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Nursing

in the 20th
century
By Leigh Morgan
Images courtesy of the American Red Cross and the U.S. Army Nurse Corps
Illustrations by Malcolm Garris
In 1912, Lillian May 2, 1998
Wald, seen in the
image above, was If you had been born in a different era, would you have
a pioneer in
providing public
wanted to be a nurse?
health nursing
services in both Think about what your daily routine might have been. In the
urban and rural early 1900s, you would have spent your time sterilizing
areas. equipment and administering leeches. In the middle of the
century, you would have been at the patient’s bedside often,
but you still may have sharpened needles two days a week.
As recently as the’80s, you wouldn’t have known what a
personal computer was, let alone used one to access
information.

There’s no doubt that nursing roles have changed


dramatically throughout the 20th century, and for the better,
according to many nurse historians. Here are some of the
highlights in the evolution of contemporary nursing.
Early 1900s
More than a maid

In the early 20th century, most nurses received their education


from hospitals, not colleges or universities. While earning
diplomas at hospital-based schools, student nurses provided
the facility with two to three years of cheap and abundant
labor, typically working 10- to 12-hour shifts seven days a
week, with only a few hours dedicated to classroom
instruction. Historians describe early clinical training programs
Some of the first
African-American as rigorous and exhausting.
nurses to serve
with the U.S. Army A new nursing student, known as a probationer, often began
stand outside their working primarily as a maid—dusting, scrubbing, and washing
quarters at Camp
dishes—under the scrutiny of a superintendent. Above all, the
Sherman in
Chillicothe, Ohio, probationer adhered to a code of etiquette that required utter
at the beginning of deference to physicians and supervisors. If she passed
the century. muster, the student could expect to move on to more patient-
<click photo to see oriented duties.
larger image>
"Every nurse in our School has from four to six weeks’ training
in operating room work alone," wrote a probationer in 1899 at
ON THE WEB
the Orange Training School for Nurses in New Jersey. "During
Nursing this time she has to make up and keep on hand thousands of
history sponges, wipes, bandages, and dressings of all kinds, and
attend to the sterilization of the same. She prepares all the
American
Association for water used by boiling and filtering it three times and then
the History of bottling it; she sterilizes sutures and ligatures; keeps the
Nursing instruments bright and clean; and is responsible for the
perfect cleanliness of the operating room."
Army Nurse
Corps - History
After graduating, a nurse in the early 1900s usually went to
Web Page
work as a private-duty nurse in a patient’s home or as a
Black Nurses in superintendent in a hospital. According to the Department of
History Labor, private-duty nurses averaged about $5 a week near the
turn of the century—barely enough to live on.
British
Columbia The vast influx of immigrants to the United States fueled a
History of boom in public health nursing in the early 1900s, said
Nursing
Professional Stephanie Tabone, RN director of practice for the Texas
Practice Group Nurses Association. From 1820 to 1910, nearly 30 million
immigrants arrived in America, many settling in slums and
Canadian tenement housing within major cities. "At the turn of century,
Association for these visiting nurses went out to people’s homes all over the
the History of
Nursing

History of Men
in Nursing

Lucy Lincoln
Drown Nursing
History Society
country and taught them about cleanliness, nutrition, and child
care to decrease disease and suffering in these poor
environments," she said. In 1912, the National Organization
for Public Health Nursing was founded.

Before going on Nursing often boiled down to housekeeping during this period,
duty, Army nurses said Vern Bullough, PhD, RN, FAAN, a historian and
stand in front of sociologist, and visiting professor of nursing at the University
the 13th Station of Southern California. Nurses spent hours sweeping,
Hospital, Australia,
mopping, dusting, polishing, cooking meals, stoking coal
1943.
<click photo to see stoves, filling kerosene lamps, cleaning chimneys, and
larger image> washing and folding linens. By the 1920s, nurses still earned
low wages—about 50 cents an hour, Bullough said.

Nurses’ caregiving duties included giving baths, inserting


catheters, administering enemas and medications, dressing
wounds and sores, and generally monitoring patients’
appearance. In the early 1900s, nurses still administered
leeches to treat inflammations or engorgement and relied
heavily on poultices, stupes, and plasters to relieve everything
from congestion to colic.

No longer reserved for the indigent and the dying, hospitals


during this time were being transformed into mainstream
institutions where the middle class went for treatment and
childbearing, said Barbara Brodie, PhD, RN, FAAN, professor
in the school of nursing at the University of Virginia in
Charlottesville and director of the Center for Nursing Historical
Inquiry.

