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1700-1869 1870-1899 1900-1929 1930-1959 1960-1989 1990-2000

1931

Army School of Nursing suspends operations.

American Association of Nurse Anesthetists organizes.

1932

Chi Eta Phi Sorority, a national sorority composed of African American professional registered nurses, organizes.

The Maternity Center Association and the Lobenstine Midwifery Clinic open the School of Nurse-Midwifery in New York City.

  • In the early decades of the twentieth century, reformers led a variety of efforts to improve what they considered inadequate maternity care, especially among the poor. The New York City-based Maternity Center Association, concluded that use of trained midwives, a practice prevalent in foreign countries, resulted in much lower complication and mortality rates among new mothers and infants. The Maternity Center Association proposed that professional nurses could be easily trained as midwives. Since the closing of the Manhattan Midwifery School in 1931, however, midwifery training in the United States was essentially non-existent. The Maternity Center Association joined with the Lobestine Midwifery Clinic in establishing the School of Nurse-Midwifery. This offered a course of study for professional nurses to prepare them for the practice of nurse-midwifery.

The Committee on the Costs of Medical Care releases its final report.

  • This self-appointed group of medical practitioners from a number of private organizations carried out an extensive five-year program of studies of economic issues surrounding the delivery of medical care. Members of the committee included leaders from the fields of medicine, public health, medical institutions, social science, dentistry, and nursing. Eight philanthropic foundations provided financial support. As a result of its studies, the committee made five major recommendations for the future delivery of health care services. Unable to reach unanimity, however, the committee also released two minority reports and one personal statement from committee members who disagreed with aspects of the majority recommendations. In addition, one other member signed a statement indicating his inability to sign the final report. Recommendations in the majority report of particular interest to nurses included the following:

    • that medical services, both preventative and therapeutic, including nursing services, be furnished by organized groups associated with hospitals
    • that nursing education be completely remolded to provide well-educated and well-qualified registered nurses
    • that a group of lesser, but thoroughly trained nursing aides be established for delivery of care to the public
    • that adequate training for nurse midwives be provided.

1933

Congress establishes the Civil Works Administration.

  • Among its numerous projects, this temporary program employed over 10,000 nurses in a variety of health care settings, not only offering work for unemployed nurses but also providing the delivery of essential services to the needy.

1934

Committee on the Grading of Nursing Schools publishes two reports, An Activity Analysis of Nursing and Nursing Schools—Today and Tomorrow.

  • The first of these reports, An Activity Analysis of Nursing, met one of the committee's original goals: completing a job analysis of the activities engaged in by practicing nurses. It contained three extensive tabulated lists:

    • a list of patient conditions encountered by nurses in a variety of health care settings
    • a classification list of twelve general aspects of nursing care
    • a very detailed and specific list of activities carried out by nurses based on the general classification list.
  • The Activity Analysis recommended that the lists be used to plan and develop courses of study for student nurses as one means of raising nursing school standards. The impact of the report on improving educational conditions in schools of nursing was limited. Most schools continued to teach students only the tasks required by the affiliated hospital's specific group of patients. Yet, the Activity Analysis provides an illuminating picture of what patient conditions nurses treated in the 1930s and the techniques and treatment modalities they employed.
  • Nursing Schools Today and Tomorrow, the final report of the Committee on the Grading of Nursing Schools, reviewed the committee's eight years of research, summarized its major findings, and proposed recommendations intended to improve the supply and quality of nurses available to the public. The comprehensive report highlighted a number of problems, most of which had been identified previously, including extensive use of student nurses for delivery of patient care, inadequate educational standards in nursing schools, a rapid increase in the number of nursing school graduates flooding the labor market, and a dysfunctional hiring system that both failed to offer full employment to registered nurses and was unable to provide qualified practitioners to the public. The committee found that without a stable source of income, nursing schools remained tied to the hospital-based system where students traded their labor for whatever education the hospital was willing and able to provide. The committee repeated a number of familiar recommendations on improving both the education of nurses and the delivery of nursing care. For the most part there was little that was new in its findings.

National Association of Colored Graduate Nurses establishes headquarters in New York City.

