Nursing has deep historical roots, evolving significantly over centuries. Its early forms trace back to the Roman Empire, where nurses assisted physicians in hospitals established across the empire. In the Byzantine era, the role became more formalised, with both male and female nurses serving in specialised roles. The Catholic Church played a pivotal role during the Middle Ages, sustaining nursing through monasteries and religious institutions, where compassion and service were seen as essential virtues of care. Emperor Charlemagne’s reforms, which encouraged the establishment of hospitals in churches and monasteries, further entrenched the image of nursing as a selfless, service-oriented discipline.
Between the 10th and 16th centuries, charitable houses expanded the scope of nursing, even catering to the wealthy. However, the Protestant Reformation in the 17th century disrupted this system: monasteries were closed, hospitals lost funding, and religious nurses were forced out. Despite this, nursing persisted especially in Catholic regions and gradually adapted. Nurses began taking on roles traditionally held by apothecaries and physicians, particularly within private households.
By the 18th and 19th centuries, the profession began to modernise in Britain and North America. The development of germ theory, the discovery of anaesthetics, and antiseptic surgery transformed public health and institutional care, increasing the demand for structured and skilled nursing. However, most nurses at this time still came from religious orders or were untrained individuals working from a place of compassion rather than academic instruction. Nursing was still widely seen as a vocation, a calling rooted in empathy and service.
Florence Nightingale was instrumental in redefining nursing as a technical profession. She founded the first formal training school for nurses in 1860 and strongly believed that nursing must remain grounded in vocational ideals, asserting that technical skill alone could not replace empathy and care.
The Rise of the Professional Nurse
Today, nursing is widely recognised as a profession, characterised by formalised education and rigorous training. In South Africa, entry into nursing requires a National Senior Certificate (NSC) with Umalusi endorsement, and specific subject requirements: 40% in Mathematics (or 70% in Mathematical Literacy), 50% in Life Sciences, and a 60% aggregate overall (excluding Life Orientation). Students graduate with qualifications ranging from Higher Certificates to Diplomas or Degrees.
This formalisation has advanced the field considerably. Nursing is now better resourced, more respected, and more technically capable. Technology has revolutionised diagnostics, documentation, and care delivery. Yet, this progress has come at a cost: reduced staff-to-patient ratios, increased administrative burden, and less time for direct patient engagement.
The Loss of the Human Touch?
A common concern from patients today is that nurses “don’t care anymore.” There’s a growing public perception that nurses are more preoccupied with paperwork than with patient interaction. This criticism raises a critical question: Has the professionalisation of nursing diluted the vocational essence that once defined it?
The Oxford Dictionary defines a profession as “a paid occupation, especially one that involves prolonged training and a formal qualification.” In contrast, a vocation is “an activity or function one feels compelled to engage inessentially, a calling.” This distinction speaks directly to the tension within modern nursing. Are students entering nursing for the love of caring, or simply to secure employment in a competitive market?
Empathy, Care, and the Public’s Expectations
At the heart of nursing are the concepts of empathy and care.
- Empathy is the ability to understand and share the feelings of another.
- Care is the practice of looking after those who cannot care for themselves.
These remain non-negotiable elements of high-quality nursing. However, today’s professional environment, driven by efficiency and regulation, often leaves little room for the relational aspects of care that patients value mostlistening, comforting, and building trust.
Another challenge is the public’s perception. Many people still idealise the nurse at the bedside, mopping a fevered brow, offering comfort, and acting with selfless compassion. While this image is noble, it no longer fully represents the complex, demanding nature of modern nursing. The profession now requires critical thinking, clinical judgment, and leadership skills,elements not traditionally associated with vocational stereotypes.
Finding the Balance: Care Meets Competence
So, how can the nursing profession reclaim empathy without abandoning its professional status?
- Education programs should continue emphasising soft skills like communication, compassion, and cultural competence alongside clinical training.
- Healthcare systems must invest in better staffing ratios to allow nurses time to connect with patients.
- Technology, while helpful, should never replace human interaction, AI and digital systems should enhance, not substitute, bedside care.
- Recruitment should focus not only on academic potential but also on the motivation and values of prospective nurses.
- Public education campaigns can help reshape society’s image of nurses, presenting them as highly trained professionals who care deeply, rather than just caregivers.
Nursing has come a long way, from its roots in religious service to its present as a respected and regulated profession. But the heart of nursing remains unchanged: it is about people caring for people. The challenge today is to preserve the soul of nursing, its compassion and empathy while embracing the benefits of professionalisation and modernisation. Only by doing so can we meet the needs of patients, honour the legacy of nursing, and prepare for the future of healthcare.
Written by Mandy Miller RN RM
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Article by Rose O. Sherman, EdD, RN, NEA-BC, FAAN