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1900 - 1929

1900

American Journal of Nursing begins publication

The American Journal of Nursing (AJN), published by the Associated Alumnae of the United States (later the American Nurses Association), became the leading professional journal for nurses in the United States. The AJN reflected closely the policies and goals of the professional association.

1901

The Colored Home and Hospital (later Lincoln Hospital) Training School for Nurses graduates its first class of six nurses

State nurses association forms in New York State. Nurses in New Jersey, North Carolina, and Virginia organize state nurses associations soon after

Nurses realized that forming state nurses associations was necessary if they hoped to mount successful campaigns for passage of laws of interest to nurses. Early nurse leaders considered the formation of such associations essential for passage of state nurse registration acts to establish occupational standards and license qualified professional nurses. As more and more state nurses associations formed and grew in importance, they assumed a larger role in the Associated Alumnae of the United States, the national professional association for nurses. In 1916, the renamed American Nurses Association, reorganized and became a federation of state nurses associations reflecting better the composition of the organization.

Congress authorizes the Army Nurse Corps via the Army Reorganization Act

1902

Lina Lavanceh Rogers is appointed public school nurse in New York City, the first in the country. Lillian Wald is instrumental in this appointment

School nursing began as an experiment conducted by the Henry Street Settlement of New York City. Lina Rogers’ ability to reduce school absenteeism due to communicable diseases quickly led to the employment of school nurses throughout the city and across the country. Over the years the role of the school nurses expanded to include student wellness, disease prevention and health education.

1903

North Carolina passes the first nurse registration act, licensing professional nurses. Shortly after, New York, New Jersey, and Virginia also pass nurse registration acts

Professional nurse leaders believed nurse registration acts would legitimize the profession in the eyes of the public, limit the number of people who hired out as nurses, raise the quality of professional nurses, and improve educational standards in schools of nursing. The initial nurse registration acts passed in the first decades of the twentieth century were relatively weak with few requirements mandated for licensing. However, the campaign to pass registration acts provided organized nursing with valuable political experience and paved the way for the passage of future, stronger acts. Not all nurses agreed that registration acts were necessary. Older nurses, who may not have kept up to date on current nursing techniques, and graduates from schools with below average academic standards feared that registration acts would be too strict and would prevent them from obtaining work.

1906

Elizabeth Tyler (later Elizabeth Tyler Barringer) joins the staff of the Henry Street Settlement House, the first African American public health nurse to do so

1907

M. Adelaide Nutting is appointed Professor of Institutional Administration (also referred to as Professor of Domestic Education) at Teachers College, Columbia University, the first nurse to occupy a university chair

M. Adelaide Nutting was one of the original designers of the postgraduate program at Teachers College, Columbia University. In 1907, her course in hospital economics became part of the Department of Household Administration of which she was named head. In 1910, her title changed to Professor of Nursing Education as the department became the Department of Nursing and Health. Nutting retired from her position in 1925 after successfully achieving international renown teaching and advising nursing leaders from around the world.

1908

The National Association of Colored Graduate Nurses organizes

African American nurses established this organization to combat the racism of American society especially of white nurses, as well as the exclusionary policies of the American Nurses Association. Several prominent African American nurses led this effort, including Mary Eliza Mahoney, hailed as America’s first African American trained nurse; Adah Thoms, a graduate of the Lincoln Hospital School of Nursing; and Martha Minerva Franklin, a graduate of the Woman’s Hospital Training School for Nurses. The National Association of Colored Graduate Nurses persevered through the 1920s with a small but determined membership. In the 1930s, however, the leadership of Estelle Massey Riddle, its president, and Mabel Staupers, its executive director, reenergized the organization and established its mission of desegregating nursing schools, nursing organizations, and opening up job opportunities for African American nurses. The National Association of Colored Graduate Nurses, with the help of influential white supporters, won the desegregation of the United States military nursing corps during World War II and that of the American Nurses Association in 1949. Believing its mission accomplished, the National Association of Colored Graduate Nurses voluntarily dissolved in 1951. By 1971, however, some African American nurses felt there had been little substantive improvement in addressing issues faced by African American nurses in particular issues surrounding the health of African Americans and issues regarding the role of African American nurses in professional activities. They formed the National Black Nurses Association, which still exists today in parallel with the American Nurses Association.

