Nursing is a profession within the health care sector focused on the care of

individuals, families, and communities so they may attain, maintain, or

recover optimal health and quality of life. Nurses may be differentiated from
other health care providers by their approach to patient care, training,
and scope of practice.

Nursing is a profession within the health care sector focused on the care of
individuals, families, and communities so they may attain, maintain, or recover
optimal health and quality of life. Nurses practice in many specialties with
differing levels of prescription authority.

1700 - 1869

1732

Philadelphia opens an almshouse, which later becomes Philadelphia General

Hospital

In the early American colonial period, local governments established

institutions to care for sick individuals without families or other means of
care. In more populous areas, such as Philadelphia, these institutions were
part of the municipal almshouse, an establishment providing housing and
living services for those unable to provide their own. As many almshouse
inmates were elderly, sick, very young, or otherwise infirm, the need
emerged for a section of the almshouse devoted to caring for the ill. Later,
many of these institutions shed their almshouse identities and assumed the
status of general hospitals.
 During the eighteenth and nineteenth centuries, providing institutions to
care for the sick was in many ways more self-serving than altruistic. The
frequent occurrence of epidemic illnesses drove local governments to
establish such institutions in order to separate sick and potentially
contagious individuals from the healthy population, even if it required
public monies to do so. The Philadelphia Almshouse, one of the oldest and
most famous, was reorganized and renamed several times. In 1902, the
institution received its final name: Philadelphia General Hospital.

New England Hospital for Women and

Children opens a school for nurses with a
one-year curriculum

1873

Three schools of nursing inspired by the work

of Florence Nightingale open in New York City,
New Haven, Connecticut, and Boston,
Massachusetts

Although women physicians in Philadelphia, New York, and Boston had

already established formal training schools for nurses in the 1860s, the
New York Training School at Bellevue Hospital in New York City, the
 Connecticut Training School at the State Hospital (later New Haven
Hospital) in New Haven, and the Boston Training School at Massachusetts
General Hospital in Boston were the first three nurse training schools to
claim their organization was based on the principles specified by Florence
Nightingale. Nightingale’s principles included an endowment ensuring the
independence of the training school, a superintendent of nurses reporting
only to the head of the hospital, a strong emphasis on sanitary knowledge,
clearly defined lecture and ward time for students and an insistence on the
importance of technical skill and a disciplined character in nurses. Few
training schools—even Nightingale’s own school at St. Thomas’s hospital in
London—met all these criteria, and most reported to medical directors.
Nevertheless, the idea of shaping a school around Nightingale’s principles
became an animating spirit for the experimental idea of formal nurses’
training in hospitals and accounted in large measure for its success.

1877

Women’s Branch of the New York Mission and

Tract Society sends the first trained nurses
into the homes of the poor to care for the sick

These missionary nurses were followed in the 1880s by visiting nurses

sponsored by organizations in Buffalo, Boston, Philadelphia, and Chicago.
By 1909, there were nearly 600 visiting nurse organizations across the
country to save the poor from illness.

1879
 Mary Eliza Mahoney, the first African
American professional nurse, graduates from
the New England Hospital and Training
School for Women and Children

The New England Hospital for Women and Children’s charter provided for
the admission of one African American student and one Jewish student per
year. Both groups were regularly excluded from most nurses’ training
schools.

Louis Pasteur argues the case for the germ

theory of infection before the French
Academy of Medicine

Pasteur’s work, which established that specific organisms caused diseases,

that they were identifiable, and that successful treatment to combat them
could be devised, ushered in a new era of scientific medicine in which
medical and nursing treatment became progressively more technical and
complex. Although calls for an educated corps of nurse workers to deliver
care to the ill had increased over the century, the treatment regimens
called for by Pasteur and his followers validated and increased the demand
for organized nursing services.

1885
 A Textbook of Nursing by Clara S. Weeks
Shaw, the first textbook by a nurse, is
published

Physicians had a long tradition of writing textbooks for nurses—nurses who

might be both students training in hospitals and mothers caring for their
families at home. Weeks Shaw’s A Textbook of Nursing, was the first book
in a long tradition of texts in which nurses themselves codified the
knowledge and skills necessary for nursing practice. Like other early nurse
authors, Weeks Shaw, a graduate of the New York Hospital Training School
and the Superintendent of the Training School for Nurses in Paterson, New
Jersey, saw her work as important to “training schools, families, and
private students.” Her text included instruction in such areas as “the sick
room,” “the observation of symptoms,” “medicines and their
administration,” and “poltices, formentations, and other applications.”

1886

Spelman Seminary (later, Spelman College) in

Atlanta, Georgia, begins a nursing program
for African American women

African American women and men experienced severe discrimination in

attempting to obtain a nursing education. Few gained admission to nursing
schools in either the south or the north. In response, the black community
 set up schools of nursing in traditionally black hospitals and educational
institutions. The segregated nurse education system, established in the late
nineteenth century, prevailed until the mid twentieth century.

1888

The Mills Training School for Men opens at

Bellevue Hospital in New York City

Men have worked as nurses throughout history, yet, with few exceptions,
until the late twentieth century, American professional nursing was a
mainly female occupation. Recognizing that men as well as women were
needed as nurses, philanthropist D. Ogden Mills provided the funds to open
the Mills School of Nursing at Bellevue Hospital in New York City. This
school later combined with the Bellevue School of Nursing and operated
until the phasing out of both schools in 1969. Several other schools of
nursing exclusively for men operated throughout the country, primarily in
institutions affiliated with psychiatric hospitals. A few men gained
admission to traditionally female schools. The reluctance of nursing schools
to admit men through most of the late nineteenth and twentieth century
resulted in an occupational workforce composed predominantly of females,
a situation that prevails even today.

1891
 Provident Hospital Training School opens in
Chicago as the first school of nursing for
African American women in the northern
United States

African American women and men in the north wanting to become

professional nurses experienced discrimination similar to their southern
counterparts. Few were allowed to attend nursing school or given access to
jobs except in segregated settings. The Provident Hospital and Training
School for Nurses resulted from the experience of one African American
woman, Emma Reynolds. Denied entrance to the white schools of nursing
then operating in Chicago, Reynolds prevailed upon leaders of the Chicago
African American community to open an institution in which she could
study nursing. Other historically black northern schools of nursing that
opened around the turn of the century include Lincoln Hospital School of
Nursing in New York City and Mercy Hospital School of Nursing in
Philadelphia.

