A nursing legacy—political activities at the turn of the century

AORN Journal, Nov, 1999 by Francie Lasseter

As the end of the 1990s approaches, nurses can look back on a rich history of political and professional achievements attained by their predecessors at the turn of the nineteenth century. The experiences and accomplishments of early nurses provide a strong foundation from which nurses today can enhance their profession and shape the public policy that affects it.

The valiant efforts of America's nurse pioneers are best understood and appreciated in the context of the time. Nurses' early political involvement was the result of a variety of societal, economic, and political forces, and is inextricably linked with the introduction of formal education for women, the history of medicine, and the women's suffrage movement.

AMERICA, MEDICINE, AND NURSING

The nineteenth century saw great strides in education opportunities for women in America. In the early 1800s, women generally were admitted to elementary and secondary schools, but were denied admission to most colleges. By the end of the 1870s, these policies had changed, and most state universities began admitting women. This advent of greater education opportunities laid the groundwork for future efforts on behalf of both women and nurses.

During the Civil War, an estimated 10,000 women provided care to sick and wounded soldiers.(1) This brought a new recognition of the importance of nursing and accelerated the movement to formally train nurses and establish hospitals.

New hospitals, new roles for nurses. Although three institutions known as hospitals did exist in the United States in the 1800s, it was not until 1889 that the Johns Hopkins Hospital in Baltimore opened its doors as the first hospital to incorporate the modern model of scientific method and treatment of disease. As physicians embraced the revolutionary changes in medicine--and the resulting improvement in patient outcomes--nurses' participation was required in new ways.

In addition, as physicians assumed more responsibilities related to the new model of medicine, some of their previous duties became part of nursing practice. These changes significantly changed the work of nurses, and the profession faced a host of new demands and opportunities. By the end of the nineteenth century, the number of hospitals in the country had grown from 178 in 1873, to more than 2,500.(2)

First American nurse training schools. As American health care advanced, so did nursing. Although rudimentary efforts to educate nurses did exist in the mid-1800s, it was not until 1872 that the first training schools for nurses opened at the New England Hospital for Women and Children in Boston and the Women's Hospital Training School for Nurses in Philadelphia. These were followed in 1873 by the opening of the first nursing schools to incorporate Florence Nightingale's model of nurse education: the Bellevue Training School for Nurses in New York, the Connecticut Training School for Nurses in New Haven, and the Boston Training School for Nurses.

These three schools were founded and run by nurses in response to the deplorable conditions in US hospitals and were the first to stress clinical techniques of sanitation and safety. The opening of the Johns Hopkins Hospital school of nursing further attested to the importance of employing skilled nurses when practicing modern medicine and performing more complicated procedures. Graduates of these more sophisticated nursing schools would be instrumental in shaping the future of the profession.(3)

Responding to public beliefs. Professional and public acceptance of nursing was not consistent throughout the profession's development. During much of this time, nursing was widely regarded as an occupation to which women were born--a profession that possibly required apprenticeship, but no formal education. Although many physicians appreciated the value of trained nurses and encouraged the development of the profession, the acquisition of nursing knowledge and skills was not universally welcomed. In 1908, Gilman Thompson, MD, published an article titled "The overtrained nurse" in the New York Medical Journal, stating "Nursing is not, strictly speaking, a profession.... Nursing is an honorable calling, nothing further."(4)

Nursing often was considered to be similar to a religious "calling" for women and an occupation that should not concern itself with current affairs. This belief was influenced in part by the early religious orders in which the practice of nursing is rooted.

Interestingly, in the same year of Dr Thompson's article, a federal investigation of women's occupations that were considered "morally dangerous" was conducted as a result of the 1908 US Supreme Court case of Muller v Oregon--a case that involved the length of female factory employees' work days. The investigation identified five occupations that fell into this morally dangerous category, and among them was nursing.(5)

This distinction underscored the challenging and often grueling conditions of the profession and may have added to some nurses' desire to distance the occupation from practical or worldly matters.(6) Keep in mind that in the early 1900s women were not only excluded from judicial positions, but also not allowed to vote. Even in this difficult climate with its perceptions and restrictions, early nurse activists remained strong in their convictions and persevered to create a profession that would become highly respected and valued.