The history of nursing education in the United States has reflected the development of the United States toward a more organized, equitable, and competent healthcare system. The healthcare landscape began to change as the 19th century gave way to the 20th century, in part due to the industrialization and urbanization of America, which included technological advancements in medicine. New hospitals were being built in order to treat patients with complex and growing needs. While reserved nurses play an important role in the health care team, it was not uncommon for people to be without or short of nursing services, especially in rural areas and poorly economically supported urban areas. In essence, practical nurses were developed to meet the needs of organized, available, and competent health care workers. In this regard, practical nursing developed a course of training to provide people, primarily from working-class backgrounds, the necessary skills to be able to assist physicians and registered nurses in the care of patients.
The founding of the first practical nursing school
The first school of practical nursing in the United States was founded in 1892 in Brooklyn, New York. Known as the Ballard School, the school was established under the Young Women’s Christian Association (YWCA). During a time when formal education was limited for women, and especially for women in science or medicine, the Ballard School provided a formal and organized educational program, which included actual classroom instruction, and trained women to provide basic nursing care for patients.
Evolution from home care to professional training
The original intent of the program was to train home caregivers, but the program quickly moved toward preparing professional training of nursing aides for hospitals and health care in the community. The Ballard School offered a progressive curriculum at the time that lasted approximately three months and included education on basic anatomy and physiology, sanitation, nutrition, and personal care. Students could also take part in practical hands-on training that allowed them to learn how to assist with bathing, feeding, and observing patients.
Key values and teaching philosophy ams
The Ballard School provided information focusing heavily on cleanliness, ethics, and observation, key aspects of nursing education today. While the offerings of the Ballard School were more limited than those of a registered nurse, the knowledge and training that it offered its graduates allowed them to contribute in both hospital and home settings.
Accessibility and social impact
The Ballard School was notable for its commitment to accessibility in education. Creating short-term, skills-focused training, it enabled women from lower socioeconomic backgrounds to gain a credential in the healthcare profession over a short time span, thus providing a level of democratization of nursing education. Many women benefited financially and gained independence, and many underserved communities received additional standards of care.
Influence and expansion of practical nursing education
The success of the Ballard School inspired other schools across the country and their variations of practical nursing that met the health discrepancies where they were located. Over the decades ahead, practical nursing continued to be popular and in demand. The economic repercussions of the Great Depression, and the healthcare demands of World I and World II, placed more stress on hospitals in search of capable staff who could work at a low cost. In this context, practical nurses were viewed increasingly as a vital resource, providing high-quality care for lesser compensation than the subsequent tier of the nursing pyramid—registered nurses. Accordingly, this period of focus and attention resulted in an exceptional increase in the sheer number and size of practical nursing education programs, many of which were developed in collaboration with local hospitals and/or public health departments.
Formation of national standards
The National Association for Practical Nurse Education and Service (NAPNES) was created in 1947 with a focus on developing standards and supporting the practical nurse profession. One of NAPNES’s first achievements was the development of a national curriculum and promotion of credentials which resulted in the use of the professional titles of Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN) depending on the jurisdiction, becoming institutionalized. The licensure formally recognized the practice of practical nursing with examinations, licensing, regulatory oversight, and requirements for continuing education.
Establishing a tiered nursing structure
The development of the Ballard School and subsequent LPN programs created a tiered structure for nursing in the United States, which enabled levels of variation in the training, responsibility, and pay of healthcare careers that simply did not exist previously. This variation created a pathway to expand access to healthcare professions: people can now choose from varied levels of education and credentials over the course of their lifetime. Many LPNs went on to become Registered Nurses (RNs), but those that did not, specialize in areas of practice, such as geriatrics, pediatrics, or home health, which were not as easily available to them previously.
Modern-day practical nursing programs
Today, practical nursing programs are offered by vocational schools, community colleges, and in some high schools across the country, and training programs run from about 12 to 18 months in duration. Along with technology and healthcare delivery changes, the same core values established by the original Ballard School remain in place: continued access, hands-on education, value for patient-centered care, and continued access to try to empower people, especially women, by access to education and career opportunities.
Lasting legacy of the ballard school
The impact of the Ballard School continues to be commemorated today, not only as the origin of practical nursing education in the U.S. but as part of a legacy of public health progress and gender equity. The effects, emanating from such a simple institution, have continued to extend far beyond Brooklyn, affecting the lives of millions of patients and the beginnings of countless nurses. By institutionalizing practical nursing, the Ballard School initiated a system of more available and efficient healthcare parameters for the 20th century and beyond.