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Written by Laura Gonzalez, PhD, APRN, CNE, CHSE-A, ANEF, FAAN, Vice President, Healthcare Innovation

The practice of nursing has overcome many challenges on its path to becoming a respected profession. A field dominated by women, nurses often found themselves bound by traditional gender roles and seen as inexpensive healthcare workers. Over the years, profound societal changes, technological advances, and shifts in the healthcare environment have transformed the field of nursing—and thus nursing education—from a skill acquired on the battlefield to an occupation learned both in the classroom and at the bedside. Here is a brief history of some of the major events that helped shape nursing education into what it is today.

Key Milestones in Nursing Education

1873 – The First U.S. Nursing School 

• The Bellevue Hospital School of Nursing in New York was established in 1873, becoming the first nursing school in the U.S. based on Florence Nightingale’s principles. It emphasized evidence-based practice, hygiene, and patient observation as core nursing competencies.
• The New England Hospital for Women and Children also played a crucial role in early nursing education, training some of the first formally recognized nurses in the country.
• Linda Richards, the first trained nurse in the U.S., graduated from this program in 1873, pioneering record-keeping and standardizing nurse training.

1893 – Establishment of Nursing Standards

• The American Society of Superintendents of Training Schools for Nurses (renamed the National League for Nursing Education in 1912) became the first professional nursing organization, working to standardize nurse training nationwide.

1903 – First Nurse Licensure Law

• North Carolina became the first state to pass permissive licensure laws, allowing nurses to use the title Registered Nurse (RN) if they met state standards.
• However, licensure was not yet mandatory, meaning many nurses still practiced without formal credentialing.

1911 – Mrs. Chase: The First Healthcare Manikin

• Rhode Island doll manufacturer M.J. Chase Co. created Mrs. Chase, the first life-size healthcare manikin used in nursing education, featuring movable joints and an injection site for training.

1923 – The Goldmark Report & Nursing as Higher Education

• The Goldmark Report concluded that existing hospital-based training programs were inadequate and recommended that nursing education move to universities with dedicated faculty and leadership.
• That same year, the Yale School of Nursing became the first autonomous university-based nursing school, separating education from hospital service requirements.

1952 – Formation of the National League for Nursing (NLN)

• The National League for Nursing Education merged with other organizations to create the National League for Nursing (NLN), taking over accreditation of nursing schools in the U.S.

1964 – Nurse Training Act

• This act paved the way for baccalaureate nursing education, aiming to phase out hospital-based diploma programs in favor of university-based BSN (Bachelor of Science in Nursing) programs.
• It also expanded funding for graduate studies and advanced practice roles.

1970s-1980s – High-Fidelity Simulation Emerges

• Early high-fidelity nursing simulators replaced the basic Mrs. Chase dolls, enabling more realistic patient care training.

1986 – Early Medical Simulations

• One of the first healthcare educational simulations, Surgeon, simulated an aortic aneurysm repair on a personal computer.
• While not the first medical simulation tool, it marked a turning point in digital simulation for healthcare education.

2004 – Society for Simulation in Healthcare (SSH)

• The Society for Simulation in Healthcare (SSH) was established to promote the professionalization of simulation in medical and nursing education.

Advancements in Nursing Education (2004–Present)

2011 – The Future of Nursing Report

• The Institute of Medicine (now the National Academy of Medicine) released The Future of Nursing: Leading Change, Advancing Health, calling for:
  • Increasing the proportion of nurses with baccalaureate degrees to 80% by 2020.
  • Expanding APRN roles and removing practice barriers.
  • Enhancing nurse leadership in policy and healthcare transformation.

2017 – INACSL Healthcare Simulation Standards of Best Practice™

• The International Nursing Association for Clinical Simulation and Learning (INACSL) published the Healthcare Simulation Standards of Best Practice™, which set evidence-based guidelines for:
  • Designing and delivering effective simulation experiences.
  • Ensuring validity and consistency in simulation-based education.
  • Incorporating debriefing and assessment best practices.

2018 – Nursing Simulation Validated as Clinical Training

• The National Council of State Boards of Nursing (NCSBN) found that up to 50% of traditional clinical hours in nursing education could be replaced by simulation while maintaining student competency.
• This further reinforced simulation-based learning as an essential component of modern nursing education.

2020 – The Impact of COVID-19 on Nursing Education

• The COVID-19 pandemic accelerated the adoption of virtual simulations, telehealth training, and AI-driven learning platforms to supplement limited clinical experiences.
• Remote nursing education became a permanent feature in many programs.

2023 – AI Integration in Nursing Education and Clinical Practice

• AI-powered clinical decision support tools began assisting bedside nurses with real-time patient data analysis, helping them prioritize care and predict deterioration.
• Nursing schools began incorporating AI-driven simulations, using adaptive learning to personalize student training based on competency assessments.

2024 – Growth of Advanced Practice Education

• APRN programs expanded to meet growing healthcare demands, particularly in primary care, acute care, and specialty practice.
• The American Association of Colleges of Nursing (AACN) emphasized competency-based education (CBE) for APRNs, integrating simulation, case-based learning, and AI-driven virtual patients.

Present & Future – AI and Competency-Based Nursing Education

• AI-driven virtual patient encounters are enhancing clinical reasoning skills in nursing students.
• Adaptive AI systems are now capable of grading assessments, guiding students through clinical scenarios, and simulating patient responses in real-time.
• APRN education continues to evolve, with more programs emphasizing personalized learning pathways, advanced diagnostics, and digital health literacy.

Conclusion

Nursing education has come a long way—from hospital apprenticeships to a technology-driven, evidence-based discipline. The introduction of simulation-based learning, the INACSL Healthcare Standards of Best Practice™, AI-driven innovations, and the expansion of APRN education continue to shape the future of nursing education.

As AI-powered decision support tools, virtual clinical environments, and competency-based learning models become mainstream, nursing students and educators alike are poised to navigate the next frontier of healthcare innovation with confidence and skill.