and academia, the current state of affairs will then be analyzed in terms of the forces shaping both health care delivery and higher education. Existing at the interface between these two major social institutions affords nursing both advantages and disadvantages, which will be articulated. The major challenges ahead for professional nursing education will then be summarized with an emphasis at the end on the importance of addressing fundamentals. Although the opinions expressed are those of the author, a number of nurses responded with helpful comments to a very detailed outline of the paper. They included the leadership of six major nursing organizations—the American Academy of Nursing, the American Association of Colleges of Nursing (AACN), the American Nurses Association, the American Organization of Nurse Executives (AONE), the National League for Nursing, and Sigma Theta Tau International (nursing's honor society). See the "Author's Note" section at the end for a full listing of respondents.

A Brief History Of Nursing Education

To understand the present, one must always have some sense of the past. The first "modern" school of nursing was founded in 1860 by Florence Nightingale at St. Thomas Hospital in London. A little more than a decade later, the first schools in the United States to build on her curriculum and philosophy (i.e., put patients in the best situation for nature to heal) came into existence; they were associated with Bellevue Hospital in New York City, New England Hospital for Women and Children (which became Massachusetts General), and New Haven Hospital in Connecticut. Hospital diploma schools were a boon to their institutions, since student nurses provided most of needed patient care as inexpensive apprentices. By 1900, an infrastructure for nursing education was taking shape; the American Society of Superintendents of Training Schools (which became the National League for Nursing), the Nurses Associated Alumnae of United States and Canada (which became the American Nurses Association), and the American Journal of Nursing had all been founded.

The demanding working conditions soon contributed to a shortage of student applicants. In an attempt to de-emphasize apprenticeship training, nursing schools began to be affiliated with academic institutions. The earliest university-based nursing education took place at Howard University, Teachers College of Columbia University, Johns Hopkins University, what is now known as the University of Texas at Galveston, Rush Medical College in Chicago, and the University of Minnesota, which in 1909 became the first university to have an official school of nursing. By 1920, 180 nursing schools reported having college affiliations (Goodnow, 1937).

In 1922, Sigma Theta Tau, nursing's honor society, was founded at Indiana University with the expectation that the baccalaureate degree was to be required for entry into professional practice; this has yet, however, to become the agreed-upon norm for the field. The 1920s saw the formation of two committees—the

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