The History of Nursing

The nursing profession has developed throughout history, seeing a transformation in practice, types of caregivers, roles, and policy changes, but nursing remains a profession of caring and service to those in need. Many notable nurses have worked to revolutionize this career and have allowed nursing to evolve while simultaneously providing better care and circumstances in many situations.

The earliest nurses never attended nursing school; they were often nuns or other women who provided care for the sick, poor, or homeless without family support. Women were frequently called in to work as midwives to help deliver babies, or as wet nurses to breastfeed. During the Middle Ages, early hospitals were operated by nurses who were often affiliated with religious organizations. Many of these institutions were places for patients to die, with nurses providing comfort during the final hours.

In the 18th and 19th centuries, the nursing profession expanded to include care of soldiers during many prominent wars. In 1853, Florence Nightingale served as a nurse during the Crimean War, during which she not only cared for the injured, but set standards of cleanliness in the areas where she worked; her sanitary reforms reduced the overall incidence of infection where they were implemented. Nightingale moved on to author a book called Notes on Nursing, which was written as a set of guidelines for other nurses. She eventually opened one of the first nursing schools, the Florence Nightingale School for Nurses in London in 1860.


Many nurses worked during the American Civil War; their stories and letters paid tribute to their circumstances and the large volume of casualties. Later, in 1881, Clara Barton developed a humanitarian program designed to meet the needs of those affected by disaster. Barton had served during the Civil War and understood the necessity of volunteer cooperation to meet the needs for food, clothing, and shelter for those in trouble. The organization was known as the Red Cross, and Barton served as its leader for over 20 years.

At the end of the 19th century, more nurses began to work toward changing policy in leadership and education in nursing schools, recognizing their role as more than that of a bedside caregiver. By implementing change, many nurses went beyond the scope of care to educate those in leadership about the need for prevention and to reach some groups of people that may have fallen through the cracks. In 1893, Lillian Wald began promoting the role of the public health nurse to help those living outside of the hospital setting; and in 1925, Mary Breckinridge started the Frontier Nursing Service to help some of the poor and destitute living in rural parts of America.

During the 20th century, nursing continued to evolve, with the addition of new programs and professional organizations designed to specifically address some of the challenges of the nursing profession. The American Nurses Association began publishing the American Journal of Nursing, which continuously provides new information about research and trends in current practice. Nursing programs changed to offer students new courses to become licensed practical nurses and to require certification and testing to become registered nurses. Nursing schools began to evolve from traditional hospital-based programs to university-level curricula. Nurses began to gain further education in the form of advanced degrees. In 1956, Columbia offered the first program for a master’s degree in nursing, and in 1979, Case Western offered the first doctoral program.

Nursing skills developed during the 20th century as nurses filled greater roles with more critical functions. The rise of intensive care units and specialty areas saw the expansion of many areas of expertise in nursing. Nurses began to work in more specialized care settings and studied care of patients in their respective fields. Nursing schools taught skills in areas such as orthopedics, pediatrics, critical care, trauma and flight nursing, neonatal nursing, and psychiatric nursing, among many other specialties, all of which became identifiable concentrations in which to work.

Nurses also moved beyond the role of being the doctor’s assistant, and the scope of nursing practice expanded in many specialties. Nurses now perform many procedures and lifesaving measures that were once restricted only to the practice of medical doctors. Nursing diagnoses guide the care of patients depending on their needs during hospitalization or supervision. The role of the nurse practitioner as a type of advanced specialty nursing brought nurses up to a level in which they could prescribe medication, perform procedures, and follow the course of clinical patient care. Nurses play an essential role in not just the physical or emotional care of patients, but in the management of social issues, prevention of disease, and monitoring of trends. Nursing continues to expand into a distinct element of the health care team, providing caring and service to those in need worldwide.