Nursing is a rapidly changing profession. The populace’s needs, the use of technology, and public perception of a nurse’s role radically affect nursing practice. Therefore, nursing education has had to adapt to prepare the next generation of nurses.
Nursing, and nursing education, have been in a continual state of change for as long as the profession has existed. Although people have always needed care and treatment to recover from illness and injury, nursing, as we know it, has only existed for 200 years.
Nursing’s dark ages
Nurses were originally either untrained volunteers whose experience in patient care came from looking after their families. Women in religious disciplines, such as nuns, also acted as nurses. Physicians employed women whose duties included laundry, cooking, and general housekeeping. They ran errands and carried out patient care under the doctor’s strict orders.
Before the mid-19th century, nurses were not expected to have scientific medical knowledge. They were certainly not expected to have their own opinions, medical or otherwise. Nurses, who were almost invariably female, followed the instructions of the physicians they assisted. They carried out menial or repetitive tasks to free up the doctor’s time for patient care.
The Lady with the Lamp
During the Crimean War (1853-1856), stories of unsanitary conditions in Constantinople’s military hospital were published in English newspapers. British nurses led by Florence Nightingale addressed the problem. She made significant improvements and recommendations, primarily in hygiene and nutrition, reducing the hospital’s mortality rate from 42% to 2%.
Known as ‘the Lady with the Lamp,’ Nightingale is widely credited as the founder of modern nursing. However, she was also the founder of modern nursing education. In 1855, the Nightingale Fund was established in her honor for the training and education of nurses. Nightingale used the money to open the world’s first dedicated nursing school to follow a science-based curriculum. It was named the Nightingale Training School at St Thomas’ Hospital in London.
The principles on which the school was founded were outlined in Nightingale’s publication Notes On Nursing (1859), considered the first nursing manual. Nurses trained at St Thomas’ would be the best in the world and went on to high-level positions elsewhere. Nightingale’s ideas and principles spread throughout the British Empire and beyond.
Nursing education in the US
The Civil War in the US saw an increased demand for nurses. Their importance was also recognized. In 1869, the American Medical Association (AMA) encouraged hospitals to set up nursing education programs to meet wartime requirements. Dorothea Dix, who was appointed Superintendent of Army Nurses for the Union Army, and Clara Barton, who founded the American Red Cross, are seen as the US equivalents of Florence Nightingale.
Nurses were initially trained in hygiene and patient comfort. It wasn’t long, however, before physicians began delivering lectures on anatomy and physiology to nursing students. In 1888, a formal nursing program for men was established at Bellevue University. In 1892, Chicago’s Provident Hospital began the first nurse training program that accepted African-American candidates.
Nursing education in the US took another significant step forward in 1998 when the various nursing alumni associations met for the first time and formed Nurses Associated Alumnae. The organization was dedicated to advancing the standard of nursing education. It established a code of ethics and promoted the interests of nurses and nursing. Nurses Associated Alumnae eventually evolved into the American Nurses Association.
Remote learning
Today, nurses can qualify at undergraduate and master’s level online. The first remote learning courses in nursing were correspondence courses, such as the one run by the Chautauqua School of Nursing in New York, founded in 1900. It offered three options: general, obstetric, or surgical.
Modern institutions such as Walsh University have various associate, degree-level, and graduate qualifications. They can be obtained via online flexible study schedules, such as the MSN Nurse Educator program. Nursing leadership courses have many advantages over old-style correspondence courses. Chief among them is the ability to attend classes and lectures in real-time, either as they happen or at your convenience. Students can also receive feedback and answers to questions.
Moves toward standardization
In 1903, North Carolina was the first state to implement a nursing licensure exam. By 1921, all other states had similar licensure requirements. Meanwhile, the first professional nursing organization run by women proposed a standard nursing curriculum in 1915. Called the National League of Nursing Education (NLNE), it comprised seven main sections, each with at least two courses.
In 1923, the Winslow-Goldmark Report advocated upgrading nursing education by introducing national accreditation procedures. The Committee on the Grading of Nursing Schools was established in 1925, paving the way for later national accreditation programs.
A professional career
By the end of the Second World War, nurses performed a more comprehensive range of duties. They were given more responsibility and greater authority and independence. By the 1950s, nursing was seen as a respected professional career. In the second half of the 20th century, nursing education was held to ever higher standards.
With encouragement from the NLNE and the American Nurses Association, nursing courses became more demanding and science-based. The first associate nursing programs began, while the American Nurses Association recommended that nursing programs consist of four years of study. An alternative was two years at a community college to learn purely technical skills.
Nursing For The Future, a report sponsored by the National Nursing Council, appeared in 1948. It had a significant impact on nursing education. In 1970, the National Commission for the Study of Nursing and Nursing Education (AKA the Lysaught Commission) recommended statewide planning to determine the distribution of nursing programs. It also proposed improved nurse mobility and greater cooperation between nursing education and service programs.
Healthcare in the 21st century
The Consensus Model for APRN Regulation in 2008 offered guidance to states on nursing education, licensure, accreditation, and certification. This brought greater uniformity and standardization to various graduate and advanced practice nursing programs. It was followed in 2011 by The Future of Nursing: Leading Change, Advancing Health. Thatreport by the Institute of Medicine on the impact of the Affordable Care Act on nursing practice would be the blueprint for the next decade of healthcare.
The report recommended removing limits on nurses’ scope of practice. It also emphasized the need for nurses to obtain bachelor’s degrees and pursue more graduate-level education. More residency training was advocated for student nurses to provide them with invaluable hands-on experience.
Equal partners
Just as important was the report’s recognition that nurses comprised the largest segment of the healthcare workforce and spent the greatest amount of time delivering patient care. Nurses were seen as equal partners with physicians and other medical specialists in the US healthcare system. They received the highest quality of education needed to ensure that future generations could meet the standards achieved by their predecessors.
In the last decade, nursing education has also had to keep up with the rapid growth and deployment of technology in the healthcare field. Nursing has been at the forefront of implementing technological change in patient care and diagnosis, from telemedicine to digital recordkeeping, personal health monitors, and apps.
Nursing education has continued to improve as nurses take more responsibility in the workplace. The standard of knowledge and experience required to become a nurse practitioner is higher than ever. There are also many opportunities to specialize as an advanced practice nurse, from midwifery to anesthesia or to become a nurse educator.
Nursing education must keep up with the increasing demand for new nurses while meeting ever-higher learning standards. With higher levels of education among nurses shown to mean better patient care and lower mortality rates, the trend toward continual improvement is undoubtedly here to stay.
