The Evolution of Women in Nursing


By Joe Whyte

Nursing as a profession is older than many people believe.
Although some of the very first known nurses were men who established the first nursing school in India in about 250 BC, the deaconess Fabiola played a role in ancient Rome in establishing the first Christian hospital in Rome. In fact, in ancient Rome, nurses - almost always female - ran hospitals and made home visits. Midwives also existed in the earliest societies. However, the preferred "nurse" remained a member of one's own family. "Hospital" was used equally as a place for the sick and a place for the destitute.

In the Medieval era most hospitals were run by, and as part of, convents or monasteries. This, of course, ended with the reformation, with the sick ending up in almshouses and municipal hospitals. Most "nurses" were commoner women who had no other way to make a living.

The first formal nursing schools were developed in the mid 19th century, but even then the women received only very basic instruction and the schools were strongly religious in nature. Nursing was still considered a female religious vocation.

In the mid 1800's, we meet Florence Nightingale. Many people believe she invented nursing, when in fact; she turned it into a profession. She was an educated woman by the standards of the day, properly prepared to be an upper class wife and mother. Instead, she claimed a vocation to serve others and trained, briefly, at a protestant school and hospital in Germany. Florence became superintendent of a small women's hospital until the Crimean war broke out. Nightingale discovered that British servicemen had no nursing care. She formed a group of nurses and traveled to the Crimea. Even though she didn't know anything about pathogens, she introduced modern hygiene and laid the foundation for evidence-based practice - creating the modern nursing profession and having a strong influence on medicine in general.

On her return to England, she was given a trust fund, which she used to establish the first modern School of Nursing at a London hospital, combining classroom education with practical experience.

The Civil War broke out in 1861 and America faced all of the same problems. Volunteer nurses with minimal training did most of the care for the wounded. Some of these women returned home after the war and, using Nightingale's model, founded nurse training schools of the modern type. Despite opposition from eminent physicians, nurse training schools spread through the country, although many were thinly-veiled means of getting cheap labor for the hospitals they were connected to. Licensing for nurses did not come about until the start of the twentieth century.

Modern nursing education
started to coalesce after World War II, with more and more nurses seeking college degrees and the schools seeking independence in control and funding from the hospital. Most nursing education remained diploma based programs or associate degree programs. These associate degree programs, created after World War II, finally re-opened the nursing profession to men (and also to older and married women).

Slowly, the education system moved from hospitals to universities and with that move came advanced degrees for nurses. With higher levels of education, the role of nurses began to expand, and nurses learned to perform tasks previously reserved for doctors. This role continues to expand today.

Online university education became popular towards the end of the twentieth century, and nursing education opportunities helped this new format to grow. The online courses are used in conjunction with practical training, and form an important part of modern nurse education and encouraging nurses to continue their education with advanced degrees. An online university cannot substitute for all aspects of nurse training but it does open nursing to more prospective students.