1893

Nurses meeting at the Chicago World

Columbian Exposition form the first national
professional association for nurses: the
American Society of Superintendents of
Training Schools for Nurses

Composed mainly of leading nurse educators, and conceived of as an

organization dedicated to reforming the nursing profession, the American
Society of Superintendents of Training Schools for Nurses, focused on
improving nursing education standards. In 1912, the organization
changed its name to the National League of Nursing Education, and in
1952, it renamed itself once more to become the National League for
Nursing.

Lillian Wald establishes the Henry Street

Settlement House in New York City

Wald’s insistence that sickness should be considered in its social and

economic context led to innovative and pragmatic reforms in health care,
industry, education, recreation, and housing. She coined the term public
health nurse and originated the ideas that eventually led to the
establishment of the Children’s Bureau, the provision of school nurses in
primary and secondary schools, insurance coverage for home care, and the
first national nursing service: the Red Cross Town and Country Nursing
Service.
 Howard University opens a nursing education
program, the first in the country in a
university setting

The Howard University program marked the entrance of nursing education

into a university setting initiating a very long process, remaining
incomplete today, to educate nurses in institutions of higher education.

1895

The Vermont Marble Company engages a

trained nurse to care for sick workers and
their families in the home

The growth of industrial nursing was slow. By 1910, there were only
sixty-six firms employing graduate nurses to care for their workers. But,
World War I created a dramatic increase in demand for industrial nurses.
By 1919, 871 industries employed 213 nurses. The passage of Workmen
Compensation laws also changed the organization of these nurses’ work.
With health care no longer merely a charitable contribution, employers had
strong financial incentives to reduce job-related injuries. As part of
companies’ bottom lines, industrial nurses’ practice moved from caring for
injured or ill employees in their homes to maintaining offices at factories
where they focused on the prevention and treatment of injuries on site.
1896

The Associated Alumnae of the United States

and Canada organizes

The Associated Alumnae of the United States and Canada, was founded to
be a professional association for all nurses. It was organized with significant
support from the American Society of Superintendents of Training Schools
for Nurses, which included only nurses involved in nursing education. The
new organization began as an association of the alumnae societies of
nursing schools, but it later changed its unit of membership to individual
nurses. In 1911, the association renamed itself the American Nurses
Association.

1898

Spanish American War begins. The army

organizes a nursing service under the
direction of Dr. Anita Newcomb McGee

The outbreak of the Spanish-American War provided the nursing

profession with an opportunity to demonstrate the value of an educated
corps of nurses in the military. Organized under the auspices of the
Daughters of the American Revolution and directed by physician Anita
Newcomb McGee, the Army Nurse Corps Division of the Surgeon General
 employed about 1,600 nurses, not all of them trained nurses. High troop
mortality rates related to disease rather than battle wounds led to a
postwar government investigation. The investigating body suggested the
creation of a reserve corps of trained nurses for use in future military
encounters. Instead, support for establishing a permanent military nursing
service grew. In 1901, Congress authorized the Army Nurse Corps.

1899

The Association of Hospital Superintendents

(later the American Hospital Association)
forms

Teacher’s College at Columbia University in

New York City offers a course for nurses in
hospital economics

This course was the result of efforts by leaders of the American Society of
Superintendents of Training Schools for Nurses. The society recommended
a one-year course in hospital economics be established to augment the
education of graduate nurses. The first class of two students entered in
1899. Students learned skills needed to successfully teach in and
administer hospital-based nurse training schools. Leaders in the American
Society of Superintendents of Training Schools for Nurses who served on
the education committee promoting the course included Isabel Hampton
Robb, M. Adelaide Nutting, Linda Richards, Agnes Snively, and Lucy Drown.
 They assured the program’s success by offering the society’s financial
support as well as providing faculty. The course expanded to a two-year
program in 1905, and by the fall of 1907, M. Adelaide Nutting, one of the
first nurses to hold the position of professor at a university, assumed
leadership of the program. She helped make Teachers College a mecca for
leaders in nursing education and administration throughout the world.

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.

1930 - 1959
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, R. 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 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.

1930 - 1959
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, R. 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 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.

1960 - 1989
1960

The U.S. Public Health Service reorganizes

A new Division of Nursing composed of the former Division of Nursing

Resources and the Office of Public Health Nursing of the U.S. Public Health
Service is formed and charged with increasing the number of better
educated nurses in practice and improving the quality of patient care.

The American Nurses Association’s Committee

on Current and Long-Term Goals presents a
proposal to the Association’s House of
Delegates recommending the promotion of
 the baccalaureate degree as the basic
educational foundation for professional
nursing practice

Since the beginning of the twentieth century, educating nurses in

institutions of higher education rather than hospital-based diploma
programs remained a long-term goal for the profession. Numerous reports
and studies throughout the century echoed calls for the baccalaureate
degree to be the primary educational route to professional nursing practice.
The Committee on Current and Long-Term Goals’ recommendation
propelled the American Nurses Association to more actively strive to
elevate standards of nursing education. As a result, the American Nurses
Association established a Committee on Education charged with studying
current nursing education and making further recommendations for its
improvement, formulating basic principles of nursing education, and
studying the effect of federal and state legislation on nursing education.

1962

Public Health Service develops the Nurse

Scientist Graduate Training Grants Program
 This initiative provided support to university graduate science departments
that agreed to open their programs to qualified nurses for interdisciplinary
research.

Coronary critical care units open at Bethany

Hospital, Kansas City, Kansas, and
Presbyterian Hospital, Philadelphia,
Pennsylvania

Coronary Critical Care Units expanded the concept of intensive care units.
These special units were designed to provide quick emergency action for
patients at risk of cardiac arrest and other cardiac emergencies. Nurses
specially trained in identifying and treating life-threatening cardiac
arrhythmias staffed the units.

1963

U.S. Surgeon General’s Consultant Group on

Nursing’s report, Toward Quality in
Nursing released
Beginning its work in 1961, the Surgeon General’s Consultant Group on
Nursing comprised of leaders in nursing, hospital administration, and
medicine as well as members of the public, analyzed problems facing the
nursing profession and proposed solutions. The Consultant Group’s
report, Toward Quality in Nursing, identified several serious issues
concerning the profession, including an inadequate educational system,
insufficient numbers of new recruits into the profession, a compensation
structure that discouraged people from entering the profession, a lack of
research on problems in nursing practice, misutilization of available nursing
personal, and a deficiency in the number of supervisory and teaching
nurses. The report recommended the Federal government create massive
funding programs to both increase the number of nurses and improve the
educational requirements for nursing. The report resulted in a significant
increase in federal investment in nursing education and research and
reflected the Kennedy and Johnson administrations’ support for greater
government involvement in health care.

