The Making and Life of a Registered Nurse in the Era of COVID-19: Chapter Eighteen–A Brief History of Nursing

This chapter is a discussion on the history of nursing, as in the previous chapter on medicine, a time line will be used to show the progress that nursing has made throughout its history. I have also included brief biographies on some of the most influential individuals in nursing.

The following information on nursing was taken from an article on nursing from Wikipedia.

The common belief is that nursing has always been a feminine occupation with males entering the field in recent years, but this is not the case. During the Middle Ages, nurses were mostly untrained women who helped deliver babies or were wet nurses. Nuns had more training and cared for the sick. However, by the 13th through the 16th centuries, religious orders felt as if it was their duty to care for the physical needs of people as well as their spiritual needs and formed brotherhoods to carry out this mission. In 1259, the Alexian Brothers started the ministry of caring for the sick and hungry, and they are still in existence today in many countries, including the United States. The Hospitaller Brothers of St. John of God was formed in Spain in 1550. From 1550 through 1614, Saint Camillus de Lellis cared for the sick and dying at St. James’ Hospital in Rome. It was not until 1633 when Saint Vincent de Paul founded the Daughter of Charity that women began to play a larger role in organized nursing. In 1645, Jeanne Mance, a nurse from France, established the Hotel-Dieu de Montreal in Canada, the first hospital in North America.

By the 18th century, the United States was beginning to realize the need for organized nursing services. In 1751, Benjamin Franklin and Dr. Thomas Bond opened Pennsylvania Hospital, the nation’s first hospital. It served the poor and homeless in Philadelphia. When the American Revolutionary War broke out in 1775, Congress recruited nurses to care for the sick and wounded. They requested one nurse for every 10 patients.

Throughout the years, wars have increased the need for nurses and have had a great influence on the evolution of nursing. Florence Nightingale, who is widely regarded as the mother of modern nursing, made her greatest impact when she served in the Crimean War from 1853 to 1856. Her sanitation efforts dropped the mortality rate dramatically. She went on to establish the Florence Nightingale School for Nurses in London. Between 1861 and 1865, over 2000 nurses served in the Civil War, some on the front lines. Many of these nurses wrote of their war experiences.

As the United States continued to see the need for nursing education, the first training school was opened 1872 at the New England Hospital for Women and Children in Boston. Its first graduate was Linda Richards, the first American trained nurse. After that, more and more hospitals opened nursing schools. Unfortunately, in many of the schools, the training consisted of very little book learning, and many times the students were exploited as free labor. Contrary to the autonomous Nightingale schools, nursing was under the control of medicine.

By the 1970s, the three-year, hospital-based diploma schools were starting to be replaced by two-year associate degree programs at technical schools or by four-year Bachelor of Science degree programs at universities. These schools provide the academic curricula and are affiliated with hospitals for clinical training. As the need for higher education in nursing is growing, universities also are offering master’s and doctorate programs.

The following nursing timeline shows how world events and famous nurses influenced nursing history and paved the way for modern nursing practice.

