Who Was The First Registered Nurse In The United States

Mercy Hospital School of Nursing class of 1936 Mercy Hospital Schoolhouse of Nursing class of 1936Many in the wellness-care field greeted news of this shortage with surprise. Later all, the country was nonetheless suffering from the fiscal devastation of the Great Depression. Unemployment rates for registered nurses had climbed dramatically during the early years of the depression, and hospitals found it relatively easy to secure nurses, who were always in plentiful supply. Information technology seemed almost unbelievable that nurses would become deficient. Yet, by 1936, many hospitals were reporting astringent shortages of nurses. [1]Astonished by the speed and intensity with which the shortage appeared, hospital administrators wondered, "Where did all the nurses go?"

This mid-twentieth-century shortage, which lasted into the Earth War Two years and beyond to the 1960s, was i of the start in a serial of nurse shortages that plagued the U.Due south. wellness-intendance organisation over the adjacent five decades. The story of this shortage illustrates the characteristic means in which nurse shortages take developed and the classic solutions that have been used to accost them. Each nurse shortage is unique, a function of the particular social, economic, technological, and cultural context in which it occurs. At the aforementioned time, however, nurse shortages tended to demonstrate remarkable similarities, both in the reasons for which they occurred and in the strategies selected to address them.

Wellness care and nursing leaders used a trio of strategies to deal with this mid-twentieth century shortage of nurses. The start was to increase the supply of nurses by increasing the number of students admitted to nursing schools. The 2d was to increase the utilize of less educated and trained personnel either to substitute for or to extend the work of professional person nurses. The 3rd was to shorten the educational period for nurses to produce not just more nurses, simply nurses in a faster manner.

Every bit periodic nurse shortages persisted into the century's later decades, health care policies continued to promote these methods. The 3 strategies in and of themselves continued to exist very successful at what they intended to do. The number of nurses in the U.Southward. labor force increased substantially during the twentieth century equally did the variety of nurse assistive personnel employed in health care. Yet, at the same fourth dimension, the country too failed to avoid repeated nurse shortages. This suggests we question strategies that show successful in their goals but disappoint in the long-term. Exploring alternative tactics that received less attention in the by might provide better solutions to nurse shortages.

The Kickoff of the Shortage

Student nurse preparing medication, Philadelphia General Infirmary, Philadelphia, PA, c. 1940Nurse shortages are circuitous phenomenon the consequence of many interacting factors. Most nurse shortages occurring in the twentieth century were demand-driven shortages related to increased utilization of registered nurses. This is exactly what happened in the mid-1930s, when several technological, economical, and wellness care-related events combined to increase the demand for registered nurses and to lay the groundwork for a shortage.

During the 1930s, increased hospital use, changes in infirmary construction, more technologically circuitous patient care requirements, and a reduction in the working hours for nurses all necessitated an increased number of nurses to deliver bedside intendance. [ii]Past mid-decade, reports of a shortage of nurses, described as most severe in the astute-intendance hospital sector, began appearing in various parts of the country and increased throughout the later years of the decade. [three] Unaccustomed to dealing with nurse shortages, hospital administrators reacted slowly to the situation. Some blamed nurses themselves for creating the shortage by failing to live upward to the ethics of their profession and refusing to work. [4]By the time the United States entered World War 2, signs that the country faced a critical trouble were besides obvious to ignore.

Wartime Nursing Needs

At the time of the U.S. entry into the war the immediate demand was for nurses to serve in the armed services. Gimmicky inventories of registered nurse supply indicated that a sufficient number of active and eligible nurses were present in the workforce to meet military needs. [5] By war's end, over 77,000 nurses, joined the military services. But removing what was so about 25 percent of the nurse population for the state of war effort severely compromised the nursing needs of the noncombatant population. [6]

Edna LaPorte Strumpf, U.S. Army Nurse, 1943 Edna LaPorte Strumpf, U.Due south. Army Nurse, 1943A proactive response was required. Adopting practices used in the by to deal with shortages, hospitals directed their efforts at expanding the nurse educational arrangement as the primary means of maintaining adequate nurse services. The nurse educational organization in place in the U.s.a. in the 1940s was the traditional apprenticeship type of training in which hospital-based schools of nursing took in students, teaching them the rudiments of the profession while at the same fourth dimension using them to deliver the majority of patient care. A vast number of hospitals in the country, approximately 1,300, operated schools of nursing and depended heavily on students for bedside nursing care. Hospitals hoped to alleviate the shortage of nurses past merely admitting more than students.

This fourth dimension, withal, the strategy posed a considerable challenge for the hospitals. The traditional population of nursing students: young, white females with a secondary school teaching, was exactly the same group heavily recruited by state of war-related industries. For those eager to help the war endeavour immediately, the iii years required before a immature woman graduated from nursing school was a disincentive. Farther, discrepancies between working conditions for nurses, such as low salaries, long hours, and requirements that nurses live within hospital grounds, and working conditions for other occupations made nursing a less attractive field for young people to consider.