  • Established with the support of funds from the Rosenwald Fund and the National Health Circle for Colored People, the headquarters was located in the same building as those of the three national nursing organizations, the American Nurses Association, the National League of Nursing Education, and the National Organization for Public Health Nursing. Having a national headquarters enabled the National Association of Colored Graduate Nurses to hire an executive director, increase its membership, and advance its work considerably. Despite its proximity to other nurse associations, however, the support of segregated conditions by white nurses continued to separate African American nurses from the mainstream of national professional nurse activities.

United States Public Health Service appoints the first public health nurse as a consultant in organizing and supervising relief nursing projects necessitated by the Great Depression.

American Nurses Association releases recommendations on establishing the eight-hour day as the regular working day for nurses.

  • During the 1920s, efforts to reduce working hours of nurses, who typically worked twelve-hour to twenty-four hour shifts, met with little success. However, the financial devastation of the Great Depression created an environment in which hour reduction schemes gained favor. Hour reduction plans aimed to increase employment among nurses by using a greater number of nurses for each twenty-four hour period. During the Depression such "spread the work" schemes gained popularity in industry. Although, the American Nurses Association supported the reduced hour movement, most hospitals remained opposed to it, and it was not until many years later that nurses were uniformly employed on an eight-hour day basis.

1935

Congress passes the Social Security Act.

  • The Social Security Act provided old-age benefits and aid to others in dependent or vulnerable situations. Title VI of the act also authorized funds for training public health personnel including public health nurses. Such funding enabled a significant number of public health nurses to receive additional education.

The Works Progress Administration is established as part of the Federal Government's relief program providing work to unemployed nurses in public health projects.

1936

United States Public Health Service nurse consultant service is increased from one to seven nurses.

  • Public Health Service nurse consultants worked with state and local public health authorities on improving, coordinating, and unifying public health nursing activities.

1938

The National League of Nursing Education and the American Hospital Association publish Manual of the Essentials of Good Hospital Nursing Service.

  • This manual, written as a guide for hospitals to be followed in organizing and improving their nursing services, included advice on appropriate working conditions for nurses. Although it was published in conjunction with the American Hospital Association, hospitals had no obligation to follow its guidelines.

The American Nurses Association publishes a study on working conditions for nurses entitled, Incomes, Salaries and Employment Conditions of Nurses.

  • Reports about poor employment conditions for nurses, motivated the American Nurses Association to investigate nurses' working lives. Although it was based on a small sample of nurses across the country, the study identified serious problems in the nurse workforce. The report included a long list of recommendations for improving the conditions of work for nurses.

1939

The Frontier Nursing Service in Hyden, Kentucky, establishes the Frontier Graduate School of Midwifery increasing the number of programs for nurse midwifery in the United States.

The American Nurses Association establishes a policy in favor of nurse licensure for all who nurse for hire.

  • Initial nurse registration acts all possessed one common weakness; they failed to require licensing for everyone who worked as a nurse. Anyone could work as a nurse as long as the individual did not identify as a registered nurse. By the 1930s a movement to remedy this situation gained traction. The first state to require a license for all nursing practice was New York in 1938. The components of the New York state law contained a controversial provision to license practical nurses as well as registered nurses, thus establishing two levels of nursing practice. The American Nurses Association announced support for mandatory nationwide nurse licensure one year after passage of the New York state law.

1940

Nursing Council on National Defense forms.

  • The purpose of the council, a voluntary body, was to identify and plan for the most efficient use of nursing resources should the United States enter World War II. The council included members from five major nursing organizations: the Association of Collegiate Schools of Nursing, the American Nurses Association, the National Association of Colored Graduate Nurses, the National League of Nursing Education, and the National Organization for Public Health Nursing, as well as a number of federal nursing service agencies, the Nursing Service of the American Red Cross, and the American Hospital Association. Initially, council activities were funded by donations from council member organizations and from state nurse associations. Once the United States entered the war, the council, renamed the National Nursing Council for War Service, received significant funding for its activities from the Kellogg Foundation. During the war, the council continued as the major organization responsible for coordinating nursing's response to the military effort working primarily with private agencies and on defense problems on the state and local level. A second—governmental—body commonly referred to as the Subcommittee on Nursing was established in 1941 to work on nursing matters concerning federal agencies. The National Nursing Council for War Service continued to operate for three years after the war as the National Nursing Council to plan overall nursing activities in the post-war era.

