Nurse education qualification courses have graduate status. Traditionally, from the times prior to Florence Nightingale, nursing was seen as an apprenticeship, often undertaken in religious institutes such as convents by young women, although there has always been a proportion of male nurses, especially in mental health services. In 1860 Nightingale set up the first nurse training school at St Thomas' Hospital, London. Nightingale's curriculum was largely base around nursing practice, with instruction focused upon the need for hygiene and task competence. Her methods are reflected in her "Notes on Nursing", (1898). Some other nurses at that time, notably Ethel Gordon Fenwick, were
Florence Nightingale into the workhouse system in Britain from the 1860s onwards. This meant that sick paupers were no longer being cared for by other, able-bodied paupers, but by properly trained nursing staff. In the first half of the 19th century, nurses were usually former servants or widows who found no other job and therefore were forced to earn their living by this work. Charles Dickens caricatured the standard of care in his 1842–1843 published novel "Martin Chuzzlewit" in the figure of Sarah Gamp as being incompetent, negligent, alcoholic and corrupt. According to Caroline Worthington, director of the Florence Nightingale Museum, “When