History of nursing in the United Kingdom facts for kids

Kids Encyclopedia Facts

The history of nursing in the United Kingdom shows how this important job has grown since the 1850s. But caring for the sick has been around for a very long time, even in ancient history. Back then, people were cared for in temples and other holy places.

In the early days of Christianity in Britain, some women in the Christian Church looked after sick people, even in their homes. These women didn't have formal training like nurses today. But they learned a lot from experience, especially about using herbs and old folk remedies. Some of them became famous healers, like the doctors of their time. Even today in Britain, a senior female nurse is still sometimes called "Sister", which reminds us of these religious beginnings.

Nursing Before Training (1800s)

Before nurses had proper training, their jobs were often not well paid. In London, nurses in voluntary hospitals earned about 6 to 9 shillings a week, plus some food and a place to stay. Outside London, the pay was even lower. Not many nurses had much education. Hospitals themselves often had poor conditions.

The name 'sister' came from religious sisters who were hired separately from other nurses. These sisters were seen as more respected and dedicated to helping patients. Matrons, who managed the hospital, were even more so. Groups like the Nursing Sisters of St John the Divine (started 1848) and the All Saints Sisters of the Poor (1851) provided nurses for big London hospitals until the late 1800s.

In Poor Law infirmaries (places for very poor people), nursing was often done by poor people who were healthy enough to work, and they weren't paid. In 1866, only 53 nurses worked in 11 London workhouses, earning about £20 a year.

Florence Nightingale: A Pioneer

Florence Nightingale

Florence Nightingale is known as the founder of modern nursing. Before her, there wasn't a special school to train nurses in hospitals. The first one was set up in Kaiserwerth, Germany, in 1846. Nightingale trained there.

In 1860, she used her training to start the first school at St Thomas' Hospital in London. This school was mainly for training nurses, not just for providing nurses to the hospital.

Nightingale in the Crimean War

During the Crimean War against Russia, Nightingale was asked to bring female nurses to military hospitals in Turkey. In November 1854, she arrived at a hospital in Scutari with 20 nurses and religious sisters.

At first, the doctors didn't want their help. But soon, many injured soldiers arrived from the Battle of Inkermann, and the nurses were desperately needed. Nightingale was shocked by the terrible conditions. Doctors were reusing dirty rags, and soldiers were left unwashed and bleeding. She introduced strict rules for cleanliness. Because of her efforts, the number of deaths dropped by half.

When Nightingale returned from the war in 1856, she avoided public attention. In 1860, she became the first woman to be elected to the Royal Statistical Society for her work with hospital statistics.

Making Nursing a Profession (1858–1902)

When doctors started to be officially registered in 1858, many people thought nurses should be too. The Nursing Record journal (later the British Journal of Nursing) asked for a way to register trained nurses. Support for regulating nursing grew after Nightingale's training school opened in 1860.

By the 1880s, the Hospitals Association (an early health organization) wanted nurses to be registered. The Matrons' Committee, made up of head nurses from big hospitals, agreed. But they disagreed on how long training should be. They wanted three years, while the Hospitals Association wanted one.

In 1887, the Hospitals Association created its own voluntary register. This caused the Matrons' Committee to split. One group supported the Hospitals Association. Another group, led by Ethel Gordon Fenwick, was against the new register. They wanted nurses to be more closely linked to doctors. Florence Nightingale didn't support either group. She believed that the most important qualities of a nurse couldn't be taught or regulated.

In 1887, Ethel Gordon Fenwick's group formed the British Nurses' Association (BNA). They wanted to unite all British nurses into a recognized profession and register them. This would show they had received proper training. So, there were now two different voluntary registers. The BNA's register was more focused on protecting the public.

By 1892, it was accepted in hospitals that the matron was in charge of her own staff and reported directly to the hospital committee.