1941

The Subcommittee on Nursing, the official government agency for nursing matters related to defense, is formed.

  • This agency was a subcommittee of the Office of Defense Health and Medical Committee, which coordinated health and medical activities affecting national defense. The Subcommittee was charged with analyzing the country's professional nursing needs both for the military and civilian populations, designing plans to meet those needs, and cooperating with the nursing services of allied countries. The Subcommittee worked in coordination with the National Nursing Council for War Service. In fact, many members served jointly on both committees. The National Nursing Council for War Service worked primarily with private agencies and on defense problems on the state and local level. The Subcommittee worked on nursing matters concerning federal agencies.

The Nursing Council on National Defense, the Subcommittee on Nursing, and the United States Public Health Service, with the cooperation of state nurses associations, carries out the first national survey of nurses.

  • The inventory was designed to provide a more accurate measure of the number of registered nurses in the United States, thus enabling better wartime nurse resource planning. It consisted of questionnaires sent to nurses and had a response rate of 75 percent. Results estimated the population of registered nurses to be about 290,000. The inventory identified the number of nurses actively working and provided estimates of how many nurses would be available and willing to serve either in the military or in a civilian capacity. A second national nurse inventory updating the 1941 survey was completed in 1943.

The National Association of Colored Graduate Nurses campaigns for the removal of quotas limiting the number of African American nurses serving in the U.S. Army.

1942

American Nurses Association initiates a process that will eventually result in full integration of African American nurses into the national professional organization.

  • The House of Delegates at the 1942 Biennial Convention of the American Nurses Association authorized consideration of some form of membership for African American nurses barred from joining the association because of the exclusionary policies of their respective state nurses associations.

1943

The Nurse Training Act of 1943 (Bolton Act) creates the United States Cadet Nurse Corps and provides for federal financial aid for nurse education.

  • The main purposes of the Nurse Training Act was to increase significantly the number of student nurses and, at the same time, shorten the years of schooling required to complete a nursing education program. Increasing the number of students, who traditionally carried out the majority of patient-care activities in many of the nation's hospitals, was intended to free up registered nurses for enlistment in the military without disrupting hospital care. The Bolton Act provided over $160 million to schools of nursing as well as individual stipends to student nurses. The Cadet Nurses Corps was administered by the Division of Nurse Education specifically established for that purpose within the United States Public Health Service. By the time the program was terminated in 1948, approximately 125,000 Cadet Corp nurses graduated. The academic regulations established by the Cadet Nurse Corp have been credited with improving standards in schools of nursing. Student cadet nurses were not required to enter military service upon completion of their education, although they did promise to spend six months serving in a health care facility. The creation of the corps placed nursing in a more prominent place within the Public Health Service and represented an initial federal involvement in basic nursing education.

Delaware becomes first southern state to admit African American nurses to direct membership in its state nurses association, thus allowing their membership in the American Nurses Association.

1944

United States Army and Navy nurses receive temporary commissioned rank status.

United States War Department directive removes quotas limiting the number of African American nurses in the U.S. Army.

Congress passes the GI Bill of Rights (Serviceman's Readjustment Act).

  • The GI bill provided $13 billion for home loans, educational opportunities, and unemployment pay for returning GIs. Passage of the act was an attempt to avoid the social and economic disruption experienced by World War I troops when they returned from overseas. The 1944 GI Bill is credited with opening up home ownership and college education to millions of Americans and paving their way into middle-class status. Although the legislation was passed as race neutral, restricted opportunities for home ownership and education limited its benefits for African Americans living in the South. Nurses discharged from the Army Nurse Corps were eligible for benefits under the provisions of the act. The act enabled thousands of nurse veterans, most of whom were graduates of hospital-based diploma schools, to earn baccalaureate and advanced degrees, significantly upgrading the educational and skill level of the profession.

