Connecticut nursing history vignettes

Connecticut Nursing News, Jun-Aug 2001 by Herrmann, Eleanor Krohn

This is the tenth in a she- of vignettes about Connecticut nursing history written by Eleanor Krohn Herrmann, Nurse Historian and Professor Emeritus, University of Connecticut

Licensure: The Early Years

As the end of the current academic year approached, graduating seniors turned their attention toward taking the examination that would determine their licensure status as registered professional nurses. Since April 1, 1994, the exam, called NCLEX-RN (the National Council Licensure Examination for Registered Nurses), has been in the form of computerized adaptive testing. That technology provides each candidate with a unique exam because it is assembled interactively as the individual's level of nursing competence and critical thinking are determined through their responses to the test questions. Once eligibility to take the exam had been authorized by the state health department, the candidate scheduled a date and time for the exam at one of the testing centers. Results, reported as "pass" or "fail," are generally available in two to three weeks. How different from times past!

Initially, the term "registered nurse" (R.N.) was introduced because it would bring about legal recognition of a nurse as a professional and would distinguish trained nurses who had met specified standards from those who were inadequately prepared or who were outright impostors. In Connecticut, registration for nurses was established in July 1905. It was permissive - that is, voluntary - as it was not mandated in order to practice nursing; it simply limited the use of the title R.N. to qualified nurses. It is believed that Mary L. Bolton, a Bridgeport Hospital Training School for Nurses graduate, became Connecticut's first registered nurse in the same year. A mandatory Connecticut licensure law was passed in 1913-14.

The first written exams for licensure in Connecticut were offered on June 17, 1908 to eleven individuals who were deemed eligible by the state board of examination and registration of nurses. The early licensure exams consisted of six sections: medical nursing, surgical nursing, dietetics and home sanitation, obstetrical nursing, anatomy and physiology and materia medica. There was no mention of pediatric or psychiatric nursing, clinical specialties that only began to evolve in the early 20th century. Until the mid 1940s, each state generated its own exam. The exams were written, administered and scored by members of the state board, all of whom were considered leaders in nursing. For example, the Connecticut examiners in 1929 were Martha Wilkinson, Mary Grace Hills, Sarah Hyde, Winifred Hart and Annie Crane, each of whom, with the exception of the latter, had been or became a president of what is now known as the Connecticut Nurses' Association.

The format of the early exams consisted of questions which candidates responded to in handwritten essays or via "columns and lists." The candidates had a choice of answering ten of twelve questions in each of the six sections of the exam. Marguerite Manfreda and Bernadine Potrepka, both 1933 graduates of,the, Hartford Hospital Training School for Nurses; recalled that their two-day-long exam, taken in the state capitol, also included some true/false questions. The results were reported in percentages for each section of the exam. No documentation was found to indicate that penmanship, organization, or use of the English language militated against equitable grading. Exams composed entirely of objective type test items - primarily multiple-choice questions came later and could be more quickly and equitably scored by either a standardized hand-prepared or machine scoring stencil.

There is no evidence to indicate that the early candidates engaged in formal preparatory review courses. However, it is known that a book entitled State Board Questions and Answers for Nurses, compiled by John Foote, M.D., was published in 1917. It contained questions and answers that had been submitted by 31 state examining boards for nurses. The reader was not offered any guidance about the actual test-taking process.

The 1929 Connecticut exam takers were advised that certificates of registration for those who passed the examination would not be available "for at least three months following examination." Those who failed to "make 70 per cent, in not more than three subjects [were] entitled to reexamination at the next regular examination period without further application, fee, or inquiry." The "next regular examination period" was usually several months hence since the exams were offered only twice yearly and were scheduled to closely approximate the semi-annual completion dates for graduates of hospital schools of nursing. There"was an additional-interesting twist to that scheduling. Students who had not yet completed the prescribed course of training (that usually meant not having fulfilled the required number of clinical days), but were close to finishing them, were allowed to take the examination. However, even if they passed the exam, they did not receive their certificate of registration until the board of examiners was assured by the superintendent of the training school that they had completed the school's course and had been awarded a diploma from the school.