In the one hundred and fifty years since formal nursing training programs first emerged, nurses have struggled with several issues. They have debated about how to maintain professional standards, while making nursing an accessible career path for people of different races and classes. Similarly, nurses and their allies have struggled with the need to create programs that are rigorous but efficient enough to meet the ever-increasing demand for nurses. And the history of nursing education has also been marked by a struggle to gain autonomy from male doctors and hospital administrators.1 

Oral Nursing Education Traditions

Until the late nineteenth century, most nursing education in the United States consisted of women with practical experience communicating their knowledge to those who assisted them, either with treating the sick or supporting birthing mothers. Enslaved African-American women provided crucial healing labor for both the enslaved and for white people in their communities, transmitting African medical and herbal knowledge to succeeding generations of African-American women.

Nurses who were not enslaved tended to be poor or working-class and often doubled as domestic servants. They worked long hours in private homes or in the hospitals that arose in the mid-nineteenth century to serve workers and immigrants in the U.S.’s industrializing cities. Whatever training nurses got was on the job, under the direction of male physicians. Catholic nuns were the exception, with their long history of running charity hospitals.

Florence Nightingale is credited with introducing the idea that nursing should be a professionalized field, one for educated, middle-class women, usually who were white and unmarried. In addition, the Civil War created massive illness and injury, leading to an increased awareness about the importance of trained nurses.

The Beginnings of Formal Nurse Training Programs 

In 1873,  three nurse educational programs opened in the U.S., all based on the Nightingale model. The programs generally accepted young and single women. They instituted curfews and etiquette rules, expecting their students to conform to Victorian ideals of middle-class womanhood. Mary Eliza Mahoney, the daughter of formerly enslaved parents, became the first African-American woman to graduate from an American school of nursing in 1879.

Mahoney was an exception. The Nightingale schools mostly accepted middle and upper-class white women. In response, Black nurse training schools appeared: Spelman College opened in 1881, while the Dixie Hospital and Hampton Training School and Provident Hospital and Training School both opened in 1891. 

Nightingale and the American women she inspired believed in the need for nurses’ autonomy from physicians. Female nurses acted as administrators and instructors, providing  classes to accompany the clinical experience students got in the hospitals.

Hospital-Based Training Programs

Yet as hospital administrators realized that nurses provided cheap labor that improved patient outcomes, they began to establish hospital-based programs, which soon overtook the Nightingale model. In these programs, student nurses worked long hours running most of the hospitals’ operations, and they received little classroom instruction. Hospitals also earned money by hiring student nurses out for private home visits. And after completing their training, most graduates could not get jobs at hospitals, which preferred the cheaper cost of student nurses. Graduate nurses often worked in private homes, where they may have also been responsible for domestic chores like laundry and cooking. 

Many nursing leaders criticized this model. They discussed the importance of uniform standards for educating nurses, arguing that nurses should not serve as apprentices in hospitals. These leaders called for university-based programs that would train students in scientific knowledge and medical skills. They also pushed for a system of nurse licensure that would help to differentiate between educated and uneducated nurses. In order to organize nurses and set standards of practice, leaders created the Nurses Associated Alumnae in 1896, later renamed the American Nurses Association (ANA).

Male physicians and hospital administrators opposed these moves. They feared losing cheap student nurse labor and losing their tight control over medical knowledge and technology. Well-educated, technically competent, and independent nurses represented a threat to them. It would take many decades of activism to break from the hospital-based training model.

Nurse leaders gained more rapid success on licensure: by 1921, 48 states had passed laws regulating professional nursing. 

Black Nurses in the Early Twentieth Century

Englewood Hospital

Yet these movements towards organization and licensure also created new racial barriers. Many states, particularly in the South, denied Black nurses the right to earn state registration. And nurses without licensure were not allowed to join the ANA. In response, Black women founded the National Association for Colored Graduate Nurses (NACGN) in 1908. They fought to open their own training programs like Provident Hospital and to gain admission into white programs. Yet it would also take decades before the field of nursing would become more racially inclusive.

As Black nurses continued to fight for training and employment, the nursing profession in the United States expanded. The World Wars gave additional proof about how essential nurses were to providing healthcare on the front lines and the home front.

Racial Barriers Begin to Fall; Rise of University-Based Programs
The Bolton Act of 1942 created the U.S. Cadet Nurses Corps, intended to train nurses as quickly as possible to meet wartime needs. In exchange for agreeing to work in essential sectors, nursing students would have their tuition and other expenses subsidized by the federal government. Crucially, the Bolton Act mandated standards for nursing education programs and denied funding for any schools with policies that discriminated against students’ gender, marital status, ethnicity, or race.

Nursing schools began to integrate, but Black student nurses still faced racism. For example, Dr. Barbara Norman (link to interview here), one of the nurses who contributed to our oral history project, was one of two Black students who enrolled at Grant Hospital Nursing School in 1960. When Dr. Norman scored high marks on Grant’s entrance exam, the school refused to believe she had completed the test herself, requiring her to retake the exam and undergo psychological testing before finally admitting her. 

The 1950’s and 1960’s saw advances in healthcare science and technology, which created a need for highly trained nurses in a variety of specialties. Meanwhile increased federal funding helped create many new university-based programs. By 1960, the U.S. had around 172 college-based programs that awarded Bachelor of Sciences in Nursing (BSN) degrees.  

At the same time, two-year associate degree of nursing (ADN) programs were gaining steam, aimed at quickly training skilled nurses to fill the post-war nursing shortage. ADN programs expanded along with the increase in community colleges. To this day some have argued that only nurses with BSN degrees should be able to attain licensure, while others see ADN programs as accessible and affordable options for people who otherwise could not become registered nurses.

Contemporary Nursing Education

Nursing education has continued to evolve since the 1960’s. Master’s programs have been created to train nurses in specialties like intensive care, oncology, and psychiatry, as well as to educate nurse practitioners, who have increasingly become crucial primary care providers, especially for historically underserved populations. Doctoral programs have also emerged in recent decades, providing avenues for advanced research and teaching in the field. Student nurses graduated directly into the frontlines of the COVID-19 pandemic, often caring for deeply-impacted communities of color. Today, as they did one hundred fifty years ago, Black nurses face challenges related to systemic racism, and nurse education programs continue to train students to provide crucial healthcare services to communities across the United States. 

Continue exploring our “Schools of Nursing” section to learn more about some of Chicago’s nursing schools that historically enrolled large numbers of Black students, especially before integration of the 1950’s-1960’s.