The Government Steps In

Cadet Nurse Corps Student Nurses, Philadelphia General Hospital, 1943In the early years of the war, the federal government provided a pocket-sized amount of money to subsidize some nurse educational activity activities. When the programs supported past these funds proved ineffective at increasing the number of student nurses, Congress enacted a more all-encompassing federal nurse instruction programme. The 1943 Bolton Act created the Cadet Nurse Corps, a program that ran through to 1948. The act provided $160 million for nurse education funding and fiscal back up for nursing students, a much larger corporeality of federal coin for both students and hospitals than had previously been allocated. Students enrolled in the program received a free education too equally a monthly stipend and uniforms. The intent of the Cadet Nurse Corps was specifically to maintain nursing services to hospitalized patients by increasing the number of students within nursing education programs. Students were non required to serve in the war machine. Including a requirement that participating schools reduce the length of the educational menses raised expectations for meeting the goals of the programme, which was to produce more nurses, quickly. Over 160,000 students took part in the Buck Nurse Corps that was considered contemporarily a huge success. After the war, estimates were that in hospitals associated with a school of nursing, students provided well-nigh fourscore percent of the in-infirmary patient intendance delivered during the war years. [7]

Licensed Practical Nurses and Other Assistive Nurse Personnel

A second tactic employed during the war years was to increase the use of licensed applied nurses and nurse aides as nursing assistive personnel in noncombatant hospitals. Licensed applied nurses, or LPNs, were nurses educated in curt programs—generally about a yr in length—who carried out basic nursing intendance under the supervision of a registered Registered nurse supervising licensed practical nursing student, Philadelphia General Hospital, c. 1950nurse. The licensed applied nurse motility began in the late 1930s and became more formalized during the 1940s. Many in the health-intendance field, believed that the availability of a group of less highly educated nursing personnel would solve many problems, and they greeted the entry of LPNs into hospital intendance with enthusiasm. The brusk preparation programs for LPNs, appealed to infirmary administrators who wanted more than nurses fast. The lower toll associated with educating LPNs added to their bewitchery. Since educational requirements for admission to LPN schools was less stringent than that of registered nurse programs, some believed LPN programs would attract a wider population of students and add substantial numbers to the nurse workforce. [8]

Nurses aides were another grouping of workers heavily relied upon during Globe War Ii. The utilize of some type of nurse assistive personnel, such as ward maids, nurse aides, and orderlies, was common exercise in early-twentieth century hospitals. During the state of war the use of nurses aides—both those who worked in a voluntary capacity and those who were regular hospital employees—increased dramatically. Hospital administrators found nurse aides particularly appealing to utilize considering of their low costs and flexibility. Nurse aides received training enabling them to be moved effectually the hospital as needed and assigned to a diverseness of functions. The training period was brusk; from as little equally a few hours up to vi weeks. Because nurse aides were unlicensed, hospitals felt free to use them as they saw best. [ nine] Although intended to extend the work of nurses by serving in an assistive capacity, both LPNs and nurse aides were frequently, and often inappropriately, used as nurse substitutes. [10]

The Post-World War II Shortage

One time the war was over, wellness care and nursing leaders, expected that nurses released from the war machine would resume their prewar jobs and that the nurse shortage would cease. This did not happen. In fact, non only did the shortage continue, just it too increased in severity. For a number of reasons, nurses who had served in the military failed to return to their old positions, and hospitals spent much of the late 1940s engaged in a continual battle to staff nurse-poor hospitals.

At the same time, every bit nurses seemed to be shunning hospital work, postwar nurse demand skyrocketed. Increased hospital utilization rates, a trend evident from the belatedly 1930s, continued. In the four-year menstruation between 1946 and 1952, hospital admission rates rose 26 percent. The 1946 Hill-Burton Act, a federal human action that funded hospital construction, increased and expanded hospital facilities considerably. Moreover, every bit was typical with previous nurse shortages, the escalating technological needs of patients and farther reductions in the working hours of nurses likewise fueled a greater demand for professional nurse services.

Complicating the state of affairs was a slowdown in the number of new entrants into the profession. During the state of war, admissions to schools of nursing climbed, the result of the Cadet Nurse Corps program. Simply once, federal monies for nurse education ran out, less incentive and support existed for both hospitals and the profession to attract large numbers into the profession. Enrollments in schools of nursing savage from a high of 129,000 in 1946 to a low of 99,000 in 1949. [11]

Efforts to deal with the post-state of war shortage followed familiar patterns gear up in the early on 1940s. Educatee recruitment programs flourished and widespread use of assistive personnel increased. Indeed, a redefinition of the principal role of the registered nurse in patient care evolved. Registered nurses, formerly seen as the main providers of patient care, were instead viewed as a scarce resources better utilized as supervisors of other lesser trained personnel who really carried out the majority of bedside care. Estimates of the proportion of patient care provided by professional person nurses declined from over 70 percent in 1941 to only 30 or 40 percent in 1951.

