Nursing is a profession that has been around for centuries, and it has played a vital role in health care throughout history. From the ancient civilizations of Egypt and Greece to the modern health care systems of today, nursing has evolved and adapted to meet the changing needs of society. Nurses have provided not just physical care, but also emotional and spiritual support to patients, and their contributions have been essential to the development of health care as we know it. We will explore the history of nursing, from its early origins to the present day, and discover the remarkable individuals and milestones that have shaped the profession into what it is today.

A note on gender in the history of nursing

Frequently the term “nursing,” especially in a historical context, is used when referring to any medical or health-adjacent care performed by women. In this blog we will try to hone in on the growth of nursing as a profession alongside medical advances through the ages whether practiced by men or women. It’s critical to understand the role of gender in the history of this field as women have been prevented from entering the fields of medicine and science due to sexist beliefs and values and found nursing to be a great opportunity to enter the field and make an enormous impact. However, to only focus on medical developments specifically labeled as nursing (whether due to the proximity of women or domestic environments) would be to incongruously convey nursing as a profession solely for women and to perpetuate historical beliefs of the nurse’s role as oriented to be secondary to physicians or otherwise “less related” to the science of medicine and community health.

Nursing in ancient times

(Egypt: 3100 B.C.E. to 332 B.C.E., Greece: 700-480 B.C.E.)

Derived from the Latin word ‘nurtrire,’ which means ‘nourishing,’ nursing has maintained its status as a trusted and vital role for centuries.¹ Unfortunately much of the history of nursing is lost to time as it was a role primarily filled by women and took place largely within families or in homes and thus left out of many historical medical texts. There is evidence however, that within their domestic realms, ancient nursing often involved the use of herbs and other substances to treat common ailments. Women with knowledge of the application of herbs show up in Homer’s Iliad, Greek mythology and even some Hippocratic texts.¹

In Egypt, there is evidence that both women and men served in a physician assistant role akin to nursing. While there was no apparent training for these professionals (nor for midwives, who most often were family members, friends, or neighbors and not regarded as medical professionals at the time), they were highly respected and during the time of the New Kingdom (c. 1550-1070 BCE), were linked with the divine.² Through papyri and hieroglyphs we know that Ancient Egyptians had a rather robust medical practice including surgical procedures, pharmacology, and treatment of disease, much of which is consistent or directly traceable to our understanding of these topics today. For the most part, however, it does not appear that ancient Egyptians had a clear dichotomy between medicine and magic or the divine. Physicians were frequently considered to be, or also served as, priests, a fact that serves as a connecting thread as we move forward in time following the development of medicine and nursing.³

Medieval medicine

(476-1400 CE)

In medieval times the church was central to many aspects of social and domestic life. Following teachings of Christianity, it was a religious duty to take care of the sick so it was clergy and churches that took on medical care. At this time medicine was largely rooted in the teachings of ancient Greece and based on understanding the four humors–yellow bile, phlegm, black bile, and blood–as well as the four elements–earth, water, fire, and air. There was also a prevailing belief that illness and injury were punishments for sin, making the monks and nuns who served as medical caretakers ideal for the job as they practiced both medical and religious duties. By the twelfth century there were medical schools across Europe with a few admitting both women and men that taught urinal diagnostics, how to treat through observation and palpation, and limited surgical procedures. During this time, however, there wasn’t much in the way of a specific nursing role other than wet nursing.^4,5

The Renaissance and Industrial Revolution

(1500 to 1800 CE)

The Renaissance, known as a period of cultural and artistic development, also brought about some developments in medicine but is sometimes considered the “Dark Age of Nursing.” Provisions to care for the poor were put in place at this time, but oftentimes the individuals seeking care were already well past the point where they could be healed from disease or other illness and so only received palliative care until their death, giving hospitals a negative connotation.⁶ Hospitals for the wealthy, on the other hand actually had relatively low death rates, largely achieved by denying admission to the seriously ill. Instead, the typical patients often suffered only from minor surgical issues.⁷

Nursing in the 19th Century

(1800-1899)

Florence Nightingale is likely the name most associated with the history of nursing. Nightingale ushered in the practice as being a legitimate and respected profession. At the time she enrolled in a 3-month nursing course, it was unusual for someone of her wealthier class to pursue a career in health care. Nightingale’s biggest moment of influence came when she organized a group of nurses to bring aid to soldiers fighting in the Crimean War. It was there that she witnessed soldiers dying of infection from squalid conditions rather than their initial injuries by war and made strides in understanding of hygiene’s role in health which led into many foundational public health efforts.⁶ She also dominated the field of hospital design, was instrumental in creating the International Code of Diseases (currently the medical field uses ICD-10) and was the first person known to use pie charts in health sciences.⁸

Other lesser known but important historical figures in nursing during this time include:

• Mary Seacole, a Jamaican-Scottish woman who was denied even a meeting with the British government to work at the front lines of Crimea because of her race. She instead funded her own trip and established a hospital and respite home for wounded soldiers entirely as a volunteer.⁸
• Clara Barton volunteered as a nurse during the American Civil War and ultimately established the American Red Cross.⁸
• Mary Mahoney was the first Black nurse to be educated in the U.S. and lead many efforts to improve the nursing profession for all nurses.⁸
• Mary Adelaide Nutting, a suffragette and nurse historian, was a major advocate for higher education for nurses. She was a part of the first graduating class of nurses from Johns Hopkins University in 1891 and later became the school’s second superintendent. Under her leadership the program was expanded from two to three years. She also went on to become the first woman to hold professorship at Columbia University where she created the first higher education nursing program and was instrumental in the creation of the American Journal of Nursing.⁸
• Lavinia Dock, also a suffragette, worked through the yellow fever epidemic in Florida as well as the Johnstown flood in 1890 before joining a public health nursing organization. She was an activist who worked with the New York Women’s Trade Union League and walked picket lines for the Shirtwaist strike in 1913 and spoke at an ANA convention urging nurses to support the union movement within their profession.⁸

Nursing in the 20th Century

(1900-1999)

While the end of the 19th century focused on sanitation efforts to promote the health of communities and fight communicable diseases, the 20th century saw the beginning of an emphasis on individual health. Employer-paid health insurance started up in the 1940s though similar concepts had existed earlier⁹ and the investments into antibiotics, technology, and other developments pushed the field forward. During World War I, the number of nurses in the military grew from around 4,000 to 20,000 but it wasn’t until during World War II that nurses finally received military rank, though at the time it was only temporary.⁸

Many of the nurses who made history in this time period were those who took the profession further into the treatment of specialized needs or communities. For example Mary Breckinridge founded the Frontier Nursing Service to provide care for the sick and poor in rural, isolated communities. Margaret Sanger opened a family planning and birth control clinic in 1916 that would lead to the creation of Planned Parenthood. Additionally, Virginia Henderson was highly influential in the furthering of nurse education and was one of the first nurses to emphasize and promote that nursing does not merely consist of following physician’s orders.⁸

Nursing today

There have never been more opportunities in nursing than there are today. However, many challenges face contemporary nurses that will shape the field just as the topics covered in this blog affected the trajectory of nursing up to this point. From the renewed threat of pandemics, tremendous efforts being made in the subject of health equity, and the nurse staffing shortages faced across the country, it’s also a prime time to enter the field to make a meaningful impact.

History of nursing education

As Dirschel and Klainberg wrote in Today’s Nursing Leader, “Nursing education has been determined not only by the evolution of technology and advances in science, but by the needs and development of society.” Many of the historical figures in nursing never received formal training and those who did often attended courses that taught little more than how to keep a health care environment clean and meal preparation for patients. Hospital-based diploma schools were the first form of nursing education in the United States and it wasn’t until 1872 that these institutions issued diplomas upon graduation. Associate degree and bachelor’s in nursing programs began to supersede the hospital ones in the early 1900s (Oklahoma City’s first private nursing school was founded in 1904 and became the Kramer School of Nursing in 1981) and very few hospital-based programs remain today. In 1965 the first nurse practitioner program was established but in the 1980s was folded into other nursing master’s programs.⁸

Licensure gained traction around the same time that BSN programs did and in 1901 the first conference of the International Council of Nurses (ICN) met in New York and passed a resolution that all nurses should be licensed by examination. This was met by strong opposition in most states but of course, the National Council Licensure Examination (NCLEX) is widely accepted and administered today.⁸

Sources:

1. International Journal of Caring Sciences, September-December 2015, Volume 8 | Issue 3| Page 793 from internationaljournalofcaringsciences.org/docs/31_Theofanidis_special_8_3.pdf
2. Retrieved on April 5, 2023, from worldhistory.org/Egyptian_Medicine/
3. Metwaly, A. M., Ghoneim, M. M., Eissa, I. H., Elsehemy, I. A., Mostafa, A. E., Hegazy, M. M., Afifi, W. M., & Dou, D. (2021). Traditional ancient Egyptian medicine: A review. Saudi journal of biological sciences, 28(10), 5823–5832. Retrieved on April 5, 2023 from https://doi.org/10.1016/j.sjbs.2021.06.044
4. Retrieved on April 5, 2023, from kriii.com/nursing-in-medieval-times/
5. Retrieved on April 5, 2023, from metmuseum.org/toah/hd/medm/hd_medm.htm
6. Dirschel, K., Klainberg, M. (2010). Today’s Nursing Leader: Managing, Succeeding, Excelling. Pg 23. United States: Jones & Bartlett Learning. Retrieved at google.com/books/edition/_/6qzT_IaB4gQC?hl=en&gbpv=1
7. Retrieved on April 5, 2023, from Dingwall, R., Rafferty, A. M., Webster, C. (2002). An Introduction to the Social History of Nursing. United Kingdom: Taylor & Francis. Retrieved at google.com/books/edition/_/WW-IAgAAQBAJ?hl=en&gbpv=1
8. Retrieved on April 6, 2023, from jmvh.org/article/florence-nightingale
9. Retrieved on April 6, 2023, from npr.org/2020/10/07/921287295/history-of-employer-based-health-insurance-in-the-u-s