Health Professions Education Assistance Act

enacted

Passage of the Health Professions Education Assistance Act represented a

major increase in the role of the federal government in assuring an
adequate supply of health professionals. Intended to address the shortage of
health care providers, particularly in rural and inner-city areas, the act
funded advanced clinical education in masters’ programs beyond previously
funded programs in public health and psychiatric nursing, thus increasing
the number of advanced clinical-practice nurses. The act also included
funds for construction of new teaching facilities and rehabilitation of
existing facilities.
 Barbara Resnick and Charles Lewis develop an
expanded role for nurses in the medical clinics
at the University of Kansas, Kansas City,
Kansas

1964

Nurse Training Act enacted

The 1964 Nurse Training Act, the most comprehensive nursing legislation
in American history to date, passed with wide Congressional support. The
act allocated a total of $283 million over a five-year period. Five provisions
comprised the Act including nursing school construction grants,
improvement and expansion of nursing educational programs,
reimbursement of a portion of their educational costs to hospital-based
diploma nursing programs, continuation of the Professional Nurse
Traineeship program, and a generous long-term, low-interest student loan
program. The act reflected the federal government’s enlarged financial
commitment to nursing education. Funds supplied by the act increased
enrollment in schools of nursing and led to improvements in the
educational structure of nursing. However, the act’s inclusion of support for
all three types of nurse education programs—baccalaureate, associate, and
diploma—sustained a confusing array of educational choices for new
recruits into the profession. In subsequent years, several amendments to
 the act continued significant federal financial support for nursing
education.

American Nurses Association’s House of

Delegates approves a recommendation that
the association work towards making the
baccalaureate degree the educational
foundation for professional nursing

Congress passes The Economic Opportunity

Act of 1964 as part of the President Lyndon
Johnson’s War on Poverty

The Economic Opportunity Act included funding for neighborhood health

clinics, sites in which early nurse practitioners were trained and able to
open practices.

1965
Health Professions Educational Assistance
Amendments of 1965 provide financial
assistance to disadvantaged nursing students

Medicare and Medicaid legislation enacted

The Medicare and Medicaid legislation provided government-funded health

insurance to the elderly (Medicare) and the poor (Medicaid). Signed into
law by President Lyndon Johnson, the Medicare and Medicaid programs
dramatically increased access to health care for millions of Americans and
resulted in a significant rise in utilization of hospitals and other health care
services. This challenged both hospitals and the nursing profession to deliver
greater amounts of services to a much larger population base.

The American Nurses Association issues a

position paper on educational preparation for
practice

The American Nurses Association’s definitive statement on nursing

education, Educational Preparation for Nurse Practitioners and Assistants
to Nurses: A Position Paper, stipulated two levels of nursing practice, a
professional level, minimum preparation of which was at the baccalaureate
level, and a technical level, minimum preparation of which was at the
associate degree level. The paper also identified a nurse assistant position,
education for which was recommended to be a short and intensive course
in a vocational education institution. The Position Paper’s purpose was to
enunciate and clarify the professional association’s stand on educational
preparation for nursing practice, which strongly favored institutions of
higher education as the appropriate setting for educating nurses.
The Position Paper’s proposed schema for nursing education represented a
major break from traditional methods of entry into professional nursing
practice, which depended on hospital-based schools of nursing. It created
significant dissension among nurses particularly among the approximately
78 percent of practicing nurses who were graduates of diploma programs.

Certificate program for pediatric nurse

practitioners opens at the University of
Colorado

Loretta Ford, nurse and educator, along with pediatrician Henry Silver
began this successful demonstration project to establish the viability of an
extended role for nurses in delivering comprehensive primary health care
services.

First contingent of combat troops sent to

Vietnam
 American nurse service in Vietnam began in 1956 when three Army Nurse
Corps nurses were placed on temporary duty assignment with the United
States Military Assistance Advisory Group. As the involvement of the U.S.
military increased, the number of nurses assigned to Vietnam grew. The
exact number of military nurses who served during the conflict is unknown,
although estimates range from 5,000 to over 10,000 nurses. During the
war, nurses delivered care to over 304,000 wounded and sick Americans
as well as many of the 58,182 service people who were killed as a result of
the conflict.

1966

Allied Health Professions Personnel Training

Act of 1966 enacted

This amendment to the Nurse Training Act of 1964 added provisions for
scholarships for students in need, funds for recruitment programs, and
grants to improve teaching.

1967
The Nursing Educational Opportunities
Grants program is launched providing $8.4
million in scholarships to 15,900 students

Image, the official journal of the international

nursing honor society, Sigma Theta Tau,
begins publication

The Symposium on Theory Development in

Nursing sponsored by Case Western Reserve
University held

This symposium included seminal papers by philosophers James Dickoff and

Patricia James who taught in the Yale masters program in nursing.

National Commission for the Study of Nursing

and Nursing Education established
 The National Commission for the Study of Nursing and Nursing Education
was charged with studying problems in nursing practice and nursing
education.

The American Organization of Nurse

Executives forms

A corporate subsidiary of the American Hospital Association, the American

Organization of Nurse Executives is an organization of nurse executives and
managers and provides direct nurse participation in the American Hospital
Association.

1968

Health Manpower Act of 1968 extends 1964

Nurse Training Act

Primary Nursing introduced by Marie

Manthey at the University of Minnesota
Primary nursing, hailed as a new method of nurse-patient assignment,
was based on Manthey’s conceptualization that hospitalized patients
required one designated nurse to oversee their nursing care on an
individual basis. This principle challenged the depersonalization of care that
often occurred when patient care was divided into specific tasks met by an
assortment of nursing personnel; a practice dominating in hospitals
throughout the 1940s, 1950s, and 1960s. Primary nursing valued the
centrality of the nurse to patient care and replicated in many respects the
nurse-patient relationship used in private duty nursing.

The American Nurses Association rescinds

no-strike policy opening the way for
organized nurses to use the labor strike as a
tool during labor negotiations

This policy effectively reversed the 1950 decision of the American Nurses
Association to voluntarily relinquish the right to strike.

American Nurses Association develops five

interim certification boards
 Certification boards provided a formal mechanism to acknowledge
excellence in the practice of nursing and lay the groundwork for upgrading
standards of competence for all nurses. The certification process recognized
those who attained specialized knowledge in their clinical field and thus
went beyond professional licensing schemes which set minimal standards
for professional practice. The “interim” designation of the initial boards
was used until a sufficient number of certified nurses took their place on
permanent certification boards.

