The need to formalize nursing training and practice did not become obvious until the Crimean War of the 1850s when Englishwoman Florence Nightingale demonstrated that trained nurses could alleviate the horrors of war. The acclaim Nightingale garnered for her war work enabled her subsequently to open new training programs and establish nursing as a respectable occupation.

Like most of her generation, Nightingale believed that men and women had inherently different characters and thus should occupy “separate spheres,” playing different roles in society. To Nightingale, women’s character, as well as their duty, both enabled and required them to care for others. She thus conceived of caring as nursing’s central role. In addition, because her war work had convinced her of the benefits of strict discipline, she created a hierarchical structure in which nurses and nursing students would follow orders from their nursing supervisors. This structure, she hoped, would provide nurses with a power base within women’s separate sphere that would be parallel to that of doctors within their sphere. These principles became the foundation of British nursing. A few years later, when the U.S. Civil War made the benefits of professional nurses obvious to Americans, these principles were also adopted by American nursing.

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