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A School is Born

A Need For Qualified Nurses Spurs A Grand Experiment In Nursing Education


By Gary Goldenberg


The harshness of life in 1880s and the negative effects of the Industrial Revolution on injury and disease are almost impossible to imagine. If ill, the well-to-do could at least afford to recover at home with the attention of a private physician or nurse. It was a different story for the poor and the working class, who typically had to seek "care" at almshouses or at decrepit public hospitals.

Following the Civil War, a social crusade for hospital reform began. Returning soldiers and health workers introduced the general public to the possibilities of institutional care, and slowly a more equitable system of health care emerged. Presbyterian Hospital, established by New York philanthropist James Lenox, was at the forefront.


Presbyterian opened its doors in 1872, but like other hospitals at that time, administrators had trouble finding competent staff and recognized a need for qualified nurses. 


By the late 1880s, it became clear that the only remedy was to open a nursing school, and the hospital administration began a search for a nurse who could lead it into nursing’s modern era. They found such a figure in 40-year-old Anna C. Maxwell, a native of upstate New York. The year was 1891.

Maxwell’s house

Respected and well connected, Maxwell had little trouble attracting experienced staff nurses and promising students. In a promotional circular for Presbyterian’s new two-year diploma program, Maxwell stated that the school was looking for women with “a high order of intelligence and a desire to learn … Nurses will find there is no knowledge, even of subjects far removed from nursing, which may not prove useful.”


It’s a wonder that anyone applied. The work schedule was unre- lenting and the pay low. Student nurses, who doubled as staff nurses, were expected to work and study 12 hours a day, six days a week, with three weeks’ vacation—all for a $9 monthly stipend. Nonethe- less, the hospital received 536 inquiries from prospective students within 18 months. The Presbyterian Hospital Training School for Nurses officially opened on May 1, 1892, with an enrollment of 10 “probationers” (students accepted on a trial basis) and six nurses already on the payroll, who were given advanced standing. Sixteen additional “probies” were accepted at intervals during the year.

The early curriculum

Early lectures at the school—mostly delivered by the medical staff, some of the finest physicians of the day—were rich and diverse. Topics included hygiene of  the sickroom; bacteriology; anatomy; bandaging; symptomatology of the nervous system, heart, lungs, and abdominal organs; surgical diseases; obstetrics and gynecology; contagious diseases; nervous cases; Swedish massage; and cooking for the homebound.


Like all other student nurses, those at Presbyterian made beds, and cleaned and collected bedpans, but unlike student nurses at other institutions, they also took charge of six to 10 patients, administered hypodermics, prepared ether cones, made plaster splints, performed bladder irrigations, and assisted in operations.


Students were dispatched all over the city for additional clinical experiences: Sloane Maternity, the Foundling Asylum, and Willard Parker Hospital for Contagion, to name just a few sites. Most hospitals frowned upon this practice, fearing that it would inflate operating expenses (from having to hire replacements on the wards) or that they would eventually lose these nurses to other institutions. But Presbyterian’s far-thinking administrators knew that the added experienceproduced a more well-rounded nurse—and it spread the word about the quality of the hospital’s program. On more than a few occasions, leaders of institutions that hosted Maxwell’s pupils wrote to tell her, “From now on, our matron [senior nurse] must be a graduate nurse.”


In order to complete Maxwell’s rigorous exams, students had to pass a series of tests, culminating in a day’s worth of oral examinations in medicine, surgery, and materia medica (given by a physician and a surgeon), and a practical exam on the wards (overseen by Maxwell herself). On May 15, 1894, the school graduated its first class, 21 pioneers in nursing. “Without the intelligent, well-trained, and faithful nurse, these noble buildings, with their admirable equipment and staff of skilled physicians and surgeons, would not constitute a hospital,” stated William H. Draper, MD, president of the medical board, in his commencement address. The school was off to an auspicious start.


Maxwell would preside over the program for another 25 years, expanding the possibilities of the profession each and every year. She could not have predicted that less than a century after her retirement, Columbia nurses would be earning doctoral degrees, leading major health care institutions, conducting and innovating research, setting health policy, starting businesses, practicing independently, writing prescriptions—redefining and transforming the possibilities and the profession of nursing.


*This article originally appeared in the Spring 2017 issue of Columbia Nursing magazine.