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How Has the Nursing Profession Changed through the Years?

Updated By Patrick Oney on August 31, 2020

Most people assume modern-day nursing began with the opening of Florence Nightingale's London training school in 1860. While this was a significant step forward in establishing this noble profession, George Washington actually granted authorization way back in 1775 for hospitals to be staffed by nurses at a ratio of one nurse for every ten patients. Nurses were not easy to hire, however. George Washington blamed the shortage on the low $2 a month compensation. Two years later, Congress increased nurse compensation to $8 a month. Let’s fast forward a couple hundred years and learn more about nursing, decade by decade, along with its future outlook.


After World War I and as the United States moved toward the Great Depression, there was tremendous demand for nurses, especially for working in community health in order to eradicate tuberculosis. However, before long nursing schools became crowded and within a few years there became an “over-production of nurses” and unemployment reached alarming rates. As a solution to this problem, higher education requirements, shorter working hours, and general-duty staff nursing took hold.


Toward the end of this decade, advances in education, new medical procedures, and the opening of additional occupational nursing fields (in particular, psychiatric) brought on a brighter future for nurses. In King County, Washington, private duty nurses were making an average of $25 per month.


The second World War caused a serious nursing shortage both at home in VA hospitals and abroad in the military. More than 100,000 nurses volunteered for active war service, topping all other professions. In 1949, the Mary Mahoney Registered Nurse Club began providing scholarships for aspiring young black nursing students.


This decade brought extensive lobbying and support for landmark legislation. This included the “Health Amendments Act of 1956,” which provided advanced training of professional nurses to serve in administrative or supervisory capacities, and an amendment to the Nurse Practice Act, which provided nurses with the authority to “pierce the tissues to administer prescribed drugs, injection, inoculations, tests, or other treatments.”


The development of new Associate's degree nursing programs began early in the 1960s, as did Master’s degree and certificate programs for nurse practitioners. This sparked debate over giving new, more independent roles for nurses with advanced education.


This was a time of great achievement in the nursing profession. Nurses were now allowed to diagnose and prescribe treatments and medication. Also, due to changes made to the National Labor Relations Act, nurses and hospital employees were given the right to organize and collectively bargain for wages, hours, and working conditions. National Certification programs for nursing specialties began.

Related Content: Learn How to Choose the Right Nursing Program for You.


The 1980s put significant pressure on the health system as a whole and the nursing profession specifically. An adverse economic climate, the impact of new technology, the transfer of nurse education out of hospitals and into schools, and the privatization of health care forced nursing into the modern age.


There were about 2.2 million employed nurses in the 1990s. One-third of nurses had an Associate’s degree and one-third had a Bachelor’s degree. There became a shortage of nurses with graduate and doctorate degrees.


The beginning of the millennium ushered in vibrant programs with an emphasis on quality care, patient and nurse safety, emergency preparedness, public health, and continuing education. Another wave of nurse shortages began, made worse by the increasing complexity of patient healthcare needs.


Now the largest segment of the nation’s health care workers, nurses number more than 3 million strong. The 2010 Affordable Care Act and changes in the Medicare and Medicaid programs put nurses on the front line of patient care.

2020s and Beyond

Future nurses have the potential to implement wide-reaching changes in the healthcare system. The Institute of Medicine has this to say about the future of nursing: “No single profession, working alone, can meet the complex needs of patients and communities. Nurses should continue to develop skills and competencies in leadership and innovation and collaborate with other professionals in healthcare delivery and health system redesign.” As nearly 20% of the American population will be older than 65 by 2030, there will be a shift in the nation’s healthcare needs. Nurses will be called upon more and more for administrative, research, education, and leadership roles. As you can see, nursing has always been high in demand and highly rewarding. If you’d like to pursue a higher education in nursing such as a Master’s in Nursing Administration or other online nursing programs, request more information from Independence University!