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People make history; the history of nursing and nursing education is the result of the efforts and actions of nurses, past and present.  The purpose of this web site is to tell the history of American nurses, in their own words whenever possible. In some cases the words of past nurses were captured in their memoirs and written articles . In other cases, their stories were captured through recording their oral histories.

For the purpose of this web site, I plan to concentrate on registered nurse graduates of traditional programs :Diploma, Associated Degree and Baccalaureate degree. While I am aware of the valuable  role that Licensed Practical Nurses (LPN) and Licensed Vocational Nurses (LVN) have in nursing, I have chosen, for the sake of brevity, to concentrate on the education of  professional, registered nurses. Future plans call for research into the education of ancillary nursing roles.


The history of nursing is intertwined with the history of nursing education and
nursing’s quest for a professional identity. (Allen, 2006) Education has been vital in
providing the knowledge, skills, and ability to give quality care to our patients,
elevating nursing to a profession and gaining the respect of other professions. The
path to nursing's identification as an independent profession has not been an easy one
as nursing, dominated by women, was initially bound to the Victorian ideal of
women, and hospitals' need for an inexpensive source of workers,which conspired
to slow nursing's progress toward status as a profession. Physicians, while
recognizing the need for nursing care feared that if nurses were given too much
education the nurse would supplant them. These were challenges that nurses needed
to overcome; given the enormous challenge, slowly (some say too slowly) nurses
have risen to the challenge - thus was the profession of nursing built.



Why Study History?

One question that I've been asked is: why study nursing history? How is the history of nursing and nursing education relevant to current nursing practice? In 1907, Adelaide Nutting and Lavinia Dock wrote in the preface to their book on the history of nursing:

    ". . . the modern nurse, keenly interested as she is in the present and future of  her profession, knows little of its past. She loses both the inspiration which  arises from cherished tradition, and the perspective which shows the relation  of one progressive movement to others. Only in the light of history can she see how closely her own calling is linked with the general conditions of  education and liberty that obtain - as they rise, she rises, and as they sink, she  falls."

   The study of nursing history encourages critical reflection and assists in defining our professional identity. As such, it is relevant to current nursing practice. "Indeed, nursing history should be included as part of the nursing curriculum; including nursing history into the curriculum will allow us to educate rather than
"train" our students. In so doing, we will give them a sense of professional identity, a useful methodological research skill, and a context for evaluating information. Overall, it will provide students with the cognitive flexibility that will be required for the formation and navigation of tomorrow's health care environment" (Borsy, 2009).

References
Allen, Margaret, (2006).Mapping the literature of nursing education, Journal Medical Library Association94(2 Supplement 2006

Nutting, M. Adelaide and Lavinia L. Dock, 1907, A History of Nursing,Prefacep. V.G.P. Putnam's Sons The Knickerbocker Press, New York

Borsay, Anne,Nursing History Review 17 (2009);14-27 A Publication of the American Association for the History of Nursing, Springer Publishing Company DOI:10.1891/1062-8061.17.14 Quote attributed to :Keeling , Arlene and Mary Ramos The role of nursing history in preparing nursing for the future.Nursing and Health Care16
(l):30-34 from http://www.aahn.org Nursing History in the Curriculum: Preparing nurses for the 21st Century

Major Events in the History of Nursing Education

Emergence of Nursing Schools: 'Nightingale Model' Training schools

    1872 - New England Hospital for Women

    Linda Richards: Considered America's first trained nurse

    1873 - Bellevue NY (May); New Haven, CT (October); Massachusetts General, MA (November)


Hospital based training -Nightingale Model: Differences between English model and United States model.

    English: After the Crimean war, Florence Nightingale received funding to start a school of nursing St. Thomas Hospital.
    School administration separate from hospital administration.
    United States: school under hospital administration ; apprenticeship program. Pupil nurses staffed the hospitals.
    Program length initially 2 years, increased to 3 years. Seen as women's work. Service first, Education second.


Professional Organizations:

American Society of Superintendents of Training Schools for Nurses (1893)

    Purpose “the establishment and maintenance of a universal standard of training” for nursing
    Name changed to:National League for Nursing Education (NLNE) 1912


Committee on Education: (1915 - 1918)

    Published Standard Curriculum for Nursing Schools, Purpose: To serve as a guide to training schools  regarding     standards of nursing education.. Book titles: Standard Curriculum for Schools of Nursing  © 1919     Revised 1926
    1952 - NLNE, the National Organization for Public Health Nursing, and Association for Collegiate Schools of Nursing  combine to establish the National League for Nursing (NLN)


Nurses Associated Alumnae of United States and Canada (1896)
Sponsored by Society of Superintendents of Training Schools

    Purpose: "To establish and maintain a code of ethics; to elevate the standards of nursing education; to promote the  usefulness and honor, the financial and other interests of nursing." Minutes of the Association, February, 1897   Name changed to American Nurses Association - 1912
    See "One Strong Voice" (1976) for history of the American Nurses Association


Liscensure and Registration for Nurses:

    North Carolina (1903); New York State (1904)
    Aim to protect the public: Differentiate nurses with education, who have met the standards of the profession from those    who with little or no education and therefore  have not met the standards of the profession.