Congress creates the National Center for

Health Services Research and Development

1969

American Association of Colleges of Nurses

formed

The American Association of Colleges of Nurses formed as an advocacy,

educational, and research organization to establish quality standards for
undergraduate and graduate nursing education programs in universities
and four-year colleges.
 Primex program developed at the University
of Washington School Of Nursing

The Primex concept, originally developed by nurse Madeleine Leininger,

emphasized the expanded role of nurses in providing primary health care.
Primex (which stood for primary care extender) programs focused on
primary care and preventive services delivered by nurse practitioners.
Several other Primex programs opened throughout the country.

American Nurses Association Statement on

Graduate Education for Nurses advocates a
focus on clinical practice as opposed to clinical
education

1970

National Commission for the Study of Nursing

and Nursing Education releases report
The National Commission for the Study of Nursing and Nursing Education
convened in 1967 to study problems in nursing practice and education.
The commission, which received funding from the American Nurses
Foundation, the Avalon Foundation, the Kellogg Foundation, and an
anonymous benefactor, issued a report entitled An Abstract for
Action often referred to as the Lysaught Report, after the commission’s
director, Jerome P. Lysaught. An Abstract for Action reviewed issues and
problems facing the nursing profession including the existence of a nursing
shortage, confusion over changing nursing roles and functions in the health
care system, lack of agreement over the appropriate educational setting in
which to educate nurses, and difficulties in retaining nurses in long-term
jobs. The Commission identified four priorities around which to develop a
scheme for change in nursing. These were to increase research into the
practice of and education of nurses, improve the nursing educational
system, clarify the role of nurses in contrast to those of other health
professions for the delivery of optimum care, and increase financial support
for nursing to ensure adequate career opportunities to attract and retain
the number of nurses required for quality health care.

The American Nurses Association adopts a

resolution in favor of a national health
insurance program

The American Medical Association

adopts Medicine and Nursing in the 1970’s: A
Position Statement
 Medicine and Nursing in the 1970’s: A Position Statement addressed six
areas including the supply of nurses, expanded roles for nurses, nursing
education, hospital nursing service, the health care team, and
nurse-physician collaboration. The statement re-enforced the concept of
the physician as head of the health care team but significantly recognized
the need for nurses to assume expanded roles and functions in the delivery
of patient care and recommended that doctors seek constructive
collaboration with the nursing community. The American Medical
Association affirmed its support of hospital based nurse educational
programs, identifying such programs as the main source of new nurses.

The Federal government funds a series of

projects, including the Primex program and
other United States Public Health Service
programs to prepare nurses for primary care
practice

1971

Secretary of Health, Education and Welfare’s

Committee to Study Extended Roles for
Nurses releases the report Extending the
Scope of Nursing Practice

Extending the Scope of Nursing Practice examined the potential for

expanding the use of nurses in the delivery of health care. The Secretary’s
committee, which considered the issue of health care delivery from a
consumer’s vantage point, recognized the potential for nurses to assume a
substantially larger place in the community of professionals delivering
health care services. It also noted, however, that many nurses lacked the
educational background to assume extended practice roles or did not want
to assume them. The report concluded that widening the range of nursing
functions was essential if the United States was to provide equal access to
health care for all citizens. It also called for nurses to expand their practices
to include some responsibilities traditionally performed only by physicians.
Barriers to effective utilization of advanced practice nurses were
pinpointed and more collaboration between physicians and nurses
recommended. The report also noted that state licensure laws presented no
obstacles to expanding nursing roles. The report provided incentive for
passage of the Nurse Training Act of 1971.

Nurse Training Act of 1971 passed

The 1971 Act expanded and extended federal aid to nursing education
and included monies to promote expanded roles for nurses such as the
support of nurse practitioner programs, capitation funds to allow for
larger student bodies, and support of programs designed to increase both
racial and gender diversity in the profession.

National Black Nurses Association forms

Frustrated by the limited opportunities for African American nurses for

involvement and full participation in the activities of the American Nurses
Association, several black nursing leaders organized a new professional
organization, the National Black Nurses Association, to better meet the
needs of African American nurses.

U. S. Navy Nurse Corp nurse practitioner

program begins

American Assembly on Men in Nursing forms

Idaho passes the first state practice act to

recognize diagnosis and treatment as part of
the scope of practice of advanced practice and
specialty nurses
 The National League for Nursing, the
American Nurses Association, and the
American Medical Association endorse the
National Commission for the Study of Nursing
and Nursing Education

The endorsement by the National League for Nursing came with a pledge of
financial support and services from League offices useful for implementing
the commission’s recommendations.

1972

The Laverne-Pisani Act is passed in New York

State

The Laverne-Pisani Act was the first state nurse practice act to expand the
definition of nursing practice and provide the statutory authority for
independent practice for all professional nurses.
National Joint Practice Commission holds first
meeting

The National Commission for the Study of Nursing and Nursing Education
recommended in its 1970 report, An Abstract for Action, the
establishment of a national joint practice organization composed of nurses
and physicians to discuss and make recommendations concerning
congruent roles and functions of both professions. The Joint Practice
Commission, which was composed of an equal number of members from
the American Nurses Association and the American Medical Association,
received funding from the American Medical Association, the American
Nursing Association and the W. K. Kellogg Foundation. The commission,
addressed a wide-ranging series of issues including access to care, health
care delivery systems, changes in education required to expand the role of
nurses, authority and responsibilities of the professions, relationships
between the professions, and state regulatory acts. The commission issued a
number of pamphlets on state practice acts, certification of nurses and
physicians, nursing staff in hospitals, and joint collaborative practice in
hospitals and primary care clinics. The Kellogg Foundation ceased
commission funding in 1980. In 1980, the American Medical Association
voted to terminate its financial support, at which point the commission
ended its activities.

Army Nurse Corp, Adult Ambulatory Care

Nurse Practitioner program opens at Fort
Benning, Georgia
1973

Federation of Specialty Nursing Organizations

and the American Nurses Association forms

The Federation of Specialty Nursing Organizations and the American

Nurses Association formed after an initial 1972 meeting with the
American Nurses Association and ten nursing clinical specialty
organizations convened to discuss common interests. In 1981, the
organization changed its name to the National Federation for Specialty
Nursing Organizations.

National Commission for the Study of Nursing

and Nursing Education releases its final report

This report, entitled From Abstract Into Action, described the

commission’s efforts to put into effect the recommendations of its earlier
report An Abstract for Action. The report discussed actions taken,
resulting outcomes, and remaining activities requiring attention. During
the three-year implementation phase, which commenced with the
publication of An Abstract for Action, the commission focused its work in
three main areas: the development and expansion of nursing practice
together with a reexamination of role relationships among health
professions; readjustment of educational systems in nursing to meet
current exigencies and provide a foundation for innovation; and emergence
of an unambiguous profession that would be a full partner in shaping health
policy and serve the needs of the American people.

