The Evolution of Nurse Training in the United States
Soldiers, wounded in the Battle of the Wilderness, resting outside a building in Fredericksburg, Virginia, May 20, 1864.
Up to and into the early 1800s, most health care in the United States took place in the home, the sick being attended to by family, friends, and neighbors with personal knowledge of health healing practices. Industrialization and urbanization in the early 19th century, coupled with social reform movements, ushered in a shift in health care delivery with hospitals emerging across the country to provide care to those without means. This development necessitated the need for more caregivers, which brought about the sparse beginnings of nurse education in the United States. Changes were further accelerated with the outbreak of the Civil War, creating an enormous number of sick and wounded in immediate need of quality nursing care, bringing nearly 20,000 women and men into service as nurses during the war.
Post-Civil War America saw the increased appearance of nursing training programs across the country, which led to the creation of the first formal nursing school educational programs in 1873. The success of these formally established nursing schools fostered an ever-growing list of newly established schools, which by 1900 had reached almost 800 across the nation. These schools were usually affiliated with a hospital that could provide students with practical clinical experience. Usually a two- to three-year program of training, the reality of the programs was that they functioned more like an apprenticeship, providing the hospitals the use of the student’s labor. Despite the exploitative nature of the training programs, they impacted the medical field, providing a cadre of professional caregivers who assisted hospitals in becoming scientific institutions of health care. Additionally, the profession became an attractive career path for women, who had few options available to them other than domestic work. Over time, with the increase of state licensing boards and medical treatment complexities, nursing schools evolved into more theoretical instruction, lessening the use of students for labor.
Early Nursing Training At Central State
Photograph of center building at State Lunatic Asylum, Milledgeville, Baldwin County, Georgia, ca. 1894
In 1896, recognizing that a training program for nurses would be beneficial to the operation of and quality in care at the sanitorium, an informal program was set up under the direction of Superintendent of Nurses, Ms. Cross. A large room, located in the basement of the Center Building, was designated for lectures and practical training in anatomy, physiology, and practical skills, such as bed making, bathing patients, general sick-room work, chart-making, and record keeping.
“A course of lectures has been delivered to the white female nurses by our efficient superintendent of nurses with the result of greatly increasing the efficiency of the service, as evidenced by greater interest and intelligence shown by the nurses in general in the discharge of their duties and attitude towards the patients.”- Annual Report of the Board of Trustees of the Lunatic Asylum of Georgia for the Fiscal Year from September 1, 1895, to September 1, 1897.
Photograph of interior of operating room at State Lunatic Asylum, Milledgeville, Baldwin County, Georgia, ca. 1894.
By 1898, the hospital required all hired nurses to be “young, bright, and intelligent,” with the ability to read and write. Additionally, nurses obtained a uniform for the first time, further establishing a more professional practice of nursing at the asylum. By this time, the results of the training had become evident and all nurses were required to enter the training program. Regular twice-weekly lectures were held for the white female nursing staff and were conducted by the Superintendent of Nurses. Lectures to the Black female attendants were suspended in 1897 due to the workload necessitated by overcrowding of the colored patient wards.
It was observed that the training produced clinical advantages, providing nurses with additional bedside instruction. This success led to the expansion of space allocated to the program to be increased to two rooms in the basement of the Center building in 1899, the second space designated for training in the “preparation of gauze and other surgical necessities.” It is stated in the sanitarium’s annual report of 1900 that the training program was paying off, providing a higher quality of care than seen before and increasing the nurse to patient ratio to one nurse for every eight patients.
“I am also glad to state that we have a more intelligent and efficient corps of nurses, perhaps, than we have ever had."-Superintendent Powell, Annual Report of the Board of Trustees of the Georgia State Sanitarium for the Year Ending September 1, 1900.
Photograph of dayroom at State Lunatic Asylum, Milledgeville, Baldwin County, Georgia, ca. 1894
By 1903, more bedside training was instituted into the training regime of the nurses. Additionally, training for Black attendants resumed, with Dr. Green and Dr. Walker being tasked with the responsibility of providing instruction to the Black staff. The benefits of providing instruction and training to nurses at the Georgia State Sanitarium, however unstructured the delivery may have been or how unconducive the nurse's schedules were to the devotion to study, could not be ignored. The Board of Trustees enthusiastically sought the establishment of a formal nursing training school at the sanitarium, which would come to fruition in 1910.