...historical research as a discipline is growing, and contributions are necessary in order to build our collective professional archive.As we celebrate the World Health Organization’s Year of the Nurse and Midwife marking Florence Nightingale’s 200^th birthday, it has never been more appropriate to commemorate the advent of professional nursing education. Documenting its earliest years and leaders is a way to preserve nursing history for future generations. In addition, historical research as a discipline is growing, and contributions are necessary in order to build our collective professional archive. Therefore, the importance of preserving these materials and achievements as the core of our professional identity cannot be overstated.

This article describes the work of leaders at one institution to preserve the legacy of its local nursing history and describes a far-reaching impact on the profession worldwide. Herein, we describe the formation of a nursing history committee and its constituency, process, and outcomes. As we describe the formation of this group and its work, we highlight the evolution of early nursing practice, the ushering in of the era of the “trained nurse” and the contributions made by early leaders who shaped the professionalization of nursing education.

In 2011, Massachusetts General Hospital in Boston, Massachusetts (Mass General) celebrated the 200^th anniversary of the hospital’s charter. The immediate years leading up to this milestone were filled with planning ways to acknowledge the occasion. A book titled Massachusetts General Hospital Nursing at 200 (Peirce & Ditomassi, 2011) was conceived and published, describing the evolution of nursing at the institution from 1811 to 2011.

This experience reinforced the importance of careful preservation and documentation of historical content for the profession...In the process of writing this book, archival materials illustrating a rich history of nursing education and leadership were unearthed, including information about the founding of one of the first training schools in the country; the teachings of America’s first trained nurse; and contributions of other nurse leaders who impacted nursing around the globe. This experience reinforced the importance of careful preservation and documentation of historical content for the profession and led to an ongoing initiative: a committee convened with the specific charge of researching and preserving both the local institution-based history and history applicable to nursing at large. The process of convening the committee and exemplars of its work are shared and may provide a model for others with interest in utilizing a similar process.

Background

The founding of Mass General in 1811 was pivotal to the future of the city of Boston and to medicine at large. Although the city had been home to dispensaries for soldiers and sailors, there was no hospital for the general public; the wealthy were treated at home and the destitute in almshouses. At the time, only two of Boston’s brethren, Philadelphia and New York City, had general hospitals (Bull & Bull, 2011). Nursing practice consisted of wives, mothers, sisters, or hired handmaidens comforting the sick in homes, poor houses, and on the battlefields for centuries.

The founding of Mass General in 1811 was pivotal to the future of the city of Boston and to medicine at large.There was little respect for the women who carried out these duties and they were often looked upon as little more than servants. During the mid-19^th century, as more hospitals opened, and diagnostic tools such as thermometers were starting to appear, trained nurses were needed and were vital to the health and well-being of patients. Physician James Jackson and surgeon John Collins Warren, in an 1810 letter to the community describing the need for a hospital in Boston noted:  “…Above all, [the sick man] suffers from the want of that first requisite in sickness, a kind and skillful nurse” (Jackson & Warren, 1810, p.1).

...trained nurses were needed and were vital to the health and well-being of patients.It was seven years later that the cornerstone of the hospital was laid, and another three years before Mass General would admit its first patient and hire its first “nurse.” In 1821, a young saddler suffering from syphilis was housed on the hospital’s male ward, where he would remain until his death some months later. By his side was his wife who, a month later according to hospital documents, was “engaged by the [hospital] superintendent as a nurse at seven dollars per month” (Minutes of the Massachusetts General Hospital, 1821, p.3). While it may be that she sought work to help pay her husband’s $3-a-week hospital bill, one thing is clear; she is believed to have been the hospital’s earliest known nurse. It was such discoveries uncovered while doing research for the book that spurred the creation of a nursing history committee.