Board of Directors of the American Nurses

Association accepts Interim report of the Task
Force on Affirmative Action

The Task Force on Affirmative Action convened in 1972 to develop and

implement a program to rectify inequities experienced by minority nurses.
The 1973 report included a list of six objectives designed to increase the
American Nurses Association’s attention to minority nurses concerns as
well as improve the Association’s communication, programs, and activities
to maximize involvement of black and other minority nurses in the
association.

National Association of Hispanic Nurses forms.

First National Conference on Classification on

Nursing Diagnosis held
 The First National Conference on Classification on Nursing Diagnosis was
called to develop a classification system of nursing diagnoses that would
describe the scope of nursing and define its body of knowledge. Nursing
diagnoses identify the domain of nursing practice for which the nurse is
held accountable. The 1973 Conference aimed to begin an initial effort to
categorize nursing knowledge, develop a taxonomic system of diagnoses
and establish a codification method appropriate for computerization.
Conferences continued to be held yearly subsequent to the 1973 conference.
In 1983, the North American Nursing Diagnosis Association (NANDA) was
formed and renamed in 2002, the North American Nursing Diagnosis
Association International (NANDA-I).

1974

Taft-Hartley Act amended to cover nonprofit

hospitals

Amendments to the 1947 Taft-Hartley Act ended the exemption of

nonprofit hospitals from coverage by the National Labor Relations Act. This
extended collective bargaining rights to nurses employed in nonprofit
hospitals and other health care facilities.
 American Nurses Association administers first
certifications examinations in geriatric
nursing and pediatric ambulatory care

1975

Nurse Training Act of 1975 passed

The 1975 Nurse Training Act was the first major revision of the Nurse
Training Act since its original passage in 1964. The 1975 act added funds
for nurse practitioner programs and mandated a study of the supply and
distribution of nurses for use as a guide for future legislation. It reflected a
shift in emphasis from legislation designed to address nurse shortages to
legislation dealing with maldistribution of nurses.

First convention of American Indian Nurses

Association held
 This association formed to address issues relevant to the health of Native
Americans as well as professional concerns of Native American nurses. The
association was succeeded by the American Indian Alaska Native American
Nurses Association and later by the National Alaska Native American
Indian Nurses Association. The National Alaska Native American Indian
Nurses Association is a member of the National Coalition of Ethnic Minority
Nurses Associations.

The Health Planning and Resource

Development Act signed into law by President
Gerald Ford

This act, creating a nationwide system of health planning and resource

development, represented a new approach to national, state, and local
comprehensive health planning. The major aim of the act was to promote
quality of care while slowing down rising health care costs. The act
identified a set of ten national health care priorities one of which was
increased training and utilization of health care providers such as nurse
clinicians. The act failed to effectively constrain health care costs.

1976
 The Professions Education Act amended the
Nurse Training Act to give special financial
assistance to applicants who practice in areas
with a serious shortage of nurses

1977

Denver nurses file class action suit in U.S.

District Court alleging widespread sex
discrimination and undervaluation of nurses’
services by the city and county of Denver

Lemons v. the City and County of Denver went beyond the traditional
doctrine of equal pay for equal work and raised the issue of comparable
worth. Those involved in the suit alleged that certain jobs possess enough
similarities to other jobs based on educational preparation, responsibility,
and skill level that comparable wages should be paid for both. The nurses
presented evidence that city and county starting salaries for such workers
as sign painters, tree trimmers, and tire service men (traditionally male
occupations) were higher than those for nurses (a traditionally female
occupation). The nurses failed to convince two judges in the case who ruled
 against them. The nurses appealed the case to the Supreme Court which
declined to hear the case.

1978

President Jimmy Carter pocket vetoes Nurse

Training Act amendments

In vetoing the amendments, President Carter stated that they authorized

expenditures in excess of the needs of nurse training programs and cited
the need to curb inflation. Nursing groups quickly refuted the contention
that the supply of nurses was adequate, noting reports of nurse shortages
throughout the country.

1979

President Jimmy Carter signs Nurse Training

Act amendments
 Signing this act reversed an earlier stand taken by President Carter when
he vetoed the 1978 Nurse Training Act amendments. However, the new
amendments allocated only half the monies originally proposed. The
measure provided funds for special projects, student loans, traineeships for
nurse practitioners and nurse anesthetists, and construction grants to
schools of nursing. The revised act also directed the National Academy of
Sciences to study and report on future nursing manpower needs and make
recommendations about future federal support of nursing education.

1980

American Nurses Association releases Nursing:

A Social Policy Statement

Nursing: A Social Policy Statement was a wide ranging position paper

which defined and identified the distinguishing characteristics of nursing
practice and described the profession’s responsibilities to the public.

1981
Department of Health and Human Services
publishes The Recurrent Shortage of
Registered Nurses: A New Look at the Issues

This report identified low salary levels as the causative factor of nurse
shortages. The report noted that the numbers of entrants into nursing
programs are positively related to beginning salaries for nurses. High
salaries initially attract new recruits into the profession. But as the number
of nurses increases salaries first level off and then decline relative to other
fields. The lower resulting salaries make nursing less attractive to new
entrants and lead to a decrease in the number of nurses. Once the number
of nurses decreases a new cycle of nurse shortages occurs. The report casts
doubts regarding the effectiveness of federal funding for nursing education
in relieving nurse shortages placing instead primacy on market forces.

Graduate Medical Education Advisory

Committee (GMENAC) report released

This committee advised the Secretary of Health and Human Services that
an oversupply of physicians would be evident by 2000. The report also
cautioned against increasing the number of nurse practitioners, certified
nurse midwives, and physician assistants until the need for them could be
determined.
1982

American Academy of Nursing identifies

forty-one hospitals as “Magnet Hospitals”

The Magnet Hospital program identified hospitals that were satisfying

places for nurses to work and were considered models of nursing practice.
Magnet Hospitals provided a workplace environment for nurses that allow
them to practice under optimum conditions. The Magnet Hospital program
developed into a form of accrediting for hospital nursing services and
presently is administered through the American Nurses Credentialing
Service, a subsidiary of the American Nurses Association.