I
States set standards fn order to become a registered nurse:

  •     Need a diploma from an approved (accredited) school
  •     Pass a standard examination "State Boards" (1913)
  •     At one time, needed reference from the superintendent of your school attesting to your moral character

Use of R.N. Registered Nurse - first used New York State
Other states followed at later dates. (Liscensure of professions   considered under constitution as  "States Right" )

From Apprenticeship Training to Collegiate Education

Early Collegiate Program: University of Minnesota- part Department of Medicine (1910 - first degree offered 1919) BS degree with diploma in nursing { 3 year University program + 2 years 4 months in school of nursing.)

Goldmark Report (1923)

In 1919 the Rockefeller Foundation funded the Committee for the Study of Nursing Education, to study nursing education in the United States. Josephine Goldmark, a social worker, was lead investigator and the the report, published in 1923, is known as the Goldmark Report .Committee  included Annie W. Goodrich, M. Adelaide Nutting, and Lillian Wald,

The report concluded that the quality of existing nursing programs was inadequate.

Recommendations of Goldmark Report:

  •     Nursing schools should have separate governing boards
  •     Student work week - no more than 48 hours per week
  •     Objective of training programs should be education not service
  •     Lower time to 28 month
  •     University education  recommended for future educators


As a result of the report, the Rockefeller Foundation funded an experiment in nursing education which became the Yale School of Nursing. The Yale School of Nursing was the first autonomous school of nursing with its own dean, faculty, budget,and degree meeting the standards of the University. Education took precedence over service to a hospital, with training based on an educational plan rather than on service needs

Accreditation : Setting standards for nursing education:

    Education standards for schools of nursing.
    States:  Board of Education or Board f Registration Nursing
    National: NLNE (1938) NLN 1950's.  The National League for Nursing Accrediting Commission (NLNAC, 1997)  responsible  for all accrediting activities is transferred to this independent new subsidiary..
    American Association of Colleges of Nursing (AACN) - accrediting body focused exclusively on baccalaureate and  graduate nursing programs.(1969)


WWII

Cadet Nurse Corps: Need for nurses increased; Bolton Nurse Training Act (1943) federal funds authorized for nurses training.
Accelerated curriculum; from 36 months to 30 months. To meet the  requirements of state boards, students had a 6 month practical assignment either in their home school or military. (See You Tube Video)


Post WWII

Associate Degree Program

    Committee of the Functions of Nursing: A program for the Nursing Profession (1948) Columbia University, Teacher's  College
    Range of activities involved in performing nursing functions differentiated:  from simple to complex; repetitive, uncomplicated routines to those requiring critical judgments and independent decision making ability.


Mildred Montag: Doctoral Dissertation (1948) The Education of Nursing Technicians

  •     New type of technical education proposed; 2 year program
  •     Community College; college credits
  •     Step toward BS and graduate degrees
  •     Programs started in 1951; have grown in number; Est. 60% RN's are ADN graduates.


Nurse Training Act of 1964 (“Great Society” - President Johnson)

    W.K. Kellogg Foundation: Nursing Advisory Committee: Panel report Toward Quality in Nursing:
    Phase out hospital schools:

  •     Increase number nurses graduating each year
  •     Increase number of baccalaureate nurses
  •     Increase number of master's prepared nurses
  •     Funding for nursing research
  •     Build new schools
  •     Fund programs for nurses seeking advanced degrees


ANA Report 1965

  •     All nursing education should take place in institutions of higher education
  •     Baccalaureate degrees minimum preparation for all nurse leaders (ex. head nurse) , administrators or supervisors.
  •     Associate degree (community college) minimum education for  technical


Nursing Education: Graduate /Studies and Advance Practice

  •     Clinical Nurse Leader (CNL) Master's
  •     Doctor Nursing practice (DNP)
  •     Nurse Practitioner
  •     Public Health
  •     Doctor Philosophy Nursing (PhD) Research


Institute of Medicine (IOM) Reports

Mission to improve health by providing "unbiased, evidence-based and authoritative information and advice concerning health and science policy to policy makers, professionals, leaders in every aspect of society, and the public at large Not part of federal government.
[See Finkelman, Anita and Carole Kenner 2010 ,Teaching IOM 2nd Edition ANA Publications]  .

Implications for Nursing Education

  •     Interdisciplinary assessment of care needs
  •     Examination of evidence to support care needs
  •     Interdisciplinary plan of care
  •     Evaluation of care using a quality model
  •     Application of quality improvement techniques and informatics to adjust the plan based on patient outcomes.


Results:

Evidence Based Practice (EBP)
"EBP as a problem solving approach to the delivery of health care that integrates the best evidence from well-designed studies and patient care data, and combines it with patient preferences and values and nurse expertise." (AJN, January, 2010 Vol 110, 1.) See American Journal of Nursing series(2009)  on Seven Steps of Evidence Based Practice.

Project: Transforming Care at the Bedside (TCAB)
2003 - Robert Woods Johnson and Institute for Health Improvement funded. Redesign work environment; QI approach involving frontline managers and staff. . IOM report Keeping Patients Safe (2004)
For TCAB reports on individual projects  see  series of American Journal of Nursing articles (2008)

Education Resources: Technology

    . Clinical Laboratory: Simulation

Skills:Mrs. Chase to Sim-Man: Problem solving/ Critical Thinking

    Point of Care : Tech-Tools:Reference: PDA's (Blackberries; Smart Phones)


Evidence Based Practice

    Medications
    Procedures
    Communication

History of Nursing Education: In Our Past, Lies Our Future