Navy Nurse Corps authorized by Navy Appropriations Act of 1908

American Hospital Association appoints a subcommittee on training schools for nurses

The subcommittee’s charge was to seek information on curriculum matters, consider the role of hospitals in preparing nurse assistants, and devise a model curriculum for educational programs for nurses and nurse helpers. One aim paramount to the work of the committee was investigating how to introduce a less costly, type of nurse worker for private nursing care. The committee proposed a set of general recommendations for minimum standards for schools of nursing as well as model curriculums for the different types of nurse education programs. It recommended that schools affiliated with small or specialty hospitals offer a two-and-a-quarter-year program of studies and that schools affiliated with large hospitals offer a three-year course. The establishment of this subcommittee is an early example of attention paid by hospital administrators and nursing leaders to deficiencies within the nurse educational system as well as recognition of the difficulties in financing the delivery of nursing care.

1909

A nursing school at the University of Minnesota opens as part of the university rather than the hospital, providing an alternative to hospital-based schools of nursing

Metropolitan Life Insurance Company inaugurates provision of visiting nurse service

Lillian Wald, Head of the Henry Street Settlement negotiated the agreement with the Metropolitan Life Insurance Company to provide nursing services to its sick policyholders. The agreement proved to be an astounding success: policy holders lived rather than died, and visiting nurse associations were provided with a stable source of funding. In 1911, Metropolitan Life extended this program throughout the United States. Between 1909 and 1953, more than 100 million home visits were made to more than 20 million Metropolitan policyholders at a cost of $116 million. This program was the first insurance coverage for home care.

Ludie Andrews sues the Georgia State Board of Nurse Examiners to secure the right of African American nurses to take state board examinations. She succeeds in winning her suit in 1920

Exclusionary practices for African American nurses extended beyond the educational system and often prevented them from obtaining state licensing—a critical component of professional nursing practice—once they had completed their education. Many state boards of nursing claimed graduates of black nursing schools did not meet the requirements for taking state board examinations, effectively barring such nurses from professional status.

The American Association for the Study and Prevention of Infant Mortality organizes

  • This association provided an organizational umbrella for the early twentieth century’s concerted effort to reduce shockingly high infant mortality rates. The ultimate success of this campaign depended upon thousands of nurses across the country teaching families about the importance of breast feeding, clean milk, and methods of infant feeding.
1910

Helen Hartley Jenkins endows the Teachers College course

Jenkins’s $150,000 donation allowed the creation of a new department of nursing at Teachers College, thus expanding the program begun in 1899. M. Adelaide Nutting, Teachers College’s Professor of Hospital Economics, became head of this new department.

1911

The Associated Alumnae of the United States is renamed the American Nurses Association

The new name better reflected the composition of the association, which included state, city, and county nurses’ association as well as alumnae associations.

1912

The National Association for Public Health Nursing forms with Lillian Wald as its first president

The National Association for Public Health Nursing brought together nurses from visiting nurse associations, public health agencies, and lay men and women to support the work of public health nursing.

The Children’s Bureau, an agency within the Department of Commerce and Labor is established creating an important vehicle in promoting children’s health and welfare

The American Society of Superintendents of Training Schools for Nurses is renamed the National League of Nursing Education

The Red Cross establishes the Town and Country Nursing Service, acknowledging the needs of families living in small villages and on farms who were often overlooked in the country’s emphasis on urban health care

The United States Bureau of Education publishes Educational Status of Nursing, an early study of the nation’s nursing educational system

Compiled by M. Adelaide Nutting, the study included data from 1,098 schools of nursing and provided a general description of the state of nursing education. Conclusions indicated that nursing education had become somewhat better over the last thirty-five years, but substantial improvement was still needed. For the most part, Nutting tied the lack of advancement in nursing education to the control exerted by hospitals over the nursing educational system. The copious list of problems identified in the report included the following:

• low admission standards for nursing students
• hospitals with limited number and variety of patient cases operating educational programs
• unprepared instructional staff
• lack of teaching materials, classroom space, and libraries
• assignment of excessive hours of work for students in addition to class and study time
• extremely long work weeks and insufficient vacation periods
• assignment of student nurses to private patients who paid the hospital rather than the nurse

Educational Status of Nursing did not contain an explicit set of recommendations, although the text promoted several innovations designed to improve the nursing educational system, such as the institution of an organized preliminary course of study which would provide theoretical instruction before students actually began caring for patients, the limiting of nursing education programs to general hospitals of sufficient size to provide adequate clinical experiences, the continuation of and increase in the number of schools affiliating with institutions of higher education, and the hiring of a paid staff of nurses to carry out care in teaching hospitals to reduce the amount of time spent by students in patient care activities. Ultimately the impact of Educational Status of Nursing was minimal. Problems identified in the report were already well known to the nursing and health care communities, and the crux of the problem—insufficient funding for nursing education—failed to become an issue which these communities were ready or willing to address.

1913

A California law restricting the working hours of women to eight hours per day is extended to student nurses

This law created great controversy. Arguments in its favor pointed to the extraordinarily long hours worked by student nurses; arguments against it centered on the financial burden it would impose upon hospitals and families. The act applied only to student nurses and not working nurses. Most nurses at the time worked as private duty nurses employed directly by patients. Many private duty nurses feared they would be covered by the law, raising the costs of private nursing and potentially limiting the number of individuals able to hire nurses. The act was appealed to the Supreme Court, which ruled it constitutional in California v. Merritt Hospital. Despite the benefits of this act for nursing students, nurse leaders resented government interference in what many viewed as a private matter between students and hospitals. Nurse leaders feared that similar acts in other areas of the country would limit the working hours of graduate nurses. This did not occur.

1914

A gunshot fired in Sarajevo, Serbia, sets in motion events leading to World War I

1915

A German firing squad executes Edith Cavell, the superintendent of a nurses’ training school in Brussels, Belgium, for assisting British and French soldiers to escape from Belgium. The international community expresses great anger that a nurse was so treated

1916

William Henry Welch addresses the graduating class of The Johns Hopkins School of Nursing appealing for the endowment of training schools of nursing and for opportunities for specialized nurse training

The American Nurses Association reorganizes its membership structure as a federation of state nurses associations

When originally formed as the Associated Alumnae of the United States, the American Nurses Association was an organization of school of nursing alumnae association. By 1911, when the organization officially changed its name to the American Nurses Association, membership included not just alumnae associations but also state and local nurse associations. To reduce confusion and provide a better organizing framework, the association reorganized in 1916 as a federation of state nurses associations. Membership in the association was through either a nurse’s alumnae association or a local nurse association. Moving membership to the local level solved some organizing problems for the association, but it reinforced the discriminatory practices of state nurses associations that refused to admit African American nurses by barring most of them from membership in the national professional nurse association.

1917

The United States enters World War I

The General Medical Board of the Council of National Defense organizes a committee on nursing as part of the war effort

The Council of National Defense, created in 1916 and composed of cabinet secretaries and civilian representatives from the fields of industry, finance, transportation, labor and education, was charged with coordinating the country’s defenses and planning for possible war. Once the United States entered the war a new body, responsible to the Council of National Defense, the General Medical Board, was formed to coordinate medical services. In June 1917, the Committee on Nursing, a group previously organized as a voluntary body by American nursing leaders to plan how nurses would serve the war effort, received official federal government standing. Financial support for the committee came from private individuals and nurses. The Committee on Nursing worked closely with the American Red Cross to develop a cohesive plan to meet national nursing needs, both militarily and civilian.

Base hospital units sail to Europe to deliver medical services to the military

World War I utilized a base hospital system to deliver medical services. Base hospitals were composed of medical and nursing staff drawn from large established civilian hospitals sent as a unit to the war zone. Smaller hospitals also participated by sending staffs in similar but smaller units known as hospital units. Whether it sent a base hospital or a hospital unit, the civilian hospital was responsible for organizing the staff and obtaining supplies. In essence, this hospital transplanted itself into the war zone. During World War I, 22,736 nurses served in the military, enrolled in the Nurse Corps of the Army, Navy and Red Cross.

