The history of nursing helps patients understand where nursing began.

Nursing began in the Middle Ages, appearing in a myriad of manifestations before adopting its contemporary form. Nurses were initially a provision by the Catholic Church to accommodate needs that were not met by physicians at the time. While doctors would respond to emergencies and treat illnesses, nurses would be responsible for assisting with matters such as ongoing patient care as well as caring for children and the elderly. As this service became more popular, it was commonplace for nurses to care for children from childbirth through adolescence. A nurses’ care was to the degree that they would even breastfeed children, resulting in the moniker “wet nurse.”

The Wisdom of Virchow

As nursing grew in prevalence, several attempts were made at establishing a stable and functional organization to represent and educate nurses. This began with Catholic nursing orders, which gave way to deaconess Motherhouses, but both failed due to the fact that nursing was associated with women, while Western society was unsupportive of female professional endeavors. Inevitably, both institutions dissolved and while some were still employed by hospitals, the majority pursued independent practices, most of who continued to care of children. Women became wary of the nursing profession, as it came with the stipulation of becoming devoutly religious.

Then, fatefully, German medical scientist Rudolf Virchow delivered a famous speech in Berlin before an assembly of women. In it, he stated five changes that he found essential in the medical field. These changes were as follows:

  • Men’s wards should be nursed by women
  • Large hospitals should contain training facilities
  • Small communities should contain training committees
  • Nurses should coalesce into organizations
  • Subjects in nursing, such as hygiene and dietetics, should be taught at special institutions

Among Virchow’s audience was Empress Frederick, who, inspired, established the first large secular school for nurses in Berlin called The Victoria House. According to the first superintendent of the institution, Faulein Louise Fuhrmann, Empress Frederick’s intention was to create a facility that would prepare nurses to provide the same service in the home that would otherwise be received only in hospitals and to establish an institution that would educate women without the constraints of the Catholic religion. Around the same time, another institution was erected, called the Nursing Association of the City of Hamburg. The nursing field grew in proportion to the prominence of the new establishments.

The two institutions functioned similarly to earlier, religion-based versions of a nursing organization, particularly given the fact that both encouraged the sworn fealty of its students in exchange for a lifelong provisionary program. More specifically, the students were compelled to sign a three-year contract prior to enrollment, although training only lasted one year. Thereafter, the students were required to work at a partnered hospital (akin to a residency program) for generally meager wages while residing in lodging provided by the organization. At the end of their tenure, they then had the option to disassociate themselves entirely or continue living and working through the organization for the remainder of their lives. Other benefits included pensions once the nurses reached 60 (which later became insurance around the turn of the 20th century) and continued assistance and care throughout the nurses’ old age and during illnesses. The women were respected within their community as the nursing profession adopted a level of prestige, but the women were often overworked due to the minimal wages offered by the hospitals that employed them. Furthermore, as the number of nurses educated and employed through organizations increased, the provisions that these institutions were offering became difficult to maintain and women were sometimes denied their sworn support.

Enter the Red Cross

In response to the Civil War, Clara Barton and a group of colleagues founded the Red Cross in Washington D.C. in 1881. This association and related institutions followed the same rubric that began with Catholic nursing orders by requiring lifelong servitude in exchange for provisions. Accordingly, many of the same issues encountered by earlier institutions continued to arise, such as an overworked and undereducated nursing base, and a rise in exploitation due to the immense cost accumulated in supporting entire generations of women during old age and sickness. This was not always the case, but it occurred often during peacetime. However, the organization continued to grow exponentially as the emergence of multiple wars, to include WWI and II as well as the Spanish American War, bolstered profit, the number of women in its ranks, and the quality of education that these women received. The Red Cross eventually became renowned for producing the most proficient and well-educated nurses.

The Trend Breaks

With the advent of a new organization in Germany, the Evangelische Diakonie Verein by Professor Zimmer, the trend of encouraged lifelong servitude was broken. Believing that women should retain as much individual freedom as possible, graduates were encouraged to find their own source of employment following rigorous training in various subjects and were given the option to receive two certifications aside nursing: teaching and household economy. Nonetheless, the organization retained a highly religious infrastructure, and a religious commitment was once again expected of women who studied within its institutions. Nurses who were not members of afore described organizations during this time were trained through smaller associations. One of these was known as the societies of St. John, which targeted women from wealthy families who were interested in light philanthropic work rather than a career. There was also an emergence of tiny schools located in cottages along the German countryside that produced a profession known as the “cottage nurse,” or the nanny, nurse, maid, and cook of a poor household. Nurses in other countries remained at the mercy of oppressive organizations, dubious educations, and cripplingly low wages offered by hospitals. At first, the Evangelische Diakonie Verein entertained a high degree of popularity and prestige, but growth reached a standstill about a decade into the 1900s.

A Nursing Revolution

During the Crimean War, English Nurse Florence Nightingale decided to summarize a series of personal principles in a book she titled, “Notes on Nursing: What it is and What it is Not” in order to improve wartime medical services. This highly influential volume altered many perspectives about the nursing field, such as a consideration of the nursing field separate of the medical field, a characterization of nurses that belies the assumption that they are uneducated and ignorant, and a perception of patient care that expounded on many areas that were unconsidered hitherto. Other developments in the field came at the hands of Agnes Elisabeth Jones and Linda Richards, who established two of the first quality nursing schools with no accompanying stipulations for enrollment or “membership” in the United States and Japan.

Attrition Spreads

As the Western World transitioned into the new century with the surging Industrial Revolution, the nursing workforce became discouraged due to the fact that the majority of nursing schools and organizations seemed to be those that were religiously or otherwise oppressive. Subsequently, nurse attrition rose significantly. In response, Agnes Karll, a German nurse educated in one of the best nursing schools at the time through the Red Cross, addressed the German National Council of Women on the matter, indicating a need for an independent nurse’s organization. After convening English, Irish, and American nurses and making the same statements, she laid the foundation for establishing the first nurses’ associations. Her ideals were well heard and hence, sewed the seed for later developments that would ultimately save the nursing profession.

The Birth of a New Profession

As the nursing field continued to develop, larger institutions such as universities began to adopt nursing as a major course of study. Men began to pursue careers in the field, diminishing the gender specificity with which it was previously characterized. With the enactment of various legislations across numerous countries of the Western World, comprehensive nurse training programs were developed. With the emergence of more educated specialists in the field, academic and professional journals soon followed. Although there are still problems with nurse attrition today, the field is now respected and just; in both the medical field and medical academia, nurses often hold high positions and play key roles in medical services and advancement.