The word “nurse” originally came from the Latin word “nutrire”, meaning to suckle, referring to a wet-nurse; only in the late 16th century did it attain its modern meaning of a person who cares for the infirm.
From the earliest times most cultures produced a stream of nurses dedicated to service on religious principles. Both Christendom and the Muslim World generated a stream of dedicated nurses from their earliest days. In Europe before the foundation of modern nursing, Catholic nuns and the military often provided nursing-like services. It took until the 20th century for nursing to become a secular profession.
The Mother of Nursing
Often called the mother of modern nursing, Florence Nightingale helped revolutionize the world of nursing and set the standards for the profession as it is known today. Born into an affluent British family, Nightingale was just a youth when she began caring for the sick villagers living near her family’s home. By 16, she knew nursing was her calling.
In 1854, Nightingale was asked to organize a team of nurses to care for sick and injured soldiers in the Crimea, an area where Great Britain was at war. The conditions she found upon her arrival were deplorable. Wounded soldiers were lying amidst all sorts of filth, rodents and bugs were everywhere and most of the water was contaminated. Nightingale determined that thorough cleaning was the first step toward proper healing. She also began checking on her patients’ status at all hours of the day. In the evening, she carried a lamp while making her rounds and providing care to the soldiers. Comforted by her selfless caring and compassion, the soldiers nicknamed her “the Lady with the Lamp,” and “the Angel of the Crimea.” The hospital’s death rate decreased by two-thirds during her time of service.
Upon her return to England, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report evaluating her experiences in the Crimea. The book later helped reform several military hospitals and helped establish a Royal Commission for the Health of the Army in 1857.
Florence Nightingale and the Introduction to Modern Nursing
When looking at the rise of modern nursing within Europe, it’s important to note that Florence Nightingale helped to change the nature of the profession forever. Around the early to late 1900’s, nursing was becoming more important than ever, as nurses were needed on the front lines of the many wars being waged, from the Crimean War to the Civil War. Nurses were sent to attend to the sick and wounded soldiers in battle. Florence Nightingale began her illustrious nursing career as a nurse within the Crimean War that took place in the mid 1850’s, tending to injured soldiers on the battlefield. During this time, deaths from injuries were commonplace, due to the lack of general hygiene and the huge amount of fatal infections that resulted from these wounds.
Upon encountering this, Nightingale asked for and received aid from the British government that allowed for much better hygiene throughout the battlefield and nearby hospital. It was due to this that the rate of death from infections dropped drastically in but a short period of time. Throughout the rest of her life, Nightingale advocated for sanitary living conditions for patients, as well as providing similar designs to be implemented within hospitals, an ideal that has spread throughout the entirety of the nursing profession throughout the following years.
Before the 1870s “women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession …and society at large”. Nursing had the much the same lowly status in Europe. However D’Antonio shows that in the mid-19th century nursing was transformed from a domestic duty of caring for members of one’s extended family, to a regular job performed for a cash wage. Nurses were now hired by strangers to care for sick family members at home. These changes were made possible by the realization that expertise mattered more than kinship, as physicians recommended nurses they trusted. By the 1880s home care nursing was the usual career path after graduation from the hospital-based nursing school.
Three years later, she helped fund the St. Thomas Hospital, and within it, the Nightingale Training School for Nurses. In 1873, three nurse education programs – the New York Training School, the Connecticut Training School and the Boston Training School – all began operations. All schools were founded on ideas by Nightingale, and are generally acknowledged to be the first organized schools of professional nursing education in the United States.
Two major nursing organizations were established in the 1890s and still exist today – the National League of Nursing Education and the American Nurses Association. State nursing organizations were also organized in the early twentieth century and helped pass state nurse registration acts, which regulated and provided a licensing system for the nursing practice. They also gave nurses a legal title, registered professional nurses or RN for short.