National Nursing Council for War Service creates the National Nursing Planning Committee for coordination of postwar plans for nursing.

  • The Committee was composed of presidents, executive secretaries, and postwar planning committee chairpersons of the National Nursing Council for War Services' member agencies.

1945

President Roosevelt asks for legislation to draft nurses.

  • The movement to use the draft as a means of increasing the number of nurses available to the military was a short-lived effort that ended as the war began winding down. Nurses and others debated the necessity and justice of a draft for female nurses only as opposed to a draft for women in general. During World War II, 77,800 nurses served in the military, about a quarter of the registered nurse population.

World War II ends.

National Nursing Planning Committee releases A Comprehensive Program for Nationwide Action in the Field of Nursing.

  • This guide proposed an over-all program for nursing activities in the immediate postwar period. The program was a composite of contributions by all major nursing organizations as well as certain federal agencies and the American Red Cross. It outlined major objectives towards which nursing activities were to be directed and suggested means of addressing problems connected with professional nursing. The five areas the Comprehensive Program identified for development included: nursing services, nursing education, the distribution of nursing resources, implementation of nursing standards, and informational programs and public relations.

National Nursing Council for War Service is renamed National Nursing Council.

  • The council functioned primarily as coordinator of the postwar nursing projects outlined in A Comprehensive Program for Nationwide Action in the Field of Nursing. The council oversaw or enabled two major studies of nursing: The Economic Status of Professional Registered Nurses, 1946-1947 and Nursing for the Future, a study of the nursing education system. It also referred such recommendations as the accreditation of nursing education programs and recruitment of student nurses to appropriate nursing organizations for action.

1946

Congress passes Hospital Survey and Construction (Hill-Burton) Act.

  • The Hospital Survey and Construction Bill, also known as the Hill-Burton Act after the Act's initial sponsors, provided federal financial assistance to states for construction or renovation of hospitals and such health-related facilities as public health centers. The act greatly increased the number of hospital beds in the United States and led to an increase in hospital utilization. Between 1946 and 1952 hospital admission rates rose 26 percent. The act also required that recipient institutions provide designated levels of uncompensated care for those unable to pay. It did not, however, address the nurse staffing needs of these new facilities and patients. The timing of the act's passage—in the midst of the severe post-World War II nurse shortage—placed a burden on hospitals to develop means for meeting the nursing care requirements of their patients.
  • Initially, a provision of the act permitted facilities receiving funds to deliver care in segregated facilities as long as the facilities were equal, a provision struck down by the Supreme Court in 1963. Several amendments to the act expanded its scope: a 1954 amendment provided for grants for construction of diagnostic and treatment centers; amendments passed in 1964 provided funds for modernization projects; and a 1970 amendment supplemented the grant program with a loan guarantee program.

American Nurses Association initiates an Economic Security Program.

  • This resolution affirming the right of nurses to engage in negotiations with employers over working conditions encouraged state nurses associations to act as collective-bargaining agents for professional nurses. Acceptance of the economic security resolution was a major step for the American Nurses Association whose previous involvement in work-related economic issues had been limited.

The United States Public Health Service establishes the Division of Nursing with Lucile Petry as its first director.

  • Funds appropriated for the United States Public Health Service quadrupled between 1949 and 1960 as the federal government became increasingly involved in health care issues. The Division of Nursing (sometimes called the Division of Nursing Resources) initially focused on offering consultation on nursing matters. In 1949, however, the Public Health Service created the position of Chief Nurse Officer, and Lucile Petry was appointed to that position which carried with it the rank of Assistant Surgeon General. The mission of the division expanded to include collecting statistics, assuring an adequate supply of nurses, and improving the quality of nursing care. In 1955, the division secured the first federal funding to support nursing research. During the 1960s the division actively led efforts to improve access to nursing education, resulting in the Nurse Training Act of 1964, which funded nursing student tuition, new schools of nursing, and new teaching techniques. Over a twenty-year period, the Division of Nursing vastly enhanced both basic and advanced education for nursing. Later, in the 1970s and 1980s, the division supported the development of doctoral programs in nursing to improve the quality of faculty and support research on nursing problems. The research programs carried out by the division provided the foundation for the 1986 inauguration of the National Center for Nursing Research (later the National Institute for Nursing Research) at the National Institutes of Health. The division continues to focus on assuring the provision of high quality nursing care to the American public.