Formation of the Mass General Nursing History Committee

...what the committee unearthed was a wealth of detail and previously untold stories...In 2009, when Chief Nurse Jeanette Ives Erickson recognized the opportunity to showcase the impact of Mass General Nursing as part of the 200^th anniversary of the hospital, she charged a small group with chronicling the history. This was a daunting task that required the collection and critical review of archival information and the tireless teamwork of telling the story of 200 years of nursing excellence. It was noted that “there exists only a minimal amount of written history about nursing during the hospital’s earliest years, making a substantial and detailed book a challenging enterprise” (Massachusetts General Hospital, 2009, p.1). Yet what the committee unearthed was a wealth of detail and previously untold stories, reflecting not only nursing’s dedication to the hospital’s mission, but also a legacy of leadership in nursing professionalization and education.

Designated space and project support were provided by the Mass General Hospital nursing service to enable this important work.For the first decade of the committee’s existence, the Nursing Service supported a dedicated project manager to convene the group and guide the committee members to accomplish tasks in a timely manner. Through her oversight and special talents in writing and public relations, she kept the group excited to work together and masterfully drew out each member’s best skills. The committee charge was operationalized through the conduct of well-run monthly meetings. Designated space and project support were provided by the Mass General Hospital nursing service to enable this important work. A donor underwrote the cost of publishing the book and any other expenses were supported by the Nursing Service and the Alumnae Association as appropriate. As members were all volunteers, it was pivotal that clearly identified priorities, agendas, and action plans were agreed upon by the committee and that the workload was distributed among members.

...the group continues to focus on preserving and showcasing the rich history of nursing at the hospital.Committee membership was thoughtfully appointed. The group was comprised of representatives of the Mass General School of Nursing (SON) Alumnae Association whose mission includes preservation of nursing history and who were passionate about capturing, recording, and disseminating the history of both the SON and the Mass General department of Nursing. In addition, several current and retired Mass General nurses were recruited. Other key members included the retired nurse who provides oversight to the Mass General Special Collections; a Mass General librarian; the coordinator of the MGH Institute of Health Professions archives; representation of Mass General Public Affairs; leadership from the hospital’s then-soon-to-be-opened Paul S. Russell, MD Museum of Medical History and Innovation (a four-story, 8,000-square-foot building, and the only known freestanding hospital museum in the United States); and nursing history scholars external to Mass General. Through the membership of the committee, the group was able to research key information and identify source documents; recount the history; and bridge the past with current and future practice. Building upon that original charge to prepare for the bicentennial, the group continues to focus on preserving and showcasing the rich history of nursing at the hospital.

The structure and process of the group is outlined above, but it is their outcomes that must be applauded. The group’s efforts led to at least six significant outcomes detailed in Table 1 below.

Table 1. Outcomes of the Mass General Nursing History Committee

In 2019, the Nursing History Committee was recognized by the hospital with an award (Picture 1). Committee member Susan Fisher holds the award, which bears an engraving of the hospital’s original building.

Picture 1: The Nursing History Committee was recognized with the Patricia R. Austen, RN, Mass General History Award.

Used with permission.

...recruitment of new members, ongoing research, and dissemination of the committee’s work remain top priorities.The Committee’s work remains a top strategic priority for Debra Burke, RN, DNP, MBA, NEA-BC, Chief Nurse. Entering the second decade of work, the group is co-led by leaders from the Russell Museum and the Department of Nursing. Priorities on the horizon include continued digitization of key historical documents; development of an exhibit for display in the main corridor of the hospital recognizing 2020 as the Year of the Nurse and Midwife; participating in professional nursing history associations; and planning for the 150^th anniversary of the Mass General SON in 2023. In addition, recruitment of new members, ongoing research, and dissemination of the committee’s work remain top priorities.

Exemplars: Highlights of the Committee’s Outcomes

Although the committee’s outcomes were many, we selected to highlight three exemplars in particular. In this section we discuss the publication of the book that describes the history of Mass General for the first 200 years, America’s first trained nurse, and World War 1 history in greater detail.

