History of Nursing

Families, neighbours, religious communities, military attendants, enslaved and free caregivers, midwives, servants, and paid watchers nursed long before modern registration. Much of their knowledge was practical and oral: positioning a breathless patient, noticing fever, preparing food, preventing pressure sores, managing linen, and recognizing when a condition had changed.

In Christian Europe, hospitals were for centuries run by religious orders whose members took vows of care for the sick. The Brothers Hospitallers of Saint John of God, who cared for patients in Spain from the early sixteenth century and were formally approved as an order in 1572, and the Daughters of Charity, founded in Paris in 1633 by Vincent de Paul and Louise de Marillac, both staffed hospital wards well before secular training existed. In the nineteenth century, deaconess institutions added a Protestant model: the Kaiserswerth institute in Germany, founded in 1836 by the pastor Theodor Fliedner and his wife Friederike, trained young women for hospital and charitable work. Florence Nightingale herself undertook training there in 1851.

Paid lay nursing, by contrast, had a poor reputation. The popular image was of elderly, often drunken women with little respect for patients or order. Reformers attacked that image as much as the conditions behind it, and the fight over who could be a nurse — and what nursing was — ran through the whole nineteenth century.

During the Crimean War (1853–56), reports of the conditions in the British army's field hospitals reached London in 1854. In November of that year Nightingale led a party of 38 nurses to Scutari, near Constantinople, where she organized supplies, food, bedding, cleanliness, and night rounds in the main hospital. Her nightly rounds earned her the nickname "Lady with the Lamp," and the introduction of female nurses was judged an outstanding success.

Nightingale's authority rested on organization as much as compassion. In her 1858 report, Narrative of Services in the Field Hospitals of the Army in the East, she showed that most soldiers had died of disease rather than wounds, and her own figures put the death rate in the hospitals she supervised at 42.8 percent before sanitary improvements and 2.2 percent after them. Later historians have questioned the exact figures, but the broad pattern — that preventable disease, not battle, killed most of the men — is well established. Her statistical work connected nursing to the history of medical statistics and to the history of military medicine.

Mary Seacole shows why nursing history cannot be reduced to the Nightingale model. A Jamaican-born nurse and businesswoman, Seacole was initially refused permission to join the official mission; she funded her own passage to the Crimea in 1855 and ran the "British Hotel" near Balaclava, a mess and convalescent house for sick soldiers. Her 1857 account, Wonderful Adventures of Mrs. Seacole in Many Lands, is a primary source for the war's care work. She combined nursing, provisioning, travel, and commerce in work shaped by colonial mobility and racial exclusion, and built authority through experience even when training institutions did not recognise her.

War nursing expanded elsewhere too. In the American Civil War, Dorothea Dix, already known for her campaigns on mental illness, was appointed superintendent of female nurses for the Union army in 1861 and organized hundreds of nurses for field and hospital service.

The model reached the United States in the 1870s: the Bellevue Hospital Training School in New York and the New Haven Hospital School of Nursing opened in 1873, and the Massachusetts General Hospital School of Nursing followed in 1874. Professional identity hardened around shared symbols — the Nightingale Pledge, composed in 1893 by Lystra Gretter and a committee at Detroit's Harper Hospital, and the Nurses Associated Alumnae, founded in 1896 and later renamed the American Nurses Association.

Yet hospital schools also relied on students as an inexpensive workforce. Probationers commonly worked long shifts, often through the night, for little or no pay, while the hospital gained a steady supply of ward labor. Reformers increasingly argued that the school existed to staff the wards as much as to educate the student — a tension that defined the next decades of nursing reform. The history of hospital nursing schools traces that tension in detail.

Nursing also connects to the history of hospitals and the history of public health: nurses worked where clinical care, domestic labor, public welfare, and preventive intervention met.

Respectability rules favored certain classes, ages, and forms of feminine behavior. Marriage restrictions, residence requirements, and moral surveillance shaped the student nurse's life as much as the curriculum.

Race also structured access. In the United States, Black nurses were often excluded from white hospital schools and built their own institutions and networks: the Training School for Nurses at Freedmen's Hospital in Washington, D.C., opened in 1894, and the Lincoln School for Nurses in New York opened in 1898. In 1908 Black graduate nurses founded the National Association of Colored Graduate Nurses, which campaigned for equal recognition and merged with the American Nurses Association in 1951.

Men also faced exclusion from many general nursing schools as nursing became strongly identified with women's work, although male attendants and nurses remained important in mental hospitals, military settings, and specialist fields. These barriers connect nursing to the history of women in medicine and to how health professions used training and licensing to define who could claim medical authority.

Registration campaigns sought consistent education and public protection. In Britain, the College of Nursing was founded on 27 March 1916 with just 34 members; after its campaign, the Nurses Registration Act of 1919 created registers for England and Wales, Scotland, and Ireland, with approved schools and examinations. Registration opened in 1921, and the Nurses Act of 1943 strengthened title protection and established a roll for assistant nurses. The College received its Royal Charter in 1928 and the "Royal" title in 1939, becoming the Royal College of Nursing.

The registers were divided into a general part and supplementary parts for fever, male, mental, and children's nurses — a division that reveals how regulation reproduced existing divisions of gender and specialty. In the United States, state registration laws developed through the early twentieth century, promoted by the American Nurses Association. The Goldmark Report of 1923 criticized the dependence of hospital schools on student labor, and university programs expanded gradually — the University of Minnesota established an early university-based nursing school in 1909 — while the American Nurses Association's 1965 position paper on educational preparation pushed further toward degree-level education.

Nursing expanded through district visiting, school health, maternal and infant services, tuberculosis work, vaccination, occupational care, and disaster relief. Public-health nurses translated policy into repeated household contact, often negotiating language, trust, and poverty.

The two world wars enlarged and professionalized the workforce, and in Britain the National Health Service of 1948 moved most hospital nursing into the public sector. Nursing also gained an international organization: the International Council of Nurses, founded in 1899, marks International Nurses Day on 12 May, Nightingale's birthday. The International Committee of the Red Cross created the Florence Nightingale Medal in 1912 and made the first awards in 1920.