National Mental Health Act passes, providing funds for nurses to obtain graduate degrees in psychiatric nursing.

1947

U.S. Army and Navy nurses receive permanent commissions.

  • The long and contentious controversy over rank for military nurses continued throughout the interwar and World War II period. Military nurses during World War II held relative rank as opposed to fully commissioned rank status. Despite widespread support from and the prodigious efforts of nurses groups, both in and out of the military, the American Legion, and many members of Congress, the rank issue for nurses remained unresolved until after the end of World War II. President Harry Truman signed the Army-Navy Nurses Act of 1947 which established a permanent nurse corps in both the Army and the Navy, thus ending successfully a 30 year battle for equal status for military nurses.

The United States Department of Labor in consultation with National Nursing Council publishes The Economic Status of Registered Professional Nurses.

  • In the immediate post-World War II period, concerns that economic conditions in the field of nursing were leading to shortages of nurses prompted a call for a study of the social and economic status of nursing. Initiating such a study was one of the recommendations included in A Comprehensive Program for Nationwide Action in the Field of Nursing.
  • This study of the economic status of the profession noted a rising demand for nurses at the same time as a decline in the number of practicing nurses and in student enrollments. Findings indicated that the field offered insufficient economic incentives to either attract a large number of new recruits or retain experienced nurses in the profession. Major areas of dissatisfaction among nurses were low rates of pay, lack of retirement pensions, and limited opportunities for promotion.

Montifiore Hospital (New York City) institutes a home care program.

The President's Commission on Higher Education releases its report.

  • This report proposed sweeping changes in higher education. It recommended increasing the number of two-year community colleges and adult education programs and more federal aid to education. The subsequent growth of community colleges provided the venue for the later establishment of associate degree nursing programs.

1948

The American Nurses Association provides for direct membership for African American nurses barred from membership in their state nurses associations. Estelle Massey Osborne is elected to the American Nurses Association's Board of Directors, the first African American nurse to assume this position.

  • As a federation of state nurse associations, the American Nurses Association did not have individual memberships. Nurses who joined their state nurses associations automatically became members of the national body. Many state nurses associations, however, refused admission to African American nurses. Providing for direct membership for African American nurses allowed nurses who lived in states with discriminatory practices to join the national association. Evolving American Nurses Association membership requirements culminated in 1950 with the full desegregation of the American Nurses Association.

President Harry Truman issues Executive Order No. 9981 integrating the armed services.

Nursing for the Future: A Report Prepared by the National Nursing Council by sociologist Esther Lucile Brown is published.

  • This study focused specifically on nursing education and the reasons why the educational system was unable to meet the demand for nurses in the labor market in terms of both quality and numbers. The report made a series of recommendations that centered on improving the nurse educational system and advocated moving nursing education into institutions of higher education.

The National Nursing Council legally dissolves.

  • The publication of Nursing for the Future completed the work of the National Nursing Council.

Eli Ginzberg's A Program for the Nursing Profession by the Committee on the Function of Nursing is published.

  • Columbia University economist Eli Ginzberg chaired the Committee on the Function of Nursing, assembled by R. Louise McManus, Director of the Division of Nursing Education, Teachers College, Columbia University, to review problems associated with nurse shortages. The Committee devised a list of proposals for improving the delivery of nursing care including dividing nursing into two levels of practice: professional and practical. Professional nurses were to be educated in four-year college programs, and practical nurses were to be educated in twelve-month programs based either in hospitals or educational facilities such as vocational education programs. Other proposals included substantially improving working conditions for nurses and increasing the emphasis on nursing research.

The American Medical Association's Report of the Committee on Nursing Problems is released.

