Florence Nightingale was the first modern nurse. She worked during the Crimean War 1854-1856 initially dealing with unsanitary conditions that existed in field hospitals during the war. Florence Nightingales created the Coxcomb Diagram. This was a monthly analysis categorizing death from wounds, death from preventable diseases, and death from all other causes. Simple changes to sanitary conditions resulted in dramatic decrease in mortality rates in a 6-month period. Nightingale founded training schools for nurses in 1860. Lillian Ward founded visiting nurse services of New York. She cared for poor immigrants on the lower east side of Manhattan a practice which continues to this day. Ward is credited with the organization of public school nursing designed to decreases absenteeism in NYC schools. In the 20 th Century improvement to pharmacology made it easier to treat diseases. There was also a shift from public health to individual well-being. At first, nurses were trained by hospitals, eventually institutes of higher learning; i.e. colleges and universities. One of the greatest changes in the nursing profession are the various education touchstones. The three most common are diploma, associates and baccalaureate. Today we treat the whole person and utilize a holistic approach as is seen in the metaparadigm of nursing concepts; nursing, person, environment and health.