• 1751 – The first hospital was founded in Philadelphia, Pennsylvania.
• 1775 to 1783 – Nurses were recruited to care for the wounded under the command of George Washington.
• 1783 – James Derham used his earnings from nursing to buy his freedom from slavery.
• 1841 – Dorothea Dix advocated for the mentally ill and established mental institutions.
• 1853 to 1856 – Florence Nightingale served in the Crimean War and set up a holistic system of nursing.
• 1859 – Notes On Nursing by Florence Nightingale was published. It was one of the first nursing manuals ever written.
• 1860 – The Florence Nightingale School of Nursing was opened in London.
• 1861 – Nurses began to wear uniforms.
• 1861 to 1865 – During the Civil War, over 2,000 nurses cared for injured and ill soldiers.
• 1865 – Sojourner Truth cared for injured African-American soldiers in Washington, D.C. Her sanitation practices reduced infections, and she taught other nurses her principles.
• 1873 – Linda Richards, the first American trained nurse, graduated from the New England Hospital for Women and Children School of Nursing.
• 1879 – Mary Eliza Mahoney, the first African-American trained nurse, graduated from the New England Hospital School of Nursing.
• 1881 – Clara Barton established the American Red Cross.
• 1893 – Lillian Wald founded the Visiting Nurse Service of New York.
• 1900 – The first issue of the American Journal of Nursing was published.
• 1901 – New Zealand began requiring registration for nurses.
• 1902 – Ellen Dougherty from New Zealand became the first registered nurse in the world.
• 1902 – Lina Rogers Struthers was hired as the first public school nurse.
• 1908 – Congress established the United States Naval Nursing Corps.
• 1908 – The National Association of Colored Graduate Nurses was established. It merged with the American Nurses Association in 1951.
• 1914 to 1918 – Nurses from the U.S. Navy Nursing Corps and the American Red Cross served in World War I.
• 1917 – Margaret Sanger established the National Birth Control League that later became Planned Parenthood.
• 1925 – The Frontier Nursing Service was started by Mary Breckinridge.
• 1939 to 1945 – Over 59,000 American nurses served in World War II.
• 1950 – The first intensive care units were established and created the specialty of critical care nursing.
• 1956 – Columbia University School of Nursing offered the first master’s program for nurses.
• 1959 to 1975 – Over 5,000 nurses served during the war.
• 1965 – The University of Colorado established the first nurse practitioner program.
• 1967 – Dame Cicely Saunders started the first hospice in London and provided the foundation for care of the terminally ill.
• 1972 – Eddie Bernice Johnson was the first registered nurse elected to the U.S. House of Representatives.
• 1979 – Case Western Reserve University started the first doctoral program for nurses.
• 1990 – Nursing uniforms become more casual. Nurses in hospital settings began to wear “scrubs”.
• 2009 – The Carnegie Foundation released the results of Educating Nurses: A Call for Radical Transformation , a study of nursing education.
• 2010 – The Institute for the Future of Nursing released recommendations for improved health care.

Nursing in the past laid the framework for the common purpose of health and well-being of individuals and communities. Nursing theories and processes have changed over the years, but the goal of nursing today remains the same.

How Famous Nurses Have Changed the Nursing Profession

The nursing profession has a long and interesting history forged by courageous people, almost exclusively women. Before the middle of the 19th century, most nurses were untrained and came from the lower class. Nursing was not considered to be a legitimate occupation. However, during the latter part of the 1800s and beyond, there were a number of forward-looking nurses who worked tirelessly to define and improve the role of nursing and provide the building blocks for what it is today. Wars and military nursing also have played a major role in the evolution of what nursing is today.

Florence Nightingale (1820-1910) is a name that almost everyone in developed countries knows. She is considered to be the founder of modern-day nursing. Well known for her role in the Crimean War, she returned to Great Britain in 1857 as a national hero and spent the rest of her career writing books, manuals and curriculum for nursing schools. Her very interesting Notes On Nursing
outlines her nursing theories and emphasizes sanitation, diet and psychological care of the patient. She was very much ahead of her time and a forerunner of holistic care.

Mary Seacole (1805-1881) was a contemporary of Florence Nightingale who also served in the Crimean War. To fulfill her nursing responsibilities, she delivered medicines
and supplies but also used herbal medicines and treatments that she learned from her Jamaican mother. She combined traditional nursing care of the time with alternative medicines and treatments that are gaining favor again today.

Another famous nurse was Clara Barton (1821-1912). She is best known for founding the American Red Cross in 1881 but also served in the Civil War. Always concerned with helping on a large scale, she organized the donation and distribution of medical supplies for the wounded. Later, she used this experience to organize the Red Cross. It is because of her that we have a national organization that responds quickly to alleviate suffering when disasters strike.

When one thinks of famous nurses in history, Mary Todd Lincoln (1818-1882) does not immediately come to mind, but she represents the many unknown volunteer nurses who served in the Civil War. She worked many hours in Union hospitals, tirelessly giving of herself as did so many other women of the time. She serves as an example of the many auxiliary personnel and volunteers who assist the nursing profession.

