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The Johns Hopkins School of Nursing

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The Johns Hopkins School Of Nursing

On March 10, 1873, Johns Hopkins summoned his lawyer, Charles Gwinn, and directed him to draft a letter of instruction to his trustees. His intentions with regard to nursing were quite clear:

"I desire you to establish, in connection with the hospital, a training school for female nurses. This provision will secure the services of women competent to care for the sick in the hospital wards, and will enable you to benefit the whole community by supplying it with a class of trained and experienced nurses."

Following the wishes of Johns Hopkins, both the Hospital and the School of Nursing opened in 1889. The first superintendent for nursing, Isabel Hampton, was equally clear about her vision for the new school. Speaking at the formal inauguration of the school in November, she defined the nurse she sought to educate:

"It is not so much the great amount of work that she can accomplish practically that is desired, but the kind of work ... and as the university and hospital are looked to for what is best in science, so may it follow, that as time goes on and women go forth as graduates, this School may be looked to for what is best in nursing."

An extraordinary triumvirate - Isabel Hampton, M. Adelaide Nutting and Lavinia Dock - together laid the foundation for Hopkins Nursing. Hampton, with her quick, intuitive thinking, was a natural leader. Nutting was cool, with a sharp, critical logic. Dock, independent and fearless, was the catalyst. Not satisfied with the status quo, they were attracted to and stimulated by the freedom at Hopkins and the potential it held for change.

Their work also was instrumental in creating the organizational structure that would provide permanent national leadership for the nursing profession. Concerned about the need to guarantee national standards in nursing education, in 1893 they founded the Superintendents of Training Schools for Nurses, which later became the National League for Nursing Education. To address the concerns and welfare of nurses in practice, they helped launch the organization now called the American Nurses Association. Isabel Hampton was its first president.

Hampton, Nutting and Dock established at Hopkins from the onset a tradition of leadership. Graduates of Hopkins would become faculty and deans of leading schools of nursing, pioneers in the public health movement and leaders in international health.

The three did not remain together at Hopkins for long. By 1894, Dock had left to direct the Illinois Training School, and Hampton, in line with the custom of the day, was forced to offer her resignation in order to marry Dr. Hunter Robb. In 1895, Nutting became superintendent of nursing.

An educator and scholar, Nutting focused her energies on moving nursing education away from the apprenticeship model. Her first action was to expand the school's program from two to three years and to add a six-month probationary period. This became the national model for diploma education.

Frustrated in her efforts to hire additional faculty, she realized that future advancement was tied to financial independence. She called on the alumni to begin building an endowment fund. This seems obvious, but, at the time, it was revolutionary. Schools of nursing were wholly supported by hospitals that, in exchange, were guaranteed the services of nursing students who learned by working on the wards. Reflecting on the problem, Nutting wrote:

"All good education anywhere costs, and it is a bad day for our schools, for our nurses, for physicians, and for sick people everywhere, when the first question is always, 'How little can we do it for?' Rather than how well can we do it?"

In 1907, when Nutting left Hopkins, the school was recognized internationally as preeminent in nursing education. Nutting went on to Teachers College at Columbia University where she became the first professor of nursing in the United States. Elsie Lawler succeeded her as superintendent of nursing.

Life for the student nurse during those early years was not for the frail and fainthearted. Discipline was strict. Isabel Hampton was known to fly into sudden rages. But it was Nutting who engendered real fear. She never raised her voice, but her tone of subtle scorn and her calm cool gaze were sufficient to terrify students.

The hours were long. Ada Carr, '93, recalled "being on duty all day and all night on into the next day."

As late as the mid-1930s students were "on duty" 56 hours a week, with one "shopping day" granted each year around Christmas time. Social life was further inhibited by a 10 o'clock curfew, which, since duty didn't end until 7 p.m., precluded the possibility of ever seeing an entire movie from beginning to end. Marriage was forbidden to student nurses until 1942, when the wartime need for nurses in all probability finally terminated the rule.

