Nursing Education, History of

Appropriate Qualifications

During the 1800s, as long as hospitals were primarily charity institutions that middle-class families tried not to use, nursing tended to be accomplished either by working-class women who had few choices about work or life circumstances or by the ambulatory patients themselves. As medical science improved, especially in the areas of hygiene and nutrition, hospitals became places where middle-class people would seek care or to improve the care of the poor. Just as middle-class women managed the hired help in their own homes, early nursing educators saw the vocation of nursing as one in which women could help manage the sanitation and efficiency of hospitals, as well as teach lower-class women in the community proper preventive care of their children. This was part of the Progressive reform idealism that chaos and disease could be conquered through better sanitation. Although in England, Florence Nightingale transformed the small tasks of actual caregiving into a calling instead of merely a job, she, too, insisted that only certain educated, dignified ladies of character would qualify as nursing students.

Racism affected these decisions, too. African American nursing students were not accepted in most schools run by Whites, just as African American patients were not accepted and African American physicians were not allowed to practice. Moreover, with few exceptions, Black women were denied membership in national nursing organizations. However, within the nursing schools that were developed by African Americans, educators also expressed concern about attracting and retaining higher quality students.

Through the years, especially during war time, when the need for nurses was great, nursing educators worked hard to prevent the lowering of standards by protesting the use of volunteer aides and the reduction of class requirements. Concern about educational standards was expressed by educators in the Goldmark Report of 1923, as well as by the American Nurses Association's 1965 position statement, which said that the basic education required before a student is allowed to take the registered nurse (RN) exam should be a baccalaureate degree. In spite of professional educators' attempts to distinguish between a technical and a professional nurse, most nurses were trained in diploma (three-year, nondegree) schools through the 1970s, and by the early 2000s, associate degree nurses (ADNs) far outnumbered the bachelor's degree nurses (BSNs).

One of the earliest departments of nursing was located in the Teachers College of Columbia University. The pioneering nursing educators there insisted that educational theory and methodology are essential to teaching nursing. As recently as 2003, the National League for Nursing reiterated this view in a position statement, in the face of the serious shortage of nursing educators.

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