In 1901, there were about 63,500 female nurses and 5,700 male nurses in England and Wales. Most worked in patients' homes. Male nurses mostly cared for people with mental health issues and weren't allowed in regular nurse training schools. Workhouse nurses earned about £17 a year. Hospital nurses in 1902 earned around £19 a year, but they also got free housing, laundry, and uniforms, which were worth about £30 a year. Hospital nurses often worked 12-hour days.

Princess Helena and the Royal British Nurses' Association

Princess Helena of the United Kingdom, Queen Victoria's daughter, helped nursing become a respected profession. Helena was very interested in nursing. She became President of the Royal British Nurses' Association (RBNA) when it started in 1887. In 1891, it became "Royal," and got a special Royal Charter in 1892.

Helena strongly supported nurse registration, even though Florence Nightingale and other important people were against it. In 1893, Helena said the RBNA was working to "improve the education and status of those devoted and self-sacrificing women whose whole lives have been devoted to tending the sick, the suffering, and the dying." She also warned about the opposition they faced. The RBNA could keep a list of nurses, but not a formal register.

After Queen Victoria died in 1901, the new Queen, Alexandra, wanted to replace Helena as President of the Army Nursing Service. Helena agreed to step down but remained president of the Army Nursing Reserve. Helena ran the RBNA very efficiently.

The RBNA slowly lost its importance after the Nurses Registration Act 1919 was passed. After six tries, the British parliament finally passed the law allowing formal nurse registration. This led to the creation of the Royal College of Nursing (RCN), and the RBNA lost members. Helena supported the idea of the RBNA joining the RCN, but it didn't happen. However, Princess Helena stayed active in other nursing groups.

Military Nursing

Nightingale's book Notes on Nursing set the rules for professional nursing. Her public reports about the terrible care for sick soldiers made people want change. In 1860, Queen Victoria ordered a hospital to be built to train Army nurses and surgeons. This was the Royal Victoria Hospital, which opened in 1863 and cared for military patients. From 1866, nurses were officially appointed to Military General Hospitals.

The Army Nursing Service (ANS) started overseeing nurses' work in 1881. These military nurses were sent overseas, starting with the First Boer War (1879-1881). They also served in the Egyptian Campaign (1882) and the Sudan War (1883-1884). During the Sudan War, ANS members nursed on hospital ships and in Cairo. Nearly 2000 nurses served in the second Boer War (1899-1902), alongside nurses from Australia, Canada, and New Zealand. They worked in tent hospitals, and 23 British Army Nursing sisters died from diseases.

Queen Alexandra’s Imperial Military Nursing Service

In March 1902, the Queen Alexandra’s Imperial Military Nursing Service (QAIMNS) was created and named after Queen Alexandra, who became its President. In 1949, the QAIMNS became a part of the British Army and was renamed the Queen Alexandra's Royal Army Nursing Corps. Since 1950, this group has trained nurses, and men were allowed to join in 1992.

The Queen Alexandra's Royal Army Nursing Corps Association is a registered charity. Queen Alexandra was President from 1902 until her death in 1925. Queen Mary took over the next year.

Nursing in the 20th Century

1905–1919

The National Council of Nurses was formed.
The First World War led many unmarried women to become nurses.
The College of Nursing was founded in 1915 (later the Royal College of Nursing).
The Nurses Registration Act 1919 was passed, and the Ministry of Health was created.

The demand for state registration grew in the 1890s, but disagreements within the nursing profession slowed it down. In 1902, a law was passed to regulate midwives. Two years later, a committee in the British House of Commons looked into registering nurses.

The committee reported in 1904, strongly supporting registration. However, the government didn't act on it. Over the next ten years, several attempts to pass a law for nurse regulation failed in Parliament.

First World War (1914-1918)

At the start of the First World War in 1914, women nurses had a small role in the military. But 10,500 nurses joined Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service. These services had royal support. Also, 74,000 Voluntary Aid Detachment (VAD) nurses were enrolled by the Red Cross. New ranks were created for nurses, like Matron-in-Chief and Sister. More women joined throughout the war. By the end of 1914, there were 2,223 QAIMNS members, and by the end of the war, there were 10,404 trained nurses.

