Nursing leader Isabel Hampton Robb

Isabel Hampton Robb

When the average person is asked to think of trendsetting nurses, who helped usher in the era of modern medicine, they can generally only name one: Florence Nightingale. However, the reality is that, while Nightingale's work was undeniably important, other groundbreaking nurses played critical roles in the development of modern medicine, whether by introducing new standards of patient care, emphasizing the importance of education in the life of a nurse, or establishing some type of program to assist nurses.

Isabel Hampton Robb is noteworthy, not because she did a single one of these groundbreaking things, but because she did all of those things. Not only did she do all of those things, but she was passionate about the career of nursing. While she believed that there had been tremendous advancements in the field, she asked her fellow nurses, "with progress going on in every branch around us, are we alone to stand still?" (Hampton, 1894).

Nursing Education

Robb attended Bellevue Hospital Training School and graduated in 1882. To understand the state of nursing and nursing education during Robb's time, it helps to look at how she described them in an 1893 address to a nursing conference. By that time, and at the time of Robb's education, the era of modern nursing was already beginning. Robb commented that "hospital nursing is with few exceptions already being done by the members of regularly organized schools for nurses" (Hampton, 1894). Bellevue was one such school. She also felt that "women are beginning to look upon a thorough knowledge of nursing as an essential groundwork for their medical education" (Hampton, 1894). However, Robb took exception with the notion that any woman was suited for nursing work, which was the prevailing assumption at the time that Robb undertook her work. Instead, she believed a nurse needed to be "strong, mentally, morally, and physically, and to do thorough work she must have infinite tact, which is another name for common sense" (Hampton, 1894). In short, Robb's first issue with the nursing profession was that it was not sufficiently selective.

Robb's second issue with the nursing profession was that its educational requirements were extremely fluid. Speaking of nursing schools or training organizations, Robb said, "Each school is a law unto itself. Nothing in the way of unity of ideas or general principles to govern all exists, and no effort towards establishing and maintaining a general standard for all has ever been attempted" (Hampton, 1894). For example, the duration of nursing school programs varied from a year and a half up to three years (Hampton, 1894). Student nurses at these programs would work from nine to thirteen hours each day, a figure that did not include their theoretical instruction (Hampton, 1894). Moreover, the actual instruction that the nurses received varied from institution to institution, with no set standard for medical instruction (Hampton, 1894). What was very alarming to Robb was that there were no educational prerequisites for these nursing programs and "a woman who has been refused or dismissed from one school for lack of education, dishonorable conduct, inefficiency, etc., frequently gains admittance into another, where the authorities have not so high, if any, standard required from those whom they accept" (Hampton, 1894). As a result, Robb found that the title of "trained nurse" had little practical meaning, since it in no way reflected either the practical skill or degree of education attained by the people holding the diplomas (Hampton, 1894).

Robb also took great exception to the concept of training schools sending nurses out to private families during their second year of education. The practice was done to ensure a constant income for the hospital, which would pocket most of the profits, while giving the student a small stipend. Although Robb recognized that this practice may have been necessary when there were fewer hospitals and those hospitals were small enough that they may not have been able to afford to train nurses without the additional income provided by sending the students to work in private homes, she felt that those conditions had changed (Hampton, 1894). She did not believe that a nurse could receive an adequate education in a one-year time period, and observed that programs sending students out into private homes in the second year did so at the expense of continued education for the nurses past the first year of her training program. She believed that "it is absolutely necessary that class work and lectures should be carried on through the second year as well, and if this is done, then private nursing outside the hospital is out of the question, as such interruptions would seriously interfere with any systematic teaching" (Hampton, 1894). She also felt that student nurses needed to be under daily observation by her instructors (Hampton, 1894).

Early Career

Upon graduation from Bellevue Training Hospital, Robb, along with some of her classmates, "moved to Rome to serve as nurses at St. Paul's House, a small hospital established to serve English and American travelers" (Bullough, 2002). Robb spent a small amount of time in Rome, approximately four years, where she was exposed to European nursing practices. There is little information available about Robb's time in Rome, but one might surmise that she made tremendous advances while she was in Rome, because she immediately received a prestigious position when she returned home. It is impossible to judge how much of Robb's view of nursing was impacted by her stay in Rome, but she immediately began to institute changes in American nursing programs upon her return from Europe.

Illinois Training School for Nurses at Cook County Hospital

When Robb returned from her stay in Rome, she began to experience a very rapid rise in her position. She was "appointed superintendent of nurses at the Illinois Training School for Nurses at Cook County Hospital" (Bullough, 2002). She maintained this position from 1886 through 1889 (AAHN, 2008). It was at Cook County that Robb was able to begin introducing her changes to how the practice of nursing was taught. Though it seems wholly implausible from a modern point-of-view, nurse trainees were not initially graded on their academic efforts. Therefore, one need only have training to be a nurse; one did not have to demonstrate any type of proficiency to gain the title. While it is probably the case that the majority of nurses did attain proficiency in their professions, it is undoubtedly the case that some unqualified people went on to become nurses because they completed ungraded nursing programs. Robb challenged that idea and instituted the "first grading policy in a nursing school" (Bullough, 2002). Moreover, she "abolished the practice of having student nurses do private duty nursing" (Bullough, 2002). Her most significant contribution may have been to push nursing as an academic endeavor; not only did she broaden the nursing curriculum at Cook County, but she also established affiliations with other hospitals (Bullough, 2002). She also discontinued student stipends while she was at Cook County, a practice she would carry with her to other educational institutions (AAHN, 2008).

