2: EVOLUTION OF PROFESSIONAL ROLES IN NURSING ■ 67“subprofessionals” in the 1923 legislation (Minnigerode, 1923). However, they did not
have enough influence to change the category until 1935, when Harry L. Hopkins of
the federal Work Progress Administration (WPA) reclassified nurses from “skilled non-
manual workers” to “Class 4 professional and technical workers” in a simple federal
memo (AJN, 1935). Nevertheless, this historic subclassification of nurses’ work nega-
tively affected their social standing, and more importantly affected the salaries they
earned. Even after this important 1935 regulatory memo, the status of nurses and their
work did not substantively change as the ravages of the Great Depression (1929– 1940)
continued and left nurses with stagnant opportunities for educational advancement
(D’Antonio, 2004). However, Byers (1999) views this period as a time of an emerging
liberation for all women writing:
Women’s roles began to change with World War II as many were forced to
find employment and to assume more family responsibilities as a result of
the financial devastation of the Great Depression and men being forced to
serve with the Armed Forces. (Byers, 1999, p. 12)
In reality, nurses used expert knowledge, indeed some of the same knowledge
used by physicians and often taught to nurses by physicians, but they were not seen
as colleagues of the physicians. The public health hierarchy maintained the role of
the physician as the head, responsible for making the assessments and the program
decisions that directed the care and education to be delivered by the nurse. Therefore,
while public health nurses developed a role in a new venue outside of the hospital
and changed their work from bedside treatment of illness to health promotion and
education requiring specialized knowledge, their work was still viewed within the
maternal role of women and not considered by society to be “professional level work.”
The contemporary nursing leadership held a different view and developed education
programs to promote the use of scientific knowledge when addressing issues affecting
the public. Two pioneers of nursing, Lavinia Lloyd Dock and Isabel M. Stewart, both
wrote very provocatively (in an almost unheard language of the day by nurses) in 1938
that nursing is not:
A subordinate or “satellite” vocation... nursing is as old if not older than
medicine and has had an independent existence for hundreds of years. The
Nightingale concept of nursing was not that of a sub- caste of medicine or a
“handmaid of medicine.” (pp. 365– 366)
They both further stated that:
The experience of years in many countries tends to show that nursing flour-
ishes best when it is directed and controlled by skilled and experienced
nurses and given the largest possible measure of freedom for the exercise of
its particular functions. (p. 367)
Earlier, the Rockefeller Foundation, a leader in public health research and educa-
tion, wanted to evaluate the effectiveness of public health nursing education in order to
have workers adequately trained in public health. Nurses effectively bridged the gap
between science and home, bringing health teaching to families in terms they under-
stood in incremental steps that they could take to improve their health within their
surroundings. The Committee for the Study of Nursing Education, funded by the
Rockefeller Foundation in 1919, studied the education requirements for public health
nurses. However, due to the requirement of nurses’ training, the committee decided to
study hospital training also (Winslow, 1922). Josephine Goldmark subsequently wrote
the influential Goldmark Report, published in 1923 (Gebbie, 2009), which found that the