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 Crimean peninsula. |
| 1860 | Nightingale establishes first training school for nurses in London, England |
| 1863 | International Red Cross established in Geneva, Switzerland. |
| 1873 | First “Nightingale Type” Nurse Training Schools opened in the U.S. |
| 1880s | Germ theory of disease developed |
| 1899 | International Council of Nurses founded. |
| 1893 | National League for Nursing (NLN) founded. Lillian Wald founds the Visiting Nurse Service of New York. |
| 1896 | American Nurses Association (ANA) founded. |
| 1902 | Lina Rogers Struthers hired, in New York, as the first U.S. school nurse. |
| 1908 | National Association of Colored Graduate Nurses founded; merged with the ANA in 1951. |
| 1909 | First university‐based school of nursing opened at the University of Minnesota. |
| 1912 | Public Health Nurses Association founded; merged with the NLN in 1951. |
| 1917 | Standardized curriculum for nursing developed by NLN. |
| 1920 | Women gained the vote. |
| 1922 | Sigma Theta Tau founded at Indiana University. |
| 1923 | Goldmark Report on Nursing Education. Mary Breckenridge founds the Frontier Nursing Service. |
| 1924 | First doctoral program for nurses, in education, opened at Teacher's College, Columbia University, New York. |
| 1930s | Great Depression: Graduate nurses began staffing hospitals; closure of some hospital‐based training schools; start of hospital insurance programs. |
| 1934 | Grading Committee Report on Nursing Education. |
| 1942 |