About Chinese Nursing Association

Chinese Nursing Association

The Chinese Nursing Association, abbreviated CNA, is China's national nursing academic organisation and the professional association of Chinese nurses. Founded in 1909 as the Nurses' Association of China — the NAC, in Chinese Zhonghua Hushihui — it is the predecessor body from which the modern association descends, and its establishment is regarded in the scholarly literature as the milestone event in the professionalisation of nursing in China. Headquartered in Beijing, the association today speaks for a nursing workforce that exceeded 5.02 million registered nurses by the end of 2021, works through working committees and dozens of professional committees, organises around fifty national and international conferences a year, and publishes four journals, including the Chinese Journal of Nursing and the English-language International Journal of Nursing Sciences.

The association's history spans the whole modern history of nursing in China: the missionary hospitals of the late Qing and early Republic, the creation of national curricula, textbooks and examinations in the 1910s, admission to the International Council of Nurses in the 1920s, the rebuilding of the profession after 1949, a centenary in 2009, and re-admission to the International Council of Nurses on 8 May 2013. Its president in recent years, Xinjuan Wu of Peking Union Medical College Hospital, a Florence Nightingale Medal recipient of 2011, has written the association's own accounts of the profession's development for international readers.

Founding in 1909

The Nurses' Association of China was established in 1909, at a moment when modern nursing — introduced to China by Western missionary nurses in the wake of Florence Nightingale's reforms — existed only inside mission hospitals and the schools attached to them. The scholarly history published in the International Journal of Nursing Sciences describes the founding as being of vital significance in scaling up the profession and standardising practice and education, as well as opening the possibilities for Chinese women to become nurses on a large scale.

Two figures recur in the founding accounts. Cora E. Simpson, superintendent at the Union Hospital of the Christian university in Fuzhou, was a key contributor both to modern nursing in China and to the establishment of the NAC. Nina Gage, director of the Hsiang-ya — Yale-China — nursing school in Changsha, served as president of the NAC from 1912 to 1914 and went on to become president of the International Council of Nurses in 1925, a striking marker of how quickly the Chinese association's leadership was integrated into world nursing. In the association's first twenty years its presidents were foreign missionary nurses, and membership was open to Chinese and foreign nurses with formal training and to hospitals and schools meeting its educational and ethical standards.

Standardising education: curriculum, textbooks and examinations

The early NAC set out to make nursing a regulated profession rather than a hospital apprenticeship. After the 1911 revolution, missionary nursing leaders meeting in 1912 and 1913 resolved that the association should develop national standards for nursing education in China. It designed a national curriculum, produced standardised teaching materials and textbooks, introduced a unified examination system and set credentialing requirements for schools and students alike. From 1914 it administered national certification examinations for nurses — the first such system in China.

The association held its first national convention in Shanghai in 1914, the meeting at which the Chinese word for "nurse" was adopted for standard use, and in 1920 it launched the Quarterly Journal for Chinese Nurses, giving the profession its own platform for professional discourse. Its school-accreditation rules tied a nursing school's legitimacy to the standards of its hospital: criteria set in 1919 required, among other things, that the associated hospital have at least 25 beds, serve over 200 patients annually and offer obstetrics and paediatrics services. By the late 1930s the profession the association represented had grown to some 6,000 members and nearly 200 nursing schools across the country, with new recruits joining by the hundreds.

International recognition and the interwar years

The NAC's international standing came early. It was admitted as a full member of the International Council of Nurses in 1922 — some accounts of the association's chronology, written from its later records, date its joining of the council to 1932, when it is recorded as sending delegates to the council's quadrennial meetings — and either dating places China among the earlier national nursing associations to take part in world nursing governance. Nina Gage's presidency of the International Council of Nurses in 1925, after her NAC presidency of 1912–1914, embodied that connection personally.

At home, the interwar association worked alongside the medical mission establishment and the emerging Chinese state. In 1932 the Central School of Nursing in Nanjing was established as the first nursing school run by the Chinese government, a sign that the standard-setting the NAC had pioneered was passing into public provision. The association's representatives sat on the council of the China Medical Association, and its journal and conventions carried the professional conversation of a workforce that, in 1923, already accounted for a remarkable share of the world's missionary nursing effort — China then held 53 percent of missionary hospital beds worldwide, and missionary nurses reached a peak of nearly 700 in 1927.

After 1949: rebuilding within the People's Republic

The founding of the People's Republic of China in 1949 transformed the setting in which the association worked. Missionary institutions departed, nursing education was reorganised within the state health system, and the association — renamed in Chinese usage as the Chinese Nursing Association, Zhonghua Huli Xuehui — continued as the profession's national academic body under the new order. Its publications and conferences persisted through the reconstruction decades, and the association's own journals became the principal record of Chinese nursing practice.

