A History of School Nursing: From Its Origin in New York City to Implementation in Virginia, 1900-1925

Houlahan, Bridget, Nursing - Graduate School of Arts and Sciences, University of Virginia
Keeling, Arlene, School of Nursing, University of Virginia


Both the National Institutes of Health and the Centers for Disease Control and Prevention have endorsed the role of a nurse in the schools. However, school nurses today continue to struggle with advocacy and funding of their role. To date, no comprehensive study has examined the origins of school nursing in New York City and its subsequent diaspora across the United States. Understanding the history of school nursing may provide insight into solving the ongoing difficulties school nurses face in the promotion of their role.
The purpose of this study was to identify, describe and analyze the origins and evolving role of the school nurse from New York City to the rural counties of Virginia from 1900 – 1925. A particular focus was set on investigating how place, race, class, culture, and socio-economic status affected the development and practice of school nursing across the country.
This study examined Lillian Wald, her political and social connections and her relationship to the school nurse movement. Also examined was the role of Lina Rogers Struthers as the first school nurse, the scope of school nursing practice, the role of the school nurse in home visitations, and determinants of success in the school nurses’ role in New York City at the turn of the twentieth century.
This research also investigated the diaspora of school nursing from New York City to Richmond, Virginia at the turn of the twentieth century. The relationships among nursing leaders of the time and their influence on the school nurse movement were analyzed from a social history perspective. Also examined were the convergence of social movements during the Progressive Era such as the establishment of settlement houses, the professionalization of nursing and public health reform initiatives and their effect on the advancement and spread of school nursing practice.
Included in this study was also the developing role of the rural school nurse in the Commonwealth of Virginia. In particular, this research investigated how the influences of place, race, class, culture and socio-economic status affected the Commonwealth of Virginia’s attempts to develop and provide school nursing throughout the diverse rural counties across the state.
Traditional historical methods with a social history framework were used in this investigation. Critical analysis of social, political, and economic context as well as the state of the science of medicine and nursing was also performed. Primary source data was identified, collected and analyzed from numerous sources. These included the following: The Lillian D. Wald Papers from the New York City Public Library, The Lillian D. Wald Papers from Columbia University Rare Books and Manuscripts Library, The Instructive Visiting Nurse Association Papers located in the Special Collections and Archives at the Tompkins-McCaw Library at the Virginia Commonwealth University, The Johns Hopkins School of Nursing Archives from the Alan Mason Chesney Medical Archives, Annual Reports from the Commissioner of Health to the Governor of Virginia, 1900 – 1926, Annual Reports from the Superintendent of Education to the Governor of Virginia, A Sanitary Survey of the Schools of Orange County, Virginia, The Virginia Health Bulletin, The Virginia Journal of Education, Biography of the Richmond Professional Institute, historical newspaper accounts, and numerous texts and journal articles written by leaders in public health in the early twentieth century. Secondary sources included published books, government websites, nursing, history, and public health journals.
Findings suggested that at the turn of the twentieth century, school nurses encountered tremendous challenges and demonstrated heroic measures to provide care for thousands of school children and their families who would have otherwise gone without. School nurses provided access to care for school children and in doing so reduced absenteeism to improve educational opportunities. Identified problems impeding the development of the role of the school nurse included difficulties in securing financial support, lack of knowledge regarding benefits of the role, racial and cultural concerns, poor pay and scarcity of appropriately trained nurses.
School nurses today continue to face the same struggles as the first school nurses in the early 1900s. It is a different time and society; yet similar problems, particularly as they relate to place, race, class, culture and socio-economic status remain much the same. Children’s health concerns have changed across the century, but the objectives of the school nurse remain the same. Funding and advocacy persist as challenges. Core fundamental concepts of school nursing steadfastly provide a framework for providing much needed health services to school-aged children today. Thus, just as the first school nurses demonstrated heroic measures in identifying and attempting to meet the needs of school-aged children and their families at the turn of the twentieth century, today’s school nurses must demonstrate knowledge, persistence, and creative ingenuity in doing the same.

PHD (Doctor of Philosophy)
History School Nursing
All rights reserved (no additional license for public reuse)
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