NURSING

NURSING. Prior to the Civil War, nursing in the United States was generally a casual or self-declared occupation practiced as a form of domestic service rather than a skilled craft or a profession. Americans obtained the majority of their health care at home, where family members and friends attended to their needs.

Antebellum Nursing

On plantations in the antebellum South black female slaves acted as midwives, provided child care, and performed other nursing duties for both whites and blacks. Male nurses composed the majority of hospital workers in the handful of established marine and charity hospitals of the mid-nineteenth century. Hospital officials often hired former hospital patients who had no formal training in medicine or nursing. The forces that supplanted the untrained nurse did not come into play until the late nineteenth century and early twentieth century. New and centralized technologies fueled the rise of hospital-based care. A greater acceptance of surgical procedures, urbanization, and nurses' own efforts to grapple with social problems culminated in the ascent of the trained nurse.

The idea of nursing—middle-class women managing and supervising the preparation of food, supplies, and linens and administering medications and treatments—gained momentum during the Civil War (1861–1865). Approximately twenty thousand women volunteers worked in military hospitals, but almost none had any hospital or practical training in nursing. Union hospitals hired female nurses to complement the staff of male nurses, convalescent soldiers, and male ward masters responsible for day-to-day supervision. In Confederate hospitals significantly fewer Southern women worked as nurses. Black male

slaves bathed and fed patients daily. Catholic nuns played a unique role, nursing wounded soldiers from both the Confederate and Union armies. When the war ended, medical departments dismantled their massive hospital complexes, and most of the female nurses returned to teaching, domestic service, writing, family, and marriage.

Occasionally reformers extolled the benefits of trained nurses and the specific suitability of women for that role, but the goal of a trained nurse attendant languished for more than a decade after the Civil War. The 1880 census revealed that, while over ten thousand nurses were available for hire, fewer than 1 percent were graduates of hospital nursing courses. By 1873 only four schools of nursing existed in the United States: the New England Hospital for Women and Children and Massachusetts General Hospital in Boston, New Haven Hospital in Connecticut, and Bellevue Hospital in New York City. Over the next quarter century Americans witnessed a dramatic increase in the number of nursing schools from slightly over 400 in 1900 to approximately 1,200 by 1910. Among African American women, the number of hospital-trained graduates did not keep pace. Racial quotas in northern nursing schools and outright exclusion from training schools in the South limited their access to training. In 1879 the first African American woman graduated from the New England Hospital for Women and Children in Boston. Hospital schools with the explicit mission of training black nurses to serve the African American community opened their doors in the late nineteenth century: Spelman Seminary in Atlanta (1886), Hampton Institute in Virginia (1891), Providence Hospital in Chicago (1891), and Tuskegee Institute in Alabama (1892).

Nursing Education

By the beginning of the twentieth century middle-class Americans accepted nursing as a worthy albeit demanding vocation for young women. The women who entered nursing schools encountered an unregulated and often exploitative field. Hospital administrators opened nursing programs to avail their hospitals of a cost-effective student labor force. Nursing students practiced their skills as apprentices under the supervision of second-and third-year nursing students. Most schools offered limited courses in basic anatomy, physiology, or biology, and student nurses did not systematically rotate through all medical specialties.

Nursing leaders and educators, aware of the poor formal instruction in most hospital-based programs, pushed for fundamental reforms in nursing education and national legislation governing the licensing and practice of nursing. College-based nursing programs received a welcome endorsement when Columbia University appointed Mary Adelaide Nutting the first full-time professor of nursing in 1907. Nutting and her nursing colleagues established the American Journal of Nursing in 1900. Nurses revealed a growing professional awareness when they reorganized several professional nurses' groups under one national organization, the American Nurses Association (ANA), in 1912. That year the National Organization for Public Health Nursing organized its charter. Black graduate nurses, excluded from full representation in the ANA until 1951, established the National Association of Graduate Colored Nurses (NAGCN) in 1908, and Mabel Keaton Staupers served as the organization's first executive director (1934–1946). Although African American nurses grappled with the same professional issues as their white counterparts, racial discrimination and dismal employment opportunities amplified the black nurses' struggles.

Nursing in the Armed Forces

The exegesis of war created a receptive environment for nurses to press their grievances and further their professional goals while providing a crucial service to the nation. When military leaders reluctantly established the Volunteer Hospital Corps for female nurses during the Spanish-American War (1898), nursing leaders insisted on trained applicants from accredited nursing schools. In 1901 the Army Nurse Corps became a permanent service within the Medical Department, and the Navy Nurse Corps followed in 1908. Military medical officials in concert with nursing educators standardized and improved nursing education and established the Army School of Nursing in 1918 to meet the demands of World War I. During World War II the U.S. government agreed to award officer's rank to military nurses. Congressional leaders agreed to subsidize nursing schools and nursing education to attract women to nursing, a boon for all nurses but of special importance to black women. Black nursing leaders vigorously lobbied military officials, who finally agreed to desegregate the Navy Nurse Corps in 1948. Throughout the history of military conflict in the United States, nurses overwhelmingly established their ability to handle the intensity and stresses of wartime nursing, characteristics readily apparent in Korea and Vietnam, where nurses staffed Mobile Army Surgical Hospitals (MASH).

Male nurses did not share equally from the advances in military nursing or the softening of cultural boundaries defining sex-stereotyped roles that came out of the women's movement. Until the mid-twentieth century only a limited number of schools accepted male applicants. State boards of nursing restricted licensure for men, and as far back as the Spanish-American War military officials pointedly refused to accept male applicants in any branch of the Nursing Corps. Nursing remained one of the most thoroughly feminized occupations in the United States with women making up almost 90 percent of all nursing school graduates in 1990.

Nursing in the twenty-first century became a multi-tiered career. Registered nurses worked in every facet of acute and long-term care; they staffed public, industrial, and community health departments, and they achieved diverse skills and specialization of practice. Nurses who obtain postgraduate degrees enhance their role as providers of health care as nurse practitioners, clinical nurse specialists, nursing educators, and researchers. With degrees in finance and business, nurses have also broadened their job choices as hospital and health-care institution administrators.

NURSING

Antebellum Nursing

Nursing Education

Nursing in the Armed Forces

BIBLIOGRAPHY