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
History of nursing rapidly in the late 19th century as larger hospitals set up nursing schools that attracted ambitious women from middle- and working-class backgrounds. Agnes Elizabeth Jones and Linda Richards established quality nursing schools in the U.S. and Japan; Linda Richards was officially America's first professionally trained nurse, having been trained at Florence Nightingale's training school, and subsequently graduating in 1873 from the "New England Hospital for Women and Children" in Boston In the early 1900s, the autonomous, nursing-controlled, Nightingale-era schools came to an end. Despite the establishment of university-affiliated nursing schools, such as Columbia and Yale, hospital training programs were dominant.