Lesson 1, Topic 1
In Progress

Development of Practical and Vocational Nursing

May 11, 2021

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Development of Practical and Vocational Nursing

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Attendant Nurses

The first school for training practical nurses started in Brooklyn, NY, in 1892 under the auspices of the Young Women’s Christian Association (YWCA). The Ballard School, as it was known, gave a course that lasted approximately 3 months and trained its students to care for invalids, children, the chronically ill, and the elderly. The main emphasis was on home care and included cooking, nutrition, basic science, and basic nursing procedures. Graduates of this program were referred to as attendant nurses.
Two other programs were patterned after the Ballard School. In 1907, the Thompson Practical Nursing School opened in Brattleboro, Vermont (still in operation and accredited by the National League for Nursing [NLN]), and in 1918, the Household Nursing Association School of Attendant Nursing (later changed to the Shepard-Gill School of Practical Nursing) opened in Boston. Hospital experience was not a part of the training in the early programs. The focus was on home nursing care and light housekeeping duties.
Practical Nursing Programs

Practical nursing programs developed slowly during the first half of the twentieth century, with only 36 schools opening. The practical nursing schools before 1940 had few controls, little educational planning, and minimal supervision. Between 1948 and 1954, a sharp increase in the formation of practical and vocational nursing programs was attributed to the increased demand for nursing services in World War II and the postwar years and the excellent bedside nursing care demonstrated by the practical nurse. These programs varied in administrative design. Some were affiliated with hospitals or chronic care institutions, whereas others aligned themselves with private agencies or private schools. Students in these programs provided nursing services while they were obtaining their education and training. Technical and vocational education emphasized apprentice training. Federal funds allocated for training practical and vocational nurses helped recruit men and women.
Organizational Influence

As practical nursing programs continued to grow in number, the need to establish standards of curricula became increasingly recognized. The Association of Practical Nurse Schools was founded in 1941 and was dedicated exclusively to practical nursing. Its membership was multidisciplinary and included licensed practical nurses, registered nurses, physicians, hospital and nursing home administrators, students, and public figures. Together they planned the first standard curriculum for practical nursing. By 1942, they saw the need to change the name to the National Association of Practical Nurse Education (NAPNE). They broadened their focus to include education and practice and established an accrediting service for schools of practical and vocational nursing in 1945. The association changed its name once more in 1959 to the National Association for Practical Nurse Education and Service (NAPNES). Today, NAPNES remains a guiding force in the development of practical nursing education.
In 1949, the National Federation of Licensed Practical Nurses (NFLPN) was founded by Lillian Kuster. Limited to LPNs and LVNs, this association is the official membership organization for the LPN/LVN. Working together, NAPNES and NFLPN set standards for practical and vocational nursing practice, promote and protect the interests of LPN/LVNs, and educate and inform the general public about practical and vocational nursing.
In 1961, the NLN broadened its scope of service because of the growth of practical and vocational nursing programs. The NLN established the Department of Practical Nursing Programs and developed an accreditation service for these programs, which is now called the Council of Practical Nursing Programs.
For 20 years, both the NLN and the NAPNES provided accreditation services. Nursing programs had the option of seeking accreditation from either organization. In recent years, however, NAPNES has discontinued this service.
Program Credentialing

Accreditation of a program differs from program approval. Approval is required for a program to operate. An approved program is one that satisfies the minimum standards set by the state agency responsible for overseeing educational programs: for example, it meets the needs of the student, has adequate course content and qualified faculty, is of sufficient length, has adequate facilities, and provides clinical experience. To protect the welfare of the public, the state requires programs to demonstrate all these elements for graduates to be eligible for licensure. Accreditation is a higher standard that signifies that the accrediting organization has judged that a program has met its preestablished criteria. The administrators of the program seeking accreditation submit voluntarily to the accreditation process; they do so because of the recognition of quality it confers. Often the standards established by professional organizations that give accreditation are far higher than those established by the state. Although graduates of nonaccredited programs can take the licensure examination required in most states, accreditation is extremely important when programs seek federal funding. Graduates from nonaccredited programs may face challenges when attempting to transfer completed course work to another institution for further education.

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