By the mid-nineteenth century, the demand for paid nursing had grown dramatically. In an effort to establish nursing as a respectable profession, Florence Nightingale strategically embraced the moral condemnation of the old-style hired nurse. Her vision of the trained, disciplined, clean, sober, morally upright nurse directly contrasted those earlier nurses who, she claimed, “were too old, too weak, too drunken, too dirty, too stolid, or too bad to do anything else”.Nightingale emphasized rigorous education, technical skill, strict moral standards, and respectability as the foundations of legitimate nursing practice. In 1873, three new nursing schools opened in America, all modeled after Nightingale’s work: the New York Training School at Bellevue Hospital in New York City, the Connecticut Training School at the State Hospital in New Haven, and the Boston Training School at Massachusetts General Hospital in Boston.

In 1884, Alice Fisher, a graduate from Florence Nightingale's Training School at St. Thomas Hospital in London and author of a successful nursing manual (Hints to Hospital Nurses), arrived in Philadelphia with a single mission--reform the struggling Philadelphia General Hospital. Fisher quickly set about establishing a nurse training school and instituted standards for cleanliness and care that dramatically improved conditions in the ailing institution. She gave public lectures on the nature and benefits of modern nursing and helped build widespread support for hospital reform and women's role in nursing. When she died just a few years later in 1888, her legacy was already well-established, having played a key role in the professionalization of nursing in it's early years in America.