Professional Nursing in 20th Century Hawaii: the First 50 Years

Nursing Roots

This exhibit is based on the exhibit on display on the main floor of Hawaii Medical Library.
It will be on display there through the month of August, 2001.

Note: Click on images to access larger images.

European and American Roots
In 1836, Fredericka Munster Fliedner and her husband Theodor, a German pastor in Kaiserwerth, opened a hospital with a training school of deaconesses. A doctor gave them formal instructions, including classes in pharmacology. Mrs. Fliedner compiled her notes into what might be considered the first nursing textbook.

Florence Nightingale ca. 1857

Florence Nightingale, 1820 - 1910
As a young woman, Florence Nightingale had expressed her desire to study nursing. While her parents did not support Nightingale, she made a short first visit to Kaiserwerth in 1850, returning in 1851 when she stayed for three months.

In 1853, Nightingale traveled to Paris and studied there with the nursing order of the Sisters of Charity. Returning to London, she worked as administrator and director of nurses at the Establishment for Gentlewomen During Illness where she remained until a personal friend, Sir Sidney Herbert, Secretary of War, called her into service during the Crimean War.

After the war ended in 1856, Nightingale spent the next three years working to improve the care of military personnel. In June 1860, her school of nursing based on the Kaiserwerth model opened at St. Thomas's Hospital in London. Hear Nightingales's voice and an introduction by M. Adelaide Nutting. Requires RealAudio.

Note signed by Florence Nightingale
Note requesting supplies, dated 1877. Signed by Florence Nightingale. Courtesy of Hawai'i Nurses' Association

Linda Richards, 1900

American Nursing
Linda Richards, America's first trained nurse, recalled in her memoirs her desire to devote her life "to the work of caring for the sick and suffering" after hearing of the need of nurses in the Civil War. Richards began her work at Boston City Hospital, but was disappointed "when I found my work to be only that which is today done by the ward maid." At left, Linda Richards in 1900.

In the meantime, the New England Hospital for Women and Children, under the leadership of Dr. Marie Zakrzewska, included in its act of incorporation of July 1862 the training of nurses. The New England Hospital's nurses training expanded into the "first general training school for nurses in America." Dr. Susan Dimock, an American woman, received her medical training in Europe before joining the staff at the New England Hospital. The nursing methods Dimock observed when she visited both Kaiserwerth and Nightingale's school were inaugurated at the New England Hospital. Dr. Dimock administered the school while Dr. Zakrzewska taught bedside nursing. Training included lectures from the women physicians in medicine, surgery, and obstetrics. Linda Richards received her diploma from the New England school on October 1, 1873.

Training schools soon opened in New York (Bellevue Hospital), New Haven and Boston. The Bellevue school was the first based on the Nightingale model. Linda Richards worked at both Bellevue and the Boston Training School at Massachusetts General before traveling to England to study nursing methods and make the acquaintance of Miss Nightingale. The training at New England Hospital later expanded to sixteen months; Mary Eliza Mahoney graduated from the New England Hospital's course in 1879, thereby becoming the first Black American professional nurse.

The Hawaii Story
Prior to the appearance of trained nurses in Hawaii, patient care was rendered by a makamaka or kokua. This watcher or helper might have been a family member or friend. The development of hospitals with trained physicians underscored the need for professional nursing to improve patient care. Initially, trained nurses from America were imported to care for the growing patient population.

It was years after Linda Richards' graduation that she decided to take up work for the American Board of Missions to organize a nurses' training school in Japan. Her steamer sailed by way of Honolulu where she came ashore on January 6, 1886. While in Honolulu, Richards visited the Queen's Hospital. She recalled that the hospital was "beautifully situated among palms and orange trees. Though so attractive on the outside, on entering the wards my fingers ached to put things in order."

Perhaps it was Richards' visit that influenced the Trustees of the Queen's Hospital to hire professional nurses. In July 1886, the Board minutes reveals that the "necessity of employing a female nurse was discussed & the Ex. Com. on motion authorized to employ a suitable person for the position." Two months later, "Mrs. Mary Adams had been engaged by the Ex. Com. as nurse of the hospital at the rate of $500 per annum & was apparently filling the position satisfactorily."

Nursing Caps
Nursing caps were initially functional in nature, worn to cover the longer hairstyles of the late 19th century. Eventually, each school of nursing had designed a cap for the students with bands or colors signifying the students' status.

Cap worn by Linda Richards,
the first trained nurse in America.

Nursing caps, 1916,
Queen's Hospital

Nursing Pins
Like the cap, schools of nursing designed pins that were unique to each school. Symbols, school mottos, the year of graduation were usually part of the design. At graduation ceremonies, the graduating nurses appeared in professional uniforms and were formally "pinned." Graduate nurses often continued to wear their school pins and caps when they entered the work force.

Queen's Hospital
School of Nursing pins

Next page: Nursing Schools in Hawaii

First Posted: July 27, 2001