A Brief History of Nursing

A Brief History of Nursing in the United States

Exploring the history of nursing in the United States offers insight into the critical role these professionals play in healthcare. Nursing is a dynamic field that has developed swiftly since its official start in the late 19th century. Initially, before receiving formal training, nurses learned through experience, often volunteering in caregiving roles. Today's nurses are held to strict ethical standards and undergo comprehensive education to adhere to healthcare best practices. The education and roles of nurses within the U.S. healthcare system have undergone substantial changes. This concise history of the nursing profession covers the creation of formal nursing education, licensing of the nursing practice, introduction of nursing ranks, and influential figures in nursing.

Creation of Formal Nursing Education

As healthcare progresses, so do the educational requirements for nurses and other healthcare professionals. Early nursing education was quite basic, relying largely on knowledge passed down from other nurses and doctors. Initial nurse training focused on practical bedside care, lacking formal medical science education. Early nurses were more akin to advanced caregivers than healthcare specialists. Early nursing graduates were advised against offering their opinions on medical administration, leaving diagnoses and treatments to doctors. In contrast, modern nurses are expected to contribute their insights to healthcare teams, a right earned through thorough training in human anatomy and healthcare practices aimed at improving patient care.

Florence Nightingale revolutionized nursing education by introducing a science-based approach. In 1860, she established the first formal nursing school, the Nightingale Training School for Nurses, at St Thomas' Hospital in London. This institution profoundly impacted the nursing field and served as a model for similar schools worldwide. Today, nurses typically spend three years in nursing school, with a minimum requirement of an Associate Degree in Nursing (ADN) from an accredited institution to start their careers, while others pursue higher degrees.

Licensing of the Nursing Practice

Initially, nurses did not need formal education or professional licenses to practice. Early nursing relied more on experience than formal education, as their roles were more care-oriented than scientific. Now, aspiring nurses must obtain formal education and licensure to advance their careers. Nurses with an ADN must pass the National Council Licensure Examination (NCLEX) to work. Registered Nurses (RNs) take the advanced NCLEX-RN exam to assess their expertise and leadership skills. Nursing licenses must be renewed every two years from the initial date. Various nursing certifications exist, sometimes required for specific roles. Nurses aiming for specialties like cardiac or critical care often need certification to validate their skills and experience. Healthcare organizations decide the necessity of certification for employment. Depending on the certification, nurses might need to complete continuing education credits and practical experience before applying. These certifications also require periodic renewal.

Introduction of Nursing Ranks

A major development in nursing is the establishment of nursing ranks. Today, there are six levels of nursing professionals in the U.S.:

• Certified Nursing Assistant (CNA): Entry-level position; training can be completed in as little as 12 weeks.
• Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN): Typically requires one year of training.
• Registered Nurse (RN): Requires an Associate or Bachelor of Science in Nursing; programs usually span two to four years.
• Advanced Practice Registered Nurse (APRN): Includes Nurse Practitioners, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Midwives; requires a Master's degree.
• Doctor of Nursing Practice (DNP): The highest level of nursing education; programs can take up to eight years, including special licensure and certifications.
• Chief Nursing Officer (CNO): An executive role often requiring at least a Master of Science in Nursing (MSN) or higher, frequently with additional business administration training.

Each level requires different educational qualifications and responsibilities, reflecting the diverse opportunities within the nursing profession.

Influential Figures in Nursing

When thinking about nursing, several pioneers come to mind due to their significant contributions:

• Florence Nightingale: Known as the founder of modern nursing, she established the first formal nursing school and emphasized the importance of sanitation and hygiene in patient care.
• Mary Breckinridge: In 1925, she founded the Frontier Nursing Service in rural Kentucky, providing essential healthcare to underserved rural women and children.
• Mary Eliza Mahoney: The first African American woman to complete nurse's training in the U.S. In 1908, she co-founded the National Association of Colored Graduate Nurses (NACGN), advocating for the equality of African American nurses.
• Virginia Henderson: A prominent 20th-century nurse who made substantial contributions to nursing education, practice, and research. Her work remains integral to training and has helped define the modern nursing profession.

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