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The History of the American Nurses Association

The history of the American Nurses Association (ANA) is best described as the story of individual nurses everywhere. From front-line volunteering in the nineteenth century to the budget cuts of today, nurses face obstacles which unite them. By coming together, we have been able to mobilize nursing’s incisive knowledge of the health care system to stand up for injustice and provide the momentum needed to lead health care forward. 

At the turn of the 20th century, nurses exhibited the very same strengths as we see today; yet without accreditation, licensing or unifying organizations, they had no single voice – no platform from which to lead towards better health care for all. That is where we came in. 

ANA has come a long way since 1896. When the Nurses Associated Alumnae of the United States and Canada first assembled at Manhattan Beach Hotel, near New York City, fewer than twenty of the delegates were nurses. At the corresponding convention just two years later, more than 10,000 nurses were in attendance.  

When the organization became the American Nurses Association in 1911, it was already fighting for the profession to gain the respect it deserved. Policy makers began to recognize the importance of nursing’s value to health care, and through annual conventions and academic journals, the shared wisdom of nurses inspired others to join the profession. 

Over the past 100 years, ANA has built on this spirit of solidarity and action. Protecting the interests of nurses across the United States is an integral part of ANA’s legacy. From lobbying for an eight-hour working day in 1934, to supporting the Fair Pay Act in 1995, to campaigning for wider health care reform today, it has tirelessly safeguarded the rights of its members. 

But far from solely protecting the concerns of its nurses, ANA has always used its position to take a lead role in the protection of public health. Just as a nurse identifies medical conditions through careful observation, so has ANA used the expertise of our membership to confront the health problems of the day head-on. Mental health, primary care shortages and the Zika virus are a mere fraction of the issues addressed through practice and policy development by ANA. 

More than reacting to issues and tackling obstacles, we have fought to see innovation in nursing recognized throughout the profession. ANA has supported recommendations by the National Academy of Medicine (formerly the Institute of Medicine), which would enable nurses to work within their scope-of-practice and use the full extent of their knowledge to best serve patients. By recognizing the true skill level of the profession, nurses are given greater prominence in the health care journey – and patients are the first ones to benefit.

To achieve this recognition, ANA has promoted extensive education and development. From endorsing five-year study for all phases of nursing in 1950, to establishing its own credentialing center in 1990, it has supported nurses in obtaining the skills and confidence they need to succeed. Nurses are more ambitious than ever to build on their qualifications throughout their careers, and the breadth of ANA programs reflects its members’ commitment to improving the profession.

When American nursing pioneer Alice Fisher wrote to Florence Nightingale in 1877 (see "Background to the ANA Nightingale letter" below), she did so for support, guidance and with a zeal to improve the conditions she witnessed. While the landscape of nursing has changed, it is still by uniting and sharing knowledge that nurses can make the most impactful difference in the 21st century.

Background to the ANA Nightingale letter

Miss Alice Fisher, born in England June 13, 1839, trained at the Nightingale Training School and Home for Nurses. Between the years 1876 and 1888, Alice Fisher reformed the nursing services of four important general hospitals – a feat that has probably never been equaled by any other woman, according to Sir Zachary Cope, M.D., - author of Florence Nightingale and the Doctors.

In 1876, she volunteered to be superintendent of the Fever Hospital, Newcastle on Tyne, where she found wards dirty and unkempt. Under her direction, the hospital known as a “pest house,” was cleaned, nurses trained, and the institution lost its notoriety for ward filth.

Miss Fisher was next called to reorganize the Radcliffe Infirmary in Oxford, and then went to Addenbroke’s Hospital in Cambridge. In 1882, she became superintendent of the General Hospital in Birmingham, remaining to establish a school of nursing.

Miss Fisher wrote to Miss Nightingale on November 23, 1877 from Addenbrooke Hospital, at Cambridge. In her letter, Miss Fisher recounts the difficulties and problems she encountered establishing a worthwhile nursing program and staffing it with good trained nurses. When she went to America to reorganize nursing in the Philadelphia City Hospital (now Philadelphia General Hospital), she faced a political machine that opposed her reformation. She received threatening letters, and even faced bombings.

Then she writes:

….”and now dear Miss Nightingale forgive me if I ask you a very great favor: this is our first Christmas here together – will you write my children and me a little message of encouragement that I may read them on that day. It will be such a help to us all. I should not dare to ask you only I know that you take an interest in and are willing to help even our heartfelt endeavours [sic] to walk worthy of our profession. Forgive me this long letter and believe me every your grateful servant, [s] Alice Fisher”

The ANA Nightingale letter is Miss Nightingale’s response to Miss Fisher’s request for words of encouragement.

After Fisher completed her work in the English hospitals, which included establishing a school of nursing, she travelled to the U.S. in 1884 where she created order from chaos in the Philadelphia City Hospital (now Philadelphia General Hospital) and established the hospital’s training school.

Her nursing career was brief – a mere 13 years after training – but remarkably productive. She died of heart disease in 1888, and is buried in The Woodlands Cemetery, Philadelphia, PA.

The letter was presented to ANA by Edith G. Walker, associate professor, Division of Nursing, University of Massachusetts, Amherst. Ms. Walker, who acquired the letter from a London antique dealer wrote: “The letter is really an inspiration for nurses today…”

Protecting the interests of nurses across the U.S. is an integral part of ANA’s legacy.

Learn more about ANA's history

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