How has nursing changed over the years?

Nursing is often described as the backbone of healthcare.  A profession rooted in compassion, care, and clinical expertise. While these core values remain unchanged, the practice, perception, and possibilities of nursing have transformed dramatically over the decades. From its origins as informal caregivers to its modern status as a respected, specialised profession, nursing has continually adapted to meet the changing needs of society.

Before the 19th Century, nursing was largely informal and often performed by family members, religious orders, or community caregivers. There was no formal training, and the role was not considered a profession. Care was driven by duty, charity, and in many cases, necessity, especially during times of war or public health catastrophe.

The turning point came in the mid-1800s with Florence Nightingale, the Lady with the Lamp, who is widely regarded as the founder of modern nursing. During the Crimean War, she introduced strict hygiene practices and patient care protocols that dramatically reduced mortality rates. After the war, Nightingale established the first scientifically based nursing school, eponymously named the Nightingale School of Nursing in London, which paved the way for nursing to become a formal, structured profession rooted in the twin principles of education and public health.

The 20th Century brought rapid advances in medicine, leading to new expectations and roles for nurses. First amongst these was the adoption of formal education and licensing, with governments and medical institutions around the world regulating nursing through exams, certifications, and professional associations.  Nursing schools also became affiliated with hospitals, offering hands-on learning in patient care.

By the 1950s, nursing began expanding into specialised roles, such as midwifery, anaesthetics, and mental health and from the ‘70s onward, nursing education shifted from hospital-based programs to university degrees. This change reflected the growing complexity of the role and the need for deeper clinical knowledge, leadership skills, and research capacity.  By the turn of the century, Nurse Practitioners began taking on expanded responsibilities, including diagnosing, prescribing, and managing patient care.

Today, nurses are often leaders in interdisciplinary teams, researchers in clinical trials, educators, and health policy advocates.

The new millennium has seen an explosion in medical technology, and nurses are at the forefront of integrating those advances into care. From electronic health records to telehealth, remote monitoring, and AI-supported decision-making, today’s nurses must be as tech-savvy as they are clinically skilled.

Technology has also continued the augmentation and development of how nurses are trained, with simulation labs, online learning, and virtual reality offering new ways to build both skills and experience.

As populations age and chronic diseases rise, the demand for nursing care is growing worldwide, however, many health systems face a critical nursing shortage.

According to the World Health Organisation (WHO), there is an estimated shortage of over 6 million nurses globally. This shortage is most severe in low and middle-income countries, where health systems are often under-resourced, and the burden of disease is high, but in high-income countries, the situation is also urgent.

Ageing populations, increased demand for chronic and long-term care, and too many experienced nurses leaving the profession, are all straining the system. Locally, both Australia and New Zealand continue to project critical nurse shortfalls in the coming decade unless urgent action is taken.

So, what should we be doing about it?

Firstly, governments and private sector organisations must expand training programs, fund scholarships, and ensure sufficient infrastructure exists to educate the next generation of nurses.

Secondly, addressing burnout through better pay, improved staffing ratios, better mental health support, and ongoing career development pathways are essential to keeping more nurses in the profession longer.

Ethical recruitment practices, investment in health systems in lower-income countries, and international collaboration are also important to prevent brain drain and ensure countries have the health workforce they need.

Last, but by no means least, we need to continue the recognition and integration of nurses into health policy and planning both of which will elevate the value and voice of nurses in shaping the future of care.

As we look to the future, nursing continues to evolve in response to global challenges, from pandemics and ageing populations to climate change and artificial intelligence. Yet the heart of nursing remains the same, an ongoing commitment to care.