  • This report recommended that nurses be divided into professional and practical nurses with the professional group further subdivided into college-educated nurses and nurses educated in hospital-based programs; that nurse salaries be improved; and that provision be made for retirement funds for nurses. The report asserted that nurses "innocently erred" when they voted to have their state nurses associations act as collective bargaining agents for them. The report claimed that as nurses were members of a "noble profession" they did not require bargaining agents. The report expressed the hope that nurses would correct this action in the near future.

The Exchange Visitor Program (EVP) begins allowing foreign nurses to work in the U.S.

1949

The American Nurses Association completes an inventory of registered nurses.

United States Public Health Service reorganizes with Margaret Arnstein as Director of the Division of Nursing Resources and Pearl McIver as Director of the Office of Public Health Nursing.

The Commission on Chronic Illness releases its report.

  • The Commission on Chronic Illness, a non-profit corporation formed under the auspices of the American Medical Association, the American Public Health Association, and the American Public Welfare Association, released a massive four volume work, the culmination of seven years of research and writing, which reviewed and assessed problems associated with chronic illness in the United States. The report recommended an overhaul of the financing and delivery of health care, noting the overemphasis on institutional care and the need to develop plans to allow long-term-care patients to live at home. Needed most was the coordination and financing of care at home. Nurses were central to many of the suggested solutions.

Yale begins an advanced program in psychiatric nursing.

  • Except for public health programs, this was one of the first clinically oriented graduate programs in the country. Yale also offered a certificate program in midwifery, public health, and mental health-psychiatric nursing. These were one-year graduate programs granting a Masters of Science in Nursing.

The report, Nursing Schools at the Mid-century is released.

  • This report on the status of schools of nursing was completed by the Subcommittee on School Data Analysis for the National Committee for the Improvement of Nursing Services (originally named the Committee on Implementing the Brown Report), a joint committee of six major national nursing organizations (American Nurses Association, National League of Nursing Education, National Association of Colored Graduate Nurses, National Organization for Public Health Nursing, American Association of Industrial Nurses, and the Association of Collegiate Schools of Nursing). The work of the subcommittee was part of organized nursing's response to the recommendations of the Brown Report, Nursing for the Future. The subcommittee's report surveyed 1,156 schools of nursing, 97 percent of all schools in operation at the time. It provided data on a number of factors considered critical to evaluating nursing education programs, including:
  • • school organization
    • enrollment figures
    • student health
    • curriculum
    • clinical resources
    • instructional staff
    • performance on state licensing examination
    • costs.
  • Nursing Schools at the Mid Century noted the lack of progress in raising the standards of nursing education and the persistence of using student nurses to provide care for hospitalized patients at the expense of the educational program. It identified the small and slowly growing number of collegiate programs of nursing in existence at the time, but failed to make judgments on a preferred method of educational preparation.

1950

American Nurses Association's House of Delegates adopts a platform that includes the statement that "…full participation of minority groups in Association activities…" is the association's policy. This paves the way for a fully integrated association.

  • Despite the long overdue commitment of the American Nurses Association to desegregation, only 6 percent of all graduate and student nurses in United States were African American, and the nursing educational system remained highly segregated with separate schools of nursing for African Americans. At the time, a mere 200 out of approximately 1200 schools of nursing had at least one African American student.

The American Nurses Association voluntarily relinquishes the right to strike as a strategic tool in labor negotiations.

  • Although guaranteed by federal law, the right to strike was controversial among nurses who viewed strikes as conflicting with their professional patient responsibilities. Yet giving up the right to strike denied nurses a critical tool to use in negotiating with employers. The American Nurses Association urged employers to deal fairly with nurses and their collective bargaining agents when negotiating.

The United Nations Security Council approves a resolution to support the Republic of Korea and places all United Nations forces in Korea under the command of the United States military.

  • An accurate count of the number of nurses who served in the Korean War does not exist. Estimates range from under 1,000 to close to 2,000. This was the first war in which the armed services were fully integrated. As it did in most wars, the armed services struggled to supply sufficient nurses. Nurses were placed close to battlefields, often in Mobile Army Surgical Hospital (MASH) units and carried out functions that today would be classified as advanced nurse practice skills.