1983

The Institute of Medicine releases its study

entitled, Nursing and Nursing Education:
Public Policies and Private Action
The Institute of Medicine Committee was charged with investigating
whether there was a need for continued federal support of nursing, ways to
get nurses in underserved areas, and how to encourage nurses to remain
active in their profession. The committee carried out a sophisticated and
well-documented analysis of problems in nursing, yet erroneously
concluded that the supply and demand of generalist nurses was in balance.
The committee did identify several problems in nursing including nurses’
dissatisfaction with their scope of practice and role definition and the job
strain and mental and physical fatigue they experienced. The committee
did not recommend a single educational standard for entry into nursing
practice but called for continued easy access to nursing jobs and more
funds for preparing nurse practitioners.

The Tax Equity and Fiscal Responsibility Act is

passed. Medicare’s Prospective Payment
System becomes effective

The Tax Equity and Fiscal Responsibility Act reduced many federal health
programs and mandated the development of a Prospective Payment
System for calculating Medicare reimbursement to hospitals. Medicare’s
original hospital reimbursement system used a retrospective system in
which hospitals received reimbursement for their services based on
whatever services the patient received. The Prospective Payment System
reimbursed hospitals with a flat payment based on the patient’s diagnosis.
Rates paid to hospitals were set in advance, calculated from a listing of
diagnoses called Diagnostic Related Groups. Hospitals that treated the
patient for less than the reimbursement provided were able to keep the
difference. Hospitals that treated the patient for more lost money. The
 intent of the program was to lower rising hospital costs and institute
efficiencies in hospital operations. Hospitals quickly adjusted to the new
reimbursement scheme by discharging patients faster. In the aftermath of
the Prospective Payment System, the acuity rate of hospitalized patients
increased dramatically and profoundly affected nursing practice. The
increased nursing needs of hospital patients created greater demands on
nurses and led to nurse shortages.

1985

Institute of Medicine releases

report Preventing Low Birthweight

The Committee to Study Prevention of Low Birthweight examined causes

of low birthweight and intrauterine growth retardation and identified
measures effective in dealing with these problems. The committee
concluded that prevention would contribute significantly to a reduction in
low birthweight and an improvement in child health. The committee
recommended increasing reliance on certified nurse midwives and nurse
practitioners as one means of improving access to care for at-risk pregnant
women. The committee also noted that state laws should be supportive of
collaboration between certified nurse midwives and nurse practitioners.

1986
The National Center for Nursing Research at
the National Institutes of Health is established

The establishment of a National Center for Nursing Research represented a

major step for the profession by advancing scientific research on nursing
and providing critical federal financial support. The center, which was
originally vetoed by President Ronald Reagan, received wide support from
both Republicans and Democrats. It became the National Institute of
Nursing Research in 1993. The National Institute of Nursing Research
supports and conducts clinical and basic research and research training on
issues of health and illness across the lifespan.

Federal Office of Technology and Assessment

releases the report, Nurse Practitioners,
Physician Assistants and Certified Nurse
Midwives: A Policy Analysis

The report, which was based on extensive analysis of a large number of

studies, concluded that the quality of care provided by nurse practitioners,
physician assistants, and nurse midwives was equivalent to care provided
by physicians. It noted high satisfaction among patients cared for by these
professionals and found that they were cost-effective providers of quality
health care.
 North Dakota becomes first state to require a
Bachelors of Science in Nursing degree for
registered nurse licensure and an Associate
Degree in Nursing for licensed practical nurse
licensure

1988

Secretary’s Commission on Nursing releases its

final report

The Secretary’s Commission on Nursing was appointed to determine if

there was a shortage of hospital nurses and concluded that a widespread
and significant shortage did exist. The commission found that the shortage
was related to constantly rising hospital demand for nurses. Hospitals
contributed to nurse shortages by paying nurses low wages thus making
nurses a relative low cost all-purpose employee group which could be used
by hospitals to perform non-nursing jobs. The commission predicted
continued high demand for nurses, recommending higher nurse salaries,
better staffing patterns, increased use of assistants and technology,
involvement of nurses in decision-making and federal support of
entry-level nursing education.
 1990 - 2000
1990

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.

1991
 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.

1992
 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

1993

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.

1994

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.

1996

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.

1997

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.
1999

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.

The Code of Hammurabi is a well-preserved Babylonian code of law of

ancient Mesopotamia, dated to about 1754 BC (Middle Chronology). It is one
of the oldest deciphered writings of significant length in the world. The sixth
Babylonian king, Hammurabi, enacted the code. A partial copy exists on a
2.25-metre-tall (7.5 ft) stone stele. It consists of 282 laws, with scaled
punishments, adjusting "an eye for an eye, a tooth for a tooth" (lex
talionis)[1] as graded based on social stratification depending on social status
and gender, of slave versus free, man versus woman.
Charles Dickens was a British novelist, journalist, editor, illustrator and social
commentator who wrote such beloved classic novels as Oliver Twist, A
Christmas Carol, Nicholas Nickleby, David Copperfield, A Tale of Two Cities
and Great Expectations.Aug 29, 2019

Works written: Oliver Twist, Sketches by Boz, H...

Born: February 7, 1812, Portsmouth

Died: June 9, 1870, Gads Hill Place

Profession: Author, Novelist

Dickens is remembered as one of the most important and influential writers

of the 19th century. Among his accomplishments, he has been lauded for
providing a stark portrait of the Victorian-era underclass, helping to bring about
social change.Sarah or Sairey Gamp is a nurse in the novel Martin Chuzzlewit
by Charles Dickens, first published as a serial in 1843–1844. Mrs. Gamp, as
she is usually referred to, is dissolute, sloppy and generally drunk.

1. Florence Nightingale
As the “Mother of Modern Nursing”, no historical account of the profession is
complete without noting Florence Nightingale’s contribution. Reaffirmed in an
article by a leading health care resource provider, the pioneer started her
career by training in Egypt. She then went on to make history with her service
for the British military during the Crimean War, where she developed the Polar
Area Diagram that led to modern hospital sanitation practices.

2. Clara Barton
Clara Barton abandoned her career as a teacher to fill a more pressing role in
delivering medical supplies during the American Civil War. Dubbed the “Angel
of the Battlefield” for her relief efforts, Barton eventually founded the American
Red Cross. She continued her work with the organization through 1904.

3. Mary Beckinridge
As a nurse-midwife, Mary Beckinridge introduced her specialty wherever she
practiced. In 1925, she founded the New Model of Rural Health Care & Frontier
Nursing Service, which delivers health care to underserved rural women and
children. The organization, which significantly reduces maternal and infant
mortality rates, still operate today.

4. Dorothea Dix
Dorothea Dix established the first mental asylum in the early 1800s. She
advocated for mental health rights before Massachusetts state legislators and
the United States Congress. Her work shaped current policies regarding the
rights of the mentally ill.

