68 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
long and difficult hospital training using nursing students as cheap labor for the hos-
pitals did not attract the interest of middle- class women who were thought to be able
to grasp the higher level of knowledge needed to be a public health nurse. The recom-
mendations that came out of the report called for higher entrance standards to nursing
school, as well as 3 years of hospital training plus postgraduate training, which included
classroom education as well as public health field work. The committee felt that these
steps would encourage more middle- class women to enter nursing, thus bringing more
respect to the profession. Ultimately, public health nursing became an expensive fund-
ing endeavor, because their service remained limited to the poor rather than expanding
health education to all levels of society (Buhler- Wilkerson, 1985). Public health nurses’
numbers decreased with the draw of nurses to meet war needs; furthermore, changes in
the financial arrangements to pay nurses’ salaries at the public health agencies did not
garner public support (Buhler- Wilkerson, 1993).
Nursing’s Status Post– World War II— The 1960s
After World War II, the specialized knowledge of the public health nurse became a ba-
sic part of nursing education, and the NOPHN blended into the ANA. In pursuing the
agenda of professionalization, public health nurses attempted to bring status to all of
nursing and to control their nursing work, job qualifications, and education globally.
However, a shortage of educated public health nurses hampered the tremendous need
to develop health programs in countries recovering from war. Many countries were
building their nursing education programs and did not have established public health
nursing agencies so the leaders of the World Health Organization (WHO) endorsed the
usage of lesser trained workers in public health work (Cueto, 2007).
Post– World War II advancements in medicine and pharmaceuticals, and federal
funding of the Hill- Burton Act (which increased the number of hospitals) changed the
U.S. health care system. Nurses experienced innovative programs, such as military flight
nurses caring for wounded soldiers on cargo planes and in mobile surgical units close
to the battles in the Korean War (Kalisch & Kalisch, 2003). The Truman administration’s
promotion of the community college system in conjunction with a nursing shortage
ultimately made acceptable the idea of a 2- year AD producing a college- educated nurse.
However, community colleges lacked hospital affiliations and raised educational costs
by the needed employment of additional clinical staff (Halloran, 1995). Public health
nursing changed from a post- diploma specialty to a standard part of the baccalaureate
nursing program. The Nurse Training Act (NTA) of 1964 helped fund nursing educa-
tion; however, a smaller percentage funded baccalaureate nursing education, although
the apprentice system of diploma training schools (still very prevalent, but decreas-
ing in number) and community college ADN programs received a larger share of the
money. Incredulously, this inequity still persists some 40- plus years later with the famed
researcher, Dr. Linda Aiken, co- chair of the Council on Physician and Nurse Supply
(2007), reporting:
However, nurse education is currently balanced toward associate degree
nursing (ADN) programs, which receive the bulk of federal funding for
nurse education, yet few ADN graduates progress to advanced practice and
faculty roles, both of which are needed. The Council urged a national effort
to substantially expand BSN training. (Aiken, 2007, p. 1)
The ANA’s leaders published their stance on nursing education in 1965 pro-
moting the baccalaureate degree as the entry level for professional nurses, but with