Nursing in the 20th Century: A Historical Overview

Nursing is a profession that has evolved significantly over the past century, from a domestic service to a highly respected and diverse field of health care. In this blog post, we will explore some of the major developments and achievements of nursing in the 20th century, as well as the challenges and opportunities that nurses faced along the way.

The Early 20th Century: Professionalization and Standardization

At the turn of the 20th century, nursing was still largely based on apprenticeship models, where nurses learned by doing under the supervision of physicians or senior nurses. Nurses had to perform a wide range of duties, including housekeeping, laundry, cooking, ordering supplies, and studying (Open Lines, 2020). There was little formal education or regulation of nursing practice, and the quality and status of nursing varied widely across countries and regions.

However, nurses in industrialized countries began to establish professional associations to set standards that differentiated the work of trained nurses from both assistive-nursing personnel and untrained nurses. More importantly, they successfully sought licensing protection for the practice of registered nursing (Britannica, 2023). For example, in 1916, Florida enacted the Nurses Registration Act, which required nurses with appropriate training and experience to take an examination to qualify for registration (Open Lines, 2020). These efforts aimed to improve the quality and safety of nursing care, as well as to enhance the recognition and autonomy of nurses.

The professionalization of nursing was also influenced by the contributions of prominent nurse leaders, such as Florence Nightingale, who is widely regarded as the founder of modern nursing. Nightingale advocated for sanitary reforms in hospitals, established nursing education programs, and pioneered the use of statistics and evidence-based practice in health care (Britannica, 2023). Her legacy inspired many nurses to follow her example and pursue higher education, research, and leadership roles in nursing.

The Mid-20th Century: Expansion and Specialization

The mid-20th century was marked by significant social and technological changes that affected health care and nursing. The two world wars increased the demand for nurses and exposed them to new challenges and opportunities. Nurses played vital roles in providing care to soldiers and civilians in various settings, such as battlefields, hospitals, camps, and communities. They also demonstrated their skills and courage in coping with injuries, infections, trauma, and death (Britannica, 2023).

The wars also stimulated the development and innovation of medical technologies and treatments, such as antibiotics, blood transfusions, anesthesia, surgery, and vaccines. These advances improved the outcomes and survival rates of patients, but also increased the complexity and specialization of health care. Nurses had to adapt to new knowledge and skills, as well as new roles and responsibilities. Nurses began to specialize in different areas of practice, such as pediatrics, psychiatry, surgery, public health, and education. They also developed new roles, such as nurse practitioners, nurse educators, nurse researchers, nurse administrators, and nurse consultants (Britannica, 2023).

The expansion and specialization of nursing also led to the diversification of nursing education. Nursing programs became more varied in terms of length, level, curriculum, accreditation, and affiliation. Some programs were offered by hospitals or vocational schools; others were offered by colleges or universities. Some programs focused on technical skills; others focused on theoretical knowledge. Some programs prepared nurses for general practice; others prepared nurses for advanced practice (Britannica,

The Late 20th Century: Globalization and Collaboration

The late 20th century witnessed the globalization and collaboration of health care and nursing. The emergence of new diseases (such as HIV/AIDS), the resurgence of old diseases (such as tuberculosis), the spread of infectious diseases (such as SARS), and the increase of chronic diseases (such as diabetes) posed new challenges for health care systems around the world. These challenges required coordinated responses from multiple sectors and disciplines (Britannica,

Nurses were actively involved in addressing these global health issues through various initiatives and organizations. For example, nurses participated in the World Health Organization’s campaigns to eradicate smallpox, promote immunization,
and improve maternal and child health. Nurses also joined international humanitarian efforts to provide relief and assistance to victims of wars,
and poverty. Nurses also contributed to global health research,
and advocacy through networks such as Sigma Theta Tau International,
the International Council of Nurses,
and the International Federation of Red Cross
and Red Crescent Societies

The globalization
and collaboration
of health care
and nursing also facilitated
the exchange
and integration
of knowledge,
and values among nurses from different countries
and cultures.
Nurses learned from each other’s experiences
and best practices,
and adapted them to their own contexts
and needs.
Nurses also developed a sense of solidarity
and identity as a global profession
with a common mission
and vision


Nursing in the 20th century was a dynamic and diverse profession that underwent significant changes and achievements. Nurses faced many challenges and opportunities in their practice, education, and leadership. Nurses also made valuable contributions to health care and society in various settings and roles. Nursing in the 20th century laid the foundation for nursing in the 21st century, which continues to evolve and excel in response to the changing needs and expectations of people and communities.


Britannica (2023). Nursing | History, Education, & Practices | Britannica. Retrieved from

Open Lines (2020). Nursing through the Years: 1900s to 2020 – Open Lines. Retrieved from

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