Definition of Profession

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Achieving  Professional Status

Gaining Autonomy - Control Over Practice

In the beginning, after graduation from a hospital school of nursing, most graduate nurses earned their living as private duty nurses  in the patient’s home . Hospitals did not require the services of graduate nurses as students provided nursing care. In some cases the hospital would hire a recent graduate as a head nurse or supervisor. Private duty assignments were obtained through hospital registries or directories. [i]  Private duty nurses had no control over their assignment or their pay; the registry or directory, obtained their assignments and set the rate of pay.  Between assignments, the nurse was unemployed without any income from nursing.

In 1893, twenty-one years after the graduation of Linda Richards in 1872, The American Society of Superintendents of Training Schools for Nurses was founded at the World’s Columbian Exposition in Chicago.[i]  The  Superintendents Society was founded in response to the chaotic conditions in nursing education and in practice. [ii]Four years later, in 1897, the Superintendents Society helped form the Associated Alumni of Trained Nurses of the United States and Canada which I 1911 became the American Nurses Association. 

The establishment of these two organizations was the start of achieving professional status for nurses   Prior to that time, nurses graduated and entered practice but except for hospital  alumni organizations were isolated. National organizations provided a forum for the exchange of ideas, sharing of concerns  and planning for progress. Birnbach and Lewenson, state that “unification was identified as a key to development of a respected profession”.[i]

In 1897, discussing Directories for Nurses , Lavinia Dock, considered three (3) general principles;

1.      “It should be for the nurses themselves to fix the rates of payment charged in private duty and to states these rates to the registry – not the registry to the nurses.”

2.      “The woman who nurses should be paid equally with the men who nurses”

3.      “The principle of self-government lies at the bottom of what we do, but how far are we from carrying out this principle in practice? Our fault lies in the lack of organization.[i]

The nurse leaders who formed and led the early organizations considered nursing to be profession.  At the fourth annual convention of the Super intents Society in 1897, President M. Adelaide Nutting began her address by extending a “cordial welcome  not only on my behalf but also on the behalf of the profession” she represented.[i]

While nursing leaders such as Dock and Nutting considered nursing a profession, the majority of  graduate nurses, physicians  and the general public did not. My plan is to discuss the  history  of the following  important steps in achieving  autonomy and control over the our practice.

  • Nursing Organizations – Building for the future

  • Economic security

  • Legislation

  • Nurse Practice Acts – Protection Nurse and Public

  • Professional Practice

  • Professional Standards

  • Code of Ethics