Mary Eliza Mahoney (1845-1926) was a trailblazer in nursing history as the first African-American professional nurse, and her influence is as inspiring today as it was then. After graduating from nursing school at the age of 34, she helped co-found the National Association of Colored Graduate Nurses (NACGN) that merged with the American Nurses Association (ANA) in 1951. She paved the way for minorities to enter and enrich the nursing field.

Helen Fairchild (1885-1918) was only a nurse for a short time but made a great impact on the way we view nurses in combat. In the brief time she was overseas, she wrote over 100 letters to her family describing wartime conditions and the bravery of the nurses. Because of these letters, there is a much better understanding of the value of nurses in military service.

The very controversial subject of birth control was tackled head-on by Margaret Sanger (1879-1966) throughout her nursing career. As to be expected, she had many critics, including the Catholic Church. Her legacy is Planned Parenthood that is still controversial today. She is an example of the power of public health nursing and of what just one person can do.

Most people know Walt Whitman (1819-1892) as one of the world’s best-known poets but are surprised to learn that he was a volunteer nurse during the Civil War. Many of his later writings, including Memoranda During the War, chronicle that time in history.

Dorothea Dix (1802-1887) served as Superintendent of Army Nurses in the Civil War, but her greatest achievement was as an advocate for the mentally ill. Her efforts still influence how mental institutions are run and how the mentally ill are treated today.

The modern hospice movement traces its roots to Cicely Saunders (1918-2005), a British nurse, physician, social worker and writer who dedicated her life to palliative medicine. So many people with terminal illnesses benefit from her research and teachings that define hospice care today.

Lillian Wald (1867-1940) was the founder of American community nursing. As an activist championing equal care for all, she is another example of how just one person can influence the lives of many. Her basic belief was that the world is just a larger view of a culturally diverse neighborhood.

Sarah Emma Edmonds (1841-1898) was a very interesting person who fought in the Civil War disguised as a man. Later, she worked in Washington, D.C. as a nurse and her work is recorded in Memoirs of a Soldier, Nurse, and Spy: A Woman’s Adventures in the Union Army

Linda Richards (1841-1930) was the first American trained nurse, graduating from the New England Hospital for Women and Children School of Nursing in 1873. She went on to establish nursing schools in the United States and Japan as well as instituting the first method of charting and keeping records for hospitalized patients.

Mary Breckinridge (1881-1965) was very concerned about rural health care and began family care centers in Appalachia. A nurse-midwife, she devoted her life to the care of the poor and founded the Frontier Nursing Service to ensure that people across the United States would have access to health care.

Susie King Taylor (1848-1912) was the first African-American to write memoirs about her wartime experiences. As an army nurse, she cared for black Union soldiers during the Civil War and wrote of that time. She later went on to teach former slaves in Georgia.

Eddie Bernice Johnson, born in 1935, is the first registered nurse to be elected to the United States Congress. As an African-American senator, she champions health care, racial equality and fair housing.

These are just a few of the brave individuals who have shaped nursing into what it is today. Nursing is no longer a handmaiden of medicine. It is an independent profession that stands on its own. Granted, there are still challenges to be met, but just as nursing duties and responsibilities evolved over time, these difficulties will be overcome. No longer a profession just for women, many men are finding wonderful career opportunities in nursing as well.

The nursing biographies and the time line I used was taken from the web page nursing-theory.org.

Florence Nightingale’s Influence in Nursing

Taken from a Nursing article in Wikipedia.

During the Crimean War the Grand Duchess Elena Pavlovna issued the call for women to join the Order of Exaltation of the Cross for the year of service in the military hospitals. The first section of twenty-eight “sisters”, headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, went off to the Crimea early in November 1854.

Florence Nightingale was an influential figure in the development of modern nursing. No uniform had been created when Nightingale was employed during the Crimean War. Often considered the first nurse theorist, Nightingale linked health with five environmental factors:(1) pure or fresh air, (2) pure water, (3) efficient drainage, (4) cleanliness, and (5) light, especially direct sunlight. Deficiencies in these five factors resulted in a lack of health or illness.^[21] Both the role of nursing and education were first defined by Nightingale.

