66 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
The Public Health Nurse: More Specialized and More Professional?
The public health nurse of the first half of the 20th century had several unique roles de-
scribed in the textbooks as translator, educator, advocate, and conservator of the public’s
health (Gardner, 1936). Debate heightened in the 1930s over whether their role should
be further specialized into the different services provided, such as child health, maternal
health, orthopedics, tuberculosis care, and others (Footner, 1998; Melosh, 1982). With
significant medical advances (the first antimicrobial drugs were introduced and new
surgical procedures invented), the profession of medicine was becoming more special-
ized, leading to the idea that physicians needed more specialized nurses to assist them
(Schulz & Johnson, 2003). However, a generalist role still worked best for most agen-
cies to deliver community nursing care efficiently, although nurses debated this issue.
Families usually had several problems among various members of the household, and
in order to avoid the duplication of services, a public health nurse generalist was able
to enter the home and tackle whatever problem the family presented to her. The special
tasks of public health nurses, the requirement for additional education, as well as their
autonomy in the field outside of the agency, boosted the view of professionalization in
nursing.
Indeed, even before the severance of the generalist nurse into the specialist, pub-
lic health nursing became the first specialty in nursing (Allen, 1991; Alpi & Adams,
2007; Gardner, 1936). Various postgraduate courses educated graduate nurses in public
health, sanitation, sociology, ethics, and other subjects to give them a better understand-
ing of the problems as well as approaches to assist different immigrant and impover-
ished families. Seeing the need for specialized knowledge, nursing leaders promoted
the idea of a university education for public health nurses that culminated in 1949 with
the Russell Sage Foundation– sponsored Brown Report, calling for nurses to be educated
in colleges and universities (Gebbie, 2009; Maraldo, Fagin, & Keenan, 1988). However,
nursing continued to be burdened with a label and reputation of “women’s work,”
rather than work that was valued as a “profession.” Furthermore, physician control
over nursing continued. Group and Roberts (2001) wrote “By the 1930’s the American
Medical Association (AMA) had established a set of committees on nursing that tight-
ened its control” (p. 148), and the tensions between nursing and medicine would con-
tinue for decades.
THE FEDERAL RECLASSIFICATION OF NURSING
CHANGES THE PROFESSION
The Emergence of the Recognized Professionalism of Nursing
Professionalism for nurses gained momentum just after the turn of the 20th century
with endorsements from state and federal legislation. Lusk (1997) points out in her his-
torical study that nursing leaders pushed and promoted the professional classification
for nurses based on criteria established in the literature. However, nurses’ link to service
sometimes placed them in the laborer category, especially students in training whose
work hours were limited to 8- hour days similar to unionized factory workers. Some
nursing leaders fought against these limits to autonomous practice and gained the right
for graduate nurses to set their own work hours (Lusk, 1997). Government institutions
denied professional status to nurses, which left army nurses during World War I with-
out rank or authority in battlefield hospitals (Donahue, 1985). Now with women hold-
ing the right to vote, nurses fought the federal government classification of nurses as