September 17, 2011

Nursing is the profession of caring for the health of others; it is as much an art as it is a science. Nursing care was given by family members for many centuries and soldiers took care of wounded comrades in battles. However, nursing education did not begin until the 1800s when a hospital in Kaiserswerth, Germany, opened a training school for deaconesses in 1836. Doctors began educating women about childcare and nursing. Florence Nightingale, the forerunner of modern nursing, spent a short time there gaining a limited amount of formal training.

The modern-day profession of nursing is defined thanks to the contributions of Florence Nightingale, a British woman who led 38 women to care for the wounded and dying soldiers in 1854 in the Crimea. While dealing with the tragedies of war, Nightingale made sweeping social changes that have influenced how care is given for sick and wounded people today. After the war, Nightingale wrote extensively about nursing and developed London’s first training school for nurses in 1860. She believed there was a need for education in both the classroom and the health care setting. Students worked in the hospitals and acquired skills and applied their knowledge while caring for their patients.

In the United States, within a few years, two female physicians began The New England Hospital for Women and Children and started the first general training school for nurses. Linda Richards completed the training in 1867 and is noted as America’s first “trained” nurse. Training schools soon opened in New York (Bellevue Hospital), New Haven, and Boston. The educational programs proliferated across the country and by the 1920s many hospitals were staffing their units with inexpensive student labor. The older design of the large wards for patients evolved due to the need for one supervisor to oversee a larger number of students.

Education for nurses has changed dramatically since then. Today there are different programs for the entry-level education offered at colleges and universities, while some hospital-based diploma programs still survive. Diploma programs, an outgrowth of the original hospital-based training education, take about 3 years to complete. Due to declining hospital funding, rising education costs, and the increasing need for degreed professionals, only a small number of programs still exist. Associate degrees in nursing (ADN) are offered at community and junior colleges and take 2-3 years to complete. In 2000, approximately 40% of registered nurses (RNs) received their basic education in associate degree programs while only 6% of RNs graduated with a “Diploma in Nursing.”

The Bachelor of Science in Nursing (BSN) degree programs are offered by colleges and universities and take 4 or 5 years to complete. The American Nurses Association (ANA), the national professional organization for nurses, has designated the BSN as the entry level for professional nursing. This preparation allows for greater advancement and opportunity and is often required for administrative positions. By 2000 about 38% of RNs had graduated from baccalaureate programs with another 16% (ADN and Diploma RNs) returning to school to advance their education to a bachelor’s degree. All three levels of education permit the nurse to be a candidate for the licensing exam, which, when successfully passed, results in licensure as an RN in the state the exam was taken. State laws provide for the election or appointment of members who form a Board of Nursing. The Board of Nursing for each state regulates the practice and standards of nursing in that state.

Advanced degrees in nursing have also developed, and as of 2000, more than 196,279 RNs have the education to work as advanced practice nurses (APNs). Advanced practice nurses complete a BSN, and most pursue a graduate program in nursing (MSN) and take a nationally recognized certifying exam. The four categories of advanced practice are nurse anesthetists, nurse-midwives, nurse practitioners, and clinical nurse specialists. Advanced practice nurses receive advanced education and specialization, which prepares them for more complex tasks in their chosen clinical area. Advanced practice nurses may specialize in the primary care of children, adults, or geriatrics, or focus on anesthesia, cardiac care, mental health, community health, or obstetrics. Depending on state laws they may perform history and physicals, prescribe medications or treatments, offer education and consultation, and even attend or assist in childbirth.

Registered nurses today are offered a variety of fields and settings in which to work. Nurses work to promote health and prevent disease as well as educate and advocate for vulnerable populations. They work in collaboration with physicians to perform complex procedures and staff various inpatient and outpatient areas that provide comprehensive care to a wide variety of patients. They also supervise licensed practical nurses and other unlicensed personnel in administering direct care to patients. Usually, nurses choose a specialty area and become experts in providing care in a particular setting and/or for a specific subgroup of patients, such as geriatrics, orthopedics, school nursing, occupational or forensics, psychiatry, medicine, surgery, oncology, maternity, pediatrics, or one of the acute or critical care areas, like emergency rooms or cardiac care. Some nurses become managers within the hospital and direct nursing activities and are administratively responsible for a specific section of the hospital or at higher levels often designated as a vice president of patient care.

Apart from hospital settings, nurses work in nursing homes, within the military, in doctors’ offices, home health care, and rehabilitation; occupational nurses work in manufacturing plants and industry providing both emergency care and preventive wellness and while maintaining safety, nurses are recruited today to work for health maintenance organizations and insurers as case managers.


Generally, women predominate in the nursing profession. Gradual changes have helped the number of men in nursing increase. The military excluded men from serving as nurses from 1901 until after the Korean War and the ANA did not permit males to join the organization until 1930. The proportion of men in the profession of nursing increased from 1% in 1966 to 6% in contemporary times. This increase may have resulted from greater employment opportunities in nursing, the growing acceptance of men in the profession, as well as the improved gender balance elsewhere—in areas that were dominated by one gender versus another.

In 2000, 59% of employed nurses were working in hospitals; 71.5% were married and 17.9% were widowed, divorced, or separated. People of Caucasian origin represent 88% of the RN population, while roughly 12% of the employed nurses come from non-Caucasian backgrounds. In 2000 only 9.1% of RNs were under the age of 30.

The “typical” RN is now a 46-year-old married woman from the baby boom generation. Since population growth has declined, the number of people entering the workforce will be less and a decreasing number of nurses will be available to take care of a growing number of aging Americans. Currently, nurses have reported working longer hours in highly stressful environments and a significant proportion of nurses are leaving the profession in search of working opportunities that are more flexible and less stressful. A long-term shortage of nursing is projected due to the increasing demand for nurses, the aging of the current workforce, and the decline in the number of people seeking to enter the profession. The shortage of nursing as well as the heightened level of stress and job dissatisfaction have raised important concerns over quality of care. California is the first state to attempt to regulate the nurse-patient ratios, by limiting the number of patients per RN. The outcome of this regulation remains to be seen.

Research has shown that women who graduated from high school in the 1990s were 30-40% less likely to enter nursing than those who graduated in the 1970s. Changing the image of the profession may improve recruitment, but there is a need to raise relative wages, improve working conditions and other benefits, and lower education costs, so nursing can retain its workforce rather than lose people to other occupations that may offer greater opportunity or prestige. Despite the stress and demands of health care, nurses continue to find great personal rewards when able to practice the art and science of the profession.

SEE ALSO: Women in the Health Professions (pp. 20-32), Women in the Workforce (pp. 32-40), Midwifery, Nurse practitioner

Suggested Reading

  • Baer, E., D’Antonio, P., Rinker, S., & Lynaugh, J. (Eds.). (2000). Enduring issues in American nursing. New York: Springer.
  • Buerhaus, P. I., Staiger, D. O., & Auerbach, D. I. (2000). Implications of an aging registered nurse workforce. Journal of the American Medical Association, 283(22), 2948-2954.
  • Griffin, G. J., & Griffin, J. K. (1973). History and trends of professional nursing (7th ed.). St. Louis, MO: C.V. Mosby.
  • Group, T. M., & Roberts, J. I. (2001). Nursing, physician control and the medical monopoly: Historical perspectives on gender inequality in roles, rights, and range of practice. Bloomington: Indiana University Press.
  • Schrefer, S. (Ed.). (2000). Nursing reflections: A century of caring. St. Louis, MO: C.V. Mosby.
  • United States Department of Labor Bureau of Labor Statistics (n.d.). Registered nurse. Retrieved February 13, 2003

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