Birth of the Nursing Profession

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Birth of the Nursing Profession

Overview

Led by the pioneering efforts of Florence Nightingale, the nursing profession arose during the middle and latter part of the 1800s. The establishment of a professional nursing corps in Europe and the United States dramatically impacted the medical profession and society in general, improving standards of care and providing an avenue for women to enter the work force.

Background

Although largely undocumented, some form of nursing has been practiced for thousands of years. Women's traditional roles of caregivers at home led naturally to an interest in medicine. Methods of nursing rose from two circles: one scientific, the other religious and social. Egyptians hired midwives to assist with childbirth. Emperors' wives tended to the ill in ancient Rome.

During the Middle Ages, crusaders left thousands of sick and injured behind in their quest to take back the Holy Land from the Moslems. Monks and knights took care of the sick when the fighting subsided. These men were known as "knight hospitallers." Many found that they preferred the role of nurse over solider, and nursing became their trade.

At the turn of the seventeenth century, however, a dark veil fell upon this early form of nursing. Monasteries to care for the ill were abolished by the Protestants and replaced by workhouses and almshouses for the poor. Places to nurse the sick were few and far between; those that did exist bore abysmal conditions. The period from 1600 to 1850 became known as the "Dark Age of Nursing."

Prisoners and elderly prostitutes provided much of the care in the remaining institutions. Overwhelming poverty, filth, and disease marred this early age of nursing. Those dumped in hospitals suffered immeasurable pain and suffering and, eventually, death. These horrific conditions lasted for several hundred years.

Nursing, as we know it today, began during the mid-1800s with a single woman's crusade to reform treatment of the ill during the Crimean War. In 1854 Sir Sidney Herbert, British Secretary of War, wrote to hospital reform advocate Florence Nightingale (1830-1910) asking her to lead a group of nurses to Scutari, Turkey, to tend to wounded soldiers. The Crimean War and Nightingale's involvement in it would forever change the course of nursing education.

Nightingale and her handpicked team of 38 women arrived at Scutari on November 4, 1854. Although they had heard horrifying reports of sickness from war correspondents, Nightingale and her team were unprepared for the misery and neglect that awaited them. Wounded soldiers lay scattered on filthy floors; cholera and typhus had spread through the unventilated and unsanitary wards like wildfire. The lack of sewers and laundering facilities, combined with a disorganized medical service, resulted in the death of one out of every two solders. Some 10,000 men required desperate medical care.

Nightingale forbid her team to care for the soldiers until they were specifically asked to do so by the doctors. In the week that followed she and the nurses set up a kitchen using their own supplies and provided meals to the ill. But the situation continued to worsen and doctors had to ask for help. Finally, Nightingale's crew took on the task for which they were trained. She enlisted the help of all the able bodied to dig latrines, clean barracks, wash laundry, and feed the soldiers. Nurses, at last, were able to care for the sick.

Nightingale tackled the task with almost fanatical devotion. She and her nurses brought remarkable improvement. The death rate of wounded soldiers soon dropped to an amazing 2.2 percent. By the end of the Crimean War the death rate was just one percent.

While ensuring soldiers were taken care of, Nightingale worked furiously to raise funds so the war hospital could function effectively. Yet Nightingale's most significant contribution at Scutari is said to be her profound sympathy for the suffering. Guided by a single lamp, she visited the soldiers late at night, attending not only to their physical needs, but looking out for their social welfare as well. "The Lady with the Lamp" made sure that, for the first time, wounded soldiers received sick pay.

At the close of the war in 1860, Nightingale founded the Nightingale School and Home for Nurses at Saint Thomas's Hospital in London. The school's establishment marked the beginning of a formalized and professional system of nursing instruction.

After Nightingale finished her rounds in Europe, another young woman began similar work on the battlefields of the United States. At the outbreak of the Civil War, Clara Barton resigned her job at the U.S. Patent Office and volunteered to distribute supplies to wounded soldiers. In 1862 Barton was granted unprecedented permission to deliver supplies directly to the front lines, which she did without fail. Two years after the war, Barton was named superintendent of Union nurses.

Years after the war, Barton learned about the Treaty of Geneva, which provided relief for sick and wounded soldiers. Twelve nations had signed the treaty, but the United States had refused. Barton vowed to investigate why. It was during this time that Barton learned about the Red Cross.

