What is the history of nursing the development of a profession?
While female caretakers have existed in some form for millennia, the nursing profession as it is
known today has origins in the 18th and 19th centuries. Initially, most care occurred at home
or, in the Catholic Church, was provided by esteemed monks, nuns, and deaconesses. Nursing as
a profession has existed throughout history, although it has evolved considerably over time. In
the current healthcare system, nurses are one of the most trusted healthcare professionals with a
significant role to play in the treatment and medical care of the sick.
Early history
The first known documents that mention nursing as a profession were written approximately 300
AD. In this period, the Roman Empire endeavored to build a hospital in each town that was
under its rule, leading to a high requirement for nurses to provide medical care alongside the
doctors. The profession of nursing became considerably more prominent in Europe in the middle
ages, due to the drive for medical care from the Catholic church. In this period, there were many
advancements and innovations that took place, which eventually went on to form the base of
modern nursing, as we know it.
The first Spanish hospital was built in the late 500s to early 600s in Merida, Spain, with the
intent to care for any sick individuals regardless of ethnic origin or religion. Several others were
created in the following centuries but their upkeep was neglected until Emperor Charlemagne
began to restore them and update the supplies and equipment in the 800s.
Throughout the 10th and 11th centuries, the nursing profession expanded due to changes in rulings
in Europe. Hospitals began to be included as part of monasteries and other religious places and
the nurses provided a range of medical care services, as was required, even beyond traditional
healthcare. This all-encompassing model gained popularity and continues to be responsible for
the wide range of duties a nurse is responsible for today. At the beginning of the 17th century, the
nursing as a profession was rare due to various reasons, such as the closing of monasteries that
housed the hospitals. However, in some regions of Europe where the Catholic church remained
in power, the hospitals remained and nurses retained their role.
During this time, the role of nurses continued to expand due to the need for their presence on the
front lines of wars, where poor hygiene standards often led to fatal infections in the injuries.
Nightingale campaigned for improved hygiene standards in the hospital attending the wounded
soldiers, which drastically reduced the number of deaths from infections. The profession of
nursing was pushed further forward in 1860 with the opening of the very first nursing school in
London. This was the beginning of many other schools for new nurses so that they received
appropriate training and education before they began practice on the field.
However, the need for nurses expanded with the world wars in the twentieth century, and many
nurses were required to begin providing care without adequate training. Since this time,
education institutions for nurses have continued to expand. The profession has also branched out
into various specializations with further education in particular fields of nursing care, such as
pediatrics or oncology.
What Are the Origins of the Nursing Profession?
Nursing emerged as a profession in the mid-19th century. Historians credit Florence Nightingale,
a well-educated woman from Britain, as the founder of modern nursing. Nightingale challenged
social norms – and her wealthy parents – by becoming a nurse. At the time, the public objected
to the idea of women nursing strangers. But Nightingale saw nursing as an extraordinary
opportunity for females. She believed they could use their education and scientific knowledge to
improve patient care while gaining personal independence.
In 1854, during the Crimean War, the British government requested Nightingale's aid at a
military hospital in Turkey. Within weeks of her small team arriving, the mortality rate of British
soldiers fell dramatically. Nightingale's accomplishments impressed the public and ultimately
helped convince the Western world of the dignity and value of educated nurses. Modern nursing
was founded by Florence Nightingale, who challenged social norms and justified the value of
educated nurses.
The evolution of the nursing profession accelerated a decade later during the American Civil
War. As fighting erupted in the North and South, women, mostly the mistresses or wives of
soldiers, began following the armies. They primarily tended to sick troops. Pneumonia, typhoid,
diarrhea/dysentery and malaria were the most common illnesses. One notable nursing volunteer
was Mary Ann Bickerdyke. Though she was not married to a soldier, she accompanied the army
of Union Gen. William T. Sherman. After the 1863 Battle of Lookout Mountain in Tennessee,
Bickerdyke cared for 2,000 troops on her own. Illness ravaged soldiers during the Civil War. To
care for the many thousands affected, the North and South established temporary hospitals.
There, women like Capt. Sally Tompkins and Phoebe Levy Pember, who served for the South,
supervised small teams of nurses that provided treatment.
Collectively, the volunteer nurses, often female slaves, helped save a substantial number of lives.
As a result, respect for nursing grew markedly among Americans. With newfound public support
and indisputable contributions to health care, the nursing profession would develop quickly.
During the Civil War, women who volunteered to care for wounded soldiers made a significant
impact, shaping public perception of nursing.
How Has Nursing Changed Over the Years?
Training
One prominent change in the evolution of the nursing profession is formalized education. The
first training programs opened at hospitals in the late-19th century. Student nurses received
clinical instruction in exchange for providing care to patients. During this period of training,
nurses helped hospitals make tremendous improvements in safety and quality, and humanized
medical care.
By the second half of the 20th century, patient needs became more complex and hospitals
required skilled nurses to manage them. The hospital-based education model thus declined in
favor of training programs at colleges and universities.
