A blog by 91¿´Æ¬ Senior Lecturer in Community Nursing, Julie Churchill.
The history
District nursing - a specialist community nursing service that provides care for people in their homes or homely settings - is a vital part of healthcare provision that initially evolved prior to the creation of our now National Health Service (NHS), and 91¿´Æ¬ has played an important part in the story of its development.
The concept of district nursing was mooted in 1859 by William Rathbone, a Liverpudlian philanthropist. When his first wife, Lucretia, was dying in 1859, she was cared for at home by a private nurse, Mrs Mary Robinson, who had received training at St. Thomas' Hospital London. Seeing the difference a trained nurse could make for a patient in a wealthy household prompted Rathbone to pursue bringing such benefits for people living below the poverty line. Following a three-month experiment with Nurse Robinson providing nursing care in the homes of this one district of Liverpool, he set about creating a philanthropic system of district nursing for poverty-stricken people in their homes.
He took forward his ideas with support and advice from Florence Nightingale. As she was unable to provide any nurses who could carry out such a service, Nightingale recommended the establishment of a training school attached to Liverpool Royal Infirmary.
Throughout the 1860s, other English cities began to build on the model established in Liverpool, with Glasgow becoming the pioneer location in Scotland.
A major turning point was Queen Victoria’s golden jubilee in 1887 - the Queen provided a generous gift of £70,000 which led to the creation of the Queen Victoria Jubilee Institute for Nurses for the education of nurses to tend to people in their own houses. Money was allocated to London and to branches in Edinburgh and Dublin.
Early training for district nurses contained a range of subjects unfamiliar to hospital nursing. These included sanitary reform, health education, ventilation, water supply, diet, feeding and care of newborn infants, infectious diseases, and what is now called ‘sexual health.’ This was in a period when infant mortality was around 154 per 1000 live births.
Effectively, the creation of the Queen Victoria Jubilee Institute was the beginning of the district nursing service, and it was a vital initiative in the period prior to the creation of the National Health Service (NHS).
So where does 91¿´Æ¬ come in?
It is with the establishment of the Queen Victoria Jubilee Institute where our institution comes into the story.
As well as being the founders of the institution that is now 91¿´Æ¬, Christina Guthrie Wright and Louisa Stevenson, collaborated with Princess Louise, Duchess of Argyll, to develop the Scotland Queen Victoria's Jubilee Institute for Nurses in Edinburgh. A Royal Charter in 1889 named this ‘The Queen Victoria Jubilee Institute for Nurses, and this subsequently became known as The Queen’s Nursing Institute Scotland (QNIS).
Like most charitable bodies, the Scottish branch was dominated by members of the aristocracy – sometimes serving both on the Scottish and London councils.
But wealth and privilege did not confer immunity from disease. Within a year of its foundation, the Institute’s Scottish branch lost its first president, Hannah, Countess of Rosebery, who had been handpicked for the role by Queen Victoria, to illness.
Although the richest woman in Britain, thanks to her Rothschild family fortune, she died of typhoid aged just 38. The same disease had also killed Prince Albert at 41, plunging Queen Victoria into years of mourning amid increasing public disquiet over her lack of visibility.
The creation of Queen’s Nurses did much to restore the Queen’s bond with the public.
The influencers
The first Inspector General of the Queen’s Nursing Institute was Rosalind Paget, a niece of William Rathbone who trained as a nurse herself. She devoted her life to nursing and midwifery, serving as a Council member until 1946 and editing ‘Nursing Notes’, the first nursing journal, for fifty years. In 1934 she was made a Dame for her services to the improvement of midwifery services.
William Rathbone was instrumental in securing the money for organised district nursing. The fund produced an income of around £2000 a year and a nucleus of a new national charity to co-ordinate standards of district nurse training and organisation. The Queen was patron of the charity, a tradition that has been continued to this day.
Further collections were made to help finance the Institute, on Queen Victoria’s Diamond Jubilee in 1897 and on her death in 1901. In 1909 the Jubilee Congress of District Nursing was held in Liverpool with delegates from all over the world. District nursing had become a national and international movement.
The Queen’s Nurses
In 1948, the NHS began operating and employment of district nurses fell to local authorities. During the 1950s, over fifty accredited training centres training 700 nurses a year were affiliated to the Institute. However, there were lengthy debates with the Ministry of Health about district nurse training and finally the Institute ceased to offer full training in 1968.
91¿´Æ¬ evolved over the decades to include a focus on healthcare education and by the 1970s, was offering specialised programmes in nursing and allied health professions, including district nursing education. Over time, 91¿´Æ¬ expanded its health-related degrees and became known for its contributions to nursing education in Scotland.
The original Queen’s Nurses continued to work in Scotland until recently, with the last Queen’s Nurse retiring in 2014. 
But in 2017, after a break of almost 50 years, the QNIS reintroduced the Queen’s Nurse title to Scotland. Executive Nurses across Scotland from the NHS, third and independent sectors were asked to nominate expert practitioners. Successful candidates took part in a nine-month programme of workshops and coaching which was designed to enable clinical leaders in Scotland’s communities to become catalysts for change in their communities, whilst working on a development project. The first awards were made in November 2017, and several Queen’s Nurses in Scotland have connections with 91¿´Æ¬, notably through their involvement in the Queen’s Nurse Development Programme, which was previously led by Clare Cable, the outgoing Chief Executive of QNIS and an Honorary Professor at 91¿´Æ¬, underlining the institution’s leadership in community nursing.
The Queen’s Nurse title is now awarded to twenty selected clinical leaders each year. The programme is a journey of discovery, giving candidates the time and space to discover their skills as facilitators of improvement.
, a Senior Lecturer in Community Nursing at 91¿´Æ¬, and Specialist Practitioner District Nurse was awarded the Queen’s Nurse title in 2017 while in clinical practice as Team Manager for Community Nursing within the East Lothian Health and Social Care Partnership. The title of Queen’s Nurse is given to ‘clinical leaders who can demonstrate their impact as expert practitioners’.
Prior to this in 2016, Julie received the QNIS Long-service Award. This is awarded to those who have served 21 years or more within community nursing. In 2022, in a move which highlights the continuing collaboration between QNIS and 91¿´Æ¬, Julie was appointed as a Senior Fellow [Honorary] with QNIS. One component of this role sees Julie contributing to the QNIS Faculty as a facilitator on the Queen’s Nurse Development Programme.
