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Background

Nursing dates back to the early days of families tending to the sick and injured in their homes. In the United States, caring for patients at home took place until the 1800s, when nurse education started to become more organized and hospitals started to proliferate. In the early 19th century, some doctors recognized the need for nurses and advocated for them. For instance, Dr. Joseph Warrington founded the Nurse Society of Philadelphia in 1839, a program that employed and trained nurses who cared for maternity patients.

Nurses became even more vital during the Civil War, with more than 20,000 men and women nurses tending to the overwhelming number of wounded and sick people. Nursing training programs emerged as a result of the experience of working during the war; for example, the Women’s Hospital of Philadelphia and the New England Hospital for Women and Children offered training courses for nurses.

A pivotal year in nursing history was 1873, when three educational programs were established in the United States that advanced the teachings of British nurse Florence Nightingale. These programs were the New York Training School at Bellevue Hospital, the Connecticut Training School at the State Hospital (later renamed New Haven Hospital), and the Boston Training School at Massachusetts General Hospital. Training consisted of two to three years of actually tending to patients in the hospital, while receiving minimal classroom education. They were more like apprenticeships than schools. Upon successful completion of the training, students received a diploma and could seek a position as a trained nurse.

In the early 1900s, many states passed nurse registration acts to ensure the safe practice of nursing. During this time professional associations were also established to advocate for and support the nursing profession, such as the American Society of Superintendents of Training Schools for Nurses, which is now known as National League of Nursing Education; the Associated Alumnae of the United States, later renamed to the American Nurses Association; and the National Organization for Public Health Nursing. These organizations provided standards and structures for nurse education.

More hospitals were built in the 20th century and as health care services expanded and became more complex, nursing specialties likewise developed, such as nurse anesthetists, who specialized in administering anesthesia to patients undergoing surgery. The use of licensed practical nurses and nursing aides came about in the 1930s and 1940s, to help support the work of nurses in hospitals. World War II focused attention on the importance of nurses in treating soldiers overseas, and the profession grew further as thousands volunteered their services and developed specialized skills to deal with the wide variety of injuries and illnesses. Since then, nursing specialties have expanded to include critical care, trauma, orthopedics, pediatrics, and neonatal care.

Until the 1960s the nursing profession was predominantly female, and racial segregation had created a divided educational system between white and black nurses. Segregation ended in 1964 with the Civil Rights Act, and the nursing profession has since diversified. Today male and female nurses of all races and nationalities provide primary and specialized health care services for a wide variety of employers, from hospitals and nursing homes, to schools, businesses, and private homes. There are now more than 200 health care specialties that nurses can train in, and as of 2014, there were nearly 2,000 accredited nursing schools in the United States.