62 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
in need of employment. Nightingale’s ideal plan separated ward service from nursing
education by making student nurses’ practical experiences on the hospital wards oppor-
tunities for learning with nurse instructors and physicians, rather than just providing
service to the hospital.
Scientific progress in medicine, combined with the growing promotion of social
reforms in many areas, helped formulate the idea that for better outcomes physicians
needed assistants to carry out their complex medical treatments. Recognizing that they
were following the physician’s orders, Nightingale wanted her nurses to understand
the reasons for their actions, and thus promoted the idea of education. She wanted pub-
lic support for nursing education, which included some medical education— a shift in
thinking that was not readily accepted.
In opposition to Nightingale’s educational plan for nurses were widely supported
societal ideas characterizing what constituted the natural traditional work of women,
and views that too much education would take away the feminine instinct that was
related to delivering care. The transfer of the Nightingale tenets to hospitals in the
United States altered important educational objectives, which were different from just
using student nurses to fulfill the service needs of the hospital.
The Nightingale Nursing Model Becomes “Americanized”
Hospital administrators, physicians, and women in the United States studied
Nightingale’s ideas and brought them to hospitals that had been established since the
late 18th century, staffed with employees providing care without formalized training
(Rosenberg, 1987). The first nursing schools were formed by separate nursing school
boards charged with planning and financing the institution. Unfortunately, poor fund-
ing removed Nightingale’s ideal of student nurses in the hospitals to learn. Instead, stu-
dents became the sole hospital care providers, in effect paying for their training, which
lacked public support (Rosenberg, 1987). Their education became ward service, as theo-
retical classroom time decreased and practical experience became the teacher. The pro-
liferation of hospitals in the 1870s increased the need for student nurses and the growth
of schools of nursing, which led to a diffusion of nursing education and the graduation
of a variety of levels of nurses. The reputation of nurses, as well as the quality of the
care they provided both in the hospitals and in private duty positions in the home after
completing training, varied.
In the late 19th and early 20th centuries, nursing leaders, including a group of
women nursing superintendents, shaped nursing education and work and attempted to
require prescriptively a level of consistency to nursing care, thus protecting the reputa-
tion of the schools and the work done by their graduate nurses. Although the superinten-
dent title was mostly associated with the directors of training schools in the profession’s
infancy, the “nurse superintendent” was later clarified by Davis (1929) as:
The administrator or executive head of the hospital, not the director of the
training school. In some of the smaller hospitals (unfortunately) the two po-
sitions are combined. The nurse superintendent has her chief field in the non-
governmental charitable hospital of less than 100 beds. (Davis, 1929, p. 386)
This early cohort of leaders worked together to form committees to evaluate school
curricula and the education of specialized tasks performed by nurses. They actively
promoted the formation of alumni groups (and their obvious financial philanthropy)
and became a formidable and interested group of active nurses. The American Society
of Superintendents of Training Schools, founded in 1894, promoted leadership, higher
entrance requirements for potential students, and better training schools in an effort to