The history of nursing in the United States focuses on the professionalization of Nursing in the United States since the Civil War.
Origins Before the 1870s "women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession ...and society at large". Nursing had the much the same lowly status in Europe. However D'Antonio shows that in the mid-19th century nursing was transformed from a domestic duty of caring for members of one's extended family, to a regular job performed for a cash wage. Nurses were now hired by strangers to care for sick family members at home. These changes were made possible by the realization that expertise mattered more than kinship, as physicians recommended nurses they trusted. By the 1880s home care nursing was the usual career path after graduation from the hospital-based nursing school.
Civil War During the American Civil War (1861–65), the United States Sanitary Commission, a federal civilian agency, handled most of the medical and nursing care of the Union armies, together with necessary acquisition and transportation of medical supplies. Dorothea Dix, serving as the Commission's Superintendent, convinced the medical corps of the value of women working in 350 Commission or Army hospitals. In both the North and South, over 20,000 women volunteered to work in hospitals, usually in nursing care. They assisted surgeons during procedures, administered medicines, supervised the feedings of patients, and cleaned bedding and clothes. They gave good cheer, wrote letters the patients dictated, and comforted the dying. A representative nurse was Helen L. Gilson (1835–68) of Chelsea, Massachusetts, who served in Sanitary Commission. She supervised supplies, dressed wounds, and cooked special foods for patients on a limited diet. She worked in hospitals after the battles of Antietam, Fredericksburg, Chancellorsville, Gettysburg. She was a successful administrator, especially at the hospital for black soldiers at City Point, Virginia. The middle-class women North and South who volunteered provided vitally needed nursing services and were rewarded with a sense of patriotism and civic duty in addition to opportunity to demonstrate their skills and gain new ones, while receiving wages and sharing the hardships of the men.
Mary Livermore, Mary Ann Bickerdyke, and Annie Wittenmeyer played leadership roles. After the war, some nurses wrote memoirs of their experiences; examples include Dix, Livermore, Sarah Palmer Young, and Sarah Emma Edmonds. Clara Barton (1821-1912) gained fame for her nursing work during the American Civil War. She was an energetic organizer who established the American Red Cross, which was primarily a disaster relief agency, but which also supported nursing programs.
Several thousand women were just as active in nursing in the Confederacy, but were less well organized and faced severe shortages of supplies and a much weaker system of 150 hospitals. Nursing and vital support services were provided not only by matrons and nurses, but also by local volunteers, slaves, free blacks, and prisoners of war.
Professionalization Nursing professionalized rapidly in the late 19th century following the British model as larger hospitals set up nursing schools that attracted ambitious women from middle- and working-class backgrounds. Agnes Elizabeth Jones and Linda Richards established quality nursing schools in the U.S. and Japan. Richards was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston. Hospital nursing schools in the United States and Canada took the lead in applying Nightingale's model to their training programs. For example, Isabel Hampton Robb (1860–1910), as director of the new Johns Hopkins Hospital Training School for Nurses, deliberately set out to use advanced training to upgrade the social status of nursing to a middle class career, instead of a low pay, low status, long hours, and heavy work job for working-class women.
After 1880, standards of classroom and on-the-job training rose, as did standards of professional conduct. For textbooks, many schools used: A Manual of Training (1878); A Hand-Book of Nursing for Family and General Use (1878); A Text-Book of Nursing for the Use of Training Schools, Families, and Private Students (1885); and Nursing: Its Principles and Practice for Hospital and Private Use (1893). These books defined the curriculum of the new nursing schools and introduced nurses to modern medical science and scientific thinking.
In the early 1900s, the autonomous, nursing-controlled, Nightingale-era schools came to an end. Schools became controlled by hospitals, and formal "book learning" was discouraged in favor of clinical experience. Hospitals used student nurses as cheap labor. In the late 1920s, the women's specialties in health care included 294,000 trained nurses, 150,000 untrained nurses, 47,000 midwives, and 550,000 other hospital workers (most of them women).
Sandelowski finds that by 1900 physicians were allowing nurses to routinely use the thermometer and stethoscope, and in some cases even the new X-ray machines, microscopes and laboratory testing tools. For the first time, nurses could supplement their subjective observations with scientific tools. Most nurses remained at the bedside, where they used the new technology to gather information for doctors, but were not allowed to make a medical diagnosis. Their bond with the patient remained their primary role.
The John Sealy Hospital Training School for Nurses opened in 1890 in Galveston, Texas. It grew rapidly and in 1896 became the School of Nursing, University of Texas; it was the first nursing school to become part of a university in the state of Texas. In recent decades, professionalization has moved nursing degrees out of RN-oriented hospital schools and into community colleges and universities. Specialization has brought numerous journals to broaden the knowledge base of the profession. Very few blacks attended universities with nursing schools. The solution was found by the Rockefeller's General Education Board, which funded new nursing schools headed by Rita E. Miller at Dillard University in New Orleans (1942) and by Mary Elizabeth Lancaster Carnegie at Florida A. & M. College in Tallahassee (1945).
