advances the nursing profession has made in
defining itself in the past centuries, there is still more work to be done. As the
healthcare field is ever-changing and evolving, nurses will continue to further define
professional nursing standards, research and support nursing autonomy and protect the
nursing profession. The nursing timeline of the future will call for integration of new
technologies into nursing practice, molding nursing practice to fit into current health
care delivery systems and continuing nursing research that supports the positive role of
nurses as part of a health care team.
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