Chapter 9: The Limits of “collaborative relationships”

Chapter 9: The Limits of “collaborative relationships” By: April Southern and Kathy Ravenell

Introduction • In 1900, for every 100,000 people in the U.S. there were 173 physicians and only 16 nurses. • By 1930, the trained nurses numbers continued to rise; ultimately, outnumbering physicians by 40,000. • Nursing became occupied with: • Increasing self-assessment • Collaborative relationships with physicians • Expansive rationalization of the health-care system

Nursing Leaders • Nursing leaders • Sought to document the reasons for nursing’s problems • Define professional nursing • Attain the financial support needed to meet their goals

Nursing Leaders • The most important change that the nursing leaders wanted: • Be unified and well-educated within the profession: • Remove nursing education from the hospitals • Place education exclusively within the collegiate setting • The demand for nursing, the Depression of the 1930s, and the impending war made these changes very difficult.

World War I and the Nursing “Madness” • World War I • Demand for nurses within the military and civilian hospitals almost overwhelmed the nursing profession • The military were willing to use a supplementary voluntary aide system to meet the nursing need • There was an overwhelming amount of patriotic women wanting to become nurses • undermining and threatening the nursing standards that were already in place

Opposing sides • Two opposing sides formed on how to handle the demand for nurses: • Jane Delano, the Red Cross nurse, and Dr. S. S. Goldwater • supported increasing the supply of nurses through the use of “aids” • Acquiring educated “leisure class” women

Opposing Sides • Nursing leaders • Use of trained nurses • Implementation of an Army School of Nursing • Increasing enrollment in civilian schools • Beginning a special training program geared towards college-educated women

The Army Nursing Board • The Army Nursing School became authorized on: • The basis of the statistical evidence of the nurses • Their promise that trained nurses had greater discipline and efficiency • The divided opinions of the General Medical Board.

Flu Pandemic • The flu pandemic made its entrance about 2 months prior to the end of the war • Mortality rates rising • Demand for nurses increased • The Red Cross intervened - Aides were called for training as “hospital helpers” for civilian care

Effects of Flu Pandemic • Dr. Charles Mayo solution was to train “100,000 country girls as sub-nurses” by: • Lower nursing educational requirements • Decrease length of training • Mayo undermined standards and professional efforts of trained nursing • The nursing leaders refused to accept or acknowledge having more than one kind of “trained” nurse • Hospitals began to offer training programs for “hospital helpers” due to shortage in help

Question • What were the two major contributing factors for the demand of more nurses?

“The Great Hope” • Goldmark Report: The first major study on nursing • Nursing leaders hoped that it would: • Separate nursing education from the hospital setting • Give basis for requesting financial support

Goldmark Report • Goldmark Report findings: • A need for nurses with post graduate course work in the public-health field • Similar additional training for educators, supervisors, and superintendents • The maintenance of high education standards • Properly funded school with graded curriculum of 28 months • The endowment of a university-based school of nursing to train • The replacement of student nurses by graduates in hospitals • The training of “hospital helpers” only in “non-educational” duties

Goldmark Report Shortcomings • Criticized by many nurses • The report called for the “definition and licensure of a subsidiary grade of nursing service” • Many in nursing opposed the acceptance of another trained nursing worker • Although, the Report did allow for the creation of many bachelor’s degree programs, it did little to improve conditions in the majority of the training schools • The Report did not commend the best training schools or discredit the worst ones

Question • What was the name of the first major study in nursing?

Committee on Grading of Nursing Schools • Formed in 1926 • May Ayers Burgess, Director of Studies • Skilled statistician • Objectives were to survey comprehensive “nursing ills” • Study supply & demand for nursing services • Job analysis of nursing work • Grading of nursing schools

Anne Strong • Nursing leader: • Director of the School of Public Health Nursing at Simmons College in Boston • Need to exclude certain women from nursing that do not define a professional worker • Suggested a division between nursing schools & separate titles for different graduates • Immature • No high school education • Limited or poor background

Grading Committee • Extensive statistical survey of nursing utilizing census reports & questionnaires • Nursing registry & public-health agency • Subscribers to the JAMA & AMA • Sample of their patients • Ten-state selection of nurses, hospital superintendents, & nursing superintendents • All nursing schools in U.S.

Question • Identify 3 purposes for the Grading Committee

Grading Committee Results • First published in 1928, as Nurses, Patients, & Pocketbooks • “Crisis” facing nursing • 1 out of every 590 people in U.S. is active graduate nurse • 2296 Schools of Nursing & growing • 20, 000 new graduates yearly • 10,000 have not graduated from HS

Final Recommendations of Grading Committee • 6-years later • Reduction in the number of schools • Higher entrance requirements • Separation of nursing education & nursing service in hospitals • Aid to assist hospitals in funding nursing services • Public funding of nursing education

Response to Grading Report • AMA, The Medical World, & JAMA • Sanctimonious, unsupportive • Hospital administrators • Unsympathetic, denied there were problems • “Why don’t you nurses do what the doctors tell you to do?”

Second Grading Report, 1932 • 81% of nursing schools responded • 75% of responses from schools were better than 1929 • Improvements in beginning phase • No list of best or worse schools

Association of Collegiate Schools of Nursing • Established in 1932 • Set standards & accrediting procedures for university-based schools of nursing • Refused to find solutions to the problems of the majority of women already in nursing • Pressured them into hospital staff nurses

Private Duty Nursing • By encouraging Collegiate Nursing, Private Duty Nurses abandoned • No place to work • 1932-33, depression 60% nurses unemployed • Many schemes were tried to help nurses • Reduced hours • Wages • Donations

Collaboration • Collaboration did not lead to real improvements in the nursing profession

Question • The Association of Collegiate Schools of Nursing was established for what purposes?

Christmas Bonus Question • What was the last thing Tiny Tim said in “A Christmas Carol”?

Chapter 9: The Limits of “collaborative relationships”