Prior to the 1800s in both the United States and England, most nursing education occurred within families or religious institutions such as the Sisters of Charity. Toward the end of the nineteenth century, nursing started to be professionalized, and methods of training nurses began to evolve. This entry looks at issues of concern to nursing educators, beginning in the late 1800s, including the role of nurses in both hospitals and the community and appropriate qualifications for nursing education applicants, nursing graduates, and nursing educators.
During the 1800s, as long as hospitals were primarily charity institutions that middle-class families tried not to use, nursing tended to be accomplished either by working-class women who had few choices about work or life circumstances or by the ambulatory patients themselves. As medical science improved, especially in the areas of hygiene and nutrition, hospitals became places where middle-class people would seek care or to improve the care of the poor. Just as middle-class women managed the hired help in their own homes, early nursing educators saw the vocation of nursing as one in which women could help manage the sanitation and efficiency of hospitals, as well as teach lower-class women in the community proper preventive care of their children. This was part of the Progressive reform idealism that chaos and disease could be conquered through better sanitation. Although in England, Florence Nightingale transformed the small tasks of actual caregiving into a calling instead of merely a job, she, too, insisted that only certain educated, dignified ladies of character would qualify as nursing students.
Racism affected these decisions, too. African American nursing students were not accepted in most schools run by Whites, just as African American patients were not accepted and African American physicians were not allowed to practice. Moreover, with few exceptions, Black women were denied membership in national nursing organizations. However, within the nursing schools that were developed by African Americans, educators also expressed concern about attracting and retaining higher quality students.
Through the years, especially during war time, when the need for nurses was great, nursing educators worked hard to prevent the lowering of standards by protesting the use of volunteer aides and the reduction of class requirements. Concern about educational standards was expressed by educators in the Goldmark Report of 1923, as well as by the American Nurses Association’s 1965 position statement, which said that the basic education required before a student is allowed to take the registered nurse (RN) exam should be a baccalaureate degree. In spite of professional educators’ attempts to distinguish between a technical and a professional nurse, most nurses were trained in diploma (three-year, nondegree) schools through the 1970s, and by the early 2000s, associate degree nurses (ADNs) far outnumbered the bachelor’s degree nurses (BSNs).
One of the earliest departments of nursing was located in the Teachers College of Columbia University. The pioneering nursing educators there insisted that educational theory and methodology are essential to teaching nursing. As recently as 2003, the National League for Nursing reiterated this view in a position statement, in the face of the serious shortage of nursing educators.
The Role Of Nurses
Whites and Blacks wrestled with the problems of gender essentialism and hierarchy during the period in which women’s suffrage was an important part of the reform movement. While Florence Nightingale insisted on the value of female compassion and responsibility— she said that nursing diploma schools should be separately managed from the hospital by nurses—she also insisted (because of her military experience) on the importance of discipline and submission to authority within the hierarchy. This attitude seemed to sanction the exploitation of nursing students in hospitals.
Though they were called students, women were actually unpaid employees, with second-year students supervising and teaching the first-year students, and all the women working long hours and living in carefully monitored dorms. When there was an oversupply of nurses as a consequence of the use of student labor instead of graduate labor, some hospital trustees justified their actions by saying that well-trained nurses made good household managers.
Revering of hierarchy and discipline also cemented the authority of the physicians, in spite of the knowledge of observation, interpretation, and action required of nurses when physicians are not present; early examples of highly trained nurses without the authority of physicians were the midwives, nurse anesthetists, and cardiac care nurses.
Public health nurses, both African American and White, retained much more independence than hospital nurses, beginning with those in the Henry Street Settlement House in New York. Much of the work of these nurses involved teaching, providing preventive care, and becoming involved in social reform such as women’s suffrage and unionism. However, they considered their nursing community, as well as their patients, part of their education, in contrast to the more narrow view of education held at the university.
The nursing focus on teaching and psychosocial care continues today in the form of “nursing diagnosis,” as opposed to “medical diagnosis,” and the opening of nurse-managed clinics, in which nurses diagnose patients’ responses to illness and life situations, concentrating on disease management and life circumstances that may contribute to illness. However, some nurses prefer to try to work as colleagues with physicians, contributing to medical diagnoses and treatment.
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- Bankert, M. (1989). Watchful care: A history of America’s nurse anesthetists. New York: Continuum.
- Christy, T. E. (1969). Cornerstone for nursing education: A history of the Division of Nursing Education of Teachers College, Columbia University, 1899–1947. New York: Teachers College Press.
- Committee for the Study of Nursing Education. (1923). Nursing and nursing education in the United States: Report of the Committee for the Study of Nursing Education . . . and a report of a survey by Josephine Goldmark, secretary. New York: Macmillan.
- Hine, D. C. (1989). Black women in White: Racial conflict and cooperation in the nursing profession. Bloomington: Indiana University Press.
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- Stewart, I. M. (1943). The education of nurses: Historical foundations and modern trends. New York: Macmillan.
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