The evolution of nursing education and current trends in the field

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Nursing has long been considered an admirable profession, providing invaluable service to society’s most vulnerable. From quick recoveries to catastrophic accidents and chronic diseases, nurses operate in the hardest, most stressful, and most heartbreaking situations in order to keep their patients as healthy as possible, even in the face of seemingly insurmountable odds. Part of this dedication is due to the education nurses receive as they train to provide life-saving care. As the role of nurses evolves and they begin to adopt more responsibilities in the field, however, academic instruction must also change. Today’s nursing education looks very different from what it did in the 18th and 19th centuries. 

This article explores the changes academic nursing instruction has made over the years as well as what we see in the profession’s future. 

The roots of nursing

Nursing is not a field that popped up one day when people recognized a need in the market. On the contrary, the profession of nursing has evolved. More specifically, nurses existed as far back as the 17th and 18th centuries, although they were not known by that title. Physicians during this time were often responsible for traveling great distances to care for patients, leaving the ill, the pregnant, and the aging behind in the process. 

History’s first nurses gradually evolved from female family members caring for loved ones in need. Over time, these women (and those who came after them) became seen more as medical providers and caregivers than family members spending time with ill or infirm relatives. The continued rise of female midwives certainly helped in this regard as they also cared for ill and aging patients as well as pregnant women. 

At this time, there were no official nursing programs. Instead, midwives and nurses relied on practical experience and home remedies to care for patients. It wasn’t until the 19th century that formal education would be provided to aspiring nurses. 

Florence Nightingale (1855)

In 1855, Florence Nightingale was granted the “Nightingale Fund”. These funds allowed her to establish the world’s first nursing school at St. Thomas Hospital in the United Kingdom. The school opened in 1860 and marked a clear shift from home-based remedies to science-based care. The Nightingale Fund remains in place today, providing funding to help midwives, nurses, and other care professionals pay for their education.

Dorothea Dix (1861 and 1873)

In 1861, the nursing revolution spread to the United States via Dorothea Dix, the superintendent of Army Nurses during the height of the Civil War. Under her direction, nurses operated all over the country, offering effective and standardized care. Her dedication to the craft and the more than 3,000 women who rose to the challenge of caring for the wounded during an active war raised the nursing industry to a new level of respect. 

In 1873, just 12 years later, the Bellevue Hospital School of Nursing opened in the United States. The Boston Training School at Massachusetts General Hospital and the Connecticut Training School at New Haven Hospital followed soon thereafter. These schools were landmarks in nursing education for a few different reasons. The most important of these is that instructors began to teach aspiring nurses the basics of physiology and anatomy. Nurses were now trained on a medical foundation rather than an anecdotal “best practices” one. This change led the way for nurses to be considered legitimate medical professionals working with doctors not just for them. 

Nurses Associated Alumnae (1896)

Another important year in the evolution of nursing education was 1896, when the Nurses Associated Alumnae (NAA) was established. Comprised of professional nurses from top alumni groups around the country, the NAA was responsible for developing the first official code of ethics in nursing as well as further raising the standards of nursing education. The NAA eventually became the American Nurses Association, an organization that remains extremely influential. 

Chautauqua School of Nursing (1900)

Established in the early 1900s, the Chautauqua School of Nursing is thought to be one of the first, if not the first, nursing schools offering programs for different nursing specialties. They offered three courses: one on general nursing, one on obstetric nursing, and one on surgical nursing. The Chautauqua School was also the first educational organization offering remote learning, which consisted of nurses learning via correspondence education.

The National League of Nursing Education (1915)

The National League of Nursing Education (NLNE) established a standardized curriculum for nursing education around the country. The curriculum greatly expanded the knowledge nurses should learn before entering the field of nursing and included no less than 14 courses, with some schools including additional coursework. This was further reinforced by the Committee on the Grading of Nursing Schools in 1925, which sought to hold nursing schools accountable for their programs. The committee graded nursing schools around the United States of America and laid the foundation for accredited programs.

NLNE and higher education (1947)

In 1947, the NLNE was working towards bringing nursing schools into the higher education system. They began several “pilot” programs during this time, which quickly revealed the value of longer programs (two to three years) leading to associate or baccalaureate degrees. Thanks to their work, nursing education became a respected program in universities rather than separate programs scattered around the country.

Modern nursing instruction

We know how nursing education has changed over the past few centuries, but what does that mean for today’s nurses? The modern educational curriculum for nurses is based on highly skilled instructors delivering engaging, active, and experiential lessons. Rather than sitting in a large lecture hall listening to the professor talk for an hour or three, today’s nursing students are part of a rich academic culture aimed at teaching by engagement. Simulated environments, for example, help nurses understand real-world scenarios they otherwise might not experience until entering the job force. 

Simulated environments likely won’t be a one-time addition to students’ curriculum, either. The lack of available nursing residencies means that aspiring professionals will need to get creative to fulfill their practical training requirements. Some of this can be done using simulated environments built to mimic common nursing scenarios. These can be surprisingly effective and ensure nurses are better able to jump into their work once they’ve graduated. 

Rising degree demands

Another change worth mentioning is the shift from nursing diplomas to nursing degrees. Most states have started preferring degrees for incoming nurses rather than a certificate of completion from hands-on coursework alone, which is what used to be the gold standard for nursing education. This is especially true of more advanced nursing positions. If you want to know how to become a nurse practitioner in Texas, for example, you can expect to complete a bachelor’s degree in nursing as well as an advanced program or degree specific to your area of interest, such as family nurse practitioners or geriatric nurse practitioners. Texas Woman’s University is an especially well-respected institute with specialty nurse practitioner courses. 

Nursing trends

Now that we know how nursing education has changed over the centuries, let’s take a look at where it currently stands. We’ll start with how education is conducted as well as where it is conducted. 

Online classes

In the not-so-distant past, completing a nursing program was an in-person experience. Students were required to come on campus at specific times to sit in classes, take exams and other evaluations, and study with classmates in study halls. Today, that is no longer the case. While many nursing programs are in person, some of them are trending toward entirely remote degrees. This means that students can take their courses online and do not need to be on campus at all. 

Different degrees have different expectations about how this arrangement works. Some universities record professors delivering lectures and lessons and store those videos for students to access when they have time. This gives them the ultimate flexibility. Students who work during the day can always log on at night and listen to the required lectures, for example. Those who have a few days every week that are overloaded with other responsibilities can often schedule their study time for less stressful times. 

Other universities do not offer the above program structure and require students to be online at certain times for live lectures. Even this is more flexible than in-person studying, however. Students who are out and about can often take part in these lectures via their phones. All you need is a quiet location, a good pair of headphones (preferably with a microphone), and a bit of spare time. Some people can even use their lunch breaks to listen to lectures scheduled during the day, allowing them to work around their studies in a way that might not be possible if they were constantly traveling to and from campus. 


Another trend in nursing is an increased focus on technology. Wearable medical devices are a good example of this. Patients with a wearable blood sugar monitor, for example, have a record of sugar spikes and crashes every day. This allows nurses to better understand patient needs, especially if they must be admitted due to a medical emergency relating to diabetes. Wearable medical devices are an increasingly common tool, often used in conjunction with smart beds. Smart beds are used in some hospitals (and even some residential homes) to keep track of a patient’s vital signs and generate care recommendations based on the data. 

Another area where technology is changing the way nurses operate is telemedicine. The availability of remote medical care rose dramatically during 2020 when many people were ordered to stay inside and keep themselves safe from the COVID pandemic. The demand for convenient healthcare solutions has, predictably, remained high even as doctor’s offices open around the country. Many nurses find themselves providing care via telephones and cameras, especially in rural areas. They must understand how to use the technology in question as well as how to integrate it into their days, especially when they are also working with patients in person. 

The use of technology in the nursing field will only increase in the coming years. We believe that this is one area where the trends will see little change in the short-term—technology is here to stay. 

Autonomy, independence, and new responsibilities

Throughout the 18th and much of the 19th centuries, nurses were doctor’s assistants. Their role was to carry out the more mundane tasks of caring for sick patients and assisting doctors with other requests and needs as they arose. Today, they are much more. Modern nurses are responsible for many aspects of care, and these responsibilities are only growing. The increased emphasis on community health screenings and preventative care has changed the way nurses interact with patients. From educating patients about proper home care to helping them avoid serious complications, nurses are responsible for more primary care than ever before.

As their responsibilities grow, the way nursing works has also shifted. A few centuries ago—or even a few decades ago, depending on the area—nurses in the United States worked strictly under the purview of a doctor. Physicians were responsible for making decisions, and nurses were responsible for enforcing them. Today, nurses use their own best judgment in many areas, such as medication administration. Nurses must now be able to work independently to make quick decisions as well as within a team to ensure that patients receive the best care possible. We see this trend toward increasing independence continuing to shape the future of nursing. 


We’ve talked about the shift from in-person to online courses, but education is changing in more ways than one. As you know, given the timeline of nurse schooling we put together above, the way nurses are trained and educated before they begin work has transformed over time. We see these changes continuing in both the short and long term. 

More specifically, we have seen a recent push for nurses to hold bachelor’s degrees in order to practice. While this is not yet a requirement in many states, at least at the time of writing, heated discussions are occurring all around the nation. Should nurses be required to hold an undergraduate degree in order to work? The tides seem to be shifting from “no” and “maybe” to “yes”. This has newer nurses opting for more advanced degrees before they officially graduate, and we don’t see this changing any time soon. 

The trend towards higher education in nursing is one that will likely remain for years to come. 

Emphasis on nurse health

One of the most encouraging trends in nursing is a renewed focus on nurses’ physical and mental health. For decades, nurses have been responsible for great numbers of patients at all hours of the day and with relatively few vacation days to help them recover. This has led to a steady increase in burned-out providers as well as those struggling with mental and physical health problems as a result of the workload. 

Partly due to the increased attention to the importance of nurses during the advent of the COVID pandemic in 2020, legislators and the general population alike are pushing for better care for nurses. From providing them with mental and physical health resources to bringing more professionals into the field to better regulate shift length, slow and steady changes are taking place every day. 

This increased emphasis on nurse health is incredibly important for the well-being of nurses around the country. We see this trend continuing for at least a few years to come, and we hope that permanent change is made during that time.

The future of nursing

The future of nursing is an incredibly interesting one. The next few years, potentially even decades, will likely be full of changes. From requiring more advanced degrees to increasing the number of responsibilities they take on, nurses are in for a bit of a rollercoaster. The good news is that while the changes might feel pervasive at times, the increased interest in nurses’ physical and mental health means that the future might also be a much more considerate one. Overall, the trends in the industry continue the evolution of the field explored in the first few sections of the paper. Nurses have always adapted to meet changing needs, and the next metamorphosis should be for the better. 

Are you interested in learning more about how to become a nurse or a nurse practitioner? You can find remote programs from top universities online! Do a bit of digging and you’re sure to find your perfect fit. 

Natasha M. McKnight

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