1951

National Association of Colored Graduate Nurses voluntarily dissolves as an organization. The American Nurses Association assumes the functions of the dissolved Association.

1952

First two-year associate nursing degree program opens.

  • In the context of an ongoing nursing shortage, Louise McManus, Director of the Division of Nursing Education at Teachers College, Columbia University, put forward an educational model aimed at preparing more bedside nurses and moving nursing education into the American system of higher education. A five-year research project developing and evaluating associate-degree nurse education began with Teachers College professor Mildred L. Montag as project coordinator. Montag envisioned the associate-degree "technical" nurse as an assistant to the "professional" baccalaureate-degree nurse. She placed these associate-degree programs in two-year community colleges, thus providing a less costly education without the service component rendered by student nurses required in hospital-based diploma programs. Associate-degree nurses were considered ideal for performing tasks of a technical nature, such as the carrying out of treatments and medication administration, under the direction of a professional nurse. Associate-degree nursing programs proved very popular, and program enrollments rose rapidly. The development of a new type of nurse worker, however, created yet another level of nurse, confusing the public and fueling debate over which type of nurse was appropriate for a particular health care setting.

The National League for Nursing recommends that specialty preparation for nurses should be at the Master's degree level.

The scholarly journal Nursing Research begins publication.

The President's Commission on the Health Needs of the Nation conducts its study of the nation's health requirements.

  • The commission, composed of fifteen members, including nurse Marion Sheahan, Associate Director of the National League for Nursing, made approximately one hundred recommendations on improving health services. The commission's recommendations were based on a conservative approach to the nation's health needs. They described the patient-physician relationship as paramount and favored the status quo in care delivery and payment for services, placing the major responsibility for improved health on the individual.
  • The commission noted severe shortages of nurses and other health personnel in many areas of the country. It promoted federal funding of educational programs including collegiate schools of nursing. The committee also noted health disparities between white and black Americans and outlined several measures to alleviate these differences.

National professional nurse organizations reorganize.

  • In 1944, the American Nurses Association, the National League of Nursing Education, and the National Organization for Public Health Nursing—later joined by the Association of Collegiate Schools of Nursing, the American Association of Industrial Nurses, and the National Association of Colored Graduate Nurses—undertook a joint survey of their organizational structures, functions, and resources to determine if a better way to organize and promote professional nursing existed. In 1952, the Structure Study, as it was called, resulted in a restructuring of the professional nurse organizations into two associations—an already existing organization, the American Nurses Association, and a new organization, the National League for Nursing. The National League for Nursing combined the National League of Nursing Education, the National Organization for Public Health Nursing, and the Association of Collegiate Schools of Nursing. The National Association of Colored Graduate Nurses had disbanded in 1951, and the American Nurses Association had assumed its functions. The American Association of Industrial Nurses remained independent.

1953

Critical care units open at the University of North Carolina in Chapel Hill; Manchester Memorial Hospital in Manchester, Connecticut; Albany Hospital in Albany, New York; the Veterans Administration Hospital in Hines, Illinois; and the Chestnut Hill Hospital in Philadelphia, Pennsylvania.

  • The emergence of these early critical care units, also known as intensive care units, ushered in a new approach to placement and treatment of physiologically unstable hospitalized patients. Previous schemes for grouping unstable patients together, such as recovery rooms, polio wards, and military field hospitals influenced the development of critical care units. These early units were organized on a similar plan. Patients were grouped together, usually in small patient units of four to six beds. These units were open rooms with common observation areas so that nurses could see all of the patients at once. They also utilized a more concentrated nurse staffing pattern than found in the general hospital units. By 1969, over half of the nation's not-for-profit hospitals possessed a critical care unit.

1954

Brown v. Board of Education outlaws racial segregation in public schools.

1955

The American College of Nurse-Midwives forms.

The American Nurses Association approves a legal definition of nursing designed for use in state nurse practice acts.

Section 301 of the Public Health Service Act provides federal funds for nursing research.

