In this work, the authors argue that studying nursing history provides nursing students with a “sense of professional identity, a useful methodological research skill, and a context for evaluating information” (Keeling & Ramos, 1995). Therefore the purpose of this chapter is to provide the reader with a brief overview of the history of American nursing from the middle of the 19th century through present-day nursing practice.
Nursing has indeed evolved over the course of more than 150 years since the inception of the first Nightingale schools in the United States, but it has not done so without significant challenges along the way. In fact, many of these challenges persist today: issues surrounding gender, race, socioeconomic status, educational requirements for entry into practice, professional licensure, pandemic disease, war, and nursing shortages.
To assist mid–19th-century women with their caretaker role, Florence Nightingale published Notes on Nursing: What It Is and What It Is Not. In the preface of this book, first published in 1859, Nightingale explained that her notes on nursing were “meant simply to give hints for thought to women who have personal charge of the health of others. Every woman … or at least almost every woman has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid—in other words, every woman is a nurse” (Nightingale, 1859, p. 8). Although more than 150 years have passed since Nightingale wrote her book, and today's nurses are professionals, many of her notes on nursing continue to be relevant to contemporary nursing practice.
THE BEGINNING OF NURSING TRAINING PROGRAMS
Florence Nightingale is well known for her work during the Crimean War (1853 to 1856). Her wartime experience shaped her ideas about the value of the trained nurse and was later the impetus for the creation of the Nightingale Training School for Nurses at St. Thomas's Hospital in London in 1860. Just as Nightingale's work in the Crimea was an impetus for instituting a training school for nurses in England, the provision of nursing care by American women during the United States Civil War (1861 to 1865) demonstrated the effectiveness of skilled nursing on improving outcomes for sick and injured soldiers. Women from both the North and South volunteered en masse to care for the injured, sick, and dying soldiers in hospitals and infirmaries and on battlefields. Their success in reducing morbidity and mortality in the camps provided evidence that the use of trained nurses could benefit the military and society as a whole. Thus in the years following the war, philanthropic women in the United States devoted their energies to establishing nurse training schools that were based on the Nightingale model (Woolsey, 1950; Dock, 1907).
In 1873 the first three training schools were established: one at Bellevue Hospital in New York City, one at the Connecticut Hospital in New Haven, and one at Massachusetts General Hospital in Boston.
A 1902 textbook of nursing describes the relationship between physicians and nurses during this era: “To the doctor, the first duty [of the nurse] is that of obedience—absolute fidelity to his orders, even if the necessity of the prescribed measures is not apparent to you. You have no responsibility beyond that of faithfully carrying out the directions received” (Weeks-Shaw, 1902, p. 4).
In January 1894 these superintendents created the Society of Superintendents of Training Schools for Nurses of the United States and Canada (later renamed the National League for Nursing Education [NLNE] in 1912). The goals of the Society of Superintendents were “to promote fellowship of members, to establish and maintain a universal standard of training, and to further the best interests of the nursing profession” (American Society of Superintendents of Training Schools for Nurses, 1897, p. 4).
The efforts of the Associated Alumnae resulted in...
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