Real World Interview
The possibilities and the problems we confront in our daily work raise new questions that we look to documents in our archives to answer. Our generation wonders how groups of nurses influenced broader movements of social change, transforming their lives as well as those of their patients and communities, and created opportunities and aspirations that took them beyond the health care system itself.
Patricia D'Antonio, PhD, RN, FAAN
Carol E. Ware Professor in Mental Health Nursing
Director, Barbara Bates Center for the Study of the History of Nursing
University of Pennsylvania School of Nursing
Philadelphia, Pennsylvania.
Case Study 3.2
Adah Belle Thoms graduated from the Lincoln Hospital School of Nursing in 1905, a New York City school only for Black students, although under White administration. During the First World War, nurses volunteering for war service joined the American Red Cross but Black nurses were rarely accepted. Only during the last month of the war, in the fall of 1918, were 24 Black nurses called up. Meanwhile, 22,000 White nurses had been accepted. Seeing the futility of trying to volunteer, Thoms set up an organization of Black nurses called the Blue Circle Nurses, which was associated with the recently founded Circle for Negro War Relief. These nurses functioned as public health nurses for needy Black families. In 1929, Thoms was appointed the first Black Assistant Superintendent of Nurses at Lincoln Hospital. That same year, Thoms' book, Pathfinders, the first account of prominent Black nurses, was published (Clark Hine, 1989).
Consider why Black patients, nurses, medical, and ancillary staff needed Black hospitals during the late nineteenth and early twentieth centuries.
Thoms was a remarkable early nurse leader, as evidenced by her organization of the Blue Circle Nurses, her administrative work, and her book, all accomplished within the context of rampant racism. Can you identify some leadership qualities she might have possessed to support her in accomplishing all this?
Professional Nursing Matures
Nursing education was, in some respects, a victim of its own success. Nursing students were both superior to untrained women and cheaper than graduate nurses. Nursing students were highly disciplined and compliant young women who could work longer and harder than nursing employees at a fraction of the cost. Nursing students were expected to work at least 8 hr a day and then spend time preparing for classes. In most schools, students worked more than 48 hr a week on day duty and, in about 40% of schools, they worked over 70 hr a week on night duty (Committee, 1934, p. 166). Disturbingly, most of the nursing superintendents in the mid‐1920s preferred student nurses rather than graduate nurses to give patient care. Some of their reasons were: “The student nurse is less apt to be careless in technique, gives better cooperation in regard to hospital regulations, is less extravagant with hospital linen and supplies, and with the help and advice of an experienced supervisor, gives her patients care equal to that of the graduate”… “Graduates on general duty are demanding, exacting, and shifting” (Burgess, 1928, p. 412).
The 1920s and 1930s: Evolving Hospital Nursing
The nurse training period in the 1920s was typically 3 years. This time was mainly spent working within different wards of the hospital and attending lectures after work. But this was not an apprenticeship. The students were the nurses for the hospital patients. They were not practicing under the direction of graduate nurses. A national study by the Committee on the Grading of Nursing Schools in the early 1930s found that two‐thirds of the schools did not have even one graduate nurse employed for bedside nursing (Committee, 1934, p. 180). Upon graduation, the new crop of nurses were given a diploma and left the hospital, mainly to work as nurses in private homes, while the hospital nurse training school admitted a new batch of students. Hospital administrators could not ignore the advantage of an unpaid nursing workforce and the number of nurse training schools mushroomed. In 1880, there had been 15 schools. In 1920, there were 2,155 schools (Burgess, 1928, p. 35). However, many of these new nurse training schools were situated in small or specialist hospitals, entirely unsuited to general nursing education. Furthermore, as noted earlier, African Americans were rarely accepted as students or nurses at White hospitals, while men were rarely accepted at any hospital or nurse training school. A few male only and African American only nurse training schools were founded; the latter also served as training and practice sites for African American physicians and other health care workers.
Nurse leaders were concerned at the direction nursing education was taking. Some university schools of nursing were opening and the large teaching hospitals still gave a broad education and attracted well‐educated nursing students. But these nurse training schools were in the minority. The Committee on the Grading of Nursing Schools, cited earlier, publicized this issue but did not correct it. The correction came from the financial collapse of the Great Depression. In essence, people could not afford to hire nurse training school graduates as private duty nurses. Thus, the graduate nurses were desperate for work and accepted positions in hospitals for just their room and board. This being even cheaper for hospitals than operating training schools, the smaller, poorer schools rapidly began to close. From 1926 to 1936, there was a drop in the number of hospital‐based diploma nursing schools nationwide, from 2,155 schools in 1926 to 1,478 schools in 1936 (JAMA, 1937).
Case Study 3.3
Anne Larson Zimmerman, born in 1914, graduated with her diploma in nursing in 1935. Later she remembered a nursing school instructor whom she had greatly admired, who told Zimmerman that she, “had been promised when she came that if her work was satisfactory after the first year, she would be given a raise in salary,” and then the superintendent said to her, “Well, we're doing so much charity and we are so poor that we really won't be able to give you a raise,” and she said, “Well, but sister, I am doing your charity, not you … and I don't think I should subsidize what you call your charity” (Fitzpatrick, 1985, p. 2). Zimmerman's nursing school instructor's words remained with her as she worked as a single mother in Montana, California, and finally in Illinois. As the Executive Director of the Illinois Nurses Association, Zimmerman encouraged nurses to stand up for their rights. At Chicago's Cook County Hospital, where the conditions for nurses and patients were awful, a colleague remembered that Zimmerman “was excellent. There on every picket line. Always there. She would never ask you to do something she had not done herself” (Stafford, 2016). As President of the ANA from 1976 to 1978, Zimmerman advocated for economic welfare for nurses, nationalized health care, and passage of the equal rights amendment. Not surprisingly, Zimmerman successfully argued that the ANA president deserved a salary.
With some insight into nursing history, what do you think about nurses unionizing today?
Zimmerman remembered a former nursing instructor who would not accept the superintendent's denial of her raise. What is your opinion of the nursing instructor's argument that she should not have to subsidize “what you call your charity”? Figure 3.4
Source: Anne Zimmerman Collection, Midwest Nursing History Research Center, University of Illinois at Chicago, College of Nursing.
Collegiate Education in Nursing
Mary Adelaide Nutting, a renowned nurse educator and activist, declared in 1908, “There is no place in its (the hospital) strenuous scheme