National Nurses Week: Celebrating Nurses of the Past, Present and Future - Part I

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By Kristin Rothwell, NurseZone Feature Writer

In honor of National Nurses Week, NurseZone looks at how nursing has evolved, what nurses are accomplishing today and what the future holds for nurses in this special three-part series.

Note: To read about nursing's present state and accomplishments, click on National Nurses Week: Celebrating Nurses of the Past, Present and Future-Part II To read about nursing's future, click on National Nurses Week: Celebrating Nurses of the Past, Present and Future-Part III.

Most widely known for providing care to the poor, sick and wounded, nurses have also been the influential leaders in healthcare reform, political activism, civic mindedness and humanitarian efforts. Since the days of emptying bed pans, caring for hundreds of patients at one time and serving in times of war, nurses have come into their own. Today’s nurse helps to reshape healthcare delivery and has earned a new respect, not only as caregiver, but also as educator, researcher, critical thinker, inventor and leader.

Like the nurses of the past, today’s nurses continue to make more breakthroughs in their profession, including improvements in patient care, science and legislation. Though there are many more advancements ahead for nurses, the future is bright for those with the perseverance, courage and desire to become a nurse and continue the commitment to further develop and broaden the nursing profession.

Nursing: The oldest of the arts and the youngest of the professions

Nurses’ Duties in 1887

The item below is from a newspaper clipping Lois Turley, RN, found in her mother’s old Bible. The clipping outlines the job description given to floor nurses by hospitals in 1887.

In addition to caring for your 50 patients, each nurse will follow these regulations:

  1. Daily sweep and mop the floors of your ward, dust the patient’s furniture and window sills.
  2. Maintain an even temperature in your ward by bringing in a scuttle of coal for the day’s business.
  3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys and trim wicks. Wash the windows once a week.
  4. The nurse’s notes are important in aiding the physician’s work. Make your pens carefully; you may whittle nibs to your individual taste.
  5. Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m. except on the Sabbath on which day you will be off from 12 noon to 2 p.m.
  6. Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church.
  7. Each nurse should lay aside from each pay day a goodly sum of her earnings for her benefits during her declining years so that she will not become a burden. For example, if you earn $30 a month you should set aside $15.
  8. Any nurse who smokes, uses liquor in any form, gets her hair done at a beauty shop, or frequents dance halls will give the director of nurses good reason to suspect her worth, intentions and integrity.
  9. The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.

Source: Lois Turley, RN, works at an allergy clinic in Arkansas. She is a freelance writer. See Turley’s Web site at http://www.care-nurse.com.

In ancient times, nursing was not a profession but a ritual that was often carried out by sorcerers who believed that pain and illness were associated with evil. Since then, nursing has continued to evolve with the development of herbs, drugs and healthcare practices. As early as A.D. 369, St. Basil of Caesarea founded the first large-scale, Christian hospital for the seriously ill and disabled. The 300-bed facility housed victims of the plague, the poor and the elderly, ailing travelers and leprosy patients. However, since nurses were not established in the professional sense at that time, nuns took the role of nurse, standing behind the principle that they should show their love to the weak just as Christ did.

“Founder of Modern Nursing”

By the mid-1800s, Florence Nightingale revolutionized the practice of nursing by making it a more socially acceptable job pursuit for women. Influenced by the nursing techniques of the Sisters of Charity in Paris and Kaiserswerth, a hospital and school for deaconesses in Germany, Nightingale encouraged better hygiene and improved sanitation and healthcare standards among the poor.

These standards were especially important during the Crimean War, where Nightingale first developed a systematized form of record-keeping. Her careful record-keeping and statistics not only showed that mortality rates had declined with the implementation of sanitary reform, but proved to be helpful for compiling comparative hospital statistics.

In 1860, Nightingale founded St. Thomas Hospital School of Nursing in London, the first nursing school. Once nurses completed their training at St. Thomas they were sent to staff hospitals in Britain and abroad to establish nurse training schools using the “Nightingale Model.” In fact, the New York Training School for Nurses at Bellevue (the first professional school of nursing in the United States), established in 1873, was based on Nightingale´s innovative organizational principles. “Let us never consider ourselves finished nurses,” Nightingale once said.

Following the opening of Bellevue, several more nursing schools were established on the East coast, and eventually extended across the United States with the development of training schools in hospitals. The hospital schools required women to complete a two-year course of study, which allowed them, upon graduation, to work as trained nurses in the private homes of the sick. For the first 50 years of nursing in America, private duty nursing was the main form of employment.

