2: EVOLUTION OF PROFESSIONAL ROLES IN NURSING ■ 63increase the professionalization of nursing and protect trained nurses’ legitimate role in
society. Renamed as the National League of Nursing Education in 1912, members aimed
to encourage more women to enter nursing by pushing for progressive reforms, includ-
ing shorter days, a university education, and a standard curriculum (Dock & Stewart,
1938).
The reputation of hospitals during the 1800s kept many ill people at home to be
cared for by their families. With the growth of nursing training schools, those who could
afford supplementary care hired a private duty nurse to come to the home to carry out
physician treatments and provide skilled nursing care to the sick individual. Demand
for private duty nurses increased as female family members increasingly joined the
workforce. After the turn of the 20th century, hospitals also arranged for private duty
nurses to provide care within the institution, which created employment opportunities
for the majority of graduate nurses (Whelan, 2005). These nurse- owned and operated
registries were formed to assist nurses with finding work while granting them the free-
dom to choose the job, although this type of autonomy did not add to the professional
image of nurses. When caring for patients in their homes, nurses fought against the
image of subservience, especially African American nurses, who had been kept in infe-
rior positions by a White majority of nurses and society alike (Young, 2005). Following
Nightingale’s promotion of highly moral and educated women, nursing leaders from
the first half of the 20th century promoted the ideal nurse to have “the exercise of supe-
rior intelligence, a large body of knowledge and skills, sensitiveness, and imagination”
(Harmer & Henderson, 1939, p. 4). However, middle- and upper- class women did not
join nursing in large numbers, leaving women of the lower socioeconomic class with a
high school diploma to enter training (Dock & Stewart, 1938; Rosenberg, 1987).
THE TOIL AND CONTRIBUTION OF PUBLIC HEALTH
NURSES TO NURSING
Nursing’s Role in the Public’s Health
Public health nurses had specialized knowledge and skills obtained by furthering their
education after hospital training and required to be effective in the communities where
they worked. Advances in medicine and science during the late 1800s, specifically the
wide acceptance of the germ theory, helped change the thinking about infections and
debunked the previously held moral aspects of the causes of disease (Rosen, 1993).
Identifying controllable germs as the root cause for illness and disability a global initia-
tive sprang up asking governments to take responsibility to respond to the public wel-
fare and to subsidize improvements in community sanitation, water supplies, and other
alterable situations that, if left unattended, could lead to higher morbidity and mortality
rates from infectious disease. The federally funded U.S. Public Health Service (USPHS)
is one example of the U.S. government’s attention to the need for community services
to protect the health of citizens. Although the USPHS can trace its early history back to
1798 with an act designed for the relief of sick and disabled seamen, its history was more
formally established by legislation in 1889 forming the USPHS Commissioned Officer
program (Williams, 1951). At first, only physicians were admitted to the Commissioned
Officer Association, with the first nurses not commissioned as officers until July 1945
(Parascandola, 2007; U.S. Public Health Service Nursing, 2009). Nevertheless, nurses in
the 20th century would serve a fundamental role in this agency.
At the turn of the 20th century, the continuing influx of immigrants from around
the world and overcrowding in urban areas led to a renewal of social reforms in which