The History of Education in Nursing: The Time Is Now : Nursing Education Perspectives

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The History of Education in Nursing: The Time Is Now

D’Antonio, Patricia; Clark, Jessica

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Nursing Education Perspectives: 11/12 2022 - Volume 43 - Issue 6 - p 385-386
doi: 10.1097/01.NEP.0000000000001059
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The Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania is privileged to serve as the manuscript and digital repository of materials and videos from the National League for Nursing (NLN). In 2017, with generous funding from NLN donors and the Independence Foundation, we initiated a four-year process of identifying and preserving NLN archives and of developing and implementing an archival repository that includes the League’s annual reports, educational videos, and significant publications of data not easily found elsewhere. The NLN Archives Project (Archives Project) is an invaluable resource for those interested in exploring topics as broad as nursing and the history of women’s education in the United States or as focused as that of the debates behind the 1960s and 1970s Curriculum Revolution in nursing education.

However, archives are only as influential as their utilization. We would like to suggest several critically important questions for nursing education today that we believe the Archives Project may be able to help us better understand. These questions, we admit, are by no means exhaustive. We offer them only to serve as examples of how the NLN’s history continues to influence our present and future directions.


Today, in our commitment to equity, inclusivity, and diversity, we are called to seriously reexamine how structures and practices of nursing education reinforce structural racism. Broad historical answers are already known: In a segregated society and health care system, nurses of color had their own segregated nurse training schools well into the 1960s. However, we are now asked to dig deeper. In both histories of nursing and medical education, we are now asked to explore how materials taught in classrooms, memorized from texts, and practiced on wards refract and reinforce heretofore invisible assumptions and biases about what kinds of knowledge — validated by the social and racialized positions of those acknowledged as experts — count as authoritative. We are asked to wonder about the erasure of indigenous and personal knowledge systems and argue about what may have been lost, what may have been gained, and what may have been so seamlessly absorbed that we can now speak of “nursing intuition.”

Not surprisingly, very preliminary studies that explore these questions focus on the system of modern nurse training associated with Florence Nightingale. How did Nightingale’s position as a White, upper class, confirmed colonialist, and, according to some, racist affect her ideas about the education and role of trained nurses? We would point, more especially, to the oft-repeated phrase that we, in the United States, adopted, the “Nightingale system” of nursing education, in our early training schools. We did not. We adopted the prestige and its White, middle-class rhetoric, but we explicitly rejected its class-based structure and its centralization of power in a matron. American nursing education leaders argued toward a more democratic and capitalist economy that enabled graduates to make their own choices about employment opportunities. Now, the NLN’s digitized annual reports allow us to look more deeply at the curriculum specifics and explore how their orientation to medical sciences reflect the structural racism that historians of science have already identified.


A prior generation of research has painted nursing education in a rather dismal light: hospital training schools as places of serious labor exploitation, unyielding discipline, and powerless superintendents at the mercy of hospital superintendents. Newer work, influenced by expanding definitions of women’s activism and sources of power, challenges this older argument. Casting aside gendered definitions of labor activism (i.e., strikes, slow-downs, and unionization), these studies emphasize collective actions. For example, the class of 1919 desperately wanted permission to “bob” their hair when that particular style exploded at the beginning of the Roaring 20s. Their superintendent refused with the threat of immediate dismissal. However, the senior students, well aware not only that they were the most experienced nurses in a hospital run on student labor but also that the hospital could not run without their expertise, decided that, as a group, they were too valuable to be unilaterally expelled. They all bobbed their hair and, true to their prediction, remained in training until their graduation.

What other area of historical power and authority did nurses know they possessed? We think particularly of the much understudied Curriculum Revolution of the 1960s and 1970s. The Archives Project offers clues to where and how leading nurse educators conceived of this revolution. It can identify sources of support both within and outside the discipline. It can chart the course of intellectual thinking about the essential triumvirate of education, research, and practice. Also, as we think about a new revolution in competency-based, connected education, it can offer important insights about how to proceed.


There are so many more questions for which the Archives Project can provide answers. How does the long history of innovation influence our current perspectives? Given the data supporting the fact that nurses have always had assistants (even if they were once called nursing students), what do we make of the often unending debates about how nursing knowledge should be shared? Also, can we glimpse any answer to the current organization of nursing’s work that might help address the current and acute nursing shortage? Who have been the unacknowledged leaders in nursing education — especially those from Black training schools and those leading schools in Catholic hospitals? Also, what can we say about nursing as a course of social as well as professional mobility?

These questions, we would say in closing, are not sterile academic ones. We ask you to come, explore, and, in the end, ask and answer the kinds of questions you think are essential to understand the history of nursing education. Your answers can shape a course as we engage with 21st century challenges and possibilities.

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