Despite successes, nursing still faced a number of challenges, specifically in employment. In the early 20th century, most hospitals only hired a few graduate nurses, preferring to use students to supply most of the patient care labor. Most nursing school graduates instead became private duty nurses employed by individual patients, rather than hospitals. However, private duty nursing did not provide regular or dependable employment, and the service was limited to those who could afford it. It wasn’t until the mid-20th century that hospitals began hiring staff nurses on a permanent basis, providing full-time professional healthcare to all their patients.
By the early 20th century, nursing was quickly becoming a growing profession. Most hospitals considered nurses essential to patient care and registered nurses were using their skills to provide quality care to patients outside of traditional healthcare institutions.
In 1893, Lillian Wald founded the Henry Street Settlement House, which helped provide healthcare and other social services to the impoverished immigrant population in low-class areas of New York City. Replication of the Henry Street Settlement eventually helped lead to the establishment of the field of public health nursing.
Nurses In Need
World War I created one of the largest demands for nurses, as more than 23,000 delivered care to soldiers serving on the front lines and to servicemen who returned home injured. During their time of service, many nurses learned specialized skills that were essential to providing quality care to the sick and injured. As a result, several fields of healthcare were established based on the skills nurses learned during the war. For example, many nurses began administering anesthesia during surgery, leading to the specialty field of nurse anesthetists.
When World War II began, nurses stepped up again. More than 78,000 nurses joined the armed forces and served in various areas, both on the battlefront and in recovery hospitals. After the war, however, the nursing profession experienced new challenges. While the healthcare system required more RNs with advanced and technical care skills, fewer young women were interested in choosing nursing as a full-time career. Despite being acknowledged as heroic work during the war, the reality was that nurses were typically paid low wages, work hours were demanding and working conditions were often very poor.
Additionally, there was debate about how nurses should be educated, what the minimum requirements for a nurse should be and how they should be divided into different specialized fields. By 1960, roughly 170 college-based nursing education programs offered Bachelors of Science in Nursing degrees (BSN). Experts determined that better educated nurses should be given more responsibilities and be given the opportunity to work in advanced healthcare fields.
Before the debate was settled, community colleges emerged as an alternative to four-year schooling. Two-year nurse training programs at community colleges offered what traditional colleges couldn’t – a cheaper, faster program that provided higher education. Community colleges could graduate larger classes and get working nurses to the bedside faster, offering relief for the on-going nursing shortage.
However, community colleges were not the long-term answer. Programs did graduate many new nurses, often at a lower cost than four-year programs, but as the health needs of patients became more complex, research studies found that nurses taught at the baccalaureate level provided better patient outcomes than nurses with a two-year education. As a result, several hospitals and healthcare institutions began requiring nurses to obtain a BSN degree.
Nursing professionalized rapidly in the late 19th century following the British model as larger hospitals set up nursing schools that attracted ambitious women from middle- and working-class backgrounds. Agnes Elizabeth Jones and Linda Richards established quality nursing schools in the U.S. and Japan. Richards was officially America’s first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston. Hospital nursing schools in the United States and Canada took the lead in applying Nightingale’s model to their training program. For example, Isabel Hampton Robb (1860–1910), as director of the new Johns Hopkins Hospital Training School for Nurses, deliberately set out to use advanced training to upgrade the social status of nursing to a middle class career, instead of a low pay, low status, long hours, and heavy work job for working class women.
After 1880 standards of classroom and on-the-job training rose, as did standards of professional conduct. For textbooks they relied upon: A Manual of Training (1878); A Hand-Book of Nursing for Family and General Use (1878); A Text-Book of Nursing for the Use of Training Schools, Families, and Private Students (1885); and Nursing: Its Principles and Practice for Hospital and Private Use (1893). These books defined the curriculum of the new nursing schools and introduced nurses to modern medical science and scientific thinking.
