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Changes in Nursing Education Over Time

by Carson-Newman … on August 14, 2018
Nurse student wearing a backpack and carrying books

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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.


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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 the medical needs of the Civil War 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 Future of Nursing Education Involves Increased Advanced Education

The Institute of Medicine (IOM) has recommended that the percentage of nurses who hold bachelor's degrees be increased by 80% by 2020. Increased education levels in nurses are correlated with lower levels of patient mortality. Pursuing a bachelor's degree also provides more career opportunities, as many institutions prefer to hire bachelor's-educated nurses.

As a nurse, or nursing student, one is part of a long legacy of commitment to serving the needs of society. The future of the nursing profession requires advanced education. Pursuing further nursing education demonstrates dedication to increasing your knowledge base and providing superior care to patients.

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American Association of Colleges of Nursing (2015). Nursing shortage.

Berman, A., & Snyder, S. (2012). Kozier & Erb's fundamentals of nursing: Concepts, process, and practice 9th Ed. Upper Saddle River, New Jersey: Pearson Education, Inc.

Egenes, K. ( 2009 ). History of nursing. In O'Roux, G., & Halstead, J. Issues and Trends in Nursing Essential Knowledge for Today and Tomorrow. (p.1-26). Jones and Bartlett Learning.

Ellis, J. & Hartley (2012). Nursing in today's world: Trends, issues, and management. 10th ed. Wolters-Kluwer/Lippincott, Williams, & Wilkins.

National Institute of Health. (2014). Nurse staffing and education linked to reduced patient mortality. Retrieved from

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