NURSING

NURSING. Prior to the Civil War, nursing in the United States was generally a casual or self-declared occupation practiced as a form of domestic service rather than a skilled craft or a profession. Americans obtained the majority of their health care at home, where family members and friends attended to their needs.

Antebellum Nursing

On plantations in the antebellum South black female slaves acted as midwives, provided child care, and performed other nursing duties for both whites and blacks. Male nurses composed the majority of hospital workers in the handful of established marine and charity hospitals of the mid-nineteenth century. Hospital officials often hired former hospital patients who had no formal training in medicine or nursing. The forces that supplanted the untrained nurse did not come into play until the late nineteenth century and early twentieth century. New and centralized technologies fueled the rise of hospital-based care. A greater acceptance of surgical procedures, urbanization, and nurses' own efforts to grapple with social problems culminated in the ascent of the trained nurse.

The idea of nursing—middle-class women managing and supervising the preparation of food, supplies, and linens and administering medications and treatments—gained momentum during the Civil War (1861–1865). Approximately twenty thousand women volunteers worked in military hospitals, but almost none had any hospital or practical training in nursing. Union hospitals hired female nurses to complement the staff of male nurses, convalescent soldiers, and male ward masters responsible for day-to-day supervision. In Confederate hospitals significantly fewer Southern women worked as nurses. Black male

slaves bathed and fed patients daily. Catholic nuns played a unique role, nursing wounded soldiers from both the Confederate and Union armies. When the war ended, medical departments dismantled their massive hospital complexes, and most of the female nurses returned to teaching, domestic service, writing, family, and marriage.

Occasionally reformers extolled the benefits of trained nurses and the specific suitability of women for that role, but the goal of a trained nurse attendant languished for more than a decade after the Civil War. The 1880 census revealed that, while over ten thousand nurses were available for hire, fewer than 1 percent were graduates of hospital nursing courses. By 1873 only four schools of nursing existed in the United States: the New England Hospital for Women and Children and Massachusetts General Hospital in Boston, New Haven Hospital in Connecticut, and Bellevue Hospital in New York City. Over the next quarter century Americans witnessed a dramatic increase in the number of nursing schools from slightly over 400 in 1900 to approximately 1,200 by 1910. Among African American women, the number of hospital-trained graduates did not keep pace. Racial quotas in northern nursing schools and outright exclusion from training schools in the South limited their access to training. In 1879 the first African American woman graduated from the New England Hospital for Women and Children in Boston. Hospital schools with the explicit mission of training black nurses to serve the African American community opened their doors in the late nineteenth century: Spelman Seminary in Atlanta (1886), Hampton Institute in Virginia (1891), Providence Hospital in Chicago (1891), and Tuskegee Institute in Alabama (1892).

Nursing Education

By the beginning of the twentieth century middle-class Americans accepted nursing as a worthy albeit demanding vocation for young women. The women who entered nursing schools encountered an unregulated and often exploitative field. Hospital administrators opened nursing programs to avail their hospitals of a cost-effective student labor force. Nursing students practiced their skills as apprentices under the supervision of second-and third-year nursing students. Most schools offered limited courses in basic anatomy, physiology, or biology, and student nurses did not systematically rotate through all medical specialties.

Nursing leaders and educators, aware of the poor formal instruction in most hospital-based programs, pushed for fundamental reforms in nursing education and national legislation governing the licensing and practice of nursing. College-based nursing programs received a welcome endorsement when Columbia University appointed Mary Adelaide Nutting the first full-time professor of nursing in 1907. Nutting and her nursing colleagues established the American Journal of Nursing in 1900. Nurses revealed a growing professional awareness when they reorganized several professional nurses' groups under one national organization, the American Nurses Association (ANA), in 1912. That year the National Organization for Public Health Nursing organized its charter. Black graduate nurses, excluded from full representation in the ANA until 1951, established the National Association of Graduate Colored Nurses (NAGCN) in 1908, and Mabel Keaton Staupers served as the organization's first executive director (1934–1946). Although African American nurses grappled with the same professional issues as their white counterparts, racial discrimination and dismal employment opportunities amplified the black nurses' struggles.