Preventative Medicine Through Public Health Nursing

Trained as a nurse at the New York Hospital training school, Lillian Wald went on to the Women’s Medical College in New York to become a doctor. However, while organizing classes in home nursing and hygiene for immigrant families, Wald’s aspirations to become a doctor were diminished when a child led her to a tenement where a woman had been hemorrhaging for two days after giving birth. The incident forever changed Wald’s life and professional direction.

With the assistance of her friend and fellow nurse Mary Brewster, Wald established the first Nurses’ Settlement in 1895, which was later named Henry Street Settlement, with the hope of curing the sick and improving health education and public health standards. Choosing to live among the poor in New York City’s Lower East Side, Wald, Brewster and a staff of nurses provided healthcare, in addition to offering organized boys’ and girls’ clubs; courses in arts and crafts, English, homemaking and drama; social events; and, vocational training.

During the sixth year after the Henry Street Settlement opened, Wald noted that 4,472 patients were served; 25,844 nursing visits were made; and, 15,514 first aid cases were treated. As a pioneer of public health nursing, Wald believed that the nurse’s “organic relationship with the neighborhood should constitute the starting point for a universal service to the region.”

In addition to creating Henry Street Settlement, Wald also established the New York Visiting Nurse Service; National Organization of Public Health Nursing; the Metropolitan Life Insurance Company Nursing Service; the Children’s Bureau; and, the Town and Country Nursing Service of the American Red Cross.

Public health nurses soon became a vital necessity in rural areas, as well, where hospitals were not easily accessible and doctors were in short supply. While serving as a public health nurse in World War I, Mary Breckinridge became convinced that her nurse-midwife skills could help those in rural America. In 1925, she set out to the rural parts of Kentucky, where she established the Frontier Nursing Service in 1928. Entirely underwritten using her own funds,

Did You Know...

  1. There are nearly 2.7 million registered nurses in the United States. And, 2.2 million of them are actively employed.
  2. The Bureau of Labor Statistics lists nursing as one of the top 40 growth jobs for the next ten years. However, there’s a projected need for 2.6 million working registered nurses by the year 2005--that’s an additional 800,000 registered nurses above current levels.
  3. The nation's registered nurse workforce is aging significantly and the number of full-time equivalent RNs per capita is forecast to peak around the year 2007 and decline steadily thereafter, according to Peter Buerhaus of Vanderbilt University's nursing school. Buerhaus also predicted that the number of RNs would fall 20 percent below the demand by 2010 (Journal of the American Medical Association, June 14, 2000).

Source: American Nurses Association.

Breckinridge created the program around a central hospital and one physician with several nursing outposts. Due to unreliable roads and transportation, nurses at each outpost were provided a horse so they could reach remote areas in any type of weather. During the first five years of the program, the Frontier Nurses reached more than 1,000 families. Due to the success, members of the program organized what later became the American Association of Nurse-Midwives, which still exists today. “The glorious thing about it is that it has worked,” said Breckinridge on her deathbed.

Nurse Registration Movement and State Licensing Boards

By the 20th century, Ethel Bedford Fenwick gained professional status for nurses in England. Despite opposition by Nightingale and others, Fenwick campaigned for the registration of qualified nurses to safeguard the title “nurse.” Though it took Fenwick 15 years to pass the Nurses Act in England, which passed in 1919. Its passage established a nursing training program with standardized curriculum and exams.

During the same period, several state nursing associations in the United States were calling for registration laws and the establishment of state boards. Though there was opposition among nurses, law makers and the press, the licensure laws proved beneficial by upgrading nursing school requirements, lengthening the program of study and raising the standard of nursing.

“We stand today united in the belief that ‘state registration’ is necessary for our progress; that without it we remain stationary; retrogression, under these circumstances, being the inevitable result,” said Sophia Palmer, the first editor of the American Journal of Nursing and one of the first nurses to campaign for state licensing and nursing registration legislation “We are not working for ourselves in this matter, but for those who are to come after us.”

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Between 1903 and 1917, 45 states, North Carolina being the first, enacted practice acts defining nursing practice and adopting the term “registered nurse.” By 1991, all 50 states, including the District of Columbia, and the five United States territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico and the Virgin Islands) became members of the National Council of State Boards of Nursing. Through the National Council, board members created a standard qualifying examination acceptable by all state boards. Today, the National Council continues to develop licensing examinations in nursing while also meeting on matters of common interest and concern affecting the public health, safety and welfare of the nursing profession.


National Women’s Hall of Fame
National Council of State Boards of Nursing

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