Barton's crusade for the Treaty of Geneva and the Red Cross began in 1873—the same year the first nursing school opened in the United States. She moved to Washington, D.C., where she successfully lobbied for her causes. The American Red Cross formed in 1881, and the U.S. signed the Geneva agreement the following year. Barton remained Red Cross president until 1904.

Impact

The impact of the efforts of Nightingale, Barton, and others to establish nursing as a legitimate part of the medical profession was enormous. In addition to improved standards of care, not only on battlefields but in hospitals as well, the rise of nursing provided an important venue whereby women could enter the workforce. Before this could happen, however, the nursing profession had to institute training and education standards.

During the time of Nightingale and Barton, nurses were largely untrained personnel. Female nurses fought an uphill battle for recognition of their profession. Many considered nursing a lowly job and assumed its practitioners were dubious at best. But Nightingale believed nursing to be a suitable career for women, and she worked toward ensuring that the relationship between nurses and doctors was a professional one. In 1873 in a letter offering advice to nursing students, Nightingale wrote "nursing is most truly said to be a high calling, an honourable calling." By the end of the nineteenth century, the idea that nurses needed to be educated and trained had spread to much of the Western world.

Inspired by Nightingale's founding of the first nursing school, other schools were established in the United States in New York, Massachusetts, and Connecticut. The first nursing school in the United States, New York's Bellevue Hospital, opened its doors on May 1, 1873, with little or no fanfare. The Connecticut Training School in New Haven and the Boston Training School at Massachusetts General Hospital started that same year. Five years later, in 1878, the New England Training School for Women and Children was founded in Boston.

Linda Richards became the first American woman to graduate from nursing school. She went on to become superintendent of the new Boston Training School and later founded several other training schools, including one in Japan.

Six years later, Mary Eliza Mahoney became the first African American to receive a nursing degree. The Massachusetts-born hospital worker received her diploma from the New England Hospital for Women and Children. Medical, Surgical, and Maternity Nursing were required courses during the first year, while the last four months were dedicated to home care, or Private Duty Nursing. Only 4 of 18 women who started the rigorous course with Mahoney graduated. Her high level of performance thwarted racial bias and paved the way for other African American women to enter the profession.

The nursing profession still lacked prestige, however. Male physicians often treated nurses with disrespect, others half-heartedly accepted them under the condition that they "stayed in their places." But despite the dominating male attitude, men, too, entered the nursing profession. The Mills School for Nursing and St. Vincent's Hospital School for Men were started in New York in 1888.

At the very end of the nineteenth century, historical and social events occurred that supported the rise of modern nursing. As medical science advanced and new hospital facilities opened, professional nurses slowly gained acceptance. During the early twentieth century, the army and navy nurse corps were established, increasing the need for professional training. Florence Aby Blanchfield, the first commissioned female in the U.S. Army, served as superintendent of the Army Nurse Corps (ANC) during World War II. Blanchfield commanded more than fifty thousand army nurses and began posting them near the front war lines to provide surgical nursing care.

In 1894 the Superintendents of Female Nursing Schools gathered in New York for their first annual meeting. Early nursing leaders in the United States were intelligent women who, like Florence Nightingale, possessed a great talent for organization. All shared a vision of what they thought nursing should be and they organized groups of dedicated women to implement the actions that would make the vision a reality.

In 1896 Isabel Hampton Robb, a graduate of Bellevue Training School in New York, organized the American Nurses Association and the National League for Nurses. Three years later Lavinia Dock formed the International Council of Nurses (ICN.) ICN promoted a four-fold function of nursing—promote health, prevent illness, restore health, and alleviate suffering.

Soon, nurses began performing tasks once reserved solely for physicians. Many followed doctors into specialties, such as pediatric nursing.

Today in the United States, nursing candidates must graduate from a state-approved nursing school. Options available are two-year associate degree program, a three-year diploma program (usually hospital-based), or a four-year university program. Throughout the world, registered nurses form the largest group of healthcare workers. In 1999, 1.8 million people worked as RNs in the United States. Historically, more women than men entered the nursing profession, but between 1980 and 1992 the American Nurses Association reported a 97% increase in the number of men entering the profession.

KELLI A. MILLER