Hospitals The number of hospitals grew from 149 in 1873 to 4,400 in 1910 (with 420,000 beds)U.S. Bureau of the Census, Historical Statistics of the United States (1976) p 78 to 6,300 in 1933, primarily because the public had more trust in hospitals and could afford to pay for more intensive and professional care. Most larger hospitals operated a school of nursing, which provided minimal training to young women, who in turn worked without pay. The graduates obtained RN status, but there was little professional work for them. Hospitals only hired a few; in the 1920s, 73 percent employed no graduate nurses, and only 12 percent employed five or more. Most RNs worked for private families, or left nursing.Susan M. Reverby, Ordered to Care: The dilemma of American Nursing 1850-1945 (1987) p. 188. The number of active graduate nurses rose rapidly from 51,000 in 1910 to 375,000 in 1940 and 700,000 in 1970.Historical Statistics of the United States (1976) p 76
Hospitals were operated by city, state and federal agencies, by churches, by stand-alone non-profits, and by for-profit enterprises run by a local doctor.
Religious hospitals All major religious denominations in the United States built hospitals staffed by primarily by unpaid student nurses supervised by some graduate nurses. Catholics led the way. In 1915, the Catholic religious orders for women operated 541 hospitals. Costs were minimized relying on the work of women students who paid tuition and nuns who had taken a vow of poverty.
The Lutheran and Episcopal denominations also entered the health field, especially by setting up orders of women, called deaconesses who dedicated themselves to nursing services. The modern deaconess movement began in Germany in 1836. William Passavant in 1849 brought the first four deaconesses to Pittsburgh, in the United States, after visiting Kaiserswerth. They worked at the Pittsburgh Infirmary (now Passavant Hospital).
American Methodists engaged in large-scale missionary activity in Asia and elsewhere in the world, making medical services a priority as early as the 1850s. Methodists in America took note, and began opening their own charitable institutions such as orphanages and homes for the elderly after 1860. In the 1880s, Methodists began opening hospitals in the United States, which served people of all religious backgrounds. By 1895, 13 Methodist hospitals were in operation in major cities.
In 1884, U.S. Lutherans, particularly John D. Lankenau, brought seven sisters from Germany to run the German Hospital in Philadelphia.
By 1963, the Lutheran Church in America had centers for deaconess work in Philadelphia, Baltimore, and Omaha.
Public health
Public health nursing after 1900 offered a new career for professional nurses in addition to private duty work. The role of public health nurse began in Los Angeles in 1898, and by 1924, there were 12,000 public health nurses, half of them in America's 100 largest cities. Their average annual salary of public health nurses in larger cities was $1390. In addition, there were thousands of nurses employed by private agencies handling similar work. Public health nurses supervised health issues in the public and parochial schools, supplied prenatal and infant care, provided dental care, handled communicable diseases such as tuberculosis, and dealt with an aerial diseases.United States Public Health Service, Municipal Health Department Practice for the Year 1923 (Public Health Bulletin # 164, July 1926), pp. 348, 357, 364Barbara Melosh, "The Physician's Hand": Work Culture and Conflict in American Nursing (1982) pp 113-57.
Historian Nancy Bristow has argued that the great 1918 flu pandemic contributed to the success of women in the field of nursing. This was due in part to the failure of medical doctors, who were predominantly men, to contain and prevent the illness. Nursing staff, who were predominantly women, felt more inclined to celebrate the success of their patient care and less inclined to identify the spread of the disease with their own work.Lindley, Robin, The Forgotten American Pandemic: Historian Dr. Nancy K. Bristow on the Influenza Epidemic of 1918 ; Nancy K. Bristow American Pandemic: The Lost Worlds of the 1918 Influenza Pandemic (Oxford, 2012).
During the Great Depression, federal relief agencies funded many large-scale public health programs in every state, some of which became permanent. The programs expanding job opportunities for nurses, especially the private duty RNs who suffered high unemployment rates.Melosh, The Physician's Hand, pp 144-45Kalisch and Kalisch, Advance of American Nursing (1986) pp 474-84
In the United States, a representative public health worker was Dr. Sara Josephine Baker who established many programs to help the poor in New York City keep their infants healthy, leading teams of nurses into the crowded neighborhoods of Hell's Kitchen and teaching mothers how to dress, feed, and bathe their babies.
The federal Office of Indian Affairs (OIA) operated a large-scale field nursing program. Field nurses targeted native women to increase health education, emphasizing personal hygiene, infant care, and nutrition.Christin L. Hancock, "Healthy Vocations: Field Nursing and the Religious Overtones of Public Health," Journal of Women's History (2001) 23#3 pp 113-137
Military nursing