Exemplar 1: Publication of a Book Describing 200 Years of Nursing History
A book (Peirce & Ditomassi, 2011) titled, Massachusetts General Hospital Nursing at 200, emerged from the committee’s research. This publication provides a comprehensive look at the progress of Mass General nursing, from the first known documentation of a nurse hired in 1821 through the modern-day interdisciplinary, team-based approach (see Picture 2). The main source material was approximately 43 boxes of documents and photographs relating to the SON from its founding in 1873 to its closure in 1981. These items had been meticulously catalogued by an instructor but had rarely been consulted for research.

Picture 2: Cover of Massachusetts General Hospital Nursing at 200.

The book received external recognition as recipient of the 2013 Nursing Media Award for Print from Sigma Theta Tau International and the 2013 Lamplighter Award from the New England Society of Healthcare Communications.
Used with permission by Massachusetts General Hospital Nursing at 200.

The book gave voice to some of the hospital’s earliest nurses...The book gave voice to some of the hospital’s earliest nurses, who described the rudimentary training they received, their difficult working conditions (e.g., including housekeeping in addition to clinical duties), and the joys and frustrations of caring for patients. Through these first-person accounts and copious portraits and photographs of nurses at work, readers were presented a vivid picture of the evolution of training, working conditions, and medical technology. These and other highlights from the book are summarized in Table 2.

Table 2. Featured Events from Massachusetts General Hospital Nursing at 200

(Peirce & Ditomassi, 2011)

A staff nurse was studying a photo of nurses who volunteered in WWI and discovered that one was a relative.The book ushers readers into more recent history, describing nurses as “always ready to serve the cause of research” and staffing what was to become a renowned research ward (Perkins, 1975); SON director Ruth Sleeper’s efforts to further professionalize nursing; and recognition of Mass General as the state’s first Magnet^® hospital by the American Nurses Credentialing Center in 2003. When the book was published, a concerted effort was made to acquaint both SON Alumnae Association members and Mass General staff with nursing’s rich history; it was distributed to over 1000 alumnae and to every nurse employed at the hospital. From this wide dissemination, a rewarding anecdote emerged: A staff nurse was studying a photo of nurses who volunteered in WWI and discovered that one was a relative.

Exemplar 2: America’s First Trained Nurse
Before the era of the professionally trained nurse (mid-late 1800s), nurses learned needed skills from those already practicing as nurses, or from working side by side with doctors on the wards and operating rooms. They did not attend structured formal nursing programs. It was the work of Florence Nightingale in the Crimean War in the 1850s that brought about a more formalized training approach for nurses, first in England, then worldwide. The Nightingale Training School was established in 1860 at St Thomas' Hospital in London, and its first trained nurses were welcomed to the Liverpool Workhouse Infirmary in 1865. Similar training schools were begun around Europe, and in 1873, three such schools were established in the United States (Anderson, 1981). This marked the transition from the era of the “untrained nurse” to the “trained,” a major advance and the beginning of professional identity as we know it today.

It was the work of Florence Nightingale...that brought about a more formalized training approach for nurses...The impact of Florence Nightingale on the profession of nursing can be traced through numerous settings, practices, schools, people, literature, and art. Her impact on Linda Richards (see Picture 3), known as America’s first trained nurse and who later studied with Florence Nightingale, is evident (Richards, 1911). Richards is a significant figure in nursing history. Her role in promoting professional nursing education in the United States during the 19^th and 20^th centuries was remarkable. While conducting research for the book, the committee collected and archived materials documenting Richards’s contributions both locally and internationally, which are described below.

Picture 3. Linda Richards, instructing a class at Hartford Hospital.

Linda Richards, considered America’s first trained nurse, became the superintendent of the Boston Training School for Nurses in 1874 and later studied with Florence Nightingale.
Used with permission by Massachusetts General Hospital Nursing at 200.

