Changes in Nursing Schools: From Sources of Free Labor to Respected Institutions

NursingDecember 11, 2014

Whether you have completed nursing school or are juggling it right now, you may be surprised to learn that the nation's first nurses did not need any education. This is because nursing did not start out as an organized profession. In the early history of nursing, nurses were individuals who decided that they wanted to take care of members of the community. Nursing therefore started out as home health care far before it moved into hospitals and clinics. Changes in nursing during wars initiated the creation of formal nursing education.

Nurses During War

It wasn't until after the Civil War that nursing education became more common, but it was a European nurse by the name of Florence Nightingale who spurred this development. Nightingale practiced at a hospital in London when the British Secretary of War, Sidney Herbert, sent her a letter. It asked her to assemble a team of nurses to take care of sick and injured soldiers at the Crimean War zone. While her work there made her a hero, her most lasting impact on nursing took place after the war. She established a nursing school and wrote the widely influential "Notes on Nursing," which outlined nursing standards and principals. Shortly thereafter, the United States was plagued by the Civil War. Nurses played key roles taking care of wounded soldiers. The war made it clear that nurses could make a significant difference in patient care, and shortly thereafter, several nursing schools launched.

Formal Nursing Schools

The first nursing schools were associated with hospitals. While the programs were based on the teachings of Nightingale, in reality, the nurses spent much time serving as free labor for the hospitals. Gradually, their responsibilities and education improved. According to the National Women's History Museum, schools were motivated to provide better training because a nurse's cap identified her school even after graduation. The hospital's reputation was therefore only as good as the nurses they trained. Early nursing schools were segregated as were workplaces for nurses. Men were typically not accepted into nursing programs until civil rights laws outlawed it. When state licensing boards started implementing training requirements and licensing systems, nurse education became more formalized.

Nursing Education Today

There have been many changes in nursing since hospital-affiliated education first started. Current nursing programs are highly regulated institutions. Traditional hospital-based nursing education still exists, where students become nurses by obtaining a diploma in nursing and then passing the National Council Licensure Examination (NCLEX) exam. More common today, however, are nursing programs at colleges and universities, such as an Associate Degree in Nursing Program (a two-year program) or a Bachelor of Science in Nursing Program (a four-year degree). After passing the NCLEX exam, students can practice as nurses or continue to earn graduate degrees. Today, it's difficult to imagine nurses practicing without any education, or nursing schools asking their students to spend much of their time cleaning hospital rooms. Most current nursing schools offer challenges even before you attend your first class in the form of a comprehensive entrance exam. The strict requirements to become a nurse not only ensure that patients are protected, but they have also increased the respect the public has for the profession. 


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