Fundamentals Nursing

The Development of Nursing in America

In North America, nursing and health services were slow to be established before the American Revolution (1775 – 1783). One notable organization was the Nurse Society of Philadelphia, which gave women minimal instruction in obstetrics to enable them to provide maternity nursing services in home settings.

During the American Civil War, several nurses emerged who were notable for their contributions to a country torn by internal strife. Harriet Tubman and Sojourner Truth provided care and safety to slaves fleeing to the North on the “Underground Railroad.” Mother Biekerdyke and Clara Barton (who is credited with founding the American Red Cross) searched the battlefields and gave care to injured and dying soldiers. Noted authors Walt Whitman and Louisa May Alcott volunteered as nurses to give care to injured soldiers in military hospitals. They chronicled their experiences in their writing as a permanent record of nursing’s contribution during this time.

The late 1800s was a time of rapid reform of nursing services in the United States and Canada. Schools of nursing with planned educational programs were founded. A number of their graduates became the early leasers in the profession. Isabel Hampton Robb is one example a young school-teacher in Canada. Robb decided to change her profession and entered the Bellevue Hospital Training School in New York. After graduation, she nursed in Rome for 2 years, and then she became superintendent of the Illinois Training School at 26 years of age. Three years later she went to Baltimore to organize a new school in connection with Johns Hopkins Hospital. Among her many accomplishment was to author nursing textbook, which became the standard text for nursing schools in America.

Mary Adelaide Nutting, also from Canada, was in the first class at Johns Hopkins. After graduation, she established a course of training for students prior to ward experience at Johns Hopkins. Later, she reduced the nursing training to 3 years.

Mary Agnes Snively graduated from Bellevue Hospital Training School and returned to Canada to take charge of the nurses’ training at Toronto General Hospital. She is credited largely with direction of Canadian nursing education and was the first president of the Canadian Nurses Association.

Two American graduates of the New York Hospital, Lillian D. Wald and Mary Brewster, were the first to offer trained nursing services to the poor in the New York slums. Their home among the poor on the upper floor of a tenement is now famous as a center of public health nursing: the Henry Street Settlement, school nursing was established as an adjunct to visiting nursing. Again, Wald was involved, along with Lina L. Rogers.

Linda Rochards, who graduated in 1873 from the New England Hospital for Women and Children Training School for Nurses in Boston, is cited by many historians as America’s first trained nurse. She is credited with reforming nursing in 12 major hospitals, some of which were specialized mental hospitals. She also founded the first training school for nurses in Japan.

Some, however, despite that Richards was the first trained nurse. Evidence in a seriese of reports if Women’s Hospital of Philadelphia suggest that Harriet Newton Phillips was the first trained nurse to receive a certificate from that hospital in 1864 (Large 1976, p. 50). Philips is also considered the first trained nurse in America to do community nursing, to do missionary service, and to take postgraduate training.

America’s first trained black nurse was Mary Mahoney. She trained at the same hospital as Linda Richards and graduated in 1879.

The need for concerted action by nurses was first felt in England during the late 1800s. In 1894, the Matron’s Council of Great Britain and Ireland was organized, followed by the American Society of Superintendents of Training Schools for Nurses of the United States and Canada. Alumnae associations joined to form the Nurses Associated Alumnae of the United States and Canada in 1897. These North American organizations were the predecessors of current national groups. The Society if Superintendents divided nationally and ultimately became the Canadian National Association of Trained Nurses in 1908 – now the Canadian Nurses Association (CNA) – and the National League of Nursing Education in 1912. The Nurses Associated Alumnae became the American Nurses Association (ANA) in 1911. In 1908, the National Association of Colored Graduate Nurses was founded by a group of nurses who felt such an association could further not only the nursing cause but also their own interests.

In 1893, the Nightingale Pledge was written and administered to the graduating class of the Farrand (Nurse) Training School in Detroit, Michigan. At the time, the pledge reflected the nurse’s commitment to moral and ethical values and principles in the practice of nursing. Despite modern criticism of the pledge as portraying the nurse as subservient to the physician, it continues to provide “a framework for clarifying moral and ethical values and principles needed for delivering health care and promoting the standards of nursing” (Calhoun 1993m p. 130).

