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The term “nurse” is derived from the Italian word, nutrire, meaning to feed, nourish or suckle a baby. The earliest written records of nurses are from the Roman Empire.

In ancient Greece, approximately between 460 and 375 BCE, Hippocrates realized that human disease was based on biology and not supernatural causes. He developed the concept of physical observations and reporting on the holistic health of the patient. He is famous for writing the Hippocratic Oath, which was a pledge that all doctors had to take. Although in recent years the Oath has fallen out of favor, a survey of all medical schools in the UK found that 70% of those responded still used a version of the oath (Green 2017).

Throughout the early middle ages, health care and therefore nursing in England was set within and controlled by the churches, mainly the Roman Catholic Church.

The Reformation, a movement across Europe, began in about 1517 driven in part by Martin Luther, and posed serious political and religious challenges to the Roman Catholic Church and specifically to the authority of the Pope. In England, the Reformation under the reign of Henry VIII led to the Church of England breaking away from Catholicism. This then led to the dissolution of monasteries between 1536 and 1541, and the shutting down of the associated hospitals and infirmary buildings. This has come to be known as the “Dark Age of Nursing” as the English Reformation resulted in many hospitals being closed down. The larger hospitals in London such as St Thomas’ and St Bartholomew’s, although at risk through the Reformation, were able to survive with their management taken over by the City of London. Henry VIII’s only son Edward VI ordered charters for the continued use of these organizations and institutions as hospitals.

Throughout this period there was no, or very little, formal training for those who considered nursing as a job. Nurses were seen as subordinates, servants and individuals who were given nursing jobs instead of, for example, a prison sentence. Nurses were generally disregarded by society and other health professions.

The professional era for nursing began with the establishment of the first training school for nursing in Kaiserswerth, Germany, in 1836. The school was founded by the Lutheran Order of Deaconesses for the purpose of providing high‐quality nursing training to the Deaconesses.

The Anglican Nursing Sisterhood of St John’s had developed a Nurse Teaching School in London in approximately 1848. As well as providing successful clinical training, the nursing school supported the individual’s spiritual calling with a real emphasis on the all‐important Christian duty expected in this Victorian era.

In 1856 the Sisterhood took over nursing at King’s College Hospital, London, and then in 1866 took over responsibility for nursing at Charing Cross Hospital. It was also known as the Training Institution for Nurses for Hospitals, Families and the Sick Poor. At that stage nurse training was a combination of clinical training and religious education, highlighting the continuing control the church had on health.

It is argued that the world’s first non‐religious nurse training school, “La Source” was established in Lausanne in Switzerland. It was founded in 1859, a year before the Nightingale Training School in St Thomas’ opened.

Florence Nightingale, considered by most to be the founder of modern nursing, studied at Kaiserswerth and on returning to England she became superintendent for the Institution for the Care of Sick Gentlewomen in Distressed Circumstances in London.

The Crimean War began in 1853, and news reports described deplorable conditions and a lack of medical or nursing care for injured British troops. Nightingale was asked by the British Government to go to the Crimea and organize better care for the troops. Accompanied by a number of nurses, Nightingale found the troops experiencing horrifying conditions. She set about transforming the general conditions of the soldiers, and the main impact was as a result of improvements in sanitation and hygiene, leading to improved clinical outcomes.

Following her experiences in the Crimea, Nightingale returned to London and in 1860 established the first secular nurse training school in the UK at St Thomas’ Hospital London – the Nightingale Training School. Nightingale’s new training system was described as ground‐breaking at that time. It was noted that the Nightingale Training School, while being the second non‐religious nursing school, adopted the “sisterhood” approach to training and instigated the ward system. Nightingale’s initiative was opposed by many physicians at the time who argued that nurses needed only minimal training, enough to provide cleanliness, poultice‐making and attending to patients’ personal needs (Kalish and Kalish 1995). History records that Nightingale set up the foundations for non‐secular training of women of “good character” from all backgrounds. A further unique element of Nightingale’s approach was the recognition of science as the essential basis for nursing care.

