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 Medal spirit in the areas of public health or nursing education". It was initially set up to be awarded to six nurses annually, although the first 42 awards were only made in 1920 due to the disruption of the First World War. The medal was restricted to female nurses until regulation changes in 1991. Under the new regulations it is open to both women and men, and is awarded every two years to a maximum number of fifty recipients worldwide. The vesica piscis-shaped medal is composed of gold and silver-gilt and bears a portrait of Florence Nightingale surrounded by the words