Is nursing a profession

Nursing becomes a profession

In the 19th and early 20th centuries, nursing gradually became a state-recognized profession. Courageous pioneers like Florence Nightingale and Agnes Karll were instrumental in this.


At the beginning of the 19th century, nursing was far from being a officially recognized profession. There was no defined job description, no uniform training and no social security. The state held nursing in low esteem. In particular, the dubious activities of the guards who were considered unreliable, unqualified and corrupt, who worked in the hospitals and were socially ostracized, cast a negative image on the entire professional group.


Low appreciation

The nursing school at the Berlin Charité was founded in 1800. It was the first attempt to introduce a nursing educational institution in Prussia. It took 32 years for the nursing school to start operating. This long period of time symbolizes the low esteem and the associated subordination of nursing in the Prussian medical system.

In the 19th century, mainly denominational forms of organization such as Catholic religious orders and the Protestant diakonia were involved in nursing. The Catholics made up the largest proportion of the nursing staff with values ​​between 48 and 65 percent. Diakonie and other cooperatives played a subordinate role in terms of numbers. The freely practicing carers, whose activities developed out of the desire or the need for more financial independence, were also of less significance from a statistical point of view. Their share was less than ten percent at the turn of the century.

The mother house system brought into being by Vincent de Paul gained numerical importance towards the end of the 19th century: Young women in these denominational communities received training in caring and household chores with low pay and severely restricted personal freedoms.

The Red Cross Sisterhood, which emerged in the second half of the 19th century, served the church motherhouse system as a model. What was new, however, was that the activity was no longer based solely on “Christian love activity” and was defined as a medical care profession. The focus of the Red Cross nursing was practical activities with limited theoretical qualifications and domestic skills.

State social security was introduced in the 1880s, which caused the number of beds in hospitals to rise rapidly. As a result, more and more people found employment in nursing. Nevertheless, improvements in working conditions were a long time coming. At the beginning of the 20th century, nurses were still in a largely unlawful area. The introduction of a nursing exam in Prussia in 1907 did little to change this. This only achieved a distinction between nurses who had a minimum qualification by taking an exam and those without an exam.

The wars of unification, social change and the devastating cholera epidemic did nothing to change the low importance and esteem of the nursing profession. In order to change something about this situation, the former Red Cross sister Agnes Karll founded the “Professional Organization of Nurses in Germany” (B.O.K.D.) in Berlin in 1903, the forerunner of today's German Professional Association for Nursing Professions (DBfK). It was the first free association of women who were not bound by their mother's home, with the aim of developing nursing into a qualified profession.

For the members of the organization, which was run as a registered association, there were detailed rights and obligations. To the services of the B.O.K.D. included, among other things, an extensive range of advice and information. The B.O.K.D. an independent profile over the years and increasingly gained political weight. Among other things, the association contributed to the development of training paths and the definition of working conditions.

In 1904 Karll founded the B.O.K.D. led the International Council of Nurses (ICN) together with representatives from the USA and Great Britain until her death in 1927. In 1909 Karll was elected President, and in 1912 the ICN Congress, which was highly regarded by politics and the public, took place in Cologne.

The First World War breaks out

In 1914 the First World War broke out. Out of national enthusiasm, a large number of women volunteered to help in the war. Agnes Karll's magazine "Unterm Lazaruskreuz" called on all sisters to "honor their association by performing the utmost duties" - there were no more parties, only a people of Germans. During the war, many nurses looked after refreshment, food and first aid stations at train stations.

The Red Cross played a central role in war nursing. Since the first Geneva Convention in 1864, the organization's task was to train enough nurses in case of war. In the first war after the founding of the Red Cross, the Franco-Prussian War in 1870 and 1871, the use of nurses at hospitals and refreshment stations was only necessary to a relatively manageable extent. In view of the millions of army now at war, a completely new level of aid and mobilization was required. The Red Cross, which was recognized as neutral by the belligerent powers, also took care of prisoners of war. The Red Cross Sisters worked, among other things, at first aid stations and war hospitals in the front line, on hospital ships, as well as in convalescent homes and overnight accommodation.

 "The Lady with the Lamp"

One of the most important figures in nursing in the 19th century was undoubtedly the Briton Florence Nightingale. She was born in Florence in 1820 during a two-year trip to Europe with her parents and was the youngest daughter of a wealthy British family. Already in childhood he showed great linguistic talent and good powers of observation. Nightingale received lessons from her father in Latin, Greek, German, French and Italian, as well as history and philosophy.

A flu epidemic struck southern England in the 1830s, killing many people. Nightingale stayed healthy and took care of sick people intensively for four weeks. Nightingale had already gained initial experience in nursing while caring for sick family members.

In 1845 Nightingale decided against her parents' will to devote her life to nursing. The strict rejection of the parents was mainly due to the poor reputation of nursing in Great Britain at the time. The nurses at the time were mostly unqualified people who could not find another job and were therefore forced to earn their living from this work. They were considered unreliable, corrupt and addicted to alcohol.

After Nightingale witnessed a patient dying from a nurse's incompetence, she recognized the need for basic nursing training. She herself trained as part of a three-month internship at the Salisbury Hospital. Nightingale also attended the Kaiserswerther Diakonie, an institution founded by the Protestant pastor Theodor Fliedner, where deaconesses received training as nurses, community nurses, educators or teachers. Even though Nightingale described the Kaiserswerther Diakonie in a letter to her father as "poor and ugly", she was deeply impressed by the weekly lecture that Fliedner gave for the sisters and by the strict rules that apply to the sisters.

At the time of the Crimean War, Nightingale cared for wounded British soldiers on behalf of the British government in the Turkish military hospital in Skutari - today's Istanbul suburb of Üsküdar. In 1855 she traveled from Skutari to the hospitals in the Crimea. Since she visited the patients at night with a lamp in her hand, she became known as "The Lady with the Lamp". During her assignment Nightingale fell ill with crime fever and struggled with her life for weeks.

In 1856 Nightingale returned to Great Britain, badly damaged but celebrated as a national heroine. Despite a physical breakdown in the following year and increasing need for help, Nightingale helped reform the army's medical system and published her standard work "Notes of Nursing", which caused a worldwide sensation.

In 1860 the Nightingale School of Nursing was opened at London's St Thomas ‘Hospital. There, what is known as the Nightingale system today, was implemented, which soon attracted public attention and led to other hospitals also setting up courses for nurses. Nightingale's training model was that young professionals were taught by experienced caregivers rather than doctors. The focus of the training was the observance of hygiene. Nightingale believed that most illnesses could be cured with cleanliness, proper ventilation and adequate diet. In the 1870s Nightingale worked tirelessly for higher educational standards in nursing and continued to implement her ideas of the recognized women's profession without church influence . Shortly before her death in 1910, Nightingale became the first woman to receive the British Order of Merit.


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