The History of Nursing: From Ancient Times to the 20th Century

History of nursing

Treating the sick is nothing new. People have cared for the sick throughout history, beginning in ancient times. However, considering the long history of nursing, it was not until fairly recently that nurses received a formal nursing education. Over hundreds of year, nursing has undergone an evolution, eventually transforming itself into the respected profession we all know of today. Read on to find out how the progression of nursing through the years has helped to shape the modern healthcare system.

Nursing in Ancient Times

In some early cultures, the provision of nursing care was assigned to females, because women provided nurturing to their infants and it was assumed that they could provide the same type of care to the sick and injured. In other ancient societies, however, men were designated to care for the sick, because they were considered priests, spiritual guides or “medicine men.”

There was no formal education available in primitive societies, so the earliest nurses learned the tricks of the trade via oral traditions that were passed down from one generation to the next. They also learned how to nurse patients back to health through trial and error and by observing others who cared for the sick. The earliest nurses used plants and herbs to heal and believed that evil spirits and magic could affect one’s health. Illness was often viewed as a sign that something was done to offend the priests or gods.

The Egyptian healthcare system was the first to maintain medical records starting at around 3000 B.C. Egyptian society was also the first to classify medications and develop plans to maintain people’s health. In ancient Rome, during the early Christian era, deaconesses were selected by the church to provide care for the sick. Deaconesses had some education and were selected by the church’s bishops to visit and care for the sick in their homes. The deaconess Phoebe is considered to be the first “visiting nurse” who provided expert home nursing care.

Nursing in Medieval and Early Modern Europe

Throughout the history of the nursing profession, nursing care provided in patients’ homes was preferable. Only people who didn’t have family nearby sought nursing care at hospitals. Religious communities founded the earliest hospitals during the Middle Ages. Nuns and monks established care for the sick poor in hospes, which were facilities located near churches or monasteries that provided nurturing and palliative care. The words hospital and hospice are derived from this term. The Christian faith stressed personal responsibility for one’s health and for others, which was reflected in the care of the sick.

During the Renaissance period from 1500 to 1700, a growing interest in science and technology led to advances in medicine and public health. At the time, the rich paid for their sick to be cared for at home, while the poor were cared for in hospitals. By the time many poor people arrived at hospitals, they were already very ill, so they often died in the hospitals. Being hospitalized had negative connotations for most people, as hospitals were considered places where people went to die.

Following the Protestant Reformation, monasteries and covenants were closed and the lands were seized. “Common” women who were too old or ill to find other jobs started caring for the sick. Although there were a few hospitals in Protestant Europe, there was no regular system of nursing. Female practitioners cared for neighbors and family, but their work was unpaid and unrecognized. Sick people who did not have family members to take care of them were warehoused in hospitals overseen by attendants who had no knowledge of nursing care. In Catholic areas, however, the tradition of nursing nuns continued uninterrupted.

Foundations of Modern Nursing

Modern nursing began in the 19th century in Germany and Britain. The practice had spread worldwide by about 1900. British social reformers advocated for the formation of groups of religious women to staff existing hospitals in the first half of the 19th century. Two influential women in the field of nursing during this time period were Elizabeth Fry and Florence Nightingale.

Elizabeth Fry

The Quaker Elizabeth Fry founded the Protestant Sisters of Charity in 1840. Members of this sisterhood received a rudimentary education in nursing and observed patients at two London hospitals. In 1848, the English Protestant sisterhood St. John’s House was founded. These sisters lived together as a community and participated in a two-year long nursing education program. They were required to work for St. John’s House for five years in return for room and board plus a small salary. They nursed for a few hours each day and spent the rest of the time in prayer and religious instruction.

Impressed with the work of Elizabeth Fry, the German Lutheran pastor Theodor Fliedner established a Deaconess Home and Hospital in Kaiserswerth, Germany. Together with his wife, Fliedner founded a training program in which deaconesses learned about nursing, religious instruction, and the provision of social services.