Grace McDougall (1887–1963) led the First Aid Nursing Yeomanry (FANY), which started in 1907. McDougall was even captured by Germans but escaped. The British army didn't want them, so they drove ambulances and ran hospitals for the Belgian and French armies.

The First World War finally pushed for nursing regulation. This was partly because of the nurses' important work during the war and the increased role of women in society. The College of Nursing (later the Royal College of Nursing) was founded in 1916. Three years later, they convinced a Member of Parliament, Major Richard Barnett, to introduce a bill to create a regulatory system.

The bill passed in December 1919. Separate Nurses Registration Acts were passed for England/Wales, Scotland, and Ireland (which was then part of the UK). These laws created the General Nursing Council for England and Wales and other groups. These groups lasted until 1979, when the UKCC and National Boards of Nursing were created. Ethel Gordon Fenwick was the first nurse on the English register.

1920s

In the 1921 Census, 111,501 women and 11,000 men said they were nurses. The new registration system stopped very small hospitals from offering training. The first national nursing exam was in 1925, and about 40% of candidates failed.

The Labour Party suggested its first policy for nurses in 1926. They wanted a 48-hour work week, separate training schools from hospitals, and for nursing to be organized like a trade union.

1930s

The National Society of Male Nurses was founded.
The Royal College of Nursing received its special royal charter.

In the 1931 Census, 138,670 women and 15,000 men said they were nurses. Most of the women (88%) were single.

In 1930, nurses in hospitals worked about 117-119 hours every two weeks. In 1936, the London County Council set a standard 54-hour week for nurses, and in 1938, they moved to a 96-hour fortnight (two weeks).

In 1935, county councils started training courses for assistant nurses to care for people with long-term illnesses.

In 1937, the Trades Union Congress adopted a "Nurses’ Charter." It asked for a 96-hour fortnight, better living conditions for nurses, and the ability for nurses to live outside the hospital. At that time, nurses worked about 104 hours every two weeks. A committee was set up to look into nurse recruitment, training, and working conditions. It found that about 12,000 new nurses were needed each year. It suggested higher pay, a 96-hour fortnight, four weeks holiday, and fewer unfair rules for nurses' lives. It also suggested more domestic staff and public money for hospitals to pay for these improvements.

1940s

The Nurses Salaries Committee was created in October 1941.
The role of state enrolled nurse was officially recognized, requiring two years of training instead of three.
Penicillin became available for public use.
More male nurses joined as soldiers with medical experience returned from the war. By 1949, there were about 1300 registered male nurses.
The National Health Service (NHS) started in 1948. It offered free healthcare for everyone, paid for by taxes. Pay for student nurses was £200 (with £100 deducted for living costs), and for staff nurses £315, rising to £415 (with £120 deducted).

Second World War (1939-1945)

At the start of the war, the armed forces thought they needed 5000 trained nurses. They also expected 67,000 nurses would be needed for air-raid casualties. This was more than the number of trained nurses available. So, a Civil Nursing Reserve was set up. It included 7000 trained nurses, 3000 assistant nurses, and nursing auxiliaries. The auxiliaries received 50 hours of hospital training before starting work.

After protests, it was agreed that auxiliaries should not do domestic work. By June 1940, 6,200 members of the Civil Nursing Reserve were working in hospitals. The Ministry of Health guaranteed student nurses a salary of £40 during training, which was about double what hospitals paid before the war.

During the war, nurses belonged to the Queen Alexandra's Imperial Military Nursing Service (QAIMNS), just like in World War I. They served in every British military campaign overseas and in military hospitals in Britain. At the start of World War II, nurses had officer status but were not commissioned officers. In 1941, they were given official commissions and ranks, like Lieutenant to Brigadier. Nurses faced many dangers during the war, and some were captured and became prisoners of war. Two hundred and thirty-six nurses died because of the war. Five nurses who trained at the Royal Victoria Hospital, Belfast died in service. By the end of the war, the QAIMNS had grown to 12,000 nurses.

