"We've lost the idea of nurses as experts," says author Sarah DiGregorio. "We've lost the idea of nurses as authority figures."
It's a topic she takes on in her new book: Taking Care: The Story of Nursing and its Power to Change the World.
As nurses today fight for better pay and more respect for their work, DiGregorio points out that centuries ago, they were regarded as an integral part of the health-care system in many civilizations, revered for their knowledge and skills in healing the sick, dating back to ancient times in India and the Islamic world.
Here are some key takeaways from her book.
Nurses were star players in ancient times
Both doctors and nurses had to have knowledge about medications, but it was the nurses who provided direct patient care, according to Charaka-Samhita, a key Indian medical text from 2,000 years ago. They had to have hands-on skill with patients as well as good character, kindness and interpersonal skills.
In the 600s, a woman named Rufaida-Al-Aslamiya was a nurse in the early days of Islam when the Prophet Muhammad was at war in what is now Saudi Arabia. Rufaida and her team traveled with Muhammad's army and cared for wounded soldiers. She was later in charge of providing primary care and health education in Mecca.
"Public health care subsequently became very important in this early Islamic world," DiGregorio writes in her book. And nurses had an important role in it.
While the nursing profession today is predominantly female, that was not the case back then in the teaching hospitals of the region. "These hospitals had professional nurses, both men and women," she says.
European men took away the legitimacy of nurses
The opening of new medical schools in Europe during the Middle Ages ushered in an era that slowly pushed women out of medicine and health care.
The new medical schools, which only allowed men, started turning out a "new professional class of physicians" who were all men with social status, DiGregorio observes. Only those with a license from one of these medical schools could practice medicine. She cites scenes from court cases where popular women nurses were tried and punished.
Florence Nightingale both helped and harmed the field of nursing
While Florence Nightingale is often credited as a force in reviving the importance of nurses, her vision of the profession had flaws that have persisted to this day, argues DiGregorio.
A wealthy Londoner who trained at a nursing school in Germany and then ran a small women's hospital in London, Nightingale was well-known to the British authorities. They turned to her for help during the Crimean War in the 1850s, when British soldiers were dying at very high rates, mainly due to infections in the hospitals.
But while nurses were brought back into the health-care system under her leadership, she had a negative impact, too, says DiGregorio.
Nightingale viewed nursing as an all-female profession that's "subordinate to physicians," says DiGregorio, which "set up this idea that nurses are assistants to physicians.
She took her orders from the physicians and never challenged their authority.
"If a physician had not ordered water for a dying man, Nightingale would not give the man water," writes DiGregorio, who draws her findings from nursing historians who have studied Nightingale as well as newspaper reports.
Nightingale, in turn, didn't want her authority challenged and imposed a strict hierarchical structure for her staff. DiGregorio cites historian Carol Helmstadter, who uncovered that Nightingale fired nurses for feeding patients without explicit orders. One of those nurses complained to Nightingale's superior in London. "We do not look for many comforts, but we do feel we ought to be trusted. We are not allowed to go into the wards without one of the lady [supervisor] nurses. We must not speak one word of comfort to a poor dying man or read to him," the nurse wrote. "We are prevented from doing what hearts prompt us to do. We feel we are not so useful as we expected to be."
Racism in nursing
When Florence Nightingale announced that she was recruiting nurses, an accomplished nurse from Jamaica named Mary Seacole traveled to London to look for work.
Seacole "had [previously] been hired by the British government in Jamaica to organize nursing for an epidemic of yellow fever," says DiGregorio.
Yet she was repeatedly rejected – from the office of Sidney Herbert, the secretary at war, and his wife, who was recruiting nurses for Nightingale.
Seacole wrote in her autobiography: "Did these ladies shrink from accepting my aid because my blood flowed beneath a somewhat duskier skin than theirs? " She was so heartbroken that she left with tears in her eyes.
Still, Seacole went to the frontlines at her own expense to care for soldiers and returned home after the war.
A century later, racial disparities persist in nursing. Nursing is disproportionately white in the United States, DiGregorio says. "It's like 81% white."
And racial discrimination remains a problem. A 2021 study found that 92% of Black nurses, 73% of Asian nurses and 69% of Hispanic nurses have faced racism from colleagues and patients, and it's a major factor for non-white nurses wanting to leave their jobs.