5. Margaret Sanger
Planned Parenthood Founder, Margaret Sanger, started the organization after
witnessing her mother die at a young age due to complications from
pregnancies. The women’s health advocate spread the message “The Right to
One’s Body” amid tempestuous public opposition. Although hostility forced
Sanger to flee to Europe, she eventually returned to the United States to open
the first birth control clinic.

6. Mary Mahoney
As the first African-American nurse, Mary Mahoney inspired women of color to
enter the nursing practice, which like other professions was segregated in the
1800s. Historical sources reveal that she was one of only four students out of
42 to earn nursing certification in her 1879 class. Mahoney went on to found the
National Association of Colored Graduate Nurses (NACGN) to promote nursing
as a profession among black women in the United States and Canada.

7. Walt Whitman
Commonly known for his poetry, novels and newspaper career, literary icon,
Walt Whitman, also served as a male nurse during the Civil War. The
experience greatly influenced his writing and, in turn, many American readers.

8. Lillian Wald
Nurse Lilian Wald was a co-founder of the National Association for the
Advancement of Colored People (NAACP). Earlier, when her sister became ill,
she instantly became interested in nursing and attended the New York Hospital
Training School for Nurses. Later in life, she participated in the Women’s Peace
Party (WPP), a peaceful World War I protest group. The activist took up several
humanitarian causes during her lifetime and received recognition from many
organizations for her works.

9. Mary Seacole
Jamaica native, Mary Seacole, was born to a free family with few civil rights.
Despite her adversities, she traveled frequently, learning about medicine during
her voyages. During the Crimean War, Ms. Seacole volunteered her knowledge
and time to assist soldiers on the war front. Her work during the conflict earned
her the name “Mother Seacole.”

10. Virginia Avenel Henderson

Known as the most famous nurse of the 20th century, caregiver Virginia Avenel
Henderson influenced professional caregiver education, practice, and research.
Today, nurse educators still use Henderson’s work for training purposes. For
her contributions, the International Council of Nurses awarded her the
Christiane Reimann Prize in 1985.

Nurse practitioners and educators have a firsthand perspective regarding the

current state of health care. The American Nurses Association concurs that the
intricate understanding by professional caregivers of what factors improve or
impede community wellness is clearly a powerful tool. It gives nurses the
knowledge to present the most pressing public health concerns to health care
administrators and government legislators. As a result, patient advocacy is an
ancillary, but critical, responsibility in the modern caregiving environment.
Fortunately, today’s nurses are not alone in their pursuit. Many health care
organizations support wellness initiatives. This has never been more evident,
with virtually every state now reviewing legislation to expand the nurse
practitioner role for the sake of public health. Despite this added support,
exceptional individuals will continue to emerge as leaders among the many — a
noble goal for aspiring nurses.

Microbes keep us slim.

Microbes play an important role in our body shape by helping us digest and
ferment foods, as well as by producing chemicals that shape our metabolic
rates.

Microbiology

Definition, Branches and Applications

What is Microbiology?

Essentially, microbiology is the study of biological organisms that are too small
to be seen with the naked eye (without using such tools as the magnifying glass
or microscope etc). Microbiology is therefore dedicated to studying the lives and
characteristics of a wide variety of organisms ranging from bacteria
and archaea to parasitic worms in their environments.

Here, the discipline is used to learn about all aspects of the organisms
in order to not only determine how they live in their environment, but
also how they impact their respective surroundings and thus other
organisms around them (human beings, animals, etc).

Microbiology has proved to be one of the most important disciplines in biology,

making it possible to identify how some of these organisms cause diseases,
discover cures for such diseases and even use some microbes for industrial
purposes etc.

Some of the fields that microbiologists may specialize in include:

  Immunology
 Soil biology
 Industrial Microbiology
 Biotechnology
 Biogeochemistry
 Microbial genetics
 Aquatic Microbiology

* Although microbiology is, for the most part, described as the study of
microorganisms (those that cannot be seen with the naked eye), such groups
as algae and fungi contain organisms that do not necessarily require the use of
special tools to observe them. Therefore, microbiology also encompasses a
number of organisms that fall outside the traditional definition.

Bacterium

Branches of Microbiology

The different branches of microbiology are classified into pure and applied
sciences as well as taxonomy.

Bacteriology

Bacteriology is the branch of microbiology concerned with the study of bacteria.

This branch is further divided into a number of specializations that include
marine bacteriology, sanitary bacteriology, industrial bacteriology, agricultural
bacteriology, and systematic bacteriology among others.

Here, this branch of microbiology gives focus to such aspects as types of

bacteria and their characteristics, diseases, and application among others.

Mycology
Unlike bacteriology which is the study of bacteria, which are prokaryotic
organisms, mycology deals with the study of fungi which are eukaryotic in
nature. Found in many types of environments, the different types of fungi
(mold and yeast) can be highly beneficial or harmful.

Mycology gives focus to the different properties of these organisms

(characteristics, taxonomy, etc) which has it turn made it possible to use them
in various industries ranging from breweries to food and medicine.

Those who specialize in mycology are known as mycologists.

Protozoology

Protozoology is one of the newer branches of microbiology based on taxonomy.

It is the sub-discipline that deals with the study of protozoa. Like fungi, these
are eukaryotic organisms that include such groups as amoeboids, ciliates,
sporozans , and flagellates.

Given that a good number of these organisms have been associated with
animals and human diseases, protozoologists not only focus on their taxonomy
and morphological aspects for classification purposes, but also for medical
significance.

Some common examples of diseases caused by protozoa include malaria,

sleeping sickness as well as amoebic dysentery.

Phycology

Like mycology, phycology is one of the branches of microbiology that is

concerned with the study of multicellular organisms. Unlike mycology, however,
phycology deals with the study of different types of algae that can be found in
different types of environment.

While they may exist as small microorganisms found floating in the ocean, some
algae grow to form large seaweeds found in the aquatic environments.

Apart from being part of the food chain, algae are also involved in the
production of oxygen which makes them important in microbiology.

Those who study phycology (e.g. Carl Adolph Agardh) are known as
phycologists.
Parasitology

Parasitology is a wide field of microbiology that deals with the study of parasites.
For the most part, parasitology is concerned with organisms found in three
major groups including protozoa, helminths (worms) and arthropods.

Given that parasitology is concerned with disease-causing organisms (as well as

vectors) it has been influenced by a number of other disciplines including
immunology and biochemistry among others.

Like mycology and phycology, parasitology entails the study of both unicellular
and multicellular organisms.