Empowering nurses to oversee the programs and curriculum, the teaching, and the students was a breakthrough and a new concept in nursing education.In 1872, the Industrial Committee of the Women’s Education Association in Boston had an agenda item to search for new occupation opportunities for self-supporting women. In April 1873 a training school for nurses was suggested (Parsons, 1922). Following an agreement with Mass General trustees to establish a school in connection with the hospital, the school opened later that year. This was an important time in the history of nursing education in the United States, as two other schools opened that same year. Referred to in literature as “the famous trio of schools” were the Bellevue Training School in New York City, the Boston Training School and the Connecticut Training School in New Haven. All three have been said to be based on the Nightingale plan, whose primary philosophy was education of nurses by nurses. Empowering nurses to oversee the programs and curriculum, the teaching, and the students was a breakthrough and a new concept in nursing education (Dolan, 1975). With the founding of these schools and others soon to follow, the period of nursing history called the era of the trained nurse began. This stems, in large part, from Florence Nightingale’s ability to prove that nursing should be recognized as a vocation that required special preparation (Curtis & Denny, 1902).

The beginning days of formal nursing education were not without challenges. Administrative, organizational and financial barriers existed. Finding appropriate leadership and teachers for these schools proved to be a challenge. The Boston Training School started its first year as an “experiment” with four students and had difficulty finding a suitable superintendent. The school was permitted to continue if a trained nurse were hired to lead it. Linda Richards was recruited and began her tenure in 1874 (Peirce & Ditomassi, 2011).

Finding appropriate leadership and teachers for these schools proved to be a challenge.Richards had earned her diploma in 1872 at the newly created year-long program at the New England Hospital for Women and Children. She was the first person to begin training at the school and to receive a diploma (Doona, 2017), thus becoming known as America’s first trained nurse. Under Richards’s direction, the Boston Training School grew and thrived. She describes the hesitancy of medical staff, untrained nurses, and other employees to accept and provide education to student nurses: “It was no easy task to prove to unwilling minds that trained nurses were superior to untrained nurses ….” (Parsons, 1922, p.35)

When the school started, the students were permitted to work in limited areas only. By the time Richards left in 1877, she was in charge of all nursing and the students were providing care in most wards (Parsons, 1922). It was noted that the quality of the work had changed. Under Richards’s tenure, class instruction expanded; new courses were added, such as cooking (nutrition); and new tools such as watches and thermometers were made available. She also transferred non-nursing responsibilities such as mopping floors, to maids to give nurses more time at the bedside (Peirce & Ditomassi, 2011).

It seems fitting that her quest for excellence led her to study with Nightingale.In 1877, Richards left the school to study under Florence Nightingale in England. She went on to establish several additional schools of nursing and to serve in many leadership roles, including the inaugural president of the first professional nursing organization, the American Society of Superintendents of Training Schools for Nurses. By the time of her death in 1930 there were 294,268 trained nurses in the United States (Richards, 1911). It seems fitting that her quest for excellence led her to study with Nightingale. Of note, Nightingale spoke these words regarding Richards: “I have seldom seen anyone who struck me as so admirable. I think we have as much to learn from her as she has from us” (Peirce & Ditomassi, 2011, p. 41).

Exemplar 3: World War I Nursing History
As the centennial of World War I (WWI) approached, the Nursing History Committee and Russell Museum staff made plans to reach both internal and external audiences. The museum created the exhibit, “A Spirit of Devotion: Massachusetts General Hospital in World War I,” elements of which would appear in the museum and the main lobby. The exhibit changed frequently and followed the course of America’s involvement in the war.