Nursing in the Armed Forces

The exegesis of war created a receptive environment for nurses to press their grievances and further their professional goals while providing a crucial service to the nation. When military leaders reluctantly established the Volunteer Hospital Corps for female nurses during the Spanish-American War (1898), nursing leaders insisted on trained applicants from accredited nursing schools. In 1901 the Army Nurse Corps became a permanent service within the Medical Department, and the Navy Nurse Corps followed in 1908. Military medical officials in concert with nursing educators standardized and improved nursing education and established the Army School of Nursing in 1918 to meet the demands of World War I. During World War II the U.S. government agreed to award officer's rank to military nurses. Congressional leaders agreed to subsidize nursing schools and nursing education to attract women to nursing, a boon for all nurses but of special importance to black women. Black nursing leaders vigorously lobbied military officials, who finally agreed to desegregate the Navy Nurse Corps in 1948. Throughout the history of military conflict in the United States, nurses overwhelmingly established their ability to handle the intensity and stresses of wartime nursing, characteristics readily apparent in Korea and Vietnam, where nurses staffed Mobile Army Surgical Hospitals (MASH).

Male nurses did not share equally from the advances in military nursing or the softening of cultural boundaries defining sex-stereotyped roles that came out of the women's movement. Until the mid-twentieth century only a limited number of schools accepted male applicants. State boards of nursing restricted licensure for men, and as far back as the Spanish-American War military officials pointedly refused to accept male applicants in any branch of the Nursing Corps. Nursing remained one of the most thoroughly feminized occupations in the United States with women making up almost 90 percent of all nursing school graduates in 1990.

Nursing in the twenty-first century became a multi-tiered career. Registered nurses worked in every facet of acute and long-term care; they staffed public, industrial, and community health departments, and they achieved diverse skills and specialization of practice. Nurses who obtain postgraduate degrees enhance their role as providers of health care as nurse practitioners, clinical nurse specialists, nursing educators, and researchers. With degrees in finance and business, nurses have also broadened their job choices as hospital and health-care institution administrators.

BIBLIOGRAPHY

Hines, Darlene Clark. Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890–1950. Bloomington: Indiana University Press, 1989.

Kalisch, Philip A., and Beatrice J. Kalisch. The Advance of American Nursing. Boston: Little, Brown, 1986.

Maher, Mary Denis. To Bind Up the Wounds: Catholic Sister Nurses in the U.S. Civil War. Baton Rouge: Louisiana State University Press, 1999.

Mottus, Jane E. New York Nightingales: The Emergence of the Nursing Profession at Bellevue and New York Hospital, 1850–1920. Ann Arbor, Mich.: UMI Research Press, 1981.

Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System. Baltimore: Johns Hopkins University Press, 1995.

Schultz, Jane E. "The Inhospitable Hospital: Gender and Professionalism in Civil War Medicine." Signs 17, no. 2 (1992): 363–392.

Cecilia S.Miranda

See alsoHealth Care ; Hospitals ; Medical Education ; Medical Profession .

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

nursing science of providing continuous care for sick or infirm people. While nursing as an occupation has always existed, it is only in fairly recent years that it has developed as a specialized profession.

The Modern Profession

Nursing candidates must prepare by a rigorous course of training that includes a thorough grounding in anatomy, physiology, pharmacology, the cause and treatment of disease, the intricacies of nutrition and diet, surgical skills, and a variety of techniques pertaining to patient care. Many nurses also prepare for more specialized work, such as the care of newborn infants, maternity patients, or the mentally ill, or for duties in the operating room.

