admit, when I started my doctoral program, I had no interest in the history of nursing. Nor did I understand its value within the profession. When I took a required historical research methods course, I realized I could use history to answer my research questions instead of the more traditional methods of research I had always known. Now as a new faculty member, I continue to pursue historical scholarship, promote historical methods among the doctoral students, and host a historical book club among faculty and students to discuss important events of the past and how they inform our present profession and society.
Gwyneth Milbrath, PhD, RN
Clinical Assistant Professor
University of Illinois at Chicago College of Nursing
Chicago, Illinois
Critical Thinking 3.1
Historically, the public appears to hold nurses in higher esteem during wartime. The media's image of nurses both reflects and influences nurses' professional identity. Lusk, the author of this chapter, has conducted two studies assessing: (a) how nurses were portrayed in the general literature, 1880–1928, and (b) how nurses were portrayed in hospital management journals, 1930–1950 (Lusk, 2000, 2002). Lusk found that nurses were indeed portrayed as more knowledgeable and autonomous in these media during war years. As the First World War started, images of nurses and articles about them burgeoned in the popular press. Reporters were sent over to Europe to write about hospital work. The reporters stressed that only trained nurses, not volunteers, were needed. Nursing was portrayed as a highly patriotic occupation in which female nurses had a significant presence near the front lines. The Second World War was similarly covered. In marked contrast to the 1930s and the 1950s, when nurses were depicted as minimally skilled and subservient to physicians, nurses in advertisements during the war years of the 1940s showed nurses engaged in more complex and independent procedures, for example, adjusting nasogastric suction and setting up oxygen delivery systems. These changes may be correlated with peace time perceptions of nurses' work as lower skilled physicians' helpers as opposed to war time perceptions of nurses' work as skilled, autonomous providers of care who would help the country “win the war.” What do you think of the fact that nurses' professionally benefit from positive portrayals during times of war? There are many reasons we can speculate about why nurses were portrayed less positively after the war, during the 1950s. Some of these affect the image of nurses today. What reasons can you think of?
Critical Thinking 3.2
In 2018 the Gallup Organization found, for the 17th year in a row, that the public consider nursing to be the most ethical profession. By ethics, we mean the study of morality from a range of perspectives (American Nurses Association (ANA), 2015). In 2016 the Hastings Center produced a Report titled: Nurses at the Table: Nursing, Ethics, and Health Policy (Ulrich, Grady, Hamric, & Berlinger, 2016), sponsored by the American Academy of Nursing. The Report implied that nurses were uniformly ethical. In contrast to this, historian Lynn Dunphy (2001) wrote about nurses who cared for children with polio who were in external pressure ventilators, “iron lungs,” during the polio outbreaks of the mid‐twentieth century. These ventilators were metal tubes in which the patient's body was placed, and only the patient's head was outside the tube. Dunphy quoted a former patient: “…she [the nurse] told me to stop crying. She said she would turn my respirator off if I didn't stop crying. When she did, I passed out immediately” (p. 20). Dunphy wrote that stories like that abounded in her interviews.
Do you think that this was unusual nursing behavior?
Have you ever seen nurses behave with questionable ethics?
What would you do if you saw such behavior today?
Historical Contributions and Future Challenges
This chapter has skimmed over some of the key events in nursing's history. It has told some stories in depth, for example, that of nursing student Isabella Lauver's early experiences at Cook County Hospital in the 1880s and Madame du Coudray's work in France in the 1700s. The point is to alert you to the complexity of history. There was no golden age of nursing when nurses were always wise and had plenty of time for hands‐on patient care. That is a product of wishful thinking on the part of today's public and public policy makers. Likewise, nursing education didn't start with Florence Nightingale, as demonstrated by Madame du Coudray and her “obstetrical machine” of the century before Nightingale. The past was both worse and better than we might imagine and it cannot be judged with today's lens. Furthermore, we cannot consider nursing's past in isolation from its contextual issues of gender, society, science, and place. Society in the nineteenth and early twentieth centuries lacked today's social safety nets, such as Medicaid, Medicare, and Social Security, but medical science was advancing rapidly. Nurses thus witnessed extraordinary patient need alongside the new realities of, for example, effective drugs and newly developed vaccines. The concept of place in nursing's past means that nurses' education and practice was affected by the geographical setting—urban or rural, southern state or northern state, general hospital or tuberculosis hospital.
The rise of public health nursing came from late nineteenth, early twentieth century concerns about great income disparities and lack of health care for immigrants and the poor. Some nurses addressed these concerns at the policy level, while thousands of public health nurses went from door to door doing the actual work of nursing. The work of these public health nurses of the past has influenced health care administration today with the current shift to outpatient care wherever possible (McDermott, Elixhauser, & Sun, 2017). Additionally, nursing has a history of giving care to the poor, who in these days are the uninsured. Witness the work of Rose Hawthorne discussed in Case Study 3.4.
The checkered story of formal education in nursing, briefly covered in this chapter, must be placed in the context of society in the nineteenth century, particularly the role of women at that time. In the nineteenth century and the early decades of the twentieth century, women's education was not a priority. Women were expected to become mothers and housewives. But the scientific advances of the nineteenth and twentieth centuries required that nurses, even though they were predominantly women, become appropriately educated. The importance of professional organizations over the decades, and their leadership, cannot be overemphasized in the history of nursing. From the NLN's early nursing curricula, starting in 1917, to the Advanced Practice Nurse organizations' recent moves in clarifying and publicizing the advanced practice roles, professional organizations have led the way forward.
Appreciation of nurses' current ethical responsibilities must be guided by awareness of nursing's complex past, as described in Dunphy's (2001) story of the iron lung nurses in the 1950s and 1960s. History has shown us that nursing is not exempt from ethical wrongdoing; to state that nurses are always ethical is naïve. Critical thinking, strengthened by historical analysis, will support nurses' understanding of complex issues and ethical questions. Table 3.3 summarizes key events in the history of nursing in order to expose you to thought‐provoking elements of your profession and pique your interest for further study.
Table 3.3 Historically Significant Events in the History of Nursing Compiled by B. Lusk
| 1846 | First public use of anesthesia during surgery: allowed more complex surgeries and thus required more skilled nursing. |
| 1851–1854 |
Crimean War: English aware of poor nursing care for troops. Nightingale and 38 volunteer nurses sent to English army hospitals in Turkey, near the
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