After World War I, the Frontier Nursing Service (FNS) was established by notable pioneer nurse, Mary Breckinridge. In 1918, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages in France and taking care of sick children. In 1921, Breckinridge returned to the United States with plans to provide health care to the people of rural America. She had initially prepared herself by taking courses at Teacher’s College in New York (where she met Mary Adelaide Nutting and gained her approval) and midwifery training in London and by developing prominent social contacts for fund-raising. In 1925, Breckinridge and two other nurses began the FNS in Leslie Country, Kentucky. Within this organizations, Breckinridge started one of the first midwifery training schools in the United States.

From the beginning of formal organization of nursing if the late 1800s to the end of World War I, the general trend was rapid expansion in the establishment of hospitals, with nursing schools dependent on them for support, Hospitals in turn depended on the schools to carry the chief nursing load. During the war, greater numbers of young women were accepted for entrance, and less consideration was given to selection requirements. Most schools by this time had adopted 3-year program, but the 8-hour day originally proposed with those programs was less quickly adopted.

By 1920, the hospital system of educating nurses was coming under increasing criticism. In addition, the effectiveness of having nurses teach other nurses was being questioned. This, a special post-basic course was offered at Teachers College, Columbia University, New York, to nursing program was also developed, in response to the postwar influenza epidemic and the medical profession’s new emphasis on teaching the principles of healthful living to individuals, families, and community groups.

During the early 1920s, the Rockefeller Survey (Committee for the Study of Nursing Education) recommended that nursing schools be independent of hospitals and on a college level. As a result, two university schools of nursing were set up, on at Yale University, New Haven, Connecticut, the other at Western Reserve University, Cleveland, Ohio. The Purpose of these experimental schools was to prove the feasibility of planning both classroom instruction and ward practice in accordance with the educational need of the students. These schools emphasized the social welfare and health aspects of nursing and demonstrated the value of university standards in the nursing field.

Another far-reaching result of the Rockefeller Survey was the National League of Nursing Education’s comprehensive study of nursing education (1926 – 1934), which led to the grading of nursing schools. It was believed that grading would establish standards for education in these schools. This was the beginning of the accreditation function now carried out by the National League for Nursing (NLN).

During this period, the concept of the clinical nurse specialist arose. In the early decades of the 20th century, hospitals started to segregate patients according to their disease process. Nurses were called upon to acquire expert knowledge in the care of specific patient types. These nursing roles were called extended or expanded roles. In the early 1940s, it was thought that more emphasis needed to be placed on the clinical specialties in the advanced professional curricula of colleges and universities. Most advanced nursing curricula were preparing specialists in nursing school administration, teaching, and supervision in public health and in hospitals administration but were not emphasizing clinical specialties. These specialties gained prominence in the post – World War II society. Nurses returning from overseas were required to work in clinical areas not familiar to them. One such area was psychiatric nursing, which helped individuals readjust to civilian life. By 1946, many nursing programs in the United States were providing more clinical content. Today the clinical nurse specialist is a graduate of a master’s or doctoral program in nursing with a major in a clinical specialty. These nurses are responsible for increasing their own clinical knowledge and competence and for enhancing the quality of nursing care and the quality of the organizational climate of learning and research.

From its early days to the present, nursing has undergone change in very area. Rapid strides have been made in nursing education programs and in a wide variety of hospital and community nursing services. Throughout these changes, nursing has continued to provide a stable service to help people. Nurses have also been part of the larger societal changes that have influenced nursing. Twentieth-century nursing leaders in the United States have been active in women’s suffrage, civil rights, and health care reform movements. Nurses have been elected to office at local and state levels. In 1992, Eddie Bernice Johnson from Texas became the first nurse elected to the United States House of Representatives. The time line running throughout this article highlights selected people and events in nursing’s history, demonstrating that nursing is a profession for and influenced by women and men of all cultural backgrounds and all socioeconomic levels.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.7-11)