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In page Isla Stewart:

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In the summer of 1887, Stewart became the matron of St Bartholomew's Hospital in London.[1] She brought more order and education to the nursing program than the past administration, and enacted a set of skills the nurses had to learn and perfect or they would be dismissed from the program. She created a four year training system for nurses-to-be. After the first year they were required to take an exam on all of the information they had learned, and if they passed if they could become probationers. During the second and third year they received lectures on information relevant to nursing, and in the third year they were examined. After the third year they received a certificate, but could not practice until after the fourth year.[citation needed]