Everyone went to morning prayers, because it was there that new assignments were announced. In the early years students assigned to the isolation ward literally moved into the ward and only emerged four to six weeks later when the assignment was completed. Many, needless to say, acquired their patients' diseases, especially tuberculosis.

As late as the 1930s, students on outpatient obstetrics duty could find themselves in the middle of the night, with an intern, heading into the neighborhood, lantern in hand. Many recalled emptying a bureau drawer to provide a substitute bassinet for a newly born baby. Prepared for adventure in their student days, it is not surprising that Hopkins nurses after graduation set up health care services and schools of nursing all over the world.

Hopkins' early nurses were pioneers, known for their rigorous standards and their tenacity. They often were identified by doctors "because they asked questions." Questions were, after all, an integral part of Hopkins, where there was constant interaction between doctors and nurses and where everyone was learning and teaching. This spirit of camaraderie between physicians and nurses was nurtured initially by Halsted, Osler and Kelly and continues today.

In 1940, Elsie Lawler retired and Anna D. Wolf became the fifth superintendent of nurses. During her 30-year tenure, Lawler led a dramatic growth of nursing services produced by the expansion of the Hospital. For Wolf, the effects of the war initially would occupy much of her time. The nursing student body doubled between 1941 and 1944, while the faculty and staff shortage was exacerbated as large numbers went overseas. Once the war was over, she focused on the mission that had brought her to Hopkins. Fresh from founding a school of nursing in Peking and developing a baccalaureate program at Cornell, she had returned to Baltimore intent on developing a university-based nursing program at Hopkins. Aided by K. Virginia Betzold, she forged new links with the University, but retired after 15 years, frustrated and discouraged, her mission incomplete.

A commanding personage of regal bearing, Wolf would move through the halls of the Hospital with her long gray cape sweeping behind her. She could be formidable, and many students were terrified of her. In direct contrast, her successor, Mary Sanders Price, was very close to all of her students, beloved, but criticized by some for not fighting hard enough with the University administration. At Hopkins University, which remained all male at the undergraduate level through the 1960s, all efforts to establish a university-based school of nursing were in vain at the time.

While the goal of the university affiliation remained elusive, Hopkins alumni achieved nursing celebrity. As Louise Fitzpatrick, a Hopkins alumna and dean of Villanova, pointed out, Hopkins earned, "precognition as a molder of leaders for American nursing." She cites Ada Carr and Isabella Waters, pioneers in the public health nursing movement; Mary Lent, founder of the Baltimore Visiting Nurses Association and first nurse to serve in the United States Public Health Service; Clara Noyes, distinguished director of the Red Cross Nursing Service in its early years; Carolyn Van Blarcom, crusader in maternal-infant nursing, who led the campaign to reduce the incidence of ophthalmia neonatorum; Alice Fitzgerald, director of the Red Cross Nursing Service in Italy during World War I.

Writes Fitzpatrick:

"There are more - Effie Taylor, leader in the development of psychiatric nursing and for so long dean of the School of Nursing at Yale; Elizabeth Fox, first dean of the School of Nursing at the University of Pennsylvania; Lillian Hudson, professor of public health nursing at Teachers College for 30 years. And within the more recent past, we can cite Kate Hyder, a prime developer of contemporary maternal-child care; Virginia Dunbar, former dean at Cornell; Virginia Arnold, leader in international public health programs; Rae Chittick, a major force in the World Health Organization for so many years; as well as Irene Cam, and Doris Diller, developers of early baccalaureate nursing curricula at Skidmore College; Frances Reiter whose visionary and revolutionary ideas concerning horizontal advancement in nursing and the nurse as a clinical specialist are now recognized, and Lucille Petry Leone, who as chief nurse and assistant surgeon general of the USPHS during World War II directed the Nursing Cadet Corps Program."

