Nursing

• 1. Introduction

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  Nursing is the largest single component of most healthcare environments, and yet for roughly 200 years in Europe it barely existed as a profession at all. When Protestant reformers shut down monasteries and convents during the Reformation, the nuns who had served as nurses were given pensions or told to marry and stay home. Care of the sick passed to the inexperienced. How does a calling go extinct, then return to become the backbone of modern medicine? Why did a woman studying sanitation in India come to define what nursing means? And why, in the 21st century, are so many nurses telling researchers they want to walk away from patient care? This is the story of a profession built on caring, and the strain that caring places on the people who do it.

• 2. Out Of The Convents

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  In the fifth century BC, the Hippocratic Collection described skilled care and observation of patients by male attendants, work that resembles what nurses now do. Around 600 BC in India, the Sushruta Samhita instructed that anyone wanting thorough knowledge of anatomy should prepare a dead body and dissect it to examine its different parts. These ancient hints make historians cautious about calling antique care nursing care at all.

  In the Middle Ages, members of religious orders such as nuns and monks often provided nursing-like care, with examples in Christian, Islamic, Buddhist, and other traditions. The biblical figure of Phoebe is described in many sources as the first visiting nurse. The religious roots run so deep that in the United Kingdom the historical title sister still refers to a senior nurse. The modern deaconess movement began in Germany in 1836, and within a half century over 5,000 deaconesses had surfaced in Europe.

• 3. Nightingale And The Doctresses

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  During the Crimean War, Grand Duchess Elena Pavlovna called for women to join the Order of Exaltation of the Cross for a year of service in military hospitals. The first section of twenty-eight sisters, headed by Aleksandra Petrovna Stakhovich, the Directress of the Order, reached Crimea early in November 1854. They were among the women drawn into a conflict that would reshape how the world thought about care.

  Florence Nightingale laid the foundations of professional nursing after that war, guided by a comprehensive statistical study she made of sanitation in India. She emphasized sanitation above all. After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000. Her Notes on Nursing of 1859 was a popular call to action, and the Nightingale model of education spread widely in Europe and North America after 1870.

  Nightingale named five factors that helped nurses working amid poor sanitation: fresh air, clean water, a working drainage system, cleanliness, and good light. Her recommendations built upon the successes of Jamaican doctresses such as Mary Seacole, who also served in the Crimean War. Seacole practised hygiene and the use of herbs in healing wounded soldiers in the Crimea, Central America, and Jamaica. Her predecessors had succeeded as healers in the Colony of Jamaica in the 18th century, including Seacole's mother, Mrs. Grant, and Grace Donne, the doctress to Jamaica's wealthiest planter, Simon Taylor.

• 4. Pioneers And Pensions

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  Linda Richards graduated in 1873 from the New England Hospital for Women and Children in Boston, becoming officially the first professionally trained nurse in the United States. She went on to establish nursing schools in both the US and Japan. Around her, a generation of founders was assembling the profession piece by piece.

  Agnes Hunt from Shropshire was the first orthopedic nurse, pivotal in the emergence of the Robert Jones and Agnes Hunt Hospital in Oswestry. Valérie de Gasparin, with her husband Agénor de Gasparin, opened the world's first nursing school in Lausanne, Switzerland. Agnes Jones established a nurse training regime at Brownlow Hill infirmary in Liverpool in 1865. Clara Barton, a teacher, patent clerk, nurse, and humanitarian, founded the American Red Cross.

  Red Cross chapters began appearing after the establishment of the International Committee of the Red Cross in 1863, offering employment and professionalization to nurses despite Nightingale's initial objections. Saint Marianne Cope, a Sister of St. Francis, opened and operated some of the first general hospitals in the United States, instituting cleanliness standards that influenced America's hospital system. Formal military use of nurses began in the latter half of the nineteenth century, with active duty in the First Boer War, the Egyptian Campaign of 1882, and the Sudan Campaign of 1883.

• 5. Wars And Degrees

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  More nurses volunteered for service in the US Army and Navy during the Second World War than any other occupation. British nurses of the Army Nursing Service were part of every overseas campaign. The Nazis fielded their own Brown Nurses, numbering 40,000, and two dozen German Red Cross nurses were awarded the Iron Cross for heroism under fire. The profession had transformed under the pressures of global conflict.