Training for a career as a registered nurse (RN) can be met by several means: a two-year course at a junior college or a four-year degree program at a college or university. (Three-year courses given by hospitals are being phased out because of high costs.) Emphasis on college education for nurses is on the upsurge, because greater knowledge is required to apply the latest methods of diagnosis and therapy. Training includes both classroom study and actual hospital practice, and the graduate must still be examined and licensed by the state. This applies also to women in religious orders who train and work as nursing sisters.

The age limits and educational requirements for practical nurses are less stringent, and the period of training is much shorter, usually one year. The terms "licensed practical nurse" (LPN) and "licensed vocational nurse" (LVN) are interchangeable. Sufficient training is given to such men and women to enable them to care for and feed patients, administer medication, and perform other routine duties; however, they are always under the direct supervision of registered nurses. LPNs are generally examined and licensed by the state.

For most specialized work and teaching, nurses must complete a course leading to a master's degree or doctorate. Specializations include nurse anesthetist, which originated at the beginning of the 20th cent., and such recently established ones as nurse practitioner (licensed to perform physical examinations and other procedures under a physician's supervision), nurse midwife (see midwifery ), and nurse clinician. In addition to duties in the hospital or in the home there are many fields open to the professional nurse, such as the Red Cross , military service, public health, health insurance companies, industry, and teaching. Some nurse practitioners have become primary health-care providers, opening practices on their own (without physician supervision), and some have been accredited as such by large health maintenance organizations.

History of Nursing

In ancient times, when medical lore was associated with good or evil spirits, the sick were usually cared for in temples and houses of worship. In the early Christian era nursing duties were undertaken by certain women in the church, their services being extended to patients in their homes. These women had no real training by today's standards, but experience taught them valuable skills, especially in the use of herbs and drugs, and some gained fame as the physicians of their era. In later centuries, however, nursing duties fell mostly to relatively ignorant women.

In the 17th cent., St. Vincent de Paul began to encourage women to undertake some form of training for their work, but there was no real hospital training school for nurses until one was established in Kaiserwerth, Germany, in 1846. There, Florence Nightingale received the training that later enabled her to establish, at St. Thomas's Hospital in London, the first school designed primarily to train nurses rather than to provide nursing service for the hospital. Similar schools were established in 1873 in New York City, New Haven (Conn.), and Boston. Nursing subsequently became one of the most important professions open to women until the social changes wrought by the revival of the feminist movement that began in the 1960s (see feminism ). The late 20th cent. saw growing nursing shortages in U.S. hospitals as stagnant salaries, increasing workloads, and greater job opportunities for women led to falling enrollments in nursing degree programs.

Bibliography

See studies by V. and B. Bullough (1978), M. Baly (1986), M. P. Donahue (1986), and S. Nelson (2001).

nursing did not develop as an organized profession until the mid-19th cent., despite the establishment of voluntary hospitals in the 18th. Until then, caring for the sick had been undertaken mainly at home by relatives and neighbours, whose knowledge and experience was variable though not always as minimal as detractors have claimed. The medieval religious orders had had infirmaries, where nursing duties were undertaken by lay brethren in charge of maintenance and catering, but after the dissolution of the monasteries the able-bodied poor were often used or required to tend their sick counterparts. The early voluntary hospitals, whose nurses were drawn mainly from the domestic servant class and not thought to require any special training, frequently insisted that convalescent patients helped out on the wards, and also refused to admit those with fevers, incurable, or venereal disease; such patients were dumped in workhouses, to be tended by healthier though often infirm paupers, since there were no special arrangements for the sick. John Howard, the prison reformer, commented on the poor state of hospital care in the 1780s, but it was not until 1840 that Elizabeth Fry established an Institute of Nursing Sisters at Bishopsgate, though the scale was small. Florence Nightingale's great contribution was twofold: the work in the Crimea of her 40 nurses, sent out by public subscription, dramatized the problem, and after the war she began systematically organizing nursing services with her Nightingale School attached to St Thomas's Hospital, offering a year's course; her best pupils became matrons of other hospitals, which started their own courses. A parallel development was the district nursing scheme, initiated by William Rathbone of Liverpool, and developed through the Metropolitan Nursing Association, and then the Queen Victoria Institute for Nurses. Although the British Nurses' Association, founded in 1887, began to press for state registration of nurses, opposition to this did not lessen until a precedent was set by the far-reaching Midwives Act (1902); the College of Nursing was established in 1916, but the Nurses Registration Act (1919) and the General Nursing Council (1920) developed out of the government's own bill rather than either of the two feuding bills submitted. Nurses are now recognized as important in the culture of a hospital; their training may come through a three-year course in hospital, specialized college, or degree course in a higher education institution.

