Achieving Professional Status

Achieving Professional Status: Early Days

Gaining Autonomy - Control over Practice

National and State Nurse Organizations and Nurse Practice Acts

Looking back at nursing’s struggle for autonomy, it is important to consider the status of women in the nineteenth and early twentieth century.. Victorian ideas regarding women in society were the norm. Women lacked legal rights and had no political power. Ashley points out that “the movement of nurses to organize themselves was the result of feminine initiative”.[i] This identified an urgent need for nurses to join together –to organize – in order to obtain control over their practice.

Roberts, writing about the rise of organized nurses, states that the success of ‘trained’ nurses “stimulated an unwholesome, mushroom growth of training schools” as well as ‘short’ courses for nurses.[i] Correspondence schools offered courses that promised ‘high’-for that time- earnings as a trained nurse. The 1880s and early twentieth century saw increases in community and private, physician owned, specialty hospitals. Many of these hospitals started their own nurse training schools as this was seen as an economical way of providing patient care. Isabel Hampton (m. Robb), while acknowledging the good accomplished by the small community hospitals in providing medical care in communities that otherwise may not have a nearby medical care facility, expressed concern about the quality of training these provided .Hampton acknowledged that “many do excellent work and turn out competent graduates”. Specialty hospitals also offered nurse training schools; Hampton wrote that ‘while their graduates were competent in the care of patients with their specific disease or condition they lacked the wider range of experiences and education obtained in a larger, general hospital’. The specialty hospital school circulars claimed that their school offers a thorough well rounded nursing education which due to the limitation on the variety of patients admitted to the hospital, the school cannot provide. As the graduate of the specialty school received the same title and claimed the same public recognition awarded to graduate nurses who had a wider range of experiences and education obtained in a larger, general hospital. [i]

Using New York State as an example in 1900 New York state estimated there were 5,000 untrained nurses and about 2,500 formally trained nurses. Their training consisted of anywhere from six months to three years in a formal hospital setting. There was little control over the quality or content of nursing education at this time.[ii]

The practice of nursing requires specialized knowledge, skill, and independent decision making. There is a risk of harm to the public if nursing care is practiced by professionals who are unprepared or incompetent. It is the responsibility of the state, through its police powers, to protect its citizens from harm, to establish reasonable laws to regulate nursing.[iii]Given the differences in graduate nurse with formal nurse training and those women, without formal training, but self-professed to having nursing experience, and offering their services, how could a member of the general public evaluate which to hire to care for themselves or a family member? These concerns lead to state nursing associations working to secure standards for nursing practice. This movement lead to the establishment of Nurse Practice Acts and state licensure.[

Looking back at nursing’s struggle for autonomy, it is important to consider the status of women in the nineteenth and early twentieth century.. Victorian ideas regarding women in society were the norm. Women lacked legal rights and had no political power. Ashley points out that “the movement of nurses to organize themselves was the result of feminine initiative”.[i] Thus, the urgent need for nurses to join together –to organize – in order to obtain control over their practice.

Roberts, writing about the rise of organized nurses, states that the success of ‘trained’ nurses “stimulated an unwholesome, mushroom growth of training schools” as well as ‘short’ courses for nurses. Correspondence schools offered courses that promised ‘high’-for that time- earnings as a trained nurse

Typical Ad of the period… Many of the correspondence schools offered nursing caps, capes and school pins.

Typical Ad of the period… Many of the correspondence schools offered nursing caps, capes and school pins.

Credentialing

Fitzpatrick, defines credentialing as a “process by which specific qualifications are formally endorsed” - ’ credentialing procedures include licensure, certification, accreditation and documentation. Nursing uses all four processes; individuals are awarded documents such as degrees after satisfactory completion of a program; licenses are issued by government agencies and professional nursing organizations issue certifications to those who demonstrate competence in a specialty.

Credentialing protects the public by defining required education and setting practice standards. Before there were nurse practice laws and licensed nurses, members of the public had no way of differentiating between the trained –graduate- nurse and the untrained ‘nurse’ without formal training.’. .Credentialing also helped graduate nurses who in competing for work with the untrained ‘nurses’ who usually charged less for their work.

The 1880s and early twentieth century saw increases in community and private, physician owned, specialty hospitals . Many of these hospitals started their own nurse training schools as this was seen as an economical way of providing patient care. Isabel Hampton (m. Robb), while acknowledging the good accomplished by the small community hospitals in providing medical care in communities that otherwise may not have a nearby medical care facility, expressed concern about the quality of training these provided; Hampton acknowledged that “many do excellent work and turn out competent graduates”.

Specialty hospitals also offered nurse training schools; Hampton wrote that ‘while their graduates were competent in the care of patients with their specific disease or condition they lacked the wider range of experiences and education obtained in a larger, general hospital’. The specialty hospital school circulars claimed that their school offers a thorough well rounded nursing education which due to the limitation on the variety of patients admitted to the hospital, the school cannot provide. As the graduate of the specialty school received the same title and claimed the same public recognition awarded to graduate nurses who had a wider range of experiences and education obtained in a larger, general hospital.

Using New York State as an example in 1900 New York state estimated there were 5,000 untrained nurses and about 2,500 formally trained nurses. Their training consisted of anywhere from six months to three years in a formal hospital setting. There was little control over the quality or content of nursing education at this time.

The practice of nursing requires specialized knowledge, skill, and independent decision making. There is a risk of harm to the public if nursing care is practiced by professionals who are unprepared or incompetent. It is the responsibility of , the state, through its police powers, to protect its citizens from harm, to establish reasonable laws to regulate nursing.[ii] Given the differences in graduate nurse with formal nurse training and those women, without formal training, but self-professed to having nursing experience, and offering their services, how could a member of the general public evaluate which to hire to care for themselves or a family member? These concerns lead to state nursing associations working to secure standards for nursing practice. This movement lead to the establishment of Nurse Practice Acts and state licensure.

After graduation from their basic nurse training program, graduates many were working as private duty nurses and were ‘isolated’ from their classmates. Isabel Hampton, Lavinia Dock and Adelaide Nutting and other leaders realizing that in order to achieve goals, nurses needed to unite in order to take charge of their practice. Alumnae associations were started at several schools: Bellevue Hospital Training School formed their alumnae association in 1889; Illinois Training School in 1891 and Johns Hopkins in 1892, formed alumnae associations.[. These alumnae organizations communicated with their members and other alumnae organizations . They served as “mechanisms for effecting progressive changes in nursing practice, education and service and have provided standards so vital to the improvement of patient care.”