The History & Evolution of Nursing

November 23, 2022

The History & Evolution of Nursing

During National Nurses Week 2020, we at Clipboard Health are particularly inspired to honor our nurses, given the tremendous courage they are displaying during the COVID-19 pandemic. Nurses around the country and across the globe are putting themselves at significant risk to do what they do best, compassionately treat and comfort patients while they battle illness.

As the pandemic situation unfolds, we realize how utterly essential nurses are to modern life. We expect when we fall sick, someone with training will care for us and heal us, even at risk to themselves. It makes us wonder, how did this expectation come about? And how did our system of nursing come to be?

The Beginning of a Calling

You can trace the origins of modern nursing back to Florence Nightingale, a British nurse and statistician who became widely regarded in Britain during her service for the Crimean War, in which she served from 1854 to 1856. Nightingale became known as “The Lady with the Lamp,” as she would visit and minister to the wounded all-day and night. In Crimea, she managed and trained a group of nurses who tended to injured soldiers. 

When she arrived at Scutari, the British hospital base in Constantinople, she found appalling conditions and a lack of hygiene.  The hospital was dirty and filled with excrement and rodents.  Supplies, food, and even water were in short supply.  Nightingale organized the cleaning of the entire hospital, ordered supplies, and implemented hygienic procedures such as handwashing to prevent the spread of infection. Some credit Nightingale with reducing the death rate in the hospital by two-thirds, on account of her advocacy for proper supplies and sanitary procedures.

When Nightingale returned from Crimea, she set up the Nightingale Training School, using money that had been awarded to her by Queen Victoria in recognition of her work in the war. In 1859, she wrote Notes on Nursing, which became the premier text in nursing schools at the time, and Notes on Hospitals, which advised on how to run civilian hospitals properly. 

Nursing Ramps Up — American Civil War

In America, modern nursing practices began to take shape during the Civil War. Before that, women would take classes at hospitals and then use their skills to nurse family members at home. During the Civil War, Dorothy Dix, the superintendent of the United States Sanitary Commission, which provided medical care to the Union, convinced the medical corps to accept women to help tend to patients. The women were well-regarded and much appreciated. Approximately 20,000 women served the Union across 350 hospitals, where they assisted doctors during procedures, helped with feeding and cleaning of soldiers, administered medications, and provided comfort and emotional support. 

A notable nurse during the period, Clara Barton, became famous for devising a system to distribute food, medical supplies, and other provisions across the battlefields of the war. Later, Barton would go on to found the American Red Cross, which continues today to provide disaster relief, organize blood drives, and provide basic medical training, such as CPR and CNA classes.

A Profession is Born

Nursing became professionalized after the Civil War. The Nightingale system of nurse training was adopted and offered at hospitals. The first professionally trained nurse in America was Linda Roberts, who graduated from the New England Hospital of Women and Children in Boston in 1873. You can thank Roberts for pioneering the concept of modern charting, by creating a system of written medical notes and records. Initially, nurses were communicating notes orally.

Another notable nurse of the time, Isabel Hampton Robb, became superintendent of the John Hopkins Nursing School in 1889. While there, she made several impactful changes to nursing training, such as extending the program from 2 to 3 years and establishing an eight-hour workday for nurses. In making these changes, Hampton Robb elevated nursing from a lowly, working-class job, to a revered profession. She also wrote the foundational text Nursing: Its Principles and Practice, which outlined the curriculum for a three-year nursing education, provided protocols for sanitation on hospital wards, and laid out a method for taking bacteriological notes.

In the 1800s, the idea of the public health nurse arose and likely originated with Lillian Ward, who founded the Henry Street Settlement in New York City in 1893. She wanted to bring nurses into the community, with a focus on assisting the poor. Public health nurses worked in clinics and schools, and they also performed home visits. These nurses taught hygiene and disease-prevention and provided services similar to primary care services we receive today. An essential part of public health nursing was understanding an illness from the perspective of the patient and providing treatments that considered the means and lifestyle of the patient.

A Need for Nurses Increases During 1918 Spanish Flu Pandemic

An event that significantly increased the optics of nursing in America was the 1918 Spanish Flu pandemic, where 675,000 Americans died. Many American nurses were overseas serving in World War II, and the country dearly felt the shortage of registered nurses. Hospitals began focusing on practical nursing training programs, which were much shorter than RN programs, to fill the void quickly. Nurses were seen as essential helpers during the pandemic, as opposed to doctors who were blamed for being unable to prevent the spread of the disease. 

Stories about heroic nurses spread, such as one about a nurse in Chicago who made a house call to treat a sick mother, but found an entire family infected with the flu, a 10-month-old baby with no food, and a delirious father roaming the streets in search of a doctor. Another much-recounted story took place in Philadelphia General Hospital, where the head nurse told the freshman nursing class that they could go home if they so chose. Instead, every student remained to help fight the illness, many of whom were stricken themselves, and six eventually died.

Nursing Becomes a Respected Career

World War II dramatically changed the landscape of work for American women. As nursing was a predominantly female profession at the time, the view of the nurse as a respected professional continued to rise. About 59,000 American nurses served in the Army Nurse Corps, and 18,000 served in the Navy Nurse Corps during World War II. Nurses served closer to the battlefield than ever before to provide immediate treatment to the wounded. Partially on account of this swift treatment, only 4% of soldiers who received post-injury medical care died during the war. 

While nurses mostly stayed out of the line of fire, 201 nurses died during the war, and several taken as prisoners of war in Japan. The US government granted nurses free education from 1943 to 1948, and in 1944, army nurses received officers commissions, dependent allowances, and equal pay. Nurses were a highly-regarded part of the war effort, and President Franklin D, Roosevelt praised their service during his “Fireside Chat” on January 6, 1945.

Modern Nursing Practices Emerge

After the war, the role of nurses evolved once again to become what it is today. Nurses became more authoritative and took control of their profession. Many had risen to senior administrative roles during the war, overseeing thousands of men, and had proved to be capable of managing large organizations. The American Nurses Association (ANA) (of which Isabel Hampton Robb served as the first president) became the leading institution for advocacy of the nursing profession. More and more, people looked to hospitals to care for the sick, and private home nursing diminished. 

Student nurses spent more time in traditional classrooms, so hospitals hired more graduate nurses at increased rates of pay, and hired nursing assistants and practical nurses to aid them. The ANA continues to “lead the profession.” It works on several fronts to advance the vision of nursing: education and credentialing, development of nursing standards, and advocacy on healthcare reform.

Today, nurses remain the cornerstone of our healthcare system, especially those working with Clipboard Health. The field of nursing continues to grow, and more areas of specialization are open to nurses as technology evolves. Nurses continue to prove how integral they are, and at no time in recent history has this been more apparent than during the COVID-19 pandemic. To every nurse out there, we at Clipboard Health thank you and wish you a Happy National Nurses Week!


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