Nurses preparing for a surgical procedure, Philadelphia General Infirmary, c. 1960 Concern over the depth of the nurse shortage stimulated the U.Southward. Department of Labor, to conduct a written report examining its causes. This 1947 investigation, entitled the "Economic Status of the Registered Professional Nurse," confirmed a rising demand for nurses at the aforementioned time the profession was experiencing a loss of practicing nurses and declining student enrollments. Findings of the study indicated that there were insufficient economic incentives either to attract a large number of new recruits or to keep experienced nurses in the profession. Nurses identified the lack of retirement pensions, a low rate of pay, and limited opportunities for promotion as sources of major dissatisfaction with their jobs. One nurse who took part in the written report forcefully described the economic situation facing nurses: "As it stands today nursing offers only enough to cover the bare essentials of living with no chance to save for the future or for emergencies. Information technology is obvious that a nurse cannot live on the gratitude of patients; she must have sufficient income." [12]The study concluded that poor working conditions, such as low salaries and long hours for nurses affected workforce participation at two points. The first was at the entry level, discouraging immature women from choosing nursing as a career. The second was within the workplace where the employment conditions deterred many from continuing to piece of work once they married. [xiii]

The idea that nursing was a difficult job with few fiscal rewards was hardly breaking news. Studies completed on nursing in 1923, 1928, and 1936 had repeatedly documented the poor working conditions and inadequate compensatory schemes nether which nearly nurses were employed. [14]Given the consistent findings of the 1947 investigation, it seemed obvious that efforts to improve employment conditions for nurses would lessen the shortage. This presented a logical course of action. And cardinal among those improvements was college wages.

Hospitals notwithstanding did not follow this logic. Instead, relying on familiar tactics, hospitals connected to put their efforts into recruiting new students into nurse pedagogy programs. To deal with the immediate problem of intendance delivery, they connected broad-scale use of assistive personnel.

Not surprisingly, the shortage persisted. In fact nurse shortage weather condition existed well into the 1960s. At that signal the federal government once again took activeness, passing the 1964 Nurse Grooming Human activity intended to increment the supply of nurses by providing pregnant funding for nurse education. [15]A noticeable rise in the number of nurses followed. While information technology is tempting to connect larger numbres of nurses in the workforce to the furnishings of the Nurse Training Human action, information technology is besides presumptuous. Several analysts take attributed the increment in working nurses not to an increase in the number of nurses, but rather to ascension wage rates for nurses. In the late 1960s, hospitals, reaping the financial benefits of the passage of the Medicare and Medicaid legislation, began offer nurses better salaries. Taking advantage of this run a risk to improve their economic situation more nurses joined or rejoined the workforce.

Back to the Future. What Does This Mean for Today?

Today, the American health care organization confronts once more a nurse shortage, one predicted to increase in severity over the next 20 years, raising the question, "Why does the United States never have enough nurses?" Well in fact, the U.Southward. has a very large population of registered nurses. Since 1900, the number of registered nurses has increased from a mere 12,000 nurses to effectually 3 million today, of which almost ii.vi million are actively working. [16]Given the size of this workforce, maybe the trouble rests in having too much demand, rather than too footling supply. Perhaps the demand for nurses required to maintain the highly technological, circuitous American health care system has grown across the nursing workforce's ability to run into that demand. Framing the consequence from the need point of view is enticing, but it fails to help u.s.a. the electric current shortage. Given the historical record and future projections about the health care needs of the twenty beginning century population, information technology is unlikely that need for nurses will lessen.

Where do we go from here?

Contemporary efforts aimed at alleviating the contemporary nurse shortage center as they did in the by on adding new recruits to the profession past enlarging the pupil torso. And, this will probably be successful. Recent reports indicate that admissions to U.Southward. nursing programs are on the upswing. Historically, the nursing profession has proven very good at producing more nurses. There is piffling reason to recall the profession will not exist able increase its numbers in the future.

Simply, adding more nurses may be an insufficient solution. And it is doubtful that the other strategies that hospitals accept traditionally relied upon will offering much help. The urge to speed upward the nurse educational process is hard to resist. Shorter nurse education programs are extremely popular in the United States. Graduates of short education programs, such as ii-year customs college programs, account for slightly over 50 percent of the U.Due south. nurse population today. And, in the Registered nurse and student nurse in ICU (Intensive Care Unit), Philadelphia General Hospital, c. 1970 Registered nurse and educatee nurse in ICU (Intensive Care Unit of measurement), Philadelphia Full general Hospital, c. 1970concluding twenty years, the per centum of nurses whose highest degree is a two-year associate degree has increased. However, contempo research demonstrating that in hospitals that have a higher percentage of nurses educated in longer, four-year baccalaureate programs have better patient outcomes raises serious questions regarding the wisdom of emphasizing shorter training courses. Likewise, increasing the utilise of assistive personnel is no longer a feasible option given the very medically complex dimensions of patient care today.