1918

The Maternity Center Association opens as part of the baby saving campaign with the aim of improving the quality of maternity care to underserved women

The Vassar Training Camp is established to educate college graduates as nurses in an attempt to meet a shortage of nurses for both military and civilian care

Fears that the supply of nurses was insufficient to meet the needs of the country in wartime led to the development of strategies to increase the number of nurses quickly. The Vassar Training Camp offered 435 college graduates an intensive three-month summer session in the basic sciences as a preliminary for entrance into nursing schools. After completing the course of study in the camp, participants enrolled in traditional nursing education programs graduating in two rather than three years. The camp demonstrated that a nursing program could be completed successfully in a shortened amount of time. It also drew nursing education into institutions of higher education, a goal that was becoming increasingly important to nurse leaders.

Army School of Nursing is organized

Establishment of this school was an attempt to meet a shortage of nurses for the military. Those promoting its creation also hoped to eliminate the need to appoint assistive nursing personnel, non-licensed workers who preformed basic nursing task, to meet rapidly expanding military nursing needs. The school suspended operations in 1931.

Great influenza pandemic engulfs the world

The 1918 flu pandemic began during the final stages of World War I and lasted into 1919. An estimated 675,000 Americans died as a result of the epidemic, many of them young and otherwise healthy. Worldwide 20-40 million people died.

The influenza pandemic had many heroes and heroic stories. The unacknowledged heroes of the pandemic, however, were the student nurses who provided almost all the nursing care delivered in American hospitals. Most stayed by their patients’ bedsides despite pleas from family and friends that they see to their own safety. Hundreds of American student nurses died from the influenza they subsequently contracted.

1919

Nursing Service, Hospital Division, United States Public Health Service established

The United States Public Health Service operated the Marine Hospital Service, charged with providing hospital care to sick and disabled seaman. Until 1919, nursing care at these hospitals was provided by men attendants rather than professional nurses. With the establishment of the Nursing Service, care was transferred to professional nurses. The US Public Health Service, nursing service also provided nursing care to veterans prior to the creation of the Veterans Bureau (later Veterans Administration) and to patients at the National Leprosarium at Carville, Louisiana. In 1930, nurses of the Hospital Division of the U. S. Public Health Service established nursing services in federal prisons.

1920

Army nurses receive relative rank

When the Army Nurse Corps was first established, an army nurse did not receive a rank, a title indicating the placement of a soldier within the military hierarchy. Such designation carried with it the obligation to obey the orders of those above one’s specific rank and the ability to give orders to those below. Rank also provided the basis for determining pay and expenses incurred as a result of military service, such as travel allowances. Nurses fought a long legislative battle to achieve regular military rank. Relative rank conferred the same titles on nurses as those of commissioned officers, but it did not provide for equal compensatory arrangements or the right of command. Navy nurses did not receive relative rank until 1942. After World War II, the Army-Navy Nurses’ Act of 1947 completed the full integration of nurses into the regular military services providing for all the rights, privileges and obligations of other commissioned officers.

1921

Veterans Bureau nursing service established

Sheppard-Towner Act enacted

The Sheppard-Towner Act represented the first major federal funding of programs to lower infant and maternal mortality. The principal pieces of this legislation provided money to send nurses into local communities to assess child and maternal health, provide instruction in health and hygiene, and promote prenatal care.

1923

First major study of American nursing, Nursing and Nursing Education in the United States, is published

Nursing and Nursing Education in the United States (also known as the Goldmark Report after the secretary of the committee, Josephine Goldmark, a social work researcher known for her study of the relationship between fatigue and industrial efficiency) was funded by the Rockefeller Foundation. The study identified problematic areas of nursing education and laid the groundwork for the growth of collegiate schools of nursing.

