The history of nursing in the United Kingdom describes the development of nursing from an unregulated and low-paid occupation into a regulated, graduate profession. Developing from a tradition of monastic infirmaries, nursing as a profession was popularised most in the 19th century by Florence Nightingale, who alongside others sought to introduce a formally trained caring profession to complement medicine. The establishment of the Nightingale Training School at St Thomas’ Hospital in 1860 marked the beginning of organised nursing education in the UK and preceded similar developments across the country. The profession matured throughout the 20th century, with state registration introduced by the Nurses Registration Act 1919 and a royal college established in 1928. The establishment of the National Health Service in 1948 resulted most of hospital nursing moving into the public sector and more standardised approaches to care. Since then there has been a shift towards nursing being a graduate profession; all UK pre-registration nursing programmes being at undergraduate degree level from 2013 with an emphasis on evidence-based practice.
19th century Before the advent of training, nursing was often casual and low paid. Pay in London voluntary hospitals was between 6 shillings and 9s 6d a week, with some board and lodging. Outside London, pay was much lower. Few nurses were described as educated. Facilities in hospitals were poor, though some began to provide meals for nurses. The designation sister arose from the ministry of religious sisters, who were recruited separately from nurses and were more respectable, honest and conscientiously devoted to the welfare of patients (which often brought them into conflict with the hospital authorities). Matrons, whose work was largely administrative, were even more so. The Nursing Sisters of St John the Divine (est. 1848) and the All Saints Sisters of the Poor (1851) provided the nursing staff for several of London's largest teaching hospitals, including King's College, Charing Cross and University College Hospitals until close to the end of the century.
Nursing in the Poor Law infirmaries was largely carried out by able-bodied paupers, who were not paid. In 1866 there were a total of 53 nurses employed in the 11 metropolitan workhouses, at an average annual salary of £20 18s (equivalent to 8 shillings per week).
Florence Nightingale
Florence Nightingale (1820-1910) was an English social reformer, statistician and is seen by many as the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers at Constantinople. She significantly reduced death rates by improving hygiene and living standards. In 1860, she laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world and led to the development of formalised nurse-training in the UK.
Other women involved in nursing in the Crimea were Betsi Cadwaladr and Mary Seacole.
1858–1900
Developments in nurse education In 1881 Eva Luckes, Matron of The London Hospital established the first two-year training scheme in London.Rogers, Sarah (2022). 'A Maker of Matrons'? A study of Eva Lückes's influence on a generation of nurse leaders:1880–1919' (Unpublished PhD thesis, University of Huddersfield, April 2022) She instituted a series of lectures by herself, a surgeon and a physician. In 1884 she introduced the precursor to Sister -Tutors, and selected two of her most trusted and skilled hospital sisters to give probationers extra tuition.Anthony, Grainne (2011). Distinctness of Idea and Firmness of Purpose. The Career of Eva Luckes; A Victorian Hospital Matron. (Unpublished Master of Arts dissertation, London Metropolitan University, 2011).Christine Hallett and Hannah Cooke, Historical Investigations into the Professional Self-Regulation of Nursing and Midwifery: 1860–2002. Vol. One: Nursing Before this the nurses home Sisters at St Thomas's Hospital used to lecture probationers from the Nightingale School. In 1895 Luckes introduced the first Preliminary Training School for Nurses in England similar to that established by Rebecca Strong at Glasgow Infirmary in 1893. This became the blueprint for nurses education following the Nurses Registration Act 1919.
1850–1870
1858 State registration of the medical professions began, prompting calls for a similar system for nursing 1859 Notes on Nursing by Florence Nightingale was published 1860 Nightingale School of Nursing was established at St Thomas' Hospital in London.
1870–1900 1879 Workhouse Infirmary Nursing Association was created 1881 Queen Alexandra's Royal Army Nursing Corps (QARANC) was formed 1886 The Hospital (journal; 1886–1924) was launched 1887 British Hospitals Association established the first UK register of trained nurses for those who could show that they had worked for at least a year in a hospital or an infirmary and had been trained in the duties of a nurse 1887 Queen's Nursing Institute (QNI) was created 1887 Royal British Nurses' Association (RBNA) was created by Ethel Gordon Fenwick. It campaigned for the establishment of a register of nurses. It wanted the training to last three years with national standards. They set up a voluntary register in opposition to that of the British Hospitals Association. Princess Helena, one of Queen Victoria's daughters, played a central role in sponsoring and legitimizing the profession. Helena had a firm interest in nursing, and was the first president of the British Nurses' Association 1888 Nursing Record, a nursing journal, was launched 1889 Queen's Nursing Institute Scotland (QNIS) was formed 1894 Matrons' Council for Great Britain and Ireland was established 1897 National Association of Workhouse Masters and Matrons was created.