Johns Hopkins Hospital

In 1889, Robb became the "head of a newly established nursing school at Johns Hopkins Hospital in Baltimore (Bullough, 2002). While working at Hopkins, Robb wrote Nursing: Its Principles and Practice, which was published in 1894, the same year that Robb's association with Hopkins ended. While at Hopkins she instituted many of the same type of changes that she had ushered in at Cook County. For example, she made changes that improved the lives of the student nurses, such as the institution of 8-hour workdays (AAHN, 2008). She also extended the formal educational program from 2 to 3 years, ensuring that nurses received an education that was adequate for the demands they would face once in the profession (AAHN, 2008). As she had at Case Western, Robb eliminated student stipends while she was at Hopkins (AAHN, 2008). Finally, she instituted two programs to improve student satisfaction. First, she began an alumnae association, so that former students could remain in contact with one another (AAHN, 2008). Next, she established a Nurses Journal Club (AAHN, 2008).

American Society of Superintendents of Trainings Schools for Nurses

Robb played a pivotal role in the establishment of some of the earliest professional nursing associations, the American Society of Superintendents of Training Schools for Nurses (ASSTSN), an organization that eventually became the National League for Nursing (NLN). In fact, she was directly responsible for the creation of this group. She began by organizing a "nursing section at [the] International Congress of Charities, Corrections and Philanthropy, [at the] World Columbian Exposition in Chicago" (AAHN, 2008). This nursing section led to the creation of the ASSTSN in 1893. Its modern incarnation, the NLN, continues to be "the preferred membership organization for nurse faculty and leaders in nursing education" (NLN, 2007).

Robb not only helped found this group, but also served as its president in 1908 (AAHN, 2008).

In a presentation Robb gave at the International Congress of Charities, Corrections and Philanthropy (ICCCP), Robb first outlined her vision for the ideal nursing education. First, she felt that there should be a national standard for nursing education, decided upon by "many really experienced in the requirements for such work" (Hampton, 1894). This would result in a uniform coursework, with roughly equivalent graduation requirements, regardless of the school (Hampton, 1894). She proposed making nursing a three-year program, and limiting practical instruction to 8-hours a day, to ensure that students had sufficient time to learn new material (Hampton, 1894). She believed that nurse training programs should be run like other higher education programs, with "stated times for entrance into the school, and the teaching year should be divided according to the academic terms usually adopted in our public schools and colleges" (Hampton, 1894).

Case Western Reserve University

One of the more interesting facts about historical nursing is that nurses were typically unmarried or widowed women. In fact, nurses were oftentimes required to live in nursing homes in order to work in public-duty positions. Those nurses who were married were often employed as private duty nurses (Bullough, 2002). Therefore, it comes as little surprise that when Robb married Hunter Robb, a doctor, in 1894, she resigned her position as a nurse with John Hopkins Hospital. However, what is somewhat surprising is that Robb's marriage did not end her involvement with the nursing profession. Instead of simply becoming a housewife, Robb continued to actively educate future nurses.

When the couple moved to Cleveland, Robb "became a professor of gynecology at Case Western Reserve University" (Bullough, 2002).

In addition to teaching gynecology, while working at Case Western, Robb "took an active role in the development of the curriculum for the new hospital" and helped found the Lakeside Training School, which is now known as the Francis Payne Bolton School of Nursing (Francis Payne, 2009). There, she attempted to institute her ideals that nurse training "should not only prepare women to give compassionate care to the sick, but also to take an active role in reforming the conditions that produce illness" (Francis Payne, 2009). While she was not able to remedy all of the problems plaguing both nursing education and the nursing profession at the time, Robb did have a noted impact on Lakeside. Even before World War I, "the Lakeside Training School achieved a reputation for producing excellent graduate nurses" (Francis Payne, 2009).

Nurses Associated Alumnae of the United States and Canada

Robb was also president of the Nurses Associated Alumnae of the United States and Canada (NAAUC), which is now known as the American Nurses Association (ANA). In fact, she was its first president in 1897 (AAHN, 2008). Robb helped set up the 1896 meeting that was the first convention of the NAAUC. She was one of less than twenty nurses in attendance (ANA, 2009). "Not one of the original attendees was a registered nurse, there were no laws licensing nurses at that time" (ANA, 2009). However, Robb, as well as the other attendees pushed for higher standards in both nursing education and the practice of nursing, which helped lead to licensure for nurses. The NAAUC became the ANA in 1911.