J. A. Cannon

nursing. Before the 19th century most nursing of the sick took place at home, sometimes with the help of a traditional female healer or ‘wise woman’. Only with the development of hospitals during the 18th century did professional nurses begin to appear. Initially, however, these were untrained, often illiterate women, and sometimes also men, who were regarded as little more than domestic servants. In 18th‐century Irish hospitals nurses spent much of their time cleaning wards, washing linen, and delivering meals. As for treating the sick, they simply carried out the doctors' orders. When workhouse infirmaries began to appear after 1838, nurses were at first pauper inmates who received increased rations for looking after patients.

The Rotunda hospital had pioneered the training of midwives in 1774 (see childbirth), but the first training scheme for lay nurses was not established until 1858 in the Adelaide hospital in Dublin. Shortly before the Sisters of Charity opened St Vincent's hospital in the same city in 1834, three nuns were dispatched to a Paris hospital for instruction. But Vincent's did not begin formal training of lay nurses until 1892 nor of nursing nuns until 1897. Yet nuns had started to take over nursing in the workhouses from 1861 and by 1903 were employed in half of them. The slowness with which nurse training was introduced in Ireland reflected the widely held belief that nursing was a moral and spiritual vocation, not an occupation requiring extensive technical education.

As well as working in hospitals, other nurses, including nuns, worked in private homes, while others still were employed in district schemes, like the Queen Victoria Jubilee Institute for Nursing the Poor in their Own Homes, established in 1889.

In an attempt to improve and standardize nurse training a General Nursing Council was set up in 1919 to produce a uniform syllabus of instruction and to keep a register of trained nurses. A similar Central Midwifery Board had been established in 1918. A Joint Nursing and Midwives Council was created for Northern Ireland in 1922, while the council and the board in the south were finally replaced in 1950 by An Bord Altranais (the Nursing Board), with responsibility for training and registering both nurses and midwives.

Bibliography

Scanlin, P. , The Irish Nurse. A Study of Nursing in Ireland: History and Education, 1718–1981 (1991)

Elizabeth Malcolm

nursing Profession that has as its general function the care of people who, through ill-health, disability, immaturity or advanced age, are unable to care for themselves. The Christian Church emphasized caring for the sick and many religious orders performed such ‘acts of mercy’. In the 19th century, Florence Nightingale revealed the need for reforms in nursing; by the end of the 19th century, England and the USA had adopted some of her principles. Modern nursing provides a broad range of services, with standards set by relevant professional bodies.

471. Nursing

1. Eira Frigga’s attendant; taught science of nursing to women. [Norse Myth.: LLEI, I: 327]
2. Irene (fl. 3rd century) ministered to St. Sebastian, who was wounded by arrows. [Christian Hagiog.: Hall, 162]
3. Lellis, St. Camillus de improved hospitals; patroness of sick and nurses. [Christian Hagiog.: Attwater, 78–79]
4. Nightingale, Florence (1820–1910) English nurse; founder of modern nursing. [Br. Hist.: NCE, 1943.]

nurs·ing / ˈnərsing/ • n. the profession or practice of providing care for the sick and infirm.