Modern nursing, a predominately although not exclusively women's field, began during the Civil War, when those women who volunteered to nurse sick and wounded soldiers proved that careful attention to proper sanitation, nourishing diets, cleanliness, and comfort dramatically cut shockingly high morbidity and mortality rates. After the war the volunteers spearheaded a movement for formal nurses' training. Simultaneously, hospitals also recognized a need for more skilled, disciplined, and competent nurses to improve the quality and efficiency of care.
By the early twentieth century women wishing to nurse "bartered" two or three years of service to hospitals in exchange for a diploma that promised entry into a respectable, autonomous form of work, free from the constraints that accompanied other "women's" occupations, such as teaching, factory labor, or domestic service. But it was not always a fair exchange. Hospitals quickly recognized student labor as a cheap and easily exploited commodity. They structured training around their own staffing needs. Upon graduation, nurses found themselves in sex-stereotyped, overcrowded, and isolated practice, competing for jobs with poorly trained women and also with new nursing graduates.
Leaders among nurses -- most often the directors of large, prestigious, urban schools -- addressed these problems by attempting to professionalize nursing education and practice. By the early 1920s, nurses created the American Nurses Association (ANA), and successfullylobbied for strict registration credentials. However, the initial registration laws were voluntary.
It was not until the 1930s that registration became a legal prerequisite to practice. By that time, nurses themselves had actively proved their worth. Public health nurses, in particular, had moved aggressively to carve an independent domain of responsibility for the health care of immigrants and the working poor in urban areas. Funded by both private and public monies, these women brought health care to those people whom other clinicians were unable or unwilling to serve.
African Americans similarly supported their own community's nurses. Barred by racist custom and often by law from working in the U.S. health care system, Black communities established hospitals for their sick and offered nurses' training schools for Black women. These activities strengthened the reciprocal bonds between Black nurses and the people they served, despite the nurses' continued exclusion from the white-run health care system. African American nurses established an ongoing commitment to care for people of color, particularly in the South, where doctors were scarce and health care limited. These nurses garnered respect and a status within the Black community often denied their white sisters, although they earned less and worked under much harsher conditions.
In 1908 African American nurses, excluded from many of the state nurses' associations, organized the National Association of Colored Graduate Nurses (NACGN) to represent their interests and to push for full integration into nursing's social and professional life. Their moment came at the end of World War II when, in 1945, the army and the navy nurse corps opened their doors to African American nurses. In 1948 the ANA followed suit and in 1951 the NACGN disbanded. In 1971 the National Black Nurses Association formed, both out of concern that the ANA had failed to recognize the contributions of African American nurses and out of a vision to increase the numbers of and the opportunities for all nurses of color.
In the postwar era, rapid changes occurred in health care treatments, technologies, research, and financing. These changes redefined nursing practice. In the new intensive care units, for example, one's background and education (in nursing, as in other professions, code words for race and class) often mattered less than one's skill and competence. Nurses then began organizing in new ways. Clinical associations now promised to be a bridge of sorts among nurses from diverse backgrounds and with professional aspirations.Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890 - 1950, Darlene Clark Hine (Bloomington: Indiana University Press, 1989)Ordered to Care: The Dilemma of American Nursing, 1850 - 1945, Susan Reverby (Cambridge: Cambridge University Press, 1987)
Patricia D'Antonio
(c) Copyright 1998 Houghton Mifflin
