What were the key milestones in nursing education from apprenticeship to university degrees?
Executive summary
Nursing education moved from informal, apprenticeship-style bedside training before the late 1800s to institutionalized hospital training schools in the late 19th century and then into university-based degree programs across the 20th century [1] [2]. Key milestones include Florence Nightingale’s model and founding of training schools, the spread of hospital-based diploma programs in the late 1800s, the introduction of university baccalaureate programs in the early 20th century (e.g., 1918–1919), the establishment of licensure and accreditation systems in the early 1900s, and the later expansion of graduate-level (MSN, DNP, PhD) programs from the mid-20th century onward [3] [2] [4] [5] [6] [7].
1. From home and convent care to apprenticeship-style hospital training: the pre‑late‑1800s baseline
Before the late 1800s most nurse education was informal—care given at home or by religious orders, and practical skills were passed by apprenticeship to senior nurses within hospitals or clinics rather than taught in classrooms [1] [8] [9]. Accounts emphasize that nursing work before professionalization was often seen as domestic or charitable labor, not an educated profession [3] [8].
2. Florence Nightingale and the birth of modern training schools: a pivotal 19th‑century reform
Florence Nightingale is widely credited with introducing a model of nursing education that emphasized training, sanitation and a systematic curriculum; her reforms helped create the first nurse training schools and anchored the “modern” narrative of professional nursing [5] [3]. Scholarly work, however, notes Nightingale was not the only reformer and that religious women and multiple actors also shaped early formal training [10].
3. Late 1800s–early 1900s: hospital-based training schools expand and diploma programs standardize
By the late 19th century hospital training schools proliferated—1873 is highlighted in American nursing history when several major training schools began (e.g., Bellevue, New Haven, Boston) and hospital-based diploma programs became the dominant model for turning students into working nurses [2] [11]. These programs emphasized hands-on ward work and practical skill, often tied to the hospital’s needs and using students as labor [12].
4. Licensure and accreditation: formal regulation arrives in the early 20th century
States and national bodies began creating legal standards and accreditation systems. For example, nursing licensure exams began in the early 1900s (North Carolina implemented a licensure exam in 1903 and all states had licensure by the early 1920s), and accrediting organizations evolved to oversee program quality [4] [6]. These measures shifted nursing from local apprenticeship toward regulated, standardized practice [6].
5. The university shift: baccalaureate programs and academic chairs (1910s–1920s onward)
Universities began to claim nursing education: baccalaureate nursing programs were approved and expanded in the early 20th century—examples include a baccalaureate program approved in 1918 and a five‑year baccalaureate program starting in 1919 at the University of Minnesota; a chair in Nursing Education was created at UC Berkeley in the mid‑1920s [13] [11]. Over decades nursing education migrated from hospital wards to colleges and universities, driven by expanding scientific knowledge and professional aspirations [12] [13].
6. Post‑World War II and the rise of graduate education: specialization and research
From the mid‑20th century onward, nursing education broadened to include associate degrees, baccalaureates, master’s and doctoral programs. Graduate education created specialties (intensive care, anesthesia, primary care nurse practitioners) and research-focused PhD programs, changing nursing from primarily practical training to a field with academic, clinical and research tracks [7] [5] [14].
7. Continuing tensions and reforms: access, professional status, and equity debates
The history includes recurring tensions—training for practical workforce needs versus extended academic preparation, struggles for autonomy from medical and administrative control, and discrimination in access (for example around race and gender). Legislation such as the Bolton Act influenced standards and admission policies, but sources show integration and equity were gradual and contested [7] [9].
8. Contemporary touchpoints and policy debates (context for the present)
Today’s milestones include the variety of entry routes (diploma, ADN, BSN), RN-to-BSN and accelerated programs, and new professional degree debates. Recent reporting shows changes in federal definitions for “professional degree” status may affect graduate nursing programs and student loan policy—an active policy story in 2025 that intersects with long-term shifts in how nursing education is classified and funded [15] [16] [17]. Available sources do not mention specific outcomes from those policy changes beyond reporting and concern [15] [16].
Limitations and competing views: historians and bibliographies stress that while Nightingale is central to the standard narrative, she was neither the only nor always the unambiguous reformer—scholarship points to multiple actors, religious institutions, and national differences shaping trajectories [10] [9]. Sources describe trends primarily in the U.S. and U.K.; local timelines and reforms differed internationally [9] [12].