In the early 1900s, the autonomous, nursing-controlled, Nightingale-era schools came to an end. Schools became controlled by hospitals, and formal “book learning” was discouraged in favor of clinical experience. Hospitals used student nurses as cheap labor. In late the 1920s, the women’s specialties in health care included 294,000 trained nurses, 150,000 untrained nurses, 47,000 midwives, and 550,000 other hospital workers (most of them women).
Sandelowski finds that by 1900 physicians were allowing nurses to routinely use the thermometer and stethoscope, and in some cases even the new X-ray machines, microscopes and laboratory testing. Nurses for the first time could supplement their subjective observations with scientific tools. Most nurses remained at the bedside where they used the new technology to gather information for doctors, but were not allowed to make a medical diagnosis. Their subjective bond with the patient remained their primary role.
The John Sealy Hospital Training School for Nurses opened in 1890 in Galveston, Texas. It grew rapidly and in 1896 became the School of Nursing, University of Texas; it was the first nursing school to become part of a university in the state of Texas. In recent decades, professionalization has moved nursing degrees out of RN-oriented hospital schools and into community colleges and universities. Specialization has brought numerous journals to broaden the knowledge base of the profession. Very few blacks attended universities with nursing schools. The solution was found by the Rockefeller’s General Education Board, which funded new nursing schools headed by Rita E. Miller at Dillard University in New Orleans (1942) and by Mary Elizabeth Lancaster Carnegie at Florida A. & M. College in Tallahassee (1945).
American Nurses Association
In 1901 the American Society of Superintendents of Training Schools for Nurses and the Nurses’ Associated Alumnae of the United States and Canada merged to form the American Federation of Nurses. It joined the National Council of Women and the International Council of Nurses. The federation was replaced in 1911 by the new American Nurses’ Association.
The United American Nurses (UAN) was a trade union affiliated with the AFL-CIO. Founded in 1999, it only represented registered nurses (RNs). In 2009, UAN merged with the California Nurses Association/National Nurses Organizing Committee and Massachusetts Nurses Association to form National Nurses United.
Historically, the nursing profession has shown its ability to adapt to changes and healthcare needs. More educational opportunities have opened the door for advanced nursing specialties and nursing remains a popular, respected and in-demand profession that strives to meet the needs of the sick and wounded. Throughout history, nurses have shown that compassion, selfless acts of kindness and care can help make a big difference on the battlefront, in small communities and in hospitals and healthcare institutions around the world.
Common Nursing Jobs in the Current Industry
When looking at how the nursing profession has progressed since its inception when nurses were largely Catholic nuns to the bustling industry it is today, it’s important to understand that the reason for this occurring is due primarily to the added specialties that current and prospective nurses could choose to focus in. As nursing is generally all about the care of a person, a nurses duties can cover a large variety of different practices. Some of the most common of these include pediatrics, neonatal, disabilities, women’s health communities, family and orthopedic nursing, among others. This allows for a huge amount of diversity within the field of nursing that never use to be present before the last 50 or so years.
Education Required of a Nurse Today
While in the late 1800’s and 1900’s, those looking to become nurses would simply go to school and achieve a certification in nursing, it’s now possible to attend nursing school and choose any number of degrees to graduate with. Here’s a small look at what those are. For instance, in the U.S., you can choose to receive a diploma in nursing, which merely requires 3 years of study and a certain amount of hours of hospital-based work. This type of degree is the oldest such nursing degree and has been present since the late 1800’s.
Today, students have the added option of choosing to pursue an associate’s degree in nursing, as well as a bachelor’s degree, master’s degree or even a doctorate degree in nursing. Each successive degree requires extra years of study, though also gives students better career opportunities within the field of nursing upon graduation, an advantage that only presented itself in the 1960’s and 70’s. Upon obtaining any one of these degree types, students will then have the opportunity of taking a licensure examination and becoming a registered nurse.
While the role of nurses in the world has expanded dramatically within the last 2 centuries, it’s clear that nursing will continue to grow into an even more important aspect of the health care industry within the years to come.
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