Those who study parasitology are known as parasitologists.

Petri Dish By Pacific Northwest National Laboratory, US Department of Energy

- http://picturethis.pnl.gov/picturet.nsf/by+id/DRAE-8DBTWP, Public Domain

Immunology

Immunology is the sub-discipline that deals with the study of the immune
system. It has been one of the most important areas of study since the 18th
Century whose efforts are directed towards enhancing the immune system to
protect the body from diseases.

It is worth noting that while diseases are caused by various organisms

and foreign substances, they can also result from the immune system
itself in cases of autoimmunity.

By studying the relationship between the body, pathogens and the immune
system, researchers have made significant strides and breakthroughs that have
made it possible to eradicate diseases that were once common in society.

These efforts continue to be seen in studies regarding such diseases and Ebola
among others outbreaks identified in different parts of the world.

A person who studies immunology is known as an immunologist.

Virology

Virology is the branch of microbiology that is concerned with the study

of viruses. Unlike most of the other organisms which are either described as
being unicellular or multicellular, viruses are acellular microbes with simple
structures and need host cells to multiply.

Given that viruses need host cells to multiply, they also, end up affecting the
cells and consequently causing disease.

In virology, researchers also focus on such aspects as biochemistry, distribution,

molecular biology as well as the evolution of viruses which makes

it's possible to not only understand them, but also develop cures to some of the
most serious diseases caused by these parasites (AIDs etc).

Nematology

Nematology is the sub-disciplines that deal with the study of

multicellular nematodes. Also known as roundworms, nematodes include a
variety of organisms (worms) found in a variety of environments on earth (they
can be found in soil, mud, sands, mountains, etc).

According to studies, nematodes are some of the most abundant organisms on

our planet. Nematology, as a branch of microbiology, has allowed for the
classification of these worms based on their general morphology, habitats as
well as whether or not they cause diseases, etc.

Those who study nematology are known as nematologists.

Apart from taxonomy, microbiology is also classified into pure sciences.

Some of the most common categories include:

· Microbial cytology - deals with the structure and function of the organisms
· Microbial physiology - is the branch of microbiology that deals with the
different parts and normal functions of the organisms (functioning of the
different parts of the organism)

· Microbial ecology - branch that deals with the surroundings/habitat of the

organism. This makes it possible to understand how the organism interacts and
affects its surroundings

· Microbial genetics - is concerned with the genetic makeup of the organism.

It is used to identify the different strains and phenotypes of an organism and
classify the organisms as such

objective lens, microscope image (Public Domain)

Applied Microbiology

Whereas taxonomy classification gives focus to the organism and its general
characteristics, applied microbiology is focused on how various organisms can
be used (applied) in given processes or the impact they can have in different
industries.

Some of the most important branches of microbiology based on application

include:

Food microbiology

Research studies focus on a variety of microorganisms that

contaminate/damage food and those that can be used for food
processing/modification among others. As such, microbiology gives special
attention to such microorganisms as molds, yeasts, and bacteria among others
that either benefit or have negative effects on the quality of food material with
public health concern in mind.

* Food microbiology is connected to several other fields (immunology and

molecular biology etc) and entails such aspects as food processing and
preservation, food ingredients, production and fermentation among others.
Medical Microbiology

This is the branch of microbiology that is concerned with the diagnosis,

prevention and treatment of diseases caused by different types of organisms
(infection agents). This sub-discipline is therefore related to a number of other
fields including virology, bacteriology, immunology, and germicrobiology.

Industrial microbiology

This branch of microbiology is concerned with the use of given microorganisms

for industrial production. Here, research studies are directed towards the use of
these organisms to increase and maximize yields in industries like fuel,
pharmaceutical, and chemicals among others. Here, the use of microorganisms
makes it possible to mass produce for a big market.

Agricultural microbiology

Agricultural microbiology is concerned with microbes associated with plants and

animal diseases and production. As such, it is not only concerned with the
medical significance of these organisms, but also their economic importance for
farmers and the industry as a whole. In the process, agricultural microbiology is
aimed to solve issues identified in agricultural practices while helping increase
yields for farmers.

Some of the other branches of microbiology based on application include:

· Soil microbiology - This is the branch of microbiology that deals with

the study of soil microorganisms and how they impact soil properties

· Pharmaceutical microbiology - Concerned with the use of microorganisms

for inhibiting contamination as well as the development of pharmaceuticals

· Veterinary microbiology - Focus on microbes that cause diseases

· Microbial biotechnology - Area of microbiology and biotechnology aimed at

using microbes for beneficial purposes: It is aimed at enhancing microbial
application in the day to day life. A good example of this is the research study
currently being conducted (at the time of writing) to use given bacteria to
replace the traditional sewage systems by the Gates Foundation.
 teach·ing
/ˈtēCHiNG/

noun

the occupation, profession, or work of a teacher.

ideas or principles taught by an authority.

What do you mean by teaching?

A definition: Teaching is the process of attending to people's needs, experiences

and feelings, and intervening so that they learn particular things, and go beyond the

given.

teach·ing
/ˈtēCHiNG/

noun

.
the occupation, profession, or work of a teacher

ideas or principles taught by an authority.

What do you mean by teaching?

A definition: Teaching is the process of attending to people's needs, experiences
and feelings, and intervening so that they learn particular things, and go beyond the
given.

Learning is the process of acquiring new, or modifying existing, knowledge,

behaviors, skills, values, or preferences. The ability to learn is possessed by
humans, animals, and some machines; there is also evidence for some kind
of learning in certain plants.

Health education is any combination of learning experiences designed to help

individuals and communities improve their health, by increasing their knowledge or
influencing their attitudes

Education is the process of facilitating learning, or the acquisition of knowledge,

skills, values, beliefs, and habits. Educational methods include teaching, training,
storytelling, discussion and directed research.

What is the main purpose of health education?

Health education teaches about physical, mental, emotional and
social health. It motivates students to improve and maintain their health,
prevent disease, and reduce risky behaviors. Health education curricula and
instruction help students learn skills they will use to make healthy choices
throughout their lifetime.
There are at least three types of health education. The first and most common is education
about the body and how to look after it. The provision of information and advice on human
biology and hygiene is vital for each new generation. The second is about health
services-information about available services and the "sensible" use of health care resources.
But the third, about the wider environment within which health choices are made, is relatively
neglected. It is concerned with education about national, regional, and local policies, which
are too often devised and implemented without taking account of their consequences for
health. This third type is part of the currently moribund public health tradition. At a time when
many are trying to improve methods of health education at least equal attention should be paid
to its content.