Florence Nightingale laid the foundations of professional nursing after the Crimean War. Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman can help improve the care of the medically sick. Her Notes on Nursing  became popular. The Nightingale model of professional education, having set up one of the first school of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870. Nightingale was also a pioneer of the graphical presentation of statistical data.

Florence Nightingale worked by sub concepts of the environmental theory. She included five factors that helped nurses in her time of working in poor sanitation and with uneducated nurses. These factors included (1) fresh air, (2) clean water, (3) a working drainage system, (4) cleanliness, and (5) good light or sunlight. Nightingale believed that a clean, working environment were important in caring for patients. In the 19th century, this theory was ideal and used to help patients all around, even if some factors were hard to get. Nightingale made this theory with the ability to be altered. This theory was made to change the environment around the patient for the better of their health.

Nursing in the 20th Century

Taken from a Nursing article in Wikipedia.

Hospital-based training came to the fore in the early 1900s, with an emphasis on practical experience. The Nightingale-style school began to disappear. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation of nurses was not uncommon by employers, physicians, and educational providers.

Many nurses saw active duty in World War I, but the profession was transformed during the Second World War. British nurses of the Army Nursing Service were part of every overseas campaign. More nurses volunteered for service in the US Army and Navy than any other occupation. The Nazis had their own Brown Nurses, 40,000 strong. Two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire.

The modern era saw the development of undergraduate and post-graduate nursing degrees. Advancement of nursing research and a desire for association and organization led to the formation of a wide variety of professional organizations and academic journals. Growing recognition of nursing as a distinct academic discipline was accompanied by an awareness of the need to define the theoretical basis for practice.

In the 19th and early 20th century, nursing was considered a women’s profession, just as doctoring was a men’s profession. With increasing expectations of workplace equality during the late 20th century, nursing became an officially gender-neutral profession, though in practice the percentage of male nurses remains well below that of female physicians in the early 21st century.

Nursing as A profession

Taken from a Nursing article in Wikipedia.

Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected in consideration with the care setting and the population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research. The nursing process is made up of five steps: 1.evaluate, 2. implement, 3. plan, 4. diagnose, and 5. assess. Nurses are able to use this process from the American Nurses Association to determine the best care they can provide for the patient. There are many other diverse nursing theories as well.

In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.

The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.

The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide; all involve extensive study of nursing theory and practice as well as training in clinical skills.

Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual’s physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.

To work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. In the United States, a Licensed Practical Nurse (LPN) works independently or with a Registered Nurse (RN). The most significant difference between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice. RNs provide scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. RNs may earn additional credentials or degrees.

In the United States, multiple educational paths will qualify a candidate to sit for the licensure examination as an RN. The Associate Degree in Nursing (ADN) is awarded to the nurse who has completed a two-year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor’s degree-granting colleges and universities upon completion of a course of study usually lasting two years. It is also referred to as Associate in Nursing (AN), Associate of Applied Science in Nursing (AAS), or Associate of Science in Nursing (ASN). The Bachelor of Science in Nursing (BSN) is awarded to the nurse who has earned an American four-year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programs in the United States, graduates are eligible to sit for a licensing examination to become a nurse, the passing of which is required for the nursing license. The National Licensure Examination (NCLEX) test is a standardized exam (including multiple choice, select all that apply, fill in the blank and “hot spot” questions) that nurses take to become licensed. It costs two-hundred dollars to take and examines a nurses ability to properly care for a client. Study books and practice tests are available for purchase.

Some nurses follow the traditional role of working in a hospital setting. Other options include: pediatrics, neonatal, maternity, OBGYN, geriatrics, ambulatory, and nurse anesthetists and informatics (eHealth). There are many other options nurses can explore depending on the type of degree and education acquired. These options can also include, community heath, mental health, clinical nursing specialists, and nurse midwives. RNs may also pursue different roles as advanced practice nurses.

Nurses are not doctors’ assistants. This is possible in certain situations, but nurses more often are independently caring for their patients or assisting other nurses. RNs treat patients, record their medical history, provide emotional support, and provide follow-up care. Nurses also help doctors perform diagnostic tests. Nurses are almost always working on their own or with other nurses. However, they also assist doctors in the emergency room or in trauma care when help is needed.