By 1960, over 170 college nursing programs dotted the country. Texas Woman's University
opened the state's first nationally accredited nursing program in 1950, making it one of the oldest
in Texas. Today, 871 schools in the U.S. offer nursing education programs at the undergraduate,
graduate and postgraduate levels.
Texas Woman's University opened the state's first nationally accredited nursing program in 1950,
making it one of the oldest in Texas.
Nurse training continues to evolve with patient needs, and the emphasis on comprehensive
education has never been greater. In 2010, the Institute of Medicine (IOM) made a definitive
recommendation. To manage increasingly complicated patient conditions, at least 80% of
registered nurses should hold a bachelor's degree by 2020. IOM also called for doubling the
number of doctorate-prepared nurses.
This standard is also set by the American Association of Colleges of Nursing (AACN),
indicating that all registered nurses should hold a minimum of a bachelor's degree or equivalent
in nursing. Colleges and universities have acknowledged these calls by increasing the capacity of
four-year nursing programs. Since 2010, enrollment has risen by 80% in registered nurse to
baccalaureate degree programs.
There is also a greater emphasis on academic progression. AACN is urging nurses to continue
their education beyond entry-level and into graduate and postgraduate programs. By doing so,
nurses can fill the nation's demand for advanced practice registered nurses.
Responsibilities
Another highlight in the evolution of the nursing profession is that nurses now have a broad
scope of duties. No longer is nursing solely considered care-taking. According to the
International Council of Nurses, modern nursing is a mix of knowledge, judgment and skill.
The current approach to education and training has stretched nurse responsibilities. The country's
workforce of over 3 million nurses is qualified to provide patient care, serve as patient advocates,
lead health care teams and conduct research to improve care.
Nurse practitioners, in particular, can offer many of the same services as physicians. This type of
advanced practice registered nursing began in 1965 after the enactment of Medicare and
Medicaid. The legislation granted low-income individuals and people over the age of 65 with
guaranteed access to health care services.
Suddenly, more Americans were seeking medical care. To satisfy the demand, some nurses
worked with doctors to receive additional training. The result was an expanded nursing
profession in which nurse practitioners could help doctors diagnose and treat common illnesses.
Nurse practitioners are now among the most sought-after professionals in the health care field.
Specialization
Nurses can practice in many areas of specialization, thanks to medical advancements and shifting
patient needs. Dermatology, emergency and rehabilitation are just a few options. Some of the
most desired specialties, however, fall under advanced practice registered nursing.
Advanced practice registered nurses hold a minimum of a master's degree and practice as nurse
practitioners, nurse anesthetists, nurse midwives or clinical nurse specialists. By 2028, the U.S.
Bureau of Labor Statistics expects employment of nurse practitioners, nurse anesthetists and
nurse midwives to increase by 26%. That is nearly six times the average for all occupations.
The employment outlook for nurse practitioners is exceptionally bright because the U.S. lacks
primary care services. A shortage of physicians and a growing population of aging adults has
created a deficit of primary care providers. The American Academy of Nurse Practitioners
(AANP) believes nurse practitioners are best positioned to address this shortage. Nurse
practitioners are qualified to provide primary care services independently, as well as in
collaboration with other health care professionals.
Nurse practitioners can specialize in dozens of areas. The most comprehensive specialty is the
family nurse practitioner (FNP), who sees patients of all ages. They focus on health promotion,
disease prevention and the treatment of illnesses that fall under primary care. Nationally, almost
67% of nurse practitioners are certified family nurse practitioners.
Almost 67% of nurse practitioners nationwide are FNPs.
Safety and Quality
Nurses have always played an essential role in patient care. But today, that role is even more
apparent. According to the U.S. Department of Health and Family Services, nurses spend more
time with patients than doctors. They also interact regularly with every member of the patient's
health care team. These factors, in addition to indispensable clinical work, empower nurses to
ensure that health care teams are rendering high-quality care.
A vast body of evidence associates exceptional nursing with positive patient outcomes,
especially among nurse practitioners. According to AANP, research shows that nurse
practitioners provide care that is safe, effective and patient-centered. Moreover, compared with
patients of doctors, nurse practitioner patients report higher satisfaction, have fewer unnecessary
hospital readmissions and fewer potentially preventable hospitalizations.
These findings by the AANP are good news for the U.S. health care system, which ranks lower
than other developed countries for quality, access, efficiency, equity and healthy lives. Many
organizations now recognize the impact of nurse practitioners and are calling on lawmakers to
allow them to practice as fully and autonomously as they are trained to do.
Nurse practitioners demonstrate high quality of care that is safe, effective and patient-centered.
What's Next for Nurses?
Change is the one constant in the evolution of the nursing profession. Comprehensive training
has enabled nurses to assume greater responsibility in more areas of health care. Even as their
duties expand, nurses continue to provide high-quality care.
According to IOM, today's nurses have the potential to implement sweeping advancements in the
U.S. health care system. But a commitment to lifelong learning is one of the prerequisites.
The future of nursing relies partly on the academic progression and engagement of nurses. If you
are a registered nurse with a bachelor's degree in nursing, then it's time to consider earning a
master's degree. Graduate-level education can help you become proficient in areas that IOM
deems critical, including leadership, research and teamwork.