  • Although research monies, which were disbursed through the Division of Nursing Research, focused largely on issues related to the education and supply of nurses, nursing research supported by federal dollars gradually became more sophisticated permitting the carrying out of more complex research projects.

American Nurses Association forms the American Nurses Foundation to collect tax-free donations with which to support desirable charitable, scientific, literary, or educational projects.

1956

The Health Amendments Act is passed

  • This act provided support for the education of practical nurses and advanced training for public health nurses. Through the Professional Nurse Traineeship Program, it also provided funds for preparing nurses for careers in teaching, administration, and supervision.

The U.S. Public Health Service Division of Nursing Resources Extramural Grant Program in Nursing Research begins providing support for individual research, faculty research development projects, and several national research conferences.

The Surgeon General's Consultant Group, Subcommittee on Paramedical Personnel in Rehabilitation and Care of the Chronically Ill releases a report noting a shortage of paramedical personnel, including nurses, health aides, technicians, and practical nurses, to meet the needs of chronically ill patients.

1957

The National League for Nursing's Report on Hospital Schools of Nursing is published.

  • This report measured the progress made by hospital-based schools of nursing in improving their educational programs in order to receive accreditation by the National League for Nursing. The report was based on responses to questionnaires completed by 798 hospital schools of nursing—86 percent of the hospital schools in the country. The questionnaire focused on seven school characteristics: philosophy and purposes, faculty, clinical resources, library, curriculum, financing, and performance of graduates on state licensing examinations. The report noted over-all progress in all seven areas; yet a significant number—551 (69 percent)—of schools failed to achieve full accreditation. The report did not include conclusions, although it suggested that schools should use the information in the report to compare themselves to other schools and to initiate plans for improvement.

The National League for Nursing publishes Nurses for a Growing Nation.

  • This study, carried out by the League's Committee on the Future, projected that the country would need between 300 and 350 registered nurses per 100,000 population by 1970. Reaching this goal would require increasing the number of student nurses, reducing the withdrawal rate at nursing schools, and expanding educational facilities. The report addressed different types of educational pathways into nursing, noted that an increased number of nurse faculty would also be required, and supported increasing the number of graduates from baccalaureate programs. Predictive in nature, the report raised more questions than it answered. For example it did not address the means through which a significant increase in numbers of nurses could be achieved. Interestingly, the number of nurses the study projected would be needed by 1970—700,000—came very close to the actual number of nurses in that year—about 720,000.

Hildegard Peplau begins the first nursing graduate program in psychiatric nursing at Rutgers University.

  • Peplau, a renowned psychiatric nurse, educator, and theorist, believed nurses prepared at the graduate level could provide therapeutic one-to-one patient relationships which could include interpretation of patient data and prescription of interventions.

The United States Public Health Service organizes a study of progressive patient care programs.

  • Unlike the traditional method of placing patients throughout the hospital based on disease category or type of room accommodation, progressive patient care programs, initially proposed by the United States Army in 1951, classified and grouped patients according to their changing medical and nursing needs. Progressive patient care divisions include intensive care units, intermediate care units, self care units, long-term care units, and home care. Patients moved through each care unit based on their current status and requirements for nursing and medical care. Nurse staffing arrangements reflected the specific needs of each unit. Although intended to distribute nursing services in hospitals and communities in a more appropriate manner, progressive patient care failed to garner significant acceptance from either hospitals or the public. However, implementation of one aspect of progressive patient care schemes, intensive care units, spread rapidly throughout the country in the late 1950s and 1960s.

1958

First liaison committee between the American Medical Association and the American Nurses Association meets to identify and discuss areas of agreement and disagreement.

1959

Introduction of closed-chest massage to restart stopped hearts.

  • The introduction of emergency life-saving techniques, such closed-chest massage, which were implemented directly at the patient's bedside, emphasized the critical and expanded roles nurses began assuming in the late 20th century.

The Surgeon General's Consultant Group on Medical Education releases Physicians for a Growing America.

  • The Bane Committee, a part of the Surgeon General's Consultant Group, forecast a dire shortage of physicians in the coming ten to twelve years. The committee also provided some acknowledgement of the interrelationship between medicine and other health professions.