New institutions began to adopt the principles established by Florence Nightingale, which emphasized formal education and specialized hospital-based training rather than informal apprenticeship. This movement toward professionalization, which began around 1873 with the opening of the first American Nightingale schools, sought to elevate the status of nursing by imposing strict standards on who could enter the field. However, these newly established educational criteria were often layered with social and cultural biases, creating a framework that systematically determined who was deemed suitable to become a “trained nurse.” This era of standardization established a pattern of institutional exclusion that governed access to the new career path.
Identifying the Excluded Group
The group systematically excluded from nearly all mainstream nursing education programs until 1886 was African Americans. This exclusion was a direct reflection of the widespread institutional segregation that defined American society in the late 19th century. While professional nursing was predominantly a female occupation, both African American men and women faced severe discrimination when seeking a formal education in the field. Before the establishment of formal schools, nursing care provided by Black women was often informal, practiced through domestic service, or rooted in the healing traditions passed down from formerly enslaved communities. The few exceptions, such as Mary Eliza Mahoney who graduated in 1879, only highlighted the depth of the general exclusion from white-run institutions.
The Prevailing Model of Nursing Education
The early American nursing schools, such as those established at Bellevue Hospital and Massachusetts General Hospital, were modeled on Nightingale’s vision, which sought to reform nursing from a low-status occupation into a respected vocation. These institutions aimed to recruit a specific demographic, primarily seeking young, single, white women from middle-class backgrounds who possessed social refinement. Entrance requirements were not just academic; they often included subjective criteria related to moral character, physical appearance, and social standing. These schools enforced strict behavioral codes, with rules concerning curfews and etiquette that aligned with Victorian ideals of womanhood and moral purity. This emphasis on a particular type of applicant ensured that African American women were barred from entry without the schools needing to explicitly state a racial ban. Dominant institutions did not consider Black women to fit this desired image of the professional nurse, who was expected to bring a moral and religious commitment to the hospital.
The Establishment of Training Schools for Black Nurses
The year 1886 marks a significant turning point with the founding of the first formal nursing training program specifically for African American women at Spelman Seminary in Atlanta, Georgia. This program was a direct response to the systemic denial of access at white institutions, offering a path to professional accreditation within a segregated educational system. The establishment of this program was quickly followed by others, such as the one at Provident Hospital in Chicago, which opened in 1891 and was the first school of nursing for African American women in the Northern United States. These schools were often founded in connection with hospitals created by and for the Black community, providing healthcare to a population that was frequently refused treatment at white hospitals. Despite their foundational significance, these segregated training schools often operated with resource limitations and less funding compared to their white counterparts, yet they provided essential professional training and a route to the middle class for Black women, even though graduates faced a segregated employment field.