Changes in Nursing Education Over Time

A Brief History of Nursing Education in the United States 

The nursing profession has undergone many changes within the last two centuries. The number of nurses pursuing higher education is a testament to the advancement of the profession. Many more educational options are available to today's nurses, such as the online MSN-FNP program, a great option for working nurses. 

In the field's younger days, nurses were taught measures to keep their patients comfortable, and were also charged with other duties, such as laundry, food preparation, and housekeeping. Nurses were also viewed as servants of the physicians and were responsible for carrying out orders without questioning them. The speech given to the first graduating class of nurses by Dr. Hooker at the Springfield Hospital in 1894 stated that nurses must remember that it is the physician's duty to diagnose the patient, and that they should refrain from holding an opinion themselves – a stark difference in comparison to today's standards. 

Read on to learn more about the history of nursing education and changes in nursing education over the years. 

Florence Nightingale Changed Nursing Programs to Become Science-Based

Florence Nightingale continued to make incredible improvements in nursing education around the same time that Dr. Hooker gave his graduation speech. She recognized the need for consistent, and formal nursing education, and opened a nursing school in London – the first to be science-based. 

At this time, nursing programs were primarily limited to learning how to perform basic skills and neglected the involvement of science. Programs initially required one year of training and education, which was then increased to two, and then three years. Nursing was seen as a "calling", rather than a professional career option, or a respected member of the health care team. 

As post-Civil War medical needs increased, in 1869, the American Medical Association (AMA) encouraged hospitals to implement a nursing education program to increase the supply of nurses. The AMA also recommended that these programs emphasize religion and integrate it into nursing. 

Nursing Licensure Implemented in All Existing States by 1921 

Slowly, the nursing field began to gain traction as a profession. The health care needs of society were changing and growing, and nursing had to adapt. It became clear that nurses must be able to provide care that met set standards. 

In 1903, North Carolina became the first state to implement a nursing licensure exam. This proved to be one of the most significant changes in nursing education. All existing 48 states had implemented nursing licensure by 1921. Patient care began to increase in complexity in the following decades as medical and nursing knowledge increased. 

Nursing Considered a Profession by the 1950s

 By the 1950s, nursing was considered a major professional career field. The American Nurses Association (ANA) recommended that nursing programs require four years of study, unless the student required only technical skills, which they could obtain in a two-year program at a community college. 

Now, in the 21st century, in order to obtain nursing licensure, students must graduate from a diploma or college nursing program that includes a clinical experience component, which range from associate to doctoral-levels. The ANA still recommends a bachelor's degree or higher to practice as a registered nurse, a symbol of the advancement of the nursing profession. 

The COVID-19 Inflection Point

 The COVID-19 pandemic marked a defining moment for the nursing profession. More than 100,000 nurses left the workforce during 2020–2021 alone, accelerating burnout and reshaping conversations around staffing, mental health support, and retention. These shifts have directly influenced nursing education priorities, placing a greater emphasis not only on clinical competency, but also on resilience, adaptability, and leadership in high-pressure environments. 

The Future of Nursing Education Involves Increased Advanced Education 

The National Academy of Medicine — formerly the Institute of Medicine (IOM) — previously recommended increasing the proportion of nurses with bachelor’s degrees to 80% by 2020, based on evidence that higher levels of nursing education are associated with improved patient outcomes, including lower mortality rates. 

While that goal helped drive meaningful progress in nursing education, it has not been fully realized. According to the 2024 National Nursing Workforce Survey, the percentage of nurses holding a BSN peaked at 51.1% in 2022 before declining to 47.8% in 2024, falling well short of the 80% target. 

Despite this gap, the importance of a bachelor’s degree in nursing remains clear. Many healthcare employers continue to prefer or require BSN‑prepared nurses, and advanced education is closely linked to expanded career opportunities, leadership roles, and improved patient care outcomes. 

At the same time, workforce demand underscores the urgency of higher education in nursing. The U.S. Bureau of Labor Statistics projects approximately 189,000 registered nurse job openings each year through 2034, while national workforce analyses estimate that hundreds of thousands of additional nurses will be needed by the end of the decade to meet growing demand and replace retiring professionals. 

The Rise of Online and Hybrid Nursing Education 

At the same time, how nurses learn is evolving. The expansion of online and hybrid education has become a defining trend in modern nursing, offering greater flexibility for working professionals seeking to advance their careers. What began as a growing option has now become a core pathway—accelerated significantly by the pandemic. 

Programs like Carson‑Newman’s online MSN‑FNP program provide a practical way for nurses to continue working while gaining advanced clinical knowledge, helping meet workforce demand while supporting career mobility in real time. 

Technology & Simulation in the Classroom 

Technology is also transforming the learning experience itself. Virtual simulation—once considered a future innovation—is now a standard component of nursing education. These immersive environments allow students to safely practice complex, high-acuity scenarios before entering clinical settings. 

Recent research highlights how AI is further advancing nursing education, supporting personalized learning systems, simulation-based training, automated assessment tools, and even curriculum planning through predictive analytics.  

Together, these tools help prepare nurses to deliver care in increasingly complex, technology-driven healthcare environments. 

Nurse Burnout as an Education and Retention Challenge 

Burnout has also emerged as one of the most pressing challenges facing the profession. More than half of nurses report feeling too fatigued to face another workday, underscoring the toll of sustained workforce shortages and high patient demand. 

In response, modern nursing education has evolved to include training in well-being, resilience, and leadership—equipping nurses not just with clinical skills, but with the tools needed to sustain long-term careers in a demanding field. 

As the healthcare landscape continues to evolve, the need for highly educated nurses—and pathways to advanced practice—remains critical. 

As a nurse or nursing student, you’re part of a legacy built on meeting society’s needs—not someday, but now. Advanced education is no longer optional; it’s essential to delivering the level of care patients deserve today. Continuing your education strengthens your expertise and prepares you to lead in a rapidly evolving healthcare landscape. 

Contact us to find out more about Carson-Newman's online nurse practitioner programs.