After completing the training program and becoming America’s first trained nurse, several options lay before Potsdam native Linda Richards: head nurse at either of two hospitals, operating a nurse’s training program at another, or night superintendent of the Bellevue Hospital Training School in New York City.

While the others appeared more inviting, she chose Bellevue, with clientele from the slums: the poor, sick, mentally ill, and addicted. In her estimation, it was where she could learn the most and at the same time do the most good.

She soon learned that communications between nurses, and between nurses and doctors, were conducted verbally. About a year into her service, Linda recorded day-to-day notes on a patient, including vital signs, and when a doctor saw the written notes, he believed they were created for his use. After discovering otherwise, he praised their value, expressed his appreciation, and asked Richards to keep similar notes on all serious cases. The practice spread throughout Bellevue, and remains today standard procedure in all hospitals. Linda Richards is credited as their originator.

After a year at Bellevue, she passed up the position of assistant superintendent of the training school there and became superintendent of the training school at Massachusetts General Hospital. In most medical facilities, nurses were treated as underlings whose work often went unappreciated. This was a test position to see if the training school could be run by nurses and organized into a valuable arm of the hospital. It proved to be a pivotal moment in American nursing.

Facing much resistance from the hospital staff, including doctors, Richards began making changes in procedures, sanitation, and training. Performing at increasing levels of efficiency earned a newfound respect for the nursing staff. Before the first year passed, the training school was embraced, and a building for nurses was provided on hospital grounds. By the second year, the school was serving nearly the entire hospital, and nurses were routinely asked to accompany doctors on their rounds. There was no denying it: Richards had created a nurse-training facility that was now an integral part of hospital operations.

But there was no resting on her laurels. After two and a half years at Massachusetts General, Richards fulfilled her dream of training under England’s system established by the legendary Florence Nightingale. Arriving there in April 1877, Linda spent a total of eight months at St. Thomas’s Hospital and King’s College Hospital, both in London, and the Edinburgh Royal Infirmary. She did so at the suggestion of Florence Nightingale, to whose home she was invited within days of arriving in England.

Meeting her idol was one of the great highlights of Richards’ life: In her own words, “Many and varied blessings have come to me through the years of my hospital life, but never one greater than the privilege of having seen and known Miss Nightingale. I have never ceased to appreciate the benefits derived from that first visit.”

Near the end of her overseas trip, Richards was invited to Nightingale’s country home, where she spent several days discussing all that she had seen and learned, and what improvements might be made in the future. She then spent a month in Paris, visiting several hospitals to observe and assess their operations. A job offer was made by an American physician there, but Linda was anxious to return to America and apply new training ideas that had reignited her passion to improve the nursing profession.

It was at Boston City Hospital where she had first learned that many nursing jobs principally involved maid work. Here she was, eight years later, hired once again by Boston City, but this time as hospital matron and superintendent of the training school. Employees there hardly welcomed her with open arms, resisting her efforts to introduce changes and improvements in daily routines. Said Richards, “Nevertheless, although in the beginning they succeeded in making my trying work much more difficult, several of them became warm friends of the cause before they left the hospital.”

Still, she said, “That first year was filled with anxiety and vexation of spirit,” and doubts persisted as to whether she could succeed in such a contentious atmosphere. Perseverance—and being right all along about training and improvements—were the keys to success, and at the end of 18 months, the efficient nursing program was much appreciated by the medical staff.

At that time, a replacement superintendent was chosen, allowing Linda a few months’ rest to recover from the great stress endured over an extended period. Instead, a protracted illness overtook her for the next three years. Upon returning to Boston City Hospital, she discovered that her efforts had taken root and resulted in a “wonderful transformation in hospital and training school methods.” After another 18 months at the helm, she took an additional two years away, returning in fall 1881 and staying on for another four years.

In 1885, the American Board of Missions sought a nurse to organize training schools in Japan. Richards volunteered, and at the end of December she sailed for Japan to begin her work in Kyoto. While studying hard the first few months to learn the language, she worked as a volunteer during a cholera outbreak. The media praised the foreigner who selflessly risked her own health to help others, earning Linda’s acceptance among the Japanese in general. She expressed love for the people, whom she found very warm and kind—and anxious to learn the most modern methods of nursing.

A two-year course she designed covered the gamut, and included caring for private patients in their homes as a sort of internship. Among the first graduates in 1888 were a few who stayed on to further the school’s training program. After the second year, the school had produced 24 nurses. Richards noted that, “A demand now arose for home instruction to mothers and grandmothers,” a need she met through lectures and home meetings. The program continued expanding, and by the time Linda left the islands five years later, Japan had an established nurse-training program, the roots of today’s modern system.

Next: The Conclusion.

Photo: Linda Richards in Japan in a jinriksha (1886, from Reminiscences of Linda Richards, America’s First Trained Nurse)