Many exhibits included reproductions of scrapbook spreads that bore snapshots of the hospital, staff, and patients, and programs for special events.A series of eight small exhibits described Mass General’s establishment of Base Hospital No. 6; the conditions that staff and patients faced there; chemical warfare and shellshock; the 1918 influenza epidemic’s effect on the hospital; and the practice of various specialties, such as surgery, radiology and pathology. Represented prominently throughout were the voices and images of nurses. Many exhibits included reproductions of scrapbook spreads that bore snapshots of the hospital, staff, and patients, and programs for special events. The exhibits were supplemented with objects such as a Mass General nurse’s WWI dog tag, a contemporary copy of a bill to grant army nurses rank, a nurse’s wool cape on a mannequin, and a reproduction of an oil painting of Sara Parsons, Chief Nurse of Base Hospital No. 6 (see Pictures 4 and 5).

Picture 4. Collage of Archived Materials from WWI Used In Displays

Used with permission by the MGH Nurses’ Alumnae Association

Picture 5. A Mass General Nurse in Full WWI Dress

Used with permission by the MGH Nurses’ Alumnae Association

The video made extensive use of quoted images from the scrapbooks and SON archives.A looping 12-minute film gave an overview of Mass General clinicians’ service at Base Hospital No. 6; life and work there; the influenza epidemic; the Halifax explosion; and medical advances that emerged from the war. The video made extensive use of quoted images from the scrapbooks and SON archives. An exhibit summarized Mass General’s WWI involvement and featured the belongings of a Mass General nurse during her tenure at the base hospital, including her steamer trunk, uniform, cap, cape, bedroll, and blanket. Several other extraordinary WWI-related resources emerged, including a handful of scrapbooks created by Mass General nurses at Base Hospital No. 6, which provided an unparalleled view into daily life. Photos of nurses at the base hospital were enlarged and placed in the museum’s first floor windows facing a major Boston thoroughfare.

The museum created the exhibit, “Bostonian and Haligonian: Aid after the Halifax Explosion, 1917.” When one ship loaded with relief supplies collided with one bearing explosives, the harbor city was flattened; 2,000 people were killed and 9,000 injured. The governor of Massachusetts pledged to help, and clinicians rushed to board trains north (The Nursing History Committee, Caring Headlines, December. 14, 2017a). The exhibit detailed contributions by nurses to the relief effort. In thanks to the city of Boston for its aid, the province of Nova Scotia provides Boston with a Christmas tree each year. In 2017, with the tree’s arrival in Boston, the museum held a special reception for Nova Scotia dignitaries and Canadian first responders. The reception featured a nurse historian who spoke about nurses’ response in the disaster.

The exhibit detailed contributions by nurses to the relief effort.In July 2017, Mass General’s newsletter Hotline, which is made available in print and online to the hospital’s 26,000 staff members and to patients, devoted a special issue to the hospital’s WWI history, offering a preview of what was to come at the museum and in the main lobby (Hotline, July 7, 2017).

Throughout 2017, Nursing History Committee members researched and wrote nine articles that appeared in Caring Headlines. Given its focus on staff members’ exemplary ingenuity, perseverance, and care, it felt apt to present to modern-day staff how their predecessors exhibited those same qualities in WWI. The stories included:

• An introduction to Base Hospital No. 6, in Talence, France, where ultimately more than 65 Mass General nurses would care for patients throughout the war (Mass General Nursing History Committee, Caring Headlines, April 6, 2017).
• The process for becoming a WWI nurse at a time when women could not yet vote. (Mass General Nursing History Committee, Caring Headlines, May 4, 2017).
• Base Hospital No. 6 chief nurse Sara Parsons’s fight to gain rank for military nurses (Mass General Nursing History Committee, Caring Headlines, July 6, 2017).
• A profile of nurse Helen Dore Boylston, whose WWI diary would go on to be published as Sister: The War Diary of a Nurse, and who would later write the popular Sue Barton series of books, inspiring a generation of women to become nurses (Mass General Nursing History Committee, Caring Headlines, August 3 & September 7, 2017).
• A profile of Carrie Hall who became chief nurse of Base Hospital No. 5 (also in France) and was later awarded the Florence Nightingale Medal, the highest international recognition for a nurse, for her courage and devotion (Mass General Nursing History Committee, Caring Headlines, October 5 & November 2, 2017).
• Two installments of harrowing descriptions of daily life, including nurse Maude Barton administering ether in the dark, and Helen Dore Boylston’s account of applying fresh bandages to hundreds of soldiers’ wounds (Mass General Nursing History Committee, Caring Headlines, December 14, 2017a).
• A description of Mass General nurses’ role in relief efforts after the Halifax explosion and a personal reflection on the explosion (Mass General Nursing History Committee, Caring Headlines, December 14, 2017b).