Florence Nightingale

Florence Nightingale was a philanthropist from a wealthy English family who studied nursing under the direction of Pastor Fliedner in Germany. Nightingale forever changed the practice of nursing. At the time, it was unusual for an upper-class woman to care for the sick, but Nightingale felt a calling to serve humanity.

Upon graduating from the nursing education program, Nightingale was appointed superintendent of the Upper Harley Street Hospital in London, a small hospital for sick and elderly women of the upper class who were experiencing financial difficulties. She also observed the hospital work of the Catholic Sisters of Charity in Paris and volunteered at the Middlesex Hospital during the cholera epidemic.

When the Crimea War broke out in 1854, Nightingale was appalled to discover that the mortality rate of British troops was 41% and that the British army lacked nurses. Nightingale received permission for herself and a group of upper-class women to travel to Crimea to care for sick and injured troops. Nightingale believed that dirt was the cause of disease, so she ensured that the soldiers’ barracks and hospital wards were thoroughly scrubbed and that they had plenty of sun and fresh air. She also documented the results of her care and used these records as the basis for further interventions. Her work was the foundation for today’s evidence-based nursing practice.

Owing to Nightingale’s efforts, the number of deaths among British soldiers decreased dramatically within months. When Nightingale returned to England, she was hailed a heroine. She then established the Nightingale School of Nursing at St. Thomas’s Hospital in London, offering education for professional nurses. Unlike previous nursing education programs, Nightingale’s school combined classes in nursing theory with clinical experiences at hospital wards.

The History of the Nursing Profession in the US

The Civil War laid the foundation for professional nursing in the United States. There were no nursing schools or trained nurses in the United States at the time, but thousands of women left their husbands and/or families to serve as nurses and care for sick and injured soldiers. According to USA Today, Union hospital documents show at least 21,000 women on the payroll during the war.

After the Civil War, hordes of immigrants came to the United States and people flocked to the cities from rural areas to work in factories. Crowded, unsanitary living conditions in cities led to the spread of disease. Many of these new arrivals lacked family members to take care of them, so they sought care at almshouses, which eventually evolved into hospitals.

Drunkards, former convicts, and former prostitutes provided much of the nursing care at these early hospitals. Social reformers and physicians in the United States promoted the idea that safe nursing care was important and that nursing care should be provided by those with a formal education. They worked to sanitize almshouses and hospitals as well as provide patients with better care.

US Nursing Schools: The 19th and 20th Centuries

In the late 19th century, nursing professionalized rapidly in the United States. Women who had served as nurses during the Civil War realized the importance of a formal nursing education and played a crucial role in establishing the first nurse training schools. Hospitals began setting up nursing schools that attracted women from both working-class and middle-class backgrounds.

The first permanent school of nursing founded in the United States was the nurse training school at the Women’s Hospital of Philadelphia, which was established in 1872. In response to nurse shortages after World War II, the first associate’s degree in nursing (ADN) program was founded. As the number of ADN programs increased, the number of hospital-based diploma programs declined.

During the second half of the 20th century, the number of baccalaureate and graduate programs in nursing grew rapidly. Graduate nursing programs focusing on clinical specialties laid the basis for the expansion of advanced practice nursing. By the end of the 1960s, there were 1,343 nursing schools with 164,545 nursing students enrolled, according to the National Student Nurses Association (NSNA).

Joining the Future of Nursing

From the beginning of mankind, people have performed the functions we know now as nursing care. Nursing has come a long way since its early days, when nurses were untrained and looked down upon by the rest of society. Today’s nurses are well educated and have earned the trust and respect of the public. The history of nursing shaped our current healthcare system, but nurses must continue to monitor developments in science and technology, as well as changes in society to determine how to best need the needs of the future. Explore nursing education programs today if you would like to play a part in influencing the future of the nursing profession.