The scale of the workforce it served changed beyond recognition. In 1950 China had only a small fraction of its later nursing strength; by the end of 2021 the total number of nurses in mainland China exceeded 5.02 million, more than a hundred-fold increase compared with 1950, accounting for 44 percent of all health professionals in the country, at 3.56 nurses per 1,000 population. The association's role changed with the numbers: from standard-setter for a small mission-linked profession to the academic home of one of the largest nursing workforces in the world.

Centenary and return to the International Council of Nurses

The association marked its centenary in August 2009, an anniversary widely noted in the international nursing literature as an occasion to review the development of nursing education in China and to plan its future direction. Four years later came the step that reconnected the association formally to world nursing: on 8 May 2013 the Chinese Nursing Association joined — in the careful wording of the International Nursing Review's account, it is hoped that by sharing the history of nursing in China, scholars globally can incorporate it — the International Council of Nurses, resuming the international membership its predecessor had held in the interwar period.

Rejoining the ICN mattered because of what had happened to the discipline in the meantime. Nursing had been identified by China's Ministry of Education in 2011 as an independent first-level discipline, like clinical medicine and dentistry, transforming its academic status; master's education had begun at Beijing Medical University in 1992 and doctoral programmes multiplied from the 2000s, with ten doctoral nursing programmes established by 2008. The association's return to the ICN in 2013 placed the representative body of that newly elevated discipline back inside the world federation its own former president had once led.

Structure, committees and conferences

The modern association works through a committee system that mirrors the specialisation of the profession. Its structure has been described as comprising 16 working committees and 47 professional committees, covering fields from intensive care and emergency nursing to oncology, geriatrics and diabetes care. Provincial nursing associations connect the national body to nurses in every province, and the national association leads its committees and provincial associations in joint programmes, notably the science popularisation campaigns it runs nationwide.

Conference activity is correspondingly large: the association hosts around fifty national and international conferences a year, continuing a convention tradition that began with its first national meeting in Shanghai in 1914. Its specialist training role has grown sharply since the 2000s: specialised nurse training commenced in 2002 under the modern system, and by the end of 2021 the association had performed specialised nurse training in 28 fields — including intensive care, emergency care, geriatric care, perioperative nursing, oncology nursing and diabetes care — covering more than 30,000 specialised nurses, with about 8,000 nurses taking part in its training programmes in 2021 alone.

Publications

Publishing is one of the association's founding functions — its Quarterly Journal for Chinese Nurses dates to 1920 — and it remains central. The Chinese Nursing Journals Publishing House edits and publishes four journals for the association, chief among them the Chinese Journal of Nursing, the profession's flagship Chinese-language journal, and the International Journal of Nursing Sciences, its English-language journal, published with Elsevier and carrying Chinese nursing research — including the standard English history of the association itself — to international readers. The journals serve clinical nurses, managers and educators as platforms for mutual learning and sharing, and during the COVID-19 emergency they carried special issues selecting the latest scientific and clinical findings for front-line nursing staff.

The continuity is notable: an association that began by standardising textbooks in the 1910s now operates a bilingual publishing house whose English journal is the venue in which much of the world's knowledge of Chinese nursing first appears. Its editor-in-chief roles have been held by its presidents — Xinjuan Wu, for example, has served simultaneously as president of the association, director of the nursing department of Peking Union Medical College Hospital and editor-in-chief of the Chinese Journal of Nursing.

The association in the COVID-19 period and today

The COVID-19 emergency of 2020 — the International Year of the Nurse and the Midwife, and the bicentenary of Florence Nightingale's birth — was the association's most visible recent test. Under Xinjuan Wu's presidency it issued a proposal for the scientific and active response to epidemic prevention and control to nurses across the country through its website and official accounts, sent a letter of support to the Hubei Provincial Nursing Association, and mobilised members of its professional committees and other backbone experts to the front line in Hubei. While in charge of clinical nursing services, those experts drafted and edited a series of guidelines and expert consensuses on the key points of nursing care for COVID-19 patients and on the disposal and reuse of medical devices.

In calmer years the association's public work includes its annual International Nurses Day science popularisation activities, which it states benefit tens of millions of people, its science popularisation campaign in rural areas for remote communities, and a standing Science Popularization Specialist Team that trains the backbone force for health-knowledge promotion. For a directory of Chinese national organisations, the Chinese Nursing Association is a major entry: founded in 1909, standard-setter of a profession within five years of its founding, a member of world nursing's council within its second decade, and today the academic association of a workforce of more than five million nurses.