Conclusion: A Call to Action

...the Mass General Nursing History Committee remains a relevant and integral part of our healthcare journey bridging nursing’s past, present, and future.Through effective leadership, active engagement of members, and the articulation of a clear charge, the Mass General Nursing History Committee remains a relevant and integral part of our healthcare journey bridging nursing’s past, present, and future. The committee’s contribution to the evolution of our profession is an exemplar to be replicated by other disciplines and institutions.

Our professional identity as nurses is an extension of all the nurses who came before us.Understanding our history and learning from the efforts of our predecessors is critical to advancing any profession. The roots of nursing practice are embedded in our desire to reform and improve healthcare for individuals and populations, locally, and globally. Our professional identity as nurses is an extension of all the nurses who came before us. An examination of our rich history offers a glimpse into the origins of our relationships with other healthcare professions and encourages reflection on the value of our own contributions to healthcare and society. It gives us valuable perspective about how to meet emerging health challenges and informs decisions about the future of our practice.

All nurses play a part in collecting, preserving, and disseminating nursing history. It is more than a fond retrospective of accomplishments; it is a vital record of our contributions and impact over the centuries. In words often attributed to anthropologist Margaret Mead (Wikiquote, n.d., Disputed section), “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

Acknowledgments
Special thanks each member of the Mass General Nursing History Committee (past and present) who has tirelessly committed to capturing and recording nursing’s impact over time. In addition, the authors acknowledge Georgia Peirce’s leadership and support as Special Project Manager for the first ten years of the Committee’s tenure. Finally, our thanks to the Massachusetts General Hospital Nurses’ Alumnae Association for their dedication to nursing history and efforts to preserve and provide materials.

Authors

Mary E. Larkin, MS, RN
Email: mlarkin1@mgh.harvard.edu

Mary E. Larkin, MS, RN, is a nurse manager at Mass General Hospital, the chairperson of the Mass General Nurses’ Alumnae oral history project, a member of the Nursing History Committee, past president of the Nurses’ Alumnae Association and served on the Mass General Hospital Nursing at Two Hundred book committee.

Michelle Marcella, BS
Email: mmarcella@mgh.harvard.edu

Michelle Marcella, BS, is the assistant director of the Paul S. Russell, MD Museum of Medical History and Innovation. She is a member of the Nursing History Committee and served on the Mass General Hospital Nursing at Two Hundred book committee.

Sarah Alger, BA
Email: salger@mgh.harvard.edu

Sarah Alger, BA, is the director of the Paul S. Russell, MD Museum of Medical History and Innovation, is co-chair of the Nursing History Committee, and past president of the Medical Museums Association.

Susan Fisher, BA, RN
Email: sfisher80@comcast.net

Susan Fisher BA, RN, retired from active nursing in 2008 after a career in community health. She has since pursued her interest in nursing history as a board member of the Mass General Nurses’ Alumnae Association and editor of its alumnae magazine, served on the Mass General Hospital Nursing at Two Hundred book committee, and volunteers with the Mass General archives.

Marianne Ditomassi, DNP, MBA, RN, NEA-BC, FAAN
Email: mditomassi@mgh.harvard.edu

Marianne Ditomassi, RN, DNP, MBA, NEA-BC, FAAN, is the executive director of Nursing and Patient Care Services Operations at Mass General Hospital. She was the co-editor of the award-winning book Mass General Hospital Nursing at Two Hundred and is co-chair of the Nursing History Committee.