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The Movement of Nursing to a Respectable Profession

Late 18th century: the start of nursing manual use

Kaiserworth, Germany 1821 - Pastor Theodor Fliedner founded a hospital for the sick and to serve as a teaching facility for deaconess instruction.

1836 - Gertrud Reichardt, daughter of a physician, was the first probationer of the hospital. Pastor Fliedner’s wife instructed the deaconesses.

The Kaiserworth nurses became respected worldwide for their honorable reputation

Elizabeth Fry referred Florence Nightingale to Kaiserworth

Ireland and Worldwide 1831 - Catherine McAuley and a group of Irish women formed a system of nursing known as careful nursing.

Philadelphia 1836 - The Nursing Society of Philadelphia founded

1850 - home and a school of instruction opened

Early 19th century: efforts to formalize nursing education began

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American Hospital Training Programs and Diploma Schools

Nursing training programs started simultaneously when society accepted and provided opportunities for college education for upper class women

Nursing education became established as an apprenticeship training under the control of physicians and hospitals

First nursing training programs: established 1872 and 1873 in Boston, New Haven, and NYC

Nursing programs were opened for black nursing students in the 1880s

By 1880, 15 programs existed

Within a decade, number of programs grew to 432 and had graduated 3,456 nurses

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How the Programs Worked

Early training schools had some autonomy, but depended on hospitals for financial support, eventually becoming nursing service departments within affiliated hospitals

Students worked 7 days/wk, 50 wks/yr, for 1-2 years in exchange for on-the-job training, few lectures, and small allowance

Only unmarried (single or widowed) women were accepted

Hospitals discovered the advantages of patient care with students/faculty (more patient care and larger profit)

Led to the increase of nursing programs from 15 to 2,155 between 1880 and 1926

Australia and Great Britain also had programs

Hospital training programs became the dominant form of nursing education in the early part of the 20th century

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Proliferation of Nursing Education Programs

Nursing programs between 1880 and 1900 resulted in widespread variance in nursing education and quality

Linda Richards, first trained American nurse, led  reforms in major American nursing programs

Isabel Hampton Robb led the first educational program for nursing faculty at Teacher’s College in New York in 1901

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Timeline

1897 - First school for training practical nurses opens

1893 - Daughters of the American Revolutions serve as the examining board for military nurses

1903 - North Carolina becomes the first state to require registration of nurses

1911 - 1,006 hospital-based nursing training programs and the 90 mental health institution-based nursing programs exist

1923 - The Goldmark Report proposes the additional education beyond the basic diploma is needed for practice in public health, nursing education and supervision

1909 - University of Minnesota starts a baccalaureate degree nursing program

1920s - Apprenticeship approach dominates nursing educations

1926 - 25 nursing programs grant Bachelor of Arts (BA) or a Bachelor of Science degree in Nursing (BSN), with Yale opening the first separate university nursing program department

1930 - 11 practical nursing programs operate in the United States

1936 - 1472 hospital-based education programs, 70 collegiate nursing education programs, and 36 practical nursing programs exist

1941 - Crash Programs are developed to train nursing aides to alleviate the nursing shortage of World War II

1948 - The Brown Report ranks nurses as important to the society as teachers and ranks collegiate nursing education as equal to other professional education programs

1952 - Accreditation programs are created for practical and professional      nursing schools

1954 - 296 practical nursing programs are in existence

1958 - Birth of ADN programs in community colleges

1964 - The Nursing Training Act is enacted

1965 - The ANA releases its Position Paper on Education for Nursing

1966 - 797 hospital-based, 218 ADN, and 210 BSN programs exist

1982 - 288 hospital-based, 742 ADN, and 402 BSN programs exist

2003 - 60 hospital-based, 890 ADN, and 661 BSN programs exist

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Baccalaureate Programs

In 1893, the School of Medicine at Howard University established the first nursing diploma program within a university setting

In 1909, University of Minnesota established a 3-year diploma nursing program within its College of Medicine

Eventually, colleges adopted the pattern of combining academic and professional nursing courses that led to both a diploma and a BSN degree.

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Associate’s Degree Programs

The Brown Report and the Ginzberg Report suggested that nursing education should be moved from hospitals and be transferred to a college setting.

Mildred Montag suggested that technical nursing education should be taught at a college, which would result in a terminal degree and would be able to attain a semi professional identity.

Upon graduation, a person with a technical degree would be prepared for hospital or nursing home employment

Graduates from ADN programs were given the same professional nursing licensure examination as graduates from diploma and baccalaureate programs

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References

Hood, L.J.  (2018). Leddy and Pepper’s Professional Nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.