1990 - 2000


Health and Human Services Secretary Louis Sullivan creates Commission on the National Nursing Shortage

The 1990 Commission on the National Nursing Shortage, designed to implement projects recommended by the 1988 Commission on Nursing, focused on a number of areas: student recruitment and educational pathways, career development and retention of nursing personnel, the restructuring of nursing services, effective utilization of nursing personnel, data collection and analysis requirements, use of information systems and related technology in nursing. The study resulted in a number of recommendations. The easing of the contemporary nursing shortage in the early 1990s diminished the urgency felt by those in the hospital and health care field in addressing the problem and reduced the commission’s effectiveness.


The Supreme Court upholds the National Labor Relations Board regulation allowing separate bargaining units for registered nurses, easing nurses efforts to organize for collective bargaining activities

American Nurses Association releases Nursing’s Agenda for Healthcare Reform

Nursing’s Agenda for Healthcare Reform, a joint statement in which over sixty nursing and other health professional organizations participated, articulated the profession’s blueprint for health care reform. The Agenda, promoted by the authors as fiscally responsible, called for expanded patient access to primary health services, a movement from a health system based on illness care to one which focused on wellness, and utilization of the most cost effective health care providers. The Agenda supported the establishment of a federally defined standard package of essential health care services for all Americans provided by and financed through a combination of public and private plans and sources.


The Joint Commission for Accreditation of Healthcare Organizations creates an at-large nursing seat on its twenty-four-member Board of Commissioners ending a twenty-year lobbying effort by the American Nurses Association

Eddie Bernice Johnson elected to a Texas congressional seat, the first registered nurse elected to Congress


The National Institute of Nursing Research established at the National Institutes of Health

The promotion of the National Center for Nursing Research to the status of a full-fledged institute within the National Institutes of Health climaxed a long battle fought by nursing groups over many years. The change in status recognized the critical contributions to the nation’s health made by nursing research and provided a strong base for the funding of research projects

Vietnam Women’s Memorial dedicated in Washington, D.C.

Dedicated on November 11, 1993, the Vietnam Women’s Memorial honors the 265,000 women who served in the military during the Vietnam era. Although the exact number of women who served in Vietnam is unknown, 90 percent were estimated to be nurses. The campaign to erect a memorial to the women was spearheaded by Diane Carlson Evans, an Army nurse who served in Vietnam from 1968 to 1969. Eight women, all nurses, died in the conflict.


President Clinton’s Health Security Act dies in Congress

The Health Security Act, proposed in 1993, was viewed by supporters as the best effort in over forty years to increase access to health care for all Americans. Professional nursing groups took an active role in formulating and supporting the act continuing a tradition among nursing groups dating back to passage of the Medicare and Medicaid legislation in 1965 of advocating for better health care for all.


Institute of Medicine’s report, Nursing Staff in Hospitals and Nursing Homes: Is it Adequate? released

Congress directed the Institute of Medicine to carry out this study on the effects of the drive for cost effectiveness, cost containment, and competition on nursing staff and the quality of patient care in hospitals and nursing homes. The study concluded that the number of professional nurses was adequate for the immediate future but noted the educational mix of registered nurses, i.e., the mix of nurses with associate and baccalaureate degrees, might be insufficient to meet current and future demands of the health care system. The panel carrying out the study expressed concern that the health care system was undergoing major changes without adequate monitoring or evaluation of the impact of these changes on patients. The study recommended greater involvement of nurses in restructuring initiatives and more research into their effects on patient outcomes. An extensive list of recommendations accompanied the report.

Health Insurance Portability and Accountability Act signed into law

The Health Insurance Portability and Accountability Act protected health insurance coverage for employees either changing or losing their jobs. The act also included significant provisions regarding maintaining the privacy and security of health data.


The Balanced Budget Act of 1997 passed by Congress

The 1997 Balanced Budget Act, a bipartisan effort to balance the federal budget by the year 2002, significantly altered the Medicare and Medicaid programs and the access of vulnerable populations to health care. It provided for increased Medicare privatization options, allowed states greater flexibility in administering their Medicaid programs, and implemented a Prospective Payment System for Medicare-funded home nursing care. The measure also enacted the State Children’s Health Insurance Program (SCIP), funding health insurance coverage for children of low income families. The act’s provisions also directed Medicare reimbursement to all nurse practitioners and clinical nurse specialists in all geographic areas and clinical settings, opening up advanced nurse practitioner services to a larger population base.

President Clinton formally apologizes to the men involved in the Tuskegee Study in a White House ceremony

The U. S. Public Health Service Study at Tuskegee, the infamous study of untreated syphilis in African American men was conducted over a forty-year period by the United States Public Health Service. Over the course of the study, the Public Health Service failed to inform the men included in the study that they were study subjects and lied to them about the nature of the “treatments” they received. They also failed to provide them with information about treatment options available for syphilis and discouraged other health professionals from treating them. The study is widely viewed as one of the worst examples of racial injustice inflicted on the African American community by the medical research establishment. The role of public health nurse Eunice Rivers in the study and her involvement in carrying out deceptive practices during the conduct of the Study is the subject of much debate, discussion and controversy.


California Governor Gray Davis signs the nation’s first state law mandating specific nurse-to-patient ratios

Passage of the California law mandating minimum and specific nurse-to-patient ratios was the result of a twelve-year battle engaged in by the California Nurses Association and the National Nurses Organizing Committee. The intent of the law was to improve patient safety and increase quality of care. The law did not go into effect until 2004 and was the subject of many efforts to delay or overturn it.