Chapter 2: The History
and Social Context of
Nursing
Bonnie M. Wivell, MS, RN, CNS
Florence Nightingale
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Aristocrat of Victorian England born in 1820
At age 30 entered nurses’ training program
Crimean War – improved sanitation and
ventilation
In 1860 founded the first training school for
nurses in London that became the model for
nursing education in the U.S.
Notes on Nursing and other publications greatly
affected the development of nursing as a
profession
The Civil War
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Catholic Orders responded to the call for nurses
Dorothea Dix an advocate for the mentally ill
was appointed Superintendent of Women
Nurses of the Union Army
Clara Barton – “Angel of the Battlefield” and
founder of the American Red Cross
This war helped advance the cause of
professional nursing as leaders
Schools of Nursing
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The first three American training schools for nurses
opened in 1873
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Bellevue Training School for Nurses in NYC
Connecticut Training School for Nurses in New Haven
Boston Training School for Nurses at Mass General
Linda Richards was the first trained nurse, graduated in
1874
Separate schools later emerged for African-Americans
out of necessity to care for segregated population
Male students not allowed until 1886
Characteristics of the Early Nurse
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Sensitivity
“Good breeding”
Intelligence
“Ladylike”
Submission to authority
Professional Organizations
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1893 Chicago World’s Fair pivotal point
American Society of Superintendents of Training
Schools for Nurses was formed
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Precursor to NLN
Addressed issues in nursing education
Paper by Florence Nightingale on the need for scientific
training of nurses was utilized
1896 Nurses’ Associated Alumnae of the U.S. and
Canada was founded
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Became ANA in 1911
Initial mission was to enhance collaboration among practicing
nurses and educators
Professional Organizations Cont’d.
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1899 International Council of Nurses was
founded
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Dedicated to uniting nursing organizations of all
nations
1908 National Association for Colored Graduate
Nurses was formed in NY
Achieve higher professional standards
 Break down discrimination
 Develop leadership
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The Henry Street Settlement
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Infectious disease prevalent due to poverty,
overcrowding, and primitive living conditions in
inner city
Founder Lillian Wald
First formalized public health nursing practice;
VNA
Care included: well baby checks, tx minor
illnesses, preventing disease transmission, and
provided health education
African-American Clinic Nursing
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TB major health problem in the slums, especially
among AA population
AA nurses hired to persuade people to accept
treatment
Jessie Sleet Scales was hired as a district nurse on
a trial basis for this project
Succeeded in providing excellent nursing care to
underserved families
Some Facts
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Spanish-American War created need for nurses
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First attempt to use only trained nurses in war
setting the stage for development of Army Nurse
Corps and Navy Nurse Corps
Oct. 1900 – First edition of AJN was published
1903 – Initiation of state licensure which
standardized nursing education
1917 - 1930
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WWI, the Influenza epidemic and the early depression
era
Strong demand for nursing services
Public health nursing flourished providing education in
home nursing and hygiene
1920 – Congress passed a bill providing nurses with
military rank
Increased use of hospitals and an acceptance of the
scientific basis of medicine
Publication of the Golmark Report, a study of nursing
education that advocated for collegiate SONs instead of
diploma programs
Establishment of programs in rural midwifery
Frontier Nursing Service
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First organized midwifery program in U.S.
Worked in rural areas in the Appalachian Mountains
Traveled via horseback to serve the health needs of the
poverty-stricken mountain people
Delivered babies, provided prenatal and postnatal care,
educated mom and families about nutrition and
hygiene, cared for the sick
Demonstrated nurses ability to provide primary care
1931 – 1945
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The Great Depression
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Hospitals were staffed with nursing students so most
graduate nurses worked in private duty
Hospitals were forced to close their schools of nursing so
they lost their “free help”
Many families could no longer afford private duty, therefore
unemployed nurses went to work for minimum wage caring
for increased number of patients needing charity care
1935 – Social Security Act, enhanced the practice of public
health nursing (care for crippled and blind)
WWII
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Cadet Nurse Corp added 124,000 new RNs to the profession
AA collegiate programs participated
1945 – 1960
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1946 surge in growth of new facilities
Acute shortage of nurses
Difficult working conditions
Team nursing introduced
ADN program initiated
Clinical nursing research began and Journal of
Nursing Research published
The 1960s
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Era of specialty care and clinical specialization
Emergence of NPs in primary care
1971 Idaho became first state to recognize dx
and tx as part of the legal scope of practice for
NPs
The Last 20 Years
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DRGs and managed care instituted to improve
quality of care and reduce costs
Attempt to obtain third-party reimbursement for
APNs in primary and acute care
EMRs
Technological advances improved ability to keep
patients alive created new ethical challenges
Culturally sensitive care needed due to increased
immigration
Provision of care to the poor, elderly, and disabled
through Medicare and Medicaid
Social Context of Nursing
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Several social factors that have influence the
development of professional nursing
Female-dominated profession
 Feminism and stereotyping
 ANA chose not to endorse ERA until the late 70s
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Men had difficulty entering nursing until after
WWII
The number of men in nursing is gradually
increasing
Image of Nursing
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Uniforms and caps
Informal style of address
Public’s perception
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Rated #1 except in 2001 after 9/11
Influence of media
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We must take direct action when nurses are
portrayed in an unfavorable light
Social Phenomena
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The aging population (greatest population growth > 85
yo)
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Gerontological courses added to nursing curriculum
Gerontological specialty
Certification and advanced practice
The rise of consumerism
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Patient Bill of Rights
Must actively participate in the health care system
Responsible for our own health maintenance
Demand high quality, cost-effective care
Social Phenomena Cont’d.
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Increasing cultural diversity
Anglo-American culture will become minority
 Nursing must change to meet the requirements of
the ethnic groups they serve and work with
 Need for cultural competence
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Violence
Caring for victims
 Violence in the workplace
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Social Phenomena Cont’d.
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Technological advances
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Biomedical technology
Pacemakers/defibrillators
 Insulin pumps
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Information technology
 Knowledge technology
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Sim lab
High-tech vs. high-touch nursing care
Imbalance in Supply and Demand
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Nursing Shortage
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Internal
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Salary issues
Long hours
Increased responsibility with little authority
External
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Changes in demand
Increasing age of the population
Greater patient acuity
Public perception of nursing
Increased career options for women
Efforts to Manage Shortages
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Shortages often limited to certain geographic
areas or specialties
Increased use of UAP
Manger relief
Import nurses
Travelers
The Current Shortage
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Higher patient acuity demands more RN time
Technology requires specialized nurses and
because patients are critically ill, one nurse can
only safely care for 1-2 patients
Advances in technology prolong life which
increases need for LTC
Cost-containment measures result in more
patients in fewer hospitals staffed with fewer
personnel
The Impact on Patient Outcomes
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The gap between a desirable level of care and
the care nurses are able to provide creates moral
distress
Poor patient outcomes no longer tolerated
Magnet status – SEE HANDOUT