In response to the findings of the Goldmark Report, Yale University offered its facilities for the first experimental university-based independent school of nursing. Annie Goodrich, a member of the committee that carried out the study, became the Yale School of Nursing’s first dean and professor of nursing. The Rockefeller Foundation gave Yale a one million dollar endowment to assure the permanence of this school.

During the same period other universities also initiated collegiate nursing programs. In 1921, Western Reserve University in Cleveland authorized the Department of Nursing Education. Two years later, with considerable financial support from Frances P. Bolton, a wealthy Cleveland philanthropist and future member of Congress, the University School of Nursing was established at Western Reserve (later Case Western Reserve University). This school was later renamed the Francis P. Bolton School of Nursing.

1925

Rockefeller Foundation study of the state of nursing education for African Americans, A Study of the Present Status of The Negro Woman in Nursing is completed

The Rockefeller Foundation commissioned this survey to determine what facilities existed for training African American women in nursing and the extent of their opportunities for employment. Ethel Johns, a Canadian on the staff of the Rockefeller Foundation visited twenty-three historically black hospitals and schools of nursing in the northern and southern states. Her findings were disheartening and were never made public.

The Committee on the Grading of Nursing Schools begins a major study of nursing education and working nurses

This committee, composed of representatives from the American Nurses Association, the National League of Nursing Education, the National Association for Public Health Nursing, the American College of Surgeons, the American Hospital Association and the American Public Health Association, carried out the largest and longest study of nursing education and practice to date. Three major projects formed the bulk of the committee’s work: a study of supply and demand for nursing service; a job analysis of nursing; and a grading (ranking) of schools of nursing. The committee received financing through donations from interested groups and individuals including a generous donation of $93,000 from Frances P. Bolton, a Cleveland philanthropist and future member of Congress. The majority of funding for the committee, however, came from nurses themselves who contributed one-half of the funds required to carry out the studies.

Manhattan Midwifery School opens to educate nurse-midwives, the first nurse-midwifery program in the United States

Mary Breckinridge, a trained nurse-midwife, establishes the Frontier Nursing Service in remote Kentucky

Many early nursing and public health leaders envisioned nurses as ideal practitioners for midwifery services, yet few nurse-midwives existed in the United States in the early twentieth century. Leslie County, Kentucky, an area which suffered staggering rates of maternal and infant death, provided an opportunity to showcase the benefits of using nurse-midwives. Nurse Mary Breckinridge decided to establish a nurse-midwifery service in the area to improve the health of the inhabitants. As few opportunities to learn midwifery existed in the United States, Breckinridge traveled to England to receive midwifery training. The Frontier Nursing Service is an early example of nurses practicing in roles outside the scope of traditional nursing practice. The service successfully provided primary health care services to an area grossly lacking in access to medical and nursing care.

John Hancock Mutual Life Insurance Company establishes a visiting nurse service for its policy holders

1928

The Committee on the Grading of Nursing Schools publishes its first report on working nurses entitled, Nurses, Patients, and Pocketbooks

This was the first study carried out by the Committee on the Grading of Nursing Schools. The study gathered data on the contemporary nurse workforce, detailing the employment rate of registered nurses and the positions in which nurses were employed. Included also were descriptions of how various groups such as nurses, patients, hospital administrators, and physicians envisioned the role of professional nursing. Conclusions of the study indicated that there was a sufficient number of nurses and echoed nurse leaders concerns that the labor market was overcrowded. Released in 1928, at the start of the economic downturn known as the Great Depression, Nurses, Patients, and Pocketbooks was a sober assessment of employment opportunities in nursing. The committee’s report included a number of recommendations designed to improve the employment situation for nurses.

1929

Stock market crashes on Wall Street sending the nation into a widespread financial depression

Baylor University Hospital establishes a prepaid hospital insurance plan for schoolteachers in Dallas, Texas

The Baylor plan, which paid for services incurred during hospitalization, was an early prototype of future hospital insurance plans. It quickly increased its subscriber base, and while it operated at a deficit in its first years, the loss to the hospital was not as great as it would have been had the subscribers entered the hospital without insurance.