  In the 19th and early 20th century, nursing was considered a woman's profession, just as doctoring was a profession for men. Hospital-based training became standard in the US in the early 1900s, with an emphasis on practical experience, and the Nightingale-style school began to disappear. Hospitals and physicians often saw women in nursing as a source of free or inexpensive labor, and exploitation by employers, physicians, and education providers was not uncommon.

  The development of undergraduate and post-graduate nursing degrees came after the Second World War. Florence Nightingale's epidemiological study of mortality among British soldiers had been published in 1858, but with the exception of her works, nursing practice remained an oral tradition until the mid-20th century. The inaugural issue of Nursing Research, the first scientific journal specialized in nursing, came in 1952. During the 1960s, interest in attaining PhDs increased among nurses in the US, though few journals existed until the 1970s.

• 6. What A Nurse Does

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  Assessment is an essential nursing skill, and in hospital settings nurses regularly perform assessments to notice acute changes in their patients. They assess physical and mental health, a patient's response to medication, physical activity, and blood transfusions. In emergency situations, nurses must quickly assess a patient and determine the best course of action. Critical thinking is central to the work.

  Medication management and administration are common hospital nursing roles, though prescribing authority varies across jurisdictions. In many areas, registered nurses administer and manage medications prescribed by others, yet they remain legally responsible for the drugs they administer. In the United States, nurses have the right to refuse to administer medication they deem potentially harmful. If a prescription contains an error, the nurse may be expected to note and report it.

  Effective patient and family education leads to better outcomes, and nurses explain procedures, recovery, and ongoing care. Often, though, nurses are busy, leaving little time to educate patients. Nurses also manage and coordinate care to support activities of daily living such as hygiene, toileting, and mobility, often delegating such tasks to nursing assistants. The nursing process, as defined by the American Nurses Association, comprises five steps: evaluate, implement, plan, diagnose, and assess.

• 7. Where Nurses Work

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  Operating room nurses work in surgical settings and perform tasks that other nurses do not, and in the United States, RN first assists perform some basic surgical procedures. Nursing is the most diverse of all health care professions, with major specialties spanning public health, pediatrics, obstetrics, neonatal care, mental health, oncology, palliative care, emergency care, and telenursing, among many others.

  Nurses work on cruise ships, military bases, and in combat settings, as well as in private homes, schools, and pharmaceutical companies. Some are attorneys, and others work as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can also work on a temporary basis through per diem, agency, or travel nursing.

  Digital health platforms now connect nurses and nurse assistants with job openings in skilled nursing homes, home health agencies, and hospitals. In 2017, the UK's National Health Service began trialing such a platform. United States platforms such as ConnectRN, Nomad Health, Gale Healthcare solutions, and Lantum add resources, career development tools, and networking opportunities. According to the WHO's 2020 State of the World's Nursing, approximately 90% of the nursing workforce is female.

• 8. The Cost Of Caring

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  Nurses have among the highest levels of occupational stress among all professions, driven by emotional labor, physical labor, shift work, and high workload. They carry high rates of occupational burnout at 40% and emotional exhaustion at 43.2%, which raise the risk of illness, medical error, and suboptimal care. Compassion fatigue and moral distress can damage their mental health.

  Healthcare has consistently ranked among the industries with the highest rates of musculoskeletal injuries, largely related to patient handling. The most frequently injured body part is the back, with up to 72% of nurses reporting non-specific low back pain. The US Bureau of Labor Statistics reported that for 2021-2022 the rate of overexertion injuries leading to days away from work was 45.4 per 10,000 full time nurses, and 145.5 for nursing aids, against an all-industry average of 26.1.

  In the US in 2011-57% of nurses reported being threatened at work, and 17% were physically assaulted. Patients are the main perpetrators; 80% of serious violent incidents in health care centers were committed by patients. Interventions can help. In some Japanese hospitals, powered exoskeletons reduce physical loads, and combining organizational and individual stress programs is most effective.

  These pressures shape who stays. A global McKinsey and Company survey in 2022 found that between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan, and France said they were likely to leave direct patient care within a year. The top reasons to stay were a safe working environment and work-life balance. Pay ranked eighth.