THE LIMITS OF “COLLABORATIVE RELATIONSHIPS”

BEF 644: Philosophy of Science and its Relation to Education

Chineda Hill and Curt Spires

Crisis in Nursing

Licensure laws

Overproduction of nurses and low standards

Physicians create unified profession

Nurses sought to define professional nursing

World War I and the Nursing “Madness”

Supplementary voluntary aide system

Mobilization of “Leisure class” women

Army School of Nursing

War and pandemic years

World War I and the Nursing “Madness”

cont’d American Hospital Association call for “hospital

helpers”

“Sub-nurses”

Chicago Training School for Home and Public Health Nursing

“The Great Hope” Study on public health nursing

Goldmark Report

Nursing divided

“FAILURE OF THE GRADING SOLUTION”

The Grading Solution

National League of Nursing Education’s Committee on Grading

Reviewed results of Goldmark report Organized “independent” study including

representatives from major nursing, hospital, public-health & medical associations

AMA NOT happy because study NOT AMA controlled

Grading Committee Objectives

Survey comprehensively nursing’s ills & propose necessary changes

Study supply & demand for nursing services

Job analysis of nursing work Grading of nursing schools Prove quantitatively & objectively

problems nursing faced

Grading Report Findings

First published in 1928 as Nurses, Patients and Pocketbooks

Oversupply of nurses & increasing unemployment

Undersupply of nurses able to provide skilled & complex care at reasonable costs

Crisis Facing Nursing

One out of every 590 people in US is an active graduate nurse

2296 schools of nursing in the US – numbers seem to be increasing

This year (1928) 20,000 new graduates entering profession

Average professional life of the nurse is little more than 17 years

Crisis Facing Nursing Continued

Of the 20,000 new graduates, nearly half are women who have never finished high school – academic education is less than that of stenographers, typists or file clerks

Under educated women coming not only from small hospitals, but from larger ones as well

Only 3 out of 10 graduate nurses belong to the American Nurses’ Association

Grading Committee Overall Work

Best Summarized as

Why Not Improved Training for Fewer Nurses

Other Points of Grading Committee

Class distinction – “Working class” vs. “High-grade”

Wanted to exclude certain “classes”“Somehow these undereducated women, in

inadequate social and academic backgrounds must be kept out of the profession. Fortunately there is no longer any need for them….Therefore our first problem … how can women be kept out of nursing who manifestly have not the proper background to enter”

“ABANDOMMENT OF PRIVATE DUTY”

Private Duty Nursing

Majority of “trained nurses” employed in the home setting

“Trained Nurses” competed with cheaper services of the “untrained nurse” & charitable services of the public-health nurses

Well-to-do patients began utilizing hospitals & private duty nurses began to “special” them in the hospital as compared to the home

Private Duty Nursing

Expensive Service – less utilization Private duty nurses can’t find

employment in the home because patients admitted to hospital – can’t find employment in the hospital because of hospitals use of undergraduate (student) nurses

1932-33 Sixty (60) percent of ALL nurses unemployed

Private Duty Nursing

Depression era had significant impact on use of Private Duty

Many nurses left profession entirely due to inability to obtain work

Various “remedies” attempted – group practice, community health nursing partnerships, etc.

Private Duty Nursing

Grading Committee’s final report (1932) “Too many, yet too few trained nurses” Too many ill-prepared Too few “broadly-experienced,

professionally-minded”

Private Duty Nursing

Physician’s increasing power & professional autonomy impacted nursing profession

Ill-trained and subordinate ranks of nurses impacted profession

Nursing administration unable & unwilling to make bold moves to transform nursing education waited as change swirled around them