1950s

Many nurses from the Caribbean came to train in Britain.
The introduction of tranquillisers changed mental health nursing.
Male nurses were allowed to join the main nursing register in 1951.
The University of Edinburgh started the first course for clinical nurse teachers.
The Mental Health Act 1959 ended the legal separation of psychiatric hospitals, allowing patients to be admitted to any hospital.
By 1959, most hospital nurses worked an 88-hour fortnight.

1960s

The availability of sterile supplies meant nurses no longer had to wash and sterilize equipment like dressings and syringes. Edinburgh started the first degree in nursing. The "Nurses (Amendment) Act, 1961" was passed, removing the word "assistant" from the State Enrolled Nurse's job title.

The Nursing Homes Act 1963 brought registration and more control by local authorities.
The Salmon report suggested changes to nurse grading, which led to the end of the traditional matron role.
Nurse Dame Cicely Saunders opened the first hospice in 1967.
In 1960, the University of Edinburgh was the first UK university to offer a bachelor’s degree in nursing.

1970s

Nurses marched to Downing Street demanding better pay and won increases of up to 58%.
Manchester University appointed the first professor of nursing.
The Royal College of Nursing (RCN) became a trade union.
The Nursing Process introduced a way of thinking based on assessing, planning, doing, and evaluating patient care.
Changes to shift patterns began.

The Briggs Committee was set up in 1970 to look at nurse training and nursing's place in the NHS. It suggested changes to education and replacing the nine different regulatory bodies across the UK with one central council and separate boards in each of the four countries. It took six years for these ideas to become law in the Nurses, Midwives and Health Visitors Act 1979.

1980s

Large meetings were held about pay, the state of the NHS, and changes to nurse roles.
The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) became the new main regulatory body in 1983.

In 1983, the UKCC was created. Its main jobs were to keep a register of nurses, midwives, and health visitors, give guidance, and handle complaints about professional conduct. At the same time, National Boards were created for each UK country. Their main jobs were to check the quality of nursing and midwifery education and keep training records for students.

This system lasted until April 2002, when the UKCC was replaced by the new Nursing and Midwifery Council (NMC). The English National Board was also removed, and its quality control job was taken over by the NMC. New groups were created in other countries to take over the National Boards' jobs.

1990s

Changes to training under Project 2000 began.
Education for nurses after they qualified was introduced.
The nurse-led helpline NHS Direct was started.

2000s

Healthcare changes were set out in The NHS Plan.
The Nursing and Midwifery Council took over from the UKCC in 2002.
Agenda for Change created a new pay structure for nurses.
Nurse employers were checked for staff-friendly policies under Improving Working Lives and Investors in People.
In 2005, the number of nurses reached an all-time high of 397,500.
Nursing students were given "supernumerary status" during their three years of training, meaning they were there to learn, not just to fill staff shortages.
Thanks to more funding, in 2006, 383,000 qualified nurses and midwives worked for the NHS, a 24% increase since 1997.
By 2001, almost half of new registered nurses were immigrants, mostly from the Philippines, India, South Africa, Australia, and Nigeria. This was up from 10% in 1990.
In 2009, Healthcare Assistants (HCAs) became entitled to commissions (payments).

2010s

In 2017, the student nurse bursary (a grant to help with living costs) was removed in England and Wales. This led to a 23% drop in applications for nursing degrees. Northern Ireland kept the bursary, and applications stayed steady.
After the EU referendum in 2016, nurse applications from European countries fell by 96%. For example, in July 2016, 1,304 nurses from the EU joined the Nursing and Midwifery Council register, but in April 2017, only 46 joined.
The "Quality with compassion: the future of nursing education" report (from the Willis Commission on Nursing Education) was published in 2012. This report gave a history of nursing education.