World War II
Move to the bedside

"World War II was a major turning point for nurses," said Mary
Ellen Doona, EdD, RN, associate professor of nursing at
Boston College and a historian for the Massachusetts Nurses
Association. "For the first time, nurses were out of the
hospital, where they had been very constrained by rules and
procedures, and were really at the patient’s bedside, making
their own choices based on their own judgment and dealing
with the consequences. They were discovering that’s what
nursing is all about."

As nurses joined the war effort, civilian hospitals that had


sprung up around shipyards and military bases became short-
staffed. In 1943 Congress initiated the Cadet Nurse Corps
Program to subsidize education for nursing students who
promised to work in underserved areas for the duration of the
war. Over 150,000 nurses gained training through the
program over the next three years, according to the U.S. Army
Center for Military History. During a brief shortage of military
nurses in 1945, more than 100,000 Cadet Nurse Corps
trainees volunteered for duty.

Overall, some 200 nurses died while serving the Army in


World War II and over 1,600 received medals or other honors
for their efforts.

Nurses returned from the war armed not only with solid public
support, but with new skills. The military had trained nurses in
specialties such as anesthesia and psychiatric care, and
offered valuable hands-on experience that would ultimately
broaden the scope of the profession for future generations.

After the war, the nation’s economy and huge appetite for
health care enabled nurses to seek more independence and
education, Brodie said. "We emerged from that war one of the
richest countries in the world and with a great belief in the
power of science and the federal government to solve our
problems. Congress passed acts that poured billions into
health care. That’s when medical insurance became part of
employment packages."

A pharmaceutical revolution followed, Brodie said. Penicillin


drastically changed health care by curing infections and
allowing more invasive surgeries. Other advances included
TB treatments, the polio vaccine, new contraceptives, anti-
inflammatory drugs, and even Valium.

Despite the modernization of health care, some aspects of


nursing still lagged in the 1950s. Donna F. Ver Steeg, PhD,
RN, FAAN, a researcher of healthcare manpower who
graduated from nursing school in 1950, said she remembers
preparing an injection by mashing pills in a mortar, heating the
powdered mix in a teaspoon over an open flame, and drawing
the liquid into a glass syringe.

Hospitals still strapped oxygen tanks to patients’ beds in the


1950s and didn’t have much disposable equipment. Nurses
still autoclaved catheters and sharpened needles.

1960s and after


Break with tradition

Historians point to numerous changes in health care,


medicine, and nursing during this decade. "In the’60s, the
intensive care unit was developed," Doona said. "With ICUs
you have top-level doctors and nurses taking care of acutely ill
patients. The technology drove a higher level of training, so
you get specialization in nursing and, along with that,
advanced degrees."

The big development in the ’60s was the nurse practitioner


movement. "These were nurses who were semi-independent
and did many of the things physicians had done," Bullough
said. With most hospital nursing schools closing by this time,
"there was an attempt to have everybody become a
baccalaureate-prepared nurse."

By the late ’60s, cutting-edge hospital equipment was


relatively user-friendly, so machines could be easily operated
by nurses, Ver Steeg said. "That meant that nurses were
staffing ICUs 24 hours a day, taking blood pressure, reading
heart monitors, and doing all the high-tech stuff. Doctors were
beside themselves. It was clear that nurses were practicing
medicine." Ver Steeg said physicians resisted the advent of
advanced practice nurses, but ultimately gave way to the
public pressure that favored the shift. "Nurse practitioners
started existing by the late ’70s as a separate legal entity in
some states," Ver Steeg said.

Today
Increasing responsibility

In recent decades, nurses have become much more


responsible for the care and monitoring of patients, as well as
more collaborative and accountable, Brodie said. Tabone said
she sees nursing "going back to the future" with an emphasis
on public health care rather than hospital-based nursing. "In
the coming paradigm shift in the delivery of health care,
nurses will have a greater educational role outside institutions,
identifying ways to keep entire populations healthy," she said.
For example, nurses will work in greater numbers as disease
managers, case managers, home health providers, clinic-
based providers, and parish nurses. "These things are the
future of the profession. Not new pumps and better surgical
procedures, but actually dealing with the health of
communities and empowering people to have the greatest
optimum health possible. "In some ways that’s what nursing
started out doing at the turn of the century," Tabone said.