Nursing

Nursing. Nursing of the sick, injured, and wounded has been performed by a variety of individuals, from the Roman tent companions and recuperating patients to Catholic nuns and Protestant deaconesses.Modern American nursing, however, developed in the post–Civil War period as part of the women's movement. Its impetus lay in the British example of Florence Nightingale, as well as the many women who gained recognition in the American Civil War for nursing soldiers. It quickly became one of the breakthrough “new” occupations—along with librarian, social worker, elementary school teacher, and secretary—pioneered by women.

Professional nursing accompanied the rise of general hospitals in America. The first three “Nightingale” schools opened in 1876: at the Massachusetts General Hospital in Boston, Bellevue Hospital in New York City, and the Connecticut Training School in New Haven. Others quickly followed. By 1900, over four hundred were in existence. Nursing schools not only saved hospital administrators money but offered patients better care. Student nurses furnished almost all the nursing needs in hospitals until after World War II. Graduate nurses primarily engaged in private‐duty nursing, became teachers or administrators in nursing schools, or, after the 1920s, worked as public‐health nurses. The first major hospital to employ graduate nurses for staff was the newly opened University of Chicago Hospital, in 1929.

In 1894 professionalizing nurses organized the Society of Superintendents of Nursing Schools of the United States and Canada (later called the National League for Nursing Education) and the Associated Alumnae, shortly thereafter renamed the American Nurses Association (ANA), comprising graduates of various training schools. These two nursing groups were among the early national ones organized by and for women. (Male nurses were not admitted to the ANA until the 1930s.) The first priority of the fledgling ANA was to distinguish between training‐school graduates and other “nurses,” primarily through state registration. Thus early nursing leaders concentrated on securing the right to the title “R.N.” (registered nurse). They also sought to upgrade the credentials of nursing school faculty, an effort that began in 1899 with an extension program at Teachers College, Columbia University.

Nurses were both more protected and more emancipated than most other women. Hospitals, for example, often required nurses in their employ to live in a nurses' residence so they would be available for emergencies or because of split shifts. This meant that for the most part the married women in nursing engaged in home nursing or part‐time work, although by the end of World War II the demand for nurses was such that hospitals generally abandoned the residence requirement. At the same time, nurses could go where few other American women could: working in urban slums, isolated rural communities, and foreign mission fields; crisscrossing the country as airline stewardesses (who originally had to be nurses); or serving in the military.

To meet the need for more nurses during World War II, the U.S. government enacted the Nurse Training Act of 1943, establishing the Cadet Nurse Corps, which gave nurses free training, a uniform, and a small stipend for thirty months. The program played a major role in raising nursing‐education standards, because schools had to meet certain fixed criteria to be accepted. By the time the program ended, some 170,000 women had become cadet nurses at 1,125 different nursing schools. The program marked the massive entrance of government into nursing education, which increased substantially in the 1960s as the U.S. government became more and more involved in health planning.

The military's official policy of refusing to use male nurses during World War II led to a rapid drop in the number of male students, even in the all‐male nursing schools. The low point was reached in 1945, when only 169 men were enrolled nationwide. An upward swing began after 1954 when the military commissioned the first male nurses.

From the beginning, nurses played a subordinate role to (usually male) physicians, but inspired by the feminist movement of the 1960s, nurses began demanding more independence and recognition. Despite considerable physician opposition, nurses succeeded in expanding their roles and power, sometimes through legislative action. As health care became more complex and nursing grew more sophisticated, the number of baccalaureate programs increased. Hospital‐based nursing schools found that they could no longer depend on nursing students for their free labor and had to provide a costly education as well. Beginning in 1952 the hospital‐based schools moved to community colleges, where students earned associate degrees. Increasingly community‐health nursing required a baccalaureate degree, while most of the nursing specialties—nurse anesthetist, nurse midwife, nurse practitioner, the clinical nurse specialist, and nursing administration—demanded a master's degree.

As the profession redefined itself, a number of functions once performed by nurses fell into the hands of nursing aides, licensed practical nurses, and other health‐care specialists, such as physical therapists.
See also Death and Dying; Disease; Education: Education in Contemporary America; Health Maintenance Organizations; Medicine: From the 1870s to 1945; Medicine: Since 1945; Missionary Movement; Professionalization.

Bibliography

Vern L. Bullough and and Bonnie Bullough , The Care of the Sick: The Emergence of Modern Nursing, 1978.
Vern L. Bullough,, Bonnie Bullough,, and and Barret Elcano , Nursing: A Historical Bibliography, 1981.
Barbara Melosh , “The Physician's Hand”: Work Culture and Conflict in American Nursing, 1982.
Susan M. Reverby , Ordered to Care: The Dilemma of American Nursing, 1850–1945, 1987.
Julie Fairman and and Joan Lynaugh , Critical Care Nursing: A History, 1998.

Vern L. Bullough