Hopkins also counts among its alumni Carolyne Davis, past administrator of the Health Care Financing Administration (HCFA); Sally Sample, a leader in the ANA; Barbara Donaho, the first nurse on the executive committee of the Joint Hospital Accreditation Committee, and a host of nurses who have served as vice presidents of hospitals across the country from Joyce Littlefield in South Carolina to Mary Middleton in California, and countless nurses who serve as faculty members in schools of nursing.

In 1973, when the Hospital School of Nursing closed, its alumni numbered not only many who earned national recognition but also many more who quietly but significantly contributed to the profession and to humanity. They hold in common a profound belief in nursing as a great human service. They are joined together by a loyalty and commitment to Hopkins that was expressed with great affection by Adelaide Nutting:

"This is the dearest old hospital in the world and I offer up perpetual psalms of Thanksgiving that I came here instead of elsewhere."

In 1983, after a feasibility study by Dr. Carol Gray, University Trustees finally established a School of Nursing as a degree-granting division of The Johns Hopkins University. It was a long-sought goal of countless alumnae who tenaciously and finally saw their dream become reality.

The new School was dedicated in September 1984, with Carol Gray as dean. She held to the vision that nursing education at Johns Hopkins must conform with the mission of the University and must support a philosophy of academic excellence, scholarship and humane practice. Baccalaureate, master's, Ph.D. and postdoctoral programs have been established.

"In the words of Isabel Hampton Robb, we seek to be looked to for what is best in nursing," said Gray. "Our goal is to educate nurses who, in the Hopkins tradition, ask questions, are not satisfied with mediocrity or the status quo but are always striving to define better ways of caring for patients and of teaching the next generation of nurses. While our basic mission has not changed since 1889, the means of achieving our goals have altered radically. Nutting sought to move away from the apprenticeship model for nursing education and this has been achieved. Discipline is no longer taught by fear and rigid social rules but through a rigorous academic curriculum."

Gray knew that advances in biotechnology were changing health care delivery daily. Nurses no longer can be trained to do things. By the time they graduate, the technology has changed. They must have a solid scientific understanding of illness and health and of the rationale for treatment. Sophisticated budgets and personnel management have been added to their responsibilities.

"Perhaps more than in any time in its history, creative leadership is needed in nursing today," she said.

"Practical creativity is rooted in an educational system that nurtures a spirit of inquiry, in an environment where the potential for change is supported. Hopkins is an ideal environment to prepare nursing leaders. It remains today, as it was in 1889, an institution in which innovation based on rigorous scientific inquiry is the norm."

From 1994 until 2001, the school was led by Sue K. Donaldson, Ph.D, R.N. During that time, Donaldson created the infrastructure needed to support the developing research program of the faculty at the School of Nursing. She implemented the school's first doctoral porgrams -- offering Ph.D. and Doctor of Nursing Science degrees -- and established joint programs with other Johns Hopkins divisions. Donaldson guided the construction and occupation in 1998 of the Anne M. Pinkard Building, the school's first stand-alone headquarters. In collaboration with The Johns Hopkins Hospital, she founded the Institute for Johns Hopkins Nursing.

"The most significant measures of the School of Nursing's quality are the caliber of the students and the achievements of its graduates," she said. "They are, by any standard, the finest in the world and their excellence continues the legacy of Hopkins Nursing."

Martha N. Hill, Ph.D, R.N., is the current dean of the School of Nursing, which now has more than 550 students enrolled in undergraduate, graduate, doctoral, and post doctoral programs. Hill's history with Johns Hopkins dates back to 1964, when she earned a diploma from The Johns Hopkins Hospital School of Nursing. She is internationally known for her work in hypertension care and control among urban, underserved African-American men. Hill was the first and only non-physician to serve as president of the American Heart Association. She is a fellow of the American Academy of Nursing and a member of the Institute of Medicine of the National Academy of Sciences.

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