What's left? Nosotros may need to revisit the points made past the 1947 U.Due south. Department of Labor study and examine the
economic condition of registered nurses. Nurses have made dramatic gains in improving their working weather condition in the last few decades; yet, the electric current nurse shortage indicates that nosotros may take reached the position where compensation and opportunity are non loftier enough to maintain a stable and sufficient workforce. History is expert for providing us with a sense of what has worked and non worked in the by. In this case we also take an case of an approach seldom tried. Nosotros need to attend to the economic problems facing the profession, bug that both historically and currently trouble u.s.a.. Economists note that when a labor market demonstrates a shortage of workers, the typical response of the market place is to experience a rise in wages in an effort to describe more people into the occupation. Past insuring that nurses' wage rates reply to normal labor market place principles, we may begin to put a dent into the nurse shortage problem. Nursing has always been a satisfying ennobling career that provides numerous intangible benefits. Remembering that nurses need to receive equally satisfying concrete rewards may provide united states with a more lasting solution to our nurse shortage dilemmas.

References

[one]"Nursing at Recent Hospital Conventions," American Journal of Nursing 36 ( 1936): 1156-1162; Stella Goostray, "Supply, Need, and Standards," American Periodical of Nursing 41 ( 1941): 745; "The Nursing State of affairs in New York State," Trained Nurse And Hospital Review 96 ( 1935): 253.

[ii]Marilyn Flood, "The Troubling Expedient: General Staff Nursing in United states Hospitals in the 1930s, A Means To Institutional, Educational and Personal Ends" (Ph.D. diss., University of California, Berkeley, 1981).

[3]Robin Buerki, "President's Accost," Trained Nurse and Infirmary Review, 38 (1936): 302-iii.

[four] "Nursing Bug Receive Special Accent at Hospital Meetings," Trained Nurse And Infirmary Review, 97 (1936): 478;"'Ties That Bind,"Trained Nurse And Hospital Review, 99 ( 1037): 404; "ane,200—Nurses Imported For N.Y.C. 8-Hr 24-hour interval," The Modernistic Hospital, 49 (July, 1937): 104.

[5] Pearl McIver, "Registered Nurses in the The statesA.," American Journal of Nursing 42 (1942): 769-73.

[6]Mary Roberts, American Nursing: History and Interpretation (New York: Macmillan Co., 1954).

[7]Roberts, American Nursing, 383-393.

[eight]Jean C. Whelan, "Too Many, Too Few: The Supply, Demand, and Distribution of Private Duty Nurses, 1910-1965" (PhD. diss, University of Pennsylvania, 2000): 324-348.

[nine]"Nursing Situation Takes Spotlight at A.H.A. Midwinter Conference," Modern Hospital seventy (March, 1948): 130; Florence Hyde, "What Are The States Doing Most Licensing of Practical Nursing," Hospitals seventy (September,1950): 73, 76-84.

[10]William White, "Mandatory Licensure of Registered Nurses: Introduction and Impact" in Simon Rottenberg, ed., Occupational Licensure and Regulation (Washington: American Enterprise Institute for Public Policy Research, 1980), 53-54, 57-58.

[xi]Joan Due east. Lynaugh and Barbara L. Bush, American Nursing From Hospitals to Health Systems, (Malden, MA.: Blackwell Publishers, 1996), 1-25.

[12]United States Section of Labor, The Economic Condition of Registered Professional Nurses 1946-1947 (Washington, D.C.: Bureau of Labor Statistics, 1947): 37

[xiii] U.s. Department of Labor, The Economical Status of Registered Professional Nurses 1946-1947.

[14] Josephine Goldmark, Nursing and Nursing Teaching in the United States (New York: The Macmillan Co., 1923); May Ayres Burgess, ed.,Nurses, Patients, and Handbag (New York: Committee on the Grading of Nursing Schools, 1928); American Nurses Association, Study of Incomes, Salaries, and Employment Conditions Affecting Nurses. (New York: American Nurses Clan, 1938).

[fifteen]Lynaugh and Castor, American Nursing.

[16] The Registered Nurse Population Findings from the 2008 National Sample Survey of Registered Nurses, (Rockville, Medico: Usa Department of Health and Man Services Health Resources and Service Administration, 2010).

Jean C. Whelan (1949-2017) was Adjunct Assistant Professor of Nursing, University of Pennsylvania School of Nursing.