In 1849 Pastor Fliedner, who was the driving force in setting up Kaiserswerth, established the first Protestant hospital in America. The trained Deaconesses who travelled with him started the first formal nurse training program in the Pittsburgh Infirmary, Pennsylvania, which still exists today as the Passavant Hospital.

When state registration of doctors in the UK began in 1858, there was also a call for registration of trained nurses. In 1887, the British Nurses Association was created and received the Royal Charter in 1892, becoming the Royal British Nurses Association (RBNA). Princess Helena, the daughter of Queen Victoria, was president of the RBNA and was keen to enhance the training and status of nursing. The RBNA was in favor of registration as a means to ensure and enhance the professional status of trained nurses.

The First World War acted as a catalyst for the regulation of nursing. During the war the role of women, in general, in British society changed. The number of women in paid employment almost doubled from 1914 to 1918, and women were working in occupations they would previously have been excluded from, including heavy industry such as shipbuilding. At the end of the war over eight million women were granted the right to vote for the first time, and the Eligibility of Women Act 1918 allowed some women to be elected as Members of Parliament.

In addition, nursing increasingly contributed to the war effort. There was a significant increase in the number of nurses in the military, and at the end of the war there were over 10 000 nurses working in the Queen Alexandra’s Imperial Military Nursing service. This coincided with the establishment of the College of Nursing in 1916. In 1919 a Private Members Bill was passed, the Nurse Registration Act, providing the legislation for formal nurse registration. This resulted in the establishment of the General Nurse Council for England and Wales.

Throughout the 1920s to the 1970s the nursing profession fought for further recognition, with a focus on pay and conditions, quality of training, and status of role in the NHS, amongst many other issues.

In 1979, further legislative changes created the United Kingdom Central Council (UKCC) for Nursing, Midwifery and Health Visiting, a new regulatory body being formally established in 1983. The purpose of the UKCC was to maintain a register of all UK nurses, midwifes and health visitors, produce guidance for registrants, and handle any complaints. In 2002 the UKCC became the Nursing and Midwifery Council (NMC) that exists today. The stated purpose of the NMC is (NMC 2020):

We maintain the register of nurses and midwifes who meet the requirements for registration in the UK, and nursing associates who meet the requirements for registration in England.

We set the requirements for the professional education that supports people to develop the knowledge, skills and behaviour required for entry to, or annotation on, our register.

We shape the practice of the professional on our register by developing and promoting standards including our Code, and we promote lifelong learning through revalidation.

Where serious concerns are raised about a nurse, midwife or nurse associate’s fitness to practice, we can investigate and, if needed, take action.

The NMC has published a detailed code of practice, “the Code,” which forms the reference point for revalidation of nurses. Table 2.1 shows the requirements for and examples of the supporting evidence for each registrant over a three‐year cycle in order to revalidate.

Table 2.1 Revalidation: requirements of a nurse and examples of supporting evidence.

Requirements over a three‐year cycle	Supporting evidence
450 hours of practice for each registration (if dual registration requires 900 hours)	Record of practice hours Scope of practice Details of the work setting
35 hours of continuing professional development (of which 20 hours must be participatory)	Details of the CPD recorded including: The CPD method used (e.g. online, self‐learning) Each CPD session mapped to the code
Five pieces of practice‐related feedback	Notes on the feedback Details of how feedback used to improve practice
Five written reflective accounts	Written reflection on CPD/feedback or an event/experience Describe relevance to the code
Reflective discussion	Record of a reflective discussion NMC number of the person
Health and character	Self‐declaration of health and character
Professional indemnity	Evidence of appropriate professional indemnity
Confirmation	Following face‐to‐face or video meeting, a record of the conversation with an appropriate “confirmer,” e.g. line manager or a GP

As we will see in later chapters, this process shares many of the elements of the current revalidation requirements for doctors.