The History of Practical Nursing

The history of licensed practical nursing in the United States, like much of nursing, dates back to the late 1800's. In 1892, the Young Women's Christian Association in New York City gave the first training for practical nurses. Later, Ballard School, also in New York, was the first official school for training. At the time, practical nurses were taught to care for the sick and also were taught homemaking skills. After 1900, the education and licensing of LPNs became more formalized, with standardization developed in 1917 by the National League for Nursing, which was then called the National League of Nursing Education.

There was a shortage of practical nurses during World War I. The Army School of Nursing was formed to help train more practical nurses. The Smith Hughes Act provided money for more practical nursing schools.

The National Association for Practical Nursing Education and Service (NAPNES) was formed in 1941, and it accredited training programs from 1945 to 1984.

Between the two World Wars, many of the nurses did not continue working. Those who did during the 1920's and 1930's worked as visiting nurses or with public health agencies.

During World War II, there was again a severe nursing shortage in the United States. Practical/vocational nurses were in more demand. LPNs were being taught basic medical knowledge, but their training was focused more on the delivery of hands-on nursing care. LPNs working under the supervision of RNs made it possible for the RNs to take care of more patients.

Not only did LPNs work in clinics, health departments, industries and hospitals, but they also went on wartime “hardship tours” in Europe, North Africa, and the Pacific.

The National Association for Practical Nursing Education and Service (NAPNES) was formed in 1941, and it accredited training programs from 1945 to 1984. There were a number of different groups that evaluated the tasks and education of practical nurses, including the National Federation for Licensed Practical Nurses.

The Board of Vocational Nurse Examiners (BVNE) was created in 1951. The first licensures from this board were granted by waiver, based on experience and physician affidavits. In 1952, the first national examinations began, and no more licenses were granted by waiver. By 1952, most programs training practical nurses were in hospitals. Licensing was done on the state level. However, not every state passed licensing laws immediately. By 1955, all the states did have their own regulations for LPNs.

The BVNE created standards for training in 1961. In the 1970's and 1980's, there was continued divergence of the two nursing pathways, LPN and RN. Examinations were standardized. To obtain a license, LPNs would have to pass the NCLEX-PN in addition to completing training.It has been suggested that only RNs should work in hospitals, but this has never actually been legislated. There are also suggestions that all nurses should have increased training. 

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