Military nursing Nightingale laid the foundations of professional nursing with the principles summarised in the book Notes on Nursing.A. Summers, Angels and Citizens: British Women as Military Nurses 1854–1914 (Routledge & Kegan Paul, 1988) Her highly publicised exposure of the abysmal care afforded sick and wounded soldiers energized reformers. In 1860 Queen Victoria ordered a hospital to be built to train Army nurses and surgeons. The Royal Victoria Hospital opened in 1863 at Netley and admitted and cared for military patients. Nurses were formally appointed to Military General Hospitals from 1866.
The Army Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with the First Boer War (often called Zulu War) from 1879 to 1881. They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.
Princess Helena was also President of the Army Nursing Service. Following Queen Victoria's death, Queen Alexandra took over the presidency, but Helena retained presidency of the Army Nursing Reserve.Chomet, p. 122
20th century 1900–1914 The pressure for state registration grew throughout the 1890s and continued in the pre-War period, but was undermined by disagreements within the profession over the desired form and purpose of the regulatory system. There were six failed attempts between 1904 and 1918, the British parliament passed the bill allowing formal nurse registration. A government committee reported in 1904 setting out a detailed and persuasive case for registration. However, the government sat on the report and took no action. Over the next decade, a number of Private Member's Bills to establish regulation were introduced but all failed to achieve significant support in Parliament.
In 1901 there were 3,170 paid nurses employed in workhouses, with about 2,000 probationers - about one nurse for 20 patients. In total there were about 63,500 female nurses and 5,700 male nurses in England and Wales, working both in institutions and, the majority, in patients homes. The men were almost entirely mental nurses and were not admitted to nurse training schools. Nurses in workhouses were paid about £17 a year. Hospital nurses in 1902 were paid around £19 a year, but the cost of maintenance, laundry, uniforms and accommodation which were provided was around £30 a year. In domiciliary work two guineas a week with meals provided was normal pay, and the work was easier. In hospitals 12-hour days were normal. In March 1902, Queen Alexandra’s Imperial Military Nursing Service (QAIMNS) was established, named after Queen Alexandra, who became its President 1902 Midwives Act was passed, introducing state regulation of Midwives, prompting calls for a similar system for nurses 1904 a House of Commons Select committee was established to consider the registration of nurses, but no action was forthcoming. 1905 Nursing Times (journal) was launched 1907 First Aid Nursing Yeomanry (FANY) was created. Confusingly, their main roles were not as nurses but as ambulance drivers and as the organisers and administrators of hospital and casualty clearing stations for the Belgian and French armiesRoy Terry, "McDougall, Grace Alexandra (1887–1963)", Oxford Dictionary of National Biography, (2004); online edn, May 2006 accessed 6 March 2013Janet Lee, "A Nurse and a Soldier: Gender, Class and National Identity in the First World War Adventures of Grace McDougall and Flora Sandes," Women's History Review (2006) 15#1 pp 83-103; Janet Lee, War girls: the First Aid Nursing Yeomanry in the First World War (Manchester University Press, 2012) 1908 Fever Nurses Association was created 1908 National Council of Nurses was formed 1909 Voluntary Aid Detachment Nurses (VADs) was formed.
1914–1920
First World War By the beginning of the First World War in 1914, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were 74,000 Voluntary Aid Detachment (VAD) nurses who had been enrolled by the Red Cross.Brenda McBride, Quiet Heroines: Story of the Nurses of the Second World War (1985) The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.
The First World War provided the final impetus to the establishment of nursing regulation, partly because of the specific contribution made by nurses to the war effort and also as a reflection of the increased contribution of women more generally in society. The College of Nursing (later the Royal College of Nursing) was established in 1916 and three years later persuaded a backbench Member of Parliament